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Moonlighting: The best of both worlds | |||
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Over the past several years, an interesting transformation has unfolded within the locum tenens staffing industry. What once was dominated by a single demographic class has evolved into three distinct categories of temporary physicians and non-physician providers: the semi-retired; those in mid-career; and younger professionals just out of residency. Although a growing number of professionals have adopted the locum tenens lifestyle as a full-time career choice, there are, however, still those clinicians who only periodically accept temporary opportunities. For them, the extra duties are a means to enrich their professional lives by expanding their practice parameters, supplementing their incomes, or simply as a way to explore what the marketplace has to offer—even if they already have a permanent practice. A NEW TWIST TO AN OLD IDEA The concept of moonlighting is nothing new. There have always been instances when colleagues ask others to cover for them on relatively short notice. Sometimes this occurs within the same facility or multi-physician group, the community, or among friends. With the expanding physician shortage, the circumstances no longer fit these types of informal arrangements. Whether it is due to a lack of time or qualified professionals or non-medical factors, such as reimbursement concerns, more healthcare organizations and private practice groups are turning to staffing companies to recruit short-term personnel. "It has become more challenging to manage these relationships independently, especially as malpractice rates increase," notes Linda Rosen, vice president of Weatherby Locums, located in Ft. Lauderdale, Florida. "Staffing firms put the necessary pieces together, including malpractice insurance coverage, travel, and housing. Also, there are situations in which hospital administrators or group partners prefer contracting with locum tenens professionals from out of the area rather than relying on someone locally." Regardless of specialty, moonlighting is often an ideal choice for practitioners of all ages. Of course, the largest segment of locum tenens physicians remains those who have entered retirement or a semi-retired state. They have been practice owners, partners, or have spent a majority of their careers associated with hospitals, clinics, and other healthcare facilities. For these individuals, short-term contracts present an avenue to still practice medicine, but under schedules they control. "Most likely, they are ready to wind down their professional lives and use locum tenens to test the waters, even while still running their own practices," explains Ms. Rosen. "They are exploring alternatives for their medical careers and determining whether they are well-suited to the mobile lifestyle." The idea of supplementing a full-time position with contingent staffing opportunities is perhaps most appealing to mid-career practitioners. They pepper their full-time commitments with temporary positions to augment their incomes or clinical skills. "These providers may be considering other available options," says Ms. Rosen. "Or they may be growing their private practices and need to create an alternative income source during that process. In these cases, most moonlighting practitioners want to take on as much call duty or weekends as possible. They are there for a limited time and want to make the most of it. In addition, mid-life physicians and other clinicians usually have accumulated significant amounts of vacation time and would like to use it to accept opportunities, often in specific locales." The locum tenens lifestyle offers physicians in residency or providers pursuing advanced training, such as fellowships, the chance to broaden their experiences and increase their earnings. Those who are just starting their careers also may opt for temporary positions so they can test out practice settings, communities, and different patient populations. MAKING THE MOST OF THE TIME Jonathan Adkins, MD, is among the younger physicians choosing locum tenens opportunities while completing a fellowship. He recently signed up with Houston, Texas-based PrimeStaff. "I just started accepting contracts in February, totaling 6 to 8 shifts a month," says the general surgery specialist who holds two state licenses. "I wanted to earn some additional income until I join a private group in July after I complete my training." Currently, Dr. Adkins combines his fellowship responsibilities with a moonlighting opportunity at a local long-term acute care facility in the South, committing to 12-hour shifts, generally from 6:30 a.m. to 6:30 p.m. And, although he is new to this career alternative, he appreciates the educational moments that come with it. "The patients at this particular facility are generally in poor health. I have seen people with heart disease, HIV, and post-operative cases who are not stable enough to return home. When their primary doctors are not available to address their immediate needs, I step in. I assess, treat, and stabilize patients until their regular physicians can be contacted for further care." He notes, "Accepting locum tenens contracts has been valuable to my professional practice. Caring for patients who are declining has been a true learning experience for me. In addition, the degree of autonomy awarded to me is not one that is typically granted in a training setting—which has helped to further build confidence in my skills." Dr. Adkins chose a local contract so he could exercise greater flexibility in combining both of his professional commitments. Despite the convenience of not having to travel, he still must strike a balance between the two positions. "I primarily perform my locum tenens shifts on the weekends and some weeknights if my fellowship schedule allows it," he explains. "But I also enjoy the setting and the community." Whether filling his role as a fellow or as a locum tenens physician, Dr. Adkins acknowledges that adaptability is key to both. "You have to expect the unexpected and be able to deal with anything that comes your way." That ability to quickly adjust also applies to his future prospects. Although his moonlighting days are set to conclude this summer, there is always the possibility that he may once again find himself accepting interesting short-term situations. MIXING IT UP George F. Dietz, Jr., MD, AMFP, a family medicine specialist with 50 years of experience, has made a career out of handling multiple professional commitments. He currently splits his time between three different permanent employers in his Midwest hometown—the city transit authority, a home health company, and a two-office private group—and locum tenens opportunities selected exclusively through Staff Care, based in Irving, Texas. "My career has been like playing poker, in that every time you complete a hand, you are dealt a new one. Now, my hand is a mixture of duties, and temporary contracts complete it." Dr. Dietz's primary commitments include a wide range of medical services. For the city, he examines employees returning from sick leave or disability, as well as new hires. In his role with the home care business, the doctor visits paralyzed individuals, attending to their ongoing medical needs. And for the past 2 years, he has been assisting the private family medicine group's full-time physicians with their caseloads. Since they serve a predominantly Hispanic community, Dr. Dietz's ability to speak Spanish is a great asset. With each of these positions only requiring a few days of his time a week, Dr. Dietz is free to accept locum tenens opportunities. "In the past 3 years, I have had some contracts that were as short as a day and others as long as a month, with many in between." While he prefers small private offices, Dr. Dietz has practiced in a variety of settings when on the road. "I enjoy going into an office where there are a couple of physicians who may be related or have an affinity for one another. Also, I like an atmosphere in which the staff members are lifelong employees and part of the local community. I have found this scenario to be very welcoming and hospitable." Dr. Dietz has also provided temporary services in industrial medicine clinics as well as on Native American reservations. "I recently completed a month on a Cherokee reservation in the South. Years ago, I was sent by the U.S. Army to a reservation in the Central Plains region," he states. "I have seen a lot of the country just by being a doctor." Meeting all of his responsibilities sometimes requires creative scheduling. "Recently, I put in a full day treating patients in my hometown, flew to another state, and then drove to my locum tenens location. After sleeping a few hours and attending church services during Holy Week, I completed a full shift. Early the next morning, I returned home and put in another full day." What advice can he give others interested in moonlighting as a locum tenens practitioner? "Consider finding a staffing firm to assist you with opportunities. I particularly appreciate the help representatives provide with the credentialing process, which can be involved and lengthy. I think gathering all the necessary documentation would be very hard to do on your own, especially if it is a short-notice request. Also, I believe it would be difficult to find locum tenens opportunities independently on a consistent basis." He asserts, "I thoroughly enjoy all of my positions and do not expect to slow down any time soon. Given the fact that I am only 76, and both of my parents lived independently into their late 90s, I have a long way to go." A CREATIVE COMBINATION Moonlighting enables providers not only to exert control over their scheduling, but also to observe various medical modalities in different regions and a variety of clinical settings. "For example," states Ms. Rosen, "if you are involved with a solo practice at home, you can go to a multi-specialty or a large single specialty group as a locum tenens practitioner. That flexibility appeals to many people." "From my own experience as a former travel nurse, I know firsthand that each location has its own style of practice," she adds. "Mobile professionals can learn about new procedures or pieces of equipment and bring that knowledge back with them to their own practices. But this is also an opportunity for the permanent staff to tap into the visiting physicians' expertise, allowing for an exchange of information." Still, blending a full-time job with moonlighting commitments demands due diligence and open communication between all parties. "Certainly, there is a challenge that comes with striking a work/life balance, and that requires efficient time management. And that is where staffing companies can really help busy individuals," says Ms. Rosen. "Our consultants become very familiar with physicians' personal situations, such as their regular hours, family needs, and outside interests. We help them manage it all." In order to do that, though, physicians need to be up front and clear with their locum tenens expectations as well as other priorities. Advises Ms. Rosen, "Share your interests and motivations so recruiters can use that information to match your desires with the positions presented and find the best fit." Indeed, combining interim opportunities with permanent practice is a chance to broaden professional skills sets, supplement income, and gain exposure to new experiences in general. Ms. Rosen concludes, "I think locum tenens is a great way to experience an alternative to your regular practice. It is a chance to have the best of both worlds."
Demographics Retired or semi-retired physicians represent the largest segment of locum tenens physicians; and moonlighting presents an avenue to still practice medicine but under schedules they control. Mid-career practitioners pepper their full-time commitments with temporary positions to augment their incomes or clinical skills. Physicians in residency or advanced training moonlight to broaden experiences, increase earnings, and test out practice settings, communities, and different patient populations. Must-haves |
