Ali: So extremely important for us to approach our careers, not on autopilot, but thinking intentionally about what it is that I'm doing, why am I doing it, and is it going to lead to fulfillment in 10, 15, 20 years?

Sam: Hi everyone, and welcome to another episode of EMPlify.

I'm your host, Sam Ashoo.

Before we dive into this episode, I want to say thank you for joining us.

I sincerely hope that you find it to be helpful and informative for your clinical practice, and I want to remind you that you can go to ebmedicine.net where you will find our three journals, Emergency Medicine Practice, Pediatric Emergency Medicine Practice, and Evidence Based Urgent Care, and a multitude of other resources, like the EKG course, the laceration course, interactive clinical pathways, just tons of information to support your practice and help you in your patient care.

And now, let's jump into this month's episode.

Ali: I'm Ali Chaudhary, board certified emergency physician.

I live in Allentown, Pennsylvania.

I did my medical school out in the Dominica, Ross University, did my residency out in Akron, Ohio, Summa Health System.

And I've been here on the East coast since.

Originally from California, born and raised.

Sam: Awesome.

Thanks for being on the podcast.

I really wanted you to have a time to share with us, because you have a very unique perspective on emergency medicine.

So all our listeners who are in training and already out there in their careers may not realize, but you have kind of made it your passion to talk about.

The locums life and what it's like to be sort of your own business and the freedom that that brings in your career.

Is that right?

Ali: Absolutely, man.

I mean, look, I graduated in 2014 from residency and it's been about 11 years now, which it seems like a lifetime.

But I argue now that emergency medicine, the way that it is structured today is dead.

It's beyond broken, it's actually dead.

It's not sustainable as a career anymore.

Just about everyone that I work with who isn't a 10 99 locum is burnt out, is depressed, is seeking a way out.

Sam: Yeah.

Ali: So I've been able to find freedom , and be able to live a life that is fulfilling and more enjoyable and adventurous.

So I just wanna share with other doctors that like what it is that I'm doing and how I got here.

It's not some sort of secret hack or some trick that only I knew somebody who can get me in.

This is available to everyone who's a mercy doctor and other specialties.

I don't know if there's other specialties that listen to this podcast, but it does apply to anesthesia, GI, and some other specialties that are procedure based.

But my heart really goes out to ER docs because no one gets what we go through,

Sam: Hmm.

Ali: Not our spouses at home, not our kids, not our other colleagues, not other specialties.

I see what we go through and just the stress of the job itself, the psychological stress, the emotional stress, the physical stress of nights and days and going back and forth, and somehow it's normalized that we just accept that and work 14 days a month doing that every single month.

I just don't understand how that became normal.

And so I'm surprised more people aren't burnt out and you know, we're a specialty that has the highest burnout rate.

Why aren't we addressing these issues?

Why aren't emergency physicians taking control of this or having a voice that actually matters?

And for me, locum tenens is a way to actually take back control, take back freedom, and operate and approach your career in a way in which you have the autonomy and freedom, but also at the same time, practicing as an emergency physician.

So there's a lot to say about this.

We can go in many different directions.

I could keep going.

Sam: So if you're listening to this podcast and you don't know what locum tenants is, it's a form of working where you're not employed by just one person.

You're kind of an independent corporation, and you get to pick and choose where you're gonna work.

And you're not a standard W2 employee of some healthcare system or a hospital or an urgent care center or wherever it is that you're currently working.

Now tell me when did you get your start doing locum work?

Ali: And I wanna maybe just add a little bit more color to that because that key difference, what you just described, the difference between an employee and a independent contractor is the reason why emergency physicians are feeling trapped and burnt out.

That's the reason why we are not living life to the maximum potential that we possibly can.

That's the reason why emergency doctors aren't making half a million dollars every single year.

That should be baseline.

So it's a very simple difference.

It's not like, again, you don't have to read it in some thousand page book in the middle somewhere where you can't get this information.

It's very straightforward.

It's very easy to understand.

Once you understand it, you will start to approach the way that you are practicing differently, because now you'll recognize the difference .

W2 employment is a standard approach that every doctor, when they graduate from residency, is what they're gonna get into.

So whether you're an employee at a hospital, contract management group, usually is W2, some are 10 99 though, if you join like the travel team or whatever.

Or if independent group, there's a little bit of a different structure, but a lot of doctors go into employment because it's the most common and easiest way to practice medicine.

Why is it easy?

Because you get your benefits handed to you.

You don't have to think about them.

And you get paid your check, your schedule is made for you and you can make requests here and there, but it's pretty much handed to you.

And so you're kind of like on autopilot in your career, right?

But that's the problem.

When we go into autopilot and because of how stressful our career and our job is and no one actually understands how it is.

That's what leads to burnout and discontent with our life and our career.

What 10 99 does, and what practicing as a locum does is it gives you, in the word itself, independent contractor, you're now independent, right?

You're not dependent on a single hospital to take control over you and give you your schedule and give you your hours and all this stuff.

You're taking control back now.

Now you have control over your schedule and how much you get paid.

Sam: Hmm.

Ali: I'll touch upon this now.

Last year I made over $550,000 working the same number of hours my W2 colleagues are working.

Sam: Hmm.

Ali: They're not making more than 350.

Almost 200 K more.

But what about the benefits and all that stuff?

Yes.

Benefits don't cost me $200,000 a year.

Okay?

And so I did a presentation recently at a residency program in Modesto, California, and I showed them the difference in terms of just income, even taking into account for benefits and things like that, over the course of 10 years, you're making over a million dollars more as a 10 99 locum than an employee.

Sam: Yeah.

Ali: So again, this is a whole topic and I have a section on my book about this.

I have a section in my course about this.

I can go into a lot of depth, but we'll leave it there.

Sam: So if you are someone who is interested in locums, is it something you'd recommend doing directly out of residency or do you need a certain amount of time at a hospital or as a W2 employee before you should venture out and start being an independent contractor?

Ali: I think it's important to know where your shortcomings are.

I think that for some doctors coming outta residency and we have a few that work with us right out, get the residency , and they're killing it.

They're doing a great job.

The directors love them, but there's a few others and my experience has been much less of these two maybe struggle with the single coverage sites.

Right.

And so it's important to kind of know where you fall in that.

So if you find yourself that, you know, you maybe need a little bit more encouragement or maybe a little bit more time to just start getting independent on your own, in those scenarios, I would say maybe start working as a W2 or you get a locum job in a place that has double or triple coverage during those shifts where you're not just by yourself.

Sam: Yeah,

Ali: I think that kind of scares us sometimes.

So it is very possible, but it's important to be honest with yourself as well.

Sam: And if you're looking for locums opportunities, do they generally tend to be more of the single coverage type because they're in different types of hospitals?

Ali: Can be, but not necessarily.

Critical access hospitals and hospitals that are remote generally tend to have a higher need, but not always.

Oftentimes there are satellite hospitals to a main center.

Right.

So it's just about looking around, it's about being informed.

That's the one thing I tell doctors coming outta residency and as attendings who've been in the game for years, you have to be informed about your options and know what's out there.

If you don't know what's out there, you're going to undervalue yourself, or you're gonna put yourself in a position where you're underpaid, put at the wrong site that's understaffed and get screwed.

You can walk on some landmines if you're not informed.

That's why it's important to educate yourself about the career options that you have in front of you.

You don't have to take the locums, but you should know what it is.

You should understand what the benefits are, what the disadvantages are, and so on.

When you're not informed is when you make decisions that can compromise your wellbeing and your happiness and could lead to burnout and things like that.

So extremely important for us to approach our careers, not on autopilot, but thinking intentionally about what it is that I'm doing, why am I doing it, and is it going to lead to fulfillment in 10, 15, 20 years?

Sam: So if someone is considering a locums career and then say, has a family, do you have a family?

You have children.

So how do you handle that with locums?

Does that have you traveling more say than a W2 position might and how do you work that into your family life?

Ali: Great question.

I get this all the time, Ali, I do locums, but I have a family.

Okay.

Now everyone's family is different.

I can't say that each situation is copy and paste and you can do the exact same thing.

But I'll tell you this, yes, I'm a father.

I travel.

I'll tell you example of a mom that works with us.

She has five children.

She works full-time locums now because she says it gives her actually, so two things.

One, it gives her time to decompress between shifts.

Again, ER, no one understands what we do.

When you go home from an ER shift, you need a breather.

You need to take a little bit of time to relax.

I still work clinically.

I still work a hundred hours a month.

So your family, when you get home, is expecting you to be on the moment you walk through the door.

Your kids aren't gonna give you some time to just chill and relax and drink your tea and whatever, right?

You gotta put 'em to bed.

You gotta make them meals.

They're waiting for you.

You've been gone all day.

You got responsibilities the moment you walk through that door.

Your spouse may not understand what you're going through.

If they don't work in the ER as a doctor or a nurse or something, they don't get it, and you can't expect them to.

So they're not gonna understand that they need to give you a little bit of time to decompress as well.

So she said, this is the only time I get to myself and I love it.

So in between shifts, you'll work like four or five shifts in a row, stay at the hotel, and guess what?

She has time to herself.

She never gets time to herself besides the locum shifts that she's working, and so she absolutely loves it.

Now what a lot of doctors do, and I did this as well, is that during the times that we're away, we'll get additional help for our spouse.

Her spouse works from home.

His job is remote, and they're able to get a nanny or babysitter or some extra help or extra care during those days.

So that's one way to do it.

Another benefit of that is I think it actually helps strengthen relationships Being gone for a period of time.

When you come back, you look forward to seeing your spouse and your kids.

It is a little bit stressful when you need to decompress and you can't.

Right.

And you're just all in each other's faces all the time.

So I've actually found in my experience and other people who've done it, like it actually helps.

Have a little bit of distance, a little bit of time away.

Then when you come back, you're, you know, they say absence makes the heart fonder, right?

And so that's another benefit of it as well.

And not to mention, that was last year, I told you how much I made 500 plus thousand.

This year I'm working only eight shifts a month and I'm on target to make over $380,000.

Eight shifts a month.

So I wish I could show you my schedule, but I work them all in one block.

I'm in the middle right now of a five week vacation.

Sam: Wow.

Ali: And I do this every other month now.

I take four weeks off at a time.

I work my block.

So I'm working until, I'm off until August 23rd.

I think 24th is my first shift.

I've been off since I think early July.

I don't even remember.

I traveled the world.

I was in Tunisia, I was in London, I was in Switzerland, Portugal.

I just got back.

I still have two weeks off.

Do you understand?

Sam: Yeah.

Ali: I have more time with my family than any one of my colleagues does, and I get paid more than them.

So I can do whatever I want.

I can work eight shifts a month and still make more.

Or if I wanna make more money and just stack up my cash and, you know, invest or buy a house or whatever, I can do that too.

Sam: So when you work your eight shift, you're doing that in one large block to accumulate that the rest of the time off.

Ali: Eight, 12 hour shifts.

I make $330 an hour, and over the course of a year, if you just add that up, do the math, it's $380,000.

And people might say, well, I can't do eight shifts.

You can, if you know you have four or five weeks off right after that.

Right?

And in between shifts, I optimize for sleep.

For recovery.

I'm not doing a lot of things between on those shifts, that eight shifts block.

I work some nights as well in that block.

You know, there's not enough productivity on me.

I don't see my family sure for eight days, but for 30 plus days, I am.

Right.

And I'm actually there.

So people talk about this idea like, are you really present when you're home between shifts?

Oh yeah, I wanna be home every day.

Okay.

Is that just something you were told because that's what the expectation is, because that's what the norm is?

Or is it actually good for you being home after a shift when you're tired and burnt out.

Sam: Hmm.

Ali: I just need a freaking break versus working a stretch of shifts being away then coming back and being, Hey, I'm home for 30 days, I'm good.

Right?

I don't know.

I think people have it twisted.

They just don't know what they don't know.

Sam: And when you do your stretch of eight, for example, is that all in one facility, one location?

Ali: So I've been fortunate.

I've been at this site in Delaware for about six years as a locum.

Sam: Wow.

Ali: The last three years as pretty much full-time, meaning I work there exclusively.

I am credentialed at a couple of other sites and the game for locum is always, you gotta be credentialed at least two, ideally three sites at any given time in case one dries up, you can always work at another one.

So you're never out of a job.

That's what people say, oh, locums is unstable.

It's not if you play the game and I've been playing it for 10 years and I'm a pro at it, so I can teach you a thing or two.

Sam: So when you say you've been at the same facility for six years, are you the only locums person and is everybody else a W2 or is it just kinda a mix or how does that work exactly?

Ali: Well, I've been there longer than most of their full-timers

Sam: Wow.

Ali: I'm definitely not the only locum there.

So yeah, there's a bunch of other locums.

As a matter of fact, I have a staffing company as well.

It's called Locum United.

I started that eight years ago.

And so we have a few other docs that work there through our staffing company to help, and people always have this idea, if I may add that, locum is only at dumpster fire sites.

This is another common misconception.

I think a lot of residents, when I see them they ask me this question, Hey, are they only at dumpster fire sites?

Because I think that's the thing that gets passed around

Sam: Sure.

Ali: from attendings who don't know any better, who've never done it.

And I've been at, if I've been doing it for 10 years full time, now it's 11.

I've been at a dozen plus sites in the last 10 years, and only one, which was the first one I went to, was a dumpster fire site, which was understaffed and just complete chaos.

And that was from another company that is big name company that's out there that put me at this place.

And that's the reason why I actually started my own company because like, you know what?

I'm not gonna do any doctor like they did me.

You know?

And so I started my own.

I was like, yeah, I'm gonna pay my doctors good and I'm gonna send 'em to sites I would work at.

Sam: So I could see maybe years ago where, you know, staffing shortages were not as bad and people could become W2 employees and stick around for a while.

The only sites that couldn't hire people would be those dumpster fire places, as you said.

But now, you know, national shortage, emergency physicians are in high demand everywhere.

So you're saying you could actually get a locums position in a larger city, maybe like an urban center even.

And sometimes they're temporary and sometimes, like in your Delaware case, they're not.

Ali: Most of the sites I've worked at and everything's about geography, so like you said, there's a supply and demand tension here, right?

Less supply of doctors, high demand.

Now doctors, we don't understand or we've forgotten basic economics.

When that happens, you can demand a higher price.

But we let the hospital dictate to us what they're gonna pay us and take a fraction of what we deserve.

And so we're not playing that supply demand tension in our own favor.

And I'm not saying we should gouge the hospital and make a thousand dollars an hour.

No, I don't think that's necessarily it either, but I think what we do, the work that we do, we need to get compensated more for.

I just don't think anyone else gets it, again, not admin or anything else.

So this supply demand tension that exists, it means that there's gonna be hospitals all across the country that are short staffed.

Now, if you go to maybe Hawaii, you're gonna have a hard time finding a locum need there because everybody wants, if they can be there and they'll take a much smaller salary than anyone else.

But the big metropolitan cities, maybe just an hour, two hours outside of that, you'll find a lot of hospitals that need help.

There's nothing wrong with these places.

They run very well.

They're actually very functional places, but they don't have the desired geography for people to wanna live there.

I'll go out there and work some shifts, but I don't wanna live in small town, Alabama, right?

It's just not what I wanna raise my family in.

I don't want to build like a social network there necessarily.

'cause all my friends live here.

I wanna live in one place.

I'll go work there for like four or five shifts and then come back.

You see what I mean?

Sam: Yeah.

Ali: So that's really what the situation is for.

The vast majority of sites in my experience is that they're just short staffed.

They're all functioning places, but just can't find doctors who wanna stay there.

They'll get doctors outta residency, they'll come and stay there for a couple years, and then they're like, what am I doing here?

I need to go back.

I have a kid now I need to go back to our parents where they live and all that stuff, you know?

Sam: So in your personal geographic region, how far are you traveling routinely for your locums jobs?

I mean, you're going, like across the country.

Are you more regionalized?

What's it look like for you?

Ali: I've done it all and I've been fortunate.

I live in Eastern Pennsylvania and 90% of my jobs have been within driving distance, meaning that I could drive there, stay there for a couple days.

I couldn't drive there every day between shifts,

Sam: Sure.

Ali: But driving within two to three hours tops.

So I would usually go drive and do a stretch of four to five shifts in a row and then come back.

There are sites that I've gone to in Michigan and in California.

Those are short term.

I didn't do them as much, but some people like doing that because maybe they have some family or some relatives in California or they just wanna go visit and stay there.

Whatever.

Totally possible.

And guess what the hospital pays for your travel and for your hotel.

And guess what?

This year, because the hospital pays for my travel, I have over a million Hilton Honors points.

Which I can use for, you know, when I travel book like five star hotels for free.

And that adds up to about $20,000 a year and just free travel stipend essentially.

There's all these cool little perks that you can do and you don't have to get on a plane if you don't want to.

It depends where you do live, but most places, say you live in Dallas.

I get jobs, opportunities, and things , you know, we're an hour outside of Dallas, two hours outside of Dallas.

So you can live there if you see that you want to, but just drive out, stay there for a couple days and come back and you're done.

Sam: All right, so let's talk about some of the practical day-to-day matters of being a independent contractor.

So you've been fortunate enough to go back to some of the same hospitals again and again, but let's say you're in this position and you're working multiple hospitals, how do you adjust to different EMRs and different consultants and trying to understand the flow of and how things are done at each department without being someone who's been there for a while already.

Ali: You're gonna get butterflies for your first shift or two.

And it's because you know the medicine, but you don't know the system, so you just kind of feel somewhat handicapped.

Sam: Yeah.

Ali: I, again, having done it for at least 12 times in the last 10 years, it takes about two weeks.

Two weeks of consistency working there.

You will get a hang of the system, who to consult, what the EMR is like.

And you'll be more or less independent.

And usually hospitals, when you come on early, they recognize that you're gonna be somewhat handicapped because they know it's a new system for you.

So they'll usually have some leeway.

So yeah, it's not that hard.

I mean, we're smart people generally.

The EMRs, yeah, some are harder to learn than others, but as long as you're going there consistently and not taking months off between shifts for your locum, because then you're not gonna remember the system when you go back.

Right?

Sam: Yeah.

Ali: So there has to be some level of consistency.

But if it's Epic and you use Epic at home, then it shouldn't be that big a deal, right?

Or whatever EMR that you use.

Sam: So after say two weeks of being at a facility, then there is some advantage to going back to that same center, you know, a few more times if you have the option to in your locums geography.

Ali: Yeah, and also remember, credentialing takes forever.

It's a pain in the butt, dude.

If there's one negative to locums, it's credentialing.

I hate credentialing.

It's the most painful thing that I think physicians have to do, even the ER work is less painful in my opinion.

I guess that's debatable.

And the reason is because these hospitals have these antiquated credentialing requirements for the most ridiculous things.

And then you'll send it to them and then they'll say that they didn't get it, but you sent it to 'em two weeks ago, you can show 'em the email like, oh, well can you send it again?

And so the way that I tell doctors and the way that I train them inside our training community Locum OS is create a Google folder and have sub tabs in that folder for each thing.

So for licenses, your DEAs, your residency diploma, health documents, all those things, so that way anytime you start a new credentialing package, you have all that data ready and it's easy to plug and play because otherwise, if you're trying to figure out through your emails, try to find all this stuff, it's never gonna get done.

Sam: Yeah.

Okay.

So it takes a little organization.

I can see that.

Ali: A bit

Sam: It takes a little bit

Ali: Organization and you'll be done, you'll be set for life.

Sam: Okay so you have an interest.

Maybe you are ready to do some traveling or you're not objecting to any of the traveling.

You gotta spend a couple of weeks at each place to kinda get the lay of the land.

You've got your EMRs you can adjust to.

Do you think the majority of independent contractors are out there working on their own, or are they working with say like locum staffing companies where you get to know some people who are kind of regionally doing the same thing?

Or in your experience, how has that worked out?

Ali: Usually it's through locums companies.

And I've tried going directly as well.

This was one of the things, 'cause when I had my first job and my bad experience, I was like, you know what, I'm just gonna contact hospitals directly.

And I tried doing that and that's a big pain too because you can't find the right person to talk to.

Also if you do, they'll say, well, we don't contract directly and you have to work through X locum company or this vendor management system.

Sam: Okay.

Ali: Some hospitals will take you directly.

And so I know doctors that do do that and they'll spend the time to do it.

But the land mind of what working with the locums companies is getting underpaid, getting sent to the wrong sites and then playing games with you, right?

I know many doctors who I've worked with side by side at sites and they're getting paid $50 per hour less than I am because I take care of my docs.

I make sure that we get paid top dollar going in, right?

We don't have to negotiate or figure out what your worth is.

Whereas this other locums company, remember traditional locums companies, they have recruiters on their team, right?

Sam: Right.

Ali: I don't have any recruiters on our team.

I am the recruiter.

So their incentive is, okay, so say a doctor says I'll take 200 per hour, but say they're billing the hospital 400.

Huge commission, right?

If a doctor says, Hey, I want 300.

So there's a smaller commission there.

Sam: Yeah.

Ali: Their goal is to low volume and pray and hope that you don't know what your value is.

Sam: Wow.

Ali: And so most doctors, like myself, I was a sucker.

I didn't know what my worth was.

I took the $200 per hour job.

I did.

That was my first one I took.

And later on I was like, oh dude, I probably left 50 to a hundred thousand plus on the table.

Just 'cause I didn't know I should have asked for 300.

Right?

Sam: All right.

Ali: We're not good negotiators.

We've been in medicine.

Sam: Yeah.

Ali: One way thinking we don't know negotiating skills and all.

I mean, we're very much in many ways infantile and very juvenile in many ways because we've trained very highly and very deeply in one thing, but nothing else.

Sam: Yeah, I mean, we don't go to business school, so it's not in the curriculum.

Ali: Very underdeveloped in other ways.

And so that's part of the thing I'm also teaching doctors is start developing yourself in other realms.

Whatever it is.

Just like in terms of leadership.

In terms of entrepreneurship, in terms about just setting boundaries for yourself and knowing what your're worth actually is.

Right.

And because you miss out on that for 10 years of things that you would learn in the real world I guess.

If you were to take a job or take an offer, do a counter offer, things like that.

We don't think that way because we're just thinking about how to save lives

Sam: Yeah.

Ali: And how to do this intubation.

And if this doesn't go well, what's my next step?

All those type of things.

We're thinking algorithmically, what are we doing next?

And so there's no training for doctors once they graduate residency.

After you're done you're on your own.

Sam: Right.

Ali: So now you have to just figure out things and trial and error.

That's what I did.

I didn't know any better.

But it's important to try to find, I think, people who are where you want to be and try to see how they did what they did, because otherwise you're gonna make the same mistakes.

And those are costly mistakes that I made.

I'm just trying to teach people how not to make those mistakes that I made because I could be much further ahead if I didn't.

Sam: So then picking the right locums company is critical in this scenario.

Like one you can trust, but also one you can negotiate with in this, and one that you're not desperate for.

Ali: And to be clear, look, I would love for people to work with our company, but I logistically can't place every single doctor because we have limited number of jobs and we do get those placed quickly.

But what's more important is that you know what your worth is and what your value is.

Sam: Hmm.

Ali: Right, so I tell ER docs, if you're working at a site, generally speaking, don't take anything less than $300 per hour.

If it is 10 99, don't take less than $300 per hour.

Now, the caveat to that is if you're working at a 24 hour shift at a small critical access hospital that only sees four patients a day.

Those are sometimes a little less than that, like maybe in the two hundreds or so, but beyond that, 300 should be your baseline and then go up from there.

I dunno if you're familiar with the EM doc jobs Facebook group.

And on our newsletter as well.

So we post these jobs in there and our jobs have been up to 330, 350 per hour, 75.

We even posted one last year for 400.

My goal is to just pay docs what our value is, what our worth is.

So that way, honestly, like we can set ourselves up for success outside of the walls of the hospital because I want us to have good, happy, long fulfilling careers.

Sam: So when you, as a independent contractor, register with a locums company, you're contracting with them and then they go off and contract with the hospital for however many hours you're going to work.

But does that require any kind of exclusive agreement with a locums company?

Or can you contract with multiple ones?

How does that generally work?

Ali: Very good point.

Caution to everyone.

Do not share your CV with any recruiter until you're a hundred percent sure that you want to be working at that particular site.

And also make it clear to them that you only want your CV presented to that one singular site.

There's so many shady tactics that I've seen in the industry.

What some rookie recruiters will do is that they'll take your CV and they'll just shotgun it to a bunch of places without your permission, or maybe you said, Hey, you can send this one site, but let's send it to a bunch.

Sam: Hmm.

Ali: What that does is once your name has come across a credentialing site or facility, they have your name now on a file and now for two years, you cannot work at that site with any other locums company except for the one that presented you initially

Sam: Interesting.

Ali: It locks you in.

I've had that so many times.

I'll post one of these high paying jobs on this Facebook group and in my email list.

And doctors will say, Hey man, I saw this job.

Can I apply?

I'm like, sure.

So they apply and then we get a message back from the site like, Hey, this doctor's already in our system.

They can't work there with us.

So I message the doctor back, Hey, what happened?

Yeah, man, like X company and I don't wanna name names, but this company presented me like two weeks ago for 300, but I saw the job on yours for 350.

I'm like, yeah, unfortunately I can't do anything about that .

The bylaws are what they are.

And I wouldn't, because that's what the rules are.

I cautioned docs to do your homework.

Make sure you know where you're going, how much you should get paid, do some research, go to Facebook, join our newsletter, just so you know what is out there and what rates are going.

'cause otherwise you're gonna sell yourself short.

Sam: So in that scenario, you send your CV to Locum Staffing Company X, they give it to the hospital, and then the hospital says the only way you can work for us is now through this company for this period of time.

Ali: Usually it's a two year clause for that.

Sam: And that's a clause between the hospital and the locums company.

Ali: Yes.

Sam: Okay.

Ali: It's a standard clause.

And the hospital enforces that, not the locums company.

So technically, if the locums company didn't know about you.

And say, for example, I just presented and the hospital said Yes, okay, we could do that.

Sam: Right.

Ali: I wouldn't, but I'm saying that's possible.

But the hospital itself has it in their bylaws, in their system, like anyone that's been presented.

'cause they have a relationship with these companies too.

And they don't wanna burn any bridges and they don't want to do things that are outside 'cause then they won't get good candidates.

So they enforce this.

Sam: Gotcha.

But there's nothing in the contracts that makes you exclusive to a locums companies.

Ali: Yeah, no.

You can work with any company as long as you haven't been sent to that particular site, or your name hasn't been sent over to them.

You can work with any company at any time really.

Sam: Awesome.

Awesome.

And then, all right, so now tell me about your company.

You are staffing locums in a specific region of the US or how big of a blanket is it?

Ali: So we're national.

We're national.

We have contracts in California, Arizona, Oklahoma, east coast, northeast, and now starting to venture to the south as well.

And yeah, we have contracts all over and our contracts come and go pretty quickly because we post high paying jobs, like they get taken very, very fast.

And yeah, I mean, it's a physician founded company.

Myself and my brother, who's not a physician, we started the company eight years ago because of my first experience that I talked about earlier.

It was horrible.

Sam: Hmm.

Ali: And I said look man, at this point, no one's watching out for us doctors, and no one will.

I realized early on that no one really cares about us.

And I don't mean that in some sort of cliche, but it is what it is, right?

I'm not gonna try to fight the system.

The hospital system, the corporate system doesn't care about us.

We're just cogs in the wheel.

We get called into the office for a potassium that we didn't correct, that was 3.3, you know, some BS stuff, right?

And my same experience with that locum company.

So I'm like, you know what?

I've always been the type of person, like things don't have to be that the way that they are.

And so what can I do to change them and I was fortunate that my brother has a business and finance background because I don't.

I'm just a doc.

I just fix people .

And so we partnered up to build something that was gonna favor our doctors and not have them try to play the games that they had to play with these other locums companies.

We're just direct.

I still work clinically.

Like I said, I'm not some person who's made a bunch and now I'm just chilling.

I work clinically still.

I make sure that we are very high touch.

We pay them what they're worth.

And you'll see on these various forums that people love us.

I come to conferences, people love meeting me and saying hello.

And you know, we post sometimes these funny little AI images that people like and stuff too.

So we have a good time with it.

I love it because I get to meet people and honestly get to change some lives.

That's been the biggest part of and revelation for me, this year and last year, where I started seeing people who actually messaging me, saying, man, you changed my life.

Sam: Wow, that's awesome.

Ali: And I was like, wait, I thought I was just gonna do this locum thingy and now it's coming to something else.

'cause it changed my life.

So I guess I shouldn't be surprised that it's changed other people's lives.

But I wasn't consciously thinking about that.

And so now it's giving me even more meaning behind what I'm doing because sometimes I take it for granted what I'm doing now, having a month off for me is norm now.

But seeing my colleagues and what they're going through I think that it hits home now when I see them saying, Hey, actually, you helped me a lot.

It means a lot.

Sam: Yeah.

Okay, so one more question, sorry, about the practicality of how this is done.

So when it comes to the malpractice insurance portion of it, is that something that's typically covered by the locums agency, or do you have to have your own as an independent contractor?

Ali: It should be covered by your locums agency.

Yes.

And you know, there's been a lot of issues with malpractice with various large companies going under and things like that.

Just make sure that you ask your company to offer you a certificate of insurance that says that, hey, if anything happens to our companies, that you'll still be covered.

Yeah you shouldn't have to pay for that.

And most companies have similar large organizations that are out there.

They'll have a similar kind of insurance policy.

So just make sure that you're aware of that and

Sam: Keep track of that.

Ali: Keep track of it.

Yeah.

Oh, and one thing is that when you're doing your credentialing on all that, make sure you have a folder for certificates of insurance.

It's called a COI for short, because those things are almost impossible to chase down later on.

Sam: Hmm.

Ali: Sometimes hospitals shut down or someone else is coming in and you can't get a hold of the right person.

You'll always get one when you first start working at a new site from the locums company, or say you're working with a large contract management group or independent group or something else.

Just make sure every time you work on a new site, you get that certificate of insurance and you put it in a folder because otherwise it can be impossible to try trace those down.

You'll thank me for that later.

Sam: Awesome.

Awesome.

All right, well, so if someone's listening and they wanna reach out to you, how do they get ahold of you?

How do they learn more about your company?

Ali: I'm not hard to find.

I have various social medias and things like that.

I'm on Facebook as Ali Chaudry.

My Instagram is @therealtopdoc.

I have my company, which is Locums United, my staffing company, but I also have a new training platform that I just launched.

And we're doing our first live webinar this month on August 27th.

You can find out more information at thelocumos.com and you can forward slash workshop and you can sign up there and I'm gonna do my first live workshop where I'm gonna be giving away a lot of free value and a free gift for everyone who joins.

Something I've been working on for over two years.

I'm gonna give it away for free.

So make sure you comment.

I wanna see you there too, Sam.

Sam: Awesome.

Awesome.

Hey I'll be there.

I'm looking forward to it.

All right.

Well, Ali, thank you for taking the time, you know, in between your multiple weeks off to come talk to us about the locums life.

This is some precious information for anyone who's listening, who's feeling the crunch in whatever emergency department you're in.

We all feel it.

Definitely some food for thought if you're not out there working locums already.

And even if you are, whether you're a physician, really a PA, a nurse practitioner, any type of traveling locums clinician this is some solid sound advice.

Actually one question for you.

Are you staffing non-physicians as well, like nurse practitioners and PAs?

Ali: We do APPs, so PAs, NPs, CRNAs as well.

They kind of fall under the locum demographic.

Nurses we don't do because they're a completely different kind of system.

And I'll be at ACEP as well this year.

We have a booth there.

You can come find me ACEP

Sam: Awesome.

Alright, well thank you very much Ali.

Really appreciate you taking the time to share with us.

Ali: Happy to be on, man.

Really appreciate it.

Thank you.

Sam: And that's a wrap.

Thanks for joining us for this episode of EMPlify.

I hope you found it informative, and I want to remind you that ebmedicine.net is your one stop shop for all of your CME needs, whether that be for emergency medicine or urgent care medicine.

There are three journals, there's tons of CME, there's lots of courses, there's so many clinical pathways, all this information at your fingertips at ebmedicine.net.

Until next time, everyone, I'm your host, Sam Ashoo.

Be safe.