The Hiring Process: Permanent Jobs vs. Locum Tenens

Oh man, I was so confused when I finished Residency and got ready for my first ever job as an Attending Physician covering a weekend shift as a Locum Tenens Provider. A recruiter had called me up, he offered a job, I said yes, and we did the paperwork. The End. No phone calls, no questionnaires, no skills assessments, just straight to credentialing and before I knew it I was walking through the doors of the Labor & Delivery Unit in Huntsville, TX confused, white-eyed and anxious.

So, I mainly write this for the New Grad or those trying to do a Later in Life career switch that have held only one job ever; it wasn’t something my agent really talked to me much about.

Most Doctors tend to hold a very limited number of jobs in a lifetime – you build tenure and connections and you tend to plant roots. It makes sense. Therefore as you dive into your particular field and grow continuity and a base within the community, your practice grows. Working exclusively locum tenens, I have traversed the wilderness of over a dozen various facilities in the course of only 24 months alone. And, while i’ve held continuity at several, interlocking and overlapping each other, I have seen a different side of how the hiring process works for a Locum Tenens Provider versus a permanent staff member.

Becoming Staff

Believe it or not, The Nomadic Pediatrician actually held a “staff” job at a small Critical Access for several months in 2021; however, as it was designed to mimick many of the pros of a Locum Tenens job (eg: reimbursement for travel), for all intensive purposes, it felt the same. The difference of course came in the fact that I was involved, maybe unwillingly, in administrative tasks and was paid as a W-2 employee – but that’s not the point of this post.

Technically I came across that job as a locum tenens provider and my contract was converted to a permanent staff position (a costly but doable procedure); but I remember the interview like it was yesterday… After a brief phone call with the medical staff coordinator in March of 2021, I was flown out to the middle of nowhere of New Mexico – I was given a flight, rental and even a complimentary basket of wine and cheese I couldn’t possibly consume in my 2 days there. I was greeted by a tour of the hospital, dined with special food made by the hospital chef, and sat in a room of 6 different members of the medical staff and board where they asked me multiple questions as they were awkwardly all >6 feet spaced out in a circle around me. They wanted to see if i would FIT, as they hoped for a long relationship. This was followed by offering of a contract for me to deliberate on after returning to Texas. With my very transparent desperation for work at the time, after a few more phone calls to negotiate rates and a revised contract by my Contract Attorney, I took the job.

I was given all of the details of the job, all of the schedules and information on the hospital and the clinic. Multiple emails were exchanged over the course of a few months in preparing the final contract. There was an agenda, and it was followed fairly closely. And, before I knew it, I found myself as the only Pediatrician for a small town in the desert surrounded by nothing, for miles. A normal, boring, story of getting a job, I suppose… But, I am a Nomad, so I quit.

Lost in Locums

Contrast the variety of hiring processes I have seen in the quest to secure a locum tenens provider for a hospital. With some jobs, I have received detailed information in a nice presentation from a locum agent; with others, I have received pieces of ambiguity. From time to time, especially in more demanding jobs, I have been requested to have telephone interviews with the Medical Director to describe the clinical duties and to ensure I’m up to the task. However, this is little more than answering small questions on the number of beds, the types of procedures, or perhaps my experience. Unlike my permanent jobs, the nitty gritty doesn’t matter, it’s all about the nuts and bolts. A locum tenens is often sought out due to the absolute need, and depending on the time and place, sometimes it’s much harder to find a valid candidate – so, the details don’t always matter as much. Now, this comes with a bunch of it’s own risks mainly for the facility if a provider is brought on that is not at the skill level they speak of; but, once again another post for another day. The interview is to ensure I will show up and get the job done, nothing less, nothing more.

I often learn about the hospital only by googling it and the city. More put together facilities will have an orientation put together, but more desperate ones may not. Unlike the typical job hiring process for permanent jobs, I’ve had many times during which I haven’t received a true interview by any mean and instead just show up on Day One. To this day, I still am not 100% sure who I report to, or who my director was, at a few hospitals… Not quite ideal, but when my role has been to provide clinical coverage for less than a week, I suppose the lack of administrative need-to-know, precludes having a direct overseer in absence of emergencies. I show up and hit the ground sprinting. Every. Time.

The contract is also not the same. Unlike a long drawn out situation that has all of the bells and whistles of legality for a full-time permanent job, my biggest contract is with the locum agency and then the normal routine hospital credentialing paperwork. Once that’s all filled out, which is fairly standard, the process can generally be much faster. All this being said, the contracts are generally acceptable to be terminated with or without cause and without repercussions more than 30 days before starting a job. So, the risk and the uncertainty even after a great telephone interview always keeps me on edge. Unfortunately, I have had close to a half a dozen jobs fall apart despite great interviews due to unforeseen circumstances on the end of the hospital after the fact. Now, on the positive side, it is well within my right to not renew any job I feel unfit, and vice versa – it gets rid of a lot of the awkwardness of a THREE MONTH NOTICE, which…. I’ve had to do before.

So for anyone out there that’s new to the locum tenens world, get ready for a whole other concept of getting hired. The more temporary you are, the less invasive, hopefully, the process should be; yet, you may also go in more blind than not. Over time, I have become fluid to both long interviews with multiple people and none with maybe one or two emails. My biggest advice is to stay flexible and read the fine print.

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