Posts Tagged ‘locum tenens recruiters’

A Doctors’ Trade Show

October 2, 2015

I went to the doctors’ trade show

And met some folks that I know

And made some new friends

Who have the means to the ends

And, all in, all, seem like a pro

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, and two weeks a month working Urgent Care in suburban Pennsylvania. I’m attending a medical conference in Denver.  Any patient information has been included with permission.

After a three hour lecture in the morning, I went to the Exhibition Hall, a trade show for an audience of 4,000 doctors.

All the big drug companies have booths here, where “booth” can mean a display with 4 figure square footage, 6 figure inventory, double digit staff, high-tech lighting, and luxurious carpet.  The device manufacturers send representatives, too, along with recruiters, hospital systems, healthy and unhealthy food manufacturers, shoe makers, massagers, electronic EMR companies, publishers, lab companies, financial managers, 14 government agencies, imaging corporations, instrument manufacturers, market research concerns, office equipment vendors, practice management consultants, and almost everyone who wants to hire a Family Practitioner.

I could not find the company that made the recalcitrant EMR which led to my departure from Community Health back home, probably for the best.  That company’s exit from the field would not surprise nor disappoint me.

I visited the booth of the Urgent Care company I’ve worked at this summer, and bubbled over at how much I’ve enjoyed the experience.  They plan to open a center 4 hour’s drive from my home, and they offered me a more permanent spot.  All they want is a commitment to 10 shifts a month.

I also visited the representatives of the company that place me there.

But first I had a most productive talk with the Canadians, and I learned a good deal.  They explained some salient points about the credentialing process which the website does not make clear, especially regarding notarization of credential copies.  I established a relationship with a recruiter for a government agency, and expressed my willingness to work rural establishments.  The first step, a provisional license, will require a 3 month commitment, and, after that, I can do locum tenens work as I choose.  The country’s socialized medical system regards the doctors as independent contractors, and most work fee-for-service.  Medical malpractice exists, but a doctor has to really screw up to get hauled into court, and professional liability insurance, provided by a government agency, has remained affordable.  I walked away stunned.

Talking to recruiters.

October 26, 2014

For the what, the when and the where
For a job with inpatient care
I could compromise
On the salary size
But not things that I wouldn’t dare.

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center. I used vacation time to do two short assignments in Petersburg, Alaska. I left the Community Health Center this month because of a troubled Electronic Medical Record (EMR) system.
I’m talking to more recruiters these days. When I tell them I’ve recently left a position I can hear an optimistic catch in their voices. Two days ago, I said, “I imagine you have to deal with a lot of rejection in your job.” Yes, she admitted, she does.
My ideal job, I tell the locums agencies, runs something like this (translation to follow): Hospitalist, 7 on/7 off, 12 hour AM shift, ER codes, intensivists on staff, no procedures, in Alaska.
Translation with explanation:
Hospitalists take care of patients sick enough to need hospital care. The hospitalist movement goes back no more than 10 years in this country. The US remains the only industrialized nation where outpatient doctors care for patients in the hospital. During residency in the 80’s, the older docs would point out that hospital work brought in money with no overhead aside from billing; but 20 years ago we started to look at the time we spent getting to and from the patient. A decade ago we looked hard at the inefficiency of drive time. Yet when, for a multitude of reasons, I took over my practice’s inpatient duties at one hospital, I found economies of movement which increased productivity with no shrinkage of patient contact time. And when I came to the Community Health Center, my contract specified I would work half-time as a hospitalist. That operation dropped adult inpatient work last December because the midnight-to-morning workload became unmanageable.
7 on/7 off refers to a work schedule of seven consecutive work days followed by one week of continuous rest. While an 84 hour work week sounds brutal, it affords the opportunity of going home in between stints.
12 hour AM shift is not really AM, but in the business it means 12 daylight hours, as opposed to the night-time hours. I really have paid my dues at this point and put in more than my share of sleepless nights. With the hospitalist movement has come the sub-genre of nocturnalist, so new that the position is sometimes called nocturnist; by whatever name, someone gets paid to take calls in the hospital all night.
ER codes means that the ER physician responds when a patient’s heart stops beating, to attempt resuscitation. Some docs, not me, enjoy the action, and compare it to “going to the Super Bowl”.
Intensivists on staff: With subspecialization, we now have doctors that do nothing but care for ICU patients. Sick enough to need an ICU means sick enough to needs a lot of doctor time. Trying to combine those patients with the less sick frequently means irreconcilable time conflicts.
No procedures recognizes that my skills at intubation, central line placement, and arterial line placement faded before the turn of the century.
In Alaska: self-explanatory.
Of course I expect to compromise on at least one of those parameters. I don’t demand my first choice, and so far I’ve said yes to three positions that haven’t happened. Yet I’ve learned how to have a good time anyway.

An afternoon off

October 3, 2012

Doctors are in short supply,

Demographics can tell you why.

Agencies try to recruit

By offering loot

But most of us come off as shy.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

On my afternoon off I got 11 business phone calls in an hour, as I tried to nap.

A radiologist paged me, to report a very odd set of findings. 

I’d like to tell about the patient, the drama and the irony, the impact of the illness for the person and their social context, the facts and the meaning.  I did not obtain the permission; I ordered the study more as a formality than with the expectation I’d have to launch a full-court diagnostic press. 

But I called the nurse back and ordered MRI’s and magnetic resonance angiography, on the advice of the radiologist.

That radiologist doesn’t call me for routine findings.  I wouldn’t mind if he did, I enjoy him and his conversation and we have a very good working relationship.  He has a lot to teach me, and every time we talk I become a better physician. 

After that flurry of calls, while I started to close my eyes, my phone rang, and I took the call from a physician recruiting company.

During my year of walkabout, one of the recruiters from that company rubbed me the wrong way with pushiness.  I kept my words calm, respectful, and professional, but made it clear to him that I wouldn’t work with him or his company, ever.  Which, in the 21st century means not for three years (by then it’s a different company).

I told the recruiter I’d had a lengthy call from one of her coworkers the day before.  I learned that their primary care department has 10 full-time recruiters, and the company employs more than 400.

No wonder I get so many calls; that company competes with 80 other agencies. 

Yes, I still toy with the idea of going back walkabout, and if I had enough annual leave hours built up, I’d go on a working vacation.  And I’d go for spots mostly shunned by other docs.  I’d enjoy rural, Indian reservations, even prisons or Armed Forces installations.  I like low population density and the opportunity for outdoor adventure.  Even if it means lousy weather. 

I had barely hung up when another recruiter from a different agency called.  One of the places where I worked suffered a leadership crisis, making them critically short-handed.  I had to turn him down; I have a contractual obligation here.

Yet rural America’s health care force runs chronically short, and a lot of people in Western states live hours away from the nearest health care. 

The radiologist called me back; a CT scan I ordered showed an ominous set of fractures that hadn’t shown up on plain x-ray.  I called the nursing floor back and ordered calcitonin, highly effective only in fracture pain.  I put out a page to Utilization Review; and on the strength of the findings got approval to keep the patient in the hospital another day.

I got in a short nap, and cleared up documentation at two hospitals and the office, while fielding another 8 calls.

But I never got rushed.

After all, it was my afternoon off.

Prepping for a new assignment with the certainty of uncertainty

March 8, 2011

Here’s something to keep you from hurtin’,

Set emotional pain to avertin’

     Whatever’s arranged

    Is bound to get changed

The future is always uncertain

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  I just got back from a six-week assignment in Barrow, Alaska, the northernmost point in the country.

I’ve been prepping for an assignment in another country but I’ve not written any details about the trip because so many times in the past deals have fallen through at the last minute.

My plans have changed a a lot since I decided to make a career change.  I rejected my first scheme, to stay in Sioux City but work in an allied clinic closer to home, after less than a week of consideration.  Thinking it through I realized I wouldn’t be slowing down at all.

Another plan, involving a local Indian reservation, turned out to be inside the thirty-mile limit of my contract.  Negotiations with another reservation fell through, I suspect because I asked for too much money (and they didn’t even make me a counter-offer). 

Then I had the idea that I should retrace my steps coming here, and work in Michigan, Wyoming, New Mexico, and Nebraska.  The timing turned out to be too complicated. 

I started talking with recruiters from Locum Tenens agencies.  When I finally figured out where to post my bona fides I started getting lots of calls.  Hint for any doctors or recruiters who might be reading this post: and the New England Journal of Medicine have excellent bulletin boards.  I’m shocked that more agencies and doctors don’t use them.

I keep modifying my agenda, and I’ve stayed flexible.  I’ve assented to 19 jobs so far, of which four didn’t fall through and one is pending.

And I had a great time at all four jobs.

This upcoming placement, if it works, has changed and morphed.  Clinics in towns with exotic names requested a locum tenens (substitute) doctor, then changed their minds.  Other facilities, where I’d like to work, want me but bureaucratic rules could not be circumvented.  In the meantime, I corresponded with the recruiter over and over.  I searched Wikipedia and Googlemaps and  One recruiter left for a different position and another recruiter took her place. 

When we thought things were set, and that I’d for sure have work, I sent off to my licensing boards to send Certificates of Good Standing to the country’s licensing body and we booked tickets. 

Today I got an email titled Change of Plans.

I called the recruiter and turned on the phone’s speaker.

The proposed first placement wasn’t going to work out.  How about something else?

I grinned, but I watched Bethany’s smile fall from her face as we listened to details.  A different climate, and instead of pastoral farm country, we’d be on the beach.  One central hub facility and six outlying clinics.  Temperatures slightly warmer.  Excellent fishing, but marginal hunting.  I remained enthusiastic.

 In the last year I’ve learned to keep myself flexible when it comes to future plans, though I can’t deny the emotional rollercoaster ride from making plans and having them change.

When we hung up I was still smiling.  “It’s all good,” I said.  “Worst comes to worst, we’ll end up having a vacation till we’re tired of vacation, then we’ll come home and I’ll find something else.”

“I want some of what you’re taking,” Bethany said.

I handed her some chocolate chips.  “Take two of these,” I said, “You’ll feel better.”

On pushy recruiters, sleep deprivation, and our tendency to sabotage our own happiness

November 3, 2010

The price that you pay can be steep

For the nights that you spend without sleep.

     The abuse that you take

     While you’re staying awake

Can lead you to rage and to weep.

I deal with a lot of recruiters for the locum tenens agencie that find short-term work for doctors.  The level of professionalism varies a good deal.   When I started this year of going walkabout, I wanted to experience good recruiters and bad; today I dealt with the worst.

Pushy people can be trusted to be pushy; they cannot be trusted to develop good interpersonal learning skills.  For the first time ever, I told a recruiter not to call, not to email, and to take my name off his list.

In the beginning of this process, I accepted a lot of jobs  that disappeared into a cloud of bait-and-switch smoke (see my posts from March and April).  I’ve learned a lot.  I don’t have to talk to any new recruiters; I know three good ones.

I attended a patient today who might have a lot of different diagnoses, but I suspect chronic, long-term sleep deprivation gives rise to most of the problems.  Of course I ran a lot of lab work, but I did a good deal of career counseling.

Far too many people slice years from their life expectancies for the sake of their employment, notably doctors.  We get a set of skills, acquire an exaggerated sense of our own importance, and sacrifice our sleep.  Sometimes life-and-death issues justify the sleeplessness, more often late nights result from a misplaced sense of responsibility. 

Other professions provide necessary services in the wee hours, and a lot of people work nights who don’t have to.  They effectively move to a different time zone than their families live in, sabotaging intimacy.  A predictable cascade of events follows, some physical, some sociological; most to the detriment of the person, the family and society.

An industrialist friend of my started a third shift in his plant, and I begged him not to.  What you make up in increased production, I said, you’ll lose in work-related accidents and the families of your workers will suffer.   He said that he had a lot of people asking to work nights.

I’m not working nights at all in my current position.  I walk out of the office promptly at closing time: five o’clock Monday, Wednesday, and Friday; seven on Tuesday and Thursday.  This afternoon after work I went out to the trap range with my shotgun.  I can blame my mediocre shooting on the bad wind.

A privileges and credentials packet goes out

October 22, 2010

It’s not the status that’s quo,

After quite a few flops in a row

     It was quite a long caper

     To fill out the paper

And the agent came through like a pro.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  While my one-year, thirty-mile non-compete clause runs out I’m having adventures and writing about them.  I’ve worked in Barrow, Alaska (the northernmost point in the United States), I went to the American Academy of Family Practice Annual Scientific Assembly in Denver, and I took a week to visit a suddenly stricken friend.

Yesterday I got together the final paperwork pieces for the job I plan to take for the month of December.

A new medical position never runs without complications; a locum tenens job where the duration is short carries its own complications.  A Curriculum Vitae precedes any negotiation.  So far all prospective employers have asked for copies of medical licenses, residency certificate, medical school diploma, DEA certificate, CSR certificate (a state registration that qualifies a doctor to prescribe narcotics and other controlled substances), along with work history, malpractice history, and criminal history.  If the process continues, there’s a questionnaire from four to eighty-seven pages long (I didn’t fill out the monstrosity intended for another country; I decided I’d rather go somewhere else than spend weeks completing paperwork) which is sometimes accessible online.  And if all goes well, at the very end comes approximately twenty-five pages called Privileges and Credentials.  This last batch recaps everything submitted so far with a few more things thrown in.

The agency I’m working with took the information I’d given prior and filled in most of the P&C form. 

As I’ve said yes so far to 17 jobs (of which three have panned out), I’ve gotten good at completing the paperwork.

I got a call around noon, asking me if I’d like to have the raw material for privileges and credentials FedEx’d or emailed.  As I’ll be out of town for two weeks, I of course asked for the PDF file.  I printed it out at 1:00 PM and went to work.  At 1:38PM I called with some clarification questions.  I had to phone to find out the number of my professional liability insurance policies for the last seven years as well as the email addresses for those docs I’ve listed as references.  At 2:00 PM the material was ready to go.  However I had to learn how to use the FedEx system.  After a few more calls, and a light lunch, I dropped the material off at the FedEx store nearby.

I’m not complaining about the process.  Indeed, for the last 22 years I’ve sat on St. Luke’s Credentials Committee.  We’re very careful about who gets to practice, as every hospital should be.

This same agency’s recruiter has shown exceptional attention to detail, asking me to specify six parameters of reimbursement before she started negotiating with the client.   Yesterday afternoon I received my schedule as well as reimbursement plan, about 4:00 PM.

Regretfully, not all agencies have been so well organized.


Why is a free-lance artist like a locum tenens doctor?

October 18, 2010

The worst ones will lie and they’ll steal

I said to my bro at a meal

    But the great ones are pros    

   And bargain well I suppose

And everyone wins in the deal.

In the east for my wife’s family gathering, I called in New York on one my brothers and one of my sisters.

There are seven of us, we span 35 years and both coasts.  We are all intelligent and dyslexic with way  off-the-beaten-track senses of humor.  The other six (not me) possess great artistic talent.

You’ve seen my brother’s artwork in It’s a Bug’s Life, Monsters Inc, and Cars.  Currently he’s doing story boarding and working on his MFA in painting.

I talked to my brother about dealing with the locum tenens agencies (there are more than eighty; I’ve personally talked with about twenty-five), observing that the three parameters of professionalism, honesty, and flakiness shake out to a bell-shaped distribution.

“Listen,” he said, “Take it from me, and remember I’ve been free-lancing for decades, don’t deal with agencies, go directly to the employer.”

My brother should know; he sent out mailings of his portfolio on a regular basis for quite a while, and has first hand experience dealing with a dishonest agent.

I said, “I tried.  I called and mailed twenty health-care sites in central Nebraska and didn’t get a single call back.”

“Oh…Well they probably just want to deal with agencies,” he said.  “Then what you need to do is just deal with the best agencies.”

“That’s a great idea.” I said, “As part of this experience I wanted to deal with some good recruiters and some bad.  But if I was going to be doing this for very long I already know which agencies, there are two of them, that I’d go with.  The rest aren’t worth it.”

“How do you mean?”

“I’ve said yes to fifteen jobs so far and three have come through.  Sometimes it was poor communication, but I expect good communication from a recruiter, after all, that’s they do.  Sometimes they just out-and-out barefaced lied when they tried to do a bait-and-switch.”

He shuddered.

“And there’s this one recruiter,” I went on, “over the phone she sounds breathless and blond but she is a pro, an absolute professional.”  One of his eyebrows went up.  “Right after I agreed to a placement she had me specify six parameters for reimbursement…”  Both eyebrows went up.  “She wanted to know,” I explained, “How much I wanted for straight time, overtime, carrying a beeper, getting called, getting called in, and holidays.  Well, I had never thought of those things because no recruiter had ever asked me.”

“No?” my brother asked.

“Not one.  And I suspect that she’s a top-notch negotiator because she can get people to underestimate her.  She just got me a better deal than I asked for, and I’m pretty sure the folks she talked with would work with her again.  And that’s the mark of a good agent, getting the best deal for both parties.”

Comparing notes on what to look for in an employer, and how great reasonable hours are.

September 30, 2010

I went with a friend for a bite,

As the afternoon turned into night

    Comparing job notes

    Benefits, values, and quotes,

And the value of leisure delight.

Twenty-four hours ago I put data into a web site called DocCafe, which helps doctors looking for work get in touch with employers and agencies.  An avalanche of email followed.

I emailed my CV right and left.  Over lunch I spent two hours and all of my cell phone’s voltage talking to recruiters.

I spoke directly.  The ratio of jobs that fell through to jobs that panned out runs 8:1.  Yes, I said, go ahead and present me but I’m working with more than one recruiter.

After my lectures I met a friend for a sandwich.  Rebecca knew our daughter Aliya in college; she lived in Sioux City for two years and in that time befriended Bethany and I.  She lives in Lower Downtown Denver now, and, like me, finds herself between jobs.

We compared notes.  She commented on the importance of employer appreciation, and that interpersonal respect, money and benefits much be considered as a whole package.  I talked about my job during my premed years at Cybertek, the software firm that did United American Life’s computer work in a building four blocks from where we sat (the building has since had an appropriately committed relationship with a wrecking ball).  They trained me, paid me $.80 above minimum wage, let me study while I worked, and let me eat the leftover breakfast pastries.

Later in the evening I ran into an ex-partner.  Rick left our Sioux City group in 1993 to move to Greeley.  Recently a hospital purchased his practice, he stopped doing OB and making hospital rounds.  Now that he doesn’t get awakened in the middle of the night, he gets good sleep on a regular basis, and has more time.  He feels rejuvenated.  Actually he says he almost feels like he retired. 

When we shared our views, I commented on how much happier I am now that I’m not the boss, and we both talked about how we work too much, but how much we love the work.

The topic eventually came to accessibility of medical care.  Yes, we agree, all these things that we’re doing result in more leisure for us, but if all the doctors had a sudden attack of sanity and stopped working those life-shortening overtime hours, there wouldn’t be enough doctors.  And especially there wouldn’t be enough family practitioners.

I presented my plan: eliminate the premed requirements; democratize the pre-clinical med school years and put the information on the net for free.  Anyone who can pass Part I of the Boards should be allowed to continue into a clinical program. Those last two years of med school would be extended from two to two and a half years to cover everything relevant in premed and those skills that cannot be taught by computer (interviewing and physical exam).  Current medical schools, for a price, would teach those students who don’t do well with distance learning.  The result would be a much larger number of doctors willing to work fewer hours for less money. 

We agreed about the feasibility and improbability of such a scheme.

Cherry blossoms and rice wine in Iowa

April 22, 2010

For just a moment we’ll tarry

Beneath my blossoming cherry

   A moment in time

  For sipping rice wine

Both fleeting and pleasant, so very.



Three of my cherries are blooming and today I take a short time to just enjoy them.

The oldest one, an Oka Giant bush cherry about twenty feet tall, is at the peak of its blossoming beauty.  As the sun goes down I warm a shot glass with boiling water, then pour two ounces of sake and go outside. 

The point of cherry blossom time in Japan (Sakura), as I understand it, is to enjoy fleeting beauty and remember the transient nature and fragility of human existence.  I think of it as seize the day, existentialism, and stop and smell the flowers all at once. 

I don’t drink much in the way of alcohol, and two ounces of rice wine (beer really) slows me down.

Bethany comes home, and walks across the grass barefoot to me.  She’s taking a biology class as part of becoming a Certified Medical Assistant.  If we ever want to open a Mom ‘n’ Pop doc shop she can be Mom.

I tell her about the recruiter I talked with today.  The firm has more than 500 openings, many of them for primary care.  The agencies mostly want two and three-month commitments, but one place in Wyoming would want a doc for a much shorter time.  It would afford an opportunity to be tourists there and back.

The hazy western horizon darkens while we talk and I watch the half moon through the branches of the maple tree.

The scent of most fruit blossoms is strongest when the temperature brings out the bees and other pollinators, and much weaker when the sun sets.  In the middle of the day the Oka’s fragrance can be smelled from the street, and if you hold still near the branches you can hear the bees working.  Thus the bush cherry brings delight to the eye, the nose, and the ear in the spring.  The fruit comes ripe in late July.

But strong rains are forecast for the next three days, and by then the blossoms will pass their peak. Late in the day and the smell has faded.

A Japanese physician here in town came one year to sit under my blooming cherry trees.  He brought sake. He and his nurse and Bethany and I chatted while we sat on the grass.  He left town before the next cherry blossoming.

I remember it as a moment of peaceful, quiet conversation in an avalanche of a career.

The evening grows cool and the mosquitoes come out.  Bethany takes a sip of the warm sake and it’s time to go in.

Seize the day and smell the cherries.