“Start where you are, use what you have, do what you can.”
—Arthur Ashe
Resourcefulness is a skill often talked about in interventional radiology. When faced with a difficult case, we look to our knowledge of familiar catheters, sheaths, guidewires, needles and other IR equipment to concoct a customized technical strategy to get the job done. In fact, many of us were attracted to this innovative aspect of our specialty to begin with. But what about resourcefulness outside the procedure room? When you are faced with an unexpected challenge in life or suddenly find yourself on an uncertain career path, how can that same resourcefulness help you find a solution or reset your professional trajectory?
In 2017, I found myself facing just such an unforeseen situation in my career: In what seemed like a blink of an eye, I was having to look for a new job opportunity in an incredibly competitive IR job market. By then I had several years of experience in the “real world” of IR and knew what I wanted and needed from a job. I wanted clinic time and the ability to practice 100% IR so I could focus on bringing new, beneficial IR procedures to my patients. But the job market I was facing had very little to offer me in that regard.
With very few options ahead of me, I turned to what I thought would be a short-term solution: locum tenens work. With no expectations, I hoped only that it would provide income while I searched for a better opportunity. Instead, I found a different kind of practice model, one that provides both opportunities and challenges, taught me about resourcefulness outside the procedure suite, and made me a better IR.
What is locum tenens?
The word “locum tenens” is derived from the Latin phrase locus tenere, which means “holding the place of.” Locum tenens positions are essentially substituting: When there is a shortage of providers in a group or hospital, a locum provider will be hired for a limited time to temporarily perform the necessary clinical duties. Sometimes the locum will cover the temporary absence of a full-time employee (i.e., while they are on vacation), but often the locum will cover a vacant position until a full-time employee can be found.
Every locum tenens position is different, but all offer a unique kind of flexibility. This is a significant advantage: Locums are in full control of how often, how long and where they work. My locums positions varied greatly, from 1 week to 9 months in duration. During the 3 years I did locums work, I traveled all over the country, experiencing different practice models along the way—from private practice groups to academic centers to office-based laboratories. Throughout this experience, I was exposed to new procedure techniques, new equipment, and dramatically different workflows and staffing configurations. I even had the opportunity to train on cutting-edge devices that I would never have had access to if I had stayed in one location. More broadly, I was exposed to new ideas and perspectives about how to address the universal challenges that face our specialty (i.e., turf wars, the demands of diagnostic radiology, generating revenue, etc.).
There are many benefits to locums work, but as with anything there are drawbacks as well. An IR considering locum tenens positions, either as a short-term solution or a full-time career shift, should carefully consider some specific pros and cons.
Benefits
Training and networking
I truly believe that my time as a locums made me a better and more competitive IR. I gained new confidence in my procedural skills by performing successful procedures despite having to navigate new and unknown equipment inventories. By working with constantly changing teams of technicians and nurses, and having to rely on them for challenging cases, I keenly honed my abilities for on-the-spot leadership and team building. At the same time, I improved my overall skillset by gaining exposure and training in new devices and new procedural techniques. My interactions with IRs from across the country significantly expanded my professional network. I sometimes think of these positions as mini-fellowships. When I returned to a full-time position I brought the experience and lessons of all those fellowships with me.
Full-time opportunities
Each locums position I worked could be viewed as an extended job interview. Often, the group will evaluate their locums to see if they are a good fit to stay on permanently. During your locums contract, the group can directly observe your skillsets, how you work within the larger culture, and what you offer to the role. Conversely, as an employee, you get the opportunity to try out a group before committing. I was grateful to have many doors open for me and I received several job offers during my time as a locums. The experience I had with each group helped me make an informed decision of what opportunity to pursue.
100% IR
While every position will be different, I was able to specifically look for locum positions that allowed me to do almost 100% IR, even though I was not necessarily filling in for role that had been 100% IR. I negotiated this focus with each practice but that approach may not always be possible because most IR locum jobs expect some DR coverage as well. Certain practice settings (e.g., academic centers, OBLs and dialysis centers) are set up as 100% IR positions to begin with and therefore do not expect a locum to perform any DR responsibilities. Regardless of the extent of IR vs. DR responsibilities, locum positions allow you to focus entirely on your clinical tasks without becoming mired within local group/hospital politics or interspecialty turf wars. For many IRs who face these burdens in their full-time positions, the lack of politics can be a welcome respite.
Compensation
As a locum tenens provider, I was compensated by the day with additional hourly overtime coverage, as well as separate call coverage compensations. All these rates are negotiable. When taken together, the work results in an hourly compensation rate that is higher than most salaried IR positions. During my locums work, I contracted mostly through locums recruiting agencies, which ensured coverage of all my travel, hotel and car expenses; if contracting directly with a group you can still try to negotiate coverage of these expenses. However, keep in mind that, except for malpractice insurance, most locums positions do not provide benefits (medical, dental, life insurance, retirement, etc.), and one will have to file self-employment tax.
Work–life balance
As a locums provider, you are free from the extracurricular responsibilities that usually come with full-time work. There are no expectations for you to attend tumor boards or multidisciplinary conferences or do quality improvement projects. But that also means you likely won’t have a clinic or partake in research.
Challenges
Limited cases
Although you will be exposed to different types of IR procedures depending on the practice and its coverage needs, as locum tenens you will largely be doing the bread-and-butter and urgent/emergent IR cases. The more interesting elective work will often be reserved for the full-time physicians at the practice who may have seen the patient already in their clinic and/or been referred to directly.
Unfamiliar territory
Coming into new practices means you are constantly “the new kid on the block.” You are always starting from scratch to build new relationships with colleagues and staff and are always navigating unfamiliar waters. Moving to new practices also means having to learn new EMR systems, adapting to new policies, working with unfamiliar inventory and equipment, and collaborating with unknown referring providers. With the right mindset this type of environment can be very effective in cultivating skills such as team building, flexibility and resourcefulness, but it can also be challenging to navigate ever-changing surroundings.
Constant travel and Lack of stability
While this work is a great way to see the world, the endless travel can become exhausting. Because each position will need coverage for variable lengths of time, you may no longer be needed just as you grow comfortable in a position. Constantly being on planes and living in hotels can cause a sense of loneliness and impermanence. Some people will live for the excitement, but others, like me, will eventually tire of it and crave the stability of growing roots.
Lack of longitudinal care
One of the biggest challenges of locum work is that even if you can negotiate a 100% IR position, you will likely not be able to practice longitudinal/clinical care. As mentioned above, locum position durations are highly variable, making it almost impossible to consistently follow up on patients. Furthermore, your primary role as a locums provider in most practices is to simply ensure that the daily and on-call procedures are covered. There is no expectation, let alone infrastructure, for an IR locums longitudinal clinic.
Despite this accepted paradigm, new and creative setups where clinical/longitudinal care can be delivered while in a locums capacity (e.g., through telehealth visits) are currently being trialed by some intrepid IR locums providers. This will likely reinvent the traditional approach to the IR locums and possibly even establish a new practice model.
Licensing/credentialing
Prior to starting a locums job, you must have an active medical license in that specific state as well as be credentialed at the particular hospital you will cover. The process to obtain a new state medical license and complete hospital credentialing can take several months or longer. When one locum position ends and another is set to begin, the licensing/credentialing process can cause major delays in starting a new position. Furthermore, you will likely find yourself submitting the same tedious paperwork over and over for each new position.
For easy access to facilitate this repetitive process, I created a folder on my computer that contained copies of all the documents that licensing/credentialing boards typically request (i.e., copies of my MD diploma, certificates, procedure logs, state medical licenses, etc.). I also took advantage of the Interstate Medical Licensure Compact (ISMLC), which is an agreement between the medical boards of certain states that significantly accelerates the licensing process if a physician already holds a license in good standing in a participating state.
If you contract through a locums recruiting agency, they will help you navigate the licensing and credentialing processes. They can also help you get emergency or short-term credentialling at a hospital which tends to be a significantly faster process than obtaining full-time employee credentialing.
Pursuing locums work
If you are interested in pursuing locums work, it’s crucial to be clear about your motivations and goals (e.g., whether the ultimate goal is full-time employment or a better work–life balance), which will determine what type of positions you seek, as well as how many gigs you want to take at the same time.
Once you determine your goals, you will have to market yourself. Work on your CV and keep records of your procedure logs, experience, skillsets and recommendations from colleagues. Learn how to use these to negotiate competitive rates.
There are many locums positions available online via recruiting companies. Keep in mind that these companies will take a cut of what you negotiate and often require you to sign a noncompete contract that prohibits you from directly negotiating with the group or hospital for a specified period (usually 1 year). However, they also provide benefits such as malpractice insurance, assistance with licensing and credentialing, travel arrangements, and reimbursements.
It is also possible to contract directly with a group or hospital, especially if you have a personal connection to the group and are aware that they need coverage help. The new SIR Connect Locums Forum is an ideal way to find and advertise locums listings, discuss compensation and benefits, and share advice without relying on a recruiting company to be the go-between. This will facilitate direct communication between groups and providers and promote transparency. If you are interested in pursuing locums work, I highly recommend joining that forum and starting a discussion.
Conclusion
Locums work can be challenging and requires immense flexibility and an open mind. But, if you are clear about your goals and what you want from a position, it can offer untold opportunities. In the past, locums work carried an unfair negative connotation and many believed that those who took these positions only did so because they could not find “real” employment or were soon heading into retirement. But this misconception is shifting, and as the field of IR evolves and physicians focus more on work–life balance, practice models do, too.
For me, not only did locums work turn out to be a resourceful strategy to reset my career path, it was also an invaluable teacher that broadened my skills, experience and perspectives on IR. As a result, I became a more resourceful and resilient interventional radiologist overall with the confidence to face any challenge—whether in the procedure suite or out.
