Tips on Working as a Locum Tenens

• Type of work:
  
  Decide what sort of locum work you want to do (Solo or group practice, emergency shifts, walk-in shifts, obstetrics, short or long term, rural or urban, BC Rural Locum program etc.).
  
  
• Obtaining a billing number in BC
  Check the BC Ministry of Health Web site.
  
  
• Finding work:
  • Make a poster or notice. Most of the hospital medical staff lounges have bulletin board space for notices. Try to include your business cards
  • Broadcast a fax to all the potential practices.
  • E-mail to the practices or post a note on a local medical e-mail list.
  • Useful Web Sites:
    • BCDoctors.com
    • BC Northern and Rural Locum Program
    • Medical Post Classifieds
    • Canadian Medical Placement Service
    • WebDoctor Job Board
    • HealthMatch BC
  • College of Physicians and Surgeons of BC have a locum list
  • Local Medical Societies often keep lists of locums
  • Networking: Attend medical meetings and social events to make yourself known
  
  
• Scheduling time for yourself:
  After you become established, it may be easy to be booked far in advance. Make sure you block in your own holiday and CME time before it gets booked.
  
  
• Contracts:
  It is a good idea to always have something in writing, even between the best of friends. This helps avoid misunderstandings and poor memory, especially as to payment arrangements when you finally get your cheque one month after the locum is finished.
  
  A sample contract developed over two years of experience is included here and you may make changes as you see fit.
  
  
• Revenue:
  The most important aspect of your finances is your revenue. In a fee-for-service system of payment, you MUST know the fee schedule!
  Only you can give the appropriate fee codes to bill. Don't short-change yourself by not getting paid for the work you do. Bill by the book. If others (MOA or physicians) tell you it is OK to bill in a way that seems to be contrary to the written book, clarify it yourself with MSP. Make up a quick look-up list of fee codes to use in the office and/or emergency room. Make sure you include WCB and other fee codes.
  
  Keep track of your billings on a day to day basis by keeping a copy of the day sheet or writing down the total of each fee code type at the end of each day and adding it all up later. A courteous clinic will give you some kind of statement that summarizes the gross and net pay to you, but you should still keep your own records because mistakes are often made.
  
  
• Expenses:
  Keep track of all your expenses, no matter how small, if they are business-related, including home office, car, books, computer, internet access, travel, meetings, parking, etc. Use a spreadsheet or computer software to keep track of all expenses and revenue. You are self-employed and should learn all the eligible business deductions. The Canada Revenue and Customs Agency web site has information on this. If you are a BCMA/CMA member, you have access to Practice Management tips by MD Management.
  
  
• Other Business Management:
  • For safety and security, don't use your home address as your official business address. Use a post office box.
  • A rubber stamp with your College ID number, name and date is useful to stamp prescriptions and all incoming consultant notes, lab reports, etc.
  • Another rubber stamp with your name, MSP number and "Locum Physician" is useful for forms and requisitions. Make sure the usual doctor's name is on the requisitions and forms so you don't receive lab results, etc in your mail.
  • Make a quick look-up list of diagnostic codes. Keep several copies of your look-up lists because you will lose them frequently.
  • Don't do telephone prescription renewals. Just tell the receptionist when you start that you will not do them except in extreme circumstances. This eliminates a lot of unpaid work but more importantly ensures you are providing the best care to patients you have never met. Most patients seem to understand that because the regular doctor is away, they have to come in.
  • Make sure the office has a firm policy regarding non-insured medical services and make sure you know which services are not insured. Some offices bill things improperly. Just because the MOA says, "That is the way we always bill it", doesn't make it right. You are responsible for the fee codes you put down and it may come back to haunt you. If the office does not have a policy, tell the patient up front that the service will cost them privately and make up your own fee.
  • BEWARE! Doing minor surgical procedures in the office can be enjoyable, but when doing locums these procedures can be sources of embarrassment, complication and legal risk unless you are confident that the office has all your preferred and properly sterilized tools, supplies, dressings, lighting and physical space. For a short term locum, it may be best to defer the procedure until the regular physician is back.
  • Carry a few of your favourite pocket reference books or electronic information on your laptop computer It is sometimes difficult to find ready and current references where you are working.
  • Always introduce yourself to patients and shake hands.
  • Don't change any of the regular doctor's care plans for the patient unless you feel strongly that it cannot wait until he/she comes back.

Good Luck!