Are you a resident about to graduate from training? Have you decided that you’re going to start your career by working locum tenens full-time? Are you unsure how or where to start? If so, keep reading – this article is for you.
Step #1 – Start planning now!
As you’ll see, there’s plenty of work to be done in the six months before you start your first gig. We’ll walk through the steps, but the first thing to know is not to procrastinate. Some things need to be put into motion now in order for you to start making the big bucks after you graduate.
Step #2 – Pick a location
Where do you want to work? There are two approaches to this question:
- The rewarding approach. Do you want to live somewhere fun/warm/exciting? You might be daydreaming during daily rounds about the beautiful beaches of Maui or surfing off the coast of San Diego. No one can blame you, especially if you’re doing your residency somewhere cold and gray. Hawaii or California may be good options for you, but be aware that beautiful locations generally don’t pay as well.
- The practical approach. Do you want to work hard, save money, and take a raincheck on fun and sun? If you have medical school debt you want to pay off fast, postpone the house by the beach. If you can tolerate cold/gray/boring for at least three years of residency, what’s another two, right? Then you’ll be closer to financial freedom.
If you have medical school debt, as most graduates do, I suggest you go the practical route. If you have indeed chosen this approach, you want to look for gigs in areas that do the following:
- Pay well. For hospitalists, the best pay will be in the South, Southwest, and Midwest.
- Have abundant work opportunities. To guarantee sufficient work, consider states that are sufficiently populated. Based on my experience, this means states with at least a few million people. This will let you tap into a good number of locum gigs.
- Have zero or low state income tax. States with no income tax are AK, FL, NV, TN, TX, WY, and SD, and low-income tax states are IN, ND, PA, and WA. Use this great online tool to get a decent estimate of how much state income tax you are going to pay. You can also check out this article for a quick map showing rates by state: How High Are Income Tax Rates in Your State? | Tax Foundation.
There’s an important caveat here: you should always talk to a tax professional regarding important tax implications of a locum tenens career (e.g. working in multiple states, nonresident vs resident taxation, etc.).
Step #3 – Contact the locum agencies and start negotiating
You might be asking, “How do I know which agency or agencies to choose?” To help you get started, I explained in another post how to find the best locum tenens companies. Make sure you check out available reviews of the companies, as well. Consider reaching out to colleagues or former residents in your program who have experience working locums, or check out social media physician groups. Physicians often discuss their locums experiences there and are usually willing to answer questions.
After you’ve done your research, you’ll be ready to start the negotiation process. First, tell the agency to look for long-term gigs (6+ months) in the states of your choice. Then you can negotiate your pay rate for each locum gig. You also want them to cover:
- Your state licensing cost in addition to an acceptable pay rate (ie, do NOT agree to a low pay rate just because they cover your license fees)
- Living expenses instead of the typical hotel/rental car
Even though with this career path you won’t be signing a traditional employment contract, you should consider having a lawyer review the locum tenens agreements for any red flags.
Step #4 – Apply for licenses
Now that you know where you want to go and you’ve started the negotiation process, it’s time to apply for medical licensure in each state. I suggest you start by creating a profile with the Federation Credentials Verification Service (FCVS). This is a great way to create a repository of all of your *verified* credentials (identity, medical school, residency training, etc.).
After everything is entered and verified, the service sends your credentials to one or multiple state medical boards. In other words, FCVS fast-tracks your licensing for any state. In my experience, this investment can cut licensing time by months. All states accept FCVS verification and some even require it.
Step #5 – Get credentialed
Getting credentialed at hospitals is also a lengthy process, but you can probably start this three to four months before starting work. I suggest you get credentialed at three or four hospitals.
Submit your paperwork as soon as you can – don’t be the bottleneck in this process.
Step #6 – Schedule your shifts
You should start scheduling your shifts three to four months before you start working. You might be thinking that you want to jump right in and start making money. It may even be tempting to schedule 20 or more shifts in one hospital. But I’m here to tell you – don’t do it!
As I’ve learned over the years, it’s impossible to predict what kind of experience you’ll have in a hospital. Don’t overcommit until you know the lay of the land.
To avoid being stuck in a bad spot, make sure you schedule only five to ten shifts a month at each hospital for the first couple of months. After checking out a few places, you’ll get a good feel for which gig will be the best fit for you long term.
Another way to create a buffer is to space out your shifts at the same hospital by 30 days, which is the typical cancellation period. This way, if you realize you hate the place, you can cancel your remaining shifts before it’s too late. If you cancel within that window, you may be on the hook for fees or expenses. Be sure to read your contract to understand the policies ahead of time.
Step #7 – Set up your safety net
If you want a secure and stress-free transition out of residency, you want to be sure your affairs are in order. If you have a safety net in place, you’ll also be a better negotiator because you won’t be grasping at straws or desperate to make a deal.
I recommend the following at a minimum:
- Disability insurance
- Life insurance
- Health insurance
- Savings / emergency fund
And Finally, Start working!
After you’ve completed steps one through seven, it’s time to get to work. This is an exciting time!
You’ll travel to new places, meet a lot of people, and make new friends. You will learn so much – from new EMR systems and billing practices to effective ways to communicate with your colleagues and patients. Finally, the responsibility is all yours!
As to the locums work, you’ll start to figure out which hospitals you like or don’t like. You can begin to create a tiered list: “tier one” includes your favorite(s), “tier two” might include your back up choices, and “tier three” can represent your ‘never again’ list. This might be immediately obvious, but it might take a few months before you’re comfortable making these decisions.
Last, but not least, you can bask in the glow of being able to make a dent in your student debt. Obviously the timeline depends on your pay, level of debt, and lifestyle, among other things, but I’m confident you can pay off your loans in a few years with a locum tenens career. Best of luck to you!