In my four years of working as a locum tenens dermatologist, I’ve learned some lessons the hard way. One assignment I was on was a shocker. The EMR was brand new when I arrived so all the patient notes for previous visits were on paper and reading the previous dermatologist’s handwriting was a real challenge. In addition, the exam rooms were so small that I could hardly move around without bumping into something. The tables were a bit older and the lighting was dim. I felt I couldn’t treat patients as well and as a result, I left that placement after a week. However, it was a valuable lesson to me before accepting my next assignment: Always ask questions and be as specific as possible! Here are some of the questions I’ve learned to ask when considering a dermatology locum tenens placement:
#1 What EMR does the practice use? How long has the practice used this system?
EMRs are a given these days — unless you’re placed at a practice that has new ownership bought just days before. This is what I experienced. You may find that a practice may have an EMR system, but it’s so new that accessing previous records is cumbersome. Always ask about the system and its use, including when the clinic implemented the system and support should issues arise.
#2 How long has the clinic been without a provider?
This will help you understand what you’re getting into. Would you have a stack of phone calls to return, refills to approve and insurance paperwork to sign? These additional duties would have a large impact on how much you’ll enjoy the placement and it may be something to discuss when you’re negotiating pay.
#3 How many staff members would be assigned to me? Do your staff members scribe?
Ask about the support staff surrounding you because this would impact the time you are involved with each patient visit. Would the staff members anticipate the tools and equipment needed for each office visit? Would they serve as scribes or would you need to chart at the end of each clinic day? Are the staff members used to working with locum tenens dermatologists? Clearly understand your work responsibilities and keep this in mind when negotiating your daily rate.
#4 How many patients would I see in a day?
Be specific about your work load. Use the responses from the previous questions to determine the average amount of time for each patient visit. This will allow you to determine how many patients you can see each day and what your compensation should be for each visit. Everything is negotiable, including your patient load. You don’t have to take what the agency is telling you. Know from your experience what you are comfortable with, such as you can’t see 30 patients in a day but you can see 25. Placements may be short-term, but they need to be sustainable.
#5 Is pathology read by a dermatopathologist?
This is extremely important for liability reasons. Always ensure dermatopathologists read your pathology samples to protect from error.
#6 What types of patients would I treat?
Think about your experience and comfort level. Do you want to treat children? Do you want to do excisions, surgeries or cosmetics? Does the clinic have the tools for you to complete the required tasks? Knowing what you have confidence in and advocating for yourself will allow you to create a sustainable placement.
#7 What travel expenses are covered?
Consider the extra costs of traveling, such as hotel stays, gas, rental car and transportation from your home to the airport. Don’t let them take advantage of you. Make sure the contract includes every cost you incur (even baggage fees). In my experience, this is more of an issue with direct contracting.
#8 What are the additional expectations? What if I have a personal emergency?
As much as you can anticipate, specify, specify, specify! Prepare for potential emergencies and have that spelled out in the contract. This was something I dealt with specifically with one direct contract assignment and the practice was unwavering with days off when my dog unexpectedly passed away. Going forward, I would include an emergency related to my pet in a direct contract. The practice may not agree with this, but you must decide what you value and be ready to walk away.
#9 What’s the starting pay?
Ask about the starting pay but don’t take it at face value. Remember that you are a 1099 worker so that means you will not receive healthcare and retirement benefits. You’ll also need to account for paying estimated taxes on a quarterly basis, which will include both portions of Medicare and Social Security taxes.
In all, know what’s important to you and stay strong in your asks. With the larger locum tenens agencies, your agent will serve as your representative and should be your advocate. However, if you find the service lacking, you can switch agents within the same agency. Locum tenens works well when you know what you want and need, and can advocate for yourself accordingly.
