Vlad Dzhashi, MD
I sat down for an in-depth discussion with locum tenens urologist Dr J.W., who almost quit medicine altogether after being hospital employed for three years after training. He knew he never wanted to be employed again but also recognized the struggles of independent practice. He found the perfect solution in locum tenens urology.
We discussed how working as a locum tenens allowed him to keep practicing urology on his terms, touched on how to find positions, demand for locum tenens urology, and typical work settings.
In addition, we reviewed typical pay rates for locum tenens urology, how to negotiate pay and understand how to leverage your position during pay rate conversations, and typical schedules.
We covered the quality of equipment, supporting staff and administration, and the question of patient coverage when the locum job is over.
Finally, we examined troubleshooting locum tenens urology gigs and what he might have done differently in retrospect.
Enjoy reading the interview below, or watch the video here.
Table of Contents
Why choose locum tenens as a urologist?
After training I took an employed urology job, and really came to understand the difficulties within the system, not having a final say or control over a lot of things. I almost had my foot out the door- I got my real estate license and was looking at options other than healthcare because of burnout. I knew I never wanted to be somebody’s employee again, putting myself in a position where I can’t deliver patients the care that I want at the quality that I want.
Thankfully, I found locums; I still love urology and I love helping people through surgery. Also, I was able to claim back some of my time. I’ve been able to make basically the same or even a bit more than I was making as a full-time doc in about half the time.
What is the best way to find locums work as a urologist
While I’ve done some research into direct locums and per-diem, honestly I’ve found that working with a company that already has relationships has been more fruitful and easier.
Trying to figure out what facilities are in need, who to contact and how to get malpractice insurance is not easy, and not the best use of my time, so working with a couple of companies I have been able to maximize my time and minimize the need to do that work myself.
I think having a couple of different companies you have a good working relationship with that send you jobs is in your best interest. Usually the notice for a job ending is pretty short- say, thirty days- and so you can be left scrambling, especially if you have to credential and get a new state license asap.
Working with a couple of different companies gives you some protection from that scenario.
Our High-Paying Urology jobs:
$4000/day Urology Locums in York, PA. Clinic only, no call. Close to DC and Baltimore.
$400/hr Urology Locums in Illinois. No call. Clinic/OR.
$5000/day Urology Locums in KY. Call only No clinic.
What is the demand for locum tenens urologists
Demand for locum tenens urologists is quite high. Urologists are already a critical shortage throughout the country, and about 35% of us are over the age of 65. It’s a numbers game- yes, you’re going to have to find the situation and opportunity that’s good for you, but I still get emails and messages or text messages pretty much every week, if not more.
When I’m talking to hospitals or negotiating, I know they can’t do the work without me, but I can work without them somewhere else. And the reality is, there’s already a huge shortage.
To a large degree, I think that the urology opportunities that are out there is only going to get more and more numerous.
What is the key to having more locums opportunities
The more flexible you are, the more willing you are to go to different areas or get new state licenses or be that jack of all trades, the more opportunities you will have.
That doesn’t mean that if you’re uncomfortable doing something that the hospital is going to make you do it- you can tell them, listen, this is off limits, but these are all the things that I will do.
Typical locum tenens urology gigs
There is a big variety- some are just inpatient, some just outpatient, and some are a mix. The need in each place can be very different. I’ve worked in situations where I was doing clinic and taking call, and I’ve worked in situations where I was just doing outpatient clinic or where I was just doing inpatient call and kind of a condensed half day.
You can often find exactly what you want, but the more flexible you are, the easier it’s going to be for you to find a job and keep cash flowing for yourself and your family.
Also, while it varies, certainly more rural hospitals are struggling, so I think many jobs do tend to be more rural.
Typical schedule for locum tenens urologist
I think they’re looking for consistency- whether you can commit to a week a month or 10 days a month or what have you. Most of the time they’re looking for a consistent commitment for days that you can work within a month to help them fill their schedule.
Once you are credentialed with them and get set up for the assignment, to some extent you’ll be able to pick and choose the dates that are available. If there’s more available and you want to take more dates than what was agreed upon, you usually can. If there’s not or you want to take just what you agreed on, you usually can.
How far out do you book your schedule
That can vary.
Right now I’m scheduling one or two months in advance, but prior to that, I was actually getting scheduled out about six months in advance. Because the hospitals want continuity, smoothness, no big gaps in their schedule, they want the consistency to be able to make sure that the hospital is covered.
From that standpoint, for a lot of them scheduling out further in time makes a lot of sense for them.
Pay rates for locum tenens urologists
When I started out, I was basically making about 2,700 for a day of clinic and I think about 3000 or 3,300 or so for a day of call. Now I’m making about 5,500 a day- that includes clinic or outpatient surgery and 24 hour call all in one.
I consider that within the time I dedicate to them there are significant limitations to what I can otherwise do. Therefore, I value my time at about $250 an hour- about $6,000 a day.
Also, you need to understand that it’s a bit of a numbers game- you may expect to get more no’s if you’re asking for higher rates but I think the opportunities are still out there.
I have it on pretty good authority that the average hospital is paying out about $7,500 a day for call coverage.
Unfortunately, a lot of the agencies that are out there are not so transparent, and a lot of them are taking 30 to 50% off the top.
Some agencies have deceptive business practices in that regard. But I would encourage folks to shoot high and you may not make that, but if you’re above what they were offering, that’s still a win-win. There is a little bit more work that’s involved, but it also allows you to earn a higher rate.
I don’t mind the agency making money, but I don’t want them to make more money than I’m making based off my work.
Negotiation strategies for locum urologists
I like the idea of anchoring high, as described in the book Never Split the Difference by Voss and Raz. Even if you fall below your anchor, you are still getting more than you were originally going to get. Also, remember, they need you more than you need them.
Again, it’s a numbers game- determine what your worth is to yourself. Analyze the job and determine what the pain points are- if you’re taking call for one hospital, that’s one thing, but if you’re taking call for three hospitals that are around a 10 or 15 mile radius, then that’s going to be a significantly different situation.
I would encourage you not to accept less than you think you’re worth, at least to a significant degree. I mean, if you need to take a job that’s paying a little bit less for a while, great, do it.
But in the long run I would really focus on deciding what your value is and communicating that. And if they don’t see your value and they’re not willing to work with you on that, then that’s probably not a job you really want to be taking anyway.
I mentioned one situation where I left and there was nobody there for a week afterwards. In that situation, they have to transfer everything out. Think about all the lost revenue, and difficulty for everyone.
Remember when you’re talking about any type of trauma center, they absolutely have to have subspecialty coverage or they’re at risk of losing their accreditation, so it is an opportunity cost piece.
If you’re not there and they can’t serve people, then they’re going to lose a heck of a lot more money than they otherwise could potentially be spending to pay you for your wages.
Our High-Paying Urology jobs:
$4000/day Urology Locums in York, PA. Clinic only, no call. Close to DC and Baltimore.
$400/hr Urology Locums in Illinois. No call. Clinic/OR.
$5000/day Urology Locums in KY. Call only No clinic.
Surgical equipment at the hospitals during your locums assignment
Stone disease is one of the most common things that you’re probably going to deal with on these types of assignments. Things you’re going to be doing over and over again, you really want to make it as easy as possible for yourself.
I think this is something that I would certainly recommend that anybody asks about when they’re considering a job. I always make sure I ask about their ureteral scopes.
Even if they’re older, a lot of the scopes are still functional. I think you do have to be a bit flexible in that again, and to some extent work with what they have. But at the same time, that’s another thing you can inquire about upfront and ask Is there any flexibility or consideration for replacing that?
Quite honestly, I’ve found most of the hospitals are pretty flexible about that type of thing. They realize that you have to be able to have have the tools to do your job.
Do you find supporting staff helpful during your locums assignment?
Yes, most of the places have pretty good support staff in place. It can vary of course, but most of the places recognize that you need a team around you to be able to serve the best you can.
The only caveat to that that is a lot of these places are kind of distressed and may not have the best “culture” in the world.
There also can be some significant turnover in that type of situation, so, that’s something to think about as you’re preparing for an assignment.
Are the administrators supportive and helpful during your locums assignment?
Generally speaking, yes.
However, there was one situation where I got out pretty quickly because I realized that they didn’t really care about me or trying to help patients. That was one of those places where there was a lot of turnover in the staff too.
That’s where I was like, all right, I’m going to give you my notice and I’m going to find a different situation- that’s one of the bonuses of being an independent contractor- you get to make that decision, to say, yes, I’m going to continue to work here, or no, this is really not a situation that I want to be involved in.
Who covers the urology patients after you leave your locums assignment?
Many places want a schedule commitment per month, so they know when you’ll be back, but I have also been in situations where I left and there was no one else there. The hospital didn’t have anybody to cover, which was concerning for the patients. It’s certainly a big strain on the system because they have to ship out consults.
But some of these places are distressed and in the grand scheme of things you can only do the best you can.
But most of the time you’re going to have, for example, another doc that is alternating with you. Some facilities have other urologists that are already practicing full-time there. They just need extra help. They don’t have other full-time employees. The full-time docs would be able to cover and take care of stuff if you’re not there.
Troubleshooting urology locums
You have to understand you’re going into a distressed situation, and you can’t expect it to be the most well-oiled machine. There’s certainly any number of different things that could be problematic, including, for example, travel or equipment, etc. Setting your expectations for that upfront, I think is a great way to try to avoid some of the stressors.
Another important point is that communicating with whatever agency you’re working with and with the site is very important.
That’s why I think asking upfront and starting that conversation very early and saying, hey, listen, if things really aren’t working out with the equipment, I’m not able to do my job the way I need to. Is there room for us to maybe make some improvement? The ureteroscope is a significant investment for a lot of hospitals. But there’s a lot of newer technology like a disposable ureteroscope that is just as good or better than the reusable ones and can be much less of an investment for the hospital.
I think there’s always some solution that can potentially be found. I think keeping that conversation going is super important.
Understand that you’re there as a visitor for a defined time. A lot of these places will do whatever they need to do to keep people coming to help.
Remembering your leverage points is a great way to get changes made if they need to be made, if they’re really problematic.
What would you do differently if you started as a locum tenens urologist again
I think probably the biggest thing that I would do differently is just try to negotiate locums pay rate harder upfront. To some extent, I didn’t know much better. As I went along, I learned more about my value and what the industry was paying.
I think otherwise it is like any other journey. You’re going to expect some bumps here in the road here or there, and you’re going to expect to potentially have some shifting in your expectations.
I think, again, just asking as many questions as you possibly can upfront before you ever get into an assignment is the best way.
Also, try to create the relationship early through communicating. It is going to be that relationship with the site and with the agency that will allow you to help them the best that you can.
From that standpoint, I think it is a very valuable way for you to protect yourself and just make sure that it’s going to be the right situation for you.
