Locums Life

I never imagined four years ago that I’d be spending my life living out of a suitcase practicing IR in several very different settings. Locums is a path that isn’t discussed much. Some may even view it as a negative or a professional failure of sorts. I even had that connotation in my mind before signing up, but it has become clear to me that this road is essential for those of us who want to do things our way and not be subject to typical employment settings for most interventional radiologists. 

When things were starting to turn south between my former partner and I, I knew I had to make a move for my mental health. While the opportunity at the time allowed me to do what I wanted from a clinical standpoint, I had very little control over key business decisions which I felt were important to my overall professional growth and development. As such, I decided to pivot. My goal at that time was to figure out how I can keep up all of my skills and get paid as much as humanly possible while doing so. So I took a negative situation and turned it into a huge win. 

For those of you practicing IR, you are probably not strangers to the endless stream of recruiters calling, emailing or texting you about opportunities. A lot of those opportunities are garbage, but I still take the time to make connections with recruiters. They can be annoying, but they’re just people doing their jobs and you never know when something will pan out.

I learned about an opportunity to practice 100% IR in the upper midwest. It’s a practice that just lost its third physician and has a tough time recruiting, presumably due to its location over 2 hours from a major city and a very harsh winter climate.  At first, I was thinking that this could be a short term opportunity while I sought traditional employment in an OBL setting to bridge the 2 years I have while my wife finishes fellowship training. I am not really passionate about hospital based work and I found what makes me tick professionally, but I soon came to learn that doing what I want to do professionally as an employee will come with some significant constraints which I find unacceptable. Ultimately I made the decision that for me the number 1 priority is becoming a business owner and the number 2 priority is doing what I love to do in IR. I want to do what I want for myself and have control over my time. Not being able to take care of patients and do the procedures I want to do caused me to burn out in my first traditional hospital IR/DR job.  It then took a failed OBL partnership to realize that even when I am able to clinically practice how I’d like to, I will likely never be satisfied unless I control my own destiny. It’s just how I’m wired. If I can’t pursue my dreams of an independent OBL practice at this moment, my next best bet is being an independent contractor and using this time to continue to learn more about myself and the steps necessary to get to where I want to go.  

So back to the hospital I went. I’m not going to lie, the first couple of weeks being back was a total kick in the ass. Having not done bread and butter cases for over a year, I had to get back into a groove. But in due time I got back in true Line Monkey shape, channeling those skills from fellowship. Just when I got used to the funny accents and the new system I was working in, the sub-zero degree Farenheit temperatures of winter hit. I almost died driving in a snowstorm (not really, but I felt like it). I really started to question what I got myself into. 

I’ve since rounded out my hospital experience by contracting with OBLs in a very different geography (a much warmer one) where I get to remain active doing vascular work which I don’t do in the hospital. So between a busy hospital practice doing all the usual things in addition to OBL work on average 1 week a month, I’ve created a professional existence where I do just about everything in IR with the exception of certain interventional oncology procedures and aortic interventions.

This life isn’t without its challenges. You have to adapt to new systems and processes. Unless you’ve established some semblance of an intermediate term presence (in my case 15 months at minimum), it’s hard to have clinical follow-up with your patients. There is a huge element of luck involved because you won’t know who your partners really are until you get to your assignment and start working with them.  The biggest challenge for me though is living out of a suitcase and being on the road. I’ve spent more time on Delta Airlines flights than I’d ever care to. Sadly I spend more nights in a Sheraton Inn than anywhere else. You have to be very disciplined. Keep up a routine. Make sure you workout regularly. Don’t eat like an idiot because this isn’t really a vacation!  As they say, freedom isn’t free. Though the long layovers in hub airports do provide plenty of time to reflect and write these blogs. 

Locums life for me has been very lucrative, both financially and professionally. One thing I did was aggressively negotiate my hospital contract which pays very generously for the work I do. I’ve in turn added value to the local practice by giving a grand rounds talk on prostate artery embolization and helping to bring in more of these procedures, taking on more PE and DVT thrombectomy work and just doing what I can to be a good team player for my two IR colleagues who are both fantastic. I’ve learned from the mistakes I’ve made as a fresh graduate in an IR/DR group. As such I’ve taken the following approach which is serving me well:

1. Being enthusiastic, but not too enthusiastic. 
2. Reading the room and realizing that there are people here with far more experience than me. It is not my job to change how they think. Long story short, no one cares how you did things in your fellowship program and there is more than one way to do things.
3. Being humble and realizing that there is a lot I can learn from those I work with. Leverage the experience of your senior partners as much as possible. Ask for help even if you think you don’t need it. You’ll always learn something new and I think they’ll appreciate it.
4. Not being too aggressive too quickly trying to build a practice. 
5. Working on forming good relationships with key stakeholders in interventional radiology and referring physicians. 
6. Finding out what the pain points for my colleagues are and doing what I can to make their lives easier. 

Locums life has also given me a new perspective on IR and has solidified some of my past experiences and feelings about those experiences. Look, my hospital position where I spend the majority of my time isn’t my dream job in my dream location, but it has been a terrific experience working with some awesome people and it has allowed me to stay fresh with my diverse skill set. I’ve been able to do some great work here including multiple TIPS, BRTOs, PE thrombectomies, deep venous work, PAE, UFE, trauma embolizations and more. I’ve also done a lot of stuff I don’t care for: every single lung biopsy imaginable, LPs, thyroid FNAs, dialysis catheters, thoracostomies for prematurely pulled chest tubes, drainage of abscess in just about every location conceivable short of the brain (and yes some NP asked me if I could drain a brain abscess. I kid you not). Room turn-over, transport delays, scheduling difficulties, being paged at all hours for dumb things…those are all universal in the busy hospital setting whether you’re in Northern California or Northern Minnesota. As much as the big hospital cases provide a nice adrenaline rush, that rush isn’t the same for me now as it was 4-5 years ago. It is what it is and I’m confident the hospital is a setting I don’t want to be primarily based in for the rest of my career. 

The OBL is clearly where my heart is. I’ve continued my vacation coverage for an IR I’ve gotten to know well. In his OBL I get to do exclusively vascular work: PAD, veins and dialysis cases. I’ve also had the unique opportunity providing on site PAE case coverage/coaching for my friend and mentor in his OBL which has been tons of fun. PAE has become the procedure that I have developed expertise in and being able to help a colleague build a program has only solidified my previous high volume experience and has given me further confidence that I actually know what I’m doing. 

I still do diagnostic teleradiology for the VA.  I recently reactivated by CA medical license to take on a second teleradiology opportunity to tackle studies while taking weekday hospital interventional call. Keeping those diagnostic skills sharp is a great financial hedge to an uncertain IR future and affords an even faster path to financial independence and further leverage to say no to situations which do not help me achieve my professional goals.

My final professional activity, if you’d even consider that, is writing this blog which is honestly more fun than work. This blog has allowed me to connect with many different people which has been incredibly meaningful. It’s true when they say your network is your net worth.

While this experience is uniquely mine, I know there are other IRs out there doing what it takes to pursue their own dreams. We seem to exist quietly in the background hustling, just minding our own business. Maybe it’s because we don’t want people to know what we’re up to while we are formulating business plans? Maybe it’s because our training pathway/culture has put negative labels on unique work circumstances such as temporary work? Maybe we’re just too tired from all the travel?

For those of you looking to get into locums work make sure you have clear criteria such as time commitment, daily rate and call coverage/weekend rates. Be careful with recruiters and agencies. While they can be very beneficial to help with credentialing and organizing things for you, this will come at a cost. I’ve worked with agencies and done things without agencies. Either way, make sure you aggressively negotiate your rates. Happy to discuss finances with anyone offline. 

While we will likely be in the minority seeing as it takes a certain risk tolerance and unique personal circumstance to afford the ability to live the way I currently do, I get the feeling that more interventional radiologists moving forward will consider locums pathways like this as a bridge to get them to where they want to be. 

How long will I do this? Basically until I get to a point of geographic stability in my life where I can begin the road to building the clinical presence I dream of, again. And from there, there will be new challenges and obstacles which I’ll be sure to chronicle on this blog. I’ve learned to embrace uncertainty and constantly adapt. It’s amazing what we are capable of when we adopt the right mindset.