Locuming: avoiding the pitfalls

In spring 2023, when the Medical Post polled its doctor readership on the question, “Would you advise a young doctor to locum for a while today?” a sizable 89% of respondents said “yes.” And why not? With the challenges of running a practice these days (including managing/buying/leasing a clinic), it can be tempting for physicians, especially those who are early-career, to go the locum route. It promises less commitment and potentially more adventure and can broaden exposure to different places and to more varied clinical work. We spoke to several physicians who are experienced in locuming. Dr. Sarah Giles, a rural family and emergency doctor in Kenora, Ont., was a locum family/ER physician in northern Ontario, Northwest Territories and other parts of the world for 14 years and has written about her experiences in the Medical Post. “Locuming has always been something new grads have gravitated to. But there are downsides, like learning new systems, doing large volumes of call, learning new EMRs, not being home,” she said. Dr. Jemy Joseph does a blend of emergency medicine and family medicine in rural Ontario and Northwest Territories. She also recently spoke at length about locuming on Dr. Stephanie Zhou’s YouTube series Breaking Bad Debt, in the episode called, “Top 5 Career Mistakes New Doctors Make.” Dr. Paul Johnson, a family physician in Sherwood Park, Alta., took 18 months to locum before settling down into his practice. “It’s in your best interest to get a taste of different practices, practice settings, or hospital work, etc.,” he said. “Treat yourself as a free agent so that if there is a practice setting or something that you do not like, you are not locked in long-term.” These locum-experienced physicians highlighted some of the top pitfalls to avoid when taking on a locum assignment. Pitfall: Not asking enough questions Each locum assignment comes with new colleagues, new workplace culture, new demands, new patients, new technologies and a new community. It’s key to be open and adaptable, but also realistic about what is workable for you. Solution: To avoid any surprises, use available resources, like the locum checklist from the CMA available online (“Locum Evaluation Checklist”) or those provided by the provincial medical associations or the CFPC. In her Medical Post article, “How to be an effective locum,” Dr. Giles said she always asked 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?” Dr. Johnson recommends visiting the clinic where you will be working, if possible. “You can usually observe if a clinic is a well-run organization,” he said. “It’s also good if you can talk to someone who has worked there or done rotations there.” Pitfall: Not signing a contract “Without getting in writing the terms and conditions of the work, locums have been surprised with discrepancies between what is said and the reality of the job they walk into,” said Dr. Joseph. “This can have grave consequences if the locum placement doesn’t work out.” Solution: Always have a signed contract and get it reviewed by an employment lawyer. Dr. Giles said, “Get the contract and the call schedule ahead of time, so there are no big surprises.” The contract should also include details about remuneration that specify whether payment is fee-for-service (or split), a stipend, hourly or blended and who is paying overhead costs. Pitfall: Overwhelm and burnout Locums can involve a steep learning curve, especially for early-career physicians, and there can be a tendency to take on too much. Expecting to work at the same pace as the doctors you are covering for may be setting yourself up for falling behind, risking burnout, said Dr. Joseph. Solution: “It is better to take on lesser work and build your way up than to sign up for a lot or longer days or larger patient loads,” she said. “It is not worth the risk to make more money at the expense of making more mistakes, risking college complaints and increasing burnout.” Pitfall: Not surrounding yourself with mentors Whether you are just starting out or are an experienced locum physician, every time, the situation is new. Solution: You can’t do too much prep when it comes to locums, nor have too many people in your corner. “You don’t know what you don’t know, and leaning into the wisdom of those who did it, tried it, survived it before you goes a long way to help you prepare clinically and for living in different communities,” said Dr. Joseph.

Locuming: avoiding the pitfalls

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