¶ Board Certification and Recertification Opinions
I got my own opinions on board certification and recertification . Basically , I think it's bullshit . I don't think it actually assesses anything with regards to competency , especially surgical specialties , because you cannot tell me what my surgical technique is based on competency testing assessments . You don't know if I'm a butcher in the OR .
I think it's a CYA thing and the problem is that most of the public thinks that passing tests actually equals competency and it doesn't .
But you're coming in hot tonight .
I think it's both . We know that we have worked with people who can pass a test with their eyes closed , but you wouldn't let that person touch you with a 10-foot pole , and y'all know that .
That's true all right , what's good everyone . This is dr knee and I should say newly minted board certified general surgeon , trauma surgeon , locum surgeon for about 12 years now . Are you newly minted ? Because I just recertified myself . That's why I'm newly minted .
What do you call that ? I'm newly minted .
Either way , we're going to get into that a little bit right after this and also a host of Docs Outside the Box . I'm your boy , Dr Nii .
I'm joined by Dr Renee Shabongbongman .
Did you miss me ? Ok , all right . So let's get back to this issue of board certification real quick . So , listen , your boy's been out for 10 years , and every 10 years at least , for the American Board of Surgery . You got to research Right .
So you got to take a test again to show that you know as much as you know know in general surgery and you get board certified . But anybody who has taken a board examination , whether you're in medical school residency , and damn sure if you're 10 years out , there's a lot of anxiety with having to take that test all over again .
So , yeah , every 10 years in the past you would have to take this test right . And this test covered everything , even though most surgeons , most people who go into the specialty , they only really focus on a certain area , right ? So for me , I focus on trauma , acute care surgery .
I don't do much breast , I don't do much cancer outside of , like cancers that you know are in the belly and you need to operate on them emergently .
But all the things that go into like understanding , all the things like like the cytokines and all that stuff , I don't remember all that stuff big deal to like , say , yo , I got to take this test , this recertification test , and they got rid of it several years ago .
I think ACOG did that also , which I think is an amazing thing , but these , a lot of these specialties have gotten rid of , like taking this big certifying test a formal test for a whole host of reasons , but for me I'm just happy that I don't have to take that test .
But I think the thing that you have to do is you have to show like a certain amount of continual education . So you have to get CME and you have to show that over like a five year or 10 year period every year or however long , like you are doing continuous medical education .
You go into conferences , you go into you know you're doing something online , something that you got to pay for to get CME . You're doing it Right . Then you got to be in good standing . You got to have a license .
You got to hold Like I'm not getting into it , but either way I did it , and it wasn't exactly an ice water enema to get recertified , but it was still painful .
It was damn near close .
It was close , an ice water enema so this is what they do . So , rather than having to take this long ass test , like you had to in the past , and you studying for this test now , what they did is they gave you 40 questions that you have to . It's open book open book yeah open book open articles well , actually , how about this ?
Why don't you say what's it like for ACOG to re-cert ?
So we do ours every year , we do our maintenance of certification every year and every year , as long as you hit a certain threshold .
What does that mean ?
certain threshold for the score , then you stay within this cycle as long as you hit a certain threshold . What does that mean ? Certain threshold For the score Mm-hmm , then you stay within this cycle where you don't necessarily have to sit for this big standardized test .
Nobody's trying to do that .
The ACOG recertification works is that you have to do 15 articles . Each article has about eight . It has about eight questions and you read the articles and you answer the questions per the article that is presented to you .
Very straightforward . That sounds reasonable , yeah , but the American Board of Surgery , if y'all listening , if you pay attention to Docs Outside the Box , listen , we got to talk . I don't understand the rationale of why you guys decide to do something completely different . So , the way how it is , it's 40 questions , 40 random questions .
You can choose the type of questions you get , like you can say , well , I just want to focus on general surgery . Or you could say I want to focus on breast or whatever .
You have categories .
You have categories , so when you get a set of questions , it's open book .
Open article .
And it's basically it's open articles . You're using articles to help you answer the question and you can't go past the question that is currently in front of you . So there's no going back and there's no going forward . You answer the question in front of you , you get instant feedback and then you move forward .
Question in front of you , you get instant feedback and then you move forward . What I didn't like about it is open article meant that you had to go through at least 40 different articles and find the right article . You have to first of all deduce that what they're asking you correlates to the article that they gave you .
Then you have to go through that article and make sure that you're answering it correctly .
No , you have to deduce that it correlates to one of the articles that they gave you right , Because they don't give you the actual article .
Multiple articles cover the same thing .
So what you showed me was this you showed me a question and then I said , ok , well , where's the article ? And then you showed me a whole list of articles . And when I say it was a list , it was a list of articles . And you're like , yeah , the answer is somewhere in one of these articles . I'm like which one ?
And you're like they don't tell you which article it is .
I didn't like that at all . I didn't like that at all . I didn't like that at all . And you know , look , you're doing the test by yourself , you're taking a test by yourself . But I just felt like there's got to be a better way than having to go through and figure out which article you're asking this question from .
I'm sorry , american Board of Surgery , if you're listening right now . The way how you do this continuous certification , this assessment , it doesn't make sense to me . I think it makes more sense Give me articles and at the end of the articles I answer the questions related to that article , like why would you ? I didn't like this at all , but I passed so .
I want my certification and for all of those , for all those people who pocket watch and just go to American Board of Surgery , type in my name , Darko , you'll see Board certified .
Yeah , it just seems that they made it unnecessarily , it's surgeons Like unnecessarily difficult ? Yeah , for no reason .
Even if their rationale was well , if you were looking for literature on something , right that you wouldn't know exactly what article to go to , I'm like , okay , that's fine , but once you do have the article , that's at the point at which you would present the question to yourself what would I do , you know , during this management ?
So I don't know why they made you go through the exercise of actually finding the article first Makes no sense .
Like that doesn't make any sense . It's basically the same thing . If you've taken an MCAT , it's the same thing as okay , every question . And I'm just giving you biochem textbook .
Yeah .
Textbook , orgo textbook , whatever English textbook .
And just find it .
You find the answer in there , that's it . That's the equivalent of what they gave me .
Yeah .
And I was like this doesn't make any sense it was .
I don't like this . For me it was just more of .
American surgeon or surgeons out there rise up Because I feel that that survey I let them have it . I was like , no , this doesn't make any sense , you got to change this . I'm okay with the continuous certification . That's great , but this anyway .
What do you think ? The whole process of continuing certification , what's the purpose ? Like the real purpose , not the oh , we need to make sure the doctors are up to par and blah , blah , blah . And even board certified doctors take out people's you know liver thinking . It's their spleen you you want .
I think that it has to do with well I . I think the premise is is it better to assess someone's competency , like continuously , like over you know a several year span , or is it better to just like not hear from them , but then 10 years later , their ability to show competence is all that matters , right ?
So , basically , it's one or the other , like do you want to know how they're doing continuously or do you want to see it one shot at all ?
You know it's one shot in a certain spectrum and obviously I think everybody would say , yeah , like you want to see this person continuously see how they're doing and stuff , Right , I don't know how effective it is , I know that it reduces the anxiety .
I don't care about any of that other stuff , I just know about this test and I know that , for the sake of testing and so forth , I'd rather have the latter , which is look , you know , I take this shortened version of this test .
I show you proof that I'm continuously getting myself educated by me , showing you , seeing me , there's references that you can go to and ask them questions , because they're going to go and ask them , you know , does this person have any red flags about them and so forth ? Are they involved in any like continuous , you know , program improvement ? I get that part .
It's just that , the way in which they ask the question , that part I just had a I had a major problem with . So all the other stuff , it's like I had a major problem with , so all the other
¶ Locum Tenens Flexibility and Experience
stuff .
It's like Well , I got my own opinions on board certification and recertification and basically I think it's bullshit the way that they do it and I don't think it actually assesses anything with regards to competency , especially as it relates to surgical specialties , because you cannot tell me what my surgical technique is based on .
You know competency testing assessments . You can't tell me what that is , you know . You don't know if I'm a butcher . You know in the OR , you don't know anything about actually what I actually do .
I think it's a CYA thing you and I have talked about this offline but I think it's a CYA thing for these organizations to just say , hey , we covered our asses , we gave the doctors a test , and the problem is that most of the public thinks that taking tests actually equals your passing tests actually equals competency , and it doesn't .
As we know that , like I just kind of referenced , there are board certified physicians and surgeons who really just aren't practicing medicine in any way , shape or form , under any standard .
So that's how you can have a board certified surgeon taking out someone's liver when he was supposed to be taking out their spleen , like if he says well , yeah , technically we don't know if they're board certified , though . Well , most likely he is right . Let's just put it out there . He was working at an institution .
Most institutions are going to check whether or not you're board certified . So I'm going to say for argument's sake that he most likely was board certified . If he wasn't , that's also on the institution .
Make sure you guys let us know If someone knows the details of that . Let us know if they're board certified but you're coming in hot tonight .
I personally think that it's . I think it's bull . I think it's bull and I think we all know that it's bull . I think all of us , as physicians , as much as we want to big up that , oh , we board certified now .
We board certified now , we know that that thing doesn't mean anything , because we know that we have worked with people who could pass a test with their eyes closed but you wouldn't let that person touch you with a 10 foot pole , and y'all know that . That's true . But that's all I'm going to say . But I am coming in hot because I've been out for some time .
Did you miss me ?
I'm going to just let you keep cooking . You want to keep cooking ?
Well , I will just say this where I was All right , we're moving on guys .
I was going to say where I was Okay , hurry up , come on , move on . So .
I spent a week in a Canadian hospital with my mother , who was visiting Canada , and ended up having emergency surgery .
So my brother called me on a Sunday this is kind of going to go into what we're going to be talking about today but my brother called me on a Sunday at noon and by 5.30 , I was on a plane to Canada to go see my mom drop the kids off at your sister's house .
My sister-in-law and you ended up coming leaving work just a day early to you know , just come and get the kids , take them to school . The next day . I spent a week there tending to my mother , making sure that she was getting the care that she was supposed to .
And , by the way , just again along these lines , just letting you know that when I went and examined my mother , I found that she had a surgical belly , but they had no intention of doing surgery on her until I asked specifically did you check for diverticulitis ? They had not .
So they took her to a CT scan to another CT scan , I should say , because they only did chest and abdomen . They didn't do chest , abdomen and pelvis , which is where they found what the issue was . So yeah , essentially I diagnosed my mother and got her into surgery , which she desperately needed .
So that's where I was , and we probably should talk about my experience at the Canadian hospital on another episode , but I just wanted to point out that I spent a week there and I was able to do that because I work locums and I didn't have any . Oh shit , stop .
What do you call it ? How are you going to bring that on ?
What , what is so funny ?
Oh first of all , first of all , you couldn't record during that time . So let's talk about that .
Let's talk about how you could have recorded Wait , wait , wait wait , let's talk .
No , no , let's talk . No , no , no , I'm finished . I'm I'm the host in the show . Can I finish my ?
point . I didn't finish my point . No , you can't finish your point , I worked locum point of privilege oh my goodness robert , rules of order .
Now , you didn't finish recording , so you owe me some episodes . First of all , what right you do ? You owe me some episodes anyway , and then get on to this .
So the reason why you don't hear that your mother-in-law was in a can hospital .
Well , you're the one who circled it to . The reason why you're able to do it is because of locums it was you didn't even say anything about . Like yo , the Lord done , saved my mama , and you didn't say nothing like that .
I'm talking about . I'm trying to stay on task . I'm trying to stay on task here .
We can talk about my experience later , but I wanted to make the point today , right , I wanted to make the point today , tonight , that the reason that I was able to spend a week and not have to worry about what was going on with , you know , my job , my this , that is because I work locums and I , you know , I think that yeah , I lost some money , though
I had to come home early Anyway . I think that you know having the schedule that I have , you know working locums , the way that we do affords us . You know these . You know opportunities if you will . I don't know if that's an opportunity , but it allows us to be able to be free .
You know , to do things that come up very unexpectedly , so well look , uh , shout out to your mom and , um , yeah , we'll get on another episode and talk about that stuff .
So thank goodness for the way in which we work , because that allowed us to be pretty flexible , with you going out to Montreal to be with your mom and take care of her , and then it allowed me to come back home ASAP and be with the kids and so forth . So we're going to get into that , but we're going to talk a little bit about locums .
But hold on , let's take a real quick break and we are back . All right , we are back . So we got questions are back . So we got questions . You know I can answer any question that anybody has because I have all the answers . So we got a question .
This is for entertainment purposes only .
We got a question from Kim B
¶ Medical Mission Work and Family Integration
. She says I am a third year medical student at Toro College of Osteopathic Medicine . I've been following Docs Outside the Box and I love your podcast . I met you both at AMEC that's the Annual Medical Educational Conference for the Student National Medical Association . That was what was that this year it was in St Louis .
No , it was New Orleans yeah .
In New Orleans and was inspired by your craft . I'm interested in medical missions and participated in many mission trips to Ghana . I'm also interested in OB-GYN and would love to have a quick meeting with Dr Rene about the specialty and how to incorporate medical missions into your practice while raising a family . Please let me know if that's possible .
So Kim B shout out to you , third year medical student at Toro . This is a good question . So what I wanted to say , the reason I brought this up is obviously this has a lot to do with locums .
This has a lot to do with medical missions and also raising a family , and so I just wanted to jump into this and say if you had a chance to meet with her she presented this to you . What would you say to her ?
Well , first of all , I would tell her that all of that is possible . I mean , she's already doing the medical missions . I know she's only in her third year and she's going to be going to residency .
So that you know , after she goes into residency , after next year , you know she can still do the medical missions , but it might look , you know , a little bit different in terms of kind of timing , right ? So it all depends on what her residency program allows .
If you are going international , some residency programs will actually let you take two weeks at a time , but some other residency programs may not necessarily allow that . Some residency programs might actually let you take an elective as a , you know , a medical mission as an elective .
So you know , that's one thing , or those are some questions that you might want to ask of a residency program . Exactly , how could you continue the medical mission work that you're already doing in Ghana ? So I don't know if that would be a deal breaker for you in terms of residency , because I think the point of residency is that you need to just get out .
You need to get out Now . As far as raising a family , you know , of course , I mean you can make . Here's the thing about medicine .
There's no cookie cutter way of doing it Right , like I can tell you the way that we do it , but there literally is no cookie cutter way of doing it right , like I can tell you the way that we do it , but there literally is no cookie cutter way of doing it .
Actually , let me . Let me chime in Cause I actually have an example of someone who's doing this right now . Um , so when I did my fellowship , I met one of the fellows above me . Uh , went and did she's trauma , critical care , practiced on the other coast and decided like three years in that she didn't want to practice in the United States anymore .
She actually grew up as a missionary in Africa , I think it was Zambia . Long story short , she's a surgeon , her husband is not , and I think she took her I think it's one or two children , I can't remember , but they went to Zambia and they're practicing right now doing medical mission work right now . They've been there for three years .
So I have some notes here . One of the notes that I have here says kids are mad resilient . So I think if you're going to raise kids in a different country , just know that usually the biggest holdup is you .
Not the kids .
The kids have no don't usually have that many problems with the change in scenery or the change in resources . They can figure it out . Usually it's the family member or the parent or the adult who has a difficult time .
So one of the things that I would say also is make sure you know how long you can practice outside of the United States , like if you are going overseas .
If this is going to be a short stint and I would say a short stint would likely be probably a year or less Most people who do medical mission work are probably going to do like two to three weeks , maybe a little bit longer , but there's some folks who maybe do a year and then some people want to do even longer than that .
But I would say , if you're going to go a year or longer , make sure you check with your specialty group . Make sure you also check with your state license , because the experience that you have in another country that may or may not be acceptable as actual experience in the United States . You know how arrogant we are right .
So you may be doing a whole bunch of surgeries in you know wherever . Pick a country .
Ghana .
Ghana , in Ghana , I don't know this for a fact because I haven't looked it up , because I haven't stayed that long .
I thought you had all the answers , but okay .
She got me there .
I be listening . She got me there , I be listening .
All right , see , you're not supposed to be listening that hard but listen . Listen , guys , listen , come on , listen , listen , Listen , listen .
So I'm telling y'all , make sure you check out with your specialty group how long you can actually not be practicing in the United States or if the country that you're going to be practicing in like if you can transfer that you know , those patient experiences over .
Yeah .
Because that can help either extend or may shorten your trip overseas . So that's really important to know . And then also , actually , where would you want to practice ? Where would I want to practice , yeah , overseas . Where would you want to practice ? In Ghana , really , yeah . What about Haiti ?
If it were more stable . Yeah , yeah . You know , if Haiti were more stable , then absolutely , you know , I think , going back to that point of you know how long you're going to be out of the country and will , will your trip be truncated or extended , like you said . You know , look , look up your what is required in your specialty .
A lot of times in OBGYN , a lot of these credentialing committees want at least 60 deliveries over , I think , two years or something like that . I don't know if the numbers have changed or not , but a lot of these credentialing committees in hospitals , you know they want to see a certain number of deliveries .
They want to see a certain number of , you know , of surgeries that you've done . So just kind of keep that in mind . The other thing is , yeah , you might decide to live right , and this is kind of something that we're talking about , but you know , moving to Ghana , right .
So we've talked about , okay , moving to Ghana in a couple of years and what that would look like for us , and that might mean that you live in a different country . You decide you want to do medical missions in that medical country and you live there , but you come back to the United States every now and then to stack cash , right .
So in Haiti we would call that vaille-vienne coming and going right . So you come , you work , some locums work , you do your thing for a few weeks , then you go back home . You go back home to your international country and you keep doing that .
I know someone who's doing that right now . I know someone who's doing that right now . Yeah , I know someone who's doing that . They are in trauma acute care surgery . They actually live across the atlantic ocean and , um , they actually live in a third world country yeah and they come to united states developing country , that's true developing country .
they come there and they stack cash and then they go back to their country and they do whatever work they do there for a significant period of time . So there's so many ways that this you can make this work . That's the best part for me .
The best part is , kim , is you know , yes , like if we were to meet with you personally , like that's exactly what we will tell you , which is , you know , get as much experience as possible , work with as many people as possible and see how they do things .
And what you end up doing is you'll pick up like positives from one person , negatives from another person , and then you'll kind of decide what type of career that you may want to have , whether it's hybrid You're in the United States and also doing work in another country or , you know know , just may want to just completely jump ship and just be overseas .
Figure out how to make it work overseas .
That's kind of what we did with locums . Like we got out and in my experience as a resident I had no experience with any attendings who did locums . As a fellow , I had no experience with anybody who did locums , except for you , renee , and I just said .
I wanted to do it . I was in attending and you were still in training .
I was , I was , you were definitely funding my lifestyle .
You called me Dr Vonley and I called you Nee . Yes , yes .
That did not happen , guys .
It really didn't In your mind , it really didn't because one time you introduced me to your medical students as Renee , while you were technically still a resident and I was technically in attending , and they sit there calling you Dr Darko and calling me Renee . I'm like how did that ?
happen Because you're not in my specialty .
It don't matter , I was still in attending and , frankly , if you had come into my OR but we weren't in the OR setting though . But if you had come into my OR , you would have had to call me Dr Volney I wouldn't have to call you anything . Yes , you did , yes , you would yes you would , I would not have to call you anything .
Out of respect , I would have just said hey , dr V , you know what's going on , but I wouldn't have to call you anything . Yes , you would , yes , you can you help me me fix this bowel perf ? No , because you would have been walking in with your talking about continuous certification .
You would have been walking in with your attending just the same way that I would have been walking in with my resident .
Well , that's what happened , thank you . That's what happened at Robert Wood Johnson .
That's not what happened at Morehouse yeah , cause , y'all are reckless .
Also board certified , though Also also board , certified though also which don't mean nothing . So yours don't mean nothing ? No , it don't mean nothing .
Board certification don't mean nothing kim .
Good question , we'll reach out to you because we got your phone number yes and um , let you know how to incorporate all that stuff . But you can make it work . You just got to be .
You just got to recognize that it's not going to look the way how the majority of people , the majority of the experiences that you have at your program , at your medical school , the majority of people are not going to be doing this and that's fine .
And you have to be able to understand hey , it's going to . You know , if you already , you know , have a spouse or you know are looking for a spouse , that you make sure that this is something very upfront you know in the relationship that you say that you want to do , because that will definitely , definitely impact .
Breakup material .
Not breakup material . Breakup material , but it is definitely , definitely an important part of your career , right ? But she would have mentioned that already . She's not mentioning that , it doesn't matter she just said she wants to know how it would be with kids .
That's what she said .
So I don't know if she's planning on having a spouse or not , but if you are , then take that into consideration , because Real quick before we jump into our next question .
Just want you guys to know if you go to the show notes in the podcast or if you check in the show description , if you're watching on YouTube , what's up y'all . There is a link that we have there that we want you guys to take a look at . It's a free download Seven considerations before starting locum tenens .
The link is there and we go through the seven things that you need to consider before you jump into locum tenens . I think a lot of people are really interested and it's going to lead into our next question .
But a lot of people have so many different questions about you know , should it be a locum tenens independent person , individual , or should they be an agent whatsoever ? But check out that free download and let us know you know what your email is so that we can get in contact with you or at least send you this information ASAP .
All right , make sure you check out seven considerations before starting locum tenants . All right , let's take a quick break . All right , we are
¶ Locum Agency Contracting Strategies
back . Our next question . I think we answered this already , but it's all good . You know my memory , you know , but we're going to answer this because this is actually a really good question . This is from Dr Cesar S Cesar . Is it Cesar Cesar ? So he says my name is Dr Cesar , full-time locum hospitalist interested in opening my own agency .
I don't know , everybody wants to do their own agency .
Yeah , because everybody wants to be their own boss . I don't blame them .
I saw two of your YouTube videos about starting a locum agency and I had a couple of questions . One if I do locum work in a hospital for that , if I do locum work in a hospital that , for example , is through . I'm just going to say the S group , an S group , which is a agency .
Maybe it's not a locum agency , though , but if it is , does that mean I can't recruit hospitals in other places that work with the same group , right ?
Oh , I see what you're saying . Yeah , okay , so it's a group of doctors not not the agency Gotcha . So he he currently works as a hospitalist .
Yes .
And he's with a certain group .
He's with a company . It's not a locums , but it's a company .
No , no , but it's a group , meaning it's a company .
Yes .
Gotcha Okay .
Hence why I said company .
Dr Renee , I know everything .
All right . And then number two what is the best way to approach a hospital to see if interested in contracting a locum agency ? So he wrote some additional things . I'm going to cut that off so just for the sake of the question . Three also in one of your video you mentioned a couple of times that you need a VA . What does that mean ?
And then four do you know the best source links for malpractice , depending on state type of attorney , to help with contracts and who would ask about other licensing or paperwork to have besides the LLC S-Corp for the company All ?
right , you don't get a lot of questions today , zav .
It's a lot of questions , but these are good . These are really good questions .
They are good questions .
We're not going to get into all of this , but I think the biggest thing , man , I think we're going to answer two of these questions . Then it's going to be story time , because I got a good story . Remember that story I was telling you about with that doctor .
No .
You don't Okay Well .
It'll be like I'm hearing it for the first time .
You're going to hear it for the first time . So the first question is if I do locum work in a hospital that , for example , is through A group . A group . Does that mean I can't recruit hospitals in other places , that hospital with the same group ? Basically , what basically ?
if you basically what he's saying is he's only working at this one hospital because he's with that group .
So , but that group works out of different hospitals he wants to know if that group works at different hospitals .
Could he try to go to those other hospitals and say , hey , I want to do a side competing deal and bring my other agency to work at your hospital , even though I know that you're using the same group that I work for and I'm going to say likely not .
Check the fine print . Yeah , yeah , check your contract Most companies .
I'm going to tell you right now I'm not going to name this company , but I looked them up and their doctor run . That'll mean nothing , Because doctors are all about capitalism . Doctors are all about making money also , and the number one asset when you are working with a group that is sending doctors to a hospital is to protect the IP and to protect the .
The IP is the doctors . That's it , Right ? And what I mean by that is not like literally protecting the doctors but not allowing the doctors to get out of their contractual agreement to work at these hospitals through that company , Right ?
So long story short is if I got a bunch of doctors and they're working at that hospital , I'm gonna make it really hard for that hospital to try to recruit those doctors outside of this contract , Right , Because that completely deads everything Like the strength of being the middleman . That's what these companies are making money as .
The strength of being the middleman is being able to tie doctors in and saying , hey , if you leave , you are in breach of this contract . And then , on the other end , these same companies tell the hospitals if you try to recruit this doctor , you're going to owe us like 50 stacks , Right ? And then what ends up happening is a risk benefit ratio .
If the hospital really wants this person , would they go and not only put them in an employee contract but also have to pay that other ? company to buy them out . Is it worth it to do that ? I don't know . But either way , this is business , this is capitalism , this is cutthroat . Read your contract . I'm telling you right now .
Read your contract and just know that these places will come for you . So I would be careful and , in my opinion , I would just steer clear of any hospital that this group that you are working for . If that group is servicing that other hospital and you want to work there as a locums , I wouldn't do it .
But read your contract , yeah , I mean , I guess my question , I guess my question to Dr Cesar would be you know , why specifically do you want to work or why specifically do you want to recruit ? You know those hospitals to potentially your own agency when there are so many different hospitals .
Is it because you know those hospitals to potentially your own agency when there are so many different hospitals ? Is it because you know that they are more susceptible to accepting you know groups and locums and things like that ?
Because the answer , honestly , if that's the question , then the answer is there are lots of hospitals out there who are looking for locums , who are looking , you know , for staffing , and I think if you were to go to any job board or whatever , you would see a lot of companies who are asking for locums , who are asking , you know , for staffing , who are asking ,
you know , for staffing . So I don't necessarily , I don't think it's necessary to go to the hospital specifically that your group works with .
So my only suspicion is probably this group works in a certain geographic area .
And that geographic area is also the same place that this doctor works in . Yeah , it's desirable . Yeah , is also the same place that this doctor works in . Yeah , it's desirable .
Yeah , so that's usually the situation , which is I know these hospitals that are in my geographic region . I don't know these other places that are in a different area . So if this group has a lockdown on all of these hospitals that are in a certain mile radius , it's going to make it really difficult .
Right .
You know . So I don't know , but that's my biggest , that's my biggest suspicion it ain't worth it .
Yeah , risking the relationship with the group that you currently work , I think is not worth it . But read your contract , read the fine print , because if it doesn't say anything about it , then maybe all bets are off .
Just be prepared , y'all . Just let me . All is fair in business . I'm just telling you right now I'm not saying that you shouldn't do it , but if it's not in your contract and you go ahead and do it , just know that they will come for you in some form or fashion . Yeah , because that's kind of like a I don't know well .
It would be kind of like a non-compete , basically . So the next question he has is what is the best way to approach a hospital to see if interested in contracting a locum agency ? I asked because I work in different states . My plan was to ask around in other hospitals around the area . I'm currently doing locum work at that moment .
So I actually think what you're saying is a good idea . I look , there's many different ways you can do about . You can go about this . My opinion is to go in as an individual , get your foot in the door and just say there's more docs like me that are coming that come through my company and I have an agency , so why don't you just contract with
¶ Approaching Hospitals as a Contractor
me ? I think hospitals tend to be more resistant if you come in as a doctor saying that you have a locums agency . That's my opinion . I think it could work , but I think they're more likely to not take you seriously .
It's about the verbiage , yeah .
What do you mean ? What do you mean by that ?
Meaning that if you go , I have my own locums agency versus , listen , I have a lot of doctors that I can bring to the table . I think people are more susceptible to that , right . They're more likely to respond to that .
So , for example , this is why hospitals like to recruit , you know , doctor and spouse teams , right , when they say , oh , you're a doctor and your wife is a doctor , yeah , come on in , right . But if you say , well , my wife and I we do a locums company , they're going to be like what ? Like doctors don't do business business . Like what y'all talking about .
Well , but I think there's other reasons why they would say no to that . Outside of that , I think the biggest thing that I would say with that is hospitals they're not trying to work with locums right . Unless they have to .
But what they want is a consistent warm body on the schedule , butts in the seat , and with locums you just have way too much autonomy that they are very comfortable with , right ? So I think that ends up being the issue .
It's like , listen , I get that you want to work here and you want to be locums , but I need someone who's going to work the fifth and that's it . And if you're saying that you're not available and I can't force you to , then that's a problem .
I'm not saying that that's an overall problem or that's your problem as a locums doc , but that's a problem for them . So that could be the major issue , but I would definitely say that the best way , oof . So do you think the best way , do you agree with that the best way is to come in as an individual and then be like the Trojan horse ?
Or is it just say , be open and honest and say , hey look , I got a locums agency and I want a contractor ? I mean , I would say that it's best to come in and just be like yo , we're cheaper than everybody else , because that's the that's the bottom line .
That's the bottom line , Right ? Is that , yeah , we're cheaper than everybody else . Now , what you don't want is to lowball so much so that now you're not really getting what you even deserve , and then on top of that , you can't give the people who you're recruiting to come to get what they deserve either , Right ? So there's like a balance of that .
I think that you know you come in and you basically say if , if you can avoid saying the word locum for a long time , I would personally .
That's a good point , I agree . I agree with you a hundred percent .
I would avoid saying that word , even though , even though the concept is the same you're coming in , you're independently contracted , you know you can say hey , listen , I'd like to contract with you .
I have a lot of other doctors who you know will be coming in with me , who are very interested . Some good points .
Yeah , because what they want to know is , like you said , you know , can , can you fill the schedule ? That's the first thing , right , and this is something we're kind of getting into it , but these are the things that we're going to be discussing in our locums course .
Right Is how do you approach a hospital , how do you approach a facility , you know , and finding out the things that they want so that you can , you know , essentially appeal to the things that they need , right , and so you mentioned before the you know , the seven considerations if you sign up for that particular seven considerations before starting locum tenens you
sign up for that You'll also be on the list that introduces when we're going to be talking about the course and introducing the course .
But you know this , these are things that we're going to be talking about , like , if you can , you know , bring other people with you and say , hey , the strength of me is that I bring other people with me who can fulfill this particular need , so that you don't have to worry about holding the schedule .
I think that is you have a problem , I have a solution and , at the end of the day , right , because even your contract is not going to say locums . Our contracts don't say locums , our contracts say independent contractors .
Yeah .
Right so , but essentially it's the locums Right so who really cares ?
You done .
Yeah .
So the third question he asks is in one of your videos , you mentioned a VA . A VA is a virtual assistant Usually you get . A virtual assistant is someone that you hire online . You interact with them online and they usually live in a different geographical location .
It could be in the United States unlikely but usually they're in a different country and what they're really good at is doing like repetitive tasks . Let's say , you need timesheets from all the doctors who are working under the company , or they need to send out like travel arrangements and you need like a PDF that's sent to the doctor who's traveling .
Hey , like here's the flight you're going to catch , here's your car rental and then here's your hotel information . Things that you don't want to do but are very important , right Like that , are very repetitive . That's what a VA , particularly in this sense , is really good for , you know . So I think that's something to keep in mind .
But I'm not going to answer the last question because I think that that's . You just got to get into too much depth , but I want to do story time real quick .
Okay , so the last question was about malpractice .
Yeah , yeah .
Yeah , that's a little more in depth than we have time for today . Take it where you can Dr Susan
¶ Navigating Contractual Obligations in Hospital Employment
Take it where you can .
So you know this one , this one , this one thing that I want to talk about . It actually speaks to number your first question , which is , you know , working at the same hospital as you know the group that you're working with , right , we're basically like going against a non-compete clause . So let's just say , dr A works with Locum's company .
A Locum's company sends this doctor to a hospital . This doctor knocks it out the park . She does extremely well , she works very hard and you know this happens a lot . At times the hospital asks doctor hey , why don't you work for us , or let's work together and you get out of your contract with the locums company and go from there ?
Doctor says sure , oh , I know who you're talking about Not knowing that when she probably signed an agreement between her and the locums company in there . It basically forbids solicitation by the hospital to the doctor .
Well , probably doesn't forbid it , but it probably has a contingency . Possibly , most likely .
Most likely a contingency Right Most likely . Most likely a contingency .
Right . But I do know most contracts that I've seen say there is no solicitation of any employees in the locum's company or any agents of the locum's company , right , which could be sometimes be thought of as the docs Mm-hmm , right , yeah .
So what happens when the doctor in the hospital , they get into a contract and it's like , yeah , this is going to be great , and then someone gets cold feet let's say it's the hospital . They get cold feet . They're like you know , this is not going to work anymore , but the contract has been signed by both parties , so it's executed . And never .
That doctor never told the locums company that , hey , I'm not going to be on your roles anymore , I'm not going to be taking , you know , your , I'm not going to be working at this hospital anymore , starting in two months , right Under assignment , under locums assignments .
So I had a situation where I had to talk to someone about this because , you know , this person was explaining to me everything that's going on . And I'm just sitting there like did you not tell your locums company that you're not going to be working for them in about two months ? No , I haven't .
I didn't think I needed to and I was like wow , right , like the reason I bring this up is listen there . You know we talked about birth board certification earlier in the show and the education that you have . This is business .
No board certification needed for this .
This is business , yo . The biggest thing that these locums companies will do and they will fight tooth and nail is to protect you from going to the hospital that they sent you to . So they're going to make it really difficult . So I would say listen , this happens actually a lot where the hospital will try to recruit you .
But you got to be very open and transparent and let your locums company know , hey , they're trying to recruit me . And , just like Dr Renee said a lot of times , they'll say , oh yeah , you know what ? Actually we do have a provision for that .
It's just that it's going to cost us like , excuse me , the hospital's going to have to pay us like 50 stacks , sometimes even 75 stacks .
Or more , who knows ? Or more , depending on their individual contracts .
Because you got to consider right , like , if the hospital signs this doctor , the locums company is missing out on a whole lot of money . So they're going to want their , they're going to want paint , they're going to want what ? Is it remuneration for this ? I mean ?
Look at me using these big words and stuff , start saying remiss , start wearing a bow tie and stuff . Right . Okay when , whenever I wear a bow tie I wouldn't mind at all no , anyway , um , so yeah , that's um . That's something that I was telling this person about . I was like you need to get a lawyer and you know they were hesitant at first .
But I'm like , listen , like you know , when , when 75 000 or 100 000 gets thrown out because that needs to be paid to buy you out , like at this point , like the mistakes that you're making , you need to talk to a lawyer about this stuff .
Because , first of all , the fact that the hospital has cold feet and they have an executive you know an executed contract who's to say that they're not going to go to the locums company and the locums company is going to be like yo , somebody owes us money because this person doesn't work for us anymore , because this person has a relationship with the hospital now
.
Now I know I'm talking like nebulous and so forth , but just know that it's a big deal , guys . Well , my question to you about this was how she signed a contract with the hospital without consulting a lawyer . That happens a lot Y'all listening .
you guys are listening and you know this happens a lot . That happens a lot . Y'all listening , you guys are listening and you know this happens a lot .
She don't listen to the show .
Yeah , that should not happen .
That is a . That's a big fat no-no , that's a huge no-no , you know . And so now the question is is this going to cost her ? Is this going to cost her her relationship with the locums company ? Is this going to cost her her relationship with the hospital ? Is this going to cost her dollars ?
Especially since the hospital was having cold feet Right , and now they don't want to move forward with the contract . So then , how do you even get out of the contract ? Because it's executed .
Well , the only other thing that I could say is so the only way that she can get out of this scot-free and nobody knows anything is that she . If the hospital really has cold feet and it's like I don't want to execute , she goes . Well , I don't want to execute either , and nobody says anything to the locums company .
You rip up the contract like it never happened , that is literally the only way that she can get out , but it's like an addendum has to be written up no , it doesn't .
You just rip up the contract . The contract no longer exists . Really , it just doesn't exist , okay , I mean , if there are any lawyers out there , if there's a mutual agreement that this contract doesn't exist anymore , right ? If you say , well , you were in breach anyway , and I was in breach anyway and I don't want to pay .
Well , it doesn't have to be said on email anyway , though , or like some type of documentation . Something has to be documented that you're walking away , I'm walking away , and that's it .
Well , yeah , you could . You could do that . I mean , you could certainly do that and just be like , all right , I don't want to be in it anymore . Or if you actually signed , you could just rip up the contract .
As long as there's no copies of the contract contract no longer exists , you just shred it .
Your locals companies , locums companies . Be like music industry .
Yo this is like the music industry , basically if she read a book , they owe money too . I'm telling you , it's like 360 deals they got you . Is she gonna just be careful ?
concert . She going to her now . She owe her . She owed her money too be careful , y'all .
Like this , is this like listen , I'm not saying this to to get you guys to just stay in your employed positions or in your academic positions ? If you want to go , you want to go , that's fine . All I'm just saying is just make sure you talk to a professional about this stuff yeah , yeah , just that's all you do talk to a professional about .
This is going to cost a little bit of some money , but it's an investment that's well worth it , right ? At least you're moving in confidence and nothing is going to come up and sneak you .
You know you're not going to get sneak attacked , basically , and I think that if you're interested in starting your own locums agency , it behooves you to really get a lawyer who understands , who really understands the lay of the land , not only contractually but also in your field , right .
So if you get a lawyer who doesn't really understand , well , first of all , lawyers understand contracts . Right , but if they don't understand , lawyers but if they don't , but , but if they don't even understand your field , really , Right . They could be negotiating on your behalf , or even just putting stuff in language in your contract that is not relevant .
So then , when the hospital looks at it , they're like what ?
the hell is this .
Right , you know . So there's something to be careful of .
Yeah .
I'll leave it at that .
So the only other consideration I would have and I don't know if we know the answer to this is does she have damages ? Ie , did she buy a house ? Did she commit to a mortgage ? Right , thinking you know what ? I'm going to be moving here in a couple of months , I better settle down here Now .
If that happened , she is likely not to let go of that contract which we something before things really are rolling and before they know whether or not they really want to stay at this facility in that capacity .
This is the second example I talked about of someone being an independent contractor and then deciding to stay at that place and look Because then she would have damages .
And at that point why don't you sue somebody ?
Why , why ?
But it's like , could she actually sue for damages if she's the one that was in breach of a contract ?
It's possible , yeah .
I mean , it's always possible to sue anybody .
If there's any lawyers listening , let us know yeah .
Because you know , isn't there like the doctrine of clean hands ? You got to come in with clean hands .
¶ Board Certification Thank Yous
You've been watching a lot of judge , oh I watched , just judy , I watched it well , anyway , listen guys . Dr caesar , I'll let you know . Dr caesar and kim , thank you for writing into docs outside the box . Everybody , thank you for giving me what's up on my board certification , even though this episode ain't come out .
But I know y'all love me that much and y'all gonna give me props for getting recertified . Um , american board of surgery do better . Board of Surgery do better . Listen guys , we're going to catch you guys on the next episode of Docs Outside the Box . If you got any questions , make sure you send it to us .
You know we're going to answer it because I got all the answers I got you entertainment purposes only don't come and sue us . Catch you guys on the next episode . Peace .