EPISODE 64
What It Actually Takes to Build a Sustainable Locums Career | Megan Hoot of CompHealth
Episode Transcript
Dr. Randy Lehman (00:00:00):
Welcome back to the Rural American Surgeon. I'm your host, Dr. Randy Layman, and I am pleased to have a episode for you about locum surgery today. My guest is none other than the locums handler, if you will, that I have been personally working with for five years through CompHealth, Megan Hoot. So Megan, thanks for joining us.
Megan Hoot (00:00:24):
Yeah, of course. Thanks so much for having me. And I love the idea of being considered something like an FBI handler. It feels very fierce.
Dr. Randy Lehman (00:00:32):
Yeah. So I don't know what's the right word?
Megan Hoot (00:00:35):
It's
Dr. Randy Lehman (00:00:35):
Not handle,
Megan Hoot (00:00:36):
I'm considered a physician recruiter. Of course.
Dr. Randy Lehman (00:00:39):
Recruiter. Okay.
Megan Hoot (00:00:40):
People call me everything from my gal who books me work to boss lady
Dr. Randy Lehman (00:00:47):
Or like a rep or something. I mean, it's a coordinator in some ways. Recruiter is a great word. So anyway, just tell me about your background. It's introduced to you, so what you do, what your job is like at CompHealth.
Megan Hoot (00:01:01):
So I've been at CompHealth for almost nine years now. Almost half of which I worked with you obviously. I actually moved out to Salt Lake City, Utah for this job back in 2017 when everything wasn't work from home. Picked up the family, AKA, the dog, and moved to Salt Lake City from Atlanta on a Hope and a dream and what the heck is locums? I'm not sure, but we'll find out together kind of attitude. So it's been quite a whirlwind of trial by fire. A lot of folks who do locums don't have a history in locums. They have a history in compassionate industries, client-focused industries and service industries, that sort of thing. A lot of folks might not know that much about medicine if they haven't been working locums as long as I have. But the key component with being a good recruiter is obviously always caring.
Dr. Randy Lehman (00:01:53):
Yeah, that's beautiful. So what exactly is Locums?
Megan Hoot (00:01:58):
Good question. So locums is Latin. Nobody speaks Latin, but it is Latin for in place of the locums industry was actually founded by Comp Health back in 1969. There was an obvious need for rural physicians in general. They were getting burnt out. Maybe they were the only physician for a hundred miles in any direction, never got time off and were even falling behind on things like CMEs because they were so busy. So a couple of med students up at the University of Utah founded an organization called Rope, which is the rural Organization for Physician Engagement. Essentially helped them put together the groundwork to be able to take the time off and build a network to have other physicians cover. So we're not at locums yet. This is physicians working with physicians and covering for each other so that they can have a better work-life balance.
(00:02:56):
Ultimately, obviously those that students became physicians and realized there's an industry here and founded Comp Health Locums being in place of is a bit of a misnomer because it isn't necessarily in place of another physician. A lot of opportunities that we get will be maybe like a 0.5 ft or something where they don't have enough work for another full-time physician. They don't want somebody to move to the area with the expectation this is a permanent long-term opportunity, but they need somebody to come in and help out, give their physicians relief, avoid that burnout, that sort of thing.
Dr. Randy Lehman (00:03:30):
So some of what you do is physician placement and then some of what you have these jobs and sometimes their people generally think of as to stand in place of just like you said, and it's like a part-time short-term deal. But what you're saying is it can also be long-term, so sometimes short-term, sometimes long-term.
Megan Hoot (00:03:47):
Yeah, absolutely. I work with one surgeon who's been covering at the same hospital for 10 years. He does weekend call coverage. He's best friends with the surgeon there and he's been doing the same job for 10 years. There are tons of long-term opportunities, and I always say every locums has the propensity to become something permanent. If they do have a need, there's always a point where they think about cutting me out of the deal, which is not the best for me, but it's what's best for the patients and the hospital and the physician and that's also great.
Dr. Randy Lehman (00:04:20):
Sure. And there's ways to do that so that it makes sense for everybody. Exactly. If that's the case then though, I we're talking about everything from quite short-term to quite long term, but what's the typical general surgeon's locum assignment in terms of days call scope?
Megan Hoot (00:04:39):
The vast majority of our opportunities are call coverage. Typically hospitals will only bring in a surgeon for clinic and scheduled cases or time if there is a profitability margin. They did have a physician before. Those can range anywhere from a weekend, a month to full-time for three to six months. I used to be able to say, well, these are the places that we get opportunities. This is what those opportunities look like. And then 2020 came and just put the kibosh on everything that we ever expected. The variety of opportunities is just as varying as the variety of physicians.
Dr. Randy Lehman (00:05:17):
What would you say is the biggest misconception surgeons have about locums?
Megan Hoot (00:05:22):
Gosh, that's a really good question. Can I give you three answers? Sure.
Dr. Randy Lehman (00:05:27):
So
Megan Hoot (00:05:27):
I would say the biggest misconception is that it's easier to do locums. People do locums because they can't get a job doing something else, which is the actual opposite of the truth. Since we cover malpractice for all of our physicians, it's actually a little bit tougher to do locums. We're a little bit more stringent because it's opening us up for liability to be directly sued. And as the biggest locums agency, we actually underwrite our own malpractice policy. So again, we're in trouble if something bad happens. So it is a little bit tougher to actually do locums. I would say another misconception is bouncing around. I have that surgeon who's been doing the same weekend assignment for almost 10 years. You don't have to bounce around. You don't have to meet new people every single week in order to be a successful locums physician. Most of the surgeons that I work with, if they are doing full-time locums, they'll have one regular steady ongoing assignment that's maybe a week or two a month and they've got that and then they'll sprinkle in other things as they want.
(00:06:33):
So you don't necessarily have to travel all over the country and meet somebody new every single week. The third expectation I would say, and only because I get, you'd be amazed how many calls I get from surgeons asking for this, but they'll say, well, I want to do locums, but I only want to do it if it's within 20 minutes of my house and I only want to do it on night shifts, night call after the other surgeon is done clinic in or from 5:00 PM to 7:00 AM on Tuesdays, Wednesdays, and Thursdays because we've worked together a long time. That's not a very realistic expectation. So there is a misconception that, hey, I want to do locums. I'm going to immediately jump into locums. I'm going to get exactly what I'm looking for, and that's easy. But as you know, there's a lot of competition, particularly in surgical specialties, so it's not as easy to find something close to home, but having an open mind is definitely key.
Dr. Randy Lehman (00:07:30):
Yeah, no, that's a extremely good answer to that question and I think there's a lot of misconceptions and the idea that people are doing locums because they have to is another one that you didn't really mention, but kind of a little bit. You're saying it's the opposite in a way, but and that it's a red flag that there's somebody sitting on the locum circuit for a couple years. I actually think that if that's all there is, that might be true. It's definitely means something if you can stick and stay at the same place. But if you're just because doing locums, but you're going back to the same place, that's kind of the same as sticking to I guess I have a lot of resident listeners and to the listener who is a resident, I would not say that you should worry about your resume looking worse if you do locums.
Megan Hoot (00:08:26):
Yes,
Dr. Randy Lehman (00:08:27):
I definitely agree with that in some capacity. But if it's my opinion, if it is all you're doing and if you're changing between a lot of different assignments and nothing's ever sticking and you do that and you come out of residency and you do that and then it's four to five years into it, and then I'm looking to hire you, I would have some serious questions about why that was the case, but I don't think that from what I've done with Locums, I went to one place I went to, and I've not been back and I only covered one
Megan Hoot (00:08:59):
Weekend. It was like one weekend. Yeah, I remember. We won't name names
Dr. Randy Lehman (00:09:03):
Other than that, I just worked in two different hospitals and each time for years and there's a good reason why the one ended and then the other one basically never did, I guess I don't to say details about that and it's been a good thing for me, but also at the same time, I had a regular stable job where I stuck for also years. So just a few follow ups on that basically. Did you have something else?
Megan Hoot (00:09:30):
I do, yeah. The other side of that coin, a lot of the recruiters that we do work with who are staffing locums know the nature of locums. They know that there's going to be more affiliations, they know that folks have bounced around and that sort of thing. But there's also just a lot more attrition in general in locums assignments right there, a surgeon that I used to work with, for example, she would spearfish scuba and spearfish three to six months out of the year. So she would take a three month assignment for a maternity leave or a leave of absence, and then she'd go do that for a few months and go spearfish in the Caribbean. So there's some situations where they say, okay, doing this ongoing every single month schedule just doesn't work for me. I'd rather do three to six months and then take a couple months off, three to six months, take a couple months off, that sort of thing. So there's a lot of difference. And honestly, I love residents. They're probably my favorite group. So fun. And they're our age. They're closer to our age than some of the other surgeons I work with, but especially at conferences, we really have a lot of fun with the residents.
(00:10:37):
Well,
Dr. Randy Lehman (00:10:38):
I'm going to keep the show sort of on track with the typical episode things that we normally do. So why rural surgery, how I do it, financial coronary, even in classic rural surgery, stories, resources, all the things we normally do that we kind of did the intro, but let's do Y rural surgery and then let me, I'm going to then at that point fill in a little bit on my personal experience and then we'll do how I do it. And how I do it for this episode will be sort of like if anybody wanted to do locums, how the technical things. So first let's bring it back. You talked about rope. Well, it's a great acronym. Throw me a rope to give me a little breather, but it's specifically rural. The R is rural. So where is the greatest need right now, rural or urban? For locums
Megan Hoot (00:11:27):
For sure. Rural. So a lot of the hospitals that we work with are in more rural areas and rural locations, just obviously rural areas have a more difficult time for a variety of reasons accessing care. But in general, a smaller population means that there's a smaller population of physicians. So say for example a small hospital in a rural area in New Mexico or Arizona might have a really challenging time convincing a physician to move there and set up their life if they need certain amenities. I've spoken with surgeons who have special needs kids or maybe their spouse needs to be in a certain location for work, but they really do want to help in rural communities or help with locums and build that comradery. Ongoing rural locations are perfect for that, and they do definitely have more of a need,
Dr. Randy Lehman (00:12:21):
And that's why I'm doing this episode is so basically you're the most help to the person you were five years ago, and it's the rural American Surgeon podcast, and my listener and I are passionate about rural surgery. That's what this show is about. And so I think locums plays an important role, both as a breather for the existing surgeon, sort of a introduction for some people that might want to sort of try it out and see what it's all about on a low risk thing. There's a lot of ways that locums plays in, so that's why we're doing it. One more quick question, just are rural jobs easier or harder for locum surgeons compared to urban?
Megan Hoot (00:13:03):
Good question. But since I live in Salt Lake City, I have to do a Salt Lake City call out. I feel like asking whether it's more difficult is asking whether it's harder to ski or snowboard. They're not necessarily more difficult, but they are different and they're differently suited for different people. So depending on your skillset, depending on what interests you, I had a surgeon who worked in a rural community in New Hampshire for years, and he fly fished all day while he was waiting to get called in, and then he would get called in and go hang out with all the doctors he was friends with. But if you don't fly fish or you're not into the outdoors or that's not a good fit for you and your lifestyle, then it's not going to be a good fit to be in a rural community. So it's not better or worse, harder or easier, it's just different.
Dr. Randy Lehman (00:13:54):
You know what? That's a great answer. And as you're mentioning it, I come up with something else too because I'm viewing it more as the actual work as the surgeon because there's a lot of ways you can answer whether it's harder, more hours worked, more cases done, more pressure, more responsibility,
Megan Hoot (00:14:17):
Less
Dr. Randy Lehman (00:14:18):
Backup. That is true. So what I have, I would say I've seen is as I see the urban jobs going through, maybe those are trauma call situation. There's also a lot of times more of an elective practice too, I feel like to those jobs than the rural jobs, which a lot of times are more just the call coverage. But as I've been out there in rural America practicing the hard part is resource management.
Megan Hoot (00:14:49):
That is definitely true.
Dr. Randy Lehman (00:14:51):
So even knowing to ask if we have ultrasound,
(00:14:58):
I would never have thought to ask if we have ultrasound in my residency program at Mayo Clinic, it's just 24 7. We always have it and there's multiple people and there's multiple pieces of equipment, but that is not always the case. And then similarly, MRI, similarly, do we have a radiologist in-house to do a upper GI study? Do we have PAL certified nurses? Do we have age limits? Do we have weight limit restrictions on what surgery we can do and who's working with me? And those are the hardest parts. It's not the surgery itself that in rural surgery, that's the hard part. It's more of the resource management and it can be the call burden. And I've heard call is like radiation. Its affects are both detrimental and cumulative. So I don't know. But if you take call in a locums environment and you don't have an elective practice on top of it, sometimes I feel like I bring work from home and I get paperwork and administrative stuff done while I'm there and I always bring my family and then I feel like I spend actually more quality time, definitely more time and more quality time with my family when I'm on a locums assignment too, because I'm not going in and doing my regular eight to five or seven to five job and then still have the stuff that comes in on top of that and it all squeezes and I just have an hour or two instead, I'm just waiting for the ER to call me.
(00:16:27):
So you have to be flexible with that. And maybe I already started going into my experience. So what I did is I started practicing in 2020 and I started a rural hospital county of 12,000 and there were two other surgeons there and nobody who was very busy including me, and I got to decompress from surgery and my wife said, I feel like I married a different person than who you are now in a good way. And everything was kind of like I got to start right away out of residency, got to start getting paid right away out of residency, but then there was a slow ramp up. But me now you kind of know me a little bit more because if you've listened to any other episodes, it didn't take long for me to start panicking about if I don't pick up my practice real first off, I'm just antsy not doing anything. You are
Megan Hoot (00:17:20):
Your doer for sure.
Dr. Randy Lehman (00:17:22):
Yeah. At doer, the ESTP, I think Young Myers-Briggs personality, the Enneagram, whatever, they all agree, action, person of action. For me, I was like, I got to find something to do. Well, I go around, I'm building my practice by meeting all the primary care docs, doing all the things that you're supposed to do, and the practice referral itself was picking up. But in the middle of this, I got this email about, and you get lots, you get hammered with emails about locums. I know I was getting emails about locums when I was a resident and I couldn't even go do the thing. I got one email. And so you just ignore, ignore, ignore, ignore one email about Prairie Sheen, Wisconsin. And I was like, God, what was that from? Yeah, from I think so it had to be. And then I said, I know ine because we used to fly directly over it when we flew home to Indiana from Rochester, Minnesota, and I've stopped after hours at least one time and let my kids take a leak on the side of the airplane and it took back off again. I'm not kidding. Hey,
Megan Hoot (00:18:32):
You got to do what you got to do when nature calls,
Dr. Randy Lehman (00:18:35):
And I love the Cooley region and the Mississippi River and the geography of it, and there may be places that need things that's in the place geographically that you love as a listener. And so I was like, I'll check that out. And I know I already have a Wisconsin license because residency and stuff had Minnesota and Wisconsin. So I called and I talked also to my hospital and they said, you can do anything you want on your vacation. And I had six weeks of vacation per year, and so I was like, look, I don't need all of this. I don't plan to travel. My whole life is a vacation and I want to look into this. So I basically started doing four weeks or so of locums at this place. And the other thing that I'll say is there were some things about my first job and first few months that were very, I don't want to say the wrong thing because I don't want to throw anybody else under the bus, but I am here for the listener and the listener needs to. And like I said, most valuable to the person you were five years ago and if somebody would've told me, so toxic and scary are the words that kind of come up and intimidating. I felt like the locums thing was almost like a bug out bag
Megan Hoot (00:19:53):
Really
Dr. Randy Lehman (00:19:55):
For me,
Megan Hoot (00:19:56):
Just in case we're going to,
Dr. Randy Lehman (00:19:58):
Yeah, I could pick up more shifts right away. I have privileges somewhere else that I could go right away if all of a sudden I was like, I can't do this anymore. I can't take this or whatever situation there was.
Megan Hoot (00:20:12):
Well, it's like diversifying not just your stock portfolio but your human capital. You now have more capital that you can leverage to diversify your income streams.
Dr. Randy Lehman (00:20:23):
That was a very big reason why I started doing this. And of course you wouldn't do it if it was free, so you're going to get the income and that was great, but really it was like a forced family vacation, almost go to a place in the world that I enjoyed. We stayed in a hotel, we had little kids, 3-year-old and 1-year-old. We chose and they had a water slide, had a water slide, a little water splash thing inside. We became friends with the hotel owners. It was like a thing. Honestly, my son for his birthday, we took him to Prairie Sheen even after that assignment ended.
Megan Hoot (00:20:59):
I didn't know that
Dr. Randy Lehman (00:21:00):
Years later. So I did that and then it continued for a couple years. There were basically two surgeons. They needed like two and a half. So I was filling in along with some other people, year
Megan Hoot (00:21:13):
And a half,
Dr. Randy Lehman (00:21:15):
Part of the half even because there were other Locums people doing some work there too. Then they went with Rural Physicians Group, which is a contracted physician staffing for hospitalists, and they're kind of getting into the surgery game too. And they're not very big. At that time, they only had four hospitals nationwide and some of 'em were kind fizzling. So I don't know how they're doing. I actually reached out to the RPG leader. I was going to see if they wanted to come on the show and give me an update too. Oh, love that. But regardless, they went a different route. And so the Locums thing wasn't needed anymore around that same time. And I probably was there for about two and a half years or so, I'm not really sure. Two years.
Megan Hoot (00:21:58):
It was a while.
Dr. Randy Lehman (00:22:00):
And then at the same time, my contract with you was actually through Gunderson Comp Health to Gunderson to Crossing Rivers, which was the hospital. And then Dr. Minus had unfortunately unexpectedly passed away at toma, which is in Wisconsin, different location. And they pitched to me, would you come over here? Well, first I was at Prairie. I'm like, I don't have any extra time. But then that all ended around the same time, and so then I said, try it out. So I went up there and that was also great, very similar deal. Matter of fact, we found a hotel that has straight up waterpark attached to it, and then we'd stay there. And then my kids were bigger. So it's kind of funny because it aged with us. So your story may not be the same as my story, but maybe you're single, maybe you're married, maybe your kids are out of the house, maybe your kids are little. There's a different thing that you may want, but there's lots of different opportunities and you don't have to say, I mean you can't say yes to all of 'em.
(00:23:07):
So it sort of worked. Each decision just sort of worked with us and it became something that we then more wanted to go do rather than now in Indiana, I then expanded to three other hospitals, so a total of four hospitals, and I left that first practice eventually, and now I've got bug out bags in my back door. If there was a problem, I don't need it anymore. But I still continue to do that locums work because it just works for our family and our life. And it sort of feels like a place that we almost like you. Some people go to a cabin in Wisconsin, we do that, but it's a working vacation. And then because I liked it to operate, I don't have an elective practice up there, so I just spend the time with my family. But when I get called from the er, I'm happy because I like to go do surgery and when I don't get called from the er, I'm happy.
(00:24:01):
I just keep spending time with my family. Course you spend family if your family's flexible. But now even in toma, we have my brother-in-law bought his engagement ring and proposed to my sister-in-law in toma. No way, God, this 4th of July, we're all going up there with my wife's whole extended family. We've taken several friends up there with us and they spend the week with us while I'm doing. So there's all these things that we've been able to personally enhance our lives while I provided the care for the patients in rural America, which is something I'm very obviously passionate about and help the surgeons. And I go in with an approach. I don't have to build a practice here. I just have to not let the wheels fall off of this thing that I'm stewarding for this period of time.
Megan Hoot (00:24:49):
Exactly.
Dr. Randy Lehman (00:24:50):
So that's been my experience. And so if someone was interested in doing something like that, I guess one question is how fast could someone realistically go from zero to doing their first locum shift?
Megan Hoot (00:25:04):
So that is going to depend entirely on every different situation you already had that Wisconsin license. If somebody doesn't have a license, but they are interested in an area, obviously it's going to be a little bit more challenging to get that license. I would say licensing is one of our biggest hurdles for our surgical specialties in particular, a lot of hospitals don't plan out their surgical schedules a year in advance. That's very rare. Everybody knows, okay, here's your schedule for the next two months or whatever. So our average booking timelines for surgical specialties are about one to three months in advance. No matter how hard we try to turn that into two to six months, it's stuck at one to three for a decade or so. So getting that license is probably the biggest hurdle. But I think my quickest assignment from the presentation we presented the physician on Tuesday morning, sent his CV over to the hospital. He flew out Wednesday and covered a rural hospital in Colorado starting Thursday morning. So it can be Oh yeah. Wow.
Dr. Randy Lehman (00:26:10):
Oh
Megan Hoot (00:26:10):
Yeah.
Dr. Randy Lehman (00:26:10):
But he had the state license already.
Megan Hoot (00:26:14):
He did.
Dr. Randy Lehman (00:26:15):
And so they get around insurance credentialing because it's emergency stuff.
Megan Hoot (00:26:20):
They end up getting temporary privileges essentially. Temporary privileges are going to be a slightly different version of the full privileges. So maybe the full privileges require four references. One must be supervisory. The temporaries will say one supervisory and one same specialty physician or something like that.
(00:26:39):
So they're still checking those boxes, but not quite as thorough. Or maybe they'll say, if we can get a reference from the hospital that you work at now, we'll hold off on the primary source verification for those privileges. So every hospital has their own rules. There are a lot of hospitals that we work with that don't do temporary privileges, and they'll try to book three to six months in advance so that they have time to privilege. But I honestly am a little hesitant when it comes to anything that doesn't allow temporary privileges. So just in my experience, setting up assignments, I'm sure I've told you this a million times, I don't do assignments where they don't have you booked for days. So that's my personal preference. And after doing this for a long time, I've just seen too many times where physicians have been burned and it ruins my relationship with them as well.
(00:27:32):
If they do the privileges, you jump through all of these hoops and they don't have a light at the end of the tunnel, they don't end up, oh, we hired a permanent surgeon. We actually don't need the coverage after all. And you're like, okay, not only us, it's your hospital's med staff office, it's the surgeon, it's our privileging team. Everybody has spent so much time on this, it's just a gut punch. For the most part, licensing is our biggest hurdle. But that being said, Colorado is the fastest license in the country. They can issue a license for somebody in less than three to five days. And there's emergency licenses, especially in 2020. We had a lot of emergency licensing options and things like that. And of course the IMLC, the Interstate Medical Licensure compact has eliminated a lot of those licensing hurdles.
Dr. Randy Lehman (00:28:21):
So when I was a resident, I didn't know about any of this stuff.
Megan Hoot (00:28:27):
I don't think the IMLC existed when you were a resident. It came out. It came out right around the time that I was starting to work locums in 2017. So 20 16, 20 17 was about when it came out,
Dr. Randy Lehman (00:28:37):
So that's a good point. I am old. You're right,
Megan Hoot (00:28:40):
You're
Dr. Randy Lehman (00:28:40):
Right.
Megan Hoot (00:28:40):
We're the same age, so I'm not judging you getting
Dr. Randy Lehman (00:28:43):
Over all the time.
Megan Hoot (00:28:44):
Hey, my birthday is this coming Saturday? No, not this coming Saturday. The following Saturday we
Dr. Randy Lehman (00:28:49):
Were like exactly the same age. You're born in 88.
Megan Hoot (00:28:52):
I was born in 87, so I'll be 39 on Saturday. Saturday, the perfect date. April 25th. Not too hot, not too cold. All you need is light jacket.
Dr. Randy Lehman (00:29:02):
Well, happy birthday.
Megan Hoot (00:29:03):
Thank you.
Dr. Randy Lehman (00:29:05):
Okay. But what I was trying to say is you dove into extremely very good detailed stuff, and I just want to pause and say it. So the IMLC big picture is basically a license that's portable across multiple states.
Megan Hoot (00:29:22):
So I actually have the perfect explanation. So I always say that the IMLC is like TSA pre-check, right? They do additional background checks up front so that you don't have to take your shoes off when you go through security, but you do still have to walk through the metal detector, right? Correct. So you still have to go online and submit for that license, but you don't have to take your shoes off or take your laptop out of the bag, and it's much faster and easier.
Dr. Randy Lehman (00:29:44):
Okay. So how many states are in that?
Megan Hoot (00:29:48):
I believe it's 42 or 43. I think North Carolina was either the 42nd or 43rd state to participate. It used to be mostly Midwest states, but now it's really expanded. Florida, Georgia, Mississippi, the vast majority of states participate now.
Dr. Randy Lehman (00:30:07):
So there's that. And to be able to operate in a hospital, I didn't even understand this as a resident. So not only do you just have to have a state license, but you have to have hospital privileges. But then in order to bill for the services, you have to have insurance credentials. And sometimes those words credentials and privileges get skewed around and sometimes they say hospital credentials and stuff. And so just to be clear, you have to have all those things in order to actually functionally do it. And for me, at my first job, the credentialing of insurance didn't really start. It probably should have before I got there. It started when I got there, and so I couldn't see certain types of insurance for months and months, and it can take a very long time. I didn't get the last insurance until nine months after I started there, but at least Medicare will come in within a month or so. But you're talking about licenses and privileges and then locums. I don't think insurance credentialing is a problem because it's emergency. They have a way around that
Megan Hoot (00:31:08):
We do. So I don't know how in depth you want me to go with it.
Dr. Randy Lehman (00:31:12):
I dunno. Somebody that doesn't really know what you're talking about, explain it to them.
Megan Hoot (00:31:17):
Yeah. So actually I had a very similar experience when I first started at CompHealth and I went through training and we met with our hospital privileging team. I remember Jamie, our hospital privileging manager said, yeah, you have to privilege them at the hospital. And I was like, wait, every time, how do we do any of this? How does this even work? How are we ever going to get doctors' places? When we are going through a locums assignment, there's a few different things that we're going through. The licensing, obviously surgeons always need a DEA, which can be a challenge. A state like Illinois is actually taking about three to four months to transfer deas even so even if you have an I-M-L-C-A-D-E-A can hold you up from an opportunity. Same with controlled substance permits. Some states have them, some don't. It's essentially a pharmacy board registration that shares all of the pharmacy and prescriber information across the whole state. Then on top of that, we have our internal credentialing with our medical staff services, which essentially credentials you with our malpractice carrier. We have the hospital privileging, which we help with as as best we can that privileges you with that hospital. And we do help with biller enrollment.
(00:32:38):
Candidly, our contracts with the hospital do say that we can't be held liable for anything that goes wrong with biller enrollment because we don't want to bill for, Hey, you guys didn't do biller enrollment. So we help with that process, but there's also a process called a Q six modifier, which is sort of one of those phantom terms that you hear in locums that people say, oh, well what about a Q six modifier? But they don't actually know what it means. Essentially if you go in and cover for another surgeon, the hospital can bill under that surgeon and say, okay, there's a modifier in this billing column called the Q six that says, okay, it was another physician doing the practice, but for this other person, so we're billing under that person because they were there. So some hospitals don't actually require biller enrollment. Almost every permanent position is going to absolutely require that because they're not going to have the option to use that modifier in their billing code. But for locums, we do have some different options and levers that we can pull.
Dr. Randy Lehman (00:33:43):
So it sounds like the surgeon has to do a lot of paperwork on their own to get all this accomplished. Is that correct?
Megan Hoot (00:33:52):
Yes and no. It depends. We pre-fill any documentation that we're allowed to. Some states have outlawed us pre-filling licensing applications, which is annoying for the most part. Our hospital privileging applications, all of that are going to be pre-filled once you do our applications. So a complete application with us is essentially completing all of the applications that we're going to pre-fill for you in the future.
Dr. Randy Lehman (00:34:16):
And basically you build a file that has the cv, the work history, different, all the things that you need. And I felt like it wasn't like that. You guys sort of made it pretty easy to sign here, do this, do that, and then it felt low risk to me. There haven't really been any bad outcomes or anything. But tell me about the risk. Who pays the malpractice and those, those kind of things.
Megan Hoot (00:34:49):
So I have had a few surgeons who have been named in malpractice over the years for the record, I've never seen our malpractice carrier pay out for any malpractice claims. We are never the type to settle. I know a lot of hospitals will settle cases and say, well, we don't want to deal with drawing this out. We just want to settle it, give 'em a couple hundred thousand and move on with our lives. We're not those guys. We have attorneys on staff who manage all of our malpractice, all of our risk, if even you call with an adverse patient outcome over an assignment, we are in touch with them. They're immediately getting the story so that in case you are served, they're on top of it. They already have everything drafted to send out. We mitigate risk really well with locums agencies or among the locums agencies I should say.
(00:35:39):
There are some me, I would never talk bad about any agency. I would never say that I'm better than anybody else or that CompHealth is better. But there are a lot of very small agencies out there now. So when I started doing this nine years ago, there were about 50 to 60 agencies. The majority of which I had never heard of, the most recent estimate is over 300. So over 300 locums agencies are vying for that. So all of those are not going to remain solvent forever. So that's my only cautionary tale when it comes to risk is make sure that that policy is not underwritten by a very small agency. Make sure it is through a reputable malpractice provider and that they do have attorneys available to help when something does go wrong.
Dr. Randy Lehman (00:36:34):
That's a great point. What does a bad first assignment look like and how do you stay away from it as a surgeon?
Megan Hoot (00:36:42):
So a bad first assignment, that's a really good question. I think a bad assignment honestly has a little bit more to do with expectations than the assignment itself, if that makes sense. But that applies to any job. I talk to surgeons all the time who say, well, I signed this two year contract and it was not what I expected,
(00:37:04):
But it's asking the questions upfront that helps you avoid those situations and saying you should never be afraid in a locums capacity to say, Hey, can I set up a call with the permanent surgeon? Can I set up a call with somebody at the hospital? A lot of times our contact is going to be administrators and folks who aren't actively practicing in your specialty, and not only that are staffing multiple specialties. So they're not as honed in as we are or especially not as honed in as actual physicians are. So avoiding it is definitely setting expectations, gathering as much information as you can and making sure that when you picture yourself on the first day, you're pulling in, you're going in, you've got your first day information, you feel comfortable, you know what you're going to do.
Dr. Randy Lehman (00:37:51):
Yeah, that's a great practical tip. So from your perspective now, what makes it easy for you to place a surgeon versus have somebody that you struggle to place them?
Megan Hoot (00:38:05):
So there's a couple of things that I have noticed over the years. My citizen science is mostly proximity and rates and malpractice history. Those are probably the biggest. So being able to drive to an assignment if say for example, we have something in Wyoming and you live in Wyoming, you're almost definitely going to get that before somebody who lives in Florida, right? Those flights are going to be huge variables, especially in the wintertime. The other thing is malpractice history, particularly in the mid two thousands, there were a lot of sweeping malpractice reforms in different states that restricted limits and made it a little bit more physician friendly when it comes to malpractice laws. So there are a good number of surgeons who have been practicing since the nineties who will have two, three, even four in some cases, millions of dollars in payouts. So things like that are going to be a huge detriment because those temporary privileges that we talked about are not going to be available to them anymore. They will have a blanket cap, you can't have more than this, and that's it. And the other one is rate. If we have five surgeons presented to an opportunity and they all have the skillset that they're looking for, they're all within driving distance and they're all clean malpractice histories, they're just going to sort 'em by rate and pick the cheapest. So that's a lot of where the rates come from, which was one of your topics. So I
Dr. Randy Lehman (00:39:38):
Won't jump into that. Yeah, actually that's the next thing. So the next thing is the financial corner. And I was going to say, give me a real range. So what's a surgeon's pay per day in locums right now?
Megan Hoot (00:39:50):
So it's a loaded question on rates, mostly because I don't set the rates and the hospital also doesn't set the rates. So it used to be, okay, hey, here's what we typically see. When you and I started working together, here's what we typically see. If it's going to be different than this, I'll let you know. Now we're getting into a place where it is just more competitive. There's more physicians interested, the entire economy and society in general is looking more for that flexible work-life balance and that sort of thing. So we're seeing a lot more competition. So the last couple of years it's been more the rates are set by what other surgeons are willing to do this opportunity for.
Dr. Randy Lehman (00:40:31):
The surgeons are racing to the bottom
Megan Hoot (00:40:33):
Basically. Yeah.
Dr. Randy Lehman (00:40:35):
Wow. I'm not doing that.
Megan Hoot (00:40:38):
I know. I know you're not. But you also have a unique skillset, which is specific as well. So I always tell my surgeons, if it's an opportunity that you say, Hey, I have family there, I love that area. I really want to go to Prairie Duchenne, then let's come in a little bit lower. Let's make sure that we're more aggressive and competitive with our rates so that you're more likely to get this opportunity. If you're like, I don't really love the Midwest. I don't really love Midwest winters, but I do want to try for it because I think it could be a good fit. They come in a little bit higher,
(00:41:10):
But my strategy over the last year or two as things have been getting, I don't want to say dicier, but they are getting dicier in medicine in general when it comes to hospital funding. But my strategy has been, okay, what are the other surgeons presented out? So when I'm bringing an opportunity, I'm saying, Hey, we have three surgeons, one's at 1500, one's at 1400 and one's at 1300 per day plus callback. What do you think? How much do you like this job? How much do you want to ask for? Theoretically, you could ask for $10,000 a day, which we're probably not going to get it depending on the skillset, like you doing C-sections is a huge plus, and that's a really rare, unique skillset. We can see something as high as 3000 per day flat rate, that sort of thing. On average, I would say we see base rates anywhere from 12 to 1800 per day, and our average callback, the average that you'll make for callback in addition to the base rate is about 30%. So across our surgical specialties, you make about 30% more than your base rate on average per day. Take home.
Dr. Randy Lehman (00:42:22):
When do people get paid for callback hour? Zero.
Megan Hoot (00:42:26):
Good question. Yeah, it's typically four TIS hours or two gratis hours depending on their volume. The hospital, and again, more depending on what other surgeons are asking for. So if you have a great clean practice history, you have the exact skillset that they're looking for, you're within driving distance and the only other candidate maybe doesn't have a license or is not within driving distance, you have a lot more negotiating power to come up on that or even come down on those gratis hours that are included in the base rate.
Dr. Randy Lehman (00:42:58):
Are the hospitals aware of the different rates that the surgeons are coming in at or is that only a health being aware?
Megan Hoot (00:43:08):
That is a really good question. I didn't even think you were going to ask that, but they are aware. So we essentially have a flat fee that we charge the hospital for all of our work in the process, the privileging, the licensing. We don't bill directly to the hospitals. If we're getting you a license, most hospitals charge hospital privileging fees. We pay those out of pocket. All of those things add up plus the malpractice coverage and my salary, the salary for the people booking your travel, the salary for the people doing your privileges. So we have a flat rate essentially that goes on top of your rate. So if you are asking for $1,500 base rate per day, and our fee for that assignment is 500, they're going to get something that says 2000. Now somebody else asked for 1700, they're going to get something that says 2200. So our fee is always built in there, but the variation absolutely comes through when they receive your cv.
Dr. Randy Lehman (00:44:07):
Okay, very interesting. That's
Megan Hoot (00:44:09):
A really good question though. A lot of people don't think to ask
Dr. Randy Lehman (00:44:12):
That. Thank you. I've been doing this a long time. No, just kidding.
Megan Hoot (00:44:15):
Me too together.
Dr. Randy Lehman (00:44:18):
Oh, I mean asking the questions, the pointed questions for the rural American surgeon listener.
Megan Hoot (00:44:23):
Good point. Good point.
Dr. Randy Lehman (00:44:25):
Alright, well we covered a lot of things. You said C-sections can get you paid more. What about Indo or any other things? Are there any other things like C-sections that a person that say they're in training and they say might want to do locums as part, or even just not even doing locums, but something to make them competitive out there, specifically rural that is there such a thing as a rural locums general surgeon who doesn't do endo, for example?
Megan Hoot (00:44:57):
Not really, no. But almost scope of them are going to do endoscopy a. Yeah, almost all of them are going to do endoscopy. A lot of our opportunities do require scopes. I would say nine years ago you could almost not get a job unless it was in a trauma one or two that didn't require scopes. We've gotten away from that quite a bit. Some of the smaller level three hospitals will have GI on staff now, but being able to do things like a food bolus or for an object, we won't say where is really important. Right, because they want the surgeon to come in for something like that. The GI isn't going to necessarily have that skillset, even if they do have one
Dr. Randy Lehman (00:45:40):
Or they don't have, most of the time they don't have gi. So there's nothing else like that. Endo C-section, any other skillset fellowship training? I don't,
Megan Hoot (00:45:50):
No, unfortunately not. And I wish there were obviously the different subspecialties that we work with since. So our team works with all general surgery, so that's including trauma, breast surgery, surgical oncology, vascular surgery, and peds. So all of those specialties are going to pay a little bit differently. But when it comes to bread and butter, general surgery, honestly, it kind of all shakes out the same. So if you're a breast surgeon, you're not going to be on call. You're only really going to ever have an eight hour clinic and or day general surgeons have the propensity to make a lot more money because they have that callback and they have the additional call at the end of the day. And same with trauma surgeons. They're typically in-house for 12 hour shifts. So they are paid hourly, which can be upwards of $3,000. But again, if you're a bread and butter general surgeon and you are actually in the facility for 12 hours, you're going to end up making the same amount of money anyway.
Dr. Randy Lehman (00:46:49):
Yeah, that makes sense. Is there such a thing as a locums colorectal surgeon?
Megan Hoot (00:46:54):
There sure is. I actually just placed my very first colorectal assignment.
Dr. Randy Lehman (00:46:58):
Oh,
Megan Hoot (00:46:59):
Just this
Dr. Randy Lehman (00:46:59):
Week. I thought that was going to be a no
Megan Hoot (00:47:01):
No. It's amazing. So I've actually worked with the physician. He's based out of California. I've worked with him for probably almost as long as I've worked with you four or five years now. And he does bread and butter general surgery, but his focus has always been colorectal and he's fellowship trained in it and it's right place, right time
Dr. Randy Lehman (00:47:21):
Use. It's got to be a big hospital that you need a locums colorectal surgeon.
Megan Hoot (00:47:25):
Yeah, it is. It is. And it sounds like they have another person who does want to do a permanent position there, but they don't want to do something. They want to have at least
Dr. Randy Lehman (00:47:35):
A week
Megan Hoot (00:47:35):
Or two off every month. So then that's where the locums comes in. They had a colorectal surgeon go out and a new one come in who said, I want flexibility. My family's not relocating here.
Dr. Randy Lehman (00:47:47):
And
Megan Hoot (00:47:47):
That's where locums comes in.
Dr. Randy Lehman (00:47:50):
Yeah. See, there's a lot of different ways that it can, and so we got to keep moving, but I do have a few specific things that I want to ask. So let's keep doing it. Rapid fire, 10 99. Is everybody paid 10 99? Do you have any sari locum surgeons that work for health? We do not.
Megan Hoot (00:48:07):
We do
Dr. Randy Lehman (00:48:07):
Not.
Megan Hoot (00:48:08):
So the only exception to that is with a PP, advanced, advanced practice providers do have an option to actually be directly employed, but that's a completely different division. We don't work with a PP at all in our subspecialties.
Dr. Randy Lehman (00:48:24):
Most people that get paid on a 10 99. Are you cutting the check to Randy Lehman, md or are you cutting it to Liberty Clinic or some other entity like that that they have created
Megan Hoot (00:48:36):
Whatever you choose for being a 10 99 employee? I think one of the biggest hurdles is health insurance. Honestly, having an LLC used to be necessary. It's not so much anymore because it's so much easier. And contract work is just more normalized in society, so it's a little bit easier to self-report your taxes and income and things like that. You don't have to have an LLC, but having a group insurance with other self-employed people is definitely very advisable.
Dr. Randy Lehman (00:49:05):
So I would advise the listeners who have a sit down with an accountant who can actually tell you about some of these things. But in general, broad overview, big strokes, I would say that there's a possibility for better tax advantaging your income if you can take some of your income on 10 99 because then you're using your laptop for work or you're using your cell phone for work or different things that you may need. Loops or piece of equipment or subscriptions, air subscriptions, travel meals, yeah, all those things. They'll have to be, they're essential for work. So you think about it, would I pay this thing if I didn't? Well, that's one way to look at it. There's different ways to look at it. Talk to your accountant basically. Yes, but you can write things off if you license to tax
Megan Hoot (00:49:58):
Accountants.
Dr. Randy Lehman (00:49:59):
Yeah, payment right on the 10 99, and I do that all the time with my accountant. I ask, is this deductible or not? Whatever. So what expenses are you guys actually paying for the locums person versus, for example, I haven't had travel meals paid, but then every receipt for every meal that I take, then I write off while I'm gone. We'll
Megan Hoot (00:50:21):
See exactly.
Dr. Randy Lehman (00:50:22):
Sometimes I have a nice dinner
Megan Hoot (00:50:25):
And as you should, you deserve a nice dinner. So we cover all of the travel expenses. So that's including flights, hotel, rental car. If it is an assignment that you're close enough to drive to, we reimburse the IRS standard for mileage. The only thing that we don't pay for is like you said, food, right? If you're going on an assignment, we don't have a set per diem or allotment for food per day, but I always recommend if somebody, I've had surgeons travel during Ramadan before and I'm like, well, we have to get to an Airbnb. What are you going to eat when the sun goes down? So it's very common. It's not just not unusual. It's very common for us to accommodate those sorts of things. And that's honestly one of the things that I love the most about our surgery specialties team is we are that accommodating. Not all specialties and teams in locums are the same way.
Dr. Randy Lehman (00:51:21):
I don't want to present it as if you're the, I don't know, the only person in the world doing locums or you're the only person in the world doing locums. Well, just like I don't want to present that I am the only rural surgeon or the only surgeon doing rural surgery. Well, that's just not true. But you're the one that I know, and I have this, I've talked to a lot of other recruiters. I've never taken any other locums assignment and I've never worked with any other company than CompHealth because it gets to the point. It's just too much. It's too complicated. And I feel like that, first off, I think that you have sort of helped to change my life and I appreciate, oh my God,
Megan Hoot (00:51:56):
Thank you so much.
Dr. Randy Lehman (00:51:57):
I mean the world to me. Well, and that's why I asked you to come on, because I trust you. Basically after the experience, we worked together and it gave me opportunities, opened my eyes to other things. So it's great. And your company also not the same, but mostly I don't talk to anybody else in the company besides you. So I think that Megan Hoots a great handler, if you will. Thank you. If you want to do something like this, you could reach out directly to her. And actually we put together a link in the show notes that you can connect directly with her and you could take that first step if you wanted to. I'll say it again at the end of the show. No pressure. And we're probably close to being done, but I have a couple more questions. Yeah, no pressure at all. But if you want to just talk to somebody, she's great. Yeah, go ahead.
Megan Hoot (00:52:55):
I was just going to say a quick plug. My advice for every physician, no matter your specialty, when you start doing locums, is to work with somebody that you like. Right? You and I got along great. We've always been able to work together, and it's never been stressful. Some agencies or some individual reps will be a little bit pushier. Maybe they don't click with your personality, maybe they just don't have anything in common or something to talk about with them. My advice is always work with somebody that you like, because the best case scenario is that you end up working with us for years. And if you don't like the person you work with, it's just like having a crappy colleague. You are not going to be happy
Dr. Randy Lehman (00:53:34):
A hundred percent. What I've got from you has changed over time. And so as I changed, what I've been able to do is tell you, this is where I'm at and this is what I'm looking for this period of time. I'm not saying don't ever call me again, but I am not going to be doing anything for this period of time. And then you respect that and respect the boundaries. You see what I'm saying? Because some people is this act too salesy and that's because that's what they think sales is, but sales is actually being likable and looking out for the other person and stuff. It
Megan Hoot (00:54:09):
Is. And I
Dr. Randy Lehman (00:54:09):
Think that
Megan Hoot (00:54:10):
There's a component also that I think a lot of people miss when it does come to locums. If a job opens in a state that you're licensed in and I'm like, he's probably not interested in this. I'll say, Hey, I got this job. Just wanted to let you know just in case. And you're like, Nope. And I'm like, cool. Sounds good. You know what they say when you assume. So there's a lot of people who will try and talk you into something like that. My job isn't to talk you into anything. My job is to consult you and give you the information and have that open dialogue to make sure that we're all on the same page and it's a good fit if it's,
Dr. Randy Lehman (00:54:42):
Yep, exactly. So classic rural surgery stories, do you have one story in particular that just stands out of something that locums rural surgery, you tell at dinner tables or whatever?
Megan Hoot (00:54:54):
I have one. I have a go-to. We call these at CompHealth, we call them making a difference story. So we actually have a nonprofit arm of our parent organization, CHG, that subsidizes medical missions all over the world for physicians. So if you ever want to participate, let me know. But we call these making a difference moments. And I did have a physician who covered for us up in Madison, Wisconsin. It's pretty rural when it comes to, it's not as rural, but for having a trauma level too. One of our reps who works,
Dr. Randy Lehman (00:55:30):
They're a surgery residency program.
Megan Hoot (00:55:32):
They do, but in
Dr. Randy Lehman (00:55:33):
A medical school. Okay, go on.
Megan Hoot (00:55:36):
Well, so she was covering up in Madison and one of our hospital privileging reps was actually life flighted to her hospital from another hospital after getting in a terrible car accident and sliding on some black ice. And she was actually able to save the life of two people who work at our company, which is completely random. And we would have no idea. But when the person who she works with our hospital privileging, when she came to, and she was okay, and she spoke with the surgeon, she said, why does that name sound so familiar? And she said, I don't know. I'm a locums. You wouldn't know me. I work here through Comp Health. And she was like, no, tell me you're not through health. But she was. Yeah. And we have stories of, I placed a surgeon here in Roosevelt Utah, who at very rural took the appendix out of one of my friend's. So we actually do get, see some of those community impacts, which just makes your heart larger and warmer, makes
Dr. Randy Lehman (00:56:40):
You
Megan Hoot (00:56:40):
Feel so good about what you actually do when you get to see the patient results.
Dr. Randy Lehman (00:56:44):
I had a big conversation with chat GPT about this recently where I was asking what's the difference between greed and ambition and then also talking about, I don't know, just how you can have a profitable, what's the point of my practice? And then you can't do it if you don't make money. Some people say, oh, no margin, no mission. The beauty of it is I'm overthinking it because it's a first world problem where I'm all set and I'm still, but the beauty of surgery is that for many of us, myself for sure, it is like sitting at the center of that icky guy for Venn diagram, Japanese I believe word, which is where you have, yes, what you can get paid for, but also what the world needs, what you're good at and what you enjoy. You can have it all if that's what you enjoy, but if you don't want to just because you can make more money, go be a day trade or be a work on Wall Street or whatever, forget that if you love that, okay. But the beautiful part about it's great paying job, but at the same time doing a lot of good and there's no losers in the whole thing.
Megan Hoot (00:58:06):
I agree. And actually, so I always joke that I like to work through crises. So I worked in finance during the 2008 market crash and I worked in healthcare staffing in 2020. So I love disaster in crises apparently, but I did the exact same thing. I worked in finance because I thought I was supposed to and that was the money and it wasn't, was I wasn't happy. So it
Dr. Randy Lehman (00:58:32):
Takes you so far.
Megan Hoot (00:58:33):
Exactly. And it goes back to doing the things that make you happy. You can't donate all of your time, you can't donate all of your money. There has to be something in the middle. So as long
Dr. Randy Lehman (00:58:43):
As
Megan Hoot (00:58:43):
You feel good and you feel like you're doing the right thing, coming from a place of integrity means that you don't have any regrets.
Dr. Randy Lehman (00:58:52):
Right. Beautiful preach. So last segment on the show resource for the busy rural surgeon. So this is, if someone's even curious about doing locums, what's the first step that they could take?
Megan Hoot (00:59:05):
They can set up some time with me, so 15 minutes, we'll have that link in the show notes. I have a whole spiel that I have honed in very well on what to expect, what it looks like, what the opportunities are, and I also send out an email each Friday with a list of all of our opportunities nationwide so that people can just get an idea of what the market looks like. Right? No secret. If you Google jobs, they're not going to always be accurate. They'll be old or maybe reposts and things like that. So I make sure to have that accurate list for all of my surgeons every week. My other advice, if you are interested in locums, is to create a folder now. Create a folder in your email. Have, if you have A-T-L-S-A-C-L-S, your board certifications, all of that, just email them to yourself and dump them into that folder. As you know, a job could open at 6:00 PM on a Sunday night and I get the notification on my Apple watch and I'm like, Hey Dr. Lehman, we've got this job right As soon as it opens, because they are so competitive and if they're asking for something like an MPDB self query for all candidates and you don't have one handy, then you might miss out.
Dr. Randy Lehman (01:00:14):
Yeah, perfect. Practical tips, and I totally agree. And so go to the link in the show notes. The other thing is they have an internal bonus program. So if you start, you get a thousand dollars bonus for working first ship. If you do it and you're referred by somebody, the person that refers you gets a thousand bucks. So feel free to tell 'em that I refer you if you want to. That link is going to
Megan Hoot (01:00:41):
Automatically be a referral for you, by the way.
Dr. Randy Lehman (01:00:43):
Okay, there you go. So just use the link. But this podcast is very expensive and nobody sponsored this episode or anything. Neither nor have I taken any sponsors, but I'm not doing it because of that. I'm doing it because this is information that I wanted to hear before and you just did an awesome job knocked out of the park. Thank, but that being said, if there's an opportunity for a bonus, go ahead and set it my way guys.
Megan Hoot (01:01:10):
Absolutely. I've got you covered.
Dr. Randy Lehman (01:01:14):
Alright, well anything else that you'd like to add? Megan? I really appreciate you coming on the show.
Megan Hoot (01:01:18):
No, I think you covered everything and honestly, I think the biggest thing that I would love to tell surgeons, especially residents and folks who are coming out of residency and fellowships and things like that, is just follow what feels right for you. A lot of programs and a lot of advisors will say, well, locums is going to look bad on your CV, or Locums isn't reliable or things like that. And I am sure putting words in your mouth, but you've probably come to find me rather reliable over the years. So even if your job with locums isn't reliable, having that recruiter that you like and enjoy working with is really the biggest thing.
Dr. Randy Lehman (01:01:59):
Yeah, I would ask those people, do you have locums on your resume? The other thing is when someone tells me, oh yeah, I wouldn't use a nurse practitioner in that way. You're opening yourself up to liability and I'm like, oh, do you have a bad experience that you want to share? Oh, no, how long have you been out of residency? Oh, eight years. I'm like, oh, so eight years, you could have been using a nurse practitioner to help you advantage your time, but you don't even really know and you're scared of something that may or may not happen. Come on people. I had people at Mayo Clinic that told me the opposite ends of the spectrum for rural practice. Okay. They'd say, yeah, rural practice, it's just like this. I one guy I know he used to eat drained here, he's out there, all he does is vascular access.
(01:02:40):
He just does ports, dialysis catheters, lines and drains, and that's all he does. And he makes 1.2 million a year. I think I should do something like that. Yeah, you should. Honestly, that's not true. And then another person is like, yeah, he went out to rural practice and there was nobody helping him and he had no support around him whatsoever. And he went in every day at five o'clock in the morning he got started and he worked all day. Fingers to the bone, barely gets out by seven o'clock. He says he go home, he is tried to get dinner with his family, but he can't. He tucks him into bed and then he just goes straight to the computer and he stays up doing notes until one in the morning back at the hospital at five the next day, literally, this is what they were telling me, two opposite ends of the spectrum, both of which are totally not seated in reality. So you got to ask what's your actual experience?
Megan Hoot (01:03:29):
Exactly. That's
Dr. Randy Lehman (01:03:31):
So
Megan Hoot (01:03:31):
True. And that is actually one thing that I leverage rather often when I'm working with new physicians is, Hey, do you want to set up a call with somebody that I've worked with for a while so that they can tell you, number one, what it's like working with me? Because working with somebody that you like is very important, but also what it's like working locums, what it's like working with health, where did we fail and where did we succeed so that you can get a real life experience.
Dr. Randy Lehman (01:03:56):
I love it. Okay, very good. Awesome. Well, this has been a lot of good information, so thanks again for taking all the time.
Megan Hoot (01:04:01):
Of course. It's always my pleasure to chat with you anytime you know that. Yep.
Dr. Randy Lehman (01:04:06):
Thank you. And thanks again to the listener. This has been another episode of the Rural American Surgeon, and we will see on the next episode of the show.
