Traveling physicians find adventure near and far
George H. Waxter, MD ’97, MS, with a friend at the summit of Cradle Mountain in Tasmania, where he just finished a locums stint.
Although physicians in locum tenens practices must be adaptable to new environments and people, breaking the ice is not always good enough. Sometimes, they have to melt it.
George H. Waxter, MD ’97, MS, had been practicing on a Navajo reservation for weeks when he encountered an elderly grandmother who spoke only Navajo. To help her, he needed to know what was wrong, but she was less than willing to share.
“As doctors, a lot of times, we have to form a bond and a trust quickly with a patient so that even though we are strangers, they feel safe to tell us the most revealing, embarrassing or even incriminating details about themselves so we can correctly treat their complaint,” Dr. Waxter said. “With the aid of a translator, it quickly became clear that this aged Indian gal had no interest in telling her private details to some young white male.”
Locum tenens practitioner, George H. Waxter, MD ’97, MS, makes a new friend in Bali, Indonesia, where he attended a medical conference.
Having acquainted himself with Navajo history and culture at the start of his assignment, he instructed the befuddled translator to tell the woman that he was “from the corn.” (He had learned that in the tribe’s creation mythology, the Navajo people originally sprang forth directly from ears of corn).
“The dour countenance of my patient disappeared instantly and her ancient face split open in a huge, gap-toothed smile accompanied with raucous laughter, gently dismissive hand waves and a good natured shaking of her head no,” he said.
By bridging the divide, Dr. Waxter obtained the information he needed to care for his patient and inspired the translator, also Navajo, to learn more about her own heritage. He later received a red corn necklace as a gift and has kept it to this day. Interacting with people throughout the world is a key attraction of locum tenens, and for Dr. Waxter, it has encompassed his entire career.
He just returned to the U.S. from Tasmania, where he spent more than a year as a hospitalist and outpatient clinician. Prior to that, he stitched together jobs in Hawaii. Locum tenens has led him to stints long and short in New Zealand, coastal Oregon, Atlanta, and the Colorado Rockies, dating back to his first position in upstate New York.
“Being a locum tenens is like working and being on vacation at the same time,” he said. “I get to experience or re-experience different parts of the country and world and revel in new cultural experiences. It is enlightening and challenging to work in different medical environments and see different approaches to the delivery of medical services.”
Jessica A. Wilson, MD, GME ’10
Having no permanent location, and being on the move so frequently, however, can be physically and emotionally stressful. Each new stop carries an obligation to establish and prove oneself all over again, he said. Jessica A. Wilson, MD, GME ’10, can relate. She, too, is a full-time locum tenens physician, and she has faced that sense of displacement and uncertainty, beginning with her very first locums role.
“As a minority woman, I was nervous for my first placement because it was in Lincoln, Maine, a town with a population of 99.8 percent Caucasians,” she said. “I was not sure how I would be accepted, but they welcomed me with open arms and a lot of curious stares. By the end of my stay at this hospital, I had met life-long friends, watched critically ill patients get better and even saw my first live moose! I learned a lot from my first assignment as it confirmed that the Medical College of Wisconsin had indeed trained me to be an excellent physician in any setting.”
For Dr. Wilson, these settings so far have included the East Coast and the Midwest, though she has a position lined up in Guam starting in January. Unsure of where she wants to settle for her career, Dr. Wilson is using locum tenens as a way to scout places she might someday want to call home. She completed a med-peds residency and envisions a future as a hospitalist. The flexibility that is so critical for success in locums will likely serve her well throughout her career.
“It is always a bit daunting to start out in a new hospital as the system is new to you,” Dr. Wilson said. “You must quickly adapt to the environment. Although this aspect is certainly challenging, it is also one of the most enjoyable things about locums. In my travels, I have met some of the best people – both patients and staff. I love the sense of adventure that comes with going to a place you have never been before.”
Rhett Silver, MD ’99, visits Machu Picchu. Travel permeates Dr. Silver’s work and recreation.
Adventure is a forte of Rhett Silver, MD ’99. In his personal time, he has explored the Great Barrier Reef, run the Great Wall of China Marathon, and toured Europe and the Far East; he snowboards annually in the Andes Mountains, and even sandboards. His choice of career has helped facilitate his travel hobby.
Dr. Silver works for Emergency Medicine Physicians, a physician-owned and operated ER group. He is Associate Director of a division within the company nicknamed the “Firefighters.” They are company employees, not locum tenens, but the travel and transitory nature of the work bears many similarities. When EMP starts a new ER contract, its Firefighters provide temporary staffing until full-time, local physicians are hired.
“I enjoy seeing new cities, new ER systems, meeting new patient populations,” he said. “I like to see different ways medicine is practiced in different areas. Since I am often one of the first EMP doctors to work at a new site, I feel like I am an ambassador for the company and really try to promote the company’s new presence at a site.”
Dr. Silver shifts positions often. He holds about 12 state medical licenses and has worked in Connecticut; Chicago; Tulsa; Evansville, Ind.; Charlotte, N.C.; Long Island; and most recently Cincinnati since becoming a Firefighter in 2007. Relocating and changing workplaces so often is packed with challenges, such as learning a hospital’s medical records system each time; sometimes he can’t even log in because his passwords don’t work.
“There is often very little time for orientation,” Dr. Silver said. “Not knowing the ER staff initially nor knowing the consultant doctor I may have to call and wake up at 3 a.m. has its challenges. It takes some time to build trust and those important relationships. It is difficult walking into a code situation and finding the oxygen mask in a different location.”
G. Daniel Miller, MD ’54, GME ’61, delivers anesthesia in a St. Lucia operating room in 1994. He travels there annually.
Compared to physicians who sought travelling positions at the outset of their careers, G. Daniel Miller, MD ’54, GME ’61, discovered a passion for locum tenens in retirement. After his enduring career in anesthesiology, locum tenens became an appealing way for Dr. Miller to travel to new destinations, often with his wife, and to grow his otherwise small nest egg.
His entry into this practice was a mission hospital in St. Lucia named St. Jude’s, where he worked four to seven weeks per year for 10 years. He later expanded his locums work to Idaho, Iowa, Minnesota, Massachusetts, Rhode Island and Wisconsin.
“One of the main reasons I wanted to do locums work was to keep up on the latest techniques and practice so I wouldn’t get stale in my practice for my return visits to St. Lucia,” he said.
All of his locums work has been in his specialty of anesthesia, and getting used to the different equipment available in a given setting is particularly challenging. He was even hired once in Idaho because he was among a rare breed who knew how to use their “copper kettle” apparatus. Most memorable, was his leadership in helping a 26-year-old pregnant woman, in heart failure from a defective valve, safely delivery her child with the aid of an epidural performed very slowly so as to not affect her blood pressure. It was the kind of success that defined his love for medicine.
“When I got back from my first seven weeks in St. Lucia, I realized how much I missed practice and wanted to keep my hand in it,” Dr. Miller said. “I have often said it was the most fun 15 years of my entire practice.”
More locum-motivated alumni
Dr. Marquis reads to his grandchildren from "Grandpa Art's Stories," a collection of bedtime stories he has told his children and grandchildren through the years, published in April 2011. Also pictured is his wife, Maggie.
Arthur S. Marquis, MD ’71, has been working in low-volume emergency rooms as a locum tenens since 2000, after closing a family practice group in Watertown, Wis. He primarily travels to Minnesota from his Merrill, Wis., home. Credentialed in about 20 hospitals, he works mainly in Two Harbors and Virginia, Minn.
Dr. Marquis enjoys choosing his availability for locum tenens, which allows him, in semi-retirement, to put family and vacation plans first. He also enjoys the interpersonal interaction. In an unfamiliar hospital, he is very dependent on the existing staff.
“It really makes me appreciate the dedication and skills of the nurses and technicians,” he said. “ It surprises me how rarely I find someone who is not really good at their job.”
As a family practitioner, Dr. Marquis had the opportunity to work with well-functioning families as well as those with problems. In his locum tenens roles, he observes how the emergency department is often the refuge of patients with the least resources – a much different perspective from his family practice in a stable, prosperous community.
Minnesota’s Mesabi Iron Range, he said, has gone from five full-time iron mines to one part-time mine. When practicing in this area, he sees a remarkable volume of people with psychiatric problems, drug habits and dysfunctional families.
“It is not clear whether the economic situation created these problems, or whether people who have these problems are attracted to the area by the cheap housing and availability of drugs,” Dr. Marquis said. “In any case, it is an opportunity to study human nature that has few parallels.”
Dr. Hartjes and family in Door County.
Thomas L. Hartjes, MD ’80, also entered locum tenens practice in retirement from family practice. He is currently working for a different clinic in his old organization in the Madison, Wis., area. Most of his appointments are of an urgent care nature, and he enjoys being able to focus on the moment at hand. No longer does he have to address a litany of issues – like inquiring about blood pressure control, diabetes control, lab results, cancer screenings and medication refills – all in one brief visit.
“My locums work has quenched my desire to get back into some aspect of patient care after retirement,” Dr. Harjes said. “It's really refreshing to enter an exam room without having anything on my agenda. I enter with pretty much a ‘blank slate,’ so I can solely address the concerns the patient brings to the encounter. Fifteen minutes actually feels like 15 minutes, rather than 15 seconds.”
The disadvantage is that he doesn’t have the long-term relationships with patients that are so rewarding in primary care, but the trade-off is satisfactory to him at this point, he said. The same could be said for relationships with the staff, which is why their attitudes are critical to Dr. Hartjes’ locums experience.
“The culture of the individual clinic and the staff that I interact with daily is certainly important, and it's essential to be sensitive to that,” he said. “Of course, sometimes the new provider is assigned the least skilled nursing staff. That's where a few years (OK, decades) of clinic experience is quite helpful.”
Nima L. Shemirani, MD ’04, GME ’09, is using locum tenens as a way to help financially support the facial plastic surgery practice he recently opened in Beverly Hills, Calif. While working full-time weekdays in Los Angeles, he travels to Phoenix one or two weekends per month in locums otolaryngology to help pay for the overhead of his practice and avoid taking out further loans.
It also helps Dr. Shemirani keep his ENT skills sharp. He determined it was not sound business to mix otolaryngology with facial plastic surgery in LA, so he otherwise would not be practicing ENT regularly. Getting used to a new hospital system is a requisite challenge in locum tenens, but it usually doesn’t take too long, though his specialty has some unique difficulties.
“The most challenging thing about our specialty is the lack of follow-up,” he said. “We do not have an outpatient clinic where I work, so you have to make sure that you do the best possible job so that there are no future problems.”
The work, Dr. Shemirani said, is very satisfying. He sees many acute ENT issues similar in complexity to a residency program. Physician supply in the state adds another layer of complexity.
“In Arizona, there is a lack of ENTs who take call, so we see all ENT emergencies throughout the whole state,” he said. “Patients are flown in on a routine basis. The best part of the job is how thankful patients are of your service. It is truly a rewarding experience.”
Andrew L. Makowski, MD ’06, chose to practice locum tenens at the beginning of his career not only because of the variety and unique experiences, but also because of the control it gives him over his schedule. This has enabled him to complete a Masters in Bioethics, submit papers for publication and pursue other academic interests while still working full time.
Licensed in 10 states, Dr. Makowski works in emergency departments primarily in Milwaukee and Chicago, though he has held positions throughout the continental U.S. and Alaska. Like other alumni, he cites adaptation to the new hospital’s records and charting system, procedures and practice variations as the most common challenges. Most orientations are adequate, but some, he said, have been as short as 15 minutes.
Dr. Makowski has taken advantage of the opportunity to visit areas of the country he might otherwise never have visited – with some posts in large metropolitan trauma centers and others in small, rural emergency departments. Either variety can keep a locum tenens physician on his toes.
“One time, I was working in a rural emergency department in Idaho and at the time, there was only one patient in the department,” he said. “Some labs results came off the printer, and I picked them up and became quite concerned because the lab values were all off, and I didn't think the patient was that sick. The nurse started giggling, because what I did not know at the time was that the results were from a horse that had been brought to the hospital for a lab draw, and the results simply printed in the ED by default!”
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