Part 6: Locum Logistics (How Providers can Get There from Here)

After wading through that tome-of-a 5th chapter on the legal and financial considerations of working locum tenens, you’ll find this chapter short and simple. Now we prepare you to actually “hit the road,” get to the hospital or clinic where you’ll fill in, and settle into your temporary living quarters (unless your assignment is close enough to “home” for you to drive back and forth).

Section 1. How Much Travel Does Locum Tenens Involve? Will I Ever Be Home if I Do This?

home-docs

Once again, let’s be honest: Traveling for work can be both a blessing and a curse.

Yes, there are frequent-flyer miles to accumulate (albeit, less generous than they once were), hotel-stay points to add up, and places to see beyond where you’ve lived or visited previously. 

However — especially in light of more-stringent security precautions that have evolved post-9/11, and heightened health-related restrictions brought on by COVID-19  — traveling can be stressful.

You’ve probably traveled by air before, so you know the drill. But just as a reminder (and because it makes for great spoiled-American sarcasm)…

First, there’s the packing — lightly and efficiently, if you want to avoid the risk your belongings board a different plane than the one you’re on because you had to check them.

While you’re culling unnecessary or impractical items from your potential “cargo,” you might as well remove anything that could be used as a “weapon” from what you carry day-to-day. Otherwise, TSA screeners will remove and keep those items for their ‘things-people-try-to-bring-onto-planes’ stockpile — like the very small, dull pocket knife (found on a Target parking lot) which yours truly carried in her purse because it included mini scissors that could be used to clip things like loose threads or news articles. Life lessons.

Also, there’s  the volume limit on toiletries, and the requirement they be segregated in see-through ‘packaging’ so TSA agents can view them as your bag(s) pass through the scanner. Nothing of volume more than 3.4 ounces (100 milliliters) or less per item, got it?

You’ll need to remove all things metallic from your pockets and the watch from your wrist, along with the shoes from your feet and the belt around your waist (should you wear one). Those must be scanned via X-ray, as well. Oh, and remove that laptop from your bag, turn it on, and place it in its own bin for scanning.

You must arrive at the airport at least two hours before your scheduled domestic flight (add an hour for international travel) to ensure you make it through the security checkpoint before your flight boards — unless you’re checking no luggage.

This seems like the perfect time to quote Dr. Vladimir Dzhashi from his blog post about “travel hacks”: “TSA precheck is a MUST for a hassle-free airport experience.” As Dr. Dzhashi notes, its benefits more than make up for the $85 outlay and the couple of weeks it generally takes to get approved. One of those benefits is reducing your pre-flight arrival time by a whole hour!

Also regarding packing, Dr. Dzhashi’s advice is to “unpack as little as possible” between trips, so adding clean clothes is the extent of packing for the next trip. “Basically, the only thing you remove from your suitcase is your laundry. Everything else should stay THERE (e.g., toiletries, gym shoes, utensils, thermos, lab coat, stethoscope, pager, badge).

How Long is an Average Locum Tenens Assignment?

“Originally, locum tenens placements were for two weeks or less to fill in for doctors who were on leave or were otherwise absent,” according to Lucidityjobs.com. “Yet in recent years, assignments have become longer. The most common assignment duration ranges from five weeks to six months. Almost 40% of clinicians prefer assignments that last between one and four months, while 16% prefer assignments between nine and 12 months.”

However, a physician who learned from a terrible locum tenens experience in a remote Alaskan village offers a cautionary tale. In an article he wrote for the AAFP (American Academy of Family Practices) journal Family Practice Management (“FPM”) back in 1999, William T. Cushing, MD, MBA, offers advice that has aged well:

“You will also want to make sure that the agreement offers a system to equitably address any conflicts and allows you an escape route if the assignment is abusive. To keep yourself from being locked into a bad situation, try to have assignments limited to just one or two weeks initially, with an option to extend the assignment if you and the practice are compatible and pleased with each other…do not make a long-term commitment until the compatibility index has been tested practically.”

Echoing Cushing’s sentiments, All 50 Medical offers, “There are often plenty of surprises for physicians who try locum work — less-than-satisfactory housing conditions, unfamiliar documentation and billing systems, and new faces that can’t be trusted yet. But at least the length of the job won’t be a mystery. Duration of locum tenens jobs ranges from very short assignments that are only a few shifts to long commitments requiring a year or more in one place.

“The duration of a job will depend entirely upon why the doctor is needed. If a provider is filling in for a physician off for maternity or health leave, he or she may fill in for 12 weeks or so and will leave when the regular provider is ready to return,” All 50 Medical says. “In other cases, a locum provider may cover a sudden hole until the hospital can find a permanent replacement. Other needs include vacation coverage, or extra staff  for a hospital or bed expansion.”

While noting that assignment length varies based on client situations and needs, Staff Care says most locum assignments last between two weeks and two months.

Pegging the typical locum tenens assignment at 3 to 6 months for hospital medicine, Dr. Dzhashi started negotiating directly with hospitals closer to his home in Washington State to work per diem (primarily) once he and his wife had kids.

He lays out options for managing locum tenens work while allowing for personal travel time in a recent post here.

Are Travel Expenses Covered for Locum Tenens Doctors?

In short, YES, generally.

In a September 2019 blog post on locumstory.com, CompHealth advises, “If your assignment requires flying, [your agency rep will] work on securing a flight that accommodates your schedule. The best part? In most cases, you have no out-of-pocket costs. However, if you decide to upgrade or make in-flight purchases, you’re typically responsible for those costs…

“If you prefer to book your flight, most agencies will reimburse you for the cost — unless you feel the itch to fly first class and sip on some champagne, in which case the agency will only reimburse for reasonable and customary costs.”

The largest US locum tenens agency, CompHealth advises you’ll be responsible for other add-ons — like seat upgrades, in-flight services or food, and alcoholic beverages.  “However, as a 1099 independent contractor, some of these things may be tax-deductible. Consult with your tax advisor to learn more.”

The company adds that, in the event you decide it’s easier or more convenient to drive your own car to the assignment, you’ll generally get reimbursed for the miles you travel at the IRS standard mileage rate.

Will I Have to Pay for Transportation If I Want To See My Family While On a Multi-week or -month Assignment?

Again, yes, most likely.

While we haven’t yet found any locum tenens agency that addresses this exact question online, we note that most family-related expenses for a locum tenens assignment are the contracting physician’s (or other clinician’s) responsibility.

This makes common sense, right? If it weren’t the case, the benefits of working locum tenens really wouldn’t be equal for providers with and without families in the picture, would they?

Looking at the question from the hiring facility’s perspective, it’s easy to appreciate that the hiring entity needs a physician to fill an open slot. It expects to pay for expenses related to getting the provider there, housing him/her during said assignment, and returning the provider home once the contracted assignment is over. Accommodating a provider’s family-related needs would add to the already-elevated cost of filling the clinic or hospital’s staffing gap.

However, this is not to say that, in difficult-to-fill situations, a willing physician couldn’t negotiate some family-related accommodation into the locum tenens contract. As seasoned locum tenens providers have noted, ALMOST everything is up for negotiation BEFORE the contract is signed by all parties involved.

What If I Want to Bring My Family Along?

CompHealth’s advice: “Many doctors like to bring their families along and make the trip a working family vacation. Staffing agencies will often help with the travel arrangements for family members too. However, you are usually required to pay for the cost of their airfare. If you plan to use frequent flyer miles to cover the cost, it’s likely you’ll have to arrange that yourself.”

The agency also offers “Key considerations when you take your family on assignment with you:

“Be sure to let the agency planning your housing know early that you will be bringing family

If the cost of housing to accommodate your additional family members or pets exceeds the housing budget for your assignment, you may be required to pay the difference.”

According to Hayes Locums, “Whether you have a spouse, significant other, children, pet or any combination of those, you might want to have them travel with you on your assignment — especially if it is for a longer period. In these situations, we will work with you to try and find the best arrangement possible.” 

And from VISTA: “The in-house travel team at VISTA arranges all travel to your assignment. Comfortable housing in apartments, extended-stay hotels, or vacation houses available in the community will be provided. For onsite interviews for permanent positions, the interviewing client will cover the cost of travel, hotel, and related expenses. We are happy to help make travel arrangements so that your family can join you, but you will be responsible for their expenses.”

Section 2. What About Housing? Will I Stay in Hotels All the Time?

locumpedia-illustration-02

After almost a year-and-a-half of spending more time at home (with family, in many cases) than ever before in our lives (because of the COVID-19 pandemic), many of us would welcome staying alone in a quiet hotel room for a few days or weeks, no doubt. Especially if that hotel is in a city or town offering new things to see and do, plenty of (affordable) places to eat out, and meaningful work at above-average rates of pay.

Sounds almost like a dream — am I right?

Nevertheless (as we’ve alluded to in previous sections) not all travel accommodations are quiet and comfortable; not all locales are accessible and entertaining; and neither the work’s importance nor the paycheck premium is worth tolerating the personalities, politics or processes involved in completing, or extending, the assignment.

This is not to completely rain out your ‘locum tenens parade,’ but to suggest you remain realistic about where you’ll stay when traveling for work. (Hey, at least you won’t be required to share a hotel room with a coworker, as we’ve heard some MAJOR retailers expect their managers to do.)

Locumstory summarizes the locum lodging ‘decision tree’ as follows:

“Once you accept an assignment, the staffing agency will take into consideration the type and length of assignment when determining where you will stay. Are you taking an assignment just for the weekend or have you chosen an assignment of 30 days or more? Maybe you’re picking up a locum shift to help out at your local hospital and are within driving distance to your own home.

“The following are general guidelines of what you can expect from most agencies for the different types of assignments:

  1. A week or less – a standard hotel room with one bedroom and one standard bathroom
  2. More than one week to up to 30 days – usually a suite or larger hotel room with a kitchenette
  3. Extending longer than 30 days – leased apartment with one bedroom and one bath, furnished with one TV and one bedroom set. Larger apartments with additional furnishings are often available as an upgrade.”

Regarding living arrangements, Hayes Locums offers: “The average locum tenens assignment will place you in an extended hotel stay — perfectly comfortable for one person, but maybe not the entire family. When it’s needed, Hayes Locums can help find accommodations that are better suited to your family.

“While the expense of larger living arrangements will likely not be fully covered by the hospital, our goal is to make sure that everyone’s needs are being met.” 

As a veteran locum tenens traveler, The Locum Tenens Guy, Dr. Dzhashi, offers some salient suggestions for negotiating housing that facilitates your stellar performance on the job in his June 6, 2021, blog post here. Scroll down to the blue bar entitled “Comfortable Stay” to learn about housing “hacks” that will make your work-related travel much more enjoyable.

Writing for All 50 Medical, Rachel Ballard advises, “Chances are accommodations will be similar to an extended-stay vs. a cozy house rental.  While housing may not be like home, the upside is if you hit a snag in the middle of your travels, you have the benefit of calling your agency for help. Most companies have a department specially dedicated to handling travel details and they can help you address problems.”

In Dr. Cushing’s FPM article, he advises you to specify in your locum tenens contract the type of lodging you expect — minimum standards, at least. He recommends you ask for a small apartment, which affords both privacy and kitchen access, so you can control your diet: “Eating out is expensive and can be unhealthy. Typically, locum companies will not cover your food expenses, but if they do not supply lodging that allows you to control food expenses, they should contribute to the costs. Put this in the agreement.”

Section 3. What About Food and Incidental Expenses (e.g., Laundry) Who Pays for These?

no-bs-guide-section02

Hayes Locums notes the following expenses are covered for those traveling to locum assignments: travel, tolls, and housing. This means, “You are responsible for any personal expenses such as laundry services and meals.”

All 50 Medical’s Ballard offers some pertinent perspective on incidental travel-related expenses for locum tenens clinicians:

“Even if all your costs are not covered, remember you are operating as an independent contractor and some of your expenses may be tax deductible. Talk to a tax professional to know what receipts to hang onto for Uncle Sam.

“If a provider takes a local job that’s within driving distance, the agency may cover the cost of gas or reimburse mileage, but that will have to be negotiated up front. Make sure to ask and always get it in writing before accepting any locum work.

“There are not usually any significant incentives for locum travel. It’s sort of an assumed part of the job. Keep in mind though, that high-demand jobs that need to be filled immediately may give you more negotiating leverage. If a hospital is desperate for a provider, they may agree to pay you more to come on a moment’s notice and meet more of your requests.

“Never assume that you will receive premium housing or travel benefits when you are negotiating a contract. It is the provider’s responsibility to clarify the locum agency’s role in travel assistance and to get any changes to the travel terms in writing.”

Physician on Fire (POF) Leif Dahleen suggests, “Travel costs on these medical-staffing assignments are typically reimbursed and you may also receive a per diem for meals and incidentals.”

Testing a Theory

As a simple test of POF Dahleen’s suggestion about “per diem meals and incidentals,” we went to Locumpedia.com to use the outlet’s “Locumpedia Search,” a new locum tenens search engine. It allows physicians, CRNAs, and advanced practitioners to search job listings posted on staffing agency websites from a central location. The search engine is free to use and does not require registration by employers or by job seekers.

Guess what: When we searched “per diem for meals and incidentals” among industry job listings, Locumpedia Search came back with more than 1,000 responses containing at least “some search terms.” So POF Dahleen was correct, it seems.

Locumpedia.com founder and Publisher Cory Kleinschmidt explains, “Unlike traditional job boards, which require registration; verification; expensive fees; and manual posting, staffing agency jobs are included in Locumpedia Search automatically with no action needed by agencies. At present, more than 30,000 locum tenens opportunities can be searched, and the index is expected to grow continually in the months ahead.”

This is not to say ALL locum jobs offer per-diem reimbursement for meals and incidentals, but — to quote an experienced locum tenens hospitalist once again, “Thankfully, in the locum tenens ‘business,’ everything is up for negotiation, including the details of your travel.”

NEGOTIATE, NEGOTIATE, NEGOTIATE! (And stay safe and healthy out there.)

Next Up: Making Locum Tenens Your Practice Style.