Episode 17: Accelerate Your Path To Earnings And Autonomy As A Locums Anesthesiologist with Kyle Hadley

Jun 7, 2019


This Episode

Interview w/ Kyle Hadley

          Kyle’s email:

You Will Learn

 – What does it mean to be a locum tenens physician?
 – How much can you make as a locums anesthesiologist?
 – What types of opportunities are available for locums work for anesthesiologists?
 – If you travel and do short-term engagements with a locums company, who pays for your airfare, food and lodging?
 – If you have a full time job already, can you still do locums work?

Resources & Links

Show Notes

This week I’m joined by Kyle Hadley, an associate vice president at locumtenens.com.  Kyle has worked for locumtenens.com for almost a decade and helps connect anesthesiologists interested in locums work, with healthcare facilities that need to fill short and intermediate term vacancies.  So if you’ve ever considered doing locums work as an anesthesiologist, you’re wondering what kind of opportunities are out there, or if you like the idea of a flexible schedule and doing anesthesia on your own terms, then you won’t want to miss this episode.

Show Transcript

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Kyle: [00:00] Some people want to go down and live in La, so we look for opportunities in your la, but some people say, I just want the money so we can find opportunities that pay more money, whether it be taking call in house, call working tens instead of aids or twelves instead of aids. But it really depends on what it is the physicians are looking for.

Justin: [00:20] Hey, this is Justin Harvey. You’re hosted the anesthesia success podcast. My wife is an anesthesia resident and I’m a financial planner and I work with anesthesia and pain doctors is my clients. This podcast is designed to help the anesthesia community be informed about their careers, the finances, and more by taking important questions straight to the experts. Thanks for tuning in this week. I’m joined by Kyle handling and associate vice president@locumtenens.com Kayla’s worked for locum tenens.com for almost a decade and helps connect anesthesiologists interested in locums, work with healthcare facilities that need to fill short and intermediate term vacancies at their institution. So if you ever consider doing locums work as an anesthesiologist, if you’re wondering what kind of opportunities are out there for you or if you like the idea of a flexible schedule and doing anesthesia on your own terms and you definitely won’t want to miss this episode.

Justin: [01:11] Hello everybody. Welcome to the anesthesia success podcast. It’s Justin. I’m here with my special guest for this week, Mr Kyle Hadley, joining us from Georgia. A really grateful to have Kyle today. Kyle is a an associate vice president@locumtenens.com locum Tenens, as you may guess, is a company that specializes in physician placement. So locums work is obviously when you’re working in an as needed basis at an institution who has a most of the time a short term need. So locum tenens.com specializes in matching institutions that provide care with physicians who can provide that care. And this can be a really valuable Arrow in the quiver of a physician to be able to do some short term work, either while you’re full time employed, taking a week of vacation to work somewhere else and earn a few extra dollars. Or maybe you want to just jot all around the country for awhile and do locums work here and there. In that case, doing locums work at the company like Kyle’s could be really helpful. So I’m grateful to have him here talking about what it means to be a locums anesthesia or pain physician. Kyle, thanks for joining us today. Thanks for having me, Justin. Really excited to be here. Um, so a little bit of background about yourself we think would be helpful to start out. So why don’t you just tell us a little bit about your company and about how you came to do what you do.

Kyle: [02:25] Yeah, absolutely. So I started my career with locum tenens.com in 2009 I graduated with a finance and accounting degree in 2009 and as you know, 2008 there was a little bit of a hiccup in that industry. It’s a tough time to find a job in finance. Exactly. So what I did was I went and took an accounting position with locum tenens.com ultimately, I had a desire to serve the frontline of our customers, which led me to a sales role with our anesthesia division. And since then I’ve elevated my role within the anesthesia division to managing director. Then also now to associate vice president where I’m focusing on the strategic initiatives and operations of our team. I mean, my favorite part of the of the job itself is just working with an unbelievable group of providers and making sure that they enjoy their assignments and provide the best experience to them.

Justin: [03:18] Yeah, that’s great. So I love the fact that you’re the managing director of the anesthesia department. I think that’s going to be, you’re going to be well positioned to get us some critical intel from the inside on what, what uh, providers, physicians and you know, see our nas to a in this case we should be aware of, should be looking for. So why don’t you talk a little bit about kind of your company and what is locum tenens.com and how long you’ve been around, what kind of volume do you do, how many physicians do you place, that kind of thing.

Kyle: [03:44] Yeah, absolutely. As you said, locum Tenens, just the term itself is to hold a place of, it’s Latin for a to hold a place up. A locum tenens.com was founded in 1995 and we’re a full service agency. We’re locum tenens physicians and crns and also advanced practitioners. We also run the largest job board in the industry. So you know, if there are physicians out there that are interested in jobs, they can access our job board, which we’ll connect them with, health care providers and clients all over the U S for free. As I said, we were founded in 1995 and it is our mission to improve the health care by providing patients access to health care through innovative staffing solutions. So we work on a day to day basis to make sure that clients have their needs filled by innovative solutions that our teams create while working with physicians.

Justin: [04:37] Okay. Put me in the, in the chair for a moment of one of these institutions, the hospitals, surgery centers, something like that. Somebody who has a staffing need, what kind of situation might they be in and when they come to you, what are they looking for?

Kyle: [04:51] Right now you probably know this, but or at the peak of the demand of anesthesia physicians and Crns I’ve never seen anything like this in my 10 years would be and where the organization, Great. There’s a lot of turnover. Um, do two groups changing, whether it be practice manager groups, private groups. There’s a lot of burnout. Burnout’s a big buzzword going around the industry right now. We’re still, you know, fill in vacation needs. We’re still filling in for maternity coverage. There’s a whole plethora of reasons that someone may need locum tenens coverage. And right now the supply is not there. So it is a market for the physicians. Hm.

Justin: [05:30] Right. So you would say if I’m an anesthesiologist or a CRNA and I’m looking to, you know, find some kind of either temporary work while I’m employed full time or to just do string together a bunch of part time gigs, I may be in the power seat from a negotiating and from an opportunity standpoint. Yeah, I think that’s fair to say at this point. Okay, great. So I’m curious, you know, if I’m, if I’m maybe either coming out of residency or I’m wrapping up my first role as an attending and I’m cured, I want to sort of dip my toe in the locums pool before I lock myself down to something. Take me through the process of what does it look like to, I mean, assuming that I know nothing about even what locums is, but I’m interested in sort of seeing what else is out there. How does that process work with a company like yours?

Kyle: [06:16] One thing to note is if you are a current resident will still work with you. We may not be able to play in opportunities, but one of our goals is to partner with the residents and make sure that we’re helping prepare your CV, preparing your references, really looking at the geography that you’re looking for and immune. If you’re interested in going to a specific town maybe that you’re from, we can help you find that job. There was an anesthesiologist that was born in Florida living in Florida his whole life. He graduated in Oklahoma Back in 2012 we placed him in 2013 in Oklahoma doing in house call shifts three days a week. And uh, he made enough money to pay down his student debt. Then ultimately we found them a locum job back in Florida. It was 20 miles away from his home town and then he took a permanent job, that same hospital. So we were able to do full circle and then also provide a great financial impact for them.

Justin: [07:10] Interesting. I want it. So I want to come back to the process in a minute, but let me just point out. So there’s this idea in finance parlance, Collette geographic arbitrage, meaning you make a lot of money in a place with a lot of demand and then you can leave that area after a period of time. So what you just described, you know, going somewhere like Oklahoma where there’s, it may be more difficult to attract physicians to certain geographic locales. Um, that can be a place where if a physician was to take a locums assignment somewhere in middle America or somewhere similar, that might be a place to earn a lot of money in a short period of time. And that’s kind of what you just described, it sounds like. Absolutely. Yes sir. And so you see a decent number of opportunities. Like if I came to you tomorrow and said, listen, I want to move to somewhere in the middle of America to be able to do something like that. You’ve got stuff on your job board or you have those connections to be able to place me.

Kyle: [08:01] Yes. So it’s funny, I don’t want to over promise and under deliver right now you just said the market is very powerful from the seat of the physician. There’s opportunities nationwide. What we would like to do is understand what is it that the residents looking for you looking to be in a specific area. If that’s the case, then we will, we’ll share these opportunities with you in that geographic location. And some people want to go down and live in La. So we look for opportunities in their la, but some people say, I just want the money. Yeah. So we can find opportunities that pay more money, whether it be taking call in house, call working tens instead of aids or twelves instead of aids. There’s a whole gamut of opportunity that w but it really depends on what it is that the physicians looking for. So it really comes down to that was their interest in why.

Justin: [08:49] Yeah, makes sense. So when I come to you and I say, listen, I’m interested in something. Maybe it’s maybe I’m just I the money or maybe I want a certain geographic locale, whatever it is. If I come to you, how do we, how are we going to kick off that process together?

Kyle: [09:01] The way that typically works is you start by talking to a recruiter. So you simply reach out. And in this case, anyone that’s listening can reach out to me directly. You can provide there my information on your podcast. We’ll put your email in the show notes for our listeners to work. So I’ll put you in touch with a recruiter that would handle a state that you’re interested in. If you’re not sure, then I’ll work with you and we’ll determine what your geographic preferences would be. And then what we do is we would look at your CV, make sure that you have references prepared, and then allow you to apply to jobs. So we would present you to locations that you’re comfortable with and that you’d give us authorization to presents you to. And after that we like for our providers to speak to the client and actually have an interview. That way they’re comfortable with the schedule, comfortable with the setting, comfortable with the contact there. And then we would take a full circle. And then locum tenens.com does all the heavy lifting. So we’ll take care of credentialing you, we’ll take care of licensing you for residents. Many of them will get two or three licenses at a time and we’ll pay for those and we’ll take care of the entire process. And then we’ll set up the travel and you’ll go to work and then we’ll pay you on a weekly basis.

Justin: [10:10] Awesome. So to zoom in on the process a little bit more, it sounds like if I come to you and I, I’m sort of figuring out what I want. I say, you know what? I think I want to be in Texas because my family is from Texas and I don’t know for sure that I want to land their long term, but I’m interested in being there. I come to you and yours at the beginning. You’re basically helping me with the CV. So you’re making sure that the holes are filled, that it looks competitive, that if there’s things that need to be fleshed out or constructive feedback at the most granular level, you’re, you’re helping me to sort of eyeball that and make sure that it looks good. Absolutely. And then you’re going to connect me with the, you know, the healthcare institutions in that state and then talk a little bit about the licensing credentialing process. What does that mean exactly and how long does that take?

Kyle: [10:50] Licensing and credentialing times both have increased steadily over the past couple of years. Licensing right now on average it takes about eight to 10 weeks or a few outliers such as California. It’s going to take you a little bit longer or it takes a little bit longer. And then there are some states like Indiana may only take three to four weeks, but the way that looks is we have specialized individuals on our, in our organization that all they do is process licensing for our physicians just to make sure that they’re ready to go to work whenever their star data is. So what they would do is they would work with the board to get an application, ensure that it’s filled out properly. We’ll take care of the payment and then we’ll keep you updated as we get updates from the licensing board. Now credentialing, it’s a similar process. We have dedicated individuals to that as well. The process for that is we’ve typically credential you internally, so we have you fill out our internal credentialing packet, which is online, and then we will turn around and will prepopulate any facility applications for you. That way you don’t have to, a lot of work, you typically just have to sign your name and put it in your social security number. Then we work with the medical staffing boards at the facilities to ensure that we’re getting updates and we’re pushing, well, our goal is to make sure that our locums physicians files are the number one priority.

Justin: [12:09] Okay, so just for my own information, what’s the difference between licensing and credentialing? Because those sound kind of similar to me.

Kyle: [12:15] Yeah. So licensing, I mean in order to practice in a state you must have a state license and credentialing is just simply ensuring that you have the privileges to work at a hospital.

Justin: [12:26] Okay.

Kyle: [12:28] It the one state specific one is facility specific.

Justin: [12:31] I see. And I’ve heard rumblings every now and then. I was like, uh, a federal licensing standard. Is that, is that something that’s on your radar at all and is that something you see potentially happening?

Kyle: [12:41] Yeah, it’s funny you say that. There have been rumblings and I’ve seen some things pop up with legislation. I don’t know that we’re really close to that. There there’s an opportunity to use a compact license in certain states where you can use, if you have a license in a certain state, you can use that, um, to expedite another state. But I mean as far as the federal standard, I think we might be a long way away from that because some of the states are willing to comply if you will.

Justin: [13:11] Got It. Okay. So if we go back to sort of the timeline, it sounds like you know it’s going to vary by state because different states licensing, timing is different, the lead times are different and I’m guessing that’s one of the constraining factors. So if I said, listen, I come to you Kyle and I think I want to go make as much money as I reasonably can as soon as possible. That is going to be constrained by the amount of time that it takes to get licensed in the states in which I’m interested in working. So there’s at least three or four or five weeks of lead time between the time that I call you in the time that I’m in the or doing a procedure. Is that right?

Kyle: [13:47] Yeah. So you’re likely going to have 60 days anyways because right now, and I should’ve said that earlier. Typically right now we’re seeing on average for an anesthesiologist to work in a hospital, it takes about 60 days to be credentialed.

Justin: [14:01] Okay.

Kyle: [14:01] A lot of these facilities have implement in board meetings just to ensure that they’re checking all the boxes when it comes to safety. And so it’s going to take you about 60 days regardless. So a lot of these facilities will allow us to license you as we’re credentialing you. So a lot of times the license is applied for the day that you accept the job and you already have it issued before your credentialing even complete. Got It. So it shouldn’t be a constraint necessarily. Wouldn’t, couldn’t be. It just depends on the situation.

Justin: [14:31] Okay. And then once I’m licensed in a state, it sounds like it would be easy at that point, are relatively easy to continue to get jobs in PR. So if I get licensed in Indiana and I’m credentialed with a hospital in Indiana and then I want to take another locums assignment in Indiana, then the only thing that needs to happen at that point is getting credentialed with another facility rather than getting re licensed. That’s incorrect. So that would be a quicker turnaround time.

Kyle: [14:55] Yeah, depending on the, yeah, absolutely. So depending on the credentialing time at the hospital. Okay, that’s correct.

Justin: [15:01] So how long does the credentialing part usually take? Understanding that usually it happens concurrently with the licensing at the, the first go around.

Kyle: [15:07] Now on average it’s about 45 to 60 days is what we’re seeing for an anesthesiologist at a hospital and now surgery centers, those are a little bit shorter. And then if, if you’re working at a critical access hospital, a lot of times those are a little shorter as well. So it really depends on the size of the facility type of facility. Is Our healthcare system involved? Do you have to go through a practice management group that requires their own credentialing? These are things that we are experts in and that we really have worked hard to, to understand and make simpler for everyone. And if you were trying to do this on your own, it would be a burden. It’s a lot to manage. It is.

Justin: [15:47] So in that context, I’m just trying to think like really, really practically if, if I want to work somewhere, it’s gonna take me two months of planning ahead in order to work there. And if I’m currently, you know, doing one locums assignment and I’m interested in maybe doing another one, eventually I need to start that ball rolling pretty much as soon as I can because it just, the credentialing and licensing takes that long. Assuming that I’m going to an institution I, that I have not worked at before. Correct. Okay. And then how does compensation work? You know, getting in the door is one thing. Understanding how much I’m going to get paid, what am I going to get reimbursed for? You know, how, how does that work?

Kyle: [16:23] That would also vary depending on type of assignment. The client type A, is it a hospital health system, ASC, the schedule depending on what your schedule is. So just to kind of bring it back to nuts and bolts oriented, physiologists and locums are paid on an hourly or daily basis. Um, typically it’s a, you know, a very fair rate. And um, at this point, as I said, the physicians are kind of in the driver’s seat. So what we’re seeing more and more is that physicians are kind of name and the price, whether we can pay that, it depends on the assignment and the client what their budgets are. But we are seeing them move the needle by requiring more rates because the supply is lower than the demand. The range would depend on the type of assignment in a Max would just depend on how many days you’re working, how many hours. I mean without saying a number, I mean I think it’s fair to say that look and provider typically would make more than a w two on an hourly basis.

Justin: [17:21] Okay. What if I came to you and said, listen, I want to make, you know I want to do weekly assignments at different places cause I want to see different practice models, different geographic locations and I want to make an annualized rate of 400 k a year. Cause that’s, you know, by my estimation based on where I’m at. That’s, I think that’s a good market rate. And so that comes to, I just did the math on my calculator here. $7,700 a week. So do I then come to you and say, listen, this is my number. Find me places where I can make that.

Kyle: [17:49] We have been told to do that before. Yeah. So I mean, um, yeah. So what we’re finding is that pool of people at this point, I mean there’s only so many anesthesiologists in the market. Our goal is obviously to increase the amount of anesthesiologists entering the market that’ll do locums. But we’ve worked with a lot of these providers for a long time. I mean locum tenens.com, Steph, nearly 20,000 providers last year. Wow. And a, um, a large number of those were anesthesiologists and Trna. So having said that, we’ve worked with these people for a long time, so we understand when they come from another assignment and tell us what they’re making, they’re not just going to take a large pay cut to work with our agency. So our goal is to at least get you that compensation or do better. That way we can ensure that we’re working with you.

Kyle: [18:40] As you said, it wouldn’t be difficult if you came to me and said, hey, my goal is to make x amount of money, my family’s going to be driving across the country. So I wanted to tag all 50 states and I want to make $7,700 a week and every state, it’d be fair to say that that’s probably impossible. It’s a lot of licensing is, I hate to be a lot of work in, just to be completely honest, we’re kind of at the Beck and call of the needs as well. So just to make sure that I’m a physician going in to locums knows that when the needs are filled, they can either take a permanent role, there are a lot of times they’re offered a permanent role there or they may be forced to go find another local assignment.

Justin: [19:22] So could you give me an example of, you know, maybe I’m just interested in picking up a day, a month or maybe I’m moving towards retirement and I want to work a little bit, but not that much or pick up an odd shift here or there or maybe I’m working full time as a younger physician, but I want to augment my current workload with a periodic, infrequent additional job elsewhere through local miss work. How might that work?

Kyle: [19:47] So I’m working with an anesthesiologist in South Carolina currently. She, she’s been working I believe for over 35 years as an anesthesiologist. She’s ready to retire. She has a lake house in Tennessee, so I just placed her at a surgery center to work one day a month at the surgery center. It’s right next door house, the lake house in Tennessee. And her plan is to work there as a locum one day a week for the rest of her career. That way she can keep medicine, you know, keep practicing medicine but retire from the fast and busy pace of the hospital. Yeah.

Justin: [20:25] And so for her, that’s a great arrangement. And it doesn’t sound like there’s a danger of her being replaced because if it’s only one shift a month, there’s they can be a little bit flexible with that. Presumably.

Kyle: [20:36] Yeah. Her goal is just to do PR in shifts so if they need her a couple of days a week or if they don’t need or a certain month, that’s fine with her. Her goal is truly just to continue practicing medicine and have a little bit supplemental income.

Justin: [20:48] Okay. And talk to me a little bit about transitioning to full time. So there’s a couple of ways that somebody might come at this. One is like I just want to see different practice models in different clinical environments and different even places in America and abroad. The other is I want to find something that maybe is close to where I want to end up and hopefully that’ll transition to permanent. So what does that process look like and how does it differ?

Kyle: [21:12] As you said, you could come at it from different angles. Sometimes we place people in situations where they think that they’re not going to like the facility and then they end up staying and going permanent. And then there’s others that they say, just find me a job in southern California and I’ll be fine because that’s where I want to live for the rest of my life. And um, that could turn into a permanent arrangement. So the driver for that is what is the need of the facility? Right now, more than ever, there are fulltime vacancies at hospitals and health systems for anesthesia providers. So more than ever there’s an opportunity to go permanent. However, if someone just has a maternity leave coverage and we fill that, fill that gap with a physician temporarily, the opportunity may not be there. So that assignment may not be the driver for a permanent placement. But the process itself, you would go work as a locum tenants provider if that’s what you’re, you know, you’re interested in doing. And then if the facility’s interested in making an offer to you, they would make that offer to us. We would share that information with you. Or a lot of times they’ll make it directly to the, to the physician just to make sure that they’re going to excel and then we would work directly with the facility on a buyout fee and then just eliminate the contract itself.

Justin: [22:27] Makes Sense. So, you know, from a staffing standpoint, if you’re, that you’re sort of the staffing company and so if you connect, uh, a, an anesthesiologist with, uh, the organization that is hiring them, you’re going to take a cut essentially of whatever that you’re, you’re passing the baton, you’re giving him the contract. And then as the hospital or the ASC, are they paying you in exchange for that connection?

Kyle: [22:51] The health system or client? Uh, as far as the facility, they would be the ones that would pay the, the bio fee.

Justin: [22:57] Right. Okay. Are there any considerations for different sub specialties where maybe, I mean, you mentioned anesthesia is in demand. Are there certain types of anesthesia that, you know, if your cardiac trained, then you can do x, Y, z. But if it’s, you know, ob, maybe it’s less or, or anything like that.

Kyle: [23:16] So, I mean we do staff, all of the subspecialties for anesthesia. So obviously general would be your general anesthesiologist, but we also staff cardiac pain management, pediatric anesthesiologists, critical care anesthesiologists and those rates are typically higher obese, typically higher due to the in house call associated with it or call associated with it and the hours required to be in the hospital. Okay.

Justin: [23:44] Makes Sense. Is there an opportunity, I’m curious like how early can I do this? If I’m like a ca to ca three I’m wrapping up the end of residency. Maybe I have some flexibility or a couple of weeks of vacation and I want to do some locums right now in my backyard. Do I have an opportunity to do that in like a moonlighting arrangement?

Kyle: [24:01] So not with us, not through our agency. Um, I mean you would have to complete residency and then B or to eligible within five years or board certified with the Ava. However, I mean I’ve heard of them working obviously with facilities associated with their academic hospitals and there’s an opportunity there and that’s just from hearsay, not from experience. Got It.

Justin: [24:26] Interesting. So talk to me a little bit about kind of the ancillary stuff. So if I take a job, if I’m in, you know, I’m living in Philadelphia, like I, right now I’m in Philly, my family’s in Philly. If I wanted to start working during the week in like Des Moines, Iowa, because there’s a this geographic arbitrage opportunity, obviously I’m getting on a plane on a Monday morning. I’m flying out there, I’m working on a bunch of shifts. I’m flying back on Friday night and I’m doing that, you know, that’s a lot of travel. That’s lodging expense. I’m running a car. How does all that stuff work?

Kyle: [24:55] Yeah, that happens quite frequently. There are a lot of physicians that are traveling during the week and then coming home on Friday nights to to be with their family for the weekend. A lot of times there are facilities that will cover your travel back and forth every single week, but there are also facilities that say, we’ll do one round trip a month. Depends on what the facility is able to cover. But all of our assignments, a locum tenens ICOM, we handle all of your credentialing, licensing and malpractice insurance. We also cover all of your housing in travel for every single assignment. This is something that we offered all of our customers and then on occasion we’ll get a request from a customer to set up apartments. So if you’re going to be there for a a long term stay, our goal is to make you comfortable. So furnished apartments or something that we try to secure for our physicians.

Justin: [25:44] Got It. So in this instance, if I’m going to des Moines and I get this job and maybe demoines as listen, we’re going to pay for one trip a month round trip and we’re not going to pay lodging. Locum tenens perhaps on my behalf is trying to negotiate a high enough rate for me that locum tenens then pays for an apartment, pays for the travel and covers that stuff for me. It am I understanding that right?

Kyle: [26:07] Our goal would be number one, to ensure that the customers pay him for everything. Right? Cause they’re the ones that need the physician. So our goal would be to have that as a direct cost to the customer. However, some of the budgets as we discussed may not warrant that. So what we would try to do is, as you said, negotiate a rate where we can afford to provide that for you. If we can’t, then we’ll be up front and honest and say, look, we’re at x amount with this customer, we can offer you a stipend. This may not be the right fit. I mean when I think of a location that really help and you’re going to be traveling back and forth, typically if they’re that desperate need there would be able to afford to put you up somewhere.

Justin: [26:51] Right. That makes sense. Yeah. So you mentioned, you know, paying for malpractice insurance as part of this. So that’s something that the client, your client that the health care institution is going to pay for when you’re talking about malpractice, you talking about like coverage during the time of procedures plus tail coverage after? That’s correct. Okay. And so tail coverage, our listeners is like, you know, if I’m working at Xyz hospital in Des Moines and I’m doing a bunch of procedures and then I was only there for a month and then I’d take a full time job somewhere else there. Those patients that I’ve served during that time, there’s outstanding liability with those patients. So if two years later something happens, there’s a malpractice claim and the anesthesiologist is implicated. Obviously I haven’t worked there for two years, but I need insurance to cover indefinitely the, the medical work that I’ve done.

Justin: [27:42] So, so what you’re saying is the tail coverage for those patients, those procedures that I’ve done is kind of like coverage and definitely post my serving those patients.

Kyle: [27:52] Yeah, that’s correct.

Justin: [27:54] Cool.

Kyle: [27:54] You’re done your research.

Justin: [27:55] Yeah, that’s right. So what are the downsides? So obviously, you know, I have the option of working with a, I think about myself, you know, I, I, if I’m a finance professional, I can either go with like an HR company and I can have them find me a job or I can go find a job myself. So you mentioned, you know, for a physician there’s significant hurdles, especially if I’m looking all over America and there’s credentialing and licensing with each state, each facility that’s a heavy lift. So obviously working with you, working with locum tenens or similar company is gonna make my life administratively a lot better. Presumably there’s a tradeoff cause there’s always trade offs in life. So what’s the downside?

Kyle: [28:32] It depends on who you are, right? Yeah. So some people don’t like to travel. So if you are doing a locum tenens assignment and you, you say you want to be within 30 minutes of your home, it might be a struggle to find new opportunities. On the other side, there are people that love to travel and we may not have the opportunities that are in their desired locations. But one big gap that the physicians and pain anesthesiologist should be aware of is the fact that these opportunities are only as good as the recruiters that are sharing them with you. So you really want to be careful with the company that you’re working for and make sure that they’re reputable and made sure that a recruiter is responsive and accessible. You don’t want to call a recruiter and get their voicemail, you know, five times a day for five days a week. You want to work with someone who’s an expert that understands the markets that you’re interested in. So there is downside if you’re working with the wrong agency. Yeah,

Justin: [29:31] That makes a lot of sense. And it’s the same in my industry. I encourage people, you know, get informed about if you’re working with a financial planner, understand how they’re getting paid and what that means for you in understanding incentive and compensation and all that. So I would say if I’m coming to you, you know, I’m a physician, I don’t know anything about locums companies. I barely know what locums is and I certainly can’t tell the good locums companies from the bad ones. So are there sort of things to look out for as far as like, oh, this is a telltale sign. You might not want to do business with a company like that?

Kyle: [30:01] That’s a, that’s a good question. One thing you could look at is, I mean their customer service ratings, locum tenens.com we’ve burned the best of staffing on the client side and physician side or talent side for the past five years. You can take a look at that and you can look at people’s net promoter score, which tells you what customers are, how likely customers are to recommend working with with an agency and locum tenens.com ranks. We have one of the highest net promoter scores in the industry. I read something that was pretty funny. It said a boutique is not necessarily better with when it comes to locums. Smaller may mean less bandwidth. So we’re talking about licensing and credentialing. Having a larger organization that specialize, it has people who are know what they’re doing when it comes to credentialing, know what they’re doing when it comes to licensing. And that’s going to take you on a smoother ride from a local’s perspective.

Justin: [31:02] Yeah, that makes a lot of sense. Um, so you mentioned the net promoter score. What is that and where can I find it? If I’m thinking, well I want to get somebody with a good one, how do I determine what that is?

Kyle: [31:12] So you can simply Google net promoter score and what it’ll do is it’ll show you the customer’s loyalty to their agency. So our customers receive a survey when they finish work on with us on the client side and talent side. And it encourages them to share their experience and customer service experience with others. It’s accessible. It shows you how likely someone is to recommend working with us.

Justin: [31:38] Got It. So is that something that’s self reported from locums agencies then? It’s done independently. Oh I see. How about international? What if I want to go to Aruba or somewhere in the Middle East or the Far East? Is that something you can help with or what should I do?

Kyle: [31:53] I don’t know of an agency that actually staffs internationally. I know that they’re, one of the locations is spoken about a lot is New Zealand and locums that go to New Zealand. Now I can tell you that we have, uh, an opportunity in the virgin islands that we do. We send an anesthesiologist there quite frequently. So cool. I have to tell Sarah about that. It sounds okay to me. Yeah, exactly. And um, I mean there’s actually a lot of people take their families with them, so it’s a great opportunity.

Justin: [32:22] Hmm. Okay. So when I’m getting paid as a physician working with locum tenants.com and you place me, I’m getting a 10 99, meaning I’m an independent contractor slash business owner, is that right? That’s correct. How do your physicians usually positioned themselves as self employed, independent to be able to make the most of that situation? So what we see more and more is that our physicians are creating LLCs or pllcs under their name to protect themselves financially. Right. And so you know there. Then the nice thing about being a self employed physician is there’s a lot of flexibility from a tax standpoint, you know, expensing all your travel and everything from a, from a retirement plan standpoint and now there are some costs like a covering benefits. How does that work with, with like health insurance and things like that. Does that, that’s obviously not part of the deal, right?

Kyle: [33:14] So we don’t provide health insurance. However, we have partnered with a group for a discounted rate for health insurance for our physicians and their families.

Justin: [33:22] Got It. Is there a, is there like a minimum, like if I’m doing a one week stint with you and then we never talk again, obviously you’re not going to give me access to your health insurance plan, I would imagine. How does that work?

Kyle: [33:32] That’s correct. So they do have to hit a certain number of hours within a year or two to attain this.

Justin: [33:39] Okay, cool. But there is health insurance opportunity through you guys for me and my family if I come to you.

Kyle: [33:45] Absolutely.

Justin: [33:46] Okay. Makes Sense. What other advice, Kyle would you offer for somebody who’s considering doing locums work and maybe is, you know, hasn’t done it before and isn’t familiar with the landscape? What, what should I be aware of? Are there any landmines to like definitely not do or anything. It’s like, Oh, you’ve absolutely need to do this. Besides what we’ve already mentioned.

Kyle: [34:04] I would say one of the most important things is just understanding the reasons why. Like why do you want to work locums? Is it, are you coming out of a residency? You’ve been in a large academic hospital for the past several years and you want to see what it’s like to work with a group. You want to see what it’s like to work at an ASC or critical access. Hospitals serve in rural communities. Are you looking for more flexible hours? There’s a lot of parents out there that have spent a lot of time going through school and then working as an anesthesiologist that just want to back the hours down a little bit and spend some time with their family. If that’s the purpose, then we can help you there. From the perspective of land mines. I think it’s just truly looking at who it is that you’re going to be working with and ensuring that you’re going to trust them. You know? I mean, we can, we can help accomplish these goals, but to know why you’re looking is by far the most them four and a factor. Right. That makes perfect sense. Can you maybe tell us a story or two about some people with whom you’ve worked and how you’ve placed them and how it worked out?

Kyle: [35:09] Yeah, absolutely. So in this kind of speaks to the lamb on. So, um, there was a group down in Louisiana that we were helping out and we had to locum tenens physicians that work in there. Uh, it was a group of eight physicians total. There were working there for those others were working locum direct. This group ended up going out of business and not paying their bills. They didn’t pay us, they didn’t pay their locum physicians. Oh. Those guys ended up in a lawsuit. The tying up a lot of legal money. And what we did was we represented our selves and, but, but our locum tenens providers were paid. So had these other physicians been working with us, they would have been paid and they didn’t even have to worry about the legal battle. So that’s just something to, to realize from a risk perspective that not only do we guarantee you pay and then we’re also going to represent ourselves and you, you don’t really have to deal with that if something does go wrong.

Kyle: [36:08] But I’ll tell you a little bit about, uh, about a few assignments and doctors that I’ve worked with in the past and kind of why you would want to do locum tenens. So there was an anesthesiologist who was from Kentucky and he always wanted to go hunting in Wyoming. So there was a critical access hospital in Wyoming and they were requiring 24, seven shifts for two weeks and they were only doing about four to six cases a week. So he wasn’t extremely busy. So he actually went up there and went on a two week hunting trip and was on call and he stayed within 30 minutes of the hospital and he was hunting and was able to um, have a great time. He took his dad with them and he was also able to take care of the patients in Wyoming. So it was a win win for everyone and he made money doing wow.

Justin: [36:54] That’s great.

Kyle: [36:55] And if you want, I can share one more.

Justin: [36:58] Yeah how about one more.

Kyle: [36:58] Yeah, now I can do that. Um, so this one it’s, you know, it’s kind of, it’ll tell you on your heart strings a little bit. There was a physician in Pennsylvania that I worked with for a very long time and her mother was diagnosed with cancer and she lived out in Oregon. So we found her an opportunity that was only about 15 minutes away from her mom and she got to spend the last two years with her mom working in Oregon. So she was able to, and she sold her house in Pennsylvania and we were covering her lodging and expensive shows. She had no overhead when she was working out there. And um, she was able to take care of her mother and work at the same time and ultimately ended up taking a permanent job there.

Justin: [37:42] Wow. So, you know, from a flexibility standpoint and a lifestyle standpoint, it sounds like locums is really an incredible opportunity to be able to put yourself somewhere far away and still maintain earning power. And I’d have to go through the headache yourself of, you know, all of the paperwork that’s required in order to do that. So that’s, that’s a great example. Let me just ask one last question and then we’ll wrap things up. You know, you mentioned this group in Louisiana that kind of didn’t pay the bills. Do you do any vetting of the, you know, your clients to make sure that either the work environment is okay or that they’re financially solvent or if you gave three or four, you know, providers to them over time and those physicians came back to you and gave you like a bad reports and I’m not going back there.

Justin: [38:29] They’re crazy. Like I can’t handle it. The surgeons or don’t want to deal with them or whatever the culture is toxic. Do you ever like remove them from your list?

Kyle: [38:37] Absolutely. Yeah. Absolutely. Um, I mean obviously it’s a deal breaker not to pay your bills. Uh, so, so I mean obviously that, that is a huge issue. Also from a political standpoint, one of the advantages of working as a locums provider is you can avoid the politics, right? You Work Right, you work your hours and you’re able to go home and you’re not forced to get into the politics of the group. And also a lot of times you don’t have the administrative duties such as scheduling. But to get back to your point, there are situations where maybe someone’s disrespectful or there’s truly a culture issue at a facility. What we would really do is provide the feedback to our customer and say, Hey, this is a situation. Is this something we can solve in an on a case by case basis? Make that decision. There have been opportunities where we’ve chosen not to work with groups again, but ultimately we think it’s in the patient’s best interest to get the care, so just being honest and upfront with them about the feedback is it has always served as well.

Justin: [39:43] Cool. Well Kyle, it’s been a pleasure speaking with you today. Thank you very much for joining us on the Anesthesia Success podcast.

Kyle: [39:49] Thank you so much for having me, Justin.

Justin: [39:53] Hey Justin here. This may shock you to learn, but I am actually not a fulltime podcast. I also run a financial planning company called quantify planning where I work closely with anesthesia and pain docs to build an implement customized financial plans. If you’re interested in working with a financial planner who knows many of the ins and outs of your profession, shoot me an email or head on over to quantify planning.com for more information. If you’re a resident or fellow, I can also offer you a free student loan analysis if you’re interested, but there might be a waiting list. So check out the link over there to see if you’re interested in learning more about the topics we discussed today. Head over to anesthesia, success.com and join our community residents and attendings and others to ask a question or get more free resources. If and only if you liked this episode, please leave us a review and subscribe. Thank you very much for listening to the anesthesia success podcast.