Episode Transcript
[00:00:00] Speaker A: I really was interested in learning about business and being an entrepreneur. And the more I learned, the more I was excited about it.
So I took my first locum job under my Social Security number. And then quickly I was like, maybe I should have an llc. Then I formed my llc, and then I was like, what else can I do with my llc? That's when I decided to have a website to offer other services to other doctors.
[00:00:24] Speaker B: Welcome to skin deep. I'm Dr. Ana Chacon, and today we have a very special guest joining us. Get ready for some expert insights you won't want to miss.
Go ahead and tell me a little bit about yourself.
[00:00:38] Speaker A: So I got into locum tenens work straight out of residency. So I always wanted to travel. I always loved just visiting different parts of the world. And when I heard about locum tenens work, I thought, whoa, okay, someone's got to pay me to travel. That's what I wanted to do. And I had wanted to do that even in medical school. I started going to conferences and talking to the locum booths and things like that. And then when I graduated, it was Residency. It was 2020. So the pandemic just like threw everyone for the. For a loop. I really didn't want to sign a three year contract or, you know, four or five year contract. And I thought this was the perfect time to jump in and try locum work. So I did it straight out of residency and absolutely loved it. The pay was phenomenal. I had autonomy over my schedule. I could pick and choose what jobs I wanted, and I wanted to see the country. So I took jobs like in Alaska or Montana or California, so I could see different parts of the country.
And I really relied on other physicians in the beginning to help me kind of figure out a lot of the obstacles, like how to trust a locum agency, what to look for, what are red flags in a job, looking at a locum contract, figuring out health insurance, travel points. And so there was a really steep learning curve in the beginning.
And as I started doing it more, I thought, well, if I can translate some of the knowledge I gained to help other people that want to get into it, that would be, you know, a win win. So that's when I developed. My website was about two years into doing locum work because I felt like I was just gaining all this knowledge, and I wanted to put it somewhere organized, structured to help other people.
And then it just kind of blossomed from there. I started making digital downloads. I ended up making a video course that I got professionally edited. I filmed it across five different countries just to really highlight that the locum life gives you a lot of flexibility to travel and. And have leisure activities outside of just work travel.
So I made the course and I just tried to hit the main highlights of what to know when you're getting into locum work. And then I started. I would DM, you know, discuss locums in my DMs on Instagram. People would message me and they would ask if we could, you know, zoom or call so they could ask more questions. So then I started making it a consulting service where people could chat with me about it and we could get on a zoom call. And then residency programs started asking me to give talks to their residents. So I've actually done probably 10 or 11 presentations for residency programs.
I did Johns Hopkins in person a couple months ago. Yale has asked me to come talk for them. Cleveland Clinic. So I'm getting more into the resident field because those are the folks that, like, might be the most interested in trying this. And it's so much unknown that where, you know, people are scared to jump in without some guidance or knowledge. So that's been really fun. And it's just opened a ton of different doors in terms of consulting services and advising even other companies and locum agencies on how to work with doctors and how to optimize their businesses. So it's been so fun. I really like it.
[00:04:07] Speaker B: That's awesome, because I was going to say with the indigenous dermatology, I'm giving a talk in Harvard this month.
[00:04:14] Speaker A: Oh.
[00:04:14] Speaker B: They also found me online, and I think that's really cool. Like, when you think of developing your passions over life throughout your lifetime, doing things that are kind of off the beaten path but that you love, you know what I mean? And helping them grow and then, you know, kind of becoming an expert in that area, you're totally up there.
So that's awesome. Which course development program did you use?
[00:04:39] Speaker A: I did it all myself and just put it on my Squarespace website. And I just had an editor from California I hired remotely to just, you know, make it look more seamless. But I outlined it and, and wrote it, the script and what I wanted to talk about basically on my own.
[00:04:58] Speaker B: Okay. What is your website so everyone can find you. I looked you up on LinkedIn and added you. But what is your website?
[00:05:05] Speaker A: It's Dr. Jacobs health.com. Dr. Jacobs health.com and I have my blog there. And you can get to my course and book a call and stuff like that. But that's kind of where I Keep, like, the hub, all of my. My information. Okay.
[00:05:20] Speaker B: I'm joining your mailing list right now.
[00:05:22] Speaker A: Okay. Yes, I was gonna say join the mailing list. Yeah.
[00:05:26] Speaker B: Awesome. Excellent. And then a couple other things. Yeah. Just where are you from originally?
Most interesting place you've been at. I'm sure that you. You, since you're so experienced, but just like, you've probably been in many different workplace settings. And yeah, what makes a workplace setting good versus bad, you know, what makes it welcoming is, hey, I never want to come back here again.
Doctors, especially traveling doctors, were exposed to a lot, a lot of good and bad.
[00:05:57] Speaker A: But, yeah.
[00:05:58] Speaker B: Yes, go ahead.
[00:05:59] Speaker A: I'm originally from Baltimore. That's where I am right now. And I did undergrad in med school at Virginia Tech and then went to University of Louisville for my PM&R residency training. So I'm a physiatrist. And Kentucky was home base while I, you know, did all these different travel assignments. Alaska is definitely one of the wildest places I've been to. I didn't go as far as borrow like you did. I just was in Anchorage. So when you were talking about how far north you went, I was like, whoa. She, like, really went there. So Montana was a really exciting assignment that I. I'm actually going back to next week. California, sort of all over. And in the process of doing all these different jobs, I've done academic medicine, inpatient rehab, outpatient MSK clinics. I' I've worked at the VA as a locum. I really tried to do everything to just see how the whole process works and red flags, at least what I tell my mentees or people that I'm advising are things like if you're working with a recruiter versus going direct with a hospital. Just knowing the language, I think is really important. Like, if a recruiter can speak the language of your specialty. Like, for example, in rehab, if you know what an IRF is versus a SNF versus an ltch that tells me that you know more about the specialty. And I'm less likely to get placed in a situation that's a dumpster fire, knowing the census, how many patients you're going to be expected to see. Because I have been in scenarios where the Census is like 25, and I just, you know, didn't ask up front or get it in writing in my contract that I wouldn't see more than X, Y, Z patients knowing the emr. I don't take jobs that are not on EPIC these days just because it's such a great way to Communicate with other physicians and when you're brand new, somewhere that's really critical.
So I don't take jobs that are not on Cerner. Location obviously is a factor and you support staff and what the nursing to patient ratios are and things like that.
So there's a lot of little tricks I've figured out over the years and I try to put them all on my blog so people can access them.
[00:08:15] Speaker B: Awesome. Yeah, I know everybody uses EPIC nowadays and I know they're getting sued for being a monopoly or something, right?
[00:08:23] Speaker A: Oh, really? Well, I don't know. I'm kind of okay with being in a monopoly.
[00:08:28] Speaker B: No, I know it's. It's crazy how there's so many systems that you can just like document on a couple other things.
How did this kind of play out? Because, you know, you are an expert. You're kind of the, you know, golden child in this area. You know, how did this play out with family, just traveling, being far away, family relationships, maybe friends. I know my parents thought I was crazy for going to Barrow. They had never heard of it before. They were tell other people, do this and leave, you know, the comfort of just, what's a nice cosmopolitan city to go to the middle of nowhere without trees and work a lot.
But yeah, what did they think about it? How is it managing family, friends, relationships, being far away from home for extended periods of time?
[00:09:20] Speaker A: It's definitely challenging relationship like, you know, maintenance is really hard when you're going to all these different places.
My parents also were like, you're going where? They were kind of horrified. It does force you to be really independent. And, you know, I would take myself out to dinner on my own all the time. I would go join activities or, you know, you really have to push yourself outside of your comfort zone to meet people, make friends. Luckily, we have FaceTime, so I could FaceTime my friends and family a lot. But it is really hard to leave, you know, your structure, your routines. I have a dog, so that made it really difficult to leave her behind, get caregivers for her.
Now I bring her with me on a lot of assignments, which helps a lot. But no, it's. It's really hard. And it is. There's certainly times where you feel lonely and you're isolated in these places and you don't know anything. And it can be difficult, especially as a physician and a female physician, because at a lot of these places, like, I have great rapport with the people I'm working with, but a lot of times they're not reporting to me. But I'm the leader of the unit, so it's a little bit harder to say, oh, let's go out and like, get cocktails and do this and hang out and kind of be laid back and be myself. Because I know, you know, the next day they might have to, might have to work through something at work. And I don't want to blur those, you know, relationship boundaries. And then it's also hard, you know, as a solo female traveler, just from a safety aspect. So it is definitely challenging. And I would say probably the biggest challenge of Lokum Tenens work is being isolated and trying to find a routine and new friends and new people every place you go. What I do a lot is I recharge by taking lots of time off between assignments. Like right now I'm about to end a two month off period before I go work for seven weeks in Montana.
And so I'm seeing friends, I'm seeing family. I'm just like recharging, doing my routines so that I can, you know, build that sense of adventure back up and feel good about going back out and trying something different again. But it's really hard.
[00:11:38] Speaker B: Yeah, it's well said and I've, I'm sure you've experienced it, but I've also worked in places really small where it's hard to avoid people.
Yeah, I very much don't like blurring those lines of work and personal.
So I kind of make it a point to avoid anyone at the workplace, outside of the workplace. But sometimes you can't because that's the whole town, you know, the whole town and Barrow, they're like the number one employer is the hospital. And I have seen people lose their jobs for blurring those lines. It's very easy to do in medicine and hard to get trapped into that. And yes, I've definitely felt like, you know, your safety could be at stake or just being a female physician, it's. It's just harder. Other things that I want to talk about, and I touched on this a little bit, the locumsmart and the monopoly that this is it Comp Health or global. Global Medicare.
[00:12:33] Speaker A: Cht. Yeah. CHG purchased Locum Smart about a year or so ago. Yeah, two years ago.
[00:12:39] Speaker B: How? Oh, okay. So you know what? That other person that's on locumsmart was on there before that, the one that I took.
Yeah.
[00:12:47] Speaker A: So how.
[00:12:48] Speaker B: Because this is something I didn't know and, and you may not be aware of unless you're in this field.
The monopolies that develop in medicine that these People have a stronghold on gets first dibs. How much do you think they're making off of this? Has anyone even brought this to light that they have this stronghold and will not will make it really tough for anyone else? Because I think one of the things that bothers me is as physicians, we're really taught to be autonomous. Like we are the decision and it gets really hard or blurred when people kind of take that out of our hands and start trying to just be right here, you know, where, you know, it kind of interferes with, with our ability to be autonomous. You know what I mean? Yeah, go into that. So just so the audience can know a little bit about that and who controls this portion of this field.
[00:13:42] Speaker A: Yeah, it's a really complicated layer, you're right. And you don't really know about this unless you're kind of deep in the industry and in the locum world. But a vend management system or a VMS is what hospitals will purchase to kind of manage their vendors. And one of those vendors is locum agencies who will then bring on physicians to fill staffing gaps at the hospital.
The issue is that this vms, one of the biggest ones is Locum Smart and they were recently purchased by chg, which is the parent company for locum agencies like Comp Health.
And they make it very difficult for smaller locum agencies or even direct physician contracts to occur for a couple of reasons. One, there's a lot of limited availability to get on the system. You have to go through an application process and there's a huge financial barrier to get onto these Systems. It's like $15,000 just to get into LocumSmart if you're granted access and then there's a monthly fee and then they'll. They also take a percentage of every job that is booked through their platform that they now own. So it really does bring up a good question. It's like, you know, are there antitrust laws here that are being kind of, you know, bended and manipulated? Because you really can't get onto these systems without CHG being the gatekeeper. I mean, essentially. I mean, it's an incredible business move from their standpoint because they're essentially going to make money whether you use their locum agency or not. But it does make the barrier to get into access to some of these facilities almost impossible for like a one off physician or an independent party, things like that.
So yeah, I'm not sure how far it's going to go or like if there'll be any like disruption of that but it does make it very challenging. So I'm interested to see how things play out in the coming years. But a lot of times I will direct contract with hospital systems, especially the smaller ones. And then a lot of times we can bypass having to use a VMS altogether. Some systems though, they hospital systems, they require you to go through a VMS and then you're kind of cut out. The mom and pop or smaller entities are cut out if you can't get onto those big giant systems.
[00:16:09] Speaker B: Licensure credentialing, because that's a big deal, can take forever in some states.
Do they do this for you? Did you do imlcc? What was your system? Did they reimburse that?
[00:16:22] Speaker A: Yes, everything is reimbursed credentialing, either by a locum agency, if you're doing that, or if you're going direct. The hospital reimburses.
If a locum agency is helping you, a lot of times they will pre fill the application for you. If you're a direct contracting, you're doing all the heavy lifting on the paperwork, which can be annoying. The IMLC is very helpful because it'll help expedite your ability to get a state license if you don't already have one in that state on the order of like four or five days. Sometimes you can get a license.
You have to be board certified to be on or eligible for the imlc. And a few other things have to be in place for you to even be able to do that. So originally, before I got my final oral board certification, PM&R, I was doing everything sort of on my own, getting state licenses without the imlc. So it can take weeks to months to get all of those things in order.
But now that I have the imlc, things are much more expedited. And the paperwork is the hardest part. I mean, that's the most labor intensive part of getting one of these jobs. I personally have a back end to my website where it is encrypted and password protected. And so I keep all of my pertinent documents there and I just send a link to the locum agency or the hospital credentialer with a specific password and let them download all the documents of mine that they need. So I'm not having to email all this stuff over like Gmail or an unencrypted server. So I found that to be really helpful. And then they don't have to ask me 17 times for, you know, my BLS card or my Covid card or whatever. It's all on the Back end of my website.
[00:18:06] Speaker B: We talked about it a little bit but just because I, I get these emails about opportunities in England.
Ok, really ventured. I, I think I've been to the airport in London like once or twice and I have not actually been in, you know, in England and I was just curious because I wanted to go there and I don't know how I ended up on their mailing list. But what is the process? Have you done this internationally? What do you think the pluses and minuses are? I think they pay less, let's say in other countries.
Tried looking into licensure. I think you were mentioning Canada. I tried to yeah, look into licensure there because there's very few dermatologists there and it just got very complicated as something about taking tests and all this other stuff. But what do you know about doing this in other countries? Whether it's locums work or licensing or pay that you want to share with the audience?
[00:19:03] Speaker A: Yeah, it's a great question and I'm adventurous so I have definitely kept my options open for international positions. I've gone down some rabbit holes trying to positions in the Middle East. I have a good friend that did her first PM&R locum position in New Zealand and she said it was a great experience. The pay is much lower, you have to pay a lot of taxes was some of the things that she highlighted as cons maybe. But obviously a beautiful place culturally, very diverse and really welcoming, friendly people in New Zealand. So she went for the experience. And a lot of people I think do go for the experience.
For Canada, for example, it depends on the province whether they make you take these days back. Probably like 5 years ago everyone had to take the Canadian board exam to work there but now it's province dependent and that's just based on my limited experience. I'm applying for one right now in Saskatchewan and there are definitely hoops to jump through. The pay is much less, probably I wouldn't say half, but maybe 60% of what I could get paid here. And interestingly for this one position that I'm looking at, they don't cover housing or travel. So I'm getting there and I'm staying there on my own dime and getting paid significantly less. But you know, I really do want to see how other cultures operate, how other hospital systems work in my specialty and just to have the experience to see what the process is like so I can tell other people, you know, this was my experience and these are the barriers.
So I think it's really a case by case situation.
But I do find that taxes end up being an issue or a barrier in pay. I will say the Middle east, they tend to pay better, but you do still have to pay some pretty heavy taxes for that. And then for the few people that I've talked to that have done work in the Middle east, especially as a woman, there's quite a bit of hierarchy there. So that can become a challenge. And there's a lot of barriers to getting into the Middle east market. So I tried pretty hard at one point to get in to some of the PM&R hospitals over there and just kind of was hit with, you know, closed door after closed door.
So it really depends and sometimes it helps if you know someone specifically that's in the place you want to work and you can kind of get in
[00:21:33] Speaker B: through, through that way payment. So I always find it awkward, you know, kind of discussing payment for new jobs and I try to find like a fair market value on GPT or something.
How do you kind of negotiate that? Have there been times where you think it's too unfair? And then I was really surprised as, as you mentioned when you were talking about the dermatologist working for like more than double the average.
How did that even come up, come about? Was were they desperate to just find people or what was like what are the ranges of pay? How do you negotiate that? What have you seen crazy stories you've heard?
[00:22:16] Speaker A: I've seen it all. For PMR in general, right now the average Pay is about 2000 for an 8 hour day and that doesn't include overtime or night pager fee or you know, any of the housing travel reimbursement. So because I'm so plugged into a lot of the locum specialties, I know what the going rate is for a lot of different types of medical providers. For PM&R specifically, I know exactly what's like a low ball offer and what's a really high offer that I'm going to jump on.
So my highest paying position for A PMR is 3000 for a 24 hour shift. And that's really good. The lowest I've been offered is like 1200, which I just don't take those jobs anymore. My first one I took was 1400 and that was even with inflation was a pretty low ball number. But I was a new grad a lot of times. New grads and new to locum people get offered really low rates because they know that we don't know at that point. Which is another reason why I started my website and having A lot of pay, transparency. So people could be up to speed. I'm a really aggressive negotiator. Frankly, if they offer me a number that is not acceptable, I'll counter with what I think is appropriate. And if they don't take it, then I just walk away. A lot of times they will say, well, hold on, let's see if we can work something out. Because they know I'm not playing around.
And honestly, I tell people all the time like, your back is your greatest asset. When you're negotiating, turn your back on them, just say, this isn't right for me. Let me know when you can, you know, afford the rates that I'm interested in and you can be pleasant about it. It doesn't have to be, you know, a bridge burning situation because a. Sometimes I'll have recruiters come back and say, hey, I actually did find a job that's in the rate range that you want. I'm like, okay, now we can discuss.
So I'm very upfront right off the bat about the rates. At this point. I'm not shy about what we're getting paid. I'm not waiting for the phone interview or the contract to come out to see the rate. I'll tell them up front this is the minimum that I'll work for. So just so they know. So we don't waste each other's time.
But that takes a lot of practice and it takes a lot of confidence in doing the job for a little bit of time gives you that confidence, but it also helps to know what other people are getting paid. So we have to talk to each other and share how much we're making, which is awkward and can be taboo. But the Facebook pages are a great place for people to find other physicians that are in their specialty that are doing locums. And a lot of times we'll, we'll share, you know, DM them or get on the phone with them. And people are rarely, I find, really open about discussing what they're making so that we all get a fair, you know, rate for what we're doing.
[00:25:08] Speaker B: I always wonder how much those recruiters get paid because some of them are really aggressive.
[00:25:13] Speaker A: They get a commission for sure.
[00:25:15] Speaker B: Yeah, some of them are, you know, they find you on, on LinkedIn or something.
So I actually read somewhere that people, doctors that do locums, it's like the best small business to kind of have because I'm sure you have your LLC and then you can run tax deductions through there.
What about that aspect really attracts you Versus just like you said, signing a contract, working Monday through Friday as an employee. I know that I really liked the Cleveland Clinic. There wasn't really anything overtly wrong other than I found it very hard to do as long as people were doing it, to commit to a job Monday through Friday.
Structured hours where they didn't even allow you to do anything, even part time or work outside of that. Like you can't see patients outside of that or even work four days a week or even change the hours. What about kind of, if you don't mind, you are a small business, not just with your consulting, but also your business that you formed to even be able to do load loans. Makes it different from just signing up as an employee for the audience who maybe may not know that you can do this.
[00:26:24] Speaker A: Yeah, I really was interested in learning about business and being an entrepreneur. And the more I learned, the more I was excited about it.
So I took my first locum job under my Social Security number. And then quickly I was like, maybe I should have an llc. Then I formed my llc and then I was like, what else can I do with my llc? That's when I decided to have a website to offer other services to other doctors. And doing all that was just a really fun way for me to exercise my brain in a way that we're never taught in med school or residency. There's not always a lot of creativity in our fields. And this was a way I found I could be creative. Having my website or being on social media, being funny or doing fun, you know, fun things just on the Internet really was a way for me to have a creative outlet and I really enjoyed it. And learning about business is so helpful, not just in medicine, but all parts of your life. And it gives me a lot of confidence to negotiate rates or do joint ventures with other companies. And it's allowed me to feel like I have the wherewithal to make difficult business specific decisions. So I've ended up being an advisor on a medical device board. And I think with the confidence I got from creating my own business and taking ownership of what I'm doing allowed me to really feel like, okay, yeah, I can do this, this is an endeavor I can take on. And it's just kind of snowballed from there.
So it's been really fun just to be a business owner and have a lot of independence and autonomy, you know, benefits wise. I have my, my own 401k so I can still contribute to my own retirement and match my own retirement. It's incredible tax deduction. So doing locum work, you can write off so many things. Like most of my life is written off because travel and going on business trips or buying supplies while I'm on a job. All of these things can be tax deductible, so it lowers my taxable income. You have to have a great cpa, which is also a challenge to find a good CPA that knows locum tax regulations in a lot of different states because you have to pay taxes in all the places you work.
So there are definitely challenges, but there's a lot of benefits. And certainly from a financial standpoint, you know, I want pay off my student loans as fast as possible and have be debt free and have financial freedom and owning your own business is is really a great way to get there.
[00:29:09] Speaker B: Thank you so much and have a wonderful, awesome day. And thanks for accepting to be a part of this.
Sam.
