Rheum to Travel Save

“Not all those who wander are lost” ~ J.R.R. Tolkien

One of the benefits of attending conferences aside from scientific exchange is meeting new people. At one symposium, I met a unique rheumatologist. I saw her sitting at a table by herself, quietly eating her breakfast. I introduced myself and sat down to eat with her. This chance meeting turned into an interview, that turned into a blog. Holly Bastian, MD is a rheumatologist practicing without the restraints of being tied to a place. She is a nomadic rheumatologist, a rheum on the road who embodies Johnny Appleseed as she spreads her knowledge and skills to multiple places in need of rheumatologic services. With her permission, this is her story:

Me: Tell me your backstory; how did you become a traveling rheumatologist?

Dr. Bastian: After moving to a major city to be with family, I left an academic position and wanted to try private practice. Following a brief stint with a hospital-based practice in the area, which later disassociated itself from all of its rheumatologists, I knew that I had to find work.  Coincidently, I received a call from a recruiter about working out of town as a locum tenens physician for a few weeks at a time that I accepted.

Me: What was your job like? Tell me about your experience.

Dr. Bastian: I arrived in Great Falls, Montana in late October 2020. My trip had been delayed for 3 days due to a blizzard, and I began to question the sanity of what I was doing. A girl from the south was going to spend a significant amount of time in a state with frequent snow falls and multiple days of sub-zero temperatures.   In addition, Montana has 1.1 million persons with few who look like me.   The contract that I accepted was to provide rheumatology care to an underserved area. These patients had lost their regular rheumatologist a few years earlier after he had succumbed to fall while mountain climbing.  The hospital had difficulties finding a replacement. Patients had been treated by other traveling rheumatologists who usually stayed 3-6 months before leaving; their other rheumatologist left 2 years after the hospital failed to hire another permanent rheumatologist.

Me: Do patients readily accept you, and do they feel abandoned once your contract ends?

Dr. Bastian: Most patients were welcoming. One lady, in particular, looked at me with skepticism and asked, “So how long are you going to be here?”  I responded, “I don’t know but my contract lasts until the end of March 2021.” This line of questioning became a recurring theme. The idea of doing locum tenens work just to get paid and for the excitement of travel became lesser objectives for me.   I agreed to multiple contract extensions lasting in total about 38 months. I had gotten to know and grew to love many of my patients.  They seemed less suspicious of my dedication and saw I enjoyed getting to know them.   I wanted them to have continuity of care at least for a while.  While having a longer contracted agreements (6-12 months or more) with locum tenens services is preferred, it is not required by agencies.

Me: What are some advantages to working locum tenens?

Dr. Bastian: [a2] Reasons for working as a locum tenens practitioner (nurse, nurse practitioner, physician assistant or medical doctor) varies based on circumstances and preferences.  Working as a locum tenens provider affords the ability to:  1.)  Experience different job settings (hospital, hospital owned clinic, private practice, rural), before signing on to a permanent position.  2.)  Pay off debt. 3.)  Have flexibility.  3.)  Achieve work-life balance by working part-time or full-time, based on your preference. 4.) Have reduced administrative duties.  5.)  Change jobs with relative ease without having to do the work to find another practitioner to work in your place or purchase your medical practice.  6.)  Work during retirement and 7.)  Travel.

Me: What about licensing and malpractice coverage if you go to different states?

Dr. Bastian: Besides the advantages noted above, licensing, malpractice insurance housing, travel, daily transportation expenses are arranged and paid for by the contracting agency   and/or by the health care facility needing the services.  Some physicians earn airline travel rewards and hotel points.  Salary is comparable or better than being in private practice, but it will vary depending on the city and state, facility, specialty, employment type (part-time or full time), and the number of patients needing services.

Me: What are some concerns about working locum tenens?

Dr. Bastian: On the downside, locum tenens physicians have less opportunity to develop long-term relationships with patients who have chronic illnesses; there also may be limited access to other specialists and imaging technology. Additionally, there may be less exposure to hospital-based patients, depending on the arrangement.  Finally, many locum tenens positions in rheumatology tend to serve rural communities and places that are hard to reach or have undesirable climates.

Me: What advice would you give someone about working locum tenens?

Dr. Bastian: My advice for those considering locum tenens work: make sure you are clear about expectations, including salary, hospital coverage, housing, call coverage and overtime pay. If you decide to move to the area and work full-time, you may be placed in an apartment or rental home.  Some arrangements may allow for a higher pay rate if they are spending less on housing. While many jobs state no hospital call coverage; they still may expect you to see hospital patients if a consult is requested.  Negotiate pay for over-time work in advance in case you must go in for a consult or urgent issues after hours.   

Me: What are some resources for rheumatologists interested in learning more or inquiring about locum tenens positions?

Dr. Bastian: There are many companies who staff rheumatologists including: CompHealth, Global Medical staffing operating in the U.S. and abroad, Medicus Healthcare Solutions, AMN Healthcare, Vista Staffing Solutions, Weatherbyhealthcare, Locumtenens.com, Ayalocums.com, Health Carousel Locums Tenens with Caliber Healthcare Solutions

After meeting Dr. Bastian, my perception of locum tenens employment changed significantly. I always thought it was a stop-gap measure for someone who is in-between permanent positions, but I never considered it a career choice. With the critical shortage of rheumatologists especially in underserved areas, locum tenens providers are helping to fill this gap.  Rheumatologists, who normally enjoy the continuity of care and long-term relationships, still can have these bonds without shouldering the burdens of administrative duties or running a practice.  It was enlightening to see a rheum without borders.