#022 - My Advice On Locum Straight from Training
“I don’t think academic medicine is right for me.”
“I just want to work; I plan to finish residency and go straight into independent locum contract work.”
“Do you think going straight into locum work from training makes sense?”
Half of my audience for this newsletter and on the website comes from medical residents and fellows.
So let me consolidate my thoughts for the next generation considering making the leap when they finish their training.
Fundamentals over everything
The only step that absolutely can’t be skipped is this one.
Without it you won’t have any chance for longevity outside of the friendly confines of a large, academic medical center as a salaried employee.
Your primary calling card is your skill at providing safe care to patients.
In order to do this, you must merry knowledge, experience, and procedural skill (I’m talking: line placement, surgery, intubation, examination, etc.).
Knowledge is mostly what you immerse yourself in on your own time: reading textbooks and studies, going to conferences, watching YouTube videos, etc.
Experience requires you to put the time and effort in over the course of your 3-7 years of residency training for physicians, or for PA’s and nurses, those first few years of practice.
If you don’t have the reps under your belt to learn what needs to be learned when you are junior, you can learn it later, but you will be behind the proverbial eight-ball.
Procedural skill requires doing. It requires even more reps. It requires failing in a safe environment with someone to co-pilot you through.
You can also learn procedural skills later, but it’s even harder to do and the risk of learning “on the job” is huge.
Chances are you won’t be even a roughly polished version of yourself immediately out of residency/fellowship or an NP/CRNA program.
It takes time to sharpen your fundamentals. So take the time. Don’t rush.
Be a good teammate
You know who gets called first when openings arise and the need for another contractor comes up?
The known quantity - the person who already has a relationship with the hospital or practice.
Your goal is to be that known quantity.
And, even more than that, it’s to be a known quantity that people like to have around.
Can you hang? Can you pass the vibe check?
Do the nurses like you? What about the doctors, surgeons, secretaries, techs, nurses aides?
If there is any team dynamic to your job, you need to be proactive especially in the most difficult or emergency scenarios.
Be memorable, but not only that. You have to make life easier for everyone when you are there.
Coming out of training it’s hard to be that slick - it takes time to finely tune your social dynamic within your respective environment.
Again, don’t rush this.
Learn to lead
Most graduating anesthesia residents haven’t had practice medically directing/supervising nurse anesthetists who might have their own way of doing things (while also having decades more of both age and experience).
The same goes for a graduating nurse practitioner in an ICU full of more sage and senior bedside nurses.
Whatever your specific role, you probably don’t have significant experience taking responsibility for other, lower in the hierarchy, members of the care team.
That is to say: as a newly minted doc/nurse/etc you now have the duty to take on a majority of the responsibility, but with much less direct patient contact and control.
You have to learn to trust. To communicate. To compromise.
When do you jump in and do things yourself? When do you criticize?
Moreover, how can you when it’s your first day at a new hospital, in a foreign city?
Leadership is a skill that takes both deliberate practice and time.
That might be tough to do while on assignment and without the security of a contract that lasts longer than 30 days.
Again, take your time to grow in a safe environment for months to years before diving straight into locum work.
Summary
Polish your fundamentals first and foremost. Get as much experience as you can, especially with the hard things.
Be a teammate who is both useful and a net positive person to be around. Life as a contractor requires being wanted and relationships matter.
Learn to lead. No matter your role, you have to navigate the hierarchy that exists in your profession to be effective and provide safe, quality care to patients.