Summary:
- Looking For Loc*ms Work [0:02:35]
- Trevor’s Long-Term Goals And Aspirations Career-Wise [0:07:24]
- When Finding Jobs – Be Positive, Know Your Worth, Don’t Put Down Somebody Else [0:12:36]
- Burntout To Badass – Honing In On Your Priorities [0:19:57]
- There’s Something Called Geographic Arbitrage [0:24:23]
- The Secret Sauce If You Are Doing Loc*ms – Call Up Hospitals And Ask For the Physician Recruiter [0:030:03]
- Loc*ms Interview Process Vs Typical Interview Process [0:33:20]
- When You Get A Job Offer, What’s Next? [0:37:26]
- Very Important – Read All Your Contracts [0:41:44]
- On Getting Paid – Do Some Simple Math [0:43:50]
Welcome to the Financial MD Show. This is the only podcast designed specifically for residents and young physicians to help you become educated on financial planning for physicians and avoid many of the common financial mistakes doctors make. Your hosts, Jon and Trevor, explore a different topic with each episode. Jon Solitro is a financial planner and certified financial education instructor. He’s been working with young physicians for the better part of the decade and lectures to graduate medical programs around the country. Dr. Trevor Smith is a board-certified ophthalmologist with a full-time practice and he has learned the ins and outs first-hand what it takes to make smart financial decisions as a young physician. And now here’s your hosts, Jon and Trevor.
Jon: Welcome everybody to Episode 16 of the Financial MD Show. Here, Trevor and I, figured out that something interesting to talk about with residents and fellows that are nearing the end of their training is finding work and, more specifically today, we’re going to talk about finding loc*ms work. This can be an extremely lucrative type of work but has pros and cons in both direction – from taxes to scheduling to how do you find the work and how permanent or temporary is the work. Dr. Smith has some recommendations and some experience, so listen up. Subscribe on Google, Apple, and Spotify, and leave a rating in, if you don’t mind. Here’s the show:
Jon: Anything in your mind financially?
Trevor: Financially? I’m paying the bills; paying those student loans off as soon as possible so I can make completely unbiased decisions about my life and be free. You know what I mean?
Jon: Yeah.
Trevor: That sounds good, yeah, which is good. I think that’s realistic this year. But yeah, that’s kind of hyper. That’s a little, you know, egocentric. That’s what I’m thinking about financially.
Jon: Let’s go about locum work or being an independent contractor as a physician.
Trevor: We probably have not although I have to say I haven’t really done it yet so probably it would be good to down the backburner.
Jon: Okay.
Trevor: I could talk about…
Jon: Looking for locum work.
Looking For Loc*ms Work [0:02:35]
Trevor: Yeah, looking for locum work. Yeah, definitely. Looking for loc*ms is highly dependent on your subspecialty – that’s one thing I’ve learned. I was talking to somebody the other day and they’re like, hey, how’s the job search going, are you still thinking maybe start your own practice or whatever, and I was like no, I’m kind of putting that on the backburner. What about loc*ms? And I said, yeah. They’re like, yeah, there’s probably lots of those jobs. Well, it really depends. She knew somebody that was an anesthesiologist and they had done loc*ms basically their entire life – 1099 all the time – hopping around, and typically if you do it your whole career, you do end up doing longer stints too like 9 years here or 10 years there. But, regardless, in anesthesiology, it’s a lot more common and it sort of just in and out work already. But other clinical work, it’s a bit less count. Just to characterize how many I’ve seen while keeping my ears open for opportunities over the last year. I’ve only seen like six-ish come up and you know that they’re really legitimate opportunities especially if you signed up for multiple loc*ms companies. They’ll all email you if there’s one that’s really broader or really looking for something. So, if you’re counting those plus like one or two extra, there’s only been about six that I’ve seen for ophthalmology in the last year. So they are not incredibly common.
Jon: Is it more common with other specialties, do you think?
Trevor: Yeah, if you can plug in and out really easily then it’s fine and then the more hospital-based it is, it seems like the more likely because they can credential you. Basically, they have to set you up to be able to get paid through the insurance and they can kind of, I think, my understanding is that like a radiologist who’s sitting in a dark room can just show up and work 8 to 5 or whatever just for chest x-rays and they can just filter. If you’re not credentialed with all of them, you’re at least going to be credentialed for Medicare which a ton of people will have.
Jon: Oh sure.
Trevor: They could have you to see those patients. They can filter that stuff.
Jon: Or I wonder if they can float you for a while until you get credentialed too.
Trevor: There is some of that. They can. If you’re seeing patients that you’re not credentialed with, though, the hospital and you will not; basically, they’re paying you a daily rate but they’ll eat the cost of you interpreting the things that you want credentialed for. So maybe they’ll eat the cost for that a little bit. Medicare is cool because you can get signed up pretty fast. They’ll backdate your payments up to 3 months. Like if someone’s opening their own practice, the first one they can get oftentimes is Medicare and maybe some private payers, but the private payers tend to take longer like up to three months, six months, or 12 months, depending on certain part of the country. As far as credentialing goes, some parts are so bad as to say that you couldn’t get it even within up to 12 months because they’ll just close off who they’re willing to credential. So they’ll have cameras it’s called but closed something. So like you could get it if you wanted to and it’s just like we’ll let you know when we’re starting to bring in new providers and you can’t get on unless they open it back up.
Jon: This is déjà vu.
Trevor: It’s crazy.
Jon: When I was a therapist, I went through some of that because I had to get credentialed for insurance companies and when I was doing it, there were a couple that were closed at the time to therapists and certain areas or whatever and so I remember that. I remember getting – yeah, Medicare was pretty easy to see. There are a couple other like – I never got credentialed with Blue Cross. I wasn’t doing it that long, just two or three years, but I would have eventually but it was just like you didn’t and then you started getting enough patients through the other carriers and it was just like it was fine. I wasn’t going to hustle too much on that but yeah I remember that process.
Trevor: Yeah. And Medicare, it depends about like they’re pretty good about paying and it’s really the private payers that can be a little bit more difficult.
Jon: So when it comes to locum work then – I don’t know when our last – our listeners knew, you were working maybe, maybe not but can you bring our listeners up to speed a little bit about what you’ve been doing, what’s your mindset behind the locum work; how does it fit into your long-term goals, aspirations, career trajectory.
Trevor’s Long-Term Goals And Aspirations Career-Wise [0:07:24]
Trevor: I started looking at loc*ms for the first time a year ago during coronavirus. I was in practice then – it wasn’t a good fit – and I started looking into right now at the time of recording – it’s mid-April – and I was starting to look pretty right around the same time a year ago. So I started looking knowing that I kind of thought I knew what I wanted in the next practice as I’m a young associate and I knew some of the things I didn’t want and you kind of collect those a little bit easier than you collect what you do want. The things that you do want tend to be a little more vague is another thing what I’ve realized so you do want good ethics, you want to have patient priority, and these are not just talking points. It’s legitimately like what are you going to do this for if you’re not doing it for a couple, you know, those important reasons, just foundational.
Jon: Right.
Trevor: And then you want to also have a good business. If you’re looking at private practice, you’re looking at the business factor too because that should be one of the reasons you’re involved in private practice or if there’s not an academic place around it. Academics will take care of some of many of those details. If you don’t really care how much you make, there’s certainly an easier way to find the ethics and the quality of patient care because you’re going to have more resources at the university, too.
Jon: Absolutely.
Trevor: So, anyway, I was looking at loc*ms because I thought it’d be a good, transitionary period. So I look at either – I didn’t know any of the ropes for building a practice – and I was just preparing to read books and realizing like, holy smokes, there’s a lot that goes into it. Anybody who’s in solo practice like that’s impressive. It’s a lot to undertake just to get the ball rolling and then you’ve got the stress and the pressure of succeeding or failing or how am I going to find patients and what’s the timeline knowing you’re going to potentially even lose money for a year or two. It’s such a significant decision so I have so much respect for people that have done that. And because they’ve been through a lot, they have a lot to pass on, a lot that they’ve learned and they enjoy sharing it with kind of the next generation. They really believe in that model. So kind of dug into that and was thinking, okay, solo is like a six-month runway from when you decide to do it. Six months is a very safe amount. If you’re really, really going after it, you can do it in like four, maybe. So I was looking at loc*ms as like a transitionary thing initially and then I happened upon a different job opportunity which was permanent and not necessarily in a place that I wanted to be long-term but seemed like a simpatico kind of business approach and heard about it. The connection was through a former attending from my residency so it came with a good kind of thumbs up, and just over a period of time, it was clear that it was not going to probably be a good fit and there’s a couple of those things where you know that someone was looking for something different than they thought they were looking for when they hired you. And you just have to know that that’s a part of it and be confident in yourself that part of what you’re looking for, someone else is also looking for something when they hire you and you can’t know, just like I didn’t exactly know what I was looking for in this second job out of residency.
Jon: Right.
Trevor: Some people when they hire you, they also kind of don’t know what they’re looking for or what they want out of the end of their career. So I found myself on a similar path as many other associates where you got hired in and you find someone was kind of planning on retiring in the near future and that’s kind of the language of it, I’m looking for a partner very soon, and then there’s things you find along the way. Maybe you find that someone had been there for a while and wasn’t made a partner or someone was there temporarily, moved along, and you didn’t know about them before. Those are the kinds of things that when you talk about a contract or negotiate about a job, you want to ask about those very thoroughly. You can go on websites actually and look at backdated versions of websites and find people who have been in the practice on the website. That was nice. I skipped one opportunity because of finding that. So these are the different things that happened. Anyways, I was in this other position for a short period of time really about six months and it wasn’t a good fit for a number of reasons and it’s one of those things like you have to be careful how you talk about things when you’ve been on the job and I do advise people, you know, know your reasons but be as positive as you can about them and no future employer wants to hear negative things when you’re interviewing at your next jobs.
Jon: That’s absolutely true.
When Finding Jobs – Be Positive, Know Your Worth, Don’t Put Down Somebody Else [0:12:36]
Trevor: You got to just be positive. You got to know your worth. You’re not worth more by putting down somebody else. Just basic stuff, which is challenging to do when you’ve been driven your whole life and you’ve been successful of becoming a doctor and getting good grades and getting a residency that you wanted and all that kind of stuff. Yeah, you can interview well. You can have had a couple job opportunities that you didn’t think were great from the start and that’s okay. You’re not going to lose opportunities for the future. You know, I picture myself at any point in the last year if somebody would have come along and said, how’s the job going, do you like it, what are your thoughts, I’d be that person or that my former self like, hey, you’re going to do a great job somewhere else. If you don’t think it’s a good fit, get going; get looking for something else. There’s no sense in hanging on to something that you feel like it’s not a good fit because there’s so many practices out there and if you just want to take good care of patients, you’re going to find a place where you can do that and not be stressed out, not feel like you’re kind of bending your care plan towards a certain mentality or efficiency or cost-effectiveness.
Jon: At what point should someone look and say, okay, either this is not a good fit or this is pretty good, there’s something in me that I need to come to terms with or adjust? How do you react with that?
First And Foremost, Don’t Make Any Rash Decisions [0:14:31]
Trevor: I agree totally. I’m somebody who looks at themselves in the mirror and really think like, okay, what can I be doing differently too. I think one thing you could do, if you find yourself in a position where you’re not enjoying your job, don’t make any rash decisions – number one.
Jon: Yup, good.
Trevor: I’d say the first thing you want to do is talk to a couple of mentors if you feel like there’s some things that are conflicting with you internally, you’re having that mental stress of like, I don’t know if this is quite the right thing or I feel like I’m not being allowed to practice in the way that keeps my patients safe or whatever it might be. You should talk to someone who’s a co-resident or a colleague or an attending and just have a confidential discussion. Hypothetically, if I found myself in this scenario, what would you think about that? Like I feel uncomfortable with it but, you know, I just came out of residency and maybe I don’t really know how the real world is and can you reassure me or is this something that should be a hang up for me I should talk to my boss about. That’s the real world. You started to have to have these conversations with your employer that are, you know, kind of uncomfortable or make you nervous but if you can have them in a respectful, responsible manner, it’s well thought out, you’re not firing off multiple e-mails, I mean, if you’re doing a lot of your discussion about this kind of stuff over e-mail, do not expect to be the one.
Jon: It’s not going to go well.
Trevor: That is not how you make any sort of resolution to really anything.
Jon: Yeah, that’s good advice. That’s general advice to anybody in the 2000s, now that we’re in this century like don’t have emotional conversations over text or e-mail. Have it verbally.
Trevor: Yeah. Even I would say don’t have any important conversations at all. If something’s a pain point for you, do not have that discussion over e-mail. I made this mistake and I was really fortunate because my first position, the president of the group – it’s a pretty big group – he would just come in and say like, hey, you know, I know you’re new, you just had residency, you want to make things better, don’t do it over e-mail. And that was like such a great tip because I was just like here I am like ambitious, well-intentioned. I’m writing this long e-mail and I’m thinking, I’m getting all my thoughts out perfectly like this.
Jon: This is going to be received so well.
Trevor: Yeah, exactly. I’m like, they’re going to be so glad they hired me. I was just like totally – I didn’t know 12 other ophthalmologists, I didn’t know. They’re going to all read one e-mail and potentially each person could take it differently rather than just having a conversation. I think that that’s something that most people wouldn’t do so it’s probably like not advice that everybody needs but I would just say the overarching thing for me like a huge – I like to have action points because it’s just easier. It’s just more tangible like here’s my rule. I really want to feel good about my work and about my ethics and about my patient care so I can easily prioritize the urgency and importance of that above the efficacy of my communication. And that’s probably a lot of doctors, I would guess. I know that’s probably why a lot of doctors butt heads with administration and hospitals and you hear that a lot. So, no e-mail for important conversations. Maybe an email to set something up to chat about it. I mean, that’s been one of my big takeaways. It goes both ways, you know. So, in terms of working on things, I have talked to a coach before which I found was really helpful.
Jon: Okay.
Trevor: A lot of people do that. it’s kind of becoming a thing now. You probably know it.
Jon: Yeah, it kind of is. You’ll see it with The Physician Philosopher and others like that in the arena that are offering coaching. Did you speak to someone that was physician-specific?
Trevor: Yeah. I found it incredibly helpful to talk to someone who was a physician who had experienced burnout. I’ve definitely experienced burnout and it’s helpful to have a little bit of that commiseration but you’re okay. The person I was talking – she gets it, you know, like she really loves people. She really loves medicine and like she was not enjoying it. She also was just not vibing; like the fit she had with her job was not good. She did not like the priorities lined up and so she made a shift and now she loves it and she doesn’t do many hours. She kind of figured out like what do I need to want to keep doing this. My story is different than hers but the same principles come across. Yeah, go ahead.
Jon: Is that somebody you think you can recommend that we could put a link in the show notes?
Burntout To Badass – Honing In On Your Priorities [0:19:57]
Trevor: Oh, totally. Let me look up her name real quick. I just got an e-mail from her. She puts out great stuff. Errin Wiseman is her name. She has a course called the Burntout to Badass. I haven’t done that. She came out with that after – I did just a few sessions with her a couple of years ago and that was incredibly helpful and so you don’t have to plan on shelling out like thousands of dollars for a year or whatever it is. I just had a few and it was just like really helped me hone in on my priorities like what I wanted, what I’m looking for. So, I’m kind of a long roundabout. We’re talking about loc*ms but – I mean, hopefully even if anyone just listens to this and it’s just like, oh, cool, there’s other doctors that thought they knew what they wanted, pride themselves on knowing what they want that didn’t know what they want, and now they’re looking for something different. Part of what I’m looking for with loc*ms is to try something different and see if maybe I like that version of medicine a little bit better and then it provides the flexibility to keep learning about solo practice. It’s also a nice try before you buy for practices so it’s sort of a non-committal or less committal almost more like dating rather than getting engaged right off the bat for starting a new job. Because you can’t know what the practice is like; you can’t really know what the flow of patients is like whether the doctor is going to share with you, you know, just the Medicare or going to share with you the premium patients. There are a lot of these things that can happen, that can really change the dynamic of what you think you’re getting and the loc*ms really is a great way, like if I had a solo practice, I would love to hire somebody and it’s a 1099 to start. They like it and I like it then boom! Let’s mutually get more serious about the job now that we know we’re good to go and now it hasn’t cost the practice or the hospitals much money and it hasn’t cost them, you know, maybe all of their time or them moving themselves or their family or something like that. To me, it’s almost like if you’re going to go like first principles thinking like how would I want to hire somebody to feel something out because we’re expensive. It’s a huge loss. You sign a full at least one-year contract for a set amount no matter how good or bad somebody is. It seems like an awesome way to hire. I’m liking it just because it’s almost like you’re dating somebody, now you feel like you’re on the same page like you’re both taking it slow.
Jon: Sure. You are friends first and then you take this to the next level.
Trevor: Yeah, so to me, it just feels like the most sort of intelligent responsible way of looking at a new physician so I’m excited about that.
Jon: No, I think that’s awesome, and so for you, it kind of started out as, you know, I got to get out of here, I know I don’t necessarily want this, I think I want to have my own practice at some point, let’s go for this kind of loc*ms part-time but still decent money. I mean is it the kind of money you said you’re going to be doing what you’re looking at right now. There’s a job that’s looking at 7 to 10 days a month, you said?
Trevor: Yeah, that’s right. So that’s what I’m looking for. I mean one thing that’s cool about medicine in general, I mean, it’s got the pros and cons, right, but if you are in rural America, you tend to get paid more. The payer mix is either higher or there’s just almost always you get paid a little bit more.
Jon: Oh, for sure. We’ve always thought it was like federal grants to some of these underserved areas can boost a lot of that or something.
Trevor: There are some of those programs but it’s mostly that there’s a different multiple that Medicare pays based on location.
Jon: Okay.
There’s Something Called Geographic Arbitrage [0:24:23]
Trevor: It’s supposed to kind of be related to living costs, I think. I’m not really sure exactly but it has to do with that multiple at least for the government program. But then there’s certain pockets of the country too that have really good pension programs. Some of them will be in rural areas so that can be helpful too. Anyways, they call it geographic arbitrage and you can work in a remote area and then do loc*ms and you can make pretty good money. I know especially like if you’re a radiologist and anesthesiologist and things like that can be really pretty easy to find a position and then you can work in places that are not as necessarily going to attract as many people and then they’ll kind of pay you a little bit more just because they need radiology and even though they’re not quite making as much – an average doctor at hospital might make like a hundred grand often a year or more eventually – maybe they’ll just eat that cost because they need a radiologist and then they’re going to make it up.
Jon: They bring in more people eventually.
Trevor: Yeah. All that’s to say you can make a little bit more money in certain areas. There’s a huge range for what they pay per day in ophthalmology. That was kind of interesting.
Jon: Oh really.
Trevor: Yeah. And you can negotiate but you’re kind of competing with other people for a limited number of positions so you don’t want to drive too hard of a bargain or else they’re just going to take guy number two for hundreds of dollars less per day potentially if they’re really price-driven.
Jon: Yeah.
Trevor: Yeah, there’s varying amounts.
Jon: Okay.
Trevor: You can look at how much doctors make and compare the different subspecialties and clearly some more than others but it is interesting to break that down all the way to a daily rate and when you’re looking at loc*ms, you’re looking at a daily rate of what that doctor will get paid for the work that they do and then you have to include the fact that if you’re working with a loc*ms agency, they’re going to get paid too at some sort of rate either for the contract duration or I’m sure there’s a few ways to do it and then they’re going to pay for your travel, for your lodging, and for your car as well, so your rental car; so flights, rental car, and lodging. I don’t know if they need to pay for food but certainly some hospitals have free cafeterias and stuff. So they’re paying your daily rate plus all of that so you already know that the hospital somehow is making more hiring you.
Jon: Yeah.
Trevor: Most physicians, they’re not going lose on average generally, right, because they can’t on average. So they’re paying somebody else to find you and you and all of your travel expenses. I talked to a radiologist. He started hunting around – he’s been doing this for 25 years or so.
Jon: Locum work?
Trevor: Yeah, just purely loc*ms. He started hunting around for his own locum’s work, not using an agency and just calling hospitals or making friends – other radiologists – and asking around. When you do that, you can cut out the middle man and meet in the middle.
Jon: Okay, So, per-day rates can be higher?
Trevor: Your per-day rate is going to be higher. And what could be better than increasing your per-day rate? You know what I mean?
Jon: Yeah.
Trevor: That’s like a lawyer charging more per hour substantially.
Jon: For the same work, yeah.
Trevor: With the same work, you’re already going to be doing the work. It’s an interesting way of thinking about a raise in a different way. That’s something I have attempted a little bit. I think it’s hard for ophthalmology, but if I was a radiologist, I would not be using a recruiter. If I was an anesthesiologist, I would not be using a recruiter, and certainly other high-paying subspecialists like if I was a dermatologist and I did like Mohs and I was just graduating and I didn’t care where I lived and I wanted to be somewhere or I was okay with being there for two to five years, you could definitely find a hospital that doesn’t have a Mohs surgeon and just call them and say, hey, would you support me in my first couple of years. You could make your own deal. I mean, residents and fellows that are graduating right now that aren’t doing that, I know it’s busy, I know it’s stressful, but if you go and do that, holy smokes! I can imagine how much more you would make in your first or second year just being basically a free agent instead of being drafted.
Jon: Sure, yeah.
Trevor: Yeah. I mean it would be loads, loads of money for those people. We’re talking like easily a hundred thousand dollar raise just from looking around and finding your own thing.
Jon: Yeah, I wonder because again we have residents that their main financial goal before they talk to us and sometimes even after afterwards is that they want to pay off their student loans first no matter what before they really invest and that’s certainly if they want to frontload that before they really settle on their final job or maybe they want to do that before they have kids or whatever the case might be, it’s a good time to do that. Maybe you can aggressively pay down loans with that extra hundred grand a few years sooner.
The Secret Sauce If You Are Doing Loc*ms – Call Up Hospitals And Ask For the Physician Recruiter [0:030:03]
Trevor: Oh, yeah. I mean some of them when I’m saying 50,000 to 100,000, that might be part of the daily rate. It might be part of whatever. If you’re doing loc*ms, they don’t really do signing bonuses but you could call – you know, the world is your oyster – you can call places and just say, hey, who’s your – and this is one thing I learned – is you have to know who to ask for. So this is like the tip of the podcast here – ask for the physician recruiter. You can just call the hospital – I feel like I’m giving away the secrets sauce here – but you can call the hospital – and I’ll let you know, me I love just like cold calling and talking to people – call the hospital. It doesn’t matter. Talk to their operators and say, hey, would you mind transferring me to administration. They’ll transfer you to admin. Someone in admin is going to know who the physician recruiter is and if they don’t outsource that then, you know, fully 100%, if they have somebody that fits that type of role a little bit or some similar name, that person will love that you went straight to them rather than using a recruiter because they save money too and they look good. So you’re helping whatever hospital you’re calling. The person who hires you and brings you to everybody else, you’re making them look good. I mean, that’s a great way to get a job right there. And those people, they’re physician recruiters so they’re also the nicest people ever. They’re always bubbly. They’re like, oh, let me take down your e-mail and we’ll let you know and let me talk to so and so and I’ll give you a call back and they’re actually responsive to e-mails. Because that’s what they do. I don’t know. If I was talking to residents, I would just say like do yourself a favor. Pick a state and just start calling hospitals and talk to their physician recruiters and see what you can find out because, you know, doctors can do this stuff and it’s not that difficult. There’s so many resources for contract negotiation now too. You know these paid services where they really do, they look at so many contracts. You could start setting yourself up for your own thing and you’re like, oh, I don’t know if this is even going to be a good deal or am I making up. You just pay under a thousand bucks and get an expert review and now you know. So now you’ve done it yourself, it’s like selling your own home, you know. For sale by owner is such a great way to sell your house.
Jon: Good learning experience.
Trevor: Yeah, the buyer’s agent will basically do all the work for you because they want the sale or else they don’t get any percentage. So if somebody brings you a buyer then you don’t even have to do any work or if you find somebody else who doesn’t want to use an agent, you can just figure out what deal you want to make and then go to a lawyer and they write it up and it cost you like 1500 bucks instead of 6 or 7% of the total worth of your house. There’s just these big moments where you can kind of buck up and do your own work and then pay an expert to make sure you’re not being an idiot and you’re going to clean up six figures pretty easily and, for a lot of people, you’re halfway done with your student loans at that point.
Loc*ms Interview Process Vs Typical Interview Process [0:33:20]
Jon: Yeah, exactly. Going about the process of finding it once you connect with some, tell us about the interview process. Is it different than a typical interview process?
Trevor: It is different. I would encourage people to interview just as seriously as you would for a normal interview. Like right now, I didn’t shave really. You can see this is my preferred kind of look but, generally, I won’t normally have, you know, maybe half this or something. But if I’m interviewing on a Zoom call for a locum which you pretty much always are, I would shave. I would wear like a dress shirt; maybe even a suit coat jacket on top. So, take it seriously. Assume they haven’t read your resume. I think on at least one interview, I was just kind of thinking they were going to take it seriously as I was taking it and I found that they didn’t really. I interviewed with somebody and then within an hour, I got an email from the locum’s person, my agent, and he was like, hey, what about this part of your resume, hey what about this part of your resume, and I was like I literally just got off the phone with them 45 minutes ago, why didn’t they ask me? I thought that was the point of the interview, you know.
Jon: Sure.
Trevor: It was just funny. I don’t know if it was a lack of organization.
Jon: What’s the point of a resume, yeah.
Trevor: Yeah, so it was just kind of funny. I was like, oh, yeah, I’ll totally, you know, here’s my answer, here’s my answer; happy to hop on a call if they need clarification. So just kind of assume they don’t know, give your story, kind of tell them what you’re looking for. And then I’ve been reading this book – I haven’t talked about this with you – but it’s called Business Made Simple – there you go.
Jon: Okay, yeah.
Trevor: Business Made Simple, and it’s by Donald Miller. I love his stuff. He is kind of like a marketing guy.
Jon: Yes, the StoryBrand.
Trevor: Yeah, StoryBrand guy. He’s written a lot of books about his own life and then he really got into marketing maybe up to 10 years ago now. Good stuff. He wrote this book and it’s sort of like a 60-day going through business principles but the first week or two or is really just on your own personal development and talking about character and your values and what are the things that matter to you that set you apart and when you develop those and they’re solidified in your mind; it’s sort of knowing your strengths. There’s always a classic like what are your strengths, what are three strengths and three weaknesses or something like that, and just knowing yourself on the level of your character and your story, being able to communicate your story in a transparent but still very positive way like no matter what. When somebody says three strengths and three weaknesses, you don’t tell them, well, I’m terrible at time management and I never get anything done. Do you know what I mean?
Jon: Yeah.
Trevor: Those are not the types of things that you would say on an interview. You wouldn’t say like, I’ve been late. You know, sorry I was late to this interview, yeah. All my friends teased me about being late or whatever it is, you know what I mean? Like you don’t tell them like worst things. You want to give them the best afford, still be honest, still be transparent. But this book, I think is really cool because it helps you prioritize real things that make a difference that’ll enhance your leadership skills.
Jon: I’ll have to check that out. Great, that’s sweet. We’ll put a link in the show notes to that.
Trevor: Yeah, it’s really good. I’ve enjoyed it. I’m about three weeks into it and they’re really short. It’s kind of like you read it and you’re like I knew that, but now it’s organized and you get that mental framework.
Jon: Yup.
Trevor: Yeah.
When You Get A Job Offer, What’s Next? [0:37:26]
Jon: Good. So you go to through the interview, take it seriously even though they may not necessarily appear to read your resume beforehand. So when you get a job offer from somewhere, what does that look like typically? What are some different things about that with locum?
Trevor: Yeah, for loc*ms that is different. So you get an offer. Basically, if you work with a recruiter, you kind of get a message like, hey, they’re like good to go, would move forward, and you’re like, okay, cool. I haven’t done this before, what does that mean?
Jon: They’re like, oh shoot!
Trevor: And they’re basically like, well, we got to get you licensed in the state and that can take however long. This is a cool thing now. They have something called a letter of qualification and you can apply for his letter. You apply actually within your own state but you use an interstate medical licensing, IMLCC, credentialing center or something; imlcc.com is the website. Anyways, you pay a pretty decent amount of money. I think it’s 700 dollars or 800 and the state that you’re in verifies, okay, yeah, like, you’re good to go. You have no malpractice claims. You have no background issues. You do fingerprinting. They give you a letter – they have like an agreement or compact with 30-ish states in the U.S. so mostly Midwest, northern, and eastern states. You can get a license within – 10 days is kind of long – but they can get them usually within 48 hours and that tends to be a rate limiting step for a lot of states with getting credentialed. The locum’s agency, if it’s a good one, they’ll pay for that so you don’t have to do it yourself; just have an out-of-pocket expense and you maybe do or don’t get a position, and then you get the state license, and they kind of walk you through it sort of. If anyone has applied to a hospital for credentialing, typically, it’s like, oh yeah, we’ll help you with all this, we’ll take care of it, and then some hospitals will fill out everything for you. You’ll send them a resume. They’ll fill it all out and you just kind of look it over and sign and then some hospitals will be like, we’ll take care of it all for you, and they send you a link and a code to log in and then you have to fill it out everything yourself, and it sounds like a silly thing to complain about but if you move to a big city, you’re doing like four or five of these, it’s a lot, like it’s one of those things that are like solo doctors. They spend a lot of their time on paperwork because they don’t have somebody who does it for them. Anyways, they’ll kind of help you with that. They make sure you have it all done but you still have to be sitting down signing PDFs like every other day for a month or so. It’s getting a home loan, they’re like, don’t worry, we just need three documents for you.
Jon: From your last one.
Trevor: You’ve gotten a home before. Yeah, this is the last one. Every day for 30 days, you know what I mean? It’s not quite as bad. They’re like Quicken Loans home loan process or something. It still ends up being, you know, it’s always like one more thing and oh can we get a little more detail on this; that date doesn’t line up with that and you’re like, oh, it turns out it was a typo. That’s kind of the process. So they kind of give you like a thumbs up and then you just start the credentialing process just like you would with a regular job. The big difference is your 1099, they do cover your malpractice and with your tail so you don’t have to pay 5 grand, 10 grand at the end of the contract. It’s just all included capped off specific to that location so you can’t work loc*ms one place and then start doing another one or like range your own or work in your practice and have that malpractice cover you. It just covers your job there.
Jon: Yup.
Very Important – Read All Your Contracts [0:41:44]
Trevor: I read all my contracts. I read them very thoroughly myself. I would encourage all doctors to do that. it’s kind of a headache. It’s kind of a pain. You feel like you don’t know what you’re reading. You read it once. If you feel like it was confusing, take a day off, read it again. It’s set in plain English because it has to be pretty easily understandable by all parties to hold up in the court of law. So like if you’re a doctor and you read it twice, you’re going to understand it. You’re not going to know what you don’t know but if it’s a hospital system, a lot of people have signed it and then you can get a contract person to review it or a lawyer to review it. It shouldn’t cost more than a thousand dollars. Anyways, that’s kind of been my process. Don’t be afraid to hunt around. Don’t be afraid to turn things down. Just because you’re doing locum, it doesn’t mean you have to take the first thing that comes along.
Jon: Good point.
Trevor: I’ve turned down three, four opportunities that I’m sure I would have gotten if I would have taken their stated introductory rate, daily rate, and I was just like that’s just not enough for me to want to fly out and do this and that. Hospitals are going to try to get the lowest amount and if you’re not getting paid for call and you’re going to take a call, that’s kind of crazy like I would definitely get paid for call. You’re giving up your time even though you’re there just for the job potentially if you’re traveling for it. Kind of value your time. It’s hard to do when you’re looking for something but just know your worth. Value your time. If you’re going to find a job that you like and it might be from that locum’s job and it might not be but find something that really compensates you at a level that you think is reasonable.
Jon: That’s good.
On Getting Paid – Do Some Simple Math [0:43:50]
Trevor: I’ve one other thought on the finance part. I would also recommend just doing some simple math on what you get paid if you were getting paid for a permanent position there. So keep in mind you’re going to have travel days on each end so you’re really losing a couple of days potentially depending on how far you have to go. So if you’re working seven days, let’s say, you get paid the same amount. Let’s say you get paid – and this would be kind of low – but let’s say you get 1500 and you work seven days with the same rate – and it might be less on the weekends, you know, if you’re not seeing patients – that’d be 10,500 dollars. And you’ve lost two days, the travel time back and forth-ish especially if there’s a time change or something. But let’s just say you work that job permanently and you were there, you know, 10,500 dollars for seven days and you multiply that by four so that’s 42,000 a month multiplied by 12 months and then that’d be 500,000 dollars. That’s really good – 500,000 dollars – but really you wouldn’t work that much and they’re kind of paying you for the time of the travel and 1500 is pretty good for ophthalmology potentially, and you wouldn’t be getting paid for those weekend days. So if you’re getting paid like 400, 450 and you’re traveling to somewhere that’s not cream-of-the-crop location – that’s not Chicago or Denver or LA – you’re getting paid pretty well for that time. But, if you cut out some of those days and then you’re down like 20%, you’re at 350,000 or 400,000. If you take a job for 300,000 in a city that you like better and you’re okay working permanently than for somebody else and all that stuff lines up where you find the perfect practice, is it worth an extra 50,000-dollar potential amount? You just have to kind of weigh that out. So I’d like to look at it both on a daily rate and like I’m traveling and losing a little bit of time perspective, and then I look at it from an annual rate too because you don’t know how to price out like how much is my daily rate worth because most doctors have never thought about that before.
Jon: No, it’s true, yeah.
Trevor: So if you’re switching, you can take your current salary and then divide it down for, you know, if you’re going to just work weekdays, you can divide it down and just look at that, but if you’re going to work 14 days and they’re not going to pay you for the weekend in between, kind of like losing some time. You just have to look at all those factors. It ends up being simple multiplication most of the time and just remembering to factor in, oh, I would have taken vacation. So, really you’d want to multiply that by 10 months because you’re probably would have taken 4 to 8 weeks of vacation so that would be 400,000. So you’re like, okay, this 1500 dollar per day rate makes pretty good sense but 1200 dollars per day definitely does not. That’s kind of like, you know, you could find a part-time job in a city or in a lot of different places potentially and make 200,000 per year. So, it’s good. It’s just an attempt to compare apples to apples.
Jon: Yup, definitely. I think which goes back to the, you know, don’t necessarily jump at it right away. You don’t always have to take the first job. Take your time both getting a job and leaving a job which, again, this is true in investing or job choices or anything but don’t base any decisions on any one point in time. Patience is power is what I tell my kids.
Trevor: Totally. Unless if you’re in like a horrendous scenario that you know you just have to get out of.
Jon: Sure, there’s an exception of that.
Trevor: Yeah, those definitely exist in medicine so I would never judge anybody who departed from something quickly just knowing those scenarios happen. There’s personal things that happen. People have step away for whatever. But really, three months, six months like you might know at one month but you can wait another month and then you’re going to start looking. Most of the time, it’s going to take you a good three months to find something especially sorting out between a few good opportunities to find the great opportunity.
Jon: Yeah. So if it’s not a big hurry or urgent, try to save up some cash for that gap.
Trevor: Yeah, definitely. I mean it’s one of the reasons you want to have an emergency fund of at least three months.
Jon: Yup, totally true. Okay, well, I think that’s about our time for today. I think that was super helpful. We got some great stuff out of that. Hopefully, there’s things that listeners can take whether they take action on it now, whether they never do anything with loc*ms, whether they’re thinking about it or they can use it in the future, this is going to be a great resource and I really appreciate your time and letting us learn from your experiences instead of having to learn the hard way.
Trevor: Totally, happy to help. If anybody has any questions, they can email me at tsmith@financialmd.com or my other email is trevorsmithmd@gmail.com. Happy to reply on a personal level or professional level if you have any questions. Happy to chat with you.
Jon: Awesome. All right. Well, everyone, we’ll see you next time on our next episode. In the meantime, be sure to get up to the Financial MD community, that’s the Facebook group that’s specifically designed for physicians by physicians to ask questions, to start some conversations. We post articles and tips and things there. Get out to our YouTube channel. Subscribe to our weekly Didactic Minute video where we put out little two-minute tips of personal finance things that pertain to you as physicians and other than that, we’ll see you next time on the Financial MD show.
Trevor: Awesome. Thanks, Jon.
Thanks for joining us for another Financial MD Show. Be sure to head over to financialmd.com to get more in-depth resources on financial tips for physicians and don’t forget to join the Financial MD community group on Facebook, where physicians at all stages of their career gather to share tips and get ideas on achieving true financial success. We’ll see you next time.
The Financial MD Show is for informational purposes only and is not an offer to invest. It is not financial, tax, or legal advice. Be sure to seek financial, legal, or tax professionals when making any financial decisions. Before investing, you should make sure that any investment strategy or investment meets your individual investment needs, goals, and objectives. Financial MD makes no claims or guarantees to individual investment performance. All investing involves the risk of loss as well as the potential for gain.
Resources and Links:
- Definition of Locum – https://dictionary.cambridge.org/us/dictionary/english/locum
- The Physician Philosopher - https://thephysicianphilosopher.com/
- Burnout to Badass by Errin Wiseman – https://www.burntouttobadass.com/about
- First Principles Thinking – https://www.jumpstarthealth.co/blog-1/first-principles-thinking-adopted-from-aristotle
- What is geographic arbitrage – https://www.realsimple.com/work-life/money/saving/geographic-arbitrage
- Business Made Simple – https://www.amazon.com/Business-Made-Simple-Leadership-Marketing-ebook/dp/B085XNKHMB
- StoryBrand by Donald Miller – https://storybrand.com/
- Interstate Medical Licensure Compact – https://www.imlcc.org/
- Financial MD Website – https://www.financialmd.co/
- Financial MD YouTube page – https://www.youtube.com/channel/UC6qEAQxK8L8JM7joy3wvdkA
- Financial MD Facebook community – https://www.facebook.com/FinancialMD/
- Financial MD TikTok – https://www.tiktok.com/@financialmd
- Financial MD Instagram – https://www.instagram.com/financial.md/
- Financial MD Twitter – https://twitter.com/financialmd2
- Financial MD LinkedIn – https://www.linkedin.com/company/financial-md/?viewAsMember=true
- Financial MD App – https://apps.apple.com/us/app/financialmd/id1507757039
- Financial MD Apple Podcast –
https://podcasts.apple.com/us/podcast/the-financialmd-show/id1548024586
