Like many physicians, my first side hustle was locums work at a nearby hospital.
I had only been an attending for a few months when I heard a rumor that a competing facility was willing to pay emergency physicians DOUBLE what I was making at my day job. My eyeballs almost popped out of my head. Double?! There had to be a catch. As a new attending I was already giddy at the money I was making. Just a few months ago I was making $40,000/year as a resident spending most days at the hospital. By my calculations I could make my resident salary in just 15 locums shifts a year.
At the same time I heard about the locums gig I had been reading about solo 401ks and backdoor Roth IRAs. A solo 401k would create extra tax advantaged retirement space. It would let me roll over an old IRA that was currently blocking my path to backdoor Roths every year. Even if I quit after one shift it would be worth it if it meant a clear path to decades of Roth contributions.
A combination of greed and personal finance nerdiness led me to call the locums recruiter. I told her that I knew what they were paying locums docs and I was interested. She quoted me a number $40/hour less than I had heard. I held my ground and told her I was only interested in my rate or she could find someone else. To my surprise, she quickly caved and said “sure, no problem”.
I couldn’t believe it! I wonder what astronomical rate would have made her flinch? That’s when I learned the first law of locums: they need you more than you need them.
The job was at a hospital 45 minutes from my house. They were 12 hour single coverage (only doc in the ER) shifts with some mid-levels sprinkled throughout the day. The shifts were longer than the 10 hours I was used to and the solo-coverage was intimidating for a new grad. Nonetheless I couldn’t stop thinking about the insane amount of money I would make.
A few weeks later I showed up for orientation. They paid me to learn the EMR, watch hospital mandated Powerpoint presentations and tour the hospital. They even paid me to learn how to work the coffee maker. As long as the meter was running, I would have let them teach me how to harvest the coffee beans, roast them and grind them by hand.
The next day I returned for my orientation shift – the only time I would be working with another physician in the department. I showed up at 6am, coffee in hand and ready to work. My orienter was one of the few full-time employees of the group. I watched him take the dumpiest sign out I have ever witnessed from the locums night doc.
“Room 3 is a neonatal fever. He’s 4 weeks old with a temp of 103. He’s been here since 3 and I don’t have a source. You’ll have to tap him. Room 7 is here with vaginal discharge and a fever. She’ll need a pelvic. Any questions?”
I waited for him to get mad and tell the night doc to get off his ass and do the procedures. Instead he just smiled and replied “Thanks for your help. Drive safe.”
Bizarre. I just watched a grown man eat a turd sandwich and ask for seconds. That’s when I learned the second law of locums: people willing to work night shifts can do no wrong.
The rest of the orientation shift went off without a hitch. There was the normal steep learning curve of new EMRs, learning who to call for admissions and trying to memorize nurses’ names. At 6PM I signed out to the night guy and walked to the parking lot laughing like I just got away with robbing a bank.
The following week I showed up for my first solo shift. I was caffeinated and ready to kick butt. I didn’t get dumped on at signout and started picking up charts as patients trickled in. The only good thing about solo coverage is there’s no mystery who is going to see the next patient. I made it through unscathed and again chuckled to myself on the way out thinking about the money I just made.
Like any ED there was a natural ebb and flow to the volume at the locums site. Some days I was seeing 40 patients a shift, doing multiple procedures, running codes and taking care of trauma patients. Some days I was seeing 20 patients and reading the news to pass the time. I came to appreciate the third law of locums: in every locums shift, someone is getting ripped off. Sometimes it’s you, sometimes it’s them.
One of these things is not like the other
I began to notice little differences between my cushy day job hospital and the locums hospital.
It was clear that this hospital had a lot of turnover. Not only was there a constant parade of new locums docs coming and going, but the nursing and ancillary staff was always changing too. Many of these people were also working there as a side hustle because it paid better than their day job. Everyone agreed that it was a great place to make extra cash, just not a great place to work full-time.
The hospital didn’t have neurologists on call 7 days a week. If a stroke presented in the tPA window we would call the hospitalist to help decide whether to administer tPA prior to shipping them out. (Thank god for exclusion criteria)
The hospital did have interventional cardiologists 24/7 but the cath lab was frequently out of commission which meant having to give thrombolytics for STEMIs (something I never had to do in residency).
The hospital was a level III trauma center and did have a trauma surgeon on call. Unfortunately if that trauma surgeon was delayed in the OR with an appy or hernia repair, that meant I was putting in the chest tube and following up on scans.
There are plenty of things you take for granted when you work at a profitable hospital. The minor differences I could let slide – the flimsy suture kits, the outdated ultrasound machine, the cheap gloves that always seemed to rip. Other differences were a real pain in the butt. No vascular studies or nuclear medicine tests after 6pm. Have a patient sent in by their PCP to rule out a DVT? Have a pregnant patient with pleuritic chest pain and a positive d-dimer? Better hope the sun is shining because otherwise your options are to keep them in the department for 12 hours or ship them somewhere else.
I had learned in residency when I worked in inner city hospitals that poor patients had lower expectations and were much more grateful for the care they received. This couldn’t have been more true at the locums gig. My patients may not have had a lot of resources but they had the ability to say please and thank you – something I rarely heard at my day job where the patients complain about the 12 minute wait to be seen.
All good things come to an end
Over time the stress started to get to me. I worried about things I missed because I was rushing. I worried about having to give lytics to strokes and STEMIs without specialist backup. I worried about the inexperienced mid levels I was supposed to be overseeing while still managing my own patients. I started losing sleep the night before a shift because I’d be worrying. Then I’d lose sleep the night after a shift as I replayed it in my head.
By the time I called it quits I had made ~75,000 in a year. Not bad working two days a month. I don’t regret the experience. It taught me how to be more efficient and how to care for patients when you don’t have every resource and specialist at your disposal. It helped me pay off my $225,000 in student loans in my first two years as an attending. It allowed me to open up that solo 401k, rollover an IRA and clear the path for years of backdoor Roths.
I would consider doing locums again under the right circumstances. I’m 7 years older and 7 years wealthier so I would be pickier this time around. Now that I have discovered physician side hustles that can be done from home it is harder to put myself back in that war zone. If someone offered me $300/hour to work at a hospital that had ample coverage with specialists and testing available 24/7 you just might see me dust off my side hustle scrubs. In the meantime, I’ll keep exploring alternative side hustles and taking you along for the ride.
What do you think? Have you ever worked a locums job? Do you agree with my laws of locums? What advice would you give other side hustlers about locums work? Leave your comments and questions below.