It is always fascinating to me the way that locum tenens providers are perceived and welcomed to new jobs. After working at over a dozen different hospitals in the short time period of 3 years, I have seen a drastic variation in how orientation works and the acclimation process from one facility to the next. Particularly of interest, within a week of each other in December of 2022, I had two jobs starting in different states within a week of each other with polar opposite opinions on the best way to “break” me in. One facility in Wisconsin had etched out a particularly superfluous schedule of 3 days of orientation. It involved intensive hours of meeting with various committees, directors and trainers and even included a requirement to stay in the hospital overnight for the potential need of emergent situations, despite 2 other back-up providers being on call. When I went live, I hardly saw any patients. Less than a week later, in a direct counter culture, another job offered me 1-2 hours of an orientation on a Friday followed by an intense 24 hour in-house shift immediately the next day on a Saturday. When I went live, I went VERY live. The best unifying confusing part for these two extremely different jobs? At both sites the directors or onboarding coordinators told me: Oh, sorry, we’ve never really worked with locum tenens so we don’t really know how to do this…

Working locum tenens isn’t for everyone – I acknowledge this very openly as do many of my more stable cohorts. Outside of the stability and the need for geographically focused jobs, there’s an element of the unknown that is always scary. When I interviewed for fellowship positions, the number one thing that I heard across each interview from the current fellows on the hardest part of their transition from medical resident doctors to medical fellow doctors was: It’s a new system and a new hospital to get used to. Not to be too cocky, but as someone who has made a living becoming an expert at this one specific obstacle, I scoffed at it.

The need and expectation of myself as a locum tenens provider always creates in my head, an over-hyped concept of myself as a special ops paratrooping relief worker. I am sent all over the country and thrown into unknown situations, sometimes given a limited map, and told, “Go.” The most extreme situations I have had have been in California and in Santa Fe, New Mexico. At one, I was given a 4 hour morning orientation and showed up the same night to a list of over 30 sick children to care for and one going into anaphylaxis (a severe allergic reaction that can lead to low blood pressure and breathing difficulties) and told I was the point person for transfer from all over the region. At the other, after another morning introduction, i returned the same evening to work a 72 hour shift that culminated in a neonatal code resuscitation. So, to be fair, I do feel I can justify the analogy when I am catapulted into a marathon on an hour of sleep with no carb loading ahead of time.

However, the expectation is ultimately the same for me to perform as a full fledged doctor no matter where I go. Lives still depend on me and my acquisition of new teams becomes dependent on my flexibility. I do not know everything, and I am ever cognizant of it by doing more work at different sites. I am sometimes tasked with clients thinking that by nature of what I do, I don’t take anytime to break in; but, I am only human. On the opposite side, I truly don’t need as much time as others might, as I do this professionally. It is in my blood to be thrown into new situations and to survive and it has been my thirst as a locum tenens provider to challenge myself to perform under these situations. I absolutely live for the moments when a flare gun signals the start to a race but i’ve barely made it onto the track.

Not everything will be fluid, and there are often learning curves at each new location. Consultations, protocols, communication and administrative standards and politics often vary, but I have learned to be flexible and mold into the space i’m given. The adrenaline is always an adventure, and when I start a new job and am thrown into a computer system i’ve only used for an hour and told to see patients quickly after, I rise to the task, retrain my thoughts, and, “Go.” Medicine and being a doctor is the same no matter where you are, a concept that so many seem to see distinction in. The details will vary and the nuance are everlasting, but at the end of the day the big picture and my gut are what I trust. So, once again, I jump into the helicopter, my heart racing and my eyes red with anticipation. I am pushed out into the clouds, a parachute hopefully attached, and when I hit the ground, I’m don’t run… I sprint.

Image Credit: https://www.primedesignprojects.com/Hit-the-ground-running-n4037/