Exciting Opportunity in a Town Far Away: Why Locums May Not Be Right for You

The emails are enticing. They promise a few hours a month in a new location, just hours from exciting adventures. They make the same vague offers: competitive pay, flexible schedules, opportunities for personal growth and development. But if it’s so great, why are they spamming a stranger to fill the position? How great can it be? Below are a few points to consider before you reply to that recruiter.

There's a reason they're hiring locums

From an administrative perspective, you want a group you can rely on. You want an emergency department whose physicians are all well-known and trusted by the rest of your medical staff. You do not want a group of temporary physicians who float in and out of your hospital with no real skin in the game. So, something must have happened to make the hospital seek locums physicians.

It may be that they're rapidly expanding and need help. Maybe they hire locums for predicted seasonal increases in volume. Maybe there's a pandemic and they have a huge surge in patients and need a bunch of doctors right now, but only for a few months.

Or maybe it's because no one wants to work there. Maybe everyone quits because of unsafe conditions, a particularly abusive patient population or dysfunctional administration. Maybe the shifts are arranged in such a way as to create horrible work-life balance, and everyone burns out early.  Maybe their shop is so bad that there are holes all over the schedule that can only be filled by people unfamiliar with their system.

Before you sign the contract, do your research. Emergency medicine is a tight-knit group of people. Use your network to contact people to get the inside scoop to find out what's been going on. Ask the recruiter for connections or see if you can speak with the medical director of the emergency department before signing the contract. You need to find out why they need locums and whether that reason is something you can tolerate.

Do you like living in the learning curve?

One of the most frustrating things in emergency departments is learning an entirely new system. Think of the last time your hospital adopted a new medical record or put in place a new workflow process – how was that experience? 

Now imagine living that experience perpetually. Locums means that every few months, you’re in a new facility. Even if you’re familiar with a medical record, you probably aren’t familiar with their instance of that medical record. The admission process is different. Writing orders, referrals and consultations are different.  You don’t know the nurses or how to get anything done. Even what’s acceptable for individual patient management is unique to that hospital.

And by the time you figure these things out, your contract is over and it’s time to move on to the next place.  

Like anything, the ability to adapt is a learned skill – the more you do it, the better you’ll get it at it. You learn to ask the right questions sooner in the game and each transition becomes easier than the last. 

The question is whether you want to learn that skill. 

Where do you want to be in five years?

There are many points in life where working locums makes more sense - you're young in your career and want to try a new region. Maybe you're at the end of your career, your kids are gone, and you want to see new parts of the country or world. Maybe you just want to experience as many systems as possible.

Consider the perspective of your future employer five years from now. You, their applicant, has just spent five years at five different hospitals. There may or may not be an established network of people who know your skills and competencies. You haven't been in any one hospital enough to be established in in administrative or academic way.  But now, you’re interested in “settling down.” 

You've picked a region you want to work, but your CV looks like you’ve never really committed to one thing. You've been all over the place and worked everywhere, but it’s hard to verify how hard you work and how dedicated you are. An employer may see your ability and willingness to move around every year and ask themselves, “Why would my emergency department going to be any different? If this person isn’t satisfied, they’ll just leave.” 

This is just something to consider and plan for up front. Have a clear understanding of why you’re doing locums and paint a picture consistent with that. If you’re doing it to narrow down a region, be able to show that. If you’re doing it to get a sense of the type of hospital you want, be able to speak to that in a coherent way. You can also be involved, publish, hold administrative positions, and make a network while you're doing locums. This is not a reason to avoid a locums – it’s something to be aware of and plan for on the front end to avoid the trap on the back end.  

You will be an outsider

Just as the system is new to you, you’re new to it. Your team will give you the benefit of the doubt as an emergency physician, but they really don’t know you. They don’t know why you’re doing locums (Is it because you couldn’t hold a “normal” job? Are you just taking advantage of the situation to make money? They don’t know your practice habits, your work ethic, or your history.  

Many of your colleagues will be full-time, long-term physicians who see no reason to give you a better deal than they get. They will take better shifts and you’ll get fewer desirable ones. You may be perceived negatively, as you’re likely getting paid more than they are to do the same job but aren’t being held to the same standards and haven’t put up with the history they have. They know they’ll still be there after you’re long gone because, after all, you’re temporary. 

This doesn’t mean that they don’t trust or like you, but it does mean you have to prove yourself. 

Easy come, easy go

Facilities prefer to hire permanent, stable and often cheaper physicians. When that opportunity arises, they will. 

You may be offered the opportunity to fill that position, moving from locums to a permanent member of the staff. Or you may simply be removed from the schedule in lieu of a permanent person. This means that your six-month, exciting opportunity will become a two-month exciting opportunity and four months trying to figure out how to get back on track.

This is something to discuss with your recruiter from the locums agency. Ask what would happen in such a situation, whether they can get you a second opportunity quickly in the area, or whether they can guarantee you a certain number of hours over a certain time period.

There is no absolute answer to whether you should do locums. Many of these issues can be addressed prior to signing a contract.  By having the right conversations with the recruiter (and ideally with the people with whom you would work) you can plan for and mitigate some of the pitfalls associated with locums work. 

But if you are uncomfortable with uncertainty, financial instability, don't like repeatedly being the new person in a new situation or want to establish yourself early in your career, locums may not be the best option for you.

**Editor's note: This publication is a follow-up to another recent article from a different perspective, Why Locum Tenens Work is Truly an Adventure**