Locums 101

Whether you are an early-career physician, or one nearing retirement, being a locum is a great way to transition into (or out of) clinical practice! Some people enjoy the flexibility of locuming so much so that they make an entire career out of it. In this blog post I will use my experiences and the experiences of my peers to hopefully pass on knowledge that will aid you in a successful transition into the locum life.

 Why locum?

• • It’s Flexible – you get to choose when, where and who you work for AT ALL TIMES. If you need a vacation you can take one without requesting time off or finding someone to cover your patient panel while away. Coming off of residency it is a refreshing level of independence!
  • It allows you to leave behind the “difficult” patients – We all have experiences with patients that give us that “gut-sink” feeling when we see them on our list… As a locum you can rest easy knowing you might never have to see them again.
  • It’s a great learning opportunity – Everyone practices a little bit differently and, most agree, that our peers are a highly regarded source of medical information (as evidenced by the very popular “hallway consult” whenever we have a difficult patient case). Covering a colleague’s patient panel allows a locum physician a unique opportunity to learn from them by seeing how they handle a multitude of clinical scenarios. If you are providing locum coverage in a different location than where you trained it is also an amazing opportunity to learn about local resources that you can use in the future.
  • It helps you define what you want – If you are a new graduate you may not know if you want to work in a small group practice, a large practice or even a solo practice! Is it important to you to have multiple MOAs available to help or do you prefer one dedicated MOA that you work closely with in clinic? Do you feel you need more than one office space to see patients out of or do you prefer the turnover of one room allowing you time to finish notes in between? Do you want to work in a practice that caters to walk-in patients or do you prefer your set list of “well-known” patients booked everyday? By working in varied clinic environments you really learn how you work best and what you want to look for in a practice you may join.
  • It can be a trial run – Try before you buy! Who doesn’t love that opportunity!? See if you fit into the office culture and if you like how a practice is run by locuming in a potential clinic before you sign-on for a more permanent position.

• Ok, you’ve decided you want to try locuming… Now how do you find a job???
  • Word of mouth – You can offer your locum services to preceptors you’ve had in the past, colleagues of yours, or ask a trusted clinic manager to pass your information along.
  • Social Media – The First Five Years in Family Practice facebook pages for both Alberta and Canada are very active with locum opportunities (both asking for coverage and individuals that are offering coverage).
  • Resident Association webpages – In Alberta both U of A and U of C have entire pages on their Family Medicine Resident Association websites dedicated to job advertisements (especially for new or early in practice grads).
    • University of Calgary –  http://calgaryfamilymedicine.ca
    • University of Alberta –  http://www.fmra.ualberta.ca/Jobs.php
  • AMA Physician Locum Services – For rural locum opportunities. Will pair you with trust clinics in rural locations that are in need of coverage. Will also organize a place for you to stay during these locums and have a contract in place before you start. https://www.albertadoctors.org/services/physicians/pls
  • APL jobs –  https://apljobs.ca/
  • Locumunity –  https://locumunity.com/

• Common locum pit falls (and tips to avoid them)
  • Not busy enough– this happens sometimes if you are covering a smaller practice or only covering a short period of time (patient’s will often put things off for a week if they know they can see their GP in the next).
    • Ask before you start; how busy the practice usually is, how large of a patient panel you will have, how busy past locums were etc…
    • You can also negotiate for a guaranteed minimum daily wage to be included in your contract.
  • Too busy – Can happen if you are you covering for multiple physicians, have a large patient panel, or are expected to follow-up on a large volume of daily investigations/labs/consult letters.
    • Be very clear in your contract how you would like patients to be scheduled. Just because the doc(s) you are providing coverage for can see a patient every 5 minutes does not mean you are expected to do the same.
    • Book time into your day to review labs/imaging if you have to.
  • Lack of routine– Like residency training; regularly moving between new work environments is not conducive for a stable routine. If you seek a more predictable schedule consider the tips below.
    • Find a long term locum to cover (eg. a maternity leave)
    • Find a few clinics that you enjoy working in and try to rotate your locums between these familiar environments.
  • Potentially unstable revenue – As a locum you have to continually seek and evaluate the next locum opportunity. You may find periods of time where you don’t have work lined up (and therefore unreliable revenue).
    • Find a walk in clinic that you trust that will allow you to do work on an ad hoc basis.
    • Sign on with a hospital to provide overnight or weekend coverage for inpatients. Often they will let you request specific days in advance or you can pick up shifts that others are giving away when it works for your schedule.
    • Reach out to rural communities to advertise your locum services and consider doing rural emergency shifts (if you are comfortable and there is a need in your area).
    • Book as far in advance in your schedule as you are comfortable to avoid trying to find work last minute. Many clinics are happy to sign a locum contract as far as a year in advance if they know they will need coverage!
  • Unfamiliar EMRs – Alberta has a variety of electronic medical records available for physicians and clinics to choose from. While it is nice that clinic owners have the freedom to choose their software; for the locum physician it can be a nightmare trying to do your job on a new computer system every time you move to a different clinic. Luckily there are a few *more* popular EMRs and once you have used them once it gets easier to rotate between them all.
    • When starting on a new-to-you EMR plan to visit the clinic in advance or leave time on your first day to learn the fundamentals.
    • Consider a lighter patient schedule or planned “catch-up” breaks the first few days in a clinic with an unfamiliar EMR as charting, prescribing meds and dealing with tasks/investigations will take you longer than expected.
    • Find out if you will be able to set up remote access to the EMR so you can work on unfinished charting and tasks from home.
  • Oh no a clinic emergency!
    • Before you start get familiar with local resources (closest emergency department etc.).
    • Have a clinic tour and identify what emergency supplies you have available (AED, supplemental oxygen, ventolin, epinephrine…).
    • Find out if the clinic has emergency protocols and who the “go-to” person is for help.

As a final word of advice; don’t say yes to every opportunity that comes along, ask lots of questions, ensure you are protected with a locum contract and take you time when evaluating potential job offers! Being a locum physician can be a challenging yet incredibly rewarding experience – you are providing a much needed service to, not only, the patient population but also your colleagues.

Author: Dr. Jennifer Ortynski,  MD CCFP
Dedicated member of the ACFP’s First Five Years in Family Practice Committee