Vlad Dzhashi, MD
Table of Contents
Tell us a little bit about yourself.
I’m a board certified general neurologist and vascular neurologist. After completing my residency, I did a year long stroke fellowship, and then I did academics full-time for five years and then part-time for a year. For the last three years I’ve been doing a combination of locums, telemedicine, and then some healthcare consulting work.
Why choose locum tenens as a neurologist
Since I was in my non-clinical fellowship, I needed more flexibility so that I could control how much I work in a given month and make a great income. So locum tenens was a no-brainer.
Between the various gigs, including the locums, I’m making enough income that I have enough personal time for me and my family, and I can also focus on what takes up the majority of my time, which is my climate and health fellowship which is basically an advocacy and policy fellowship centered around the intersection of climate change and medicine.
Best way to find neurology locum tenens jobs
When searching for a locum tenens job, I would start by asking for recommendations from your colleague. This allows you to determine which agencies are adept at providing ample neurology opportunities while maintaining a low-intrusive approach.
Additionally, exploring job posting websites like the American Academy of Neurology Career Center or the New England Journal’s job alert site is a useful option, since they often list locums jobs specific to your specialty and subspecialty.
I prefer to work with locum tenens agencies , as I found that working directly with facilities can be quite time-consuming and require a lot of work in terms of negotiations, booking, and paperwork. Furthermore, there is limited assistance available for licensure and credentialing and facilities don’t always cover your malpractice insurance when working directly.
Typically, once I’ve found one or two agencies I like, I tend to stick with them long term.
Best way to find locums neurology jobs:
♦ Working with agencies is the easiest way to find locums jobs
Demand for locum tenens neurologists:
I think there is a huge demand for both inpatient and outpatient locum tenens neurologists. There’s definitely a staffing shortage of neurologists throughout the country and even in very populous states with a lot of academic centers and a lot of major hospitals.
I also think that the gigs that are available in the market are pretty diverse. So if you’re looking for neurohospitalist, outpatient, a combination of both, or if you specialize in neuromuscular, epilepsy pain management, interventional , stroke or general neurology, they’re positions out there.
In terms of how much work you’re able to find, it’s largely going to depend on how flexible you are. Also, I’d say the big states like Texas, California, Illinois, Virginia typically have more open positions.
Demand for neurology locums:
♦ Demand remains huge for both inpatient and outpatient neurology
♦ Jobs are available for both general neurology and subspecialties
Neurology locums clinical settings
Personally, I’ve worked in Florida, Kansas, Missouri and Colorado and I’ve exclusively done inpatient locums, because I like to just have the on and off shift work and not have the continuity of care with the clinic that would eat into my time.
Also, because I’m doing inpatient, the cases I’m seeing are mostly strokes. And so when you’re doing any sort of inpatient gig, they prefer that you’re stroke boarded and stroke fellowship trained. Or, at the very least, they expect you to be comfortable with stroke in terms of reading your own, vessel imaging, perfusion scans, MRIs, and making decisions about thrombolytics and endovascular.
As to the settings, the facilities have been mostly primary rather than comprehensive centers in smaller cities or in the outskirts of larger cities. These hospitals then refer patients to the larger centers, which are most often private or less often academic.
Facilities I worked at are usually staffed by hospitalists and APP’s and usually they offer an exclusive neurology consult service without a primary neurology service. So neurology patients are primarily admitted to a medicine hospitalist service, and then you consult on them.
With that said, I’ve seen gigs out there where they want you to take care of a primary neuro service and then also do some neuro consults “on the side”. If that’s the case, they’ll have an APP working with you.
So I’d say usually locums neurologist would work with a Physician Assistant or Nurse Practitioner, less commonly solo and even less commonly along with another neurologist.
Locums neurology clinical set up:
♦ Most commonly inpatient settings
♦ Hospitals in smaller cities or in the outskirts of larger cities
♦ Neurologists act as consultants not as a primary service
♦ Neurologists typically work with APP or solo, less commonly alongside another neurologist
Locum tenens neurology hours and schedule
Typically, locums neurologist hours range from eight to twenty four. Most of the time, they want you to do a 10 or 12 hour shift. And then they’ll either have a teleservice to cover their weekends or nights or they might have you take overnight calls which can be just by phone.
Now, they might ask you to come in person depending on what it is they need. But it’s mostly day shifts, I would say, as they’ll usually employ a less expensive teleservice to cover their nights or they might not even have night coverage
Locums neurologists hours:
♦ Hours range from 8-24 hours
♦ Typically 10-12 hour shifts for inpatient coverage
♦ You may require cover night call over the phone
Pay-rates for locum tenens neurologists
The pay rates for locum tenens neurologists vary depending on the location, workload and the type of settings. Usually I’ll look for an hourly rate of around 250 or above. That’s for hospital coverage on weekdays Monday through Friday.
So typically in a day, depending on whether I’m just working business hours or taking overnight call, the daily rate would end up being $2,500 to $3000. On weekends and holidays I’m usually aiming for a higher daily rate between $3000 to $5,000.
If you provide call coverage at night, the agencies will pay for taking the pager anywhere from $200 to $500 simply to be available. And then they’ll pay you extra depending on how many hours you get called back. Usually the call back hourly rates are the same or higher, compared to the daily rate. So if you’re making $250 per hour during the day, it might be between $250 and $350/hr.
Locum tenens neurologists PAY RATES:
♦ $250-350/hr or daily rate of $2500-3000 for regular hours Monday to Friday
♦ $3000-5000 daily rate for weekends and Holidays
♦ Pager fee $200-500/night
♦ Call-back hourly rate $250-350/hr
Pros and Cons of locum tenens for neurologists
As a locum physician, I receive higher compensation for fewer hours, giving me additional time for personal stuff. I also enjoy the flexibility in my schedule and the chance to visit different cities, possibly even extending my stay into a vacation.
Another significant benefit is the potential for 1099 income, which can prompt me to establish an LLC. With the changes in tax laws, many doctors now create LLCs or S Corps and write off various business-related expenses such as licensing, credentialing fees, or equipment costs. This could be anything from headphones and laptops to phone bills and home office utilities, resulting in significant tax savings.
As to the disadvantages, there’s a few. The locum tenens licensing and credentialing process can be tedious as it needs to be redone for every hospital. It also places a burden on my colleagues who often need to provide letters of reference. Moreover, some locums agencies can be quite invasive in their communication, contacting at odd hours or during patient consultations.
Sometimes, I find the information provided by the locums agency about pay, hours, benefits, or hospital resources is not accurate as they receive it secondhand. I prefer getting this information directly from the hospital. Another downside is the need for flexibility and availability for last-minute gigs, which might not always align with my schedule.
A significant risk factor is relying solely on one hospital for work. There are times when I’ve committed to a place for months, only to be dropped when they hire a permanent person. This reality forces me to diversify and not rely solely on one place for income.
Lastly, working locums does not come with the usual benefits such as medical, dental, or 401k. If locums is my only source of income, and I’m not financially independent, that can be a risky proposition.
Neurology locums “hacks”
Before you even consider talking to the locum tenens agency, you need to be very clear about what you’re willing to do, what you’re not willing to do, and what you’re flexible on. This is because you don’t wanna be down the line with the credentialing process, decide “I don’t really want this”, or you go and you don’t do a good job because you’re not really competent in a particular area. So I have that conversation with myself first.
Once you’ve decided on your preferences and limitations, then you need to create an email template (see below) which you send to the agency to make sure they’re aware of these things. This way I don’t forget to ask anything and we don’t waste our time on going back and forth if the job doesn’t fit my preferences.
EMAIL TEMPLATE
The following is an example of the email you need to send to the recruiter that lists your requirements and preferences:
Hi, Recruiter’s Name here!
Thank you for reaching out. I’d like to get more details about this locums job to make sure it’s a right fit:
● What specific days and hours need coverage in-person and by phone-only?
● What is the expected total number of patients I would see during the day and get called about overnight?
● Would there be neurologists or APPs working along side me on shift? If so, what hours?
● What is the compensation broken down by guaranteed, overtime, holidays, nights, and weekends?
Also, I’d like let you know my preferences and my requirements for locums job:
● Up to 1 week/month out of state.
● Can do tele or in-person
● Inpatient only, not outpatient
● Inpatient consults only, no primary service coverage where I would have to admit and discharge patients.
● Will see all types of patients with neurological conditions including stroke. I do not see pediatric patients.
● EMRs: will use Epic or Cerner, but will not use Meditech
● If night call is required, I will only cover by phone, not in-person
● I do: perform lumbar punctures, give tPA (alteplase) and TNK (tenecteplase)
● I don’t: read EEG or EMG, perform endovascular procedures or surgeries
● I need a test-out option for EMR training with Epic and Cerner, I am not open to sitting through EMR training for systems I already use.
● If the hospital wants to be compensated or simply have the option to cancel within 30 days of the assignment start date, I expect to have the same privilege. Similarly, I don’t necessitate these conditions if they don’t expect them of me.
Active certifications and state licenses:
● Boarded in Neurology, Vascular Neurology (Stroke).
● Active state medical licenses: (list your licenses here)
● I have 2 active DEAs
● BLS, NIHSS are up to date. I don’t have ACLS, but can get it if needed
● COVID vaccine, flu, PPD, and common vaccinations are up to date
● NPDB with no issues as of Jan 2023 (I check annually)
● No past/current malpractice claims to my knowledge
As this is just an example, you need to personalize this email to the recruiter based on your situation.
What would you do differently if you started as a locum tenens neurologist again
Reflecting on the last three years that I’ve been doing locums as a neurologist, I would say the first thing that I would do differently is know what I’m worth and I would not take low pay rates.
Because after I did the math, I realized some of the gigs I was doing were making the same or less than my hourly rate when I was working full-time in person. So clearly that’s just not the best use of my time.
The second thing I would’ve done differently is make that spreadsheet with the list of my preferences and requirements for the agency. This would’ve minimized the communication back and forth and misunderstandings.
The third thing I would’ve done differently is I wish I’d just used my own credit card and book the trips myself to rack up miles and points cuz then I can just use that for, you know, vacations and personal stuff as these miles can build up pretty quickly. TIPS for locum tenens neurologists: ♦ Know what you’re worth ♦ Be very clear about what your preferences and requiremens are when communicating with agencies ♦ Use your own credit card to collect poitns
