Fishing, hiking, tourism and, of course, golf—the activities often cited as the benefits of a locum tenens lifestyle might seem like the stuff of a dream retirement. Locum tenens work definitely allows mobile providers to schedule these and other interests while developing their careers, pursuing their passion for caregiving, and even touring the country to try out prospective retirement locales.

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Whether you're new to locum tenens and need ideas for your days off, or a veteran traveler whose assignments are crowding your spare time, there are many unique ways to complement your medical practice above and beyond the aforementioned stereotypes: becoming an entrepreneur, pursuing an artistic dream, or even volunteering. And workaholics take note: Your recruiter actually wants you to take some time for yourself. It engenders safer medical practice, helps you avoid burnout, and can increase your long-term job satisfaction.

THE MD AS CEO

Alice So, MD, a hospitalist and internal medicine physician, exemplifies the flexibility of locum tenens work. She operates a medical legal consulting business while taking contracts with Cleveland-based Locum Medical. A self-described "professional locum" with no plans to open a permanent medical office, she tailors her assignments to match the needs of her growing enterprise.

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Dr. So started her legal practice in 2005 while completing her residency. It's based in her hometown of New York City; her locum tenens assignments take her outside the Big Apple, but she returns frequently to nurture her business. "I'm going to practice medicine, but I want to practice it on my terms and my schedule," she says. "I love being a locum because it lets me redo my schedule as it fits my personal life and my professional life."

Supportive management at her most recent hospital contract in New Hampshire allowed Dr. So to experiment with different shift arrangements until she found the right balance between career development, compensation, and personal time. Twelve-hour night shifts in groups of seven to 10 days, followed by two to four weeks off, turned out to be ideal. "I've found if I'm not at home in New York City, aside from hospitalist work, I'm limited in what I can do in my private law practice," Dr. So notes. "If I work 8 to 5, I don't make enough money on the day I spend away from my own practice. So I prefer 12-hour shifts." For her, a longer shift is worth the reduced energy and "me" time at the end of a workday if it lets her dedicate several weeks solely to developing her own practice or exploring other business opportunities—or taking a vacation.

ESCAPE FROM NEW YORK

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Dr. So manages to visit a couple of different countries each year—25 in total so far—in between taking locum tenens assignments and growing her business. London became her favorite city after she lived there during medical school, and she tries to return at least once a year. For a view with a beach, Dr. So treasures the island of Anguilla, a Caribbean strip of white sand so small and flat, she says, "if you stand on your beach chair on one side, you can see the other side." At press time, she was undertaking a month-long journey to Los Angeles, Australia, and New Zealand.

If you're new to locum tenens, Dr. So suggests you realistically assess the cost of your standard of living at home and take sufficient shifts to cover it. Don't be shy about renegotiating your rate on new contracts if it falls short. Discover the shift arrangement that best suits your monetary and off-hours needs. Once you've found your sweet spot, seek out new facilities elsewhere in your home state or across the country. This will help you resist the tendency to become settled at your first job, and diverse experience will make your CV more desirable to recruiters and hospitals. "Locum tenens is just a great way to schedule your work around your life," she says. "That's what this profession is built on—its extreme flexibility."

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As an example, Dr. So describes a fellow locum hospitalist who split his time between a contract in New Hampshire and family life in Pennsylvania. As a full-time hospital employee, her friend never saw his wife and daughter during the week, leaving home before they awoke and returning after they'd gone to sleep. But under an arrangement that, ironically, brought him closer to his family by sending him out of state, Dr. So's friend told her, "I may be away from home for 14 days a month, but when I'm home for those other days? I'm Dad." Recovering this togetherness via locum tenens practice can be priceless if long weeks at a permanent position have been wearing thin.

BETTER BALANCE, SAFER PATIENTS

George Andrews, DO, can identify with that feeling. After 21 years of permanent hospital work, he was feeling burned out. "When I was younger and just starting out in the field, I could never say 'No,'" he recalls. "The consequence of that was I ended up working 70 to 80 hours per week for years on end." He had succeeded himself into a corner: "The more you produce, the more they want. If you can do six shifts a week, then they want seven. If you can do seven, then that's what they want from you endlessly," he says.

Switching to locum tenens with Locum Medical has allowed him to set boundaries around his home life. "Balance is the key. Most people who do locum work have worked in steady, full-time jobs, and so they have some idea of what they want out of a work life," Dr. Andrews says. "I do roughly eight to 10 shifts per month," versus the 14 or 15 he was doing at his permanent position. "I worked 40 hours last week, and I've had seven days off. It's almost too much time off! After a few days, you're ready to go back to work," he adds.

One reason behind Dr. Andrews' renewed zeal for work has been the simple blessing of sleep. "You need some time periodically just to recharge your batteries. There are times when I can remember working so much that even with a couple of days off, I wasn't really rested," he says. This can make providing effective care a challenge, and not just when keeping an even emotional keel while dealing with difficult patients; the chances of committing medical errors rise, too.

Cynthia Morrison, a senior recruiter with Cary, N.C.-based Medstaff, echoes Dr. Andrews' concern over the hazards of fatigue. "Under our policy, we always make sure our doctors' needs are first. We can tell if some of our doctors are getting burned out, and we're very straightforward about that," she says. "We have some doctors who want to work as much as they possibly can," even during their time off from permanent staff jobs. The resultant exhaustion, Morrison says, not only can sour them on future locum work; it can also jeopardize their career via malpractice. And because Medstaff provides malpractice insurance to its doctors, this can endanger the firm, as well. So Morrison tries to forestall the possibility by suggesting alternative shift patterns, such as cycles of eight to 10 shifts, rather than the 14 the doctor might request. This gives them better quality of life while on assignment, and it will help make their locum tenens experience positive overall.

Dr. Andrews needs no such push. Locum scheduling has allowed him to get the sleep he needs to feel rejuvenated and eager to return to work. He's been able to pursue his favored fitness regimen in earnest. "Take care of your physical health and mental health, and take care of your sleep," he advises. "For me, that always works." He has been able to travel more often, writes in his spare time, and is currently dedicating his energies to a film project. And the scheduling flexibility of locum tenens will allow him to take a month or two off to guide it from script to screen, should he need it.

RECRUITERS TO THE RESCUE

Other recruiters concur with Cynthia Morrison that taking shift after shift does their clients no favors. Mike Zagami, senior recruiting consultant with Delta Locum Tenens of Dallas, advises new locum tenens physicians to visit their families on breaks; he finds that contact with loved ones makes doctors more eager to return to work. He notes that many locums do have side interests—businesses, real estate investments, and the like—but he still needs to nudge them away from these activities into a real break. "Sometimes they have full-time jobs, and they're working locum to supplement their income," Zagami notes. "So they won't let themselves have one day off. And I say, 'You need to relax and have a day off.'"

Carrying over a routine from their pre-locum tenens lives can help doctors adapt to a new locale and relieve stress, says Shawn Johnson, vice president of marketing with Onyx M.D. of Denver. "If you work out in the morning, make sure you go work out in the morning," he notes. Whether it's movies, skiing, fishing, or even playing computer games, Johnson and his recruiters urge new travelers to program leisure time into their days so they get a chance to decompress.

"I encourage them to get out and enjoy some of the activities in the area," says Jeff Hruska, an Onyx M.D. recruiter. Although many of his clients are eager to load up on shifts (e.g., military physicians fighting homesickness via constant locum tenens work, new graduates paying school bills), Hruska presses them to get out and enjoy local activities, especially for those posted in rural areas like Alaska or Montana.

The best course: Understand how lack of sleep or outside activities can dull your professional edge and foster discontent with your career. And keep your recruiter informed if you feel the hours piling up too high; he or she can suggest some activities and attractions around your locale to help you recover your passion for patient care.

ARE YOU LIVING TO WORK?

Locum tenens offers unmatched opportunities to blend medical practice with the pursuit of personal interests. Even if you're still years away from starting a side business or don't have an artistic bone in your body, you can still plan a more suitable schedule with your recruiter before your next assignment, choose a new area of the country to explore, or even take some time to support a charity (see "Making 'me' time into 'they' time").

Take to heart a lesson that Dr. So imparts from her time in Europe. The American habit of breaking the ice at a bar or dinner party by asking, "What do you do for a living?" is, in Europe, a major faux pas. "I found that if I met people at a social gathering, we'd have conversations about politics, philosophy, drinking, other countries, other cultures," she relates. "You can actually hang out with somebody for weeks on end and they'll never ask you what you do for a living. In the States, we live to work; and over there, they work to live."

James M. Fraleigh is a freelance writer based in Westwood, N.J.

ModernMedicine NETWORK

TOOLS
Joseph Smith, RRT, EA, offers locum tenens providers a number of timely tax tips regarding charitable endeavors—including charity work and medical missions. Go to locumlife.com/charity for more on what you can and can't deduct.

COMMUNITY
Building model airplanes and providing charitable medical care throughout the Western Hemisphere are just two passions of Roy Miller, MD. Read more about his balance of work and life at locumlife.com/miller.

Making 'me' time into 'they' time

Looking for a new way to refresh your spirit between shifts or assignments? Consider volunteering for some charity work.

Before beginning locum work, George Andrews, DO, spent five weeks as a relief doctor in Sri Lanka after the Dec. 26, 2004, South Asian tsunami. Although he hasn't had the opportunity to perform any volunteer work since starting locum employment, he's eager to pitch in as his schedule and financial situation allow.

More recently, Jen Sun, MD, an anesthesiologist with Atlanta-based LocumTenens.com, found an opportunity to assist in earthquake-ravaged Haiti. "My existing assignment had this big, six-week break in the middle," he says. Coinciding as it did with the Jan. 12 earthquake, Dr. Sun took some time away from home to travel to Haiti and provide aid amid the ongoing crisis.

If you don't currently support a charity with pro bono medical relief work, ask your locum representative if his or her agency has partnered with an aid organization. For example, through its sister company, MedicalMissions.org, LocumTenens.com can match interested volunteers with organizations sponsoring missions to countries in need.