How to be an effective locum

The art of being an effective locum comes down to communication. An effective locum communicates ahead of time, during the locum, and in followup. They are prepared for the day, honour commitments, don’t make changes for sport, and make sure the doctor they are covering for doesn’t dread coming home. After locuming for almost 14 years, I learned a few tricks of the trade. Before agreeing to a locum, I wanted to know a few key details ahead of time. How many patients will I be expected to see each hour? What is the call schedule? Am I also covering inpatients, the ER, obstetrics, or surgical assists? How much is the overhead? Who keeps the extra billings, such as workers’ compensation and money from insurance forms? Where will I be staying? Will I be sharing accommodation? Will I have access to a vehicle? Will I have any days off? Knowing what was expected of me decreased my anxiety and helped me plan my days. If I was expected to see more patients per hour than I thought was doable, I’d ask to be accommodated or let them know that I wasn’t a good fit. Read: Three financial steps to help make a locum life work for you Being an effective locum means letting the people who work in the office have everything prepared so you can hit the ground running. Send an email with all of your billing numbers and banking information ahead of time so that they can be put into the EMR. Finding out which EMR is used is helpful—you can ask for training before you start or rest easy knowing that you are familiar with it. Having your logins ready before you start also makes the first day more manageable. Also, telling receptionists which procedures you do or do not do can save some uncomfortable situations (“Sorry, I don’t do scalpel-free vasectomy…”). An effective locum honours their commitments. In all my years of locuming, I cancelled one week of a locum a week ahead of time when I had pneumonia but still came for the second and third weeks. I cancelled another six months ahead of time. Doctors in full-time practice need breaks. Barring serious emergencies, it is unacceptable to bail on a locum without notice. Doing a good job at locuming when covering a practice that sees existing patients rather than primarily consults takes time. While it might not be for everyone, I provided the best care when I had a chance to read the patients’ charts ahead of time. I would come in early, or stay late, to read the most recent entries in each chart—this works best if the receptionists can give you an idea of why the patient is coming in. If they are looking for a result, I would make sure it was on the chart and I knew the relevant history. If it was for a medication refill, I would review the medications. Taking a few minutes to make sure that preventive health issues are also up-to-date does the patient and the doctor you’re covering a great service. I would often print out requisitions for mammograms or fecal immunofluorescence testing prior to the appointment so I could just hand them to the patients. Some locums don’t spend the extra time to review charts ahead of time but I have found that failing to do this leaves patients angry about retelling their histories and me running late. Read: So, you think you can locum? At the end of the first day of a locum, check in with the clinic/hospital staff and ask, “How am I doing? What can I improve on?” Listening to the little pearls of information gleaned from these questions can make life much easier. Every doctor has their favourite drugs. Perhaps you are used to prescribing perindopril but find that the patients in a practice are mostly on ramipril. As a general rule, an effective locum doesn’t change medications for sport. If there is a problem with a medication, I won’t hesitate to change it, but if I think that there’s only the potential for a small benefit, I may leave a comment suggesting a change to the regular doctor and let them make that decision. An effective locum does the paperwork. Nobody enjoys completing forms or signing off labs, but it’s a necessary evil that locums must embrace. If patients want forms filled out, review the chart, determine if it’s possible, and then invite them to come in-person to help them fill in the form. That appointment might not be covered by medicare but it makes it so much easier to complete the form! From the vault: $5,000 for a weekend locum in Saskatchewan? When reading correspondence from other physicians, the effective locum enacts the suggestions (such as medication changes or tests to be ordered) but highlights the arrival of very important letters so that the regular doctor can know that it has been received. My method of doing this varied over the years. Sometimes I would sign off the document in the EMR but leave a paper copy for the doctor, other times I would create a document highlighting certain results in one place. No doctor wants to come back from vacation to an inbox full of results. Having a conversation about how to handle these pieces of information ahead of time can be helpful. My final tip: A happy locum is a fed locum! Find out what time the grocery store(s) opens/closes the day you plan to arrive and pack accordingly. I routinely packed cereal, a tetra pack of soy milk, bagels and peanut butter so that I could make it through most of my first day without a stop at the grocery. Happy locuming! Dr. Sarah Giles is a family/ER physician who recently shocked even herself by buying a house.

How to be an effective locum

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