I’ve been a traveling physician for almost 10 years, having worked with seven different locum tenens agencies (and directly with hospitals) in 14 different states. I have had great, and not-so-great, experiences along the way.
So, what makes the difference? You may be surprised by what I’ve concluded.
1. The Physician Hand-Off
Starting work at a new hospital or practice setting is anxiety-producing. Healthcare has many moving parts, with regulatory requirements, documentation burdens, and sick patients needing rapid and careful attention. Physicians transfer complex information to one another through “hand-offs” or “sign outs.” Without a peer to explain what patients need, or where they are in the care process, key information can be missed.
Some physicians over-rely on electronic notes to pass on information. They presume the incoming care provider can simply “get up to speed” by reading their notes in the EMR (electronic medical record system). One study suggests that in-person hand offs (rather than note reading) can reduce medical errors by 30%. I suspect the error rate (associated with digital sign outs) is even higher for locum tenens physicians because some of the information they need is not in the EMR. Simple things like “where is the crash cart located?” can be an actual matter of patient life-or-death.
Bottom line: Locum tenens physicians need thorough, in-person, peer sign outs during their transition to managing the care of a brand new group of patients.
2. Organized Onboarding
I’ve had the best experiences at hospitals with carefully planned orientation days. Although it’s tempting to cut corners with temporary staff, you never know what information they might need during the course of their work days. In one case, my orientation included a meeting with the risk management and patient advocacy team. At first, I didn’t appreciate the importance of orienting with them, but it turned out that on my second day of work, a patient had an adverse event unrelated to my care. However, because I knew the hospital procedure for such circumstances, I was able to de-escalate the situation and navigate swiftly towards a good resolution without legal repercussions for the hospital.
Who knew that my thorough locums orientation day would be so critical?
Bottom line: Don’t scrimp on locums orientation. They are probably the “highest risk” providers because they are unfamiliar with your hospital practices and policies, physical plant, or EMR.
3. Staff Empathy
It’s a little disorienting to walk into a brand new environment and be expected to become the de facto team leader. I really appreciate it when fellow physicians, nurses, and staff try to put themselves in my shoes and embrace a welcoming and sympathetic tone. Anticipating my needs -such as being given a list of patient names and room numbers (also known as a “census”) upon my arrival, explaining the culture and work flow, and calling out hospital process quirks, is super helpful.
One day, I recall arriving in a unit, and being surrounded by a group of staff all requesting things at once: orders, signatures, schedule plans, treatment decisions, etc. that had me scrambling.
One wise nurse watched the events and took me aside and said, “Has anyone shown you where the bathroom is?”
Bottom line: Staff empathy goes a long way to putting your (probably stressed out and disoriented) new locums provider at ease. A calm and happy physician translates to better patient care.
Clear, in-person peer communication about patient care, thorough orientation to the facility and its policies and practices, and anticipating needs “on the ground” in an empathetic manner are three keys to a successful locum tenens experience.
In my next post, I will discuss some finer points regarding how to make locum work more enjoyable for providers. After all, your next great, full-time employee may begin as a locum tenens provider.
