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Thinking of going Locum Only, need opinions.


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Ok... Some of you may know that I work in FP and HIV and love my job 98% of the time. This month, SP tells me that meaningful use is adding some NE bullcrap metric/criteria. This always means more crap for me to document and "capture" on my ever-growing, life sucking stack of undone charts. Since our medical group started offering bonuses for Medicare wellness visits and "Medical Service Visits" and PHQ9 visits, my documentation time has tripled.

 

This and I have been getting some burn out lately and I'm starting to resent (I know I've advocated for the "money ain't errythang" ideal here before) my lowish pay and my long hours. I mean I do a great job and my pts love me (yelp and patient fusion scores are 5 stars for me) but we are a small 2 practitioner office that can't afford much by way of raises and bonuses. I am pretty much going to cap out at some time

 

I also have an autoimmune condition that tends to flare up when I'm stressed out. I started feeling some of the typical prodromal symptoms this week.

 

Long story short, I got a call from a locums recruiter and told me I would make 30 grand more per year than I make now and only work 12 shifts a month!

 

Now I think I want to do it but never did locums before. It would be FP/UC/EM.

 

What do ya'll think?

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@ USC: Love Steve Miller Band! Gangster of love is my joint lol.

 

@Richard: have a great relationship with him. He's one of my best friends which makes it more difficult. He knows about my stress load and has brought up concern that it may cause a relapse. He's also mentioned a possible raise at the end of the year but I am certain it won't/can't match the other offer.

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I love locums work. I'm with a rural EM PA group that covers about 15 hospitals. Most shifts are 48-72 hours, with 1-4.5 hours of driving each way (although there are sometimes a few 12 hour shifts).

 

Pay is great, autonomy is great (until you have that crashing youngster). Time off is great (5 days a week off!!)

 

But do NOT think its low stress. There is the stress of the single coverage ED which is a completely different kind of stress of the various EMRs that I have to know (Cerner is the worst).

 

Benefits? None.

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It doesn't hurt to explore your options.  Can your practice hire someone to take the load off of you such as an assistant who can do the menial work that is not conducive to the Assistant? 

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It doesn't hurt to explore your options.  Can your practice hire someone to take the load off of you such as an assistant who can do the menial work that is not conducive to the Assistant? 

 

I thought of and brought up getting a scribe and the response was we cannot afford it or I can hire someone and pay them myself. We share a BO MA and we have a FO MA. THey are swamped. We are getting more swamped. We are one of the few PCPs in the area who take Covered California (Obama Care) that is not attached to county. I just got 8 new pts booked this week for me. The sad part is the reimbursement for these pts pale in comparison to the FFS we get from the Medical Group but these guys dominate my schedule. I have been adjusting my schedule and limiting the Covered Cal pts per day but the documentation is the same with more to come.

 

Boats: Thanks for posting.  I expect a level of stress in any job in medicine but at least I would not really be following these pts. I saw it as I do my time and go home. I'm sure there might be more to it than that. I really need the break from work. I mean even my weekends are not my weekends. I'm charting during Saturday and have other obligations on Sundays. And I take call every 2-3 weeks sometimes landing on weekends. I just feel stretched out in all directions.

 

I'll talk to my SP tonight after work.   

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Promises, promises.

I would take this opportunity you have to do locums on a test run.

What looks great, may not for a variety of reasons.

I have participated in hiring locums in a small ED several times. We work the person hired heavily, 5 shifts out of 7 days, 7 shifts out of 10 days, all 12 hrs plus.

They have to get up to speed quickly, not something that occurs very readily with EMRs nowadays.

 

I agree that a small ED can be very stressful because you fill many roles and your support may be tenuous.

 

If you truly love what you do and where you work, maybe a few shifts elsewhere will reinforce this for you.

 

A few other suggestions:

 

If this is a documentation / EMR issue then I would take a look at your use and see if there are ways to improve. The visits you describe amend themselves to a precompleted or templated note which could cut down on your documentation. I recently went through some EMR training and what was obvious was that many clinic visits amend themselves to one of a half dozen templated notes. You can either be a document purists or you can go home on time with all charts done and bills out the door.

 

I work in EM but what I have observed about small practices is this: they dont survive on their own unless they have some significant means of support ie grants, subsidies, etc. Are you part owner? Has anyone given a thought to doing a concierge practice? I have nonmedical friends that belong to these. One practice essentially tied the conversion to a concierge practice to survival of their clinic. They turned none of their patients away and essentially would offer all pts an appt within one week. What got you more immediate access was a tiered prepaid fee schedule that got access in different increments from emails to telephone calls to in home visits. The practice essentially told their patients they were at a point where they were going to close, lose providers or sell out to nearby medical ctr and be absorbed. 

 

Math: 1000 pts paying 50 dollars per month for a return telephone call within 6 hours and an appt within one day = 600,000 to keep your practice open, viable and get some compensation you deserve.

This may be a financial burden to some but there are plenty that will pay. If your satisfaction scores are that great, they will pay. 

 

Last, medicine in the US is a real sh&t show much of the time just like many occupations. But it pays the bills, there is some respect and both financial and altruistic rewards at times. I focus on those aspects and look at what I can actually control to improve the things I dont like. The rest I ignore as best I can.

 

Good luck.

G Brothers PA-C

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Promises, promises.

I would take this opportunity you have to do locums on a test run.

What looks great, may not for a variety of reasons.

I have participated in hiring locums in a small ED several times. We work the person hired heavily, 5 shifts out of 7 days, 7 shifts out of 10 days, all 12 hrs plus.

They have to get up to speed quickly, not something that occurs very readily with EMRs nowadays.

 

I agree that a small ED can be very stressful because you fill many roles and your support may be tenuous.

 

If you truly love what you do and where you work, maybe a few shifts elsewhere will reinforce this for you.

 

A few other suggestions:

 

If this is a documentation / EMR issue then I would take a look at your use and see if there are ways to improve. The visits you describe amend themselves to a precompleted or templated note which could cut down on your documentation. I recently went through some EMR training and what was obvious was that many clinic visits amend themselves to one of a half dozen templated notes. You can either be a document purists or you can go home on time with all charts done and bills out the door.

 

I work in EM but what I have observed about small practices is this: they dont survive on their own unless they have some significant means of support ie grants, subsidies, etc. Are you part owner? Has anyone given a thought to doing a concierge practice? I have nonmedical friends that belong to these. One practice essentially tied the conversion to a concierge practice to survival of their clinic. They turned none of their patients away and essentially would offer all pts an appt within one week. What got you more immediate access was a tiered prepaid fee schedule that got access in different increments from emails to telephone calls to in home visits. The practice essentially told their patients they were at a point where they were going to close, lose providers or sell out to nearby medical ctr and be absorbed. 

 

Math: 1000 pts paying 50 dollars per month for a return telephone call within 6 hours and an appt within one day = 600,000 to keep your practice open, viable and get some compensation you deserve.

This may be a financial burden to some but there are plenty that will pay. If your satisfaction scores are that great, they will pay. 

 

Last, medicine in the US is a real sh&t show much of the time just like many occupations. But it pays the bills, there is some respect and both financial and altruistic rewards at times. I focus on those aspects and look at what I can actually control to improve the things I dont like. The rest I ignore as best I can.

 

Good luck.

G Brothers PA-C

 

Thanks for the post. I am not a partial owner (we looked into it but decided it was too much red tape in the beginning) but I started the practice with my SP. He considers me an associate and on equal footing with him as far as medical practice and staff decisions. I also have to mention, I know he is not getting paid well either and has the same work situation as me but he has the unfortunate added pressure of financing the practice. We tossed around the idea of Concierge and may very well look to that since there have been 3 big groups buying up solo practices in the area but for now, we are holding out. 

 

I use templates but I suppose my EMR (Practice Fusion) is very text/Type heavy. Templates are great with this system for globally NL exams physicals etc but my typical multi issue pts demands more of my attention and I suppose I probably document more than the average provider.

 

I have used and have been superusers for many EMRs and have a computer background but this particular EMR is very weak. We chose it because it is free. You get what you pay for. The biggest problem is how it does not anticipate and handle the different phases of meaningful use and results in us doing workarounds in order to get the bonus.

 

I also try to focus on the "good" I am doing for my patients and they see and tell me about it all the time. This is why I am torn about possibly leaving. I suppose that I may have a touch of the Grass-Is-Greener syndrome right now.  I may just ask him for a short vacay soon and possibly altering my schedule for more time off. I may also try as some have suggested to try out Locum work while working here but I would either have to cut my days here or work my weekends and hope not to kill myself in the process. LOL. I dunno, we'll see. 

 

30 k more in salary but what about benefits ? malpractice ? etc 

 

AFAIK, they cover malpractice and there are no bennies. There is another agency offering bennies but at a lower pay rate. Still higher than what I make though...sadly...

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life is to short to stress

 

jump ship

 

try something different

 

I did a little bit of locums and did not like it as I was not in a good clinic - but think if it was a good environment and you were proficient (no mentoring) then it could be great.  I was a little dismayed at a lot of the offers - $50/hour as a 1099 is an insult (few years ago) - the one I took was $65/hr and should have been closer to $100 for the amount of revenue I was generating for Concerta.

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life is to short to stress

 

jump ship

 

try something different

 

I did a little bit of locums and did not like it as I was not in a good clinic - but think if it was a good environment and you were proficient (no mentoring) then it could be great.  I was a little dismayed at a lot of the offers - $50/hour as a 1099 is an insult (few years ago) - the one I took was $65/hr and should have been closer to $100 for the amount of revenue I was generating for Concerta.

$50/hr is low.  However sometimes it's worth it.  I just came off a 48 hour ED coverage @ $50/hr.  Probably only saw 20 patients in that 48 hours.  Worked out 4 times, read a lot, watched a bunch of TV.  Now I'm off until next Wed where I work another 48, in a different hospital for $60hr.

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As a 1099 you should be closer to $100/hr or be paid on a tiered per pt basis. Depends on specialty.

 

I see disability cases for the VA and make between $140 and $285 per pt. A visit is between 15 and 45 mins. Other providers get paid per condition---in other words if a pt has 8 conditions to be evaluated they get paid 8 times. Granted this is per diem work, but on a month where I see pts 3 days a week i need no other job.

 

PA compensation is all over the place. In some ways I think PAs should unionize. So many other professions do. Good and bad to that, but to have a $30-40k differential in salary offers for the same work in the same market is insulting to the profession. 

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$50/hr is low.  However sometimes it's worth it.  I just came off a 48 hour ED coverage @ $50/hr.  Probably only saw 20 patients in that 48 hours.  Worked out 4 times, read a lot, watched a bunch of TV.  Now I'm off until next Wed where I work another 48, in a different hospital for $60hr.

just did a 24 with 5 pts @ 70/hr. hope to be full time ( 8 twenty fours/mo) at this job within a yr.

3 of the pts were "the real deal" : htn/dm pt with CVA, teenager who passed out at school and was unresponsive for over an hr, and a pt with dka with cbg 863,  ph 7.1, k=6.3 and CR= 2.4

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I start a new gig in a few weeks, $75/hr with 72 hour mid-week shifts. Located on an interstate but still 4.5 hours from nearest level 1 center. They get about 4000 er visits a year.

 

Gonna try to do a 72 hr shift every other week. That would give me $130k+ a year while having every weekend, and every other WEEK, off.

very cool.

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I start a new gig in a few weeks, $75/hr with 72 hour mid-week shifts. Located on an interstate but still 4.5 hours from nearest level 1 center. They get about 4000 er visits a year.

 

Gonna try to do a 72 hr shift every other week. That would give me $130k+ a year while having every weekend, and every other WEEK, off.

A 72 hour shift?  Is this real life?

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I can do 72 hr shifts at places with under 4500 visits a year. Beyond that it gets too busy for me. One place I work gets almost 9000 a year and I can do 24 hrs easy, 36 safely (typical shift there is 12 hours). Beyond that not so much.

 

But sometimes you get burned. Kid with fever at midnight, woke up with new onset afib at 0200, then MVA at 0500....makes you hope ya get a long nap the next day.

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Thanks for all the input guys and gals. Spoke with my SP. I'm gonna take a short vacation in 2 weeks. We also are going to revamp my schedule to allow me regular time off during the week. Raise is still on the horizon. I'll see how this goes and put the locums job on ice for now. It'll always be there.

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You must be young to tolerate those hours!  I could never do a 72 hours shift. I'd develop a sleep disorder or really bad facial  wrinkles with that kind of schedule.

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Thanks for all the input guys and gals. Spoke with my SP. I'm gonna take a short vacation in 2 weeks. We also are going to revamp my schedule to allow me regular time off during the week. Raise is still on the horizon. I'll see how this goes and put the locums job on ice for now. It'll always be there.

I am glad to hear you are going to take some R&R. I am sure when you get back you will be rested and make wise decision and ready to jump

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