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Ultimate guide to buying your own locum tenens malpractice insurance

August 4, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

If you’re looking to buy your own malpractice insurance for locum tenens work, you may be in for a surprise.

You see, it’s much more than just having vs not having malpractice coverage. There’s lots of important things you need to consider when buying your policy.

And…if you’ve never done it before, this can be pretty confusing.

FEAR NO MORE!

You got LUCKY to stumble upon this post…

Today, you’ll learn what kind of coverage you need for locum tenens, how to save money on it, what to watch out for in your policy to avoid legal troubles and more…

On top of that, I’ll explain everything in PLAIN English, without using any confusing legal jargon, to make sure it’s as clear as it can be.

Let’s jump right in.

Disclaimer: I am not a lawyer nor am I an insurance agent. This post doesn’t provide legal advice or consultation; it is simply for educational purposes. Seek professional opinion.

Occurrence vs Claims-made malpractice insurance

Let’s start with the basics here. There are two kinds of malpractice insurance: claims-made and occurrence.

Claims-made, “Tail” and “Nose”

Claims-made policy will cover you only for liability that happened AND was reported (i.e., a claim is filed) while the policy is active (i.e., you are still paying for it).

A little confusing, isn’t it?

Let me give you the visual…

In the above example, your insurance will cover your defense costs and the settlement payout, if it gets to that.

In this case, you are not protected by your medical malpractice policy UNLESS you’ve purchased TAIL coverage from the same or other insurance company.

What is “tail” coverage?

The tail is a supplement that covers events that happened during your policy, even if they were brought up against you after your insurance’s expiration date.

This “upgrade” costs about 200% or more of your last year’s premium.

Ouch…

Another option is to purchase a “NOSE” coverage (also called “prior acts” or “retroactive coverage”). It will cover prior events, and sometimes you can get it cheaper than tail coverage when switching to a new insurance carrier.

Now, keep in mind that claims-based annual cost goes up over time, reaching its maximum in five years (this is called “maturing”). When your insurance gets to its maturity it would cost at least twice as much as your first year.

Check out the example below which is a quote I got from a broker a couple of years ago…

Occurrence

This type of medical malpractice insurance doesn’t require tail no matter when the legal claim is reported as long as the event “occured” during your policy coverage period.

So this one is easy to understand as it works the same way as your car insurance: you pay what you pay without needing to buy tail or nose coverage later on.

And that’s the reason the occurrence policy is more expensive than the claims-made premium, especially if you compare it to the first year or two of the claims-made cost.

Again, here’s a real life quote:

You can see that a claims-based yearly cost is lower than an occurrence policy in the first couple of years. After that, the difference is minimal, especially if you take the cost of the tail coverage into your calculations.

💡 TLDR:

Claims-based:

Pros: Cheaper (the tail cost excluded)

Cons: Each year gets more expensive until year five

Cons: You need a “tail” or “nose” coverage, which can be 2-4 times of your annual policy cost

Occurrence:

Pros: NO need to buy “tail” or “nose” coverage.

Cons: More expensive compared to the claims-based without the tail

Malpractice insurance COVERAGE LIMIT

Now, the other big question is how much coverage do you need?

In the locum tenens world, the standard coverage amount has been $1M/3M.

What do these numbers mean?

The first number ($1 million) is for the annual maximum your insurance company will pay for each case and the second number ($3 million) is the total annual amount if you’ve been sued by multiple patients.

Generally speaking, I would stick with the $1M/3M limit as there are potential issues with having too little or too much coverage.

Let me explain…

With the LOWER LIMIT you may be at risk of needing to pay out of your pocket. This may be OK if you practice in state(s) with a very low risk of getting sued (e.g., MN,SD etc…) AND the state has a cap on noneconomic damage (e.g., TX, IN).

Now, you don’t want to have a very HIGH POLICY LIMIT either, as you can become a “scapegoat” if multiple doctors are named in the lawsuit. You don’t want to end up in a situation where your insurance pays out more money than other defendants’ policies, as this may look like it was mostly “your fault.”

The bottom line is: with malpractice coverage limit, you want to be like everybody else.

💡 TLDR:

$1M/3M is a typical coverage limit for locum tenens

Important malpractice insurance CLAUSES

“The devil is in the details…”

And, dammit, this is so true when dealing with legal mumbo jumbo in the fine print…

As a matter of fact, there are several very important clauses you HAVE TO know about when buying your own locum tenens malpractice coverage.

Defense cost limit:

You want to make sure your policy has NO limit on defense costs, i.e., your lawyer’s fees, expert witnesses fees and other admin expenses.

The trouble here is that these fees can get very costly (hundreds of thousands of dollars at times), and you don’t want to end up paying them out of your pocket.

Deductible:

Believe it or not, some medical malpractice policies have deductibles, which can range between $2,500 and $10,000.

How do they work?

With the indemnity-only (also called “loss-only”) deductible you pay the deductible ONLY if you’ve “lost the case” i.e., the insurance company needs to make a payment to the plaintiff.

With “Indemnity and Expense” you need to pay after the legal case is open regardless of the outcome.

A deductible is not always a bad thing, as it makes your policy cheaper.

“Consent-to-settle” clause

A “consent-to-settle” clause FORCES your insurance company to get YOUR permission before they would settle any case against you.

This is definitely a must-have “perk” as some insurance companies may be tempted to settle the claim even if there’s no fault of yours. This happens if the settlement amount is less than the cost of defending you.

The problem is that this will be reported to the NPDB and will remain in your “biography” forever.

After all, it’s all about money for the malpractice insurance company, but for you, it’s about your reputation.

Hammer clause

The “hammer” clause is something you want to avoid.

It is closely related to the “consent-to settle” clause but may work against you.

Imagine a situation when after the claim is reviewed by the plaintiff and defendant lawyers as well as expert witnesses, your insurance company recommends you to settle the case (i.e. make a payment on your behalf to your former patient or his family).

Despite the advice, you refuse to settle and want to proceed to the jury trial.

Now, let’s say the jury’s decided you are responsible for a higher payout amount than was recommended by your insurance before.

In this case, the “hammer clause” will force YOU to pay the excess, which, of course, can be A LOT of money.

💡 TLDR:

Make sure your policy has a “consent-to-settle” clause.

Avoid defense cost limit and “hammer” clauses.

Check to see if your policy has a deductible, and if so, its amount and the type.

Moving on…

Locum tenens malpractice insurance cost:

I’m sure it’s not a surprise to you, but malpractice insurance can cost a LOT.

What you may have not known, however, is that it can cost up to hundreds of thousands per year.

What…!?

You heard it right…

So pay attention to what AFFECTS your coverage cost, as this may change your approach to where and how you work locum tenens.

Let’s take a look…

Specialty

Some specialties are naturally higher risk, i.e., on average, they get sued more frequently compared to lower risk specialties.

Here’s an interesting data point that was published in NEJM in 2011. They looked at a one-year period to determine what percentage of doctors is being sued based on the specialty.

The other interesting point is that some specialties, like general surgery and Ob/Gyn, are not only getting sued more frequently, but their insurance would make a payment to the plaintiff more often as well.

Where you practice

The cost of your malpractice policy varies a lot based on where you practice as well. This is based on the general risk of being sued as well as the average payouts specific for the area.

What’s interesting is that rates can be different, even within the same state, as more affluent counties tend to sue more and the settlement payouts to the high-earners are larger as well.

When you buy your own locum tenens malpractice coverage, keep in mind you need to let your carrier know if you are going to work in a new location so that they can adjust rates accordingly.

Your cost may go up, go down or remain the same.

If you work across multiple locations with different costs (even if it is within the same state), you’ll pay based on the highest premium.

Look at the example below that gives you a good idea how big of a difference your specialty and geography can make.

Internal Medicine Annual Malpractice Insurance Cost

ObGyn Annual Malpractice Insurance Cost

General Surgery Annual Malpractice Insurance Cost

Besides your specialty and your practice geography, there are other factors that can affect the cost.

Past claims and losses

The more claims you’ve had and the higher the payouts, the more your insurance will cost you.

Coverage limit

Lower limit will mean you’ll get a cheaper policy.

Deductible

If you agree to have a deductible built into your policy, your cost will go down.

How much you work

Your malpractice insurance premium is prorated based on how much you work, so if you work 50% of your average weekly hours for your specialty, you get a 50% discount.

Shopping for your own malpractice coverage

Now, after learning the basics of the locum tenens malpractice insurance, let’s see how we can shop for it like pros.

Where to buy it?

The best way to shop for your own malpractice insurance is to use a broker.

It’s much easier to work with a broker, as you can get quotes from multiple insurance companies and compare the prices.

On top of that, your broker can answer your questions, which is helpful if you’re a newby.

Buying from an insurance carrier is an option too, but I don’t think it is worth it.

You see, you’ll have to request quotes and complete multiple annoying applications to compare the rates between different companies. This will take MORE time and effort on your part without giving you any advantage.

How to find a legit broker?

To find a broker, just google “medical malpractice insurance broker” or use referrals from other physicians.

Here’s a few questions you need to ask before signing up:

Does the broker specialize in malpractice insurance?
Does your broker operate in your state of interest?
Ask for their insurance broker license number and verify online on the official government website (e.g., here’s one for WA state).
If in doubt, ask for past clients’ contact info to make sure the broker has good reviews.

Decide on what type of policy you want to get

Once you’ve hooked up with a broker, you need to decide if you want to go with a claims-made or occurrence insurance.

The way to do it is to figure out how long you need your coverage for and calculate the cost.

For example, using this quote:

You can calculate how much you’ll end up paying for occurrence vs claims-based options:

So as you can see, with this particular insurance quote, you will be better off purchasing an occurrence policy as you will end up paying less from the get go.

Let’s look at another quote (two different insurers):

As you can see here, it would make sense to get a claims-based policy as it will cost you less.

So…run the numbers before buying to see which options would be better.

Keep in mind that you can switch between claims and occurrence insurance as long as your insurance company provides both options.

Also, you can actually cancel your policy at any point, in which case you can get a prorated amount back, although most carriers will keep at least 25% of the annual cost regardless of when you’ve canceled your policy.

This gives you peace of mind, as you have flexibility if your locum tenens gig dies off or you decide to jump ships and work with a locum tenens company instead.

Insurance carrier ratings

If push comes to shove, you want your insurance company to pay the settlement, right?

After all, that’s why you’ve bought the malpractice insurance in the first place.

That’s why you need to check your carrier’s AM best rating. An “A minus” or above is a good indicator the company has a strong financial base.

Five ways to save money on malpractice coverage:

Now, I want to suggest a few ideas on how to save your hard earned money when buying locum tenens malpractice insurance for yourself.

Depending on your specialty and how much you work, this may save you tens of thousands of dollars every year (you are welcome!)

Avoid high liability areas:

The best way to deal with problems is to avoid them in the first place.

Thank you, Captain Obvious!

That’s why picking up locum tenens gigs in state(s) with a better liability situation is the best overall strategy.

If you’ve got coverage already, check with your insurer to see how much you can save by working in a more physician-friendly state. You may be surprised how big of a difference this can make.

Consider a lower limit:

Even though 1M/3M is standard for locum tenens doctors, you CAN go with a lower limit and save money.

$500K/1M or even $250K/$500K may be a good option if you are in the state with a noneconomic damage cap AND your specialty is in a “low-risk” category.

Don’t shy away from policies with deductibles:

If you are ok with having a deductible, you can potentially save tens of thousands every year, as long as you don’t have any past claims.

This makes even more sense if your deductible is low, e.g., $2500 and/or your deductible is indemnity-only [jump link here]

Reduce your hours:

Another approach that can give you cheaper coverage is to cut your work hours to be considered “part-time.”

Of course, you need to crunch the numbers and see if this makes sense for you.

For example, if I were to work part-time only, I would save about $10K a year on the malpractice insurance premium every year. But…I would “lose” $150K-200K by reducing my work hours.

So for me, as an internal medicine hospitalist practicing in WA state, switching to part time just to save money on malpractice insurance would be nonsense.

On the other hand, this may make sense if your malpractice premiums are sky high (e.g., you’re an ObGyn physician working in affluent Florida counties).

“Clean” background discount:

Some insurers offer a discount (10-15%) if you have no malpractice history, so check with your broker if this can be applied to your policy.

What if your policy is TOO cheap?

Now, we’ve talked about how to make your malpractice coverage cheaper, but what if some insurers’ quotes seem TOO LOW to be true?

If this happens, my suggestion is to ask your broker why.

Does the policy have one or more of the “sneaky” clauses I talked about earlier?
Is there a high deductible or defense cost limit?
Does the insurance company have a low AM Best Rating? Or maybe it’s not rated at all?

This is where your broker’s knowledge and expertise can help you to weed out “bad” players from the good ones.

That said, if there’s a potential risk, I would always prefer a more reliable option, even if it’s more pricey.

💡 TLDR:

Use a specialized malpractice insurance broker to get quotes from multiple companies.

Figure out how long you need the coverage for and calculate if claims-based or occurrence policy makes more sense.

Pay attention to the insurance company “AM Best Rating”, A- or higher means the company has a good financial base.

Save on malpractice coverage: avoid high-risk areas, consider lower policy limits and policies with deductibles, work part-time and ask for a “clean” background discount.

If there’s a big difference between different quotes, ask your broker for an explanation.

The Anatomy of Malpractice Certificate Of Insurance (COI)

Now, after you’ve paid your “dues,” your next step is to get a copy of the Certificate Of Insurance (COI).

COI is a document that confirms your insurance status. Think about it as your insurance policy ID.

Here’s what it would look like:

Once you’ve received your certificate, pay attention to the spots I highlighted for you on the image, and make sure your name, address, policy limit and insurance type are all correct.

Since you typically need your previous COI’s when applying for hospital credentialing, I suggest you scan it and store it on cloud storage and your laptop.

Moving on…

The little big FYI: how NOT to get cancelled...

No, I am not talking about “cancel culture” here, I am talking about legit and legal reasons why your malpractice insurance carrier will revoke your coverage.

These things may seem to be obvious, but it is still worth mentioning since losing your coverage is a HUGE deal:

If the physician DIDN’T disclose anticipated or pending claims before signing up for a new policy.

If the physician was under the influence of intoxicants or narcotics while treating a patient.

If the treatment provided by physician was experimental, or was part of the research or trial.

Conclusion: Knowledge is power!

Phew…

Today, I’ve given you a crash course on buying your own malpractice insurance.

Now you know more than 99% of US doctors about this extremely important topic, which, if not approached with caution, can mess up your career and finances.

As always, I am on the lookout for your questions, so leave your comments below and I’ll respond ASAP.

As featured on

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

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.

Locum Tenens with Family: My Experience as a Father of Two

November 2, 2020 by LocumTenensGuy

Vlad Dzhashi, MD

Locum Tenens with Family:

My Experience as a Father of Two

As a father of two young children, I prioritize family time over everything else. I want to see my kids grow and experience life with them.

After all, how can I help them grow up to be successful when I’m not around to learn who they are? If I never learn their personalities, strengths, and weaknesses?

I think we can all agree that quality family time is of utmost importance… which leads to today’s topic: job flexibility.

Pros and Cons of Hospitalist Shift Work

There’s a perception that hospitalists have one of the best clinical jobs due to time off.

Typical hospitalist schedules of seven days on followed by seven days off give decent time off and some flexibility. They also allow for predictability, depending on how far out you schedule. This is something many parents can appreciate.

However, if you dig a little deeper, you’ll see that this “flexibility” may not be so great. After all, the typical hospitalist schedule may “trap” you on some important days, including holidays.

Maybe it’s not the end of the world to work a holiday that’s not important to your family. But what about your child’s birthday? Or your anniversary? Do you ask the important people in your life to celebrate on a different day because of your schedule? I don’t know about you, but my family would not be amused!

The next problem is the “bad” shifts —night and swing shifts.

Although some hospitalist programs hire nocturnists, some expect their hospitalists to work night and swing shifts.

Of course, we all know physicians who enjoy working nights, but in most cases, night shifts equal less sleep hence less “quality” family time.

Last, but certainly not least, is the issue of vacation planning.

If you like to travel across multiple time zones, 7 days off just isn’t enough. Even if you took a family trip to the beach for 7 days, wouldn’t you like a day or two to catch up on everything at home before jumping back into work? (Sometimes we need a vacation from our vacation, if you know what I mean:-)

Requesting time off as a hospitalist could be challenging, if you even have paid time off. Planning a big family trip often requires doing so several months in advance. This is especially true if it’s a popular vacation time, such as winter break or summer holiday. You’ll probably be competing with other people’s schedules.

Locum tenens may be the way to go

If you’re a hospitalist and find yourself nodding along as you read, maybe locum tenens work is for you. I’ve posted in other places about its benefits. As they apply here, the biggest benefit is flexibility.

Personally, after “pulling the plug” on a permanent job, I’ve found that it’s much easier to plan vacations, avoid working nights, holidays, and other important days like my kids’ birthdays.

Who will factor into your decisions?

Is your significant other or partner OK with you being away from home? Is yes, how many days a month? If not, are they willing to travel with you? If your partner works, can it be done remotely? Do you have children? If so, how old? What are your plans for school?

After you answer these questions, you can start planning. There are plenty of options between locum tenens and per-diem work to “engineer” your lifestyle and schedule.

In this situation, the biggest question is whether your significant other will travel with you. Obviously, this depends on employment status and nature of work.

If your partner will be traveling with you, it’s more likely you’ll be looking for work in desirable locations (Hawaii, here we come!).

But if the location you choose is less-than-exciting, there’s a good chance you’ll be traveling alone.

There’s no right answer, of course, so you’ll have to decide what’s best for your situation.

Here’s a good example of how this worked out for a psychiatrist:

Unless you and your significant other love to be on the go, I think having a home base is best in this situation. To maintain flexibility and stay close to home, do part-time work plus per-diem or 100% per-diem.

If your partner can care for the kid(s) on their own, and/or temporary outside help is available, you could choose to take on a locums gig for extra money.

In this situation, your decisions will likely be driven by your plans for school. Do you plan to send your kids to school or will they be homeschooled?

Option 1 – local school:

Again, if flexibility is your goal, and your kids will be attending school close to home, per-diem work may be a better option for you.

If earning more money is your goal, you can achieve this by finding well-paying gigs out of state or out of town. Just make sure your significant other can and is willing to care for your children alone (or has help)!

Option 2 – homeschooling:

If you want to homeschool your kid(s), you obviously need a designated teacher for your kid(s). This usually ends up being a stay-at-home parent (sorry, honey…).

The benefit of this is that you can travel with your children ALL THE TIME. This is great if you love to travel, and you can also earn more with locum tenens gigs.

Living arrangements will be a big consideration here. You don’t want to end up in cramped quarters intended for a single physician. Consider renting a house or large condo or negotiating that into your contract.

This might seem pretty obvious, but it’s worth mentioning for physicians in this situation who may feel stuck.

Many folks send their kids off to college and only see them at holidays or other school breaks. Working locum tenens can allow you plenty of flexibility if you want to be near your kid(s) but don’t need to be present everyday.

For example, I know a hospitalist who worked locum tenens in the same town as her daughter’s college. She then flew to a different state to work more shifts.

Money vs Flexibility:

Here’s an ugly truth about locum tenens when you need to balance it with family life: you WILL be tempted to work away from home. A LOT of high paying gigs will be away from your home, and unless you take your spouse and kids with you, you will spend this time alone.

A great option to have plenty of family time AND make more money is to work as a per-diem hospitalist: per-diem rates can be as high as locum rates and even higher and you get a long-term flexible job close to home.

I have a wife and two children, and my goal has been to cut back on travel as much as possible. To maximize my flexibility and family time, I ended up working per-diem at local hospitals and stopped traveling for a couple of years.

I realize I probably could have made much more money chasing higher paid gigs in different states. But that would mean more time away from my family, which I was not ready for. So the choice was easy for me.

Now that my older kid is in school and my youngest is almost 4, I’m fine with traveling for a week per month to work. I should point out that I only do it if it makes sense financially (i.e., I make more when working away from home).

This gives me a chance to work less during winter and summer months during school break time so my family can travel together. This is absolutely the best time of the year we have as a family: so many great memories and experiences.

I especially appreciate the fact that I DON’T have to ask anyone’s permission and set my schedule the way it FITS me and my family (unlike when I had my first permanent job).

Conclusion:

In summary, there are ways to make locum tenens and/or per-diem work for you, depending on your goals. In my experience, you can outearn any permanent hospitalist job and still have plenty of quality family time.