Balancing Medicine and Business: Insights on Locum Work, Entrepreneurship, and Financial Protection. #437

Do you want to run that business while you're a full-time practicing or is that business going to be run by you and it's going to be you primarily driving the business ? Jay-z became the head of Def Jam . All the rappers at the point said that like there was a clear distinction between CEO and him as a rapper .

Now he became a really successful businessman , but he left a bad taste in some of those rappers' mouth . You don't want that type of situation .

Check out what Jamie Fleissner of Cephalife Insurance said back on episode 176 about having disability insurance early in your career .

All you have to do is show that your income is increased and you can buy more benefits at that time . No medical questions asked .

If you guys have been following what Y'all Say Fridays , our sporadic episodes where we are answering questions directly from you , the audience , lately we've been answering a lot of questions related to the concept of locum tenens , independent contracting whichever way that you want to look at it basically working for yourself .

If you're watching us on YouTube , I just want to give a shout out to you guys watching us on YouTube , as well as people who are listening on a traditional way that folks consume our content , which is through the podcast . Shout out to y'all also .

But if you're watching on YouTube , you might be wondering why am I in a different location and why I got this hat on . I'm at this location because I'm on call . Actually , I'm not on call right now , but I was on call last night . I did a night shift and I have another night shift tonight here , and the night shifts here are different .

It's 5 pm until 7 am , so it's actually a 14 hour shift , and then when you're off or when I'm off , I'm only off for 10 hours , so it doesn't make sense for me to drive all the way back home an hour and a half just to come back and hit it back again at 5 PM .

So I stay here and then I have a hat on because it's cold as hell here , this call room . I don't know what's up with the heat , but if you could look carefully , right there at my bed there's mad blankets that I stole from the surgery suite and the room is right now like 65 degrees and there's nothing I can do to increase the temperature on it .

I've gone to maintenance multiple times over the last several years and they can't do anything about it . But it is what it is , so you just make do . But yeah , there's a lot going on . There's a lot going on , but we're going to keep it to this episode , strictly on the questions that you ask .

But just in case if someone wants to go back and listen to this episode and find out what's going on , there's a lot right , like UnitedHealthcare CEO was shot in New York City yesterday or two days ago . Then we have the Blue Cross , blue Shield fiasco , where they're not going to be covering anesthesia coverage or anesthesia time .

That goes beyond a surgery up to a certain point , and then they retracted it . Those are things that we're going to talk about Me and Renee will talk about on an episode that's going to be coming up very shortly , but yeah , it's a lot .

There's also my review on Kendrick Lamar's new album , which is amazing , and actually now is the time of year where all of these apps where Spotify , I use , youtube , music but these apps start to give you little badges or they let you know how your listening habits were basically for the entire year , how your listening habits were basically for the entire year ,

and on mine , for the month of November , it says I was in the top 0.75% of listeners to Kendrick Lamar and I'm like damn , I went a little overboard . So , long story short , I was a big fan of Kendrick Lamar's GNX album . I'll talk about that on another episode but it's a great album . But yeah , let's get back to why I'm here . I'm recording here .

As you all know , I'm a locums trauma surgeon . Yesterday . I don't know about y'all , but I have Google Calendar and on Google Calendar that's my entire life , everything from what I'm doing with my kids , to what I'm doing with my wife , to what I'm doing with my family , to how I work . If it's not on the calendar , it's not going to get done .

And yesterday evening around like four o'clock , five o'clock , I get a text message from my coworkers here saying , hey , are you coming ? And I'm like , coming where ? What are you talking about ? It's not time for Eminem and all that . And they said , like , coming to work , you on call ? I'm like I am not on call , what are you talking about ?

So I go and I look at the schedule that gets sent to us on email and , lo and behold , I'm on call and I'm an hour and a half away . But like I'm literally like in 30 minutes from getting ready to get my kids you know bath and 30 minutes from getting ready to get my kids you know bath time , get them ready for bed and so forth .

But I couldn't do all that . I had to book . I had to get everything into one bag , all my clothes into one bag . And Renee was not happy , but she understood . I have to be honest , I have a very understanding wife but she understands that sometimes mistakes get made . And I called the hospital and I was like yo , my bad , I'm sorry it .

And I called the hospital and I was like yo , my bad , I'm sorry , it's going to take me like an hour and a half to get there and I drove through the woods and you have to get to the woods to get to where I'm at in PA and I just started taking a . I like to just do one and then go on from there .

But that's just the name of the game right now with my specialty . But I really prefer just to do trauma by itself or I prefer to do general surgery . And to get even more specific , I prefer to do trauma and critical care together .

If I'm going to do those , I like to do that and I like to be locked in on that and then afterwards I like to do general surgery by itself . I just like to do . That's how I am . I'm very much like give me one thing and then that's it . I don't like to multitask .

And if you're in the general surgery realm , if you were in critical care , you know what I'm talking about . Right , I just , I just I can't stand doing an appy or doing some type of major crazy surgery and at the same time someone is calling me about . You know someone in the intensive care unit who's about to , you know , lose their breathing tube and stuff .

It's like look , I'm here to operate , let me focus on operating . That's one of the disadvantages in surgery that I don't like . It's just like look , I'm sorry , but the person who's operating should not be the person who's also taking care of people in the ICU . So that's my rant . Let me get off to get off of that . But y'all let's get into this question

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In episode 176 , jamie Fleissner of Cephalife Insurance explains why the best time to buy disability insurance is during your residency .

Usually you get less healthy over time , so when you're healthy , it's easier to acquire the coverage . Number two it's also less expensive because it's based on your age and your health . You're not getting younger or healthier over time , so you're at the ideal time . The earlier you get it and the younger you are , the less expensive it's going to be .

I was very inspired by your podcast and have always wanted to create my own locums company to place myself in assignments and cut out the locums companies all together to get maximum pay . That's what a lot of people want , right ? I eventually want to create a locums company just for nurse practitioners .

How do I find out the rates that these locums companies are charging hospitals facilities based on specialty ? That's a question . I'm in the process of having a lawyer create the contract between my company and any hospital facility and would appreciate any resources you have to guide me . So that's a very interesting question and , queen , thank you for writing in .

That's a great question , but I'll be honest with you . That's a typical question that we get from a lot of people , which is hey , I've been doing locums for a while and when I do locums , I work with an agency and said agency did everything from credentialing me with a hospital , presenting me to that hospital , helping me get travel to that hospital .

So I'm talking about either a flight or a rental car or hotel , and then that's pretty much it . And I'm the person now that I'm at the hospital .

I'm doing the work , I'm showing up in the morning , I'm getting signed up , I'm seeing the patients , I'm staying late , I'm doing most of the yeoman's work now and the locums company is not doing much outside of maybe just helping me schedule , but they're taking a significant amount of the money .

They become the middleman between the hospital and then you on the other side . A lot of people like that , right , because they want separation between the hospital , but some people recognize that anytime you have a middleman , there's always going to be an opportunity to make some money as the middleman . I'll be honest with you , that's the straight thing .

That part is important because you need someone who can be able to communicate with the hospital in a business type fashion . You need someone who can help you schedule . You need someone who's going to figure out how you're going to get paid . Between the hospital and you , there's a lot of steps that you may not be aware of .

The question is is it really worth , in some cases , 30 to 40% of a markup each and every time you work we're talking about as early as the first time you start working at a facility , all the way to maybe year one , year two , year , three , where it's possible , you may be at a locum's position for that long .

I've been at this hospital for about two years . There's another hospital that I've been at for four years , but I do locums on my own , so there is no middleman . But there's some people who have done locums even longer and that's the way they work and they start to realize that , hmm , this is not as hard , or I've learned the ropes , let me do it myself .

It's like being in the NFL or in the NBA or maybe in major league baseball and realizing that , do I really need an agent ? Can I just negotiate with the sports team by myself , and then I don't have to pay that agent fee ?

But there's a lot of nasty stuff that occurs in the in-between range that you may not want to deal with and maybe it's worth just paying your agent to deal with that Kind of something similar . So that's just something to consider .

So your question about how to figure out how much locums companies are charging because you want to start your own locums company , I'll be honest with you . We get a lot of that . So I'm going to answer this with three things that you need to start your own locums company . I'll be honest with you . We get a lot of that .

So I'm going to answer this with three things that you need to consider , and I think that that's admirable , that you want to start your own locums company . I'll give you three things to consider . The first thing let me go to my notes is one there's a lot of locums companies out there .

There's even a lot of staffing recruiting companies that focus on getting people permanent jobs , that have even dipped their foot , dipped their toe into doing locums , independent contracting . Then you throw on top of that the companies that are really focused on locums .

Then you throw on top of that the locums companies that are focused specifically on specific specialties . You have some locums companies that just focus on orthopedic surgery or maybe just on critical care .

There's a lot of competition out there and I think , in my opinion , the best way for you to get ultimately to your goal , which is to start a locums company for nurse practitioners , is to really niche down , to really focus on what you do the best and that's your specialty .

That's understanding your rates in your specialty and that's also understanding what folks in your specialty , particularly the practitioners at your level , what they want , what they need and how they practice . And you have to be able to really understand that and dominate that area .

If you try to start off a locums company and you start off with too many specialties , you end up not being able to provide what each and every person needs , and I think that's a recipe for a disaster , because you don't have the money , you don't have the resources to really understand how all the different aspects and all the different specialties work .

Medical malpractice is going to be a pain in the ass . So in my opinion , I think what you should do is focus on what you do best . For the past two years you've been doing great . You've been succeeding , I'm assuming , thriving as a nurse practitioner in psychiatric , mental health .

I think you need to find some other mental health , psychiatric nurse practitioners and work together with them and find out what they need , and find out if they're looking to work in this fashion independent contracting fashion and basically try to create either a group or try to get these doctors to work in independent contracting fashion and be able to use that

leverage with a facility , a hospital , a clinic and be able to get better rates . I think that's the place where you start . Don't even start with well , we're going to get surgery , we're going to get OB , we're going to do . Don't even focus on that . I would focus on where you do best and really , you know , dominate that region .

And that's what me and Renee did right when we started our locums company . It was just me and her right . The locums company , in essence , was just me and her working . And then we got a great opportunity to run the locums company for well , basically to , in essence , fill an entire OB department , and we ran this OB department for three years .

It was amazing . I mean everything from understanding the lingo and how COOs talk , and's talk and service line managers talk , and being the go-between between them and the doctors , all the way to really understanding what the doctors need and want .

And we were able to really bypass the other locums companies that would take a significant amount of money out of the paychecks of these doctors and we were able to pay these doctors more because we use technology right . We were able to create a platform where the doctors would go online and they would schedule themselves right .

So we took more of a concierge approach . But we were smart about it and said well , listen , we know that the doctor are going to get paid more , but let's kind of put more of the work on them , but it's not that big of a deal .

So scheduling yourself on a calendar based off of what your colleagues are doing makes it much easier than you just saying this is the week that you want to work in . And I got to , as a locums company , have to figure out when and where to fit you in .

If you see the calendar yourself as a doctor , you're like okay , well , I could put myself in this day , I could put myself for this week , I can put myself for this weekend , and you feel like you have more control . And we got a lot of positive feedback for that .

There was a lot of things that we did that , in essence , we use technology to make the overhead cheaper . So , yeah , we had to make it worthwhile for us .

So we had to make it worthwhile for us as a locums company so that we would do all the work of scheduling and , um , you know , in essence , um , being there when you know errors came up or like , let's say , somebody couldn't cover at the last minute , renee would oftentimes cover . You know there's just a lot of things that you have to think about .

That we were able to , you know , be the goal between the hospital and the docs and it was great . And we , you know , because Renee understood OB so well , specifically OB , when you're working with family practice doctors , you know we really did well , you know we did really well . So that's where I'm talking about .

Like , you have to understand what your specialty and what your practitioners really want and do really well and dominate from there and then maybe you can expand . Okay , next thing that I would say is I a hundred percent agree with you . You said I'm in the process of hiring a lawyer to create the contract between my company and any hospital facility .

Excellent , right , that's my number two step is get a lawyer , particularly a qualified lawyer in , maybe , employment law , in medical employment law , who understands the lingo , and I would pay to get that done . Get a professional to do that .

And the biggest thing that I would say , where you really want to start at , is how you start the contract , how you get into the relationship with the clinic or the hospital and how you get out . That's the most important thing . I'll be really honest with you , how you get in and how you get out is , I think , the most important thing in a contract .

There's some other things that are really important but that , even more so than what the rates are going to be very important , right ? Because at certain points there's going to be disagreements with the hospital . The hospital may have disagreements with you and it needs to be very clear how you guys are going to end this relationship . It's very important .

And getting a lawyer to review your contract , I think . On average , I think you should expect to pay anywhere between $1,500 to $4,000 .

But if you think about what you're going to be doing , if you're going to be representing doctors and you're going to be charging the hospital and the hospital is going to be paying your company and then your company is going to be giving out the money to the doctors , you have to realize that you probably are going to be averaging anywhere between the high six

figures to the seven figures , right ? So you have to make sure that everything is on the up and up . So spending a thousand dollars or $1,500 or even more to make sure that the contract is legit , is still cold , is bulletproof , so to speak . I think it's mad important , it's very , very important , and that stuff is deductible . It's the cost of doing business .

So go get it done . Please don't try to do this by yourself . I'm telling you right now don't go to LegalZoom , don't go to some place online , cura , and look up some templates . It's not going to work . Just get a lawyer to do it . You'll be straight . Third point I want to say is do you want to run the business or do you want to be the business ?

He thinks do you want to run the business or do you want to be the business ? Those are two separate things . Right ? It's like Jay-Z says I'm not a businessman , I'm a business man .

Right , it's important to understand the distinction because I'll tell you right now , those points weren't so when me and Renee were running the business , she was part-time OB , I was full-time trauma surgery .

There were points where we had to get a virtual assistant to help us make sure that the schedule was correct , to make sure that everybody was getting all the tax documents at the end of the year , at the end of the year that they needed to get , to make sure that the hospitals knew who was going to be on call .

There were certain things that I just could not address . While I'm operating on someone , my hands are in someone's guts , literally , and there are issues that need to be taken care of right . So that's where a virtual assistant , or even someone you may have to hire , has to come in right .

And the question is do you want to run that business while you're a full-time practicing Um , or is that business going to be run by you and it's going to be you primarily driving the force right , driving the business right . So at one point , me and Renee were the business right .

The business was , in essence , driven by the work , the time that me and Renee would both work at a hospital and then , eventually , we had to take a step back and let the other folks do the work . And then we had to do a different type of work to make and continue to let this business thrive . We had to meet with the hospital folks .

We had to meet with the medical malpractice folks . We had to meet with the doctors and say , hey , listen , you guys are leaving money on a table here . You guys are leaving money on a table here . You guys are leaving money on a table there . You guys need to sign your documents . You can't expect to get paid if you don't sign your documents ?

How's the hospital going to bill ? These are certain conversations that someone has to have , and if you leave it to the docs to have these type of conversations , they may not be prepared to have it .

If you leave it to the hospital to have it directly with the doctors , well , first of all , the hospital really shouldn't be talking directly to the doctors , but they're always going to discuss , the hospital is always going to discuss with doctors in an employer , employee type of way , and that's not the type of relationship that we have anyway .

So that's just something to consider . Are you going to be the business or are you going to be the business ? So just consider that , if you're going to bring people on , how much are you going to work ? Because there's going to be a lot of troubleshooting that you would need to do . So that's something to just really think about .

But I admire you for your thoughts on wanting to cut locums companies out . But just think about it . You know it's someone you have to turn the lights on .

Right Like there are a significant amount of doctors , practitioners , health care professionals who are in locum tenens but may not want to do it themselves , and I think that there's an opportunity for you or anybody else who's interested to help doctors or to help medical professionals get the career that they want , get the career of their dreams .

But not necessarily let them get inundated and get stuck in the mud doing things that they may not be interested in . They may not want to deal with contracts directly with hospitals .

A lot of people may want someone to do that for them , and that's where folks can position themselves and say I can be the go-between , I can make sure the majority of the money goes to a professional , to the practitioner , and then also I can say at the same time , since I'm providing a service , it still is enough to bring profit to me and to my business

and still be able to guide . There were points where we were giving tax advice to our professionals . There were points where we were giving books , we were giving advice to them , so we made sure that we always provided value to the practitioner , so it didn't seem like we were just skimming off the top .

That's very important , very important for you guys to understand that it's .

It's really , you know , looking at the medical practitioner , almost like yourself , right , you know , like Jay-Z became the head of of , uh , of , uh , def jam , and everybody says all the rappers at the point said that like there was a clear distinction between how he practiced as ceo and him as a rapper . And some people didn't even like it .

They were just like , yeah , once you became president , like you forgot what it was like to be a rapper .

Now he became a really successful businessman but he left a bad taste in some of those rappers' mouth because he really literally just became a business person and stopped listening directly to the issues that his employees and the folks that were working with him , the rappers , really wanted . You don't want that type of situation .

You want the situation to be if you have another nurse practitioner , queen understands me , I know she's working hard for me because she understands what I'm going through . So there's something to think about guys and if you want , I'm going to give you guys a quick tour of this place real quick . So this is the entrance right here .

Come through here and then this is my entrance right here . Come through here and then this is my computer right here . This is where I do my notes , that's my couch , those are my bags , that's my bed , which is like a twin college bed , if you know . You know , you know , you know right . And this is the bathroom , typical hospital shower .

That's where I'm going to take a shower . I'm going to head to the gym first and then I'm going to go and come back and shower before my shift starts at five . But yeah , that's how we roll , and then Saturday I will go home

and then that's it . All right , y'all , I appreciate y'all writing in . We really enjoy all the questions that you guys have been submitting on what Y'all Say Friday or for what Y'all Say Friday and for everybody who wants to do locums . Really think about that . How can you be the best specifically at your specialty , at what you do ?

And starting a locums company is not for everyone . You can still start a locums company and it'll just be you . But if you want to bring other people on , you got to think about how you are actually serving those other practitioners . All right , catch you guys on the next episode .

It's Dr Nii , a cold Dr Nii with a scully on , but I'll catch you guys on the next episode . Y'all , peace .