Whether you know it or not there are rules to every game. Locum tenens is no different. The difference between winners and losers always comes down to those who leverage the rules in their favor effectively versus those who do not.
Unfortunately for those that branch out from a “standard” medical practice to locum tenens contract work, you don’t know the rules because you haven’t learned them yet. You unknowingly have accumulated a lifetime of knowledge in being an employee. You know about tax withholding, state and federal. You vaguely know about at-will employment laws.
Contract work is different. You are not employed by an employer – you work for yourself and provide your services to the client. In our case, locum medical contract work, you provide your medical skill and expertise to your client – hospital, office, surgery center, clinic, etc. You will have different legal protections, different taxation, and different pay to those of your employed colleagues earning w2 income.
Resource: Although cumbersome, the IRS site is a one-stop shop since… they make the tax law. I recommend reading through the basics on their site even if you plan on hiring an accountant so that you may be better informed.
Without further ado,
The Unwritten Rules of Locum Tenens work:
1.Never give out your CV unless you want to apply for that specific position.
Safeguarding your CV is the difference between just chatting with recruiters/agencies/direct hospital contacts and formally applying – called the “presentation” or being “presented.” Being “presented” to a client, either via an agency or directly to someone at the practice, starts a sort of “binding” process with that client through that agency, or with that client directly. Some clients, like North American Partners in Anesthesia, have limits on being “presented.”
Even if they decline contracting you after being “presented” with your CV and formally discussed, you may be barred from being “presented” – ie, applying – to other locales under that group’s management for a period of 6 months to 2 years afterwards. And some of these large client groups cover hundreds of locations. Don’t close doors, if you don’t have to.
2. You can work through a single agency or directly with the clinical site, not both.
Casting a wide net is essential to finding contracts to filter through to get the positions you want. The clinical sites do the same thing: they work with many job sites and agencies to help staff as quickly as possible. To ensure that different agencies aren’t presenting the same candidate, you will be “name cleared” – checked against previous employment in that health system, previous contract work with a different agency at that system, or multiple applications from different agencies. They usually require, depending on the agency or the health system, 2 years from the last “presentation” (see rule 1) or contract work or employment in order to “clear.”
The decision to work with an agency vs contracting directly with the hospital is nuanced.
3. Your locum tenens contract specifics are nuanced and unique. Read carefully.
Hire a labor/contract lawyer to go through the details with you carefully when the time comes. But as a non-lawyer, my quick highlights are:
Usually the client site or yourself each have 30 days to terminate the contract for any reason. Termination under 30 days requires the client to have a clinical or professionalism issue as reason for zero day notice to get rid of you. Otherwise they have to pay you for your availability offered int that 30 day window.
There need be no discussion, no investigation, no meeting – you are a contracted worker. You have no employment rights because you are not an employee. You have no rights and they have no obligation to offer any recourse. So that means if someone wants you gone, you will be gone without notice.
Usually you will offer “dates of availability” which will be agreed upon in the contract and signed off on by the client site. Or maybe they asked for certain coverage dates and you obliged. Either way, realize these are not set in stone for the duration of your 3 or 6 or 9 month contract. You have agreed to make yourself available for those dates, but if (in the above example) you want to change vacation plans outside of the next 30 days, you may. Your contract can be in flux outside of that 30 day window.
Always have minimum hours per shift listed in the contract in case clinical demand drops and they want to cut your hours.
4. Malpractice insurance must be spelled out.
This should always be explicit. Who will cover: the agency or the hospital/client directly? Get a copy of the coverage policy valid for the time you will work there for you records ASAP after signing the contract.
If you are considering per diem work for a small practice or other scenarios, you may need to directly procure your own malpractice insurance coverage. I wrote an article on Per Diem Malpractice Insurance with specifics for anesthesiologists and CRNAs that may be helpful.
5. You Have No Rights!
You are an independent contractor. A physician for hire. You will receive no employment benefits when you aren’t working. You have no workers compensation in the case that you become injured or ill as a result of your work. Even though most people, let alone physicians, never use any of these benefits, you must realize that you are your own business so you must support yourself in times that the business is at risk.
You are on your own. I suggest that everyone in our line of locum tenens contracting to have:
* Disability covering your current after tax income
* Medical and dental coverage
* Life insurance for your dependents
If you’re Locum Curious, start HERE.
Whenever you’re ready to consider a different path, reply to this email [email protected] or message me directly on the socials here:
Tell me how I can help your specific situation and find a way for you to take control of your time.
Help Patients. Work Less.
Do More of Everything Else.
