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Words Of Wisdom For Doctors Interested In Trying Locum Tenens Work

I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can benefit.

The most common question I receive is: How do the agencies compare with one another? Followed closely by: Where should I start? There is no online rating system for this industry, and so grade-focused physicians (taught to value performance ratings) feel at a loss as to where to begin. One day I hope we’ll have a locum tenens quality website, but for now  I can offer you my N=1, “case study” experience.

I’ve been doing hospital-based, locum tenens work for 6 years in the field of inpatient rehabilitation medicine. I have accepted 14 assignments through the following agencies:

CompHealth, Weatherby Healthcare, Jackson & Coker, Medical Doctor Associates, LocumTenens.com, and All Star Recruiting

I have had extensive conversations with recruiters at the following agencies, but have not ended up taking an assignment through them:

Staff Care, Delta, Onyx, Barton Associates, and Farr Health

I have summarized my experiences in this table:

Agency Name Number of Assignments Quality of Client (Hospital or Employer) Quality of Recruiter(s) Salary Provided (percent of what I would consider standard)
Comp Health 4 B,B,C,C A 80-100%
Weatherby Healthcare 3 A,B,C A 85-100%
Jackson & Coker 3 A,C,D C 85%
Medical Doctor Associates* 1 A+ A 100%
LocumTenens.com* 2 A,D B 50-100%
All Star Recruiting* 1 B- A 150%
Self-Negotiated 3 A,B,D N/A 175%

*These agencies use VMS systems.

These “data” are highly subjective, of course, but there are a few important points to be gleaned:

  1. Bad clients are hard to avoid. When I give a client a “D” rating, that means a hospital or employer that is so bad, you have concerns for your medical license or don’t feel ethically comfortable with what they are asking you to do. These are nightmare assignments and must be carefully avoided. I describe my experience with one of the “D’s” here. Big name agencies (and even I on my own) can be duped into accepting bad apple clients. Since it’s hard to know which ones are truly bad (even after a phone interview), I now only commit to a short (about 2 week) initial assignment and then extend once I feel comfortable with the match.
  2. There are good recruiters everywhere. Although the larger agencies pride themselves in outstanding customer service, the truth is that I have had great relationships with most recruiters at most agencies. From a physician perspective, the “customer experience” is fairly uniform.
  3. Vendor Management Systems (VMS) don’t create the race to the bottom I expected. The largest agencies are strongly against automated physician-client matching software (which is essentially what VMS does) and argue that they destroy the customer service experience for both hospitals and physicians. Although I am philosophically opposed to being listed on a hospital purchase order along with IV tubing and non-latex gloves, the truth is that such matching has brought me higher-paying assignments at good quality hospitals that do not hire locum tenens physicians outside of a VMS system. I see no reason to exclude agencies who use VMS, though there is a risk of being in a larger competitive pool for each individual assignment. This means that you may waste some time before being placed, but in the end if the pay is $150% of base, then its probably worth it.
  4. Boutique is not better in the locum tenens world. Unless you are in a specialty that is so small you require recruiters who can perform highly customized job matches, boutique agencies can be home to some of the most depressing assignments in America. Desperate clients who have not had success in filling positions through the (highly motivated) big agencies will turn to boutique ones, hoping that their sheer force of personality will cover for the flaws that make their hospital’s hiring difficult. I have learned to steer clear of the boutique charm offensive.
  5. You can make a higher salary if you find your own job. Agencies provide significant value to physicians. They do the hard work of locating and updating job assignments, assisting with credentialing and licensing paperwork, negotiating salary and overtime, providing professional liability insurance, and handling logistics (travel/lodging booking and re-booking).  That being said, if you’re willing to do all that yourself, you can negotiate a much higher salary if you work directly with hospital HR.
  6. Will “gig economics” eventually bypass the current agency model? Online job-matching sites will probably take a big chunk of market share, but won’t “own” the space because they don’t provide the logistical, legal, and credentialing services that physicians enjoy from agencies.  However, given that agency fees add about 40% costs to physician hiring, there is strong motivation to find alternative hiring strategies, and I suspect that Millennial physicians won’t mind doing extra work for higher pay. Websites like Nomad Health are suffering from limited user sign up (both on the client and worker side), but will likely reach a tipping point when a VC firm provides the marketing capital to raise sufficient awareness of the new hiring marketplace that bypasses recruiters and saves hospitals money. Until then, dipping your toes into the healthcare gig economy is easiest to do through an agency – and the big ones (CompHealth and their subsidiary Weatherby Healthcare have about 50% of the market share, followed by Jackson & Coker as the next largest) provide the largest number of options.

The bottom line is that part-time and short term physician assignments can prevent physician burnout and overwork. The pay is generally very good, and agencies can make the experience as painless as possible. Those who desire higher hourly rates can achieve them if they’re willing to take on more responsibility for paperwork and logistics.  Whether this “do it yourself” movement is enhanced by online marketplaces, or good old fashioned cold-calling to find work – physicians hold the cards in this high demand sector. I suspect that more of us will be ready to play our cards in the locum tenens space in the upcoming years, because full time medical work (at the current pace) is, quite ironically, simply not healthy.


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4 Responses to “Words Of Wisdom For Doctors Interested In Trying Locum Tenens Work”

  1. Selver Maric says:

    Thank you for this useful post. I hope that all can become smoother and easier when Nomad Health and other similar services reach more users and popularity.

    Locum Tenens can be great options for doctors who work in hospitals without a real vision and culture.

  2. Dr. K S Young says:

    The following was a response to a Nomad Blog article on Locums (citing 30-50% higher pay for Locums work – which I feel is unrealistic & inaccurate – @ least for primary care Locums work) that I thought I would share w/the Better Health Locums blog ….. for what it’s worth ….

    TIME OUT!! Let’s put this in the proper perspective! While the salary may appear higher for Locums work than perm positions, there are other factors to consider. Namely, a Locums position is an Independent Contractor so has NO Benefits!!! NO Health Ins or coverage of ANY kind, including any accidents that may happen while OTJ or enroute to an assignment. NO Disability Ins, NO Life Ins, NO taxes, SSI, etc taken out. NO CME allowance, NO society due/fees paid, NO paid sick days or paid vacation days, NO clothing allowance (your lab coat gets bloodstained OTJ the loss is yours alone!). And Locums is NOT reliable steady income by any means

    Also, despite what appears to be more control over a schedule in terms of days/hours worked, it is tempered by the fact that a Locums Dr has NO control over assignment length. Sounds confusing? Let me explain …..

    Yes, a Doc can decide they want to work for the months of say …May & June, then take July & Aug off to spend more time off with their kids for their summer break. However, after accepting & starting an assignment, the clinic/hosp hires a perm physician and cancels your assignment shortly after you have started. Now you find yourself w/o any income which you had planned on having to take the summer off w/your kids. Considering it takes a minimum of 3-6 wks to set up a Locums assignment, you now find yourself NOT working for the rest of May & June (when you wanted to work) and now having to work (cuz you need the income!) during the July/Aug time-frame when you wanted to be off. So bottom line is the “control” of your schedule is NOT as rosey as it seems. Neither is the “higher” income – by the time you factor in paying for your own Health, Life, Disability Ins plans – ALL of which are MORE expensive purchasing singly than on a group plan. And factor in the “lost income” for cancelled assignments as well as “misc” lost income from the occasional assignments that never end up paying the salary that was promised, or reimbursing expenses that were promised, etc (yes is happens much more than you would think!!) …… and you find that in the end working Locums is NOT any financial advantage over a perm position.

    That being said, there are some assignments that flow perfectly, some Locums companies that routinely work to honor (or make the employing clinic honor) the terms of the contracts they set up (while others just say “too bad, better luck next assignment”). Having done Locums in Primary Care/Family Practice for 3+ decades, I’ve seen Locums companies come & go, as well as dozens of Locums recruiters. Overall, Locums recruiting seems to be merely a stepping stone job that doesn’t pay well & the vast majority do NOT stay in that position more than a couple years max. It appears to be a dog-eat-dog highly competitive industry & the worst are the recruiters that work for the same company & compete w/each other within the same company for the same docs & assignments, so they don’t share info/CVs/documents/etc w/each other – a horrible business plan (imho). Most of these recruiters float from 1 Locums company to another for a couple years, then disappear. After a doc does Locums for more than a half doz years, they pretty much know more than any recruiter they encounter – LOL – LBST (laughable but sadly true).

    Locums has some definite appeal for a variety of reasons, but I don’t think the “higher income” is one of them, nor is it even valid reasoning (as outlined above), which I wanted to put into perspective. If there is interest, I am willing to submit advice & warnings to those seeking future Locums assignments.

  3. Dr. K S Young says:

    REVIEW of Locums Recruiters …..

    After recently commenting on a Locums article I read on the Nomad site, I discovered this Better Health site & references to many Locums articles. After reading Dr Jones article reviewing the Locum companies she had worked with I said to myself I should do a similar review someday. Then this morning as I was viewing some more Locums info, I viewed a video done by Barton Assoc called the 5 Myths of Locums, in which they stated that their “dedicated recruiters were available to take care of all the physicians needs”. This really disgusted me & prompted me to respond immediately, considering Barton Assoc have been the WORST Locums company I have worked with in 3+ decades of my Locums career!!

    They have screwed me over not once but twice! My 1st assignment w/them they were looking to fill a 4mos gig & I had agreed to do 2mos. I know the client was looking w/mult LT companies to fill the remaining 2 mos. After 1 month of my contracted 2mos assignment, Barton abruptly ended my assignment (@ the end of the day on a Friday the Barton recruiter calls to say that was my last day!) as they had another Dr that was available & willing to start immediately that could cover the remaining 3 mos. Rather than honoring my contract & take the chance of losing the last 2mos of the assignment to another LT company, they chose to end my assignment to put in their other available Dr to cover the remaining time. This was a Barton recruiter decision to benefit Barton, not a client decision. They/Barton screwed me over to benefit themselves. So much for “dedicated recruiter to take care of the physicians every need” as stated in their video!!!

    Shame on me for ever using them a 2nd time, but the original recruiter (from 2009) that had done me wrong was not there now (in 2013), so I tried them again for a short 2 wk assignment. As of this date, I still have NOT BEEN PAID for any of my 2wk assignment. Bartons legal team states that the hospital (in rural OK) has not paid Barton so Barton can not pay me. They state the hospital had a change of management the week after I left & the new mgt told Barton they are not responsible for my Locums hire or payment. But Barton hired me & yet has done NOTHING to try to collect from the hospital (old or new mgt) or pay me the money owed for my services, or my expenses (I paid hotel & travel expecting to be reimbursed per assurances from the Barton recruiter). And since Barton is NOT a member of NALTO (the Locums association), there is nobody to complain to!!

    LESSON #1 – NEVER do business with Barton Assoc – 2 assignments – 2 grades of F!!!

    LESSON #2 – NEVER do business w/a Locums company that is NOT a part of NALTO (Natl Assoc of Locum Tenens Orgs) – so if something goes wrong & the LT company/recruiter doesn’t do you right, NALTO can intercede to try to make it right. If you google NALTO, you can see a complete list of NALTO members.

    Since I have started w/the worst LT company (from my experience) – let me cont from worst to best.

    Comp Health – grade D – but let me state that I have NOT used them since the 1990s. I had a couple poor experiences w/them early on in my Locums career. Once I was told by their recruiter I would be reimbursed for my car rental & only after I started the assignment was I told by the Comp Health recruiter “Sorry, my mistake, the client doesn’t pay for rental cars” and they did nothing to compensate me. Another instance a Comp Health recruiter asked me if I see kids? I said as a FP I see most ages including kids but only primary care stuff (if complicated I refer to Peds specialist) and not neonatal either. I was told I was going to an FP clinic that saw a lot of kids. When i arrived I discovered it was a Pediatric specialty clinic and they were told by Comp Health that I was a Peds specialist. From that point on I have never worked w/Comp Health again.

    Anecdotal note – I do find it interesting that Comp Healths sister company Weatherby is one of the best companies I have worked with in the last decade. While I have not worked w/Comp Health since the 90s, I do know another Dr that was abruptly replaced by them simply because (according to the Dr) the client wanted a “younger” Dr. He is currently evaluating an age discrimination lawsuit against Comp Health.

    LESSON #3 – NEVER pay for a rental car or airline flight yourself. While almost every company recruiter will tell you they can NOT pay for the car/flight but you will be reimbursed – the truth is they CAN & WILL pay for the car rental and/or flight if you tell them that is a deal breaker. Since the Comp Health incident & similar non-payment/reimbursement by another LT company (no longer in existence), I have refused to repeat this & EVERY company I have worked with has paid the car rental and/or flight directly the last 2 decades. Do NOT let them tell you they can’t – it’s just NOT true!

    Also receiving a D GRADE …..
    – ISP (not even sure what ISP stands for) – small local LT recruiter in OK – failed to tell me that I was replacing a Dr that had been arrested & lost his license for massive Opioid Rxs or that the “FP” clinic they were assigning me to was in reality an Opioid “pill mill”. My 1st clue should have been the extremely high salary they were offering & the 2nd clue (red flag!) should have been that there was NO guaranteed time of assignment but was being set up on a week to week basis – I was told by the recruiter that the client wanted to make sure “I would fit into their system” before guaranteeing me any extended time. In reality, they wanted to make sure that I would write masssive amounts of Narcotic Rxs for the exorbitant salary they were paying. Needless to say, I refused & was not invited back for a 2nd week.

    – Onyx – Recruiter (from less than 1 yr ago) flat out lied to me multiple times – I finally had to speak to his supervisor & demand a different recruiter. I understand the original recruiter is no longer w/Onyx. The pay for the assignment was direct deposit & paid on time, however I was never paid/reimbursed my mileage expense.

    LESSON #4 – Google the recent news feeds on the clinics you are considering working for. Guaranteed they are googling you, so you check them out as well.
    Lesson #4a – Unfortunately, I have found it wise to go by he adage – all LT recruiters are Liars until proven otherwise! As stated in my previous commentary, LT recruiting is a dog-eat-dog business w/an extremely high turnover rate and a LOT of bad recruiters come & go (or transfer to other LT companies) but rarely last more than a few years – just luck of the draw who you get @ any particular time. So take EVERYTHING w/a grain of salt & don’t be afraid to double check things w/the recruiters supervisor or the client themselves – esp if it sounds too good to be true! Mult times I have been told by recruiter a very low # of expected pts to be seen, only to find out different once I get there.
    Examples – told I was only expected to see 4-6 pts/day – when I told this to the clinic mgr once I was there she said she told the recruiter 4-6 pts per HOUR!
    – told I was going to a sleepy slow Urg Care clinic – I get there to find out it was a busy ER instead
    – told I was going to an FP clinic which ended up being a mentally disabled nursing home. (sure wish we had computers & google back then on that one!)

    LESSON #5 – Pay attention to “Red Flags” – clients offering very high salary or unwilling to commit to a reasonable length of work time until they “see how you fit in”, or willing to credential you based solely on your CV “cuz they need someone fast”.

    LESSON #6 – Do NOT incur significant expenses out of your pocket!!
    I have been told multiple times by multiple recruiters that the client requires “whatever” and they will reimburse you for the expense. But here’s the caveat – the reimbursement will NOT come until you actually start the assignment!! You need to realize that there is NO commitment to anything until that assignment starts and the assignment can be cancelled @ any time for any reason prior to the start date!
    – The worst example was an LT company (no longer in existance) that had me spending a LOT of my money & time to apply for a state license & then the client ended up hiring someone else already licensed in that state & I was out the money & time.
    – Another example – a Golbal recruiter told me I needed to have an ACLS & PALS certificate which would be reimbursed by the IHS (Indian Health Service) client once I started – I paid & took the courses, the client cancelled the assignment, so again I was out the money. Global also gets a Grade D for the above reason – esp since the Global recruiter didn’t call me until a couple wks after the job was cancelled (cuz she thought they might change their mind) – so I didn’t find out until a few days before I was scheduled to leave.

    LESSON #7 – It ain’t a done deal till you are there & started!! Always have a backup plan – NEVER turn down other possibilities just cuz the recruiter sez it’s a done deal you will be starting whenever. I have had clients back out as late as hours before a start time.

    Other GRADE Ds – CLIENTS
    There have been a couple more Grade D Locums companies that have since gone out of business, but I must also give a Grade D to a group of clients which are IHS (Indian Health Service) clinics. I have had a half dozen or more IHS assignments and not a single one has ever been enjoyable or rewarding. They all have been rife w/problems – usually related to inappropriate (sometimes massive) Opioid and/or narcotic Rxs. The worst example being my 1st pt seen @ one IHS clinic – I’m watching out my window @ a guy (who ended up being the pt) tossing a football around w/a couple kids in the parking lot having fun – didn’t think much of it until he walks into the room for his appt & now appears to be hobbling w/a cane & wants a refill on his 3 Opioids, and his Xanax 4 times/day! He relates severe back problems, winces in pain @ the slightest palpation or attempts @ ROM testing, yet has NO records of any testing more than Xrays 4yrs previous which showed mod arthritis. He refused any further testing MRI, etc and refused to take a Urine drug screen. I refused to refill his massive Rx refills & called a pain mgt clinic which agreed to see him the next day – of course he refused that as well. Come to find out he was the brother of the tribal chief who asked the LT company to replace me the next day!
    NOTE – my IHS assignments have been in OK, AZ, NM, and I have since noticed that those same clients/clinics seem to ALWAYS be recruiting for docs thru many companies & the Govt website also. So the fact that they are always looking is another red flag. I would certainly like to think that there are some good legitimate IHS clinics in operation – I just haven’t had the fortune of working in any of them – nor have any of the many Locum Drs I have talked to – I’ve yet to talk to a Dr that has had a good Locum experience @ an IHS clinic.

    Another group of clients/clinics I give a GRADE D to are the VA Clinics not actually run by the VA but run by companies that win a contract to run the VA clinic by submitting the LOWEST bid. I have found they cut corners left & right wherever they can, to the detriment of the patients. VA jobs (& govt jobs in general) are usually the lowest paying & worst expense reimbursing anyway, so usually best to avoid as there are usually better jobs available. But I have had no problems w/the govt assignments I’ve done – EXCEPT for the couple of VA clinics being run by other companies. If it’s not an actual VA clinic run by the VA – avoid it!!!

    Unfortunately, I have exhausted my available time today discussing the bad companies & clients. But that’s OK cuz the lessons outlined are important for any prospective Locums physician. I promise I will comment in the near future giving credit to the many very good LT companies I have dealt with

  4. mgross says:

    Never work for Jackson and Coker. When they operated as JNC Nationwide, I accepted a 6 month gig and cancelled other steady work to accommodate it. On the first day at the new job, I was informed of a paperwork snafu, and that I had to go home till it was fixed. I waited a week and was then told that the hospital wouldn’t sign off on the clinic job for which I was eminently qualified. JNC then refused to either pay me for the contracted assignment or for travel and interview expenses I had incurred, and were promised to me before the job. I ended up taking an unpaid vacation for a month, thanks to the incompetent follow-up by their agents during job set-up.

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