COLLEGE

Residents’ guide to your first locum tenens

What do you have planned after residency?

Elizabeth Haney, MD

Many of us are asked about our plans after residency, regardless of how close to finishing we are. While some have concrete plans (a third-year program or fulfilling military commitments), others remain uncertain of what to do or where to go. I write this article for these people. A locum tenens position could be exactly what these new physicians seek.

The term combines the Latin words locum (place) and tenens (holding), and loosely translated means “holding a place.” A locum tenens physician, therefore, is one who works in various locations for limited periods.

A locum tenens position offers newly minted physicians the opportunity to travel, to continue learning in established practices, and to pick up practice management tips from more experienced physicians.

As a second-year resident, I cannot offer you advice based on experience, but I can give an overview based on advice collected from those more experienced. The following list is by no means exhaustive, but it should help you have positive locum experiences.

Preparation

• If looking to work abroad, ask the locum recruitment company for contact information on previous locum tenens. It is important to hear first-hand what will be involved.

• If looking to stay in a familiar place, inform preceptors of your desire to do locum tenens. Advertise on the hospital bulletin board or via internal mail your availability for locum coverage.

• Search national journals for advertised locum opportunities. Canadian Family Physician’s classified section would be a great start!

• Ensure that your training is up-to-date (Advanced Cardiac Life Support, Advanced Trauma Life Support, Advanced Life Support in Obstetrics, Neonatal Resuscitation Program, etc) and offer only services with which you are comfortable (ie, emergency room shifts, obstetrics, surgical assists).

• Obtain necessary licensing and insurance coverage for the area of practice (especially if traveling abroad; the medical society of the country in question would be a good place to start). Ask if the hiring body will cover these costs.

Contract and reimbursement

• Obtain a detailed written contract. You could have a lawyer proofread it as a precaution. The cost of an hour of a lawyer’s time might save you many future headaches.

• Your contract must detail terms of work, how and when you will be paid (preferably directly instead of through an intermediary, such as a recruitment company), funds for travel and accommodations, and malpractice coverage.

• Never start a locum without a contract or without proof of malpractice coverage.

• Have your salary clearly stated in the contract. Decide which type of reimbursement you prefer. A guaranteed minimum daily salary might be best in a slow practice rather than a set split of earnings (ie, 70:30 means that 70% of billings are paid to the locum while 30% remain within the practice to pay for staff and overhead expenses).

• If travel, accommodation, or car rental costs are provided, do not pay for them under promise of compensation. It is best to ask providers to pay up front to avoid complications.

Office

• Test-drive the locum position. For both short- and long-term locum tenens, consider working 1 or 2 days while the hiring physician is present to allow for orientation to the practice and staff.

• If planning to sign for a long-term position, try a 1- or 2-week paid locum with an option to renew for the length of time desired by the provider. This allows both parties to assess compatibility.

• Ideally, other office staff will continue to work during your locum. This offers continuity of care during the regular doctors’ absence. Ask whether the usual support staff will be there.

• Ask for an exit clause. This allows either party to terminate the locum contract prematurely if, for example, your practice patterns deviate substantially from those of the practice or if the position is not as it was advertised.

• Ask for care plans for the practice’s most complicated or difficult patients. This will ensure that their care is not placed on hold while you grow accustomed to the practice.

• Ask for a list of consultants’ names and phone numbers. This will expedite the referral process for you and ensure that you refer to consultants with whom the hiring physician has a good working relationship.

Finishing the locum

• Debrief the returning physician on important events that occurred during your locum.

• Summarize any difficulties that you had so that improvements can be made for subsequent locums.

• If you would like to return to the practice, express interest.

Good luck!

Acknowledgment

I thank Dr Ann Harvey in Fredericton, NB, for her help with this article and for her insightful advice.

Dr Haney is a second-year resident in family medicine at Dalhousie University, in Halifax, NS, currently practising in Fredericton, NB. She is editor of the Residents’ Page and is always looking for articles to publish. If you have comments, additional tips on finding a locum, ideas for articles, or articles to submit, please e-mail her: ehaney@dal.ca.