J-Lo’s Split, Breakdancing Kangaroos, and Why Locums. #426

They show you all the houses in the area and they say you know , you bought a house , you're doing all this stuff and sitting down roots into this place . And you get there and the same colleague that was like oh , you should come here , you should come here , Tells you that they just put in their three month resignation notice .

Yes , you get bumped by cases , even in Ghana . So we are on a medical mission with international healthcare volunteers and what I normally do as a general surgeon here is I do hernias and then I do more hernias and then after that , I do more hernias and then , when I get sick and tired of that , I do more hernias .

So the type of hernias that we see , we see like the Ghana hernias , which are the England hernias , where you see a lot of people who do like hard labor . We're talking about people who get on the boats in the morning time and they go fishing and they pull those nets and they develop these really large groin hernias .

We got women who have incisional hernias or ventral hernias because they've gotten C-sections or maybe they've gotten some other type of abdominal surgery and things didn't come back together the way they should and they got a big hernia that we need to fix . We take care of goiters , sometimes people not getting iodine in their salt . You know what I'm saying .

And they get these big goiters . What else do I do ? More hernias and more hernias after that . And I get an iodine in that salt you know what I'm saying . And they get these big goiters . What else do I do ? More hernias and more hernias . After that , no trauma , no trauma at all . This is pure general surgeon .

This is what the community needs , or the entire city needs . We're in Kumasi , which is the second largest city in Ghana . Dr Renee is here with me , so she is watching the kids , but also , at the same time , doing some troubleshooting with the medical mission , if need be , and that's how we're making it work .

Men's , that was must see TV . The women's basketball was must see TV also . But let me tell you something right now Track and field was amazing . You watched it , I watched it . I haven't been this hyped about United States Track and Field since the 90s and I haven't really paid attention since early 2000s . And this year it was amazing .

Sydney , with the 400-meter hurdles she needs to stop playing and just do the open 400 . With the 400-meter hurdles , she needs to stop playing and just do the open 400 . Noah Lyles to Lethile Taboho , who is , I think , the MVP of the Olympics , running the 200 , the 100 , and a 4x4 . And don't sleep .

You got somebody who's running 9.8-something seconds in a 100 and still split a 43.03 in a 400 . That is nuts . His range is really crazy . I don't think anybody else right now .

I don't know what's going on out there , but , um , I can tell you this I did watch some of the men break dancing and that was actually very like for real entertaining the women's left to be desired .

Um , definitely , having grown up in these , in the era of dancing , breaking , break into electric boogaloo , you know , and seeing it's not the same , I mean , it's just the women , I think definitely did not do it justice . I'm sorry . I don't care what anybody said , right , it's a talent show , it's the olympics , right ?

So I thought that was very strange , yeah dance in olympics , but yeah you're making up stuff all the time yeah dance should not be in the olympics so , um , yeah , I wonder if they're going to bring ballet to the Olympics next year .

But that dancer from Australia and she has a PhD in breakdancing For me I really I'm like what is a PhD in breakdancing ?

So we are here in Ghana , and one of the things that we have talked about on this show previously is that we got an apartment , we got a condo in Ghana , and I think it's worth it to kind of just let people know we're going to do something a little bit longer on it in another episode , but to just talk about our first impressions of finally getting our .

This is actually the first place that we will own and live in together , right , and so we finalized our payment what ? Just a couple of weeks before we got to Ghana . So what ? What's your first impressions on our apartment ?

Um , I don't have to worry about staying with family not to say that family is not , um , I don't want to stay with family , that's not the case at all . It's just that you know , having your own place means that you have a stake in the game and you have that much more reason to kind of keep going back to something , right ?

So for me , that's the significance . There is , like I really finally have roots there in Ghana or here in Ghana . So that's . That was a big deal for me within the apartment and all this and we can talk about that later and stuff it great , you know the apartment is nice and stuff , but , um , I don't like apartment living .

I could tell you right now I don't like apartment living no , I just I prefer being in a house , I prefer having a backyard , I prefer having the kids being able to , like , play on the grass and you know , go , you know , have a run free , run free and stuff , and I just feel really cramped in .

But I think at this point , right now , it serves the needs , which is it's a place to stay for , you know , a certain period of time , a finite period of time . I think that once you know , we make the decision to come back and stay here , if that day occurs , we would have to get a bigger place and get a backyard and stuff .

The what the building offers , especially with the pool , um , they'll be coming with a playground soon and things like that .

I think that suits the needs , you know , for the kids , um , especially since , primarily , you know , they're going to be , you know , in the apartment home with me , so I can really just take them out and go where we need to go for them to be able to have fun and get out of the apartment every now and then .

So it's a two bedroom apartment , pretty spacious , has a balcony . The me me . Please stop listening to you . No , you're not practicing break dancing right now , like , and what you're doing ain't really in practice . And break dancing right now , um , but it , uh , what else was I saying ? Oh , yes , like I said , the building has a pool .

Um , they're going to be building a playground soon . They're actually building a second phase to that building , so the complex is going to be even bigger . And when we're not in town . We'll be using it hopefully as an investment property for rentals , either Airbnb or a long rental . So that'll be very interesting to kind of see how that unfolds .

But we'll we'll do like a little video introduction so you guys can just kind of see what the apartment looks like . We're still furnishing it , that's the other thing . So , yeah , it's been a lot of fun , just kind of , you know , moving in if you will . So , all right , let's get to our Q and A . Let's get to our Q and A , lorenzo .

All right , so our Q and A is from Joshua Strayer . Today . He says I'm a resident physician finishing my transition year in Allentown , pennsylvania , and moving to Philadelphia in June to start my anesthesiology residency . After this match week , however , so this was submitted a while ago I found myself in quite an interesting position .

I matched into an advanced anesthesia program without the need to repeat my PGY1 year . I didn't know that was a thing I didn't either . Okay , interesting . Okay , therefore , I will have from June 2024 until June 2025 as a year outside of

residency . Okay , so he started , I guess he did his intern year and then matched . Okay , so he started , I guess he did his intern year and then matched and they were like , yeah , you don't need to do PGY1 over come next year . Yeah , interesting . My hope for this year is to explore a few sorry , I lost my space . My hope this year- .

Whatever it is that you're doing jumping out of planes , doing podcasting , whatever it is trust me , you have the rest of your life to do and work on your craft as an anesthesiologist , and taking one year off to go and enjoy yourself and do what you want to do .

Trust me , you will always remember that one year as a time when you got to do things that you just always wanted to do , passing on that and saying , well , I want to get my skills even better so that you can impress attending . So now you're even paying attention during your second year . I don't think that's really going to make a difference .

So kudos to you for recognizing that . Yeah , what to do , man , Whatever it is , I would say , you know , do the things that you know that you're not going to get a chance to do , you know , over the next several years , Right ?

So you know it's going to be hard as a resident to really dedicate your , your time to really , um , doing something that you can like literally enthrall , you know , put your entire self into .

So , whatever that passion may be if it's a podcast , if it's content creation , um , or maybe it's doing something , um , like volunteering , you know , teach America , um , or whatever it may be Just know that what you do , and if you really have a lot of fun and if you really throw yourself into this , do it in something that you may not get a chance to do

again . Basically what I'm saying you may not have that opportunity again . In my opinion , if I had a chance to do it , whatever it is , I'd try to make a little bit of some money , right , so that I don't have to take any more additional loans . You know I don't think you need a full-time job , but you need something that's going to help you .

You know , kind of , keep the lights on pay bills . Get something to eat , Just something that'll help to make sure that you don't have to increase your student loan burden . That's what I would do .

Has loans , then do the loan payments stop Because technically , he's not in training . Right , he's not in training .

Can you apply for some type of hardship into some type of grace or deferment period when you're actually not continuing your education anymore ? Can you apply for some type of hardship or some type of pause in your student loans while you're taking time away ? I don't know that because I haven't read .

I'm starting not to read these questions anymore because I just want to see how I react . But I'll see these questions . I'm very interested in that .

Going to give you enough money to live , pay for electricity , live and still make the minimum payments on your loans . You know , you know , live and still make the minimum payments on your loans . That's the , that's the key . And if that's the case , then I would just say make the minimum payments and don't go into forbearance .

Could , at that point he do income based loan repayment ? And because it's Teach America , we just use that as an example . We don't know whether or not he's doing that , but if you were to do that , then would that qualify as a year towards PSLF as well ? Well what is it called Public service ?

I'd be like yo go do something , epic , go work with some people that you really admire , you know , go travel or whatever it may be , try to bring some income in on the side , because you ain't going to be able to do that again . Yeah , that's the way I look at it .

I think that's a really good thought for him as well , because I do think people get stuck with oh my God , I'm a doctor and this is , this is all I know , this is all I know , and then they don't realize that there are so many other talents , so many other interests that they might have , and that they may be able to eventually merge with medicine .

This is a very but the situation that is being presented to us right now is unique , is extremely unique right , like most people who finish residence excuse me , most people who finish their intern and get accepted into a residency they're just continuing in as either a year two or that program is like bump that you coming back down to year one with us .

That could be the case also .

I mean , unless you have some trust fund somewhere , you know which he might have , you know he might have a trust fund or he might have loans , so yeah , so that part we don't really know . But whatever you do , let us know what you end up doing .

I'm a new grad OBGYN and just graduated residency . I'm delaying starting a full-time position until January and I'm hoping to do locums in the interim . Do you know good agencies for OBGYN locums ? Also , do you have any advice for a new grad going into locums ? Looking forward to hearing from you . Thank you for being a resource , and that's Dr Z .

Can I answer this ?

Every doctor in some form or fashion should be an independent contractor .

For those who are listening right now and don't know what independent contracting is or locums is basically it's you work for yourself , you don't have a boss , and you go through either an agency or you basically directly contract yourself with a hospital and you just say , hey , I'm going to work X amount of days this month and you're going to pay me X amount of

dollars and there's no taxes that are taken out and that's it . And initially , like back in the 80s and 90s , people used to always look down on locums doctors who worked there because they're like , oh , you can't work anywhere , and it was always a bunch of bad advice . And even're like , oh , you can't work anywhere and it was always a bunch of bad advice .

And even in the 2000s it was the same thing . And now everybody's doing locums . All those people who say don't do locums , low key Even then they do it . So I did so , coming out of fellowship . So I did five years of general surgery and then I did a year of trauma surgery and I just was having a hard time trying to find a job .

Anybody who knows me knows I can't commit and I just wasn't trying to commit to no three to five years . Meanwhile I'm trying to commit to this right , what is this ? This ? Hey , I'm a this . Now Listen , we don't need your laughter , guys , we need your support . We made it through it and we still together , all right , but damn sure I wasn't committing .

I'm blinking y'all . I was not committing to no job for no , three to five years . So this wonderful woman , this queen right here , my michelle , my caretta , that one , my caretta , my Coretta , you're my Coretta . Hey , change that to Dr Jonathan Majors . Dr Renee , you're my Coretta . So my Coretta gave me advice to go into what do you call it ?

To go into locums . And I was like I ain't doing it and I did it my first job . I said , look , I can only work this amount of time . And they asked for additional time and I said I can't do it . And then they paid me and it was like a great amount of money and I did it for like a year and a half and I got flown out for free .

I got put in hotels I didn't have to pay for . They took care of my medical insurance and I loved it . I loved being a general surgeon and not having a boss . I loved being a trauma surgeon and not really having to worry about things that I worried about when I was a resident someone looking over my back or anything like that . I didn't care .

Now , one thing that I think a lot of people get concerned about is , well , I'm fresh out of residency , I'm fresh out of fellowship . I need a mentor or I need you know I just what if I get into a situation that I'm not really comfortable with ? That's fair , you know . I think that that's a fair thing to be really concerned about .

If you don't feel like you know those who are listening to this podcast , like you know in , truly in yourself , if you're ready to go out and practice on your own because if you're sick and tired of listening to your attendings , you're pretty much ready to go and do it If you feel like , ah , I like my attendings , that kind of cool people .

You probably need a couple of another year and stuff when you're really sick and tired of listening to your damn attendings . That's the bar . That's the bar . That's the bar that I use . I'm done with my attendings before . Most people who are sick and tired are listening to that , but I like my attendings . Like would you shut up ?

That's when you know you're ready . Right , really .

You know what they did ? They picked up the phone and they gave me advice and that was it and I moved on . The world didn't stop . The patient did well . And there were some other times where when I was at a locum's place and I happened to be working with someone who was a little bit more senior with me , I asked them a question and kind of moved on .

There were some other times where I could see that if I asked a certain type of question , that could be used against me . So you have to be really careful about that . Some people are either fearful of you coming because they're concerned that you're going to take their job , or they're just resentful that you're getting paid more than what they're getting paid .

But I just got to tell you about these small little , infinitesimal things that are low risk , that can happen , and I think most of the things that people inflate as you got to worry about this , you got to worry about that . You got to worry about always looking for a job every two days and stuff like that .

That stuff doesn't happen quite as often as you think it's going to happen .

I think the whole concept of you being in control of your schedule , you getting paid very well , you being very fulfilled and you feeling like you're your own boss those far outweigh the concerns that you have in your mind or something that your attendings may have told you and they've never even done locum , so I've talked enough .

your field . Are getting paid to find out like details about subspecialties and medical malpractice taxes or just in general about all the other types of locum agencies . Low key . This is not being sponsored at this time . I would say check out locumstorycom . I think that's the best place to go to .

Um , when you use a local tenants agency , just you know , be prepared that you might get low vault . That's number one . So I think you know you gotta be careful about that .

But when you're first starting out , I'm going to tell you right now , as with anything else , even if you were going for a permanent position , you're not going to get , that's not going to be your best contract .

If you will right , if you start out and that's your best contract , then it's kind of like , well then that actually is never going to be your best contract .

So if you just think about it in that way that it's just kind of taking it and using it as a learning curve , and as you keep going , your contracts will get better , your compensation will get better , all the terms and conditions under which you work will get better . So just know that . You know that that is out there .

The unique thing not unique because it's not unique to OBGYN , but one of the things about OBGYN that you do need to consider is that you need to get your cases for your board certification . So in OB , we do an oral . We do a written exam followed by an oral exam .

You have to take the written exam in one year , and then you take the oral exam , I guess within five years of taking the written exam .

The thing about the oral exam , though , is that you need to accumulate enough diverse cases to be able to present for the exam , and so , if you're doing locums , depending on the type of locums that you do , you might or might not have that diversity of cases , so , for me , one of the first one of the first it wasn't the first , but one of the first locum

stints that I did was actually a long-term locum . So you can do locums in a lot of the first . It wasn't the first , but one of the first locum stints that I did was actually a long-term locum , so you can do locums in a lot of different ways . You could just do locums on the weekends , which is what I do now .

You could do locums like every two weeks . You could do locums it could look any which way . You can do locums for three months . One of the first stints that I did was a locum stint for 10 months , and I did full scope OB , so I was doing , you know , seeing patients in the office for GYN as well as for OB .

I was doing surgeries , I was doing deliveries , I was doing ER . I was doing all basically full scope OB . I was like it basically was like I was in full scope practice and I could accumulate cases from that to be able to then present for my exam .

So if you're going to do locums and you haven't gotten your board certification just yet , that's one of the things that I would actually think about is about well , how are you going to get your cases , particularly in OB or , and you know , and or in any other specialty where you have to collect cases , cause you guys in surgery you don't have to collect cases ,

correct ?

Um , I think I never , not that I never thought about it , but you know , I think the one thing that's really interesting is I like that point that you mentioned , which is you gotta you somewhere because your first contract is not going to be your best contract . When you start working , your first job is not going to be your best job .

At least you should not be going in thinking it's going to be . I know they're going to try to sell you on that , but just know that this is going to happen multiple times . Where you're going to be at a job , you're going to be there for several years , maybe even shorter . You're going to leave , go to the next one . That's just the name of the game .

And you know . Same thing with locums Like the first job you take , like you should not like cut your nose off to spite your face because you really want that perfect gig . It doesn't work like that . You got to know how the rates work .

You got to know , okay , if I am getting paid this and I go into a place and now I'm doing all of this work , if they got me doing gallbladders at like nine o'clock at night , the rate that you're offering me , that's just not going to cut it . Like the rent is too damn high .

So maybe you come back and say , hey , like you need to pay me like $500 more a day or something like that . You have to start somewhere , a reference point . So just remember that that's the key is don't seek out the perfect thing initially . If you got it , that's great , but how would you know unless you do it ?

So that's my biggest advice , particularly once you figure out which locums you're going to go with , don't try to get it all perfect . Just start and move forward .

Now when you get a job , though , like you got to make sure that you are you know you do on you're on your P's and you're on your Q's , right , because leaving oftentimes it's a bigger commitment , a little bit harder to leave .

We have our own 401k , like our own 401k , internal 401k that we use that we just took a loan out to pay for this damn house . You know , apartment , apartment , um , we , we , we use it for a whole host of different um reasons , um , but yeah , like there's a lot of benefits to it , but the also thing is there's some work that has to be put in for it .

I'm not gonna lie to you . There's some work , um , there's , you know discussions that I have with our cpa , um , a lot of times .

But I really I'll tell you right now , like if you ever asked me to go back , if I had the choice to go back to either a job that you know , literally , like I had to go back and work and I'm employed , versus doing the same exact thing , but knowing that I'm an independent contractor and locums you can ask anybody , even though I'd be doing the same type

of work , and oftentimes I'm not going to lie to you I work more as a locums yes , you do Than I was employed . But I'm just happier knowing that the compensation , the tax benefits , the ability to kind of take time off when I need to take time off for my kids or for my wife , or for my family or to do a medical mission without having to ask anybody .

Yep , like to me , that's . I love that part . Having the ability to just say no without knowing that they can't do anything . To me is great . And I don't say no often , mainly because I'm not in that type of situation where I have to say no . But I'll be honest with you .

I really think that more and more docs , more and more residents need to really consider this way of practicing . Yeah , it's the way to go . It's the way to go Okay . So yeah , anybody got any other questions right now ?

So if they haven't experienced it and as attendings they always have to have an answer they're just going to poo-poo and say certain things about it , rather than really just investigate or just say I don't know about it , rather than really just investigate or just say I don't know .

So you know , if you have an attending who's just done academic medicine for their entire career and then all of a sudden , a resident is saying , hey , you know , I'm interested in not going into academic medicine , but I'm interested in just kind of doing some locums for like a year or whatever it may be , the first thing the majority of them will say is I

don't know about that . You know , like from what I hear , it's hard for them to get a job . You know you go from job to job to job to job and people are always asking why you need to , why you can't keep a job .

And I can tell you right now , for the past 10 years practicing and we've taken most of the places that I've been at and worked at have taken people or trauma surgeons who worked there initially as locums and have switched over into becoming full-time .

And I can't recall and I've been in a lot of those interviews , I can't recall any of them looking at the CV of a doctor and saying , oh man , you've done a lot of locums . Tell us why . Of a doctor and say , oh man , you've done a lot of locums .

They don't know , right , like they have not experienced it , they don't actually know what it takes to get into medical school . They don't .

So in this case , attendings don't know what it takes to have a career in locums because they never did it , and so they have projected onto their residents what they think that their careers should look like , based on the career choices that the attending has made .

And attendings will tell you to do exactly what they've done and then complain to you about their own careers , complain to you about their own jobs . So I'm like so you're complaining about your job , but you're telling me to do the same thing . So I don't really understand what's going on . And that recently happened to you . Just just what ? Two weeks ago .

For you know , like once you're going to start working on your career ? Yeah , I think , if not the majority of them , like all of them in some form or fashion , has come back and asked me to give them advice on doing .

Low comes independent contracting , and I think what people are starting to see like this is just what happens with medicine , now with health care . Like you know , when you look at a plane , or when you look at the airline industry , and they look at the plane , like the plane is supposed to do a certain amount of hours .

Right , like the wings are supposed to be flying for a certain amount of hours before you replace it . Right , like you can widgetize that . Right , the plane doesn't have a spouse . Right , the plane doesn't have kids . The wings , you know , have no emotional components , so you can predict exactly what that wing and what that bolt's going to do .

What they're trying to do in healthcare is they're trying to predict exactly what you as a clinician , as a doctor , is going to do .

But it's like , look , like I gotta have time off , right , like I can't work like a wing , and uh , you know , I think that happens to everybody where they feel like , well , look , this is what I can do , I'm going to work really hard for like 30 years and then I'm going to retire . And it's like , well , what if you get to year 15 and you're burnt out ?

What you going to do then ? And someone has been telling you what to do . So that's why I say , like , with locums , at least you get to like work . That energy of saying , yeah , like this is how long I want to work . I want to work for a week out of the month , or I want to work for four weeks out of the month , but either way , it's my decision .

And if you want to do more , it's on you , if you want to do less , it's on you . It's almost like private practice , but with less responsibility , you know . And people will say , well , why do you say that ? I say that because I think that it's the hospital's duty to get all of the equipment you know , to hire the ancillary staff .

But I think it's the doctor's job separately to bring the brainpower right and to bring the knowledge , and that those two are mutually exclusive . The hospital doesn't own , you know , doesn't , doesn't know how to treat patients . If you really think about it , the doctors do . The doctors don't have enough money to hire and build a hospital and all that stuff .

So both of those things should should be operating separately . One should not be in control of the other . Exactly that's what I feel about , yeah , but yeah , I mean , I'm just a ganyan from irvington , new jersey . What ?

I was just talking with one of actually , we have a resident on the team here on the medical mission and I was talking with her and she's getting ready to graduate . Oh , you were talking her head off . She was like yeah , yeah , anyway , she's getting ready to graduate from OBGYN residency .

And one of the things that I let her know is , like you just got to be careful , because people will be like , oh , come to my hospital , come to my hospital , come to my hospital , where you know we're hiring , we're doing this , we're doing that .

And you go and you know you have a great visit and they , you know , they show you all the houses in the area and they , you know , you buy a house , you're doing all this stuff and sitting down roots into this place .

And you get there and the same colleague that was like , oh , you should come here , you should come here , tells you that they just put in their three month resignation notice .

And then like people like a year later say , yeah , I heard that episode where you was talking about me . Oh shit , you listened to this episode . Or like heard that episode where you was talking about me , oh shit , you listen to this episode . Or like , five years later , you know you was talking about me , like I wasn't talking about you .

Yeah , you was talking about me as that attending who never did locums . Oh , that was you . That wasn't me . That , no , that was a different knee and I was just potting . So listen , renee , stop putting my business out there and then stop telling me your business . But yo , but that happens .

I can't think of any other job where you go to a job and during your interview for your job , they also take you on a house tour . It's like , come on , man , they're really trying to rope you in .

You know , locums can be very scary sometimes for people who haven't seen it done before , who've had a lot of things put in their head about locums and you're not sure you know that . Ok , fine , I'm going to start at least W2 and then maybe I'll make my way doing locums . And you're not sure you know that ?

Okay , fine , I'm going to start at least W-2 and then maybe I'll make my way doing locums , you know , intermittently , and then see if I can do it full-time . That's fine too , but you have to be able to ask the right questions , because there are certain questions that if you do not ask , that is going to be a problem . It's going to be a big problem .

What are you doing ? Oh , so the time is 1224 AM over here , so he's basically cutting me off .

But before we get cut off , I just want to say that we are going to be doing a presentation in conjunction with the Student National Medical Association , lmsa Latino Medical Student Association as well as Tour for Diversity , and we're going to be talking about becoming a savvy , a financially savvy resident . So that's going to be what ?

September 10th , yes , I think at 8 pm Eastern . So we're going to be what ? September 10th , yes , I think , at 8 pm Eastern .

And we don't know shit about that , really , because we went from 240 000 a month to 330 000 to become a savvy financially so that's what for green ?

. But if you go to the Tour for Diversity or T4D or SNMA or LMSA , if you go to their Instagrams especially , then you should start seeing the advertisements for all the different road to residency series presentations . So ours is just one in a series of presentations that's going on for the road to residency .

So if you are going to become a resident next year , if you're planning on graduating from medical school and going into residency next year , if you're planning on graduating from medical school and going into residency next year , you should be in this series .

So I don't think it's too late to sign up , but I do think that you should definitely visit either SNMA , lmsa or Tour for Diversity IG profiles and All right , y'all Sign up .