As a locum hospitalist my entire career, I thought I’d share my thoughts for others considering or planning for it in the future.
This is a doctor hired by a third party (the doctors employer) to a client (a hospital or office) at a high hourly rate for temporary work while the client fills his position or is no longer in need of the doctors services.
The problem arises when hospitals in need of a doctor – and let’s specifically discuss hospitalists since they are the work-horse of the modern American hospital – are looking to fill old positions. Some hospitals are growing and new positions need placing, but that is a sign of a healthy hospital organization and one that can afford the cheaper and more long-term contractual agreements with candidates of their choosing. Most, however, need an old position filled. This may be due to a temporary circumstance, or it may be due to a doctor’s choice to leave for greener pastures. If that’s the case, that hospital is probably tight for money, or changing in a way that is worse for the doctor just like what often happens when a huge conglomerate healthcare organization buys a small private hospital and forces its corporate policies onto management now taking orders from HQ.
If that’s the case, the hospital could have sums of money pumped into it from the new buyer or the opposite, stricter spending policies and hiring leverage. When the hospital is in a bad financial situation (and I think most of them are these days, in America), paying two-fold for a hospitalist while searching for its own is like renting a Porsche while searching for used Buicks. Eventually, that Buick is unaffordable. So like anyone else, might as well use that Porsche while you can to its potential since its all you’ve got to work with! Catch my drift?
These can serve as leeches to the system by taking advantage of desperate hospitals and sometimes desperate doctors. They are the epitome of a middle-man. Essentially a corporate pimp. They will always be so friendly to you as the doctor, sticking up for you when you need it, pushing for your salary to go up. Don’t buy it. They are there to take advantage of you and make money from you. Here’s how.
The company has a client representative and a provider representative and their roles are to make their side happy with the contract negotiated. In between, is their boss who expects either representative to get as high or low of a price from their respective customer. While the doctor’s agent pretends to be doing everything possible to get him a higher salary (supposedly by getting more from the hospital), his colleague is doing the opposite and striking as low of price for the hospital so they pay less by the hour. In reality, they are doing the opposite – the doctor’s rep is trying to pay as little to the doctor and the hospitals rep as high as can be negotiated so that the difference between the two is absorbed by their own company who provides them a cut of the profit. The gig is supported by the ability to pin blame on the opposing parties against one another. They tell the doctor that the hospital can’t afford to pay them more while telling the hospital the hospitalist won’t work for less. How much they are offering either side is kept secret from the other.
From my experience, I’ll say don’t let any company trick you into thinking they are there for you. You make them work for you and your prices or go search for the next Locum Tenens provider. To beat them, you have to place them into their own competition against other locum companies. Choose the one that will give you the price you ask for. Never be afraid to step away, sometimes you have to. They too are in high competition now as their field of service is exploding and competitors are arising left and right. Use that to your advantage. Don’t even discuss what the hospital will pay; discuss what the other locum company will pay you. That’s the angle of approach to take.
If you are experienced working at different hospitals, you can probably skip this section. If not, expect that your work will be difficult. Any hospital in need of a doctor desperately is one where you are expected to start working full speed from the start. Don’t expect orientation. That may be as little as half a day computer lesson and shadowing a doctor too busy to teach you anything. Fingers crossed your software logins are setup for you when you start day one. Anything is possible.
Bottom-line, if you sense danger for you or your patients, walk away on the spot. As a private contractor you can do that. It’s your right. If it’s your first job, don’t forget that. Private hospitals can be cozy as well. Or, they can be nightmares that evaluate you poorly for questioning practices or leaving early.
In most situations, you are an outsider in a well-established organizational social hierarchy. Some may see you as ‘the problem.’ Either because you are ‘stealing a job’ or twice the cost (because of the middle man hiring you out). They may expect twice the value for that price and work you harder than other hospitalists. They certainly won’t consider you one of their own until you sign with them for the long-run. That’s okay, they are not your employer and you have room to dismiss their requests to your employer for decisions about you. That’s a nice separation that comes with the job and I recommend you maintain a respect for it while working the “assignment.”
That’s the most basic advice I can give but there’s details and advice about specific parts of the job that I hope to post in the future. Subscribe to Become A Hospitalist for future posts by me, doctor Matt Roman, MD. Or, take a look at my own blog, where you can follow updates to the unusual career I’ve embarked on as a Medical marijuana consultant. You can contact me through my site for feedback or enquiries.