Although not for everyone, the ability and the decision to take on the role of sole responsibility as a provider has many enlightening and eye-opening feelings and features – at least, for me, it leads to an exceptional difference in my presence, gratification and work ethic balance. While some jobs as a locum tenens are to buffer already existing staffing, many are due to the complete absence of a provider to perform that job, leaving one in the danger zone of sole responsibility, at least for their own specialty. To paraphrase a great doctor I once knew as a Pediatric Resident who is now a successful Neonatologist himself, Dr. H Zapata, “I may be not famous in many ways, but to my patients I am famous.” A phrase that has stuck with me for years now as something he didn’t realize has had a lasting impact of inspiration for myself. There is something substantial with telling a patient, “I am here, 24 hours, all day, all week, for you. I am here if you need anything, you just let me know.”
Practicing medicine in a silo is an infamously poor decision, regardless of how much experience one has. As Atul Gawande once discussed in a Ted Talk years ago, “Want to get great at something? Get a coach.” It is no mystery that in large training / academic settings or urban areas, and in busier hospital or hospital systems, there are layers of back-up in place. In a hospital with 90 beds, it would be presumed that there are at any given time hundreds of nurses, doctors, advanced practice providers, etc. around. Pooled knowledge and pooled experience leads to methods of addressing problems that may not be easily surmounted alone; and, for the rarities or difficult cases that may present themselves, a variety of practitioners can contribute input of past experiences – you’d be surprised how often one person has odd esoteric knowledge or experience from a previous life that nobody else would know about. However, often for those of us that work as locum tenens, there is often a longer time between clocking in and clocking out – there are often times where my shift isn’t only 12 or even 24 hours… But, more like 240 hours or multiple consecutive days of being, The One.
Although the benefits of multiple minds is helpful during times of uncertainty, anomalies, or troubleshooting unique or uncommon scenarios, it also can lead to “too many cooks in the kitchen,” so to speak. I once heard of a facility in which the providers that would cover the night shift, often disagreed with the primary providers during the day shift, and would alter plans set in motion with bigger pictures and perspectives than a simple 24 hour period. Especially in the world of Neonatology, the path forward is often slow and outside of emergency or acute changes, there is a required perspective on a the holistic endpoint for each patient. I don’t think simply in my changes for the hour, but the changes for the next 2 weeks. Furthermore, when I realize I am the only one around, It leads to an inevitable push to know absolutely everything about every patient and in the middle of the night, if I’m called with an emergency or a change, I know more intimately than someone covering just for the time period, the clinical course and things that may be glossed over or not clearly explained in the handover between simply a day and night shift. When I change shifts with another provider, I’m able to give them the course of the last long stretch of days, and not just the day time decision or the acute overnight events, but the entire story from start to finish.
As a Medical Student, a Resident, and even a Fellow, I felt that having support of so many other providers made it easy for me to sometimes step back from the action. It’s not something I’m proud of, but something I’m honest about because I know many people may feel the same feelings of laissez faire. Frankly, in training, if there was a task to be done after a long 12 hour shift, but 20 other people to do it, it often was a mental challenge to volunteer for more work. Now, as the sole provider, I feel the necessary pressure needed to take initiative and be the one to make the moves or jump to the procedures because, this is MY patient, I am THE doctor, and if I do NOT do it… No one will be there to rescue me.
I write this post not to scare those out there contemplating Locum Tenens. The idea of being alone is often scary and it absolutely should be; but, being scared is sometimes a necessary evil. The moment you aren’t scared is the moment that you are at risk of becoming Icarus and crashing back down to the Earth. However, the strength and the gratitude I feel, the honor and humbling feelings that wash over me, and the gratitude I see in the eyes of every patient that knows my name but more importantly know I am there for them, is purposeful. When you are the only one as a locum tenens provider out in the abyss, you redefine purpose, you move every moment with intention, and you take the time to address the patient and the family from a global perspective, whether you want to or not. I won’t tell you I’m not scared, but I will tell you I am alive.
Image Credit: ChatGPT
