Looking for thoughts/anecdotes on locums urology

[rodsquad]

I'm a current resident getting to that point where I'm starting the process of thinking about what I want my career to look like. I'm about 90% sure I'm going to end up doing general urology. I have no desire for academics. I've been trying to think ahead at what I see myself doing for my first few years of attendinghood. I know that the ABU requires 16 months of practice in a *single* community to take your boards so I will likely take a full time job until I can be board certified and pay off my student loans aggressively but after that I am seriously considering doing locums. Unfortunately there isn't a lot of information freely available on the web on what locums life looks like for a urologist. There are tons and tons of articles/blogs/etc written for ER/gas/IM/FM locums and even a decent amount of posts on reddit/SDN about general surgery locums but I was wondering if anyone here had any resources or even anecdotes on what one could expect for doing locums, especially so for a young attending urologist rather than an end-of-career urologist (though any perspective is welcome). I'm mostly curious on what caseloads are like, OR vs clinic, schedule, pay, challenges/benefits, general respect among colleagues in locums (at my hospital, for example, I know that the heme/onc locums are treated VERY poorly by the other attendings compared to the permanent heme/onc docs, but perhaps that just my hospital?).


Really any input would be greatly appreciated. I know it's a non-traditional route but it's one I'm pretty interested in pursuing for at least a few years before I 'settle down'. Thanks in advance.

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[DoctwoB]

I'm a current resident getting to that point where I'm starting the process of thinking about what I want my career to look like. I'm about 90% sure I'm going to end up doing general urology. I have no desire for academics. I've been trying to think ahead at what I see myself doing for my first few years of attendinghood. I know that the ABU requires 16 months of practice in a *single* community to take your boards so I will likely take a full time job until I can be board certified and pay off my student loans aggressively but after that I am seriously considering doing locums. Unfortunately there isn't a lot of information freely available on the web on what locums life looks like for a urologist. There are tons and tons of articles/blogs/etc written for ER/gas/IM/FM locums and even a decent amount of posts on reddit/SDN about general surgery locums but I was wondering if anyone here had any resources or even anecdotes on what one could expect for doing locums, especially so for a young attending urologist rather than an end-of-career urologist (though any perspective is welcome). I'm mostly curious on what caseloads are like, OR vs clinic, schedule, pay, challenges/benefits, general respect among colleagues in locums (at my hospital, for example, I know that the heme/onc locums are treated VERY poorly by the other attendings compared to the permanent heme/onc docs, but perhaps that just my hospital?).


Really any input would be greatly appreciated. I know it's a non-traditional route but it's one I'm pretty interested in pursuing for at least a few years before I 'settle down'. Thanks in advance.

I can’t speak as to the locum market or lifestyle, but I would worry a lot about skill atrophy.

When you take a locum gig at some hospital, you’re going to likely be filling in for a urologist on vacation, or retired while they look for someone new, etc. that means babysitting their existing patients and taking care of urgent issues. So while that means you’ll see plenty of stones and such, I wouldn’t count on doing any major elective cases like prostates or kidneys or pcnls or female or recon or what not. It will be quite hard to go from a couple years of that to being a skilled broad scope general urologist. I’m a new attending, and trust me doing a case for the first time as an attending can be hair raising, and would be much worse if it was years out from residency.

To me it seems more like an end of career “keep your toes in the water” kind of deal rather then what I would want to start my career.

 

[cpants]

I'm a current resident getting to that point where I'm starting the process of thinking about what I want my career to look like. I'm about 90% sure I'm going to end up doing general urology. I have no desire for academics. I've been trying to think ahead at what I see myself doing for my first few years of attendinghood. I know that the ABU requires 16 months of practice in a *single* community to take your boards so I will likely take a full time job until I can be board certified and pay off my student loans aggressively but after that I am seriously considering doing locums. Unfortunately there isn't a lot of information freely available on the web on what locums life looks like for a urologist. There are tons and tons of articles/blogs/etc written for ER/gas/IM/FM locums and even a decent amount of posts on reddit/SDN about general surgery locums but I was wondering if anyone here had any resources or even anecdotes on what one could expect for doing locums, especially so for a young attending urologist rather than an end-of-career urologist (though any perspective is welcome). I'm mostly curious on what caseloads are like, OR vs clinic, schedule, pay, challenges/benefits, general respect among colleagues in locums (at my hospital, for example, I know that the heme/onc locums are treated VERY poorly by the other attendings compared to the permanent heme/onc docs, but perhaps that just my hospital?).


Really any input would be greatly appreciated. I know it's a non-traditional route but it's one I'm pretty interested in pursuing for at least a few years before I 'settle down'. Thanks in advance.

Definitely need to get your board certification knocked out first. I think its a pretty big grab bag what you can expect for gigs. I know some people who have done it. Could range from weekend coverage gigs to medium term gigs lasting months where you will do clinic and OR more like a typical job. In general gigs won't be in the best locations/hospitals or they wouldn't need the help. I can see the appeal of the idea of doing some travel and maybe working less hours for the same pay, but not sure the reality will be so romantic. You aren't going to be doing nephrectomies in Honolulu; you're going to be taking call on Christmas in Fargo.

 

[Artifactual]

I did locums between the end of fellowship and starting my job. I recommend the experience. It was good to see some different sides of practice and to take a bit to decompress after training.

I had two different gigs. One was a fairly standard one covering call with a half day clinic. I did almost nothing that week and the location was beautiful - very easy money. The other was essentially being a solo practitioner in a small town about an hour outside a major metro in a place that hadn't had a urologist for several years. Many locums who take that sort of gig do very little, seeing 8-10 pts a day and doing as little as possible. I took the opportunity to treat it like a trial run at practice, so I loaded up the clinic and ORs quickly and within a week or so had two full OR days a week. I could have done major cases if I'd wanted to, as the prior urologist had done so and all the stuff was still there. I was there for about 3 months total though, and didn't want to do things that required major followup as I didn't think that was appropriate. In the end the time there felt like a really good chief resident rotation - general, mostly uncomplicated stuff, but a good opportunity to feel what it's like to be an attending and manage your time, your clinic, and your ORs.

Another benefit of doing these was seeing what general practice, especially in a small town, is actually like. This is not something most of us see in training. I should note also that both places asked me to stay on permanently, and I would have gotten a lot more in the contract than I otherwise might, because they already knew I was capable and a good worker. I think it's not unreasonable for someone considering such a job to try it as a locum first - you may well end up benefitting yourself considerably.

The downsides of doing so would be considerable though, especially fresh out of training. The sort of locum job that lets you basically be a private practice urologist is going to be one where you're alone, and your first few major cases are going to be very difficult without a senior partner or two to talk you through it or help you. It would be no different than taking a remote rural job as a solo practitioner. As you note, oral boards requires you to be in one place for 16 months, and also to have sufficient case logs, and it would be rare to find a locum job that could do that. If you're in one place that long doing that much you may as well take it as a permanent job.

As for basics, pay was about 11k a week before tax, though I have heard of some gigs that offer more. Most jobs will just have you covering for someone and doing a few clinics maybe. Those that are more like a real job are going to be places that have trouble attracting someone full-time (which is, admittedly, many places), and those that do come are likely to not want to do very much, so the opportunity will be there to do basically whatever you feel comfortable with. As others have said, though, it is not a simple matter to do these things as a fresh grad.

 

[non prostate owner MD]

Definitely need to get your board certification knocked out first. I think its a pretty big grab bag what you can expect for gigs. I know some people who have done it. Could range from weekend coverage gigs to medium term gigs lasting months where you will do clinic and OR more like a typical job. In general gigs won't be in the best locations/hospitals or they wouldn't need the help. I can see the appeal of the idea of doing some travel and maybe working less hours for the same pay, but not sure the reality will be so romantic. You aren't going to be doing nephrectomies in Honolulu; you're going to be taking call on Christmas in Fargo.

Love the last line! But there actually was a locus job offer in Hawaii I got recently.