I remember the first time I heard about Locum Tenens – I had no idea what it was and just heard a talk by an agency (who I don’t use for certain reasons, please ask me later) at our residency didactic lectures. The idea was so foreign but sounded so exciting to me, but I had no idea really where to begin. So, imagine right out of residency jumping into this world of ‘Travel/Substitute Doctoring’ amidst trying to navigate other changes such as becoming an ‘attending’ and no longer having the safety net of my training program. I had a lot of questions and have spent the last year figuring out the answers, sometimes on my own and sometimes with help. Recently I’ve had a lot of friends and colleagues intrigued by the concept of Locum Tenens so i figured I’d right this to give some tips to those trying out this nonconventional career path. At this point, I have worked with a handful and contacted at least a dozen different agencies.

However, to start with some disclaimers: I by no means think i know everything and am still learning daily, I am keeping this piece generalized as to not focus on or exclude a specific locum agency or recruiter, I don’t take any responsibility for what happens with or without this advice. This is purely to give MY own personal experience/advice from MY perspective as a Provider.

So, here we go, hopefully this helps out!

1. Understanding the Industry
   1. There are hundreds of locum tenens agencies. Technically, you don’t actually need an agency to work as a locum, but it certainly helps to facilitate everything. In theory, it is possible to arrange for a direct contract as a ‘PRN’ with a hospital, but getting coverage or reimbursement for travel, malpractice and accommodations may be a little more tricky. There are definitely pros and cons to both sides, if starting out, I for sure wouldn’t do this.
   1. Historically, some recruiters and agencies have NOT always been ethical or nice to providers, so it can be difficult and put you in bad situations. So, there was an organization formed called NALTO (The National Association of Locum Tenens Organization). Now, this is important, NOT ALL LOCUM AGENCIES ARE PART OF THIS. Does this mean they are necessarily bad? No. But, it is something to think about. For me personally, I DO tend to stick with agencies that are part of NALTO – but your level of trust may vary.
   2. While MOST big agencies do have the power, resources and money to pay for travel and accommodations as listed above, some may not. Every company will have a different list of what IS and is NOT covered, but for the most part, travel in some capacity is normally not an issue. Lodging, license fees, etc. may vary.
   3. You may click more with one recruiter vs. another but remember that their job is to SELL. I personally believe that you can have a friend-level relationship as well as professional with a good recruiter, but at the end of the day, you both want to get paid. Remember that if you get work they get paid and vice versa, it helps to understand this with your interactions and when it may come down to competition for selective jobs. I really appreciate my reps and trust them a lot.
      
2. Getting Started: Part 0 – Prepare Yourself
   1. Start Here: Locum Tenens: What It Is & 5 Reasons Why I Do It
   2. Read about the IMLC – This is for obtaining a compact medical license to work in multiple states, learn about it
   3. Renew your certifications for things like ACLS, BLS, etc.
   4. Update your CV (month/year is what I’ve been told)
   5. Look at the documents section below
   6. Get your DEA (While medical licenses are often reimbursed, DEAs usually are not)
      
3. Getting Started: Part 1 – Affiliating Yourself with an Agency
   1. Figure out what company you’re interested in, and email them! Well talk to me first so i get the referral commission of course! 😁
   2. Have a conversation with a recruiter via phone to discuss your background and what you’re interested in doing. If you hear something that doesn’t make sense to you, or is a little sketchy, not only ask for more explanations but listen to what you hear from other locum agents/agencies to guide whether or not what you’re being told is true or false.
   1. Email a CV to your agent. Scroll down for an overall list of documents to keep organized and ready to go
   2. Start credentialing with the agency – Each agency has their own forms for credentialing. This will become SUPER redundant which is why below I’ve recommended keeping adequate records. They may require procedure logs for certain things, so keep this in mind and log EVERYTHING.
      
4. Getting Started: Part 2 – Documents
   1. So, this is one of the most critical things you need to have organized. If nothing else, this is, in my opinion, one of the most important things. Staying organized is KEY to being successful at locum tenens – one thing I didn’t take into consideration until my 2nd assignment was that even after you’re credentialed with an agency you’ll have to get credentialed with EACH FACILITY! This means 1203120320 pages of paper. Now, people will often help you fill out applications but if you aren’t crystal clear, it’ll take longer. Check out “Other” below for supplementary documents I keep in Word format. To each their own, but I have a neurotically organized folder in my Dropbox with multiple subfolders, as below, that include all of my information (Obviously do what works for you!): Biometrics, Board Scores, Diplomas/Certifications/Licenses, Labs/Titers/Immunizations, Malpractice (Professional Liability), Other (*** = Special cases that have needed these extra things)
      1. BIOMETRICS
         1. Copy of drivers license
         2. Copy of passport
         3. Copy of SSN
         4. Passport photo 2″ x 2″ they always say (🤷🏽)
         5. Statement of good health from your doctor from your last physical exam
         6. Voided check copy
         7. .jpg or .png or what not of your initials and also of your full signature for Docusign and such
         8. CV in month/date form (updated when you START each job, so you don’t forget), i routinely email an updated one to my recruiters… when i remember
         9. NPDB (National Provider Data Base) Query – Although I’m pretty sure FCVS/FSM can obtain this too or needs to anytime you use it for a new license
      2. BOARD SCORES
         1. USMLE Step 1-3/COMLEX
         2. Specialty and Subspecialty Exams (ABMS = American Board of Medical Specialties)
      3. DIPLOMAS/CERTIFICATIONS/LICENSES
         1. Copy of medical school diploma
         2. Copy of postgraduate certificates (eg: Residency and Fellowship completion)
         3. Life support certifications (I recommend putting the expiration date in the name of your file to remember to re-do them. Eg: BLS (EXP 2/23)): BLS, ACLS, PALS, NRP, STABLE, etc.
         4. Copy of ALL medical licenses
         5. Copy of DEA
         6. Copy of CSR (Controlled Substance Registration – Required in a handful of states as an additional stupid thing on top of your DEA just because they want your money)
         7. ***Certificates of certain procedures (Eg: Nexplanon placement, although this may still need a procedure log)
         8. ***Copy of undergraduate transcript (Although, if needed, as in my case, may need to request directly anyways for a formal copy to be sent directly from the institution to the Board or job)
      4. LABS/TITERS/IMMUNIZATIONS/TESTING
         1. Immunization history may not always be enough, but have it (Tdap proof is usually needed in the last 10 years for sure)
         2. Vaccine titers I’ve been requested: Hepatitis B, Varicella, MMR
         3. Negative TB test (TST vs IGRA) in the last 12 months (or if positive a CXR is required) – I was able to get this covered by a locum agency when needed for the IGRA
         4. Influenza vaccine proof
         5. COVID-19 vaccine proof
         6. Mask fit testing
      5. MALPRACTICE (COI = CERTIFICATE OF INSURANCE) – As i’ve gotten more work, i’ve learned to keep a folder with my various copies of COI’s as you may be asked for them with future jobs.
      6. PROCEDURE LOGS = Keep procedure logs! Ask the MSO at the end of each assignment if they can send you a procedure log if possible (I’m definitely still learning this)
      7. OTHER – This is something I’m particularly proud of! It’s made it easier for me to ask for help with filling out 1203120 pages of applications. One thing that I’m imagining has set me apart from other people, but who knows. I don’t ask my recruiters if i’m their favorite but, come on, I probs am.
         1. Word document with my references in ascending order of who to try first (program director/department chair is what i start with), generally someone you’ve worked with in the last 12 months if possible
         2. Word document with a list of everywhere i’ve lived for the last 10 years, organized by dates of course (for background checks)
         3. Word document with all of my Hospital Affiliations and Training Programs – Including 1) Start date, 2) End date, 3) Address, 4) Phone number, 5) Fax number, 6) Email/contact if possible
         4. Word document with medical licenses/DEA information in a neat table to make it easier, example with fake numbers below, don’t try to commit fraud, I’ll find you.
            
   1. Side Note: While not listed here, it’s good to keep a separate notepad, note something in your phone, etc of all of your log-in information, ID#s and loyalty things (like to airlines!)
   2. KEEP A LIST OF EVERYWHERE YOU’VE BEEN PRESENTED AND BY WHO!!! (SEE BELOW)
      
5. Now You’ve Started: Part 1 – Getting the Job So, I’ve learned after working with and talking to like 10 companies, that this can vary from one person to another as well as one recruiter to another. If you have someone dependable, this is my general feeling on how things go.
   1. You’re told about a job – “Hey, this is Joe with LocumLocals.com, I heard you were seeking a job… How you doin’?”
      1. Location – This may not be very precise to keep the job hidden from competitors, but may be, especially if a certain hospital/clinic has a monopoly of one company
      2. Job Description – Inpatient/outpatient, number of patients, procedures required or desired for you to do
      3. Rate – THIS is where you sometimes can try to haggle. There is an art to this and negotiations and that’s for another time, but generally the rate is broken up into a few possible situations:
         1. Hourly rates if clinic or in-house
         2. Out-of-house call rates
         3. Mommy pager rates; this is separate from out-of-house and usually will be stacked on top of something like clinic during the day
         4. Overtime/call back rates, if you are currently on step B or C above and have to go back to the hospital
         5. Flat all-inclusive rates
      4. Dates – Sometimes this is 1 shift, sometimes this is a stint (Eg: 2 weeks in July) and sometimes this is a recurrent thing (Eg: 7 days every month x 6 months during someone’s maternity leave)
      5. What’s Reimbursed – Every now and then you’ll have issues with a client (aka the Hospital/Clinic) not wanting to cover something or another. Not always, but it happens
      6. Miscellaneous Details – Like EMR or support staff or whatnot
   2. You ask questions if you want – I like to ask what the daily number of patients is that I’m expected to see if it’s clinic
   3. ***IMPORTANT*** CONFIRMATION OF YOUR PRESENTATION: You say YES. Once you do this (via email/text/verbal/Harry Potter owl) you are NOW presented. What this means? From now until specified in your provider agreement with the locum agency (normally 2 years from presentation OR the last shift worked at a facility) the agency OWNS your right to work there and your CV. Here are some scenarios:
      1. You are presented somewhere by LocumLocals in September 2021 but someone else gets that job. Bummer. They quit and then you hear about it again by your new agent with LocumsOnly in July 2022. Ah well unfortunately, you can NOT be presented by LocumsOnly or you’ll violate your contract with LocumsLocals, so you can call LocumLocals back up and ask them about it – technically not a violation of the whole ‘lets keep jobs’ quiet thing…. But this is for sure an awkard grey zone i’ve been in myself… It happens
      2. You are presented to a hospital, you work there for a year and they like you and they want you to join as a full time person. Well, that’s ok, but you are binded with the locum agency until a ‘Finders Fee’ or contract buyout is agreed on between the hospital and your agency.
   4. You wait and hopefully they get back to you – SOMETIMES you may have a phone interview with the facility, but not always
   5. They say they want you!
   6. You work with your agency to fanangle your travel plans! Yay!
      
6. Now You’ve Started: Part 2 – The Job
   1. I’ll keep this simple but show up on time, dress/act professionally and remember that they don’t know you. As someone that isn’t very serious, I learned the hard way that some people are overtly sensitive and you are temporary and easily replaceable, so don’t mess this up. Don’t be a prick.
   2. Usually there is an orientation before you start.
   3. Familiarize yourself with the unit and the EMR if it’s new
   4. Read my other blogs on continuity of care and all that jazz that i’ll keep posting
   5. If inpatient spend some time getting to know the unit director, the charges, the MSO and the House Supervisors! This is INVALUABLE for references, future work and ease of functioning in a hospital. This seems super super obvious to me, but apparently it’s not, so this is my #1 survival tip in this locum eat locum world.
      
7. The Fun Part – Points on Points on Points: My recruiters know, I take advantage of this all the time. I have loyalty numbers with multiple airlines, hotels and car rental companies. Whenever I can pay on my own card (Eg: American Express Hilton or Chase Marriott Bonvoy) I do! I wait for the reimbursement, put the charge on myself and triple my points all the time.
   1. Keep a very NEAT collection of receipts and hospital folios and the such. READ THE REIMBURSEMENT POLICIES THEY SEND YOU.
      
8. SERIOUS LOCUM PROVIDERS ONLY – Get an LLC or an S. Corp. I’m not going to go into this here, but if you do this enough, I highly recommend it as a vessel to run your business and reduce your taxes as much as you can. I have not personally done this in my current situation but it’s in mind down the line.

Hopefully these help you with a good start as a new Locum Tenens provider! It can be challenging at first but organization is key. The rest is trusting in your medical skills and making sure you always have great communication with your recruiters, coworkers and the hospital administration frankly.