Vlad Dzhashi, MD
Dr. VB is a board certified locum tenens oncologist who once accepted a weekend position and never looked back. She found working as a locums to be a perfect fit to maintain a work life balance.
We spoke at length with Dr VB , now in her third year of practicing hematology oncology locums, about why she chose this career.
We discussed the typical assignment, the demand for the specialty and strategies for getting contracts.
We also covered pros and cons of working as a locums Oncologist, and, importantly, addressed pay rates and approaches for negotiating a contract.
Finally, Dr VB provides advice and reflects on what she may have done differently if she had to start again.
Enjoy reading the interview below, or watch the video.
Why did you choose Oncology locum tenens
I did all of my residency and fellowship at Brown University in Rhode Island, and ended up doing contract work straight out of fellowship for a number of reasons. I wanted to try out a position before committing to any permanent position. I really wanted something that offered me flexibility and the ability to create my own schedule and spend time with my family.
I originally agreed to one weekend call, and it was a great experience. The flexibility and lifestyle were a good fit for me. I was able to practice good clinical medicine without having to dedicate myself to long periods of time or financial commitments that you might have with private practices. It grew from there and locums has been a dream job for me.
Best way to find locum tenens Oncology jobs
An important part of landing per diem and locum tenens jobs is through your contacts, word-of-mouth. It is helpful to utilize all social media platforms, such as LinkedIn and Facebook. I belong to several groups, including women physicians, mom groups, general physician groups. These groups give you great insight into community needs.
I also pick up the phone and cold call trying to talk to the in-house recruiter, which can be hit or miss. I use Google maps to identify facilities and send a letter of introduction that includes my name, my active state license(s), experience and availability. Of course, these approaches have mixed success so it is good to set your expectations accordingly.
Demand for locum tenens Oncology
This is an important question. The opportunities vary by geographical location. For example, here in Florida I have on occasion had difficulty finding local jobs. Some areas have better markets for oncology field than others.
Sometimes you have to be prepared to travel, but the further you are willing to travel the more options you have. In general, the demand is there and you can be successful working as an oncology locums.
I am part of a WhatsApp group, HEMOC locums, and there are around 80 or 90 of professionals who share information about positions and support one another. From my time with this group and my own experience I can say that there are regular jobs available.
Now, Hematology Oncology is different from, for example, primary care, because the field is reliant on reimbursement from insurance companies. It is possible that changes within the structures of insurance companies may impact the need for oncology locums but it is difficult to tell.
Typical Hem Onc locums assignment
Hem Onc locums varies in the type of work depending on if it’s clinic, hospital or both. I have found, especially in Florida, a greater demand for inpatient roles. Other states have a greater need for outpatient work. Stepping in as a locum oncologist is tricky because many oncologists have longstanding relationships with their patients.
Working as an inpatient consultant is a good model for a locum because you can step in, provide a consult, and step away. Communication and preparation are key. I review past notes, pathology, imaging, and am ready to go.
Most of my experience is in the community setting. In locations with higher workloads, I may have a resident or PA who helps. Many of my consultations are in hematology, including issues such as thrombocytopenia, anemia, thrombosis, hematologic issues during pregnancy, iron deficiency anemia.
In general, services will usually start you with lower patient numbers, which is common for a specialist. Oncology requires a lot of coordination with other providers such as a radiation oncology, pathologist, surgical oncology. There are multiple moving parts, and this can be true at every visit.
Average patient censes
When you factor in no-shows the number of patients you see during a clinic day is pretty variable. I have seen up to 22 people in a day, but that can be a lot because some visits are very time-consuming. If I just saw all iron-deficiency anemia that wouldn’t take too long. But if a cancer is progressing or someone has a new diagnosis, then you have to, for example, set up a PET scan, a biopsy and provide counseling.
You need to counsel people on the possible outcomes of their cancers, whether they are typically curable or treatable or not curable or treatable. They also need to understand the possible side effects of any prescribed chemotherapy. It is possible they need to be set up for genetic counseling, nutritional counseling.
I have been timing some of my patient encounters because my work is time-based. The longest patient visit I had was around 92 minutes. This visit was for a new diagnosis of lung cancer. On the other hand, I might see someone with, say, pancytopenia from cirrhosis that they have had for the past three years. You tell them what’s going on and they’ll say “yeah, I don’t know why my doctor sent me…” That ends up being a pretty short visit.
That’s the thing – in my specialty you just never know. Seeing a long list of patients on your schedule can be daunting. Often it depends on what’s going on with the hospital, with the weather, etc.
You know, the good days are phenomenal, and the bad days can be very taxing. It does help to have some support in the healthcare facilities to offset the fluctuations in the schedule and at least provide some preliminary triage.
Typical practice settings for Hem Onc locums
There is definitely more demand for oncology locums in rural areas, but I have worked in urban, suburban and rural settings. The rural locations tend to be more laid back, have a bit of a different feel.
In places where you are the only doctor you need to be aware that you will be needed during the entire infusion center time. Much of your value to the facility is being physically present so that chemotherapy can be safely administered.
The urban centers tend to have a higher patient volume with possibly a lot of different hospitals. It can certainly be a mixed bag. I am open to a mix of settings and cases, but I do like my rural centers.
pros of locum tenens for Hem onc physicians
A big plus for me is the flexibility, the shorter schedules and the ability to spend time with my family while still being as busy as I would like. When I have time off I truly have time off.
The thing about oncology is that you are managing the patient and that can be inescapable. You have to wonder about their pain, headaches, fevers, and when they are sick if they will need to be seen in the emergency department, and if that system doesn’t have access to the chart then the oncologist is the gate-keeper to a lot of information.
In traditional oncology roles you are called for all sorts of things, such as refilling narcotics or patient anxiety, because you have a very specific body of knowledge related to the potential for reactions to chemotherapy or side effects from immunotherapy.
So to be able to triage a patient and help everyone to the best of your ability and then remove yourself from any ongoing needs is really helpful, especially if you have younger children. I really like being able to devote my time to my children when I’m off, and working as a locum has been a very good way to do that.
I also like being able to support other doctors who need vacations, and I really try not to bother them when they’re away. I also like not being bound by non-competes or any convoluted contracts.
For the most part, I’ve had really great relationships with my clients. I have been able to return to these facilities and form long-term relationships with many of them, even though I’m a contractor.
Cons for locum tenens Hem Onc doctors
When I’m helping with locum tenens coverage for vacations I don’t get to choose specifically when I’m going to work and end up working more weekends than I would like. If I am unable to meet the need of the facility then maybe that relationship comes to an end, and that does happen from time-to-time.
Because you’re a contractor, sometimes important information doesn’t reach you in a timely fashion. For example, you don’t always know when there has been an organizational change or a new EMR or a change in practice scope or type of patient being seen.
If you’ve committed long-term to, say, two weekends per month sometimes that kind of schedule can be difficult. If you have not committed long-term you can cut back if it’s too much. I have decided to reduce my weekends, and that flexibility is really great.
I think for someone who has a very defined idea of what they should be doing at work a locums job can be frustrating- you have to have flexibility not only with the patients but also with systems. You may have to, for instance, figure out the EMR after seeing the patients.
You have to know how to use your resources. If you are having difficulty getting around and putting in orders and finding information, it can be very frustrating. But if one place is not working out you can try an arrangement with a different place.
I do like change, trying new things and going to new places. I also keep a savings buffer. This gives me the freedom to cut back if I need to, or if something comes up and I’m not needed then I can ride that out.
Oncology locums pay rates and salary
The current hourly range for the last few years seems to be between 375 and 550 per hour. I think the very lowest I’ve been offered was for a “babysitting” job quoted at $2,000 for the day, and the highest I have ever heard of for one day was $7,200.
Sometimes the inpatient rates may be a little, but not a ton lower. In very low volume areas people may negotiate a flat 24-hour rate with extra for callbacks. I haven’t worked in very low volume areas. You usually don’t get a lot for overnights, to be honest. For a 24-hour call it might be somewhere between $3,000 to $4,000, but not considerably more.
When I do weekends I cover inpatient consults and patient calls between Friday morning and Monday morning and I get a flat rate for that. It’s a mixed bag. Lately I have been busy but haven’t had a lot of overnight calls, but every system is different.
Pay rate can depend on workload, but not always. There is a lot of inherent variability within the specialty. Sometimes your consult volume is affected by all the things that impact hospitals like a pandemic, the weather, anything shutting down the OR. Some people have trouble figuring out a new EMR. All of these things have actually happened to me.
So pay is very loosely tied to the number of patients seen. I think in general for an outpatient setting they expect to pay you for about 8 or 9 hours. I think though in the future I will try to use a capped rate model, because many of my clients are unable to judge how much work they’re giving me. With a capped rate, they will know in advance how much I’ll make.
To determine my current rate, I take the rate offered by local agencies and then add about 20 percent. I fund my own travel and locum tenens lodging. I handle my own logistics and don’t need anyone to handle that for me.
Negotiation Strategies for medical oncologist
At the beginning, because I didn’t know if I was going to stay or do the job for very long I didn’t really try to negotiate much. As I went along I found I was able to negotiate higher rates because I proved my worth.
With clients that I might have a long-term relationship with, in a desirable location with a good workload, I may not spend a lot of time negotiating. But if you’re being asked to go somewhere where you don’t really want to go and may not go back, then, yeah, I’ll ask a bit more in that situation.
You need to consider how much you want the work, the nature of the job, the initial offer. It also depends on your geographical area. You will get a different rate in Montana than in Florida than in Pennsylvania. It depends on where the need is.
It is important to understand your options. The situations changes over time, the need for locums changes, so your arrangements are flexible. For a group that I enjoy working with I am more flexible in my rate.
Advice to Oncologists who are new to locum tenens?
I have plenty of advice. I suggest starting out to under commit. You can always take on more. Then keep your commitments, be professional in all aspects. Avoid non-competes.
Learn about finances. Learn about taxes sooner rather than later, learn about business deductions and retirement accounts. They don’t really teach you these things in fellowship.
Don’t hand out your CV willy-nilly. If you are giving out your CV, make sure that it’s watermarked if you are not allowing yourself to be presented. Be very clear in your communications with clients and learn to set boundaries.
I have actually learned a lot from this process, about business, about communications. I think it has made me a better physician and a better person. I have been able to help a lot of patients, which has been fantastic.
I have realized that I love the work I do. A hematologist oncologist that is able to create connections with people. It has been phenomenal, a big learning path, but definitely well worth it.
What would you do differently if you started again?
I would have started looking at contract work earlier instead of exploring options that were clearly a poor fit. Understanding finances is really key. I don’t think I made any terrible decisions, but bookkeeping and business deductions are no small task.
I would have wasted less time with recruiters who have absolutely no idea what the gig involves. Learning to set boundaries is very important.
A few years in, I’ve done that with polite messaging about my availability. Having clear and direct communication is crucial.
