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Thursday Apr 24, 2014

Locum Tenens Work Offers Freedom, Control

Editor's note: More than 85 percent of new physicians are employed, compared with 63 percent of all active AAFP members. This is the fourth post in an occasional series of blogs that will look at the different roles family physicians can play.

My mom was born and reared in Vietnam, but neither of us had visited her native country in several years. So I took three weeks off from work in March to travel with her. We reconnected with family, experienced the culture and ate amazing food.

My schedule for this summer promises to be equally interesting because I’m leaving my home in Seattle to spend a month working in a small community hospital in Alaska. I’ll be practicing full-scope inpatient and outpatient family medicine, including obstetrics, while exploring the town of Kodiak and experiencing an Alaskan summer.

Working locum tenens has allowed me to set my own schedule. In March, I took a three-week vacation with my mom to Vietnam, including a visit to Ha Long Bay.

And I’m keeping nearly a month of my work schedule open in August for my wedding and honeymoon.

My point isn’t to brag about the frequent flyer miles I’m accumulating but to point out that for some physicians, working locum tenens can be a fantastic opportunity.

My fiancé is a third-year medical student who hopes to match to a pediatric residency. Given that there is only one such program in our area, relocation is a real possibility in just a little more than a year from now. For me, it didn't make sense to sign on to a full-time job if I wasn't going to stay in the area. So while many residents around the nation were searching for jobs last spring and summer, I was looking for locums positions in the Seattle area.

In fact, a large portion of my residency graduating class elected to do locums. It might seem like we’re delaying the inevitable and avoiding what brought us to primary care in the first place (care continuity), but how are we are supposed to know what kind of work environment we would like to wind up in if we don’t try different options?

Every practice is different and has its own ways of doing things. As a new-to-practice physician, how do you know what kind of clinic environment you need? Working locums provides an opportunity to see where you might fit best and what might keep you happiest.

I started my first position at a private practice, slowly, last July. I was only working one or two days a week at first, and that gradually increased to three or four days a week. The clinic needed a lot of help, and for a while it seemed like I was a regular employee, experiencing the benefits of continuity of care and having my own patients.

Eventually, the clinic's need decreased, and I started having shifts cancelled. I also realized that maybe private practice wasn’t the best fit for me, and maybe the patient population didn’t fulfill all of my needs. But soon after that realization, I started a role as a “float provider” with a health system that has more than a dozen locations in my area.

With so many physicians on staff, the clinics have vacancies, maternity and other medical leave, and vacations to cover. I’m paid an hourly rate and can plan my schedule months in advance. I fill in for a variety of internal medicine, family medicine and pediatric physicians, which makes things interesting. There are days I see only pediatric patients, some days that are all adult medicine and some days that are mixed.

The pediatric days, in particular, have been excellent for my training. I’ve solidified my ability to talk with kids, and I’m more confident in my skills after those shifts.

I work for the health system three to four days a week, which leaves me one or two days for precepting at my residency program. This flexibility allows me to work on mentoring and honing skills that I hope to use in the future in a faculty position at a residency program.

There are a few drawbacks to not being a full-time employee, most notably the lack of health insurance. But with no husband or children, I was able to find a reasonable plan for myself.

The lack of continuity of care also is a drawback, but so far, I’ve been able to see some patients on return visits because I’m working somewhat steadily at these clinics. I’ve heard that some physicians doing locums might run into a paucity of work, but I have yet to experience this.

For me, the benefits of my current career choice have far outweighed any negatives. What's the biggest perk of locums after three years of residency training?

Freedom.

My schedule, including vacations, had been dictated to me for my entire life, from early childhood through high school and on to college, med school and residency.

Locum tenens gives me a chance to build my own schedule. I can take a four-day weekend if I want. Or I can work seven days and take seven days off. I’m a planner, and this is all about managing my own time and having control of my professional and personal life.

Right now, I’m planning my wedding, which is like a job in its own right. When my fiancé matches, I might be ready to settle down and pick a clinic. After working in a variety of locations, I think I’ll have a better idea of what I’m looking for in an employer. And if we stay in this area, I hope the employers that have had me as a locums provider will feel confident in hiring me as a full-time employee.

One thing is certain. If I had taken a regular job last summer, I wouldn’t have been able to do many of the incredible things I’m doing now. And I wouldn’t want to miss any of it.

Jennifer Trieu, M.D., is a family physician in Seattle.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.