If you’ve listened to previous episodes, you know the value of thinking beyond your clinical income when it comes to upleveling your life. We’ve explored side hustles in general and taken a look at some of the possibilities that real estate offers. Today, though, we are going to take a deeper dive into the life of a locums doctor. Dr. Carrie Reynolds of The Hippocratic Hustle returns to the show to share her personal experience as a locums doctor. Plus, I share insight from my own experiences.
Before you can really consider whether or not becoming a locums doctor is right for you, you need to know what a locums doctor is. On the surface, a locums doctor is similar to a temporary worker for a medical practice or a hospital. However, locums work is actually much more than that. In many ways, locums doctors provide a critical bridge over a gap in care that communities would otherwise face. Perhaps it’s covering maternity leave or vacation time. In other instances, a hospital might be looking to bring on a full-time staff member, but the hiring process is involved and lengthy. Locums doctors close these gaps by providing much-needed care to patients in the interim.
One of the most important things to understand about locums work is that it pays well. In fact, Carrie says that her goal with her locums work was to bring in at least the same amount of income as she did in her previous practice. Locums work not only provides a healthy income, the way you get paid is important as well. Most locums doctors receive a 1099 instead of a W2. That means that you have more flexibility with tax deductions and write offs. If the thought of being a traveling doctor conjures up images of price tags and high costs, think again. Most locums work also accounts for your transportation, housing, and even licensing expenses.
In addition to offering financial positives, there are myriad other benefits to locums work. As a locums doctor, you have even more flexibility over your schedule. You also have the opportunity to travel widely. During your travels, you get to experience places around the country in new ways. Though I had previously visited Seattle as a tourist, my locums experience there was a fresh perspective. Locums work gives you the opportunity to really appreciate the culture and the people in the town or city.
While there are many benefits to locums work, it isn’t for everyone. If you feel like your current stage in life would prevent you from traveling entirely or even just stop you from enjoying your travels, locums may not be the best fit. Even so, there are plenty of other opportunities to think beyond your clinical income now. Plus, you never know what the future holds. Even if locums isn’t for you right now, it could be a fantastic future opportunity.
In this episode, we also explore:
- What qualities and characteristics make an ideal locums doctor
- Ways to negotiate your locums salary to earn more
- Specific examples of some of the tax benefits of locums work
- Some of the supports Carrie and her family use to make life easier while she is away
- The benefits of working with a locums agency
- The importance of tracking your certifications and personal examples
- A deeper dive into who is (and isn’t!) the right fit for locums
- The importance of “being a guest in someone’s home” as a locums doc
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Featured on the episode:
- See a special roundup of Carrie’s personal journey as a locums doctor over at Hippocratic Hustle.
- Get a refresher on the value of thinking beyond your clinical income in Episode 4.
Learn more about how to manage your mindset with Wealthy Mom MD.
Welcome to The Wealthy Mom MD Podcast—a podcast for women physicians who want to learn how to live a wealthy life. In this podcast, you will learn how to make money work for you, how you can have more of it, and learn the tools to empower you to live a life on purpose. Get ready to uplevel your money and your life. I'm your host, Dr. Bonnie Koo.
- BONNIE KOO: Welcome back to another episode. Today, we’re going to talk about locums. I brought Carrie back on today to discuss all things locums since her and I both made the switch to locums in the last year or two, so listen on.
Carrie, welcome back to The Wealthy Mom MD Podcast.
- CARRIE REYNOLDS: Oh my gosh. Thank you so much for having me. Thanks for having me back.
BONNIE: Yeah, so I brought Carrie onto the show because I want to talk about locums and I couldn't think of anyone better to have on the show to discuss locums. So the reason why I want to have a podcast, I'll probably have more podcasts on this topic, is because back to that episode where I talk about thinking beyond your clinical income, there's actually so many different ways to practice direct patient care.
You know, I was thinking when I was in residency looking for a job, so I'm a dermatologist. I thought they were really just two options. Private practice or academics or some sort of permutation of those two. I never ever considered locums. I don't even think I knew what it was back then. When did you first hear about it?
CARRIE: Well, gosh, I think I heard about locums probably back when I was a medical student, and I never really understood who would want to do that, I think. So it always seemed like, at least where I was reading about it, and I think where I actually probably heard about it was Student Doctor Network, that old forum, where sometimes if you don't do things absolutely perfect--you didn't go to Harvard and you didn't get AOA and you didn't do this and you didn't do that--then you weren't worthy to be walking on the earth.
I'm sure somewhere I heard some derogatory talk about locum tenens there and somehow got in my head that it wasn't something that people would ever want to do, unless you were forced to.
BONNIE: So interesting. You know, I don't even remember when I first heard about it. I think it must've been during residency because I think I met a locums dermatologist. We'll talk more about later, but I think locums is sort of different for different specialties just because of the nature of a hospital-based specialty versus primarily outpatient like dermatology is, and we'll talk about that a little bit later. But yeah, it's so interesting where our exposure is.
First of all, during medical school or even during residency, like no one really talks to you about what you can actually do with your degree. I think we just are pigeonholed into “You're going to get a job seeing patients.” I think that's what most of us want to do, but there's just so many other options just within direct patient care. So what do you think is the actual definition of a locums?
CARRIE: When people ask me, “What is locums?” Because a lot of times people who aren't physicians ask me what I do. If you say, “locum tenens,” no one's gonna know what you're talking about. But I basically just explain that it's like a temp agency for physicians. But then I tend to expand upon that because also people have a derogatory thought about temp agencies, right? If you are a temp for something, it's not like. But basically what I say is that I basically swoop in and help people who have a need. So a lot of times, it's a department, it's a practice. There's all sorts of different medical-type groups that need help from time to time. And it's really hard to, of course, fill those positions. It takes a long time to hire a physician and so they need these agencies or these locum doctors to come in and help when there's a need. And actually that's what I feel like. What I'm actually doing is that there is a strong need because if they're hiring locums, they probably have had a need for awhile, and so I'm basically able to kind of swoop in and help.
I feel like a little bit of a superhero in those cases because the patients, at that point, don't care. They know they've been waiting for six, eight months sometimes to see a doctor in the specialty, and so when they finally get to see me, they are so thankful. They're so thankful that I'm there, and then sometimes it comes out. I try not to say that I don't live in the community or you know that I'm traveling because it just opens a whole other conversation and sometimes we just need to focus on the medicine, but every once in a while I might let out that I came from Denver. They're like, “Oh my gosh, you traveled all the way from Denver to see me? To see us?” They're so appreciative that people are traveling from all over the country to help their community. So yes, it's actually quite fulfilling to be able to help people like that.
BONNIE: Carrie, I love that. And actually I had a very similar experience when I started doing locums. So I've had two locums jobs and specifically I was hired to fill a need, but it was because someone was going on maternity leave.
I never thought about it as I was actually helping like a hole that was already there. I guess I just felt like a substitute teacher kinda. You know what I mean? But oftentimes people would find out that I was, they call me the traveling doctor, like, “Oh, you're like a traveling doctor!” Same sentiment. But I felt like people were really appreciative, especially when I was in Hawaii. They found out that New Jersey, they're like, Whoa,
CARRIE: I know. And they're so thankful that you travel all the way out to their community to help them.
BONNIE: So yeah. And Hawaii has such a need for physicians. So I was filling in for someone who was on maternity leave but they are so, so backed up there for dermatology. And you can imagine in a place like Hawaii, there's so much skin cancer because everyone-- You live in Hawaii because you like the sun and the beach, right?
BONNIE: And you tend to spend time outside, like why would you live there? Otherwise, I thought I had seen a lot of skin cancer because I did my residency in Southern California. This was like a whole other level of skin cancer testing.
CARRIE: Wow. Oh my gosh. Yeah. So such a need in that community. That's awesome.
BONNIE: Yeah. So I didn't think we would talk about this, but I do feel like locums can be a possible solution for doctors who are feeling burned out and unappreciated. I kind of forgot that sometimes you forget that you're actually really helping people when you're feeling burned out. And I don't know if I would say that I was feeling burnt out. I definitely was feeling under-appreciated as a physician for some time, and so it was nice to get thanked. I was like, “What?”
CARRIE: Right. I know, especially when you're coming from a big city where there's lots of resources for people medically, they have a lot of options. There's a lot of places they could go. I mean, so often in my private practice, if they didn't like what I was saying, we would hear, “Oh well, I'm just going to go to the university.” You know? And it's like as if it's a threat and it's like, “Well, it's fine. You can go and see another physician.” Honestly, it doesn't matter to me. Second opinions sometimes are helpful, but people will just kind of just not be appreciative of the help that I was able to give them.
Then when you go to an underserved community, people are so thankful that there's a doctor there to see. Oh my gosh. Oh my gosh. Again, that's why I wouldn't want to tell them where I was from because people would start gushing thanks, which is amazing. And even the staff that I work with in a lot of the places where I've done locums have been so thankful because they've known that they've been behind. Everybody's trying to help their communities. Having an extra set of hands in the form of a different physician is so helpful.
BONNIE: One little story that I just want to say real quick is my last assignment in Hawaii was with Kaiser. With Kaiser, It's really easy for patients to email you, so my first thought when I knew that was possible was like, “Oh, I'm going to get so many emails.” Like it was like a negative, you know? I got emails and they were fine, but most of the emails were actually to thank me and I was so shocked. I was like, “Why are they even doing this?”
CARRIE: Yeah. Why are they using the EMR communication tool to thank you?
BONNIE: Yeah, exactly. Yes, thanks for that reminder because it's been, at this point, maybe two months since I finished locums, and I kind of forgot that already.
CARRIE: I think that really does breathe some fresh life into practicing medicine. When you feel a little bit beaten down that you can go to a fresh place and people are actually thankful for your services. It's a whole different way of practicing, which is crazy because it seems like people should be thankful regardless. I think people in their day-to-day lives just get a little bit complacent. I know I do. I probably should send some thank you notes to my physicians, too, because I've definitely been thankful for some of my doctors recently. Or even restaurants or anything I guess. The bookstore down the street that I can't go to right now because of COVID? I'm so thankful for those places and you really think about it actually now that you can't go there. I guess it makes you more thankful.
BONNIE: Yeah. I think this is a great segue to the question of who should consider locums and why. So I think we just kind of covered that. If anyone just kind of needs a change of pace because you're feeling burned out, maybe just need a break from your current job, but you still need income and you still want to practice medicine and you're trying to figure out your next move or pivot. You want to pivot? Locums is perfect because of the short-term nature.
And I think also we should talk about that a bit because I think people have this idea that there's only one type of way to practice locums. And you know, again it might be specialty specific, but just to give an example, like I was doing maternity leave coverage, so I was working for two or three months at a time, Monday through Friday for dermatology. But there are different permutations. Some locums--just because get the jobs emailed to me now--some jobs were like one week a month, two weeks a month, you know, things like that. Especially the truly underserved areas; they'll take whatever you can give. Alaska is actually big! Isn't that super popular for locums of all specialties? I know dermatology is.
CARRIE: We have a job there that's often advertised. Yeah.
BONNIE: Oh, this is another thing I love about locums. You learn so much about a whole new community because you know, right? That is super awesome.
CARRIE: That is actually one of the coolest things, seeing the different cultures in our United States. I used to think of the United States as being like a monoculture. I mean this kind of trite to say it like that because I know there's so many different types of cultures. There's so many different groups in the United States. But we tend to have a very similar accent, especially across different parts of the country.
You think of some areas where you're like, “I'm not sure what that culture is.” I worked in Maine for a while and I didn't know what the culture was there. I was able to go there for almost a year every now and then. I really got to know the people of Maine, and I really appreciate that in a way that I never would have been able to just going for a weekend vacation there.
BONNIE: So it's great for people who want lots of travel, too, right?
CARRIE: Oh yeah. I see all different parts of the country and just getting to know the cultures and the areas. It's just so fascinating. So fascinating.
BONNIE: I love it. I've had two assignments that I mentioned before, Seattle and Hawaii. It's so crazy how they even came up as an option. Because a lot of locums jobs are in relatively underserved areas that people might think, “Well, Seattle? There's plenty of dermatologists there.” But like I said, I was there for maternity leave. I literally saw this job posting for Seattle in the summer and I was like, “That is the best time to be in Seattle!” And I'd been to Seattle as a visitor. I think I was there for three months. So it was broken up. Actually that job was two weeks on, two weeks off. So that's a good example of one of the different ways, which is unusual for dermatology.
So they actually were supposed to have another dermatologist work the two weeks I was off. So we're supposed to share the position, but it didn't work out for some reason. And they'd asked me if I wanted to fill in, and I said no because I wanted those two weeks off. I wanted to travel. I was like, “Oh I could go to Vancouver and go to British Columbia. That's kind of how I kind of combined it as work and travel.
And so I totally agree. I never would have spent that much time in Seattle--just hang out and see the different sites. I brought my whole family with me. So that's also another sort of thing. A lot of people would ask me, “Did you bring your family?” And I did. I know not everyone does. Not everyone can. And so actually, that just worked out because at the time Matt didn't have a job. And I basically told him, “You can't apply for a job because you have to come with me.”
CARRIE: And he was probably like, “Okay! Adventures!”
BONNIE: Who else should consider locums?
CARRIE: Honestly, I think pretty much anybody, as long as you can work it into your lifestyle. But yeah, there's a lot of ways that people assume that they can't do it. But as far as the travel, because of kids and things like that. We've worked out a lot of those details as far as my nanny, and we have a chef that cooks us meals so that we have meals set aside, you know, so that my family's fed while I'm gone.
BONNIE: How old are your kids in case people don't know?
CARRIE: Yeah, yeah. I have one 10-year-old daughter, so that does make it easy. She's like the world's easiest child, so I'm really lucky to have her. Of course, she always says when I'm traveling that she doesn't want me to go. So it's still a little bit heartbreaking to leave. But it’s OK. When I'm gone, she's busy. She's okay.
My husband's a general surgeon, so he's really quite busy actually. So I think some people might assume that being married to a general surgeon would mean that you couldn't be the locums doctor, you know? But we totally have it worked out. We do have overnight help when he's on call, so that helps. You could do that with a nanny or an au pair or we have family in town. His dad loves hanging out with him anyway, so his dad loves coming over and he'll just sleep in our guest room when he's on call. So there's always an adult here. So there's a lot of barriers sometimes that you can work out.
I will say that as far as physician availability for jobs for locums, you are a little bit of a better candidate if you have more time available to offer to the group. Like you were saying, that Seattle job really was looking for someone who had just worked three months solid. Or your Hawaii job was maternity-leave coverage, and they really would want someone who could be there for three months at a time. And it's hard to find someone who will up and move your whole family, you know, or finding someone who is solo and could just move themselves. Even people I know who are locums, who are single, and don't have kids, they have lives. You know we have lives. It's hard to find those people who are willing to do that, but if you are willing to do that, that will make you a much more desirable candidate.
And I found too that being available two weeks of the month makes me a more desirable candidate too. I think it's pretty common for people to do two weeks. If you're the type of person who's like, I just want to work one week every three months, you can find jobs like that, but I think there's going to be less work out there for that sort of situation. People kind of want a little bit of a dedication. They also want them to know that you're available ongoing for the long term because they don't know how long they're going to need you. So if you just have a smaller amount of time to feel like you might have three months off in between jobs or after residency before your next job starts or something like that, you could probably find a job in that time, but you're just going to not be quite as strong of a candidate. I think of course they want people who have unlimited availability and unlimited time to do this. Also that you don't care where you go. The more picky you are, I think the harder it is to find a job. I guess that's the summary of that.
BONNIE: Yeah, that's so interesting. I mean, yeah, I don't think I was even looking for locums when I got my first job. And actually I feel like my story is similar to yours, Carrie, in terms of how you pivoted. We talked about that in our previous episode. Basically, you had spoken to Cherry about her product and then you guys started talking about locums offline. Soon after, you ended up pivoting from your private practice job to locums.
And I have a somewhat similar story in that I pivoted from private practice where I was full time to locums because I just needed a change basically. I think that's a common scenario that we see, right? People just needing a break.
CARRIE: Yeah. Another thing that I think sometimes can be a barrier to doing locums, and I think it's something that one would have to think about your own personal situation is that as a locums physician, there may be times where you will be unemployed or underemployed. You know, the jobs might dry up.
My very first locums job, I assumed that I would be going there and working there for months. I didn't know how long, but I had already been on the schedule for about four or five months that was into the future. Even in that first month that I got there, the department had a change in administration and they decided to cancel all the locums to save money for the department. So I only worked there for a few weeks, and then my job was canceled and I didn't have any other job.
BONNIE: Right. Because you were committed.
CARRIE: I was committed and I was assuming that I would be working there for at least a couple of months. I knew it wasn't a permanent position, so it would end at some point. And I actually didn't end up working again for maybe three or four months. And then finally I got this, basically just vacation coverage. So at any time the doctor in Maine went on vacation, I would come and cover for her. So that was being underemployed.
It was less than I wanted to work as far as covering the equivalent of what my salary was in my permanent position that I had just quit. So my goal when I started locums was always to at least make what I made in private practice and hopefully to make a little bit more. But at that very first year, I actually made a little less, probably because of the time off that I had.
BONNIE: Tell us about your current. Or how did you start out and look, in terms of like the timing. Was it one week on, two weeks? Can you tell us about that and what you do now?
CARRIE: I always started with two weeks. So what I decided to do actually was when I did the math of how much I needed to work, what I could do to break even. Essentially from what my pay was in the private practice was do one week on, two weeks off, and then maybe two weeks, two weeks off, one week. So it would end up being about maybe three weeks off in between these little stints of locums, so I would have more time at home.
Ultimately what I decided to do is just do two weeks at a time--two weeks on, two weeks off--as a start, and then I would pull back because I knew it would be easier to hit it hard and then pull back if I needed to. And so that's what I committed to at first. And actually I've been doing that for the most part except for when I was underemployed. I've been doing that since I started doing locums.
But I will say for the past year I've been working in the same location and the two weeks on two weeks off has gotten a little bit fatiguing, and sometimes I alternate it one week on, one week off, and that back and forth can be fatiguing too. So I will say it is a bit tiring to do it that way. So I think scheduling in some longer breaks here and there would be good. It's healthy, I think, because two weeks on, two weeks off is kind of a busy schedule, especially with having a family at home.
BONNIE: Yeah. I think that's also what's great about locums is you can customize it. You know, if at some point that's a few months of two weeks on, two weeks off, you're like, “This is too much”, you can always pivot because that's the nature of locums. Even if you were full time, you're never like tied. You know you're never married to your job anyway. But what's nice about locums is you can customize it as you go.
Let's talk a bit about the finances of locums. So this is probably specialty specific. So just a reminder for those who don't recall, Carrie is a pediatric gastroenterologist. For your field and Carrie has spoken to lots of people at locums, so you probably know more about this. What have you found trend wise? Do you get paid more as locums or do you get paid less? Does it depend? How does that work?
CARRIE: In general, you should get paid more, and if you are getting paid less as a locums, I would definitely reconsider that position.
BONNIE: Why? Why do you get paid more as locums? I mean, you should really be paid for the inconvenience of what you're doing. And also it's supply demand too. There's not a lot of people who are willing to go out and do this on a whim, especially to be flexible and to be like, “I'm available whenever you need me.” The sites love that. They love having someone who's just available whenever, and people who are loyal and who will keep coming back and who will be good workers for them. That sort of thing. So if you're that kind of candidate for them, you really should be paid more for that position than a regular private practice job.
BONNIE: I never thought of it like that, Carrie, but that's a good point. You know you're doing let's say regular physician work, but then there's also the intangibles of it's inconvenient for you to travel. We should talk about this actually too. Like housing and what they cover because these are the types of questions I feel like people usually ask. They obviously ask about pay. You know they want to know how much money is involved, but they also want to know, “Well, where do you stay? Who pays for this? Who pays for that? What agency did you use?” So we'll try to unpack that a little bit. So for your first locums job, did you use an agency?
CARRIE: I did. I started off with one of the national agencies. You know there's CompHealth and Weatherby. They're basically sister companies, and they are probably the largest locums agencies that's out there. So I started off with an agency. Definitely have a lot of friends who advise me not to use an agency. There's a lot of people who are very pro physician going out and finding their own job. In some cases, this is a possibility. I think it is better for someone to go out and just skip the middleman--who's the locums agency--and go out and find your own job. Definitely. If you can do that, that is way better. Basically the sites are paying the locums agencies an obscene amount of money.
BONNIE: Do you know the markup, Carrie, by any chance? The range?
CARRIE: I think 30% or something. I have an administrator friend and he works for a large hospital system and he rolled his eyes when I talked to him about locums. He's like, “Oh man, when I need an ICU doc, yeah, it's $5,000 a day a doctor.” And I was like, I know, I see your doctors are not making $5,000 a day doing their jobs. So if you do, the math they're getting in that case would probably be over 50%. That'd be like 60 or 70%.
BONNIE: They're also paying for housing and credentialing.
CARRIE: That's correct. Yes, yes, yes. In some cases that $5,000 that my friend was rolling his eyes about would probably include the housing and everything, the whole package for getting the physician there, the travel, the insurance, that sort of thing. So yeah, the locums agencies isn’t pocketing quite all that. But still, there's a huge markup. Yeah. And so if you can cut out the middleman, in some cases you could negotiate a higher rate than a locums doc may be able to.
BONNIE: I have heard of that happening. It just requires more legwork. You have to front some of the work, and so the agency is providing a service in terms of a convenience to people too.
CARRIE: Yeah, and I know in some of the organizations where I've been locums, there have been “permanent locums” where there's people who live, you know, outside the community who travel into work. But they are hired by the hospital and employed by the hospital. And I do have a feeling--it hasn't come down to this yet--but if they needed to cut because they just didn't need the locums anymore, I think they're going to keep that person who is employed by the hospital longer because the overall overhead for that person is not as high as me with an agency. I think that person who has a little bit more job security when it comes to his locums job in that particular hospital, so that's something to consider.
But on the other hand, with my specialty, I've actually tried to go out and find my own jobs. I've called the recruiters who are advertising that they're trying to hire. I've called those places where I know they've been trying to hire for like five years cause I always see their ads. I've tried. I called them and said, “I'm a locums doctor, do you need help?” And they kind of are confused in some cases because in some of these hospitals’ systems, that's not how they work. They always go through an agency, and I've run into some hospitals systems or larger hospital systems, they always just use this one agency. It's just the way that the hospital is set up, I guess. It’s just kind of the culture of how they fill those positions because my pediatric gastroenterology is not something that's all that common.
I've definitely found more success through the agency, and also it just saves a ton of headache too for me. They do paperwork for me. I mean, like right now, the state of Maine is one of the places where I've worked before. My credentials are actually expiring right now, and I haven't been back to that place in a while because they haven't needed me for, I don't know, almost a year now, but they want to make sure that my credentials are still in place.
So just in case that hospital has a need and they need to call me, they could call me and be like, “Can you come in two weeks because so-and-so is sick? So-and-so was in a car accident. Can you come and cover for her?” They have me as a resource. The point is that I would never be able to keep track of where my credentials are expiring or that sort of thing. So I appreciate the help that they give there.
I don't know if it's worth the money that they're being paid, but whatever, you know, I'm getting paid what I need to get paid to do my job. Overall I'm happy, So I'm going to stick with the agency.
BONNIE: Yeah. I mean they provide a great service. The credentialing part. I mean, I hate paperwork, Carrie, I think you do too. Who loves paperwork? The fact that they can license you and handle all that stuff.
So I did get a job where I had to do a lot of paperwork myself and I was so pissed off about it. To me that's worth having someone else deal with it to be honest. So these locums agencies-- I've only worked with one actually because my second job with Kaiser was actually directly through Kaiser, so it was a little different. But that was because I had a prior relationship with them. So that's not like a normal sort of negotiation or normal way to get a job at Kaiser.
But they do advertise locums. I think it's if they have trouble finding someone, they'll use an agency. So I think Kaiser might have some more flexibility in that sense. Is there anything you wish you knew before you embarked on locums?
CARRIE: When I first started, I did not know how much I should be paid for my position.
BONNIE: Yeah, that's definitely common.
CARRIE: What saved me is that I had to quit my private practice and so I had to figure out how much I need to make per day and how much I needed to work to break even at the break even point.
So when they came to me with a price and it was about three or $400 per day less than what I needed to do the job, I was like, “No, I'm going to just keep my permanent private practice position here, and I will not do locums because it just didn't make sense financially.” I wasn't going to lose money to do locums.
Well, I wasn't perfectly content with my job. It was fine when I said no, I waited. I think there was like three days where I just forgot about it and then they called me and they're like, “Okay, we'll take your higher rate because they couldn't find anyone.”
BONNIE: So basically you have to negotiate, right?
CARRIE: Yes. And you can negotiate when you get out there. What I would do if you're interested in locums, find other people in your specialty who are doing locums and figure out what people are making because, and we need to talk. And in fact, as the pediatric gastroenterology locums kind of little community that we have forming, you kind of run into the same people when you're in a small specialty.
So I've worked with some people, you know, and we've talked about different jobs and stuff like that, but I know how much everybody's making and we're all now, at least my friends that I know of, we are all making the same amount. And I've actually helped people raise their amount because they heard how much I was getting paid and they're like, “Oh, why am I getting paid $600 less a day than you?”
BONNIE: Yeah, that's crazy. Wow.
CARRIE: Yeah, that's because you didn't realize and you didn't negotiate. And yeah, this is our value and if we're going to keep coming out across the country, schlepping our stuff all around the United States and being away from our families, I think it is worth it. And we bring it a lot of value for these hospital systems in these groups too. So we keep it running. They would lose patients if we weren't there. They would lose business, they'd lose procedures, they'd lose a lot of stuff. So we're really valuable to them. And while they may not be making money on what the locums doctor is doing, it's keeping their practice afloat while they're waiting to get more permanent doctors in place.
It's win-win. But as long as they can do the math in general, the hospital systems that I've been working for don't mind paying what I need for me to do the job.
BONNIE: Yes, that's such a great tip: Talking to other people in your specialty. So a lot of dermatologists, when they find out that I've done locums, I do get random messages from time to time asking about my experience. Which agency did I use? Where did I go? How much should I get? How does it work?
It's so funny. I just assume people know the basics of locum. People don't even know that.
Usually, they pay for housing and airfare. I mean, I'm just trying to think, is there anything they didn't pay for? They just don't pay for food.
CARRIE: They pay for your license. They pay for it. They don't pay for your food. They pay for my gas on my sites. When you were going, you were probably living there, so maybe they wouldn't pay for your gas, I don't know. When I'm going for like a week or two, they pay for my gas, but I'm not going anywhere. I mean it's like $30.
BONNIE: Maybe I should negotiate that next time. It adds up. Another thing about finances is, generally speaking for locums, you're paid as 1099, right?
CARRIE: That's correct. Yep.
BONNIE: Yeah. So that basically means that you can write off a lot of things that you previously can’t because the tax laws keep changing, right? We can't even keep up with them. But the most recent tax change? Previously you were allowed to deduct certain types of expenses. Even as a W2, I had to meet a certain threshold I believe. But now, you can't.
But 1099, you can deduct all of them. Licensing, credentialing. Although usually agencies pay for that, but, you know, all things that the locums doesn't cover. So let me give you an example. I brought it up for a specific example. So when I was in Seattle, because they didn't pay for food, there's a per diem rate you can deduct. Do you do that?
CARRIE: I don't think we thought to do that. I think you told me that since the last time I did my taxes. So this year I'm going to have to make sure that happens.
BONNIE: Yeah. So my CPA told me that. I was emailing with mine and just making sure that I had everything in order for tax time last year. And so she told me that I could deduct a per diem, and it's set by location, so it's not one number for the whole country. It's kind of based on cost of living. New York city is going to be very different than the middle of North Dakota for example. There’s a set rate for Seattle, and so you can just write this whole number off.
So the other method is to keep track of what I'm spending on food everyday. But obviously that can get cumbersome. So she said you can do either, but she says usually taking the per diem rate, the published one, is better over time. She said basically if it's a long term assignment, the per diem rate usually ends up being better. If it's just a few days, writing off the actual food is better. Basically, you want to do whatever's better for you. And then the days you travel have a different rate. It's basically a lesser rate because you only get like half the rate. It's some percentage.
CARRIE: Oh interesting.
BONNIE: That's something I didn't know. So my Kaiser job, though, was actually a W2 job, which is a strange way to do locums. But that’s how Kaiser does it. So less tax benefits with that job because they withheld taxes and stuff. But for most people it is 1099, so there's so much stuff you can write off. So definitely make sure you talk to your CPA. If you don't have one, just make sure you really keep track of your expenses. Because bookkeeping can be a disaster if you don't pay attention to it from the beginning. Cause trying to piece together things a year later is really annoying.
CARRIE: Yeah, I’m trying to do my taxes right now. It's very true.
BONNIE: Yeah. That's another finance tip. One tip I have is, so when you do locums and let's say you end up doing multiple jobs. Everyone has a different background. So by the time I switched to locums, I already had a few jobs under my belt. I already had started my third attending job at that point. It's like a paperwork issue, keeping track of all your licenses, where you work. When you apply for these jobs, they're always asking for this information. Where did you work? When they want somewhat really exact dates, they have to explain every gap in employment, and so I had to create this document where just my master, which every physician should do, but I guess if you just have one job your whole life, but that's not common these days. You need a document that has everything. For me, it's a bit of a CV with dates, lists of all my licenses, when I got licensed, when it expires. That's a nightmare to keep track of place. I wish I had, I needed an assistant to keep track of that. And all your malpractice policies.
CARRIE: They want malpractice policies, copies of the policies, which I didn't really have at first. I had to get it from the malpractice insurance company because they didn't have a copy. And also where you've been credentialed in hospitals. Because in my private practice here, I was credentialed, I didn't even realize it because there was some hospitals I've physically never been in, but I was actually credentialed at practically every hospital in town here, just in case there was an emergency I would have to go to. So I was actually on staff at all these places.
BONNIE: And you had no idea?
CARRIE: I didn't on some of these. I didn't because some of them were like these packages, so it was like these three hospitals were in this package. That's just how they were organized administratively. So when I was at one, I was actually at all three of them. So I forgot to put one of the hospitals and they'll figure this out and they'll come back and like, “Weren’t you on staff at Aurora Medical Center?” And I was like, “I actually don't even know where we're Aurora Medical Center is.” Was I? Maybe I was, I don't know. Was I? You kind of have to keep tracking even if you're in locums.
That's a great question because they're going to be credentialing you for where they might need you. And it's quite possible now that I'm saying it out loud that even though I'm working at one site, I may be credentialed at some of the other sites that they had talked about sending me to, but I haven't actually physically worked there yet. So it's possible that I'm actually credentialed at some other places too that I'm not realizing anyway. I think that's even more of a nightmare than the States. Because I know I'm licensed in four States. I've been licensed in six total in my life. You have to keep track of the old ones too, but the hospitals, that's another story and they all expire at different times. Yeah, it's a mess.
BONNIE: Yeah, so there's a lot of moving parts. I have been getting some emails about license expirations and I've definitely had actually, so California, I don't live in California, so it's fine that I have let it expire. If you could just for, I just forget. Plus it's like a thousand dollars each time. It's so annoying. Actually a bunch of are expiring really soon and so I've been neglecting them. Actually, some are expiring next month, so I know Ihave to deal with them. But yeah, it's just a bunch of money all at once, which is super annoying.
CARRIE: Yes, yes, I know. And then you have to decide, Am I going to keep it up? For example, my very first job was in Missouri. I wondered, “Am I ever going to go back to Missouri?”
I don't know. But you know it's possible. And the locums agency, it doesn't necessarily want to pay for that state license unless they know you're going to work there. So they weren't going to pay for it. But now I'm like, Oh, should I do telemedicine? And now maybe I should have renewed Missouri.
But yeah, it's unfortunate that all of our state licensing is so expensive. So if you want it to be a telemedicine doctor working across all 50 states? Someone should add that up and figure it out. I think it'd be like $10 or $15,000 a year or something. I don't know. It's a lot of money, like $500 to $1000 a state.
BONNIE: I really wish they could cut it out. It makes sense for lawyers to have to get licensed in the state because the laws are different.
CARRIE: Yeah, exactly. Exactly.
BONNIE: Medicine does not change state to state. I mean, I understand why it's under state control, but it really doesn't make sense. Like I had to get fingerprinted recently with the digital print. I've done that before. Why do I need to do this again? I've done this before. My fingerprints are everywhere.
CARRIE: It's so true. So true. And I know in the time of COVID 19, you can't actually get fingerprints right now.
BONNIE: So I was able to reschedule it. But yeah, they canceled my appointment because of the pandemic. Then, I tried again a few days later, and they had appointments available.
CARRIE: Okay. So you were able to sneak it in.
BONNIE: And if you're traveling alone, how do you do this?
CARRIE: When I was in Missouri, I needed fingerprints for another state and figured out that I could go to the university campus police department. So I was in the booking room getting my fingerprints done for some state. I don't remember what it was.
BONNIE: Like the ink prints?
CARRIE: Yeah, it was like the ink prints, like old school. You could see where they would take the mugshots and everything.
BONNIE: I would have been like, “Hey, can I take a selfie there?”
CARRIE: Yeah, they probably would have
BONNIE: I had a hard time the last time. So Washington State requires ink prints, and I remember going to this place--my hands are actually usually in good shape--but that week, I've been washing them a lot. And so they had a lot of fissures, not cuts, but it was affecting my fingerprints and they were rejected because they were just so crappy.
CARRIE: Oh my God.
BONNIE: And then I had to go to another place, basically that said they guarantee that they will be accepted. So that's just some of the hoops that we have to jump.
CARRIE: It's kind of crazy.
BONNIE: It's super silly.
CARRIE: Yeah, it's too bad there isn't some sort of federal licensing program. Like what they do for the government? Like if you're working for the VA, as long as you're licensed in one state in the United States, the VA will take you anywhere because it's all federal. It's not state-based. So I wish that were the case. Who knows? After the pandemic, that'd be one thing to work on.
BONNIE: Yeah. So any closing tips for anyone considering locums or who wants to find out more?
CARRIE: To find out more, you can actually go to hippocratichustle.com/locumslife. I have it listed all of my episodes that I've done on my podcast about my experience with locums. So I've gone into a little bit more detail with some of the difficulties I had with negotiating my rates, losing my job at the very beginning, and that sort of thing. How it affected me personally, and I have an interview with my husband about how he takes it.
So I think it's something to consider if it matches your personality, if it matches your lifestyle, and especially if you can just kind of be creative to allow it to fit your lifestyle, then I think it's a great option for people. I've really enjoyed it.
Now when I think about it, if I could get a permanent job in town, if I think hypothetically, Would I do it? I'm not even sure. I think I might just take a locums.
BONNIE: I think locums is perfect for, like we said earlier, folks who are burned out. I also think it's perfect for people who want to work on a side hustle and want more time. When you have a regular clinical job where you're working, even if you're working four days a week and not like “full time,” sometimes you need large swaths of time to work on a project, right? And so with locums you can really carve out time: two weeks on, two weeks off, or maybe you just work one week and take three months off cause you're able to do that. So it gives you a lot of extra time to work on other things and it gives you more flexibility in that way. So that's sort of a huge pro that I see for locums.
At the time of this recording, I have finished my second locums job, and I don't have plans to do another one. I'm not saying I'm never going to do it again. It's just right now, I kind of want to stay put, but I also can't travel conveniently I guess. But at this time, I think I'm going to personally look for something local part time. I say that, but we'll see.
CARRIE: I know, right? It's hard. I don't know. It's like when you start thinking about settling down, it's like, “Oh man.”
I would say actually we didn't talk about this before, but I think it's worth it. The thing is that who locums isn't good for. I have met people on the locums trail that I think aren't good fits for the site, and they actually don't have permanency and aren't necessarily invited back because they have a very rigid mindset about how things should be done.
I always think about it when I'm in my locums spot that I'm a guest in their home, so it's like whatever their culture is, however they do their work, whatever EMR they do, whatever silly protocol they have for something, I kind of try to roll with it, as long as it's safe, obviously. Then, that's just how they do their work. And you don't want to be the guy who comes in and tries to change a department because you don't like how one thing is done. Or just complain. Oh my gosh, I've run into some locums on the trail-- You run into him in the doctor's dining room and they are like, “This place is such a mess here.” Of course it's a mess! They're understaffed. We're here to help them.
BONNIE: That's such a good point.
CARRIE: If it stresses you out too much, having a new EMR, unless you can kind of get over that hump, it's going to be really stressful for you because you're going to have a new EMR. Even if the EMR is exactly the same program, it is going to be different. If it's Epic in one place, that may not be exactly the same in another place. You just have to be super flexible and a little bit laid back with how things are done. And yeah, I always think of it, like I said, I'm a guest in their home and I'm there to help them. So I try to do that however I can.
BONNIE: That's such a good mindset. I mean, you are a guest in their home, and also even if you end up hating how they do things? The good news is you can leave.
CARRIE: Yeah, exactly. And also if you are a complainer, people know because it’s a little community, and it may get around to, so just be polite.
BONNIE: Be professional.
CARRIE: Be professional. Exactly.
BONNIE: Awesome. Well, I think we covered a lot of amazing tips for people. Hopefully this has inspired some people to pursue locums that maybe weren't even thinking about it or maybe they are wanting to sort of pivot into a nonclinical but they don't know how to do that without sacrificing their income. This is a great way to still get a physician income, but have time to work on something else.
So anyway, thanks much for being here, I'm sure we'll have you back on the show soon.
CARRIE: Thank you so much, Bonnie.
Hey, if you're a woman physician who is ready to take control of your money, you've got to check out my program Money for Women Physicians. It's part course and part group coaching and a hundred percent guaranteed to put more money in your pocket. Go to wealthymommd.com/money to learn more.
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