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Living La Vida Locum: 10 Tips For Being A Terrific Traveling Physician

*This post was initially published on the Barton Blog.

I have been working locum tenens assignments for over five years, and I’m enjoying it even more now than I did in the beginning. This is probably because experience has taught me how to handle the variety of challenges and unknowns that are a part of the job. Excelling in these environments leads to more assignment opportunities, meaningful professional relationships, and repeat business. If you’re interested in honing your locums skills, here’s how to do it:

1. Be prepared

Before traveling to your assignment, prepare a clipboard that will contain all the key information you will need while on assignment. This should include:

  • Your state license number, DEA number, and NPI number
  • Your login and passwords (you may receive them in advance or on day one of your assignment).
  • Common CPT and ICD-10 codes
  • A blank org chart that you can fill in with names of your supervisor and other key personnel. (E.g. Chief of Staff, Nursing supervisor, Medical Records, Admissions Coordinator, Risk Management, etc.)
  • Frequently called phone numbers (e.g. pharmacy, lab, hospitalist service, etc.)

You can do this with a tablet or smartphone if you prefer, but I find that most hospitals still prepare paper handouts for me during orientation – so an “old school” clipboard works well.

2. Dress professionally

They say you never get a second chance to make a good first impression. I find that scrubs and a white coat are clean, professional, and easy to travel with. It’s hard to know what the dress style will be at your assignment, but no one complains about a doctor in scrubs and a white coat. Scrubs are comfortable, and coats have plenty of pocket space for equipment. If you feel more comfortable in dress shirts and slacks, that’s fine too. Just remember that you may have long days and be on your feet for many hours, so plan accordingly. Footwear can make or break you!

3. Be tech savvy

It’s difficult to acclimate to new hospital documentation processes, but do your best to do so quickly and without complaining. You may not like the EMR at your assignment, but it’s not going to change, so you may as well dig in and figure out how to make it work for you. Do your EMR training in advance if possible. Plan to be able to compose your documentation on day one. Standing out as a locums often hinges on your ability to adapt to technology quickly.

4. Work hard

Although many locum assignments are short term, it’s still important to work just as hard as if it were a permanent position. Plan to carry the same census as your peers and work about the same hours. You will certainly stand out if you show that you are pulling your weight and are a valuable member of the team. Schedule assignments with facilities in advance and don’t cancel them within a 30-day window.

5. Document thoroughly

If you want to be invited back repeatedly to a facility, make sure you document thoroughly and accurately so that they can bill for your services. Provide them with CPT codes on a daily basis, and make sure you have signed all your charting. If you are off site and medical records call you to complete some documentation, do so quickly and without complaint. They will be grateful!

6. Develop staff report

It’s important to treat everyone with respect. Attend team meetings. Listen well. Avoid the attitude of “I don’t need to learn about this because I’m only here for a short time.” People will remember your attentiveness. Offer your cell phone number to the staff so they can get in touch with you at all times.

7. Be humble

When providers first arrive at an assignment, the natural tendency is to want to change everything to suit their own way of doing things. Resist that urge, and try to adapt to the way things are run. Every facility has its own personality and has developed a working routine. Observe it carefully before making suggestions for changing it. If you see someone doing a good job, be sure to praise them for it.

8. Be clean

Keep a tidy office space. Don’t clutter up common areas, leave old food in the staff fridge, or leave private patient information lying around. You don’t want a facility’s last memory of you to be the rotten egg salad with your name on it!

9. Have a sense of humor

When you’re the new guy/gal you’re bound to make mistakes, forget names, get lost, miss meetings, etc. Instead of being frustrated, just take it in stride and laugh at yourself and the situation. Apologize often, learn from your mistakes, and thank staff for helping you to stay on track.

10. Provide excellent patient care

In the end, the most important thing is that patients get good care. Be thorough, evidence-based, and compassionate. Engage in patient and staff education, citing medical literature as appropriate. Listen to your patients, and engage their families in their care.

If you keep these 10 tips in mind as you prepare for your next locums assignment, I have no doubt that you’ll stand out as the kind of provider everyone wants around!

When Bison Attack: Wild Injuries In Rehab Hospitals & Buffalo Carpaccio

*This post was initially published on the Barton Blog.

As a locum tenens physician in rehabilitation hospitals, I see patients with some of the most unique injuries. From rare brain infections contracted in exotic lands, to the consequences of ill-advised horseplay with guns or ATVs – I’d begun to wonder if maybe I’d seen it all.

And then I met a grandma from New Jersey, who had a life-changing encounter on a nature trail out west. In her dutiful effort to corral her teenage grandchildren, and keep them following the guide’s directions, she shouted for them to remain on the path. In so doing, her yelling attracted the attention of an ill-tempered bison. The animal rapidly approached from behind without her notice. In the blink of an eye, the bison threw her up in the air with a flick of its horned head.

“As a locum tenens physician in rehabilitation hospitals, I see patients with some of the most unique injuries.”

As she crashed to the ground, she rose up again instinctively (to dust herself off and prepare to run) as the animal came back for a second hit. One of its horns sliced a huge gash in her buttock as she fell head first on the ground, causing brain bleeding. The guide managed to scare off the beast as my patient’s granddaughter had the presence of mind to staunch her bleeding wound by having her sit on her thigh, as the guide called in an air flight to my hospital.

After stabilization in the ICU and several surgeries to correct the gashes, my patient arrived in the rehab unit with a traumatic brain injury. She was quite disoriented, her pain was poorly controlled, and even the slightest noises were very disturbing to her. She had flashbacks of the event and would call out in fear during her fitful sleep.

With careful therapy, low stimulus environment, and better pain management, I began to see glimpses of my patient’s usual brilliance and keen sense of humor. She was determined to improve, and participated eagerly in the full gamut of activities, including focused attention tasks and balance and agility tests.

One weekend I was eating at a local restaurant and noticed bison carpaccio on the menu. I couldn’t resist the opportunity to “get even” for my patient. I ordered the dish and took a photo with my smart phone. On Monday I showed her the image – and told her I had evened the score. Her face lit up from ear to ear. She told me to keep eating buffalo for the rest of my days!

Why Young Physicians Should Consider Locum Tenens: Try Before You Buy!

*This blog post was initially published on the Barton Blog.

When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is a good long-term fit can be difficult, and gaining a broader exposure to the wide variety of options is key to success. That’s why “try before you buy” can be an excellent strategy for young physicians.

Locum tenens agencies such as Barton Associates work with healthcare organizations and practice locations across the country to offer a variety of temporary assignments for physicians.

These agencies negotiate your salary and call schedule. They also arrange the logistics, covering the costs of travel and accommodations. Once the doctor and the facility agree to terms, the physician simply arrives on the required date(s) and takes on the responsibilities requested. It’s a hassle-free, minimal-commitment arrangement that pays an hourly or daily rate for work.

Locum providers are given the convenient option to receive direct deposits to their bank accounts at regular intervals. Physicians can travel as broadly as they like for assignments, and the agency credentialing team works to efficiently complete any needed paperwork for new licenses and hospital privileging.

I enjoyed “living la vida locum” for six years before I landed my dream job. That’s a long time to be living out of a suitcase, and I doubt that most of my peers would want to do it for that long of a stretch. But an amazing thing happened during those years: With each new hospital experience, I gained insight and knowledge about my specialty. By rubbing elbows and networking with a wide swath of patients and experts across the country, I became a sought-after consultant in my own right.

I experienced different ways of delivering healthcare — from critical access hospitals to bustling academic centers. I learned about best practices and creative solutions that administrators and clinical staff had discovered to improve care quality, given the limitations of Medicare rules and private insurance restrictions.

When I was hired as the Medical Director of Admissions at St. Luke’s Rehabilitation Institute in Spokane, Washington, I came armed with creative ideas and a wealth of experience to draw from. I was a highly seasoned physician who had been exposed to the widest variety of patient populations and practice styles. I knew all about the unique struggles, successes, and solutions of various rehab centers across America. I now leverage that experience to drive change at my institution, and I am virtually unfazed by new problems and challenges.

The career value of locum tenens work is extraordinary. Take the time to look around you at each assignment. Learn what works and what doesn’t work, and file it away for future reference.

Like a bumblebee cross-pollinating hospital or medical practice “flowers,” locum tenens providers have the potential to drive change like no one else. When you’ve seen it all, your insights become invaluable, and you gain the maturity to know when a full-time job is the right cultural fit. Choosing the right job, on your terms and in your time, is the key to finding happiness in healthcare.

Healthcare And The Importance Of Hope

Hope is a tricky thing. On the one hand, false hope can lead patients to opt for painful, futile treatments at the end of life. On the other, unnecessarily bleak outlooks can lead to depression and inaction. When health is at stake, presenting information with the right amount of hope can guide patients away from both suffering needlessly and/or succumbing to treatable disease.

I was reading a sad story about a patient whose physician had made her feel hopeless. She was an elderly widow with some real, but not immediately life-threatening, medical conditions. His attitude led her to believe that she was sick and useless – with little to look forward to but ongoing testing, disease progression and eventual death. His professional opinion held special weight for her, coloring her entire outlook. It wasn’t until a friend reminded her of the doctor’s fallibility that she began to question her diagnoses, treatment options, and even prognosis.

When faced with concerning new medical diagnoses, even the most educated among us tend to imagine the worst case scenario. Knowing this, physicians should take care to offer reassurance and optimism whenever it is warranted. Hope provides the energy to course correct, to fight battles that can be won, and to hold on to trust in a brighter future. Why be stingy with it when it is so easily given?

As a rehab physician I have regularly encountered bias on the part of healthy people in regards to certain injuries. I hear them whisper, “I wouldn’t want to go on living if I couldn’t walk” or “That poor man’s life must be ruined.”  And yet, these feelings are not shared by those fighting the battles. In many cases, losing an ability focuses the mind on what’s important – and on all the things that can still be achieved and enjoyed. Life is a gift, and while we all still have breath – we can make meaningful contributions.

It breaks my heart to see patients lose hope, and it is sadder still when physicians facilitate the loss. What we say carries psychological weight, and we should recognize the duty we have to deliver information with kindness and respect – focusing on the possible, dispelling unreasonable fears, and emphasizing that inner peace is attainable no matter the circumstance.

In healthcare we ought to always have hope – not for perfect health, or longer life – but in our ability to overcome obstacles, to make good come from bad, and to have a positive impact on others. The choice to live our best life is ours to make, no matter the disease or condition. Never let a doctor steal your hope, but adopt the rehab mission: to add life to years.

Doctors: It’s Not What You Say, But How You Say It

Most physicians will be thrust into the role of patient or caregiver at some point during their careers. Unfortunately, it’s not until this occurs that many become fully aware of the finer points of excellent care and communication. Take for example, the simple act of reporting test results to a patient. We do this every day, but may not realize that how we frame the information is as important as the data themselves.

I came to realize this on a recent hospital visit when I was in the role of healthcare proxy for a loved one with heart disease. Not only did various physicians present information with different degrees of optimism, but individual doctors presented things differently on different days… depending on (I guess) how tired/hurried they were. Consider these different messages with the same ejection fraction (EF – a measure of heart pump strength) and angiogram (heart vessel imaging) test results:

Doctor 1: “I wish I had better news. The EF is lower than we thought. It is low because of your previous massive heart attack.”

Doctor 2: “Although your EF is impaired, there’s a lot that can be done to improve pump function with medications.”

Doctor 1 (different day): “On the other hand, the EF might be temporarily low because of your recent flu infection. It’s possible it will bounce back in a couple of months and you’ll be back to your usual self.”

Doctor 2: “I’m not worried about your chest pain because we know it’s caused by small vessel disease. Your angiogram showed that all your main heart arteries are wide open. The pain is not dangerous, though I’m sure it’s annoying.”

Doctor 1: “Chest pain is always serious. You never know when it could be the big one.”

Doctor 3: “It’s hard to interpret EF because some people live long and productive lives with low EFs, and others are quite impaired with only a small dip in pump function.”

Doctor 2: “Sure there are medications we can try to improve your EF, but I doubt you’ll tolerate them because your blood pressure is kind of low.”

Doctor 3: “Don’t worry about the EF, it will correct on its own once we get your rhythm controlled. This is an electrical problem, not plumbing.”

All of this emotional whiplash caused by the same test results… due to different physicians’ interpretations of prognosis and treatment options. What can be done? First of all, we physicians need to take a deep breath and realize how our words affect our patients. They are scared and vulnerable, and they are looking to us for hope… and when there is real hope, why not emphasize it? There is no need to focus on the worst-case scenarios until we are well and truly in their midst.

I believe that being a good clinician is not just about giving patients factual information, but also about presenting data with kindness. Sometimes, as I’ve discovered with my own loved one, it’s not as important what you say, as how you say it.

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