Career Move: Locum tenens physician

Travel, extra income and flexible scheduling can attract physicians to locum tenens opportunities.

By Marcia Travelstead | Career Move | Winter 2012

 


Name:
Avishai Meyer, M.D.
Title: General surgeon
Employer: LocumTenens.com
Education: Sackler School of Medicine, Tel Aviv, Israel. Residency at University of Colorado, Denver and University of Nebraska, Omaha. Fellowship at University of Nebraska Medical Center, Omaha.

What do you like best about being a locum tenens physician?
I’m a locum tenens physician on weekends currently in Pierre, S.D. I like the ability to interact with and provide medical care to a rural population in need. Also, it enables me to see what it’s like in the real world of a surgeon. As a fellow at the University of Nebraska Medical Center, I am sheltered from the burden of blame, if you will. Working as a locum tenens physician gives me a taste for what it’s really like to be a doctor and incurring the entire responsibility of the care I am giving. That’s scary but welcome. It’s not just being carried by the attending. I’m doing it myself.


Is there anything you don’t like about it?
It’s sad to be away from my family. I happen to have a 6-week-old child, so not being around is a little upsetting. We also have a 2-and-a-half-year-old, so it’s difficult for my wife. I’m not there to help out. That would be the only complaint I have about it, but that’s my choice.

Why did you choose to practice locum tenens?
I’m making extra money, so I’ll be able to facilitate good things in the near future. Weighing the pros and cons, I thought it was definitely a pro. At this stage of the game, I can only give them weekends. I plan to do this weekend work for a long time.

It’s hard when you’re still in training. You don’t make much money, and you still have student loan debt and those kinds of things. One thing I do have is motivation and the ability to work.

Does the locum tenens company pay for your airfare and lodging while you are away from home?
Yes. My only out-of-pocket is for food and entertainment.

more »

 

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How can you calculate your worth as a physician?

Wondering if your compensation offers are in line? So did I.

By Steven R. Bruhl M.D. and David A. Bruhl | Remarks

 

Finding a job right out of residency is a complicated and daunting task. Although many young physicians might think they have some idea about their expected income, they often have difficulty correctly assessing the effects of different practice settings and geographic regions on their relative worth.

Once a salary and sign-on bonus has been agreed on, many new physicians fail to ask exactly what measuring stick their employer will use to evaluate their productivity and corresponding future income.

My experience with finding the perfect job was no different, and as practices started sending me contracts and benefit packages the size of small phone books, the same questions kept running through my mind: How do I know what I’m worth? How do I know which contract offers are fair, and which are attempts to take advantage of my financial inexperience?

After several hours of sifting through the various contracts, I knew I was in over my head, so I met with the business manager in charge of the cardiology practice where I was completing my fellowship.

Almost immediately, she recommended I consult the same resource their practice and hundreds of other practices use for answering these questions: the Medical Group Management Association (MGMA) manual.

Every year, the MGMA sends out the Physician Compensation and Production Survey to medical practices in order to obtain current information about the compensation and productivity of physicians around the country.

These surveys are provided to all specialty types, practice structures and regions of the country. The results of these surveys are then organized and compiled into charts to help medical practices gauge their own productivity and compensation.

Medical groups often use this information to set their own internal benchmarks for establishing future compensation and productivity standards for current and new physicians.

What I learned from the MGMA manual was that, although there are a myriad of potential variables that go into what determines a physician’s salary, there are six major practice variables that are tracked and that appear to consistently affect a physician’s compensation. They are: practice ownership, group type, geographic section, demographics, partners in practice and call responsibilities.

I found that by using the information in the MGMA manual, I was further able to estimate the average salary of a specific job offer based on the characteristics of each practice.

For example, let’s assume you are an invasive cardiologist and receive three identical compensation packages from three different practices. Practice 1 is a non-hospital owned, single-specialty group type located in a large metropolitan city in the Eastern region, such as New York City.

Practice 2 is a non-hospital owned, single-specialty practice located in a smaller metropolitan city in the Midwest, such as Cincinnati.

Practice 3 is a hospital-owned, multispecialty practice group, located in a non-metropolitan city also in the Midwest, such as Dearborn, Mich.

The first step in determining the average salary of Practice 1 is to look up the average salary for an invasive cardiologist working in a city over 1 million people and record the value. Next, look up the average compensation for an invasive cardiologist working within that region of the country.

Do the same thing for an invasive cardiologist working in a non-hospital-owned practice setting as well as an invasive cardiologist working in a single-specialty practice.

If you add up the average salaries from all four variables and divide by four, you will get what is likely an even closer estimate of the average annual salary for an invasive cardiologist working in Practice 1.

If you then repeat this process for your other job offers, you can now compare the average expected salaries of all job opportunities side by side.

Although there is no doubt that this method is a relatively crude attempt to estimate the salary of a specific practice setting—and no doubt lacks dozens of variables important to the equation—the composite estimates are at their core based on actual reported salaries of physicians working in your specialty within each specific practice setting.

Although the process of averaging four different compensation values based on four different variables is imperfect, these values can help shed light on the current trends in compensation as well as your relative worth in a given practice setting.

In about an hour, I was able to construct a chart comparing the average expected compensation from my top three job offers. Although all of the initial salaries were within 10 percent of each other, I found that the proposed salary for my favorite was 25 percent lower than my estimate from the MGMA manual.

With this knowledge and the counsel of other advisors, I counter-offered for 25 percent more than my initial offer, plus a bonus salary based on my productivity.

To my somewhat surprise, the hospital agreed to my three-year salary proposal, but suggested that my bonus salary be based on a specific work revenue value unit standard, also known as wRVUs.

Their initial productivity goals seemed somewhat high and unrealistic to my lawyer and me. So by referring to the standards published in the MGMA manual for my specific practice structure, we were able to work out a wRVU standard that was more appropriate for my specific practice setting.

From my experience, I found the MGMA manual to be a powerful tool in sorting out my financial value across very different practice settings. However, I would advise anyone consulting the MGMA manual to remember that the data should be use as a general guide rather than as a weapon.

Furthermore, if your potential employer intentionally or unintentionally tries to suggest that your proposed compensation is out of proportion to the average for your area, you may be able to use information in the MGMA manual to show otherwise.

Don’t overlook call responsibilities when discussing your relative productivity. Because call responsibilities often generate little to no direct revenue, make sure this variable is not overlooked when discussing your relative productivity.

Each practice is unique, and it is impossible to tease out the exact value of any particular variable, much less the exact value of a physician in that practice setting. However, using the variables that are known and understanding how they tend to affect compensation will help you better approximate your worth in a given practice setting and take some of the guesswork out of the negotiation process.

Although the process of estimating your worth is somewhat tedious, time-consuming and expensive, I would urge every physician to take the time and spend the money necessary to consult with physicians, practice managers and a lawyer experienced in physician contract law.

In the end, every hour and every dollar spent will likely pay dividends that go far beyond your starting salary.

Steven Bruhl, M.D., is a third-year cardiology fellow at the University of Toledo Medical Center and will be taking a position as a cardiologist at Mercy Tiffin Hospital in Tiffin, Ohio. David Bruhl is a lawyer with Rohrbachers Cron Manahan Trimble & Zimmerman Co.

The views expressed in Remarks are solely those of the author and may or may not be shared by PracticeLink or its advertisers.

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Careers for you in the military

By Mark Terry | Feature Articles | Summer 2011

 

Col. Frederick Lough, M.D., director of cardiac surgery at George Washington University Hospital

Taking care of soldiers is a huge job. “We have 4 or 5 million people, once you blend in the active duty, the reserves, the dependents and retirees,” says Frederick Lough, M.D., director of cardiac surgery at George Washington University Hospital and a colonel in the Army Reserve. “It’s an immense medical system that takes care of neonates to retirees to the actively injured in combat.”

 

The classic TV show and film MASH has given us a distorted view of military doctors. First, it focused on surgeons drafted into a war zone. Second, it was both comedy and anti-war satire. Third, times change, and the military changes with it: The classic Mobile Army Surgical Hospital no longer exists, having been phased out in 2006 and replaced with a smaller, more efficient system of treating battlefield casualties. And finally, physicians are no longer drafted—physicians in the military want to be there. And many want to be there because it can be a unique situation for a rewarding long-term medical career. more »

 

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DeVry Anderson, M.D.

By PracticeLink Staff | Snapshot | Summer 2011

 

DeVry Anderson, M.D., Chief medical officer, CEO, owner: Quick Care Walk In Clinic; brigade surgeon, Warrior Transition Brigade, Fort Hood, TX

 

Work

Chief medical officer, CEO, owner: Quick Care Walk In Clinic; brigade surgeon, Warrior Transition Brigade, Fort Hood, Texas

Education

MEDICAL SCHOOL: Thomas Jefferson Medical College, 2000

INTERNSHIP: Completed an orthopaedic internship in 2000.

RESIDENCY: Carl R. Darnall Army Medical Center, Fort Hood, Texas

IN PRACTICE SINCE: Practiced as a military surgeon until returning to family medicine residency in 2006. more »

 

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Hospitalist

Long hours and flexible scheduling mark a hospitalist’s career

By Marcia Travelstead | Career Move | Summer 2011

 

NAME: Clay Schneiter, M.D.Hospitalist, Clay Schneiter, MD

TITLE: Physician

EMPLOYER: Sound Physicians

What do you like best about being a hospitalist?

My schedule. As hospitalists, we work shifts. At the end of the day, we turn our pagers off and we’re done. At my former hospitalist job, I worked seven days on and seven days off, so that was a nice schedule. In my current position, I’m required to work 15 shifts a month. It leaves you with 15 to 16 days off a month. You also have the option of working as much as you want to. For example, you can work 20 to 22 shifts a month. I can work more to make more. However, it’s nice to only be required to work 15 to 16 days so I can see more of my family. The shifts are scheduled for 12 hours from 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m.

I like the ability to practice inpatient medicine as opposed to outpatient clinic practice. I prefer the flow…higher intensity of more ill patients versus clinic patients. I have a good group of people to work with. I practice with about 24 physicians. Eight or nine of us are on during the day. We get along well—it’s a congenial atmosphere. Everyone looks out for one another versus everyone being in for themselves trying to one out somebody for more patients, more money.

What don’t you like about being a hospitalist?

The days can be long. The 7 a.m. to 7 p.m. shift is probably a longer day than for somebody who has their own outpatient practice. For a hospitalist, it’s a 12-hour day opposed to an 8-hour day. With this day-to-day kind of work, I probably see my children less than somebody who goes in a little later. They may have breakfast with their kids and maybe see them a few hours before they put them to bed. Some days, I don’t see my kids at all. I’m gone before they’re up and I’m home after they’ve gone to bed. We have to cover the nights, so that’s a little rough. You can find yourself at 35, 40, 45 years of age and still covering the night shift.

Of those 15 shifts I work a month, three have to be night shifts. Although, nights pay a little better. You’re seeing more patients, you’re probably billing more.

Why did you choose this job?

Originally, schedule. Getting out of residency, I liked the seven on, seven off schedule. I also liked inpatient versus outpatient. For me, it was less boring for lack of a better word.

Do you have any advice you’d give to other physicians who are considering becoming hospitalists?

For hospitalists, it’s a pretty wide-open field in the job market. There are opportunities almost everywhere. So you need to make sure you’re happy in the city or the part of the country you’re in. Hospital work is hospital work across the board. The last place I worked was in a part of the country we weren’t really happy with. I liked the job very much but didn’t like that part of the country. That’s why we moved to Denver, which is more suitable for our family lifestyle. So that would be my advice: Make sure you are happy and your family is happy in the place you’re living.

Was there anything that surprised you about being a hospitalist?

I don’t know if “surprised” is the right word. It can be frustrating to see a patient continuously come back to your emergency room due to bad lifestyle choices after you’ve counseled them extensively and helped them out with the hospital’s resources to get them on track to making the right choices. The taxpayer is responsible for every unfunded, uninsured patient regardless of their lifestyle choices.

The other thing physicians who are getting into this field should realize is that your workload gets harder as years go by. I think there’s a misconception that when you get out of residency, it’s going to be easier. It’s really the opposite. Life gets a little more intense when you’re out of training rather than when you’re in training. The buck stops with you ultimately as opposed to when you’re in training and there’s always somebody to co-sign your order.

How would a physician go about finding a job such as yours?

I’d start with the geographical area you’d be happy in then start the search there. Target where you think you’re going to be happy mentally and emotionally first, and then try to find the job based on that. Others may say to go for the most accredited or widely recognized hospital wherever it is. Maybe you want to work, for example, at Johns Hopkins. Just make sure you’re happy at home first.

Do you have any objective tips on how to land a hospitalist job?

I always use this adage: A good doctor is a good doctor. They’ll find work anywhere regardless of training, background, gender or ethnicity. A good doctor will be well received. Interviews for hospitalists don’t tend to be real intense. I think it’s a buyer’s market for the physician because of shortages. Be yourself, be honest, and if you’re ready to work, there’s a place for you. Stay in the game. Medicine is always changing.

Are you looking for hospitalist jobs? Check out what’s available on PracticeLink.com—it’s FREE to search! www.practicelink.com/jobs/Physician/Hospitalist/

 

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Rural Communities—The call of the small

Community health centers and rural locations can provide an enviable pace of life.

By Eileen Lockwood | Live & Practice | Summer 2011

 

Eric Sandefur, MD, Baker City, Ore.

"For a town of about 10,000, I stay busy all the time and have a full-time assistant as well."

A nightmare episode has forced Dr. Martin Ellingham to give up a successful vascular surgery practice in London. He has developed a pathological fear of blood. As the recently arrived PBS series begins, “Doc Martin” has relocated to a tiny coastal town in Cornwall. He’s obviously less than thrilled with his assignment. Yet no matter how hard he tries to keep patients and neighbors at arm’s length, the people of little Portwenn insist on being friendly. That’s the way it is in small towns.

Meanwhile, in an equally tiny, far-northern Maine community, real-life nephrologist Jenie Smith, M.D., can’t help making the comparison: “(Portwenn) is Eastport,” she says. “I feel like I know every one of those people.”

But there’s a big difference. Smith is delighted to be near the ocean and to associate with people in a tiny island community on Cobscook Bay. There, she spends two days a week with patients at a dialysis center in Eastport, Maine, where she’s the director. Her delight at being near the ocean more than makes up for the some 200 miles she drives from Auburn, where she lives, and Lewiston, where she’s in a group of five practitioners. Her husband, a choral and orchestral conductor, often rides with her to Eastport, and they spend relaxing time at a beachfront cottage. But, she adds, “Wherever you go in town, you can still see water.”

After only one visit to the coast while in medical school at the University of Minnesota, Smith says, “I knew I wanted to be in Maine.” Thirteen years later, “I convinced my now partners that they needed me more than they knew.” more »

 

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Your Green Job Search

Does being green matter to you? Then make green initiatives something you look for in your job search, too.

By Sally Herigstad | Feature Articles | Spring 2011

 

Susan Gamble, M.D.

“…Someone who is able to take a green initiative for their office probably has it all together so they’re able to focus on the environment,” says Susan Gamble, M.D., a third-year internal medicine resident at Yale who is considering how the environment will play into her own job search.

Susan Gamble, M.D., a third-year internal medicine resident at Yale, is job hunting. She’s looking at many factors as she decides where to practice, but at first glance, the greenness of a practice or facility isn’t necessarily one of them.

That’s not to say she isn’t concerned about the environment.

“I want to be somewhere where I can control it (environmental responsibility) in my own life,” she says. “At work, I haven’t thought about it.”

But after talking about environmental consciousness and health care, Gamble is more inclined to consider it as a criterion.

After all, it’s a good sign the practice is paying attention to other things, as well.

“It’s impressive, because you think someone who is able to take a green initiative for their office probably has it all together so they’re able to focus on the environment,” Gamble says.

Green practices may sound like code for solar panels and recycling bins, or perhaps waste management. Environmentally responsible initiatives in medical practices and hospitals go far beyond stereotypical “green” projects, however.

Take Denver Health, for example. When the health care organization built the new Park Hill Family Health Center, which opened in 2009, they designed it to reduce heat and energy consumption, according to spokesperson Chris Poisson. But they didn’t stop there. more »

 

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10 signs of a well-run practice

Questions to help you decide how well a practice is run

By Teresa Odle | Feature Articles | Spring 2011 | Uncategorized

 

Jill Stoller, M.D., managing partner

A lot of young physicians have their eyes opened when they get into a practice that they haven't evaluated," says Jill Stoller, M.D., managing partner of Chestnut Ridge Pediatric Associates in Woodcliff Lake, N.J.

Location, location, location. Along with compensation, it’s one of the first considerations when physicians job search. But you can golf most anywhere and ski in most northern and Rocky Mountain states. Even if you return to your hometown, you might have several practice opportunities from which to choose. So don’t overlook how well a practice runs when researching places to work.

Most physicians would agree that resident programs don’t prepare physicians well for the business side of medicine. Jill Stoller, M.D., FAAP, managing partner of Chestnut Ridge Pediatric Associates in Woodcliff Lake, N.J., says there isn’t much emphasis on practice management. “But I think it may be changing a little bit,” says Stoller, who also chairs the American Academy of Pediatrics’ Section on Administration & Practice Management. “A lot of young physicians have their eyes opened when they get into a practice that they haven’t evaluated.”

Physicians don’t better vet practices because they may lack the business savvy to do so or they run out of time. Many simply must adjust after so many years in medical school and residency. Ryan Mire, M.D., FACP, is an internal medicine physician with a multispecialty practice in Nashville, Tenn., who has been in private practice since 2002. more »

 

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Cruise ship physician

A prime cabin, 24/7 food, diversity and the cruising life await

By Marcia Travelstead | Career Move | Spring 2011

 

NAME: Adriana Yates, M.D.
TITLE: Senior physician
EMPLOYER: Carnival Cruise Lines

Adriana Yates, M.D.

Adriana Yates, M.D.

What do you like best about being a cruise ship physician?
A lot of things. The ship is amazing! As a doctor, you are a senior officer, so you have the best quality of life on board. You have one of the best cabins with a steward to clean your cabin and wash your clothes every day. You have food available 24 hours a day. You are provided with uniforms and have the opportunity to meet people from more than 60 different countries. You can go to different lunches and dinners that are available for guests and crew. You can go to the lounges, shows, work out at the gym or get off at the ports of call. You also have 24-hour Internet access.

What don’t you like about being a cruise ship physician?
The only thing I don’t like is being away from my husband, family and friends for a couple of months. The good thing is that my husband can come with me, but not for long periods of time. more »

 

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Joshua D. Lenchus, D.O.

By PracticeLink Staff | Snapshot

 

Joshua Lenchus, D.O.

 

Work
Assistant professor of clinical medicine, University of Miami Miller School of Medicine; associate program director, Jackson Memorial Hospital Internal Medicine Residency Training Program; associate director, UM-JMH Center for Patient Safety.

Education
MEDICAL SCHOOL: Nova Southeastern University College of Osteopathic Medicine
INTERNSHIP: Broward General Medical Center, Ft. Lauderdale, Fla.
RESIDENCY: Internal medicine, Jackson Memorial Hospital, Miami
IN PRACTICE SINCE:  2004 more »

 

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