LocumTenensGuy

Locum tenens after residency: crush your medical school debt

July 17, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Locum tenens after residency has a ton of pros: you become a better clinician, make hundreds of thousands of dollars more and travel America in search of the next big adventure.

That said, I want to focus on one of the BIGGEST pros of working locum tenens after residency.

What is it?

I am talking about working locum tenens to pay off your medical school debt.

Most docs would agree that medical school debt is a huge pain in the butt.

It causes stress and anxiety, eating into your budget and limiting your financial freedom.

It’s especially painful for freshly-minted residency graduates.

A lot of them put it on the back burner and keep paying the minimum monthly payments forever.

But today I want to offer you a radical solution to crush your student debt FAST!

In fact, it’s so radical that you can pay off your loans in less than a year!

Don’t believe me?

Come closer as I’m going to share my “recipe” with you.

Recipe with two ingredients:

(LOCUM TENENS + “SECRET INGREDIENT”) x (1 – 2 years) = ZERO student debt!

Why locum tenens?

The obvious reason is that it pays better than a permanent job, especially for somebody fresh from residency.

How much you’ll make depends on your specialty and how hard you work. For example, a locum tenens hospitalist would make at least 30% more compared to the average salary.

However, if you play it smart using all the strategies I describe in this post, you can add an extra 50% or more.

“Secret ingredient” for faster check out:

While the first ingredient will make you more money, the second will SAVE you a TON!

Let me ask you this:

What are the average person’s largest living expenses?

Housing, transportation (i.e.car, gas) and utilities!

Now, what if tell you that 100% of these expenses will be covered?

Sounds great!…but how?

Your locum agency covers those FOR you!

Listen: after you graduate from the residency, you’re joining the ranks of the highly sought-after professionals.

Think about it this way: It’s almost like you are a US expat working in a foreign country where your expertise is unique. And employers go out of their way to entice you: they pay you really well and cover all kinds of expenses.

The same happens with doctors, the demand is so high that agencies are willing to negotiate to make your life easier.

Plus, they pay for travel expenses anyways, you just make them channel it differently.

Now, when you’ve got the big picture, let’s look at logistics.

How to do it?

You work full-time locum tenens:

The key is to work enough to make it worthwhile for an agency/hospital to cover as much of your expenses as possible (i.e. 10-14 shifts a month for hospitalists).
This way you can make maximum money while saving like crazy.

You stick with long-term locum gigs:

Again, it makes more sense to cover your expenses if you are there for a long time.

You live where you work:

You live in the hospital vicinity in the rented place that is paid for by the company.
Another option is to keep a “free” home base by the main hospital while traveling to another one for extra shifts (with travel paid for you of course!).

You live in a small town:

Your living expenses will be lower.
You will get a better pay.

You keep your other expenses low:

While most of your living expenses are covered, you still need to live frugally to pay off your medical school debt fast.
One exception where you don’t want to be cheap is eating healthy and exercising. Also, it’s ok to spend money doing things you enjoy (nothing too extravagant though, so sorry, no yacht racing for now).
This will help you to keep your sanity and prevent burn out.

You live a “nomadic” lifestyle:

You don’t buy or own any “stuff” that can slow you down.
You should be able to take off and go to your next assignment without needing to hire a ginormous moving truck.

How much will you save?

Great question! I thought you’d never ask!

Let’s take a look:

Housing:

You see, hotels are a good deal when you are staying for a short period of time, but when you work 2+ weeks a month, it can cost thousands. It’s much cheaper to find an Airbnb or corporate apartment for you and pay lower monthly instead of daily rates.

How much do you save that way? Based on my calculations, about $15K-20K of your after-tax dollars per year.

Utilities:

When you live in a hotel or apartment, you pay ZERO for electricity, gas, internet, garbage etc.

That’s another $200-$500 monthly savings ($2500-$6000 a year).

Car:

Here’s a hack that’s even better:

You buy a car using a 3-5 year loan and ask the agency to cover your monthly payments instead of paying for a rental car. You also have them pay the gas and auto insurance.

You’re not only saving money, but you are also paying off your own car’s principal!

If you’ve already got a car you plan to own for another few years, make sure you get your gas, insurance, and maintenance expenses paid. You can also ask for a flat monthly car “stipend” instead.

That’s another $5K-10K/year saved.

How many Benjamins will you save in total?

Drumroll…

Between $25K to $35K annually!

Now, you’ll be blown away even more if you calculate your before-tax savings.

Why locum tenens straight out of the residency?

This approach will work the best after your residency.

Why?

You still have spending habits of a resident.
You have fewer obligations (family, mortgage, etc.).
It’s easier to adopt a “nomadic” lifestyle.

How long does it take to pay off your medical school debt?

One to two years depending on your student debt amount, your specialty and how hard you work.

Plug in different numbers below to calculate how long before you crush your debt.

Student Debt Pay Off Time Calculator

Total Student Debt:

Shift/day pay:

Number of shifts per month:

Shifts

Average Tax rate:

Monthly Expenses (exluding debt):

Your Monthly student loan payment:

Monthly income:

Income after tax:

Money left / month:

Time required (in months):

Number of shifts/work days required:

Ok, now when you are all excited about the idea, let’s see how you’re going to do this step by step!

11 Steps to paying off your student debt working locum tenens:

Step #1 - Figure out where you’re going to work (6 months before you start locums):

I know what you’re probably imagining now: sandy, pristine beaches of Maui or San Diego…

Stop it!

If you are a guy or gal who can relax on the beach while your student debt is piling up, then Hawaii or California may be good places.

But If want to pay off your medical school debt fast, you have to play it smart and pick the states that:

A – pay well;
B – won’t suffocate you with exuberant taxes;
C – have more work than you need;

Where will they pay you the most?

For hospitalists, the winners are states in the South, Southwest, and Midwest. (download the report)

As to the taxes, no income tax states are AK, FL, NV, TN, TX, WY, and SD.

Low income tax states are IN, ND, PA and WA.

Source: https://taxfoundation.org/how-high-are-income-tax-rates-your-state/

If you want to get a decent estimate of how much state income tax you are going to pay, check out this great online resource I found.

That said, always talk to a CPA to understand other important tax stuff (e.g. working in multiple states, nonresident vs resident taxation, etc.).

So if Wyoming has zero state income tax and a good pay, should I get a license there?

No way!

Your should pick the states with at least a few million people. This will let you tap into a good number of locum gigs.

Now, keep in mind:

If you find yourself stuck in “analysis paralysis,” unable to make up your mind on where you want to go, just focus on the states that you have a good feeling for.

Step #2 - Contact the locum agencies and negotiate (5-6 months before you start locums):

Before you do, take a look at my post where I explain how to find the best locum tenens companies. Make sure you check out the agencies reviews as well.

The caveat here is to work with multiple firms, both local and national.

When talking to the recruiters you need to:

A – Tell them to look for long-term gigs (6+ months) in the states of your choice.
B – Request that they cover your living expenses instead of the typical hotel/rental car.
C – Negotiate your pay rate for each locum gig.
D – Ask them to cover your state licensing cost (do not agree to a low pay rate just because they cover your license).

Step #3 - Apply for licenses (5-6 months before you start locums):

Get 2-3 state licenses to start.

The best advice here is to invest time and money into creating an FCVS profile.

I’ve used it many times and cut my licensing time by months!

FCVS fast-tracks your licensing for any state. It verifies your credentials (identity, medical school, residency training, etc.) and sends them to one or multiple state medical boards.

All boards accept FCVS verification and some boards require it.

Step #4 - Credentialing (3-4 months before you start locums):

Next step is to get credentialed at three to four hospitals.

Make sure you submit your paperwork as soon as you can, and have your agency help you to speed it up.

Onward.

Step #5 - Schedule your shifts (3-4 months before you start locums):

Now, you may be tempted to schedule 20+ shifts in one hospital until your debt is paid off.

Wrong!

As I’ve learned over the years, it’s impossible to know in advance what hospital is going to be a decent place to work.

To avoid being stuck in a bad spot, make sure you schedule only 5-10 shifts a month at each place for the first couple of months.

Another hack is to space out your shifts at the same hospital by 30 days (typical cancellation period). This way you can drop them before it’s too late.

After checking out a few places, you’ll get a good feel for what gig would be the best fit for you long term.

The only situation when you can commit to only one hospital upfront would be if you’ve worked there before (e.g. your residency hospital) and know all the ins and outs.

Step #6 - Get four types of insurance (3 months before you start locums):

Get your disability, life, locum tenens health insurance and some savings.

This will be your “safety net,” so don’t skip this step!

Onward.

Step #7 - Get rid of the stuff you don’t need (a month before you start locums):

To crush your student debt you need to become a “locum tenens nomad.”

Here, you purge all the ~~CRAP~~ stuff you don’t need. You will not need any furniture (and yes, that includes your favorite coffee table!).

Anything bulky that is too precious to your heart can go into storage.

Now, when all the preparation is done, you can start your first locums job ever!

Step #8 Refinance your student loan (as soon as you graduate from residency)

Even if you pay the loan balance off in a year or two, you’ll save thousands on interest by refinancing. Check out this resource list for more info.

Step #9 - First months of locums work (month 0 to 3):

Ah…you’re gonna have fun times!

You’ll travel to new places, meet a lot of people and make new friends.

There will be lots of learning too: from new EMR’s and billing to how to talk to your colleagues and patients when responsibility is all yours.

That said, after the rigors of your residency years, it’s doable.

At the end of the first few months, you’ll figure out what hospital(s) is your “tier 1” and which ones are “tier 2” (back up).

Step #10 - Cranking out until your student debt is paid off (month 4 through 12 to 24):

This is probably gonna be the easiest part:

You…keep going!

Just keep freaking doing it until you’ve paid off your student debt!

Step #11 Celebrate:

Thanks to locum tenens, your student loan is crushed, destroyed, eliminated…

You deserve a celebration, so spend a couple of days (weeks/months) doing something you’ve always wanted to but kept postponing due to college, medical school, residency…

You are free!

My confession...

Now, I want to confess…

I was a little sneaky:

I’ve not only taught you how to pay off your debt fast, I’ve also showed you how to make maximum dollars in minimum time working locum tenens.

I hope you forgive me…

The good news – you can use this knowledge to:

Retire at the age of 40…
Buy a ranch…

Travel the world…
Start a business…multiple businesses…
Save lots of cash just because…

The end.

P.S. Now, I want to hear your thoughts on this approach to crushing your student debt.

Does it sound appealing to you?

Are you ok with living out of a suitcase for a year or two?

Let me know in the comments below!

As featured on

An (Almost) Unbiased Look at the Hospitalist Lifestyle: Employed vs Locum Tenens

July 16, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

FREE REPORT: Locum Hospitalist Pay by Region

Lots of people ask me why I am doing what I’m doing. I mean, why don’t I get a “regular” hospitalist job?

Is locum tenens really that good? Or is it just because I have a short attention span or a personality problem of some sort?

The short answer is: lifestyle!

My hospitalist lifestyle underwent a big transformation over the years as I transitioned from being a resident to a full-time employee to the locum guy.

Today, I’ll show you exactly why I made this transition, and then I’ll compare two lifestyles: permanent hospitalist and locum hospitalist.

I have to warn you, I am super biased and favor locum tenens 100%.

Having said that, if you find any outrageous lies here or you disagree with something, feel free to throw “rotten tomatoes” at me in the comments section.

Without further ado, let’s look at the “pillars” of the hospitalist lifestyle:

Schedule
Money
Spare time
Burn out
Career path

Hospitalist lifestyle: key pillars

Without further ado, let’s look at the “pillars” of the hospitalist lifestyle:

Schedule
Money
Spare time
Burn out
Career path

Are you looking for a locums job?

My agency offers the Highest Pay Rates in the Industry

Hospitalist schedule

Permanent job:

As a full-time hospitalist, you’ve got your typical 7-on/7-off schedule and its variations, e.g. 5 on/5 off or 10 on/10 off. On average, hospitalist jobs offer 11 days a year of PTO time on top of that; although, more than 50% of hospitalists do not get any PTO at all.

So we are looking at 170 shifts a year. At first glance, it looks like you work less than half a year.

Doesn’t sound like much work, does it?

When I started my first hospitalist job after residency, it felt like a dream job to me. I was truly enjoying a hospitalist lifestyle.

Of course!!!

For somebody used to working 80 hours every week during the residency, switching to 80 hours every other week was a great deal!

The best thing about the permanent hospitalist schedule is that it’s predictable: you know you are there for 7 days and then again for 7 days after a one-week break.

However, there are problems with this “fixed” schedule:

1 – Sooner or later your shifts will fall on holidays, weekends and other days that you really need to be off (e.g. kid’s birthday, anniversary, other important events that you want to attend, etc.)

2 – You will have to rotate through nights and swing shifts (everybody has to take a turn kind of a thing). It makes a hospitalist lifestyle messy, especially if you cannot stand the nights, like me.

3 – Your vacation time (the majority of hospitalists DO NOT have any PTO time) is at your administration’s mercy. The typical rule is to apply early or else you are stuck. The problem I found was that most of my peers wanted to take time off around the same times I did in winter and summer.

4 – You only get 7 days off in a row. But what if you want to be off for a couple of weeks or a month or two? The good old, “Let’s swap some shifts” doesn’t always work well, as you probably know.

Now, there are programs that are trying to create a very flexible schedule, and some even offer a few weeks of PTO. Unfortunately, they tend to pay less and you still won’t have much control over your schedule.

Locum tenens:

Here, your schedule is determined by you.

There are lots of possible options: you can find locum gigs with a 7-on/7-off schedule or you can create a M-Th or M-F schedule, as I’ve seen hospitalists with school-age kids do.

The way I’ve created my schedule this year is I’ve decided to work around 160 shifts. (My thought was it would give me a good income and leave plenty of time off.) Then, I distributed them throughout the year around the school break time. It looks like this:

My locum hospitalist schedule this year, great hospitalist lifestyle — My locum tenens schedule

As you see, my spring and fall months are busiest for me: I work 20 shifts a month. But I am COMPLETELY off two summer months a year, and I make up for it by working longer stretches for a few months.

What changed in my schedule and lifestyle compared to my previous 7-on/7-off job?

1 – I travel for a full 2 months every summer with my family without asking anybody’s permission.

2 – I’ve got a very “light” schedule during Jan and Feb. This way, I stay away from the flu season months, since they are always FREAKING BUSY.

3 – I don’t work any night shifts since I typically need lots of time to recover after them.

The beauty of the locum tenens is that my schedule is completely customized to my needs and plans.

Now, I have to admit, it doesn’t always work the way I plan. A couple of times my shifts were canceled on short notice and I had to scramble for work at a different hospital.

I also once had no work for 8 weeks in a row, which didn’t bother me much because of the “safety net” I got, including my locum tenens health insurance. I ended up making up for those by adding a few shifts a month throughout the rest of the year.

What I am trying to say is that my locum schedule is not perfect, but it’s always very good. That’s because I have the maximum possible control over it!

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Hospitalist spare time

Now, let’s look at the time when you are off.

A full-time hospitalist job gives you very predictable time off and a good amount of it. Although you still essentially work an average of 40 hours a week (84 hours every other week), it sure feels good when you are off.

However, you are limited in what you can do with your spare time because you’ve got only 7 days off.

Is this enough time off?

Actually…NO!!!

You see, the life was not created for people working 7 on/7 off. Let me explain.

Personally, I am convinced we all need to free up some time every year to learn something new or experience the things we’ve always dreamed about.

In fact, I’ve made it my rule and have followed it for a few years now. Every time it gives me a new perspective and mental energy boost for months to come.

For example, a couple of years ago, I did a month-long point-of-care ultrasound training at the University of California Irvine.

Let me tell you, I had a blast!

I learned so much in just a few weeks!

The great thing is that I was off for a month in Irvine, CA, for my training, went back to work for several weeks and then traveled for another month and a half with my family.

All of this would’ve been impossible if I had a 7-on/7-off schedule.

Let’s look at learning Spanish, for example, which is another important skill in “my bucket list.”

Wouldn’t it be nice to speak Spanish so that you could communicate with your patients without needing an interpreter?

Of course!!!

Now, with the flexibility of locum, you could take a couple of months off (or even more than that) as a traveling doctor and go to Spain or Latin America, plunge into the culture and language, and I bet you would learn it really fast!

Could you master Spanish as fast when you work a full-time, permanent job?

Not really!

Believe me, I’ve tried to learn a foreign language before: you schedule few lessons a week with a tutor, read and listen to some podcasts, but your progress is painfully slow. Shortly after you’ve started, you feel stuck and give up.

These are just examples of the experiences and skills you can jumpstart when you’re privileged to have a flexible schedule.

Since I’ve switched to locum tenens, I’ve had so many more options for what to do with my spare time. I’m convinced my life became much richer with those experiences.

Travel:

What if you want to take a really exciting trip?

If you are considering any “serious” or long-term travel, locum is the way to go.

With the 7-on/7-off schedule, you can make some local trips in your week off. But anytime you change more than a few time zones, you need a long time to recover and 7 days off is clearly not enough.

What if you need to visit your relatives abroad?

I know a lot of hospitalists whose families live abroad, and they travel to visit them every year. In fact, some chose locum tenens just to be able to visit for a month or two at a time.

The ugly side of locum tenens time off:

Enough about good stuff! Let’s talk about the “annoying part” of being a locum hospitalist.

One thing that is different from any permanent job:

YOU HAVE TO HUSTLE!

What do I mean by that?

1 – I always need to make sure I’ve got enough shifts scheduled for at least 4-5 months ahead. So I am on the lookout for new locum or per-diem gigs and probing my current hospitals to see how long they would need my services.

2 – I have to get credentialed at new hospitals as well as get new state locum tenens licenses, so I fill out lots of paperwork.

3 – When I work out of state, I spend at least 6-8 hours just to get to and from the hospital location. This could be much worse if I ever decide to fly coast to coast or want to do a long drive to the neighboring state.

Five hospital badges: it took 5 applications to complete as well as a few state licenses, multiple emails, and many phone calls to get credentialed at all these hospitals.

Doesn’t sound very exciting, does it?

Now, listen, I still think locum is totally worth it! You have to hustle, but you gain so much freedom. It’s just the price you pay for that freedom.

Plus, I’ve learned to be efficient and found very helpful resources. So at this point, I probably spend no more than a couple of hours a month on the “housekeeping” issues.

Hospitalist income

Everybody would agree that money is important for your lifestyle. It may not be as much about what you can buy with it, but more about how much freedom you have.

Now, I’ve written in detail about the locum tenens hospitalist salary. I’ve also created this locum tenens salary calculator to help you calculate your salary.

If you want to know how much locum hospitalists get paid in different regions, check out the special report I’ve created. Click Here to download it.

Simply put, as a locum tenens hospitalist, you get much higher hourly pay, which makes it a better use of your time.

To prove this, let’s take a look at the permanent and locum income more closely using a timeline.

The “regular hospitalist,” aka “Mr. 7 on/7 off,” makes a mean hourly pay rate of $123/hr and the average “locum Joe” makes $160/hr.

Let’s see how long it will take both of them to make $1M:

So it will take 160 shifts less for the “locum Joe” to make his $1M.

Congratulation “Mr. 7 on/7 off”! You’ve worked a whole year for free to get the same results.

Roughly speaking, every 3 years of locum income equal 4 years of the full-time hospitalist salary.

Do you like working for free?

I sure don’t!

Another amazing thing about locum tenens is that you can easily switch to a higher paying gig anytime. With the permanent job, once you’ve signed the contract, you get what you get.

The point is that none of the top full-time hospitalist salaries can beat the locum tenens income.

You might say, “That’s nice, but I don’t want to make more money. The average hospitalist salary will do.”

No problem!

You can work less and still have a great income.

How about only 9 shifts a month?

Exactly!

Here’s how to do it:

Simply pick a locum gig in a state with zero or low income tax, negotiate like a pro, and get your 50% $/hr more.

This way you can work 30-40% less time. So instead of 170 shifts a year, you will only need to work 110 shifts a year, or 9 shifts a month.

Onward

Are hospitalists happy? Beware the burnout

The burnout sneaks up on you when you’ve got too much long-term stress at work, and it starts affecting your functioning at the mental and physical levels.

The truth is that you can burn out as a hospitalist pretty easily if you ignore the stressors. If it happens, it’s important to take a step back and try to understand what makes you unhappy at work.

Can you burn out working locum tenens?

Yes, absolutely!

I experienced it myself when I worked too much for too long at a hospital with a very toxic culture. When I realized what happened, I canceled my shifts for the whole month and rearranged my schedule to work only at the hospitals where I enjoyed working.

Now, could I have done that so easily if I was a full-time hospitalist?

Not really!

Last time I checked, hospitalists don’t get a standard “burnout” leave unless it’s time for your vacation.

With locum tenens, you simply have so much more control of where and when to work that you can avoid the burnout in the first place and address it right away if it ever rears its ugly head.

Hospitalist career

The biggest advantage of being a permanent hospitalist is that you can easily transition to an administration role: e.g., hospitalist director, CMO, quality and safety etc.

On the other hand, if you see your career path outside of hospital medicine or medicine in general, locum is better.

The flexibility of the locum tenens schedule lets you explore and experience new things. Who knows, you may create an actual career out of it.

Your hospitalist career path may have no path at all — you are a locum hospitalist and then you retire.

If you are interested in the early retirement and financial independence, locum can be a shortcut.

After all, your schedule could be 15 years on/45 years off.

Locum bonus: no meetings or committees.

Who likes the hospitalist team meetings, raise your hand!

The truth is….NOBODY!

I always felt they were the biggest time wasters. You know, a dozen or more hospitalists gathered in the room, talking about all the grown-up stuff — productivity, billing, he said/she said BS.

The best part of the meetings was when actual patient care and workflow were discussed. However, I always felt that you could get away with a simple email or two instead of a super formal gathering.

Now, the reason I mention this is that….it’s completely missing in the locum tenens world. For good.

Locum lets you out of the seemingly endless array of meetings and hospital committees.

And that’s great! I’ve got better things to do with my life.

The best hospitalist lifestyle:

Hospital medicine is a great specialty for a balanced lifestyle.

Locum tenens, however, allows you to crystallize it.

Since I switched to the locum tenens, I’ve gotten to design my hospitalist lifestyle the way I want: I work less, make more money, and never miss out on any exciting life experiences.

Locum Tenens Contract: How to read the agreement in one minute or less

July 16, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Today, I am going to teach you how to glance at and make sense of the locum tenens agreement in less than a minute.

You may be thinking: I’ve got better things to do with my life than reading “stupid” contracts.

Wrong!

The truth is that you ALWAYS have to look at the contract. Medicine is a risky business, so you want to cover all your bases!

Now, this post is not going to make you a contract lawyer. Instead, it will give you a perfect recipe on where to look for potential “red flags,” and you’ll learn a simple way to quickly scan locum tenens agreements.

I’ll also give you examples from real-life contracts. This way it’s going to be easy to make sense of the confusing legal jargon. (BTW, you won’t find this info anywhere else on the web!)

I mention another important hack in this post: keywords that you can search within a contract document (typically a pdf file or webpage) and find the exact section you need to review it super fast.

Disclaimer: I am not a lawyer, and this article is just for self-education purposes. It’s not meant to replace professional advice. Consider getting legal consultation for detailed contract review.

What is a locum contract?

A locum contract is the work agreement between a physician and a locum tenens company or a hospital/clinic. At the core, it’s a contract a physician independent contractors sign with their temporary employers that determines how much they will be paid, contract termination, and other important clauses.

Now, let’s look at all the “moving parts” of the locums agreement in more detail.

Are you looking for a locums job?

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malpractice insurance

The standard type of malpractice insurance hospitalists get is claims-based, which means you are covered only when both the incident and the claim (when they actually sue for that incident) happen when the policy was active.

Since you may stop working with the locum agency at some point or they could go out of business, it’s important that you get a guaranteed “tail.”

This would extend the locum tenens malpractice coverage for all the incidents, regardless of when the legal claim was made.

How much coverage is enough?

$1M/3M is a standard for hospitalists. The first number ($1 million) is how much is covered for each particular incident. The second number ($3 million) is how much total coverage you get.

The more the better, but anything less – no bueno!

Here are some examples of coverage terms:

1 – “Company shall provide professional liability insurance coverage for each Physician to cover all incidents which may occur during an Assignment, in limits of $1,000,000 per incident and $3,000,000 in the aggregate.”
2 – “Provider will be insured under the terms of “Agency name” group professional liability insurance policy or similar professional liability insurance provided by Client (i.e. hospital).”
3 – “Professional liability insurance will cover Provider, for a medical incident arising out of Provider’s rendering of, or failure to render, professional services while working on an Assignment. Upon expiration of the policy, “Agency name” will purchase group tail coverage or prior acts coverage with the new policy.”
4 – “Company will procure professional liability insurance, including post-termination continuation coverage or tail coverage, as applicable, based on Company’s insurance policy.”

TIPS:

♦ For malpractice coverage, look for $1M/3M.

♦ For claims-made insurance, make sure you get a “tail” coverage.

♦ Keywords for quick “scanning”: malpractice, liability, insurance, tail, coverage, policy.

SHIFT CANCELLATION OR OUT CLAUSE in locum contract

You can typically cancel any shifts 30 days in advance, and the same goes for the hospital you work for.

Here, you need to make a note of the time frame required for termination and how termination is made – written, via phone call, etc.

Here are examples:

1 – “At all times during the Term of this Agreement, this Agreement may be terminated without cause or liability by either party upon thirty (30) days’ prior written notice to the other party.”
2 – “If Physician is not able to fulfill an assignment they have accepted, then Physician will give at least thirty days’ notice.”

The next important thing is to look at what happens when you cancel less than 30 days in advance.

Here you need to avoid the “strict lingo,” e.g:

If you fail to comply…you shall promptly pay to “Agency name” a cancellation fee equal to…”
or
“Provider will be charged for Company’s unrecoverable expenses.”

You should have wiggle room in the contract to get you off the hook if you have a legitimate excuse to cancel your shifts: e.g., illness, family emergency, etc.

Here’s an example of better wording:

Professional may cancel any scheduled placement less than 30 days in advance by giving written notice…if Professional becomes unable by reason of emergency or medical condition to fulfill an agreed placement.”
or
“If Physician becomes incapacitated or otherwise physically unable to perform Services…Physician’s cancellation shall be in writing.”

TIPS:

♦30-day cancellation window is a standard.

♦Avoid “strict” cancellations.

♦You should able to cancel any time in the event of sickness, emergency, etc. Consider adding this to the contract.

♦Keywords for quick “scanning”: cancel, schedule, notice, term.

NON-COMPETE CLAUSE in locum tenens contracts

In a nutshell, the non-compete clause in locum tenens contracts doesn’t allow you to work with the hospital through another locum company or directly for a certain period of time.

Here, you have to make sure the term is no longer than 2 years after the official end of the agreement.

Let’s look at one example:

Physician may not solicit or contract with Client or any of its affiliates…for temporary staffing assignment nor accept a permanent position…”

TIPS:

♦The non-compete clause should not be longer than 2 years after contract termination.

♦Keywords for quick “scanning”: non-compete, covenant, clause.

TERMINATION and RENEWAL of locum tenens physician contract

You should be able to terminate the locum tenens agreement any time with a 30-day written notice. It means that you officially “break up” with an agency.

But why would anybody need to do it?

Because if you don’t, it will be auto-renewed. So even if you don’t work with the agency for a while, you are still in a binding relationship with them, including the non-compete clause.

Why is this important?

A few years after my last shift at one local hospital, I decided to pick up some shifts there again. This time I wanted to connect with them directly to have a long-term locum tenens hospitalist gig close to home.

Guess what?

Since I didn’t terminate my contract with an agency that placed me there in the first place, I either had to use them again (which kills the point) or terminate my agreement and wait for 2 years.

Another example: if your agency loses the contract with the hospital, a non-compete clause will not allow you to work at that facility either as a per-diem or through another agency’s services.

In my situation, I ended up terminating my contract and had to wait for the 2-year non-compete clause to expire.

TIPS:

♦Keep in mind that a locum tenens contract is auto-renewed unless you terminate it.

♦Terminating the contract will cancel the “non-compete” clause typically in 2 years.

♦Keywords for quick “scanning”: automatically, renew, terminate.

Sample locum tenens contract template:

If you want to dig a little deeper and actually look at a sample locum tenens contract, you can check out this resource. Although this agreement seems to be much shorter compared to the ones I’ve signed in the past, it has all the important parts in it.

CONCLUSION: reading a locum tenens physician agreement

Now you know the quickest way to scan through the locum tenens agreement.

The good news is that your contract is always negotiable. So if you’ve noticed anything you want to be changed, do not hesitate to reach out and request it.

If you are too lazy to dig through the contract yourself, just ask your agency/hospital to point specifically to the important sections I mentioned.

At the end of the day, it doesn’t matter how you do it. Just do yourself a favor – ALWAYS review your agreement!

Become Traveling Doctor: satisfy your wanderlust

July 13, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Becoming a traveling doctor is a dream for many people!

A lot of physicians and medical students would agree that traveling is one of the best things you can experience in life.

And…it doesn’t even matter if your favorite place is in the US, Europe, or Asia. If you’ve ever caught a “travel bug,” it becomes your passion and your lifestyle.

But…

Here’s a catch 22:

You work and make money = You don’t travel

You travel = You don’t work and don’t make money

If you work a traditional full-time physician job, this is sad but true.

You see, most medical professionals are stuck with a few weeks of vacation per year. This means they can travel only once a year.

This may work for some, but if you want to be a traveling doctor (i.e. a real “nomad”), this is simply NOT enough to satisfy your wanderlust…

And even if you are a 7on/7off hospitalist, you have only seven days off at a time to travel.

The trouble is that any travel outside of the US would mean changing time zones (sometimes 10 or more). So if you travel in seven-day increments, you’ll have to constantly adjust to new clocks.

This sucks!!!

You will NOT enjoy your trips and you won’t be able to visit a lot of really exciting places.

You may be wondering:

Ok, I gotcha, this makes sense. But I DO want to make much more than average salary AND travel a lot…is this even possible?

YOU BET IT IS!

With locum tenens you can create the schedule that fits your lifestyle: YOU decide HOW MUCH vacation time you want and WHEN you want it.

Not only that, your work time makes you MORE money so you’ll have more cash to spend.

Sounds like a perfect COMBO to become a doctor that travels a lot!

In the next few minutes, you’ll learn exactly how YOU can create a one-of-a-kind vagabond lifestyle without giving up on money.

Let’s jump right in.

Traveling doctor's option #1:

Work locums and travel in “clusters.”

Clusters? What the hell is this?

Clusters are “longish” periods of time ranging from a few weeks to a few months.

So…for example, you can alternate between a month of working locums and a month off.

Another example could be working for three months (e.g. a lot of hospitalist gigs are 3-4 months long) and taking a couple of months off after that.

This way you’ll have more than enough time to travel AND recuperate at home before you kick off with your next stretch.

Personally, I’ve been “clustering” my work in the fall and spring and leaving summer time off so that I can travel when my kids have a school breaks.

Of course, how much time off you can “afford” will depend on how much you are trying to make.

The lower your desired amount is, the longer your time off could be, and the easier it is to create your “perfect schedule.”

But!

What if you wanna make “effing money” FIRST and travel the world AFTER hitting it big?

The next option is for you…

Traveling doctor's option #2:

Make lump sum and then travel

If you’ve got ambitious plans AND you want to become a traveling physician and see the world without giving up on them, the following approach works like a charm.

What do I mean by “ambitious plans”?

This could be anything from paying off your mortgage or medical school loans, making a large investment, saving money to start your own business, to simply having $ [name your number] in the bank…

Locum tenens gives you control to do that.

And, if you combine this approach with a frugal lifestyle you’ll end up with lots of cash that you can invest or spend on whatever makes you tick.

The success formula here is rather simple:

Come up with your after-tax $ amount.
Decide how fast you can possibly make it.
Get Board-Certified and receive all the other required certifications
Calculate how much time you need to make this happen.
Buckle down and work until you’ve got it!

Of course, don’t forget to get board-certified, get good number of state medical licenses and receive all the other required certifications if you’re fresh from training.

Here’s a good example of one of my buddies who is a hospitalist and a hard-core real-estate investor. He’s used this approach to achieve impressive results.

He would schedule his locum’s shifts based on how much cash he needed to buy his next investment property in California, New York or Florida. After he had saved enough, he took time off to regroup before his next big project.

This approach worked extremely well for my friend: he now owns multiple homes in CA and he visited a lot of fun places all over the world in his time off.

Sounds like a sweet deal to me!

Now, coming up next:

I’m about to show you how you can leverage locum tenens to travel for FREE…

This unique opportunity is available exclusively to the locum tenens docs and it is a great way to visit the most exciting places in America.

Yeah, yeah, yeah. I can hear you thinking: “There’s no FREE lunch…”

Don’t be a naysayer!

Just read on and you’ll see what I mean…

Locum tenens = free vacation

You see, when you travel to your locum tenens location, your airfare, rental car, and hotel are already paid.

Now…to “convert” your locums trip into a FREE vacation, all you need to do is to leave enough time to check out those local “hot” spots.

For example…

If you’re a hospitalist working 7on/7off or emergency medicine/urgent care doc working block schedule, you can fly in a couple of days early and stay a few days longer after your last shift.

Or…

Instead of returning home during your week off, you can stick around and spend the whole week touring the surroundings.

If you work Monday through Friday on the other hand (e.g. internal medicine doc doing primary care), you can travel on the weekends. To free up even more time for travel, you can negotiate a shorter work week for example Monday through Thursday or even Wednesday)

The point is: there are multiple ways to make it work and become a traveling physician.

And, if you you don’t mind rural areas or underserved areas, you may have even more options!

Thankfully, in the locum tenens “healthcare business,” everything is up for negotiation, including the details of your travel.

Now, you may be thinking…

Ok, Vlad…I’ve got time off, my travel is paid for…but what the hell am I going to do with my time off? How do I actually have FUN?

Don’t you worry, brothers and sisters…

I’ve got you covered!

I am about to show you a way to find countless travel ideas and…

you’ll have an unforgettable experience you’ll remember for the rest of your life.

I bet this will open your eyes!

Bonus: How to spice up your locum tenens life

In the summer of 2018 I was planning my next trip to Napa, California, where I was supposed to do a long stretch of shifts.

While browsing the internet to check the ratings of my hotel, I spotted a “things to do” section. I clicked it and saw a list of DOZENS of travel experiences: tours, trips, outdoor activities, classes, workshops…

At that moment, the LIGHT BULB went off:

Why don’t I treat my locum tenens trip the same way I treat my vacation trip?!

Let me tell ya…this “revelation” MADE A HUGE DIFFERENCE, as my next locum tenens trip turned out to be the best I’ve ever had!

And…I was also mad at myself for missing out on SO MANY adventures for years!!!

Here’s what you need to turn your next trip into a vacation you’ll enjoy 500%:

1 – Go to tripadvisor.com.

2 – Type your location in the search box.

3 – Click on “things to do.”

4 – Choose the kind of fun you want.

Another great source is airbnb.com:

1 – Go to the website and type in your location.

2 – Click on “experiences” or “adventures.”

And the best thing, if you expand your TripAdvisor or Airbnb search to the state level, you can find many more fun things to do in ANY part of the country.

This approach will work perfectly regardless of what your medical specialty is.

Final thoughts:

If traveling is your passion and you are itching to check out the most beautiful and exciting places that exist in the world without giving up on your career, know this…

Locum tenens is the BEST way to travel, see the world, create perfect work-life balance AND make $!

Period.

Locum tenens travel hacks: stay sane while living out of a suitcase

June 6, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Did you know that I am a “reluctant” locum tenens traveler?

Yes, I’ve traveled a lot, but I’ve always preferred not to do it.

Oddly enough, my reluctance made me look for ways to have a hassle-free travel experience.

So today the time has come for me to share what I’ve learned in 6+ years of driving, flying, and staying at hotels and apartments all over America while working locum tenens.

You will not only learn how to travel with comfort but, most importantly, how to stay in the best mental and physical state despite living out of a suitcase.

If you are working locum tenens now or plan on doing it, you simply CANNOT miss this stuff!

Let’s jump right in…

TSA precheck

Let’s start with the basics.

If you fly more than a few times a year (most docs working locum tenens docs do), TSA precheck is a MUST.

With the TSA precheck, you can save hours of your precious time at the airport.

You don’t have to wait in lines going through security checkpoints and you’ll have extra time before your flight since you can come to the airport as late as one hour before your flight’s departure.

TSA precheck is a no-brainer: it costs $85 and takes only a couple of weeks to get approved after you’ve submitted your application.

Onward.

Comfortable stay

Staying comfortably is the most important part of your travel, and I’ve picked up a few hacks over the years.

👉 How to vet quality hotels

One key lesson I’ve learned is not to rely only on star ratings since some 3-star hotels are no better than motels.

The best way to vet hotels is to look them up on TripAdvisor. I would avoid any hotel that has a rating of less than 4 out of 5.

Also, check out the “travelers” photo section to get an idea of what to expect.

👉 Step up your game: sweet stay in a suite

When you stay in a suite, you don’t just have more space, you are guaranteed to have a better sleep.

Think about it: your bed and the hallway are separated by two doors, which removes some of the noise coming in.

So do not hesitate to ask your staffing company to provide you with this “extra,” as the price difference is only about $20-40/night.

In my experience, no locum tenens agency ever refused. But, even if they do, I would pay out of pocket. It will cost about $200-400 for a week but it is totally worth it.

👉 Pick your room like a pro

Not only do you need to stay in a more spacious room, it is a good idea to pick your room’s location.

Make sure to call the hotel reception a few days in advance and let them know your preferences: you want to stay on the highest floor possible, far away from the elevator and also facing off the road.

If they cannot satisfy all these requirements, at the very minimum you should avoid the ground floor like the plague: you’ll be annoyed by cars, lights, people talking, etc.

This makes even more sense if you work night/evening shifts and need to sleep during the day.

Long stay = Airbnb or furnished apartment

Now, if your locum tenens gig is longer than a couple of weeks at a time, I would recommend staying at the “home-like” settings.

Renting Airbnb or furnished corporate apartments would be better options. Just make sure to read my locum tenens housing post where I show you how to avoid trouble with those.

Packing

Never spend more than 5 minutes getting ready for your travel

Packing my stuff used to be a huge time-waster for me. Over the years, I figured out a way to make it short and sweet.

Here’s a trick: to pack quickly, UNPACK as little as possible after you are back home from your trip.

Basically, the only thing that you remove from your suitcase is your laundry. Everything else should stay THERE e.g., toiletries, gym shoes, utensils, thermos, lab coat, stethoscope, pager, and badge, etc.

This way it will only take you a few minutes to pack your clean clothes and you are good to go.

Healthy Food

“Treat your body like a mansion, not a woodshed….”

I don’t need to explain what a difference healthy nutrition can make. Having said that, it’s easier said than done, especially when you are away from home.

There’s always a temptation to eat hospital cafeteria food: it is easily available and it may even be free.

The problem is that I am yet to find a hospital where you can find healthy choices.

Here are a few tips that will help you to cook your own meals while traveling as a locums.

Your own kitchen:

First, get a hotel room with a kitchenette. The fact that you’ve got everything you need to cook will leave you with no excuses, and you will be more likely to stay on the “right track” with a healthy diet.

If no hotel in the area has this amenity, at least make sure your room has a fridge with a freezer.

Take care of groceries FIRST:

Second, swing by the grocery store BEFORE you check in to the hotel. Again, you’ll have no excuses not to cook your own meals.

Instant Pot:

And, finally get this guy on your team:

INSTANT POT!

The Instant Pot is truly a “magic” machine that costs about 100 bucks, weighs 9 lb (hence it can be easily put in your luggage), and can cook healthy meals in a matter of minutes (this is not an exaggeration!!!).

In fact, it is much quicker than ordering through DoorDash or driving to the restaurant (another excuse not to cook is destroyed).

What do I make in it?

My meals usually consist of 3 components – protein (meat or fish), greens, and a little bit of complex carbs (typically beans, lentils, quinoa, or sweet potatoes).

That said, this “magic pot” can make great and healthy meals fast no matter what your preferences and dietary restrictions are.

Dealing with jet lag

You may think that unless you travel from Hawaii to the East Coast, the jet lag would not be a problem.

But, from what I’ve noticed, even one hour difference can mess me up physically and mentally. I simply don’t have as much energy and feel “foggy.” It takes a good two to three days to get over it.

Here are a few tricks that worked well for me and will help you to get up to speed.

First, limit your caffeine to one cup in the morning the day of your flight.

Second, try to work out in the morning before your shift starts. It doesn’t have to be hard or long. Working out for as little as 10-15 minutes is more than enough to get your internal “clocks” on the right track.

If you don’t feel like doing any exercise, at least take a quick walk outside.

The third is a neat hack that will work like a charm if you are willing to drop $200 on this portable lightpad.

This compact lamp generates a very bright light, simulating natural sunlight. You put it at the bedside and turn it on in the morning as soon as you wake up.

I’ve noticed it resets my “clocks” even better in the wintertime when mornings are dark and gloomy.

Onward.

Winter driving

Winter driving deserves special mention.

You see, if you ever work in the Northeast, Midwest, or any mountainous areas in the winter, you better be prepared.

Personally, I’ve made a lot of trips across the Washington state’s mountain passes and I know this can be pretty tricky.

The key here is to have a reliable car that would make your driving seamless.

First, your car MUST be an SUV or a truck and it has to be all-wheel drive. You’ll be surprised but some of these cars are front or rear-wheel drive only.

Second, at the very minimum, your rental should have all-season tires, and, ideally, special winter tires, as most rental companies prohibit you from using chains on their cars.

Hertz seems to be the only company that offers a winter tire package, but other agencies may have a few available cars with winter tires as well. The best thing to do is to give them a call and find out.

If you work with a locum tenens company’s travel agent, have them do the calling and double-check for you.

Now, the staffing agency may push back on your request, as SUVs are usually more expensive to rent. If this happens, tell them you don’t feel safe driving in the snow and explain you may not make it on time for your assignment due to the weather conditions unless you drive an SUV.

And finally, when picking up your rental, make sure to actually look at your tires. You should see one of these signs on your tires.

“Ok” option – “All-season” tires

The best option – proper winter tires.

Beating“cabin fever”

“Cabin fever” is real!

Just imagine…you are away from home, from your usual circle of friends and family, your favorite hobbies, activities, sometimes for months and months on end.

No wonder some of the locum tenens docs (myself included) start feeling lonely, isolated, and cut off from the world.

Fortunately, the solution is very simple: you MUST GET OUT of your hotel room and go places.

Just walk outside in the park, hike in the woods and breathe some fresh air, drive around a little bit, or even better…socialize with other docs.

The key is to change the environment and your surroundings when you are off work to keep your “battery” charged and stay sane.

Wrap up

That’s all I wanted to say for now! Comment below if you’ve got any other helpful tips for locum tenens travelers.

As featured on

Top five best and five worst states to work locum tenens from a liability perspective

May 31, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

In 2018 I was named in a malpractice lawsuit for the first time.

The whole experience was extremely stressful, and since this happened, I started thinking of ways to avoid this mess again in the future.

After doing my research on this topic, the first thing I realized is that a good portion of docs in this country have been sued or will be sued. For example, a 2011 NEJM study showed: “Each year during the study period, 7.4% of all physicians had a malpractice claim.”

The other revelation was that not every state is created equal and there are parts of the country that are literally a “hot mess” when it comes to liability and others are as close to “legal paradise” as they can get.

In fact, you are more than 10 times (!!!) likely to be sued in the “riskiest” state compared to the lowest risk state.

That’s why I’ve decided to collect data and present you the best and the worst states from a liability perspective.

I hope this will help you to choose which states to avoid and which states to look at more closely, whether you work locums or full-time jobs.

👉 Without further ado….let’s announce the “winners”:

Best five states with the lowest malpractice risk:

North Dakota had the lowest rate of malpractice claims against physicians. The state implemented a tort reform by limiting noneconomic damages to $500K.

On top of that, if noneconomic damages exceed $250K, the law requires additional review and approval.

The state of Wisconsin has the second-lowest rate of malpractice claims. It has the cap on noneconomic damages of $750K and also has the state-wide Patient Compensation Fund that would pay for damages exceeding the cap.

Despite Minnesota not having any noneconomic damage caps, it’s one of the best states in terms of physician liability.

The reason for that is the tort reform passed in the 1980’s that requires medical experts to confirm the claim has merit. This significantly decreased the number of frivolous lawsuits in the state.

The aloha State has a $375K cap on noneconomic damage and all initial claims are reviewed by a “conciliation panel.”

The Tar Heel State comes fifth in the ratings. It has a cap on noneconomic damage of $500K.

Now, let’s look at the worst states:

The worst five states with the highest malpractice risk:

New Jersey is the worst state in the country in terms of physician liability.

There is no cap on noneconomic damages and the number of claims is extremely high.

Louisiana may come as a surprise to many, especially given the fact that a lot of neighboring states are considered to be physician “friendly” and the fact that the state has $500K cap on noneconomic damages AND Louisiana Patient Compensation Fund.

That said, the state is known to have one of worst liability climates in the country.

Pennsylvania has no cap on noneconomic damages and has one the highest malpractice insurance premiums in the country.

The Sunshine State is known to be one of the worst states for physicians from a liability perspective. This is despite a noneconomic damage cap of $500K.

New York is the fifth on the list. Not surprisingly, the cost of malpractice insurance here is one of the highest in the country.

Differences within the state:

Please note that the risks are not spread equally within each state, as certain counties may have higher malpractice rates compared to the rest of the state. Anecdotally, this is usually the case for the “affluent” counties.

Take-home message

Fortunately, locum tenens allows you to do gigs anywhere in the country. But…before you consider working in any state, it is a good idea to check where the state stands in terms of the liability risks.

LocumTenensGuy

Vlad Dzhashi, MD

Recipe with two ingredients:

“Secret ingredient” for faster check out:

How to do it?

How much will you save?

Between $25K to $35K annually!

Why locum tenens straight out of the residency?

How long does it take to pay off your medical school debt?

Student Debt Pay Off Time Calculator

Total Student Debt:

Shift/day pay:

Number of shifts per month:

Average Tax rate:

Monthly Expenses (exluding debt):

Your Monthly student loan payment:

Monthly income:

Income after tax:

Money left / month:

Time required (in months):

Number of shifts/work days required:

11 Steps to paying off your student debt working locum tenens:

Step #1 - Figure out where you’re going to work (6 months before you start locums):

Step #2 - Contact the locum agencies and negotiate (5-6 months before you start locums):

Step #3 - Apply for licenses (5-6 months before you start locums):

Step #4 - Credentialing (3-4 months before you start locums):

Step #5 - Schedule your shifts (3-4 months before you start locums):

Step #6 - Get four types of insurance (3 months before you start locums):

Step #7 - Get rid of the stuff you don’t need (a month before you start locums):

Step #8 Refinance your student loan (as soon as you graduate from residency)

Step #9 - First months of locums work (month 0 to 3):

Step #10 - Cranking out until your student debt is paid off (month 4 through 12 to 24):

Step #11 Celebrate:

You are free!

My confession...

The end.

As featured on

Vlad Dzhashi, MD

Hospitalist lifestyle: key pillars

Hospitalist schedule

Permanent job:

Locum tenens:

Hospitalist spare time

Travel:

The ugly side of locum tenens time off:

Hospitalist income

Are hospitalists happy? Beware the burnout

Hospitalist career

Locum bonus: no meetings or committees.

The best hospitalist lifestyle:

Vlad Dzhashi, MD

What is a locum contract?

malpractice insurance

SHIFT CANCELLATION OR OUT CLAUSE in locum contract

NON-COMPETE CLAUSE in locum tenens contracts

TERMINATION and RENEWAL of locum tenens physician contract

Sample locum tenens contract template:

CONCLUSION: reading a locum tenens physician agreement

Vlad Dzhashi, MD

Traveling doctor's option #1:

Work locums and travel in “clusters.”

Traveling doctor's option #2:

Make lump sum and then travel

Locum tenens = free vacation

Bonus: How to spice up your locum tenens life

Vlad Dzhashi, MD

Table of Contents

TSA precheck

Comfortable stay

👉 How to vet quality hotels

👉 Step up your game: sweet stay in a suite

👉 Pick your room like a pro

Long stay = Airbnb or furnished apartment

Packing

Never spend more than 5 minutes getting ready for your travel

Healthy Food

Your own kitchen:

Take care of groceries FIRST:

Instant Pot:

Dealing with jet lag