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    Espousing the locums tenens lifestyle


    It all began the way many great adventures do: completely by accident.

    It was mid-2004 and I was working as an associate attorney at a large defense firm in Jackson, Mississippi, while my husband Sam finished his residency in family medicine. We were nearing the end of our academic requirements, and soon we would be free to start a new life anywhere we chose. The only problem was we had no idea where we wanted to go.

    Where we lived, Sam had many attractive job offers but felt that it was time to move on to another location, preferably one with beaches or mountains. Although I was making lots of money (by my standards, anyway), I felt convinced that the life of a fancy attorney was not right for me. In fact, as I sat despondent in my bargain-sale suit behind my polished desk at the tall, imposing law firm where most newbie attorneys would kill to work, it became increasingly clear that the only reason I went to law school in the first place was out of sheer terror of remaining a waitress at an Irish pub with an English literature degree and way too much student loan debt. It takes a law degree to figure these sorts of things out.

    Sam's graduation loomed ever nearer as we continued to interview at various locations. Nothing seemed quite right. Sam didn't want to take a position with a Jackson-based company because he felt it would be unfair to the employer if he had no intention of staying. He really wanted to find a place we both liked so that we could settle down, but the closest thing we had found that combined location, cost of living, and opportunities for both of us was a hospital-sponsored start-up opportunity on the Mississippi Coast.

    Sam felt uneasy about the concept of starting a clinic on his own. Thanks to our professional degrees, we both had plenty of student loan debt as it was. Did we really want to take the plunge and start a new clinic, only to be saddled with that obligation if it did not thrive? And what if, after a year or so on the coast, we decided we really didn't like it there after all? It's hard to just pick up and leave if you've got a clinic, a patient base, and full-time employees that you're responsible for.


    We continued to look around during those last few weeks of his residency, hoping with some level of optimistic mysticism that something would somehow work out. I started paying extra attention to my fortune cookie messages at our favorite Chinese restaurant and looked everywhere for a "sign" of what we were meant to do next. I grew up as a missionary kid, so looking for signs came pretty naturally to me.

    Thankfully, during our spare time, we'd been furiously searching online for some type of temporary work to bridge the gap for Sam until we were ready to take the commitment plunge. We had e-mailed a number of recruiters for various locum tenens positions around the United States, and one recruiter told us about an opportunity about 40 minutes from where we lived. The position was for at least two months, provided a decent hourly rate and malpractice insurance, and could begin as soon as Sam was ready to start. Perfect! Sam could start his locum tenens gig, I could keep my law firm job, and we could continue to explore longer-term options.

    Sam graduated from his residency and things were good. He liked his locum tenens job and his job liked him. In fact, the facility he was working for had indicated it would like to hire him full-time, even if he wasn't sure how long he would want to stay in the area. Maybe, we started to think, we should just stay put for a while, even if we had always planned on moving as soon as we both could.

    Maybe Jackson wasn't ideal, but the opportunities were definitely there. I had a good job, the cost of living was super low, we had friends and a house. ... Maybe—and here is where we felt the walls of justification edging in around us—we shouldn't eschew the fine metropolis of Jackson just because neither one of us particularly liked it. Maybe we should just be reasonable like most people, choose a place to live, pick good jobs, settle down, and start a family—even if that wasn't remotely what we had in mind for ourselves.

    Then, just as quickly as our ideals were giving way to conformity, a confused geriatric neighbor drove his Buick through the front of our house. Our neighbor was carried out of our home in one living, breathing piece. His car left some interesting tire marks on our wood floors, and it really opened up the place and brought the outdoors in, so to speak. Our insurance company put us up at an extended stay hotel while our home was being cobbled back together. Sam and I decided that this could very well be a sign: Get out of Jackson!


    We decided we were going to leave once and for all and took great comfort in the thought that we could actually move around the country from locum tenens position to position until we found the right spot for us to call home. (Many positions are with the military or a VA hospital and so any state license can be used. For those positions with out-of-state private hospitals or clinics, the staffing company can often help with the licensing application process.)

    Sam had opportunities anywhere he liked—from Puget Sound to Key West—but the one that piqued our interest was a year-plus position at an outpatient Army clinic in Germany. The compensation structure was a little out of the ordinary because it offered a per-patient fee instead of an hourly rate. While the position did offer malpractice insurance and some moving expenses, no other subsidies for living expenses or an automobile were in the package. Nonetheless, we were intrigued by the thought of a year in Europe and were assured both by the staffing company and by the previous locum tenens doctor that seeing enough patients to finance a year in Germany wouldn't be a problem.

    "Why not?" we said to ourselves. "We're young, we don't have kids, our home is literally in shambles ... if not now, then when?" Carpe diem can be a sneaky thing.

    Sam accepted the Germany offer and told the staffing recruiter for his current contract that he would like to extend it until we were ready to move to Germany. He estimated that this would be for another six weeks, as the visa and credentialing process to work in Germany takes at least this long. "No problem," she assured him. "They'll be happy to keep you on for as long as you want."

    Six weeks flew by in a blur of packing our belongings, filling out reams of documents for the position in Germany, giving notice to my employer, and cleaning a house that was filled with enormous quantities of dust and debris. Unbelievably, our home was fixed up in record time, and we entered into a contract to sell our house one week before our departure date. Another sign perhaps? Everything seemed to be working out way too well.


    We landed in Germany full of hope for the great adventure that awaited us. It was October 2004 and the weather was brisk. We stayed at the Army base "guesthouse" until our long-term accommodations had been finalized, and we spent the first week and a half trudging from one building to the next to get the necessary identification, registration, etc.

    Finally, Sam started his first day of work. It was an exciting prospect for us because, in an ideal world, we were set to make a decent salary with his per-patient arrangement. We soon discovered, however, that the clinic had been ill-prepared for Sam's arrival, and no one was really even aware that a physician was available to see the families of active-duty soldiers. The result? Sam had extremely low patient numbers and his take-home salary was abysmal. The thought of returning home with our tails between our legs was a constant consideration. But then again, so was this once-in-a-lifetime opportunity to actually live in the middle of Europe and drive to Paris or Prague or Munich on long weekends. We decided to stick it out.


    After half a year, patient numbers picked up substantially and we were bringing in enough cash to complete our year term. While Sam went to work, I spent my time writing, filling out state licensing documents for Sam, running household errands on an awesome Dutch bicycle purchased at the Frankfurt flea market, hosting various family members who came to visit, and test-proctoring at the Army base.

    On long weekends, we saw as much as we could of Germany and the rest of Europe with a sense of frugality that would put those shoestring-travel tour books to shame. On our self-guided tours, we saw Munich and Vienna, Paris and Calais, Prague and Budapest, Rome and Venice, Amsterdam and Brussels, Barcelona and more.

    Late summer 2005 brought us news of Hurricane Katrina, and we watched with no small amount of anguish as CNN reported on the devastation of the Gulf Coast. After all, Katrina actually came ashore in Bay St. Louis/Waveland, Mississippi, which was where we had previously attempted (unsuccessfully) to find an employed outpatient position in early 2004. To make matters worse, Sam's family lived about 40 miles north of the coast, and because of the hurricane we didn't hear from them for quite some time. We realized it was time for us to go home.

    In November 2005, we returned to the United States and looked in disbelief at the wreck that was the Mississippi Coast. There were boats in trees and whole neighborhoods with nothing but a patchwork of slabs and twisted metal. There were temporary shelters set up where there once had been gas stations and fast-food restaurants. Roads along the coastline were either cordoned off because of hazardous conditions or were missing altogether. It was a complete wasteland.

    We stayed with Sam's parents and hoped we could be of some use to the recovery efforts. I volunteered at the FEMA Disaster Recovery Center legal booth with the Mississippi Young Lawyers Division, but because of the swell of out-of-state physicians who had come down to volunteer at temporary health shelters, there was no real opportunity for Sam. Realizing that we couldn't live on volunteer work alone, we looked once again to locum tenens and found a two-month opportunity on Puget Sound. We had been interested in the Pacific Northwest for some time and thought this would be the perfect opportunity to see if the area was somewhere we could call home.


    In December 2005, we took a road trip to Seattle and settled into a small bed-and-breakfast on Camano Island. The locum tenens arrangement helped us with moving expenses, lodging, malpractice insurance, transportation for Sam and, of course, an hourly wage. Sam began his work at the nearby clinic and we used our spare time to interview at various clinics and hospitals in both Washington and Oregon.

    After two months, the clinic Sam worked at offered him a full-time position, but we weren't convinced that the Pacific Northwest was for us. Furthermore, we still felt like we wanted to be involved with recovery efforts in our home state, and I had located a paid position to serve as a Katrina Legal Fellow with a nonprofit called Equal Justice Works. It was exactly what we were looking for: a way to help disaster victims while putting some money into our bank account.

    We returned to the Mississippi Coast in spring 2006. During our first year back, Sam took a job with a medical nonprofit that provides sliding scale/free healthcare to low-income patients, while I did my fellowship. After working at the medical nonprofit for a year, Sam was offered an employed, outpatient position with the local hospital—the same hospital Sam had tried to find an employed position with back in 2004. Sam took the job and he's been working there ever since. We bought a house, I started a home-based consultation business, and we are heartened to see our state's coast slowly come back to life.

    Sam and I often reminisce on the many adventures we've had, all courtesy of locum tenens positions. How else could we have explored the coastline of the Pacific Northwest, visited the majority of nations within the European Union, and actually lived for a year in a quaint German town near Frankfurt, all while earning an income?

    Because of locum tenens, we were able to give the Seattle area a trial run and not just the perfunctory visit that most interviews would have afforded. And because we were already in the area, we were able to squeeze in interviews for a half-dozen other towns along the coasts of Washington and Oregon, too. Since we drove to Seattle from Mississippi, our commute there and back gave us an opportunity to explore towns in other states we had been interested in, all on a time schedule that was much more relaxed than if we had flown out for a solitary interview.

    Sam and I both agree that locum tenens gave us the flexibility, exposure, and time to find what we really wanted in our careers. Without it, we would very likely still be living in Jackson, dreaming of the day when we could go somewhere we really wanted to live. Will we ever consider locum tenens again sometime in the future? Perhaps. After all, it is nice to know that option is always available.