Thursday, March 26, 2009

The "Locums-O-Meter"

Medicine is on the brink of collapse. Has been for some time here in the US (blah, blah, blah see rest of blog). However, I think that Emergency Medicine in particular is the canary in the coal mine for medicine in general, and the canary is strangely quiet. Apparently, all that our national colleges can do is grab their collective ankles and get in line. And, with some notable exceptions, most physicians are too scared or too busy to speak up in their own defense when they are caricatured as money grubbing, spoiled, and greedy children.

What is not quiet is my telephone. I am getting four or five calls a day from locums companies who are desperate to talk to me about a 'super opporunity'. Translation, hospitals are desperate enough to pay the confiscatory fees of head-hunting companies to put a warm body in their ER who has some semblance of training in the specialty. Hence I think I can probably gauge the seriousness of the medical crisis by how many locums call I get a day. Can't staff your ER? Then you have lost 80% of your admissions so I think it's a fair gauge.

Any economics experts out there? Chime in about this because it is seems that is it at the level of locum tenens companies (medical head-hunting firms) that market forces are effective in the circus of American medicine. They certainly are not in effect at the level of a physician in training... one's salary is set for the length of one's training program... three to ten years, and it is set right now, medicine or surgeon, at around 43k.

Right out of residency with 100k-300k in debt and no equity it is tempting to jump in and sign on with the first physician group that comes to call (and this is often a short and abusive marriage). I am at the point now, however, that I can name my own price and name my conditions of work, and guess what? I am getting what I am asking for. I am my own boss. It is liberating.

So here's something to ponder all you ER residents out there, why not try locums first? Don't fall for the signing bonus 'carrot'. There is more need now than ever for Board-Certified EM physicians. Why sign on with some contract group with closed books (or even one with open books) and a partner track? Working your way in from locums to full time is the only way to really see the 'innards' of your new family. The market will efficiently place you and if you start your career by eating yet another shit sandwich (like you have done for the last seven years) then why would you ever stop? Your first job IS this important! Why not locums?

And you Docs who are simply holding on to the rails of the Titanic as it slips beneath the waves... just trying to eke out one more year... get off now! Set your schedule, set your price, and write that resignation letter you have always wanted to write. You and your patients will be happier and you will practice better medicine.

This "supply and demand" concept has, evidently been discovered before and is not complicated in a "market system". It IS complicated in OUR system, however, because in our system physician pay happens thusly; patient A pays for patient X with money from a drug bust that happened two years ago (on the Mexican border), and which was awarded him(patient A) in a lawsuit (filed by the Cochrane firm) who sued the police after they rear-ended him in said drug bust. Understand?

*** The Locums-O-Meter today is twelve out of ten (LOM=12/10)
**** From ACEP News...

Number of certified ED physicians may soon fall short of staffing needs, research suggests.

HealthDay (1/9, Preidt) reported that Massachusetts General Hospital researchers are saying that the "number of board-certified emergency doctors in the United States will likely fall short of hospital emergency department staffing needs in the future." While analyzing "data from the 2005 National Emergency Department Inventories USA database," investigators "found there were 22,000 board-certified emergency physicians already in practice and 1,350 who were newly certified that year." Yet, "having at least one board-certified emergency doctor present in all U.S. hospital emergency departments at all times would require 40,000 physicians with such training, which means that only 55 percent of demand was being met in 2005." In a paper appearing in December issue of Academic Emergency Medicine, the team "said alternatives should be examined, 'such as giving the family physicians who currently staff many U.S. emergency departments extra training in key emergency procedures,'" while increasing the "reliance on nurse practitioners and physicians assistants, who can help emergency physicians of any training background better handle the continually rising number of patients."


  1. I love Locums work, its like the Free-Love Days of the last 60's without the Drugs and STDs...and I can sexually harass myself all day long without worrying about a lawsuit...

  2. 911, good for you for making your own destiny. Docs don't work this hard and long to be told by the government how much they're allowed to make. Now if you guys could only figure out how to get around the "whaddya mean you want to run that test? You know how expensive it is? Let 'em die" attitude of insurance and hospitals, I'd be forever grateful.

  3. How about the daily offers I get for "internal medicine opportunity--big money, on-call only one in 6!"? Then when I inquire for details, it's always in some remote village in some red-state where only tumbleweeds and doomsday cultists would want to live.

  4. Disgruntled Internist,

    Well, that's simple, most cities are saturated with physicians. Quite frankly, an Internist in San Francisco(where the bums and gay pride parades roam) is a dime a dozen(just like every other type of physician). The little remote village in the middle of the red-state actually needs that one internist to do their work and I guess they're willing to pay for it.

    Now onto 911's post,

    Yes, the Locums are a function of the market within medicine. See, a market never ceases to be unless demand disappears. Medical demand is high and always will be high(part of the reason for the high salaries).

    The reason why Emergency Medicine Locums are so good is because there is a huge demand for EM services combined with a waning supply of those services(basically, EM Physicians ARE quitting. It's a hard field with a high burnout rate, also the irregular hours get to people). It's basic supply and demand.

    This is also the reason why Frank finds plenty of green pastures while the Disgruntled Internist finds only bad pastures(granted, I don't think you or Frank have a problem working in red states either).

  5. If I had to choose between treating AIDs patients 24/7 and working in a red state, the decision would be easy peasy.

  6. Dr Disgruntled, Some of the Remotest Red-neckiest Villages I've ever worked in are in Blue-State Cali-fornia, complete with Tumbleweeds and Militia groups...and the Golden State doesn't have a shortage of Doomsday Cults either, Google "Heaven's Gate"...agree with ya on the 1/6 call, heck even Surgery Residents don't take call that often... Heck, Atlanta's almost as Blue as Boston, Gay Pride Parades, and everything, but watta ya expect with all the carpet baggin Yankees...


  7. Thank you Lynn Price!

    the "whaddya mean you want to run that test? You know how expensive it is? Let 'em die" attitude of insurance and hospitals

    My thoughts exactly.

    As for the locum tenens subject, from reading the post it seems like a much better proposition than permanent employment in a group. Glad it works for you.

  8. I have a question on the locums thing (since it may apply to me in a few years) - after reading your post, I did a google search and found some locums companies online. I searched EM jobs for 5 of them and found a total of about 25 jobs, with most of them not seeming all that great. Are these web-posted jobs not the really good ones? Ie, do the truly reputable locums companies not post jobs online like they would for a hamburger jockey, but rather headhunt for physicians on a personal basis? (Just wondering since I'm curious how good the market for locums really is)

  9. If they were really good spots why are they lookin for someone to fill them?? I get my best gigs by networking, knowing someone who knows someone who knows someone...that and my collection of incriminating photos from my Military days....

  10. dear anonymous,
    write me offline and i'll tell you about my experience with a great locums company.

    frank has it right otherwise, networking and making a name for yourself still opens doors. being very good is still important. the palm-pressing and patient satisfaction score pumping docs don't wear well. but there is one trick. the locums companies make SQUAT if they don't place you within the group needing help. so here's an idea...

    when it comes time for you to look for work contact the group directors where you want to go and ask if they are looking for part time work. if you cut the locums out you can make more, but, coming right out of residency it might be best and safest to go with a reputable locums company as they DO a whole lot of paperwork for you. best.

  11. Quite an interesting post. First time, I'm getting to read a medical post. Got an insight into locums companies.

  12. ... I'm an EM locum recruiter.

    Here's some info for those of you who are interested. Maybe one of you could help me out too...

    Send your CV to all companies you come across because we have some of the same jobs, but we also all have exclusive jobs. My companies jobs are not posted on the net at all, but I don't really know if they're any better than the ones that are. From my experience so far, docs who get locked down by one company usually figure out they've been getting screwed. In reality every locums company is going to try to screw you, but if you're working with a bunch atleast you'll have some leverage. This means we will try to get you to accept the lowest possible price NO MATTER WHAT, if we're charging the hospital 275/hr, we'll try to get you to go for 100. Negotiate.

    We'll "stretch the truth" to get your CV...

    If you don't want to be contacted...
    Hide your phone number, keep it off the med. boards, and out of online phonebooks.

    I've been doing it for about three months and the only reason I took the job is because of the state of the economy. I'm actually an engineer who graduated from a top school (not trying to be an asshole) last year. I'm trying to get into product mgt. or a related field for a medical device company at some point in the near future.

    Post back if you want more info or to hook me up with a respectable job!

  13. I would agree with the assessment in re: "amount of times I get called...".
    As general surgeons, we get called numerous times about midwest and southwest openings, many but not all remote.
    I have done ER work in small hospital settings - taking admissions, rounding + ER, no OB, and found it refreshing once you get the full picture of capabilities, protocols, and weed out the places not at all prepared for modern ER care. Good people, dedicated to their neighbors, etc.
    As to out of the chute locums - an excellent idea in ER, not so good for surgery - not enough experience, or if no experienced back up mentor(s) on scene - and an early complication, however innocent, would kill a subsequent surgical career.

  14. I have been working locums and got into a pretty good contract for the shifts after "shopping around"

    However, later realized I could do some extra urgent care shifts for extra loot. Asked the other docs how much they were getting and my company refuses to pay me that amount.

    How do I approach this since I am already in a contract with these asses at this hospital.

    I wish there was a way to know how much they actually got paid by the hospital.

  15. tell them you will resign if you do not get your pay. i'm getting calls every day about ER work and when I tell them 'no' they ask me if i have any friends who are looking... pitiful. if you are hard wired with the contract i would just tell them you don't want to work in their stupid clinic and then go out in town and work for someone else.