Feature | Why Locum?

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This article title may sound like the subject line of one of the countless emails you get every day and conveniently delete without a second thought (if you are me). However, this is a question I was forced to ask myself.

Just so everyone is on the same page, a locum job is a short-term job with variable requirements. As a cardiologist, you may be asked to cover night call, weekend coverage or an entire week for a group or practice. What you end up doing depends completely on what kind of coverage the group needs. As such, your pay rates also depend upon how intensive and busy your coverage is.

However, there is no long-term commitment, which means that after you have performed your coverage, you can choose to whether to commit for another slot in the future or not. It is like doing shift work – you are busy when you are working but when you are done, your pager is off and you do not get any calls at all. You are completely off and can focus on nonwork aspects of your life.

In cardiology, locum practice is a hot trend these days. It has gained steam over the past few years, especially as the shortage of cardiologists in rural areas has worsened. Locum companies contract with hospitals and practices to provide coverage when they need it, and then go out searching for providers who can perform these jobs.

It helps both parties as the group does not need to hire someone just to provide intermittent coverage. For the provider, it is certainly a different lifestyle since it allows him or her to live in a city of choice and travel for a few days to work.

I had the opportunity to explore locum practice in cardiology when I needed scheduling flexibility due to family reasons. In this blog, I am going to focus on the pros and cons of locum cardiology jobs and lifestyle.

First off, almost all cardiologists who I met on the locum trail were mid- or late-career cardiologists. The kids were all grown up so they did not feel like they had to stay at home. They felt free to travel and spend a week, give or take, away from home working as a locum.

Almost all of them live in big cities but perform locum work in small towns. Part of the motivation may be higher reimbursement in small towns or competitive business environment in large cities.

The biggest advantage of locum practice is scheduling flexibility. You choose when you want to work or not. Most cardiologists I came across were doing a "one week on, one week off" model. Working 26 weeks every year while making full-time salary seems to be an attractive option from a work-life balance point of view. However, you are spending those 26 weeks away from your family and friends.

The biggest drawback of locum practice is that you do not own your patients. The patients belong to the practice. You also do not get to choose what you want to do, and instead you do what the practice needs. At one place, I had to provide STEMI coverage, only with no rounding responsibilities at all. At another place, I had to do everything – STEMI, echos and rounds – for the weekend.

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Generally, you get paid by the hour and end up making more money if the coverage is busier and more intense. An additional challenge is to get the appropriate number of procedures to maintain your skills and credentials, which is important for interventional and electrophysiology cardiology.

How does the reimbursement work? Usually, there is a daily base pay and then an additional hourly pay after certain hours. Let's say you get a base pay of $1,800 and then $250 per hour after eight hours. If you work two hours, you get base pay. If you work eight hours, you still get base pay. If you work 10 hours, you get base pay plus two hours extra ($500).

You can negotiate these rates to some extent, but locum companies have already negotiated these rates with the practice. In my experience, there is not much room for changes there. You do not have to worry about RVUs, and the billing is done by the practice. The locum companies usually also arrange for travel, accommodations and malpractice insurance. In addition, I hear there are some tax benefits for being an "independent contractor." However, I am not clear on how big of an advantage that is.

In my view, the locum lifestyle – and not the pay – should be the biggest determinant of whether one should pursue it. If you are fine with being away from family for a few weeks every month, this would work. I doubt many early career cardiologists would like that, given they are starting families. However, many late career cardiologists may prefer this lifestyle, as this can provide the work-life balance that they desire.

This article was authored by Syed S. I. Bokhari, MBBS, FACC, interventional cardiologist at Saint Joseph Hospital in London, KY.

Keywords: Clinician Well-Being; Work Life Balance; Burnout;