¶ Mona's Question About Locum Work
Previously on Docs Outside the Box . I'm currently living and doing residency in New York City . I like the city but , as you know , taxes are pretty high . Is it worth setting up a locums-focused LLC in another state solely for the purpose of reducing taxes ?
I would make sure that you figure out a way to start your business and maintain your business in the most tax-efficient way , as well as the most time saving way that you can do . That . It's going to be tough to , you know , really coordinate everything .
Because you live in New York , you're probably going to have to end up paying state taxes because you live there , and if you have your business in another state , you're going to have to pay taxes just to have your company in that state also . So my advice is just talk to a CPA about that .
All right , so Mona is going to have another question that we're going to answer today .
Taking all our time . Dag , mona , how many questions you got yo .
Mona got questions on questions on questions . Okay , so Mona , who is a third year neurology student , says after listening to your podcast , I've decided to pursue locum work after graduating in 2026 .
Good job .
Yeah , good job . I've been reaching out to some recruiting agencies to better understand the job market for neurology . Many of them request a CV either before or after an informational meeting . I wanted to ask for your advice Do you think it's okay to share my CV at this stage ?
I recall you mentioning the concept of exclusivity in your podcast , where an agency having your CV might limit your options . Could you clarify how this works and what I should be mindful of before sending it out ? Thank you both for your time and for the valuable insights you share on your podcast . Best Thanks for this question too , Mona .
Yeah , this is a great question Listen , cvs .
I'll be honest with you , mona . Cv is gold , electronic gold or paper gold , whichever way you want to look at it , but that's the currency that locum tenants companies work with , right ? Because that CV represents so much more than just you know what you've accomplished . It represents , as you mentioned , exclusivity , right ?
So the goal of a locum's company is to present physicians or nurse practitioners or PAs , or whatever it may be , to a hospital , a clinic that is looking for that specific position . And once that CV is sent to a hospital and they're looking at it , now that hospital is exposed to you , the practitioner .
And once you are exposed to a practice or a hospital or a clinic , once you are exposed , once they look at you , your CV , by that agency , then that is it . You are stuck in that type of you know , whatever that may be , that space , exclusivity with that hospital , exclusivity with that hospital . You're stuck with that agency in that fashion .
For usually it's about two years , right ? So it's not that just giving your CV to the company locks
¶ CV Exclusivity: What You Need to Know
you in . It's when the company , the agency , gives your , gives your CV to the hospital and then the hospital looks at it . Once they look at it , that's it . You're stuck in it , right , because it's based off of the introduction , right ?
So what I would say is this If you're looking at different agencies and you want to know how much you think you can get or what jobs are out there and they want to see your CV , that's fine , you can let them see your CV .
But you have to be very clear , and I would put this in an email and say hey , before you send my CV out to any hospital , to any clinic , to anybody , you need to have my written approval written approval right , you have to have a written approval from me , by email , that says that , yes , you can send my CV to this hospital , to this clinic , to whatever .
So here's an example you meet an agency you talk to , you know Nidarko and Renee agency and we're like yo , man , we're going to get you mad money . Yo , we're going to get you mad money working at mad hospitals . You want to do neurology ? Yo , we got you . Yo , we got you . But first you got to like credential with us .
You know , you got to give us your name . We got to know all the different malpractice things you're in . We got to know where you got your education . We need all that stuff , your degrees , all that , and we also need your CV . And you're like , hmm , they sound like they're dope , you know , look how they talk , right .
And um , listen how they talk and stuff , right , they sound like they're woke , right . Uh , let me , let me sign up with them , right .
So now , when you do that , I may say , once you sign up with our company , right , we just say , ok , well , listen , there's like a whole bunch of different hospitals that need a neurologist and you know , we want to send your CV to Hospital A so they can consider you for a job that's going to pay you X amount of dollars .
We technically cannot just send your CV to that hospital without your permission , right ? But I know earlier you heard me say make sure you send an email that says that . So I'm gonna tell you right now . Sometimes you have some really overzealous representatives of that agency who will just submit your CV .
Everybody don't care about the contract .
Right , trust me , particularly , you'll see that at smaller companies , right , you'll see that smaller agencies or agencies that may be run by other doctors , or agencies that may not really know , like , the national guidelines of this stuff , right Now told , they may not know the now told guidelines of this stuff .
Right , nalto , they may not know the NALTO guidelines of this stuff and they'll submit your CV for you and you may not know about it . And then now you're in this hospital system or you may not be able to go to a certain hospital system because , let's say , this agency that sent you said , hey , we're going to pay you 150 bucks an hour .
Meanwhile , you found another agency that you signed up for . And that's okay , guys , you can sign up for multiple agencies , right , you don't have to just go with us . You can go with all these other different agencies , right , because there's thousands of opportunities out there . Right , you can go with different hospital or different agencies , excuse me .
And let's say , for example , you
¶ Protecting Your CV: Written Consent
know , hospital A decided to contract with multiple agencies and now the agency B is like hey , we'll pay you $200 .
For the same hospital .
For the same hospital , but you can't move that route anymore because agency A already submitted your CV to that hospital . So now you're stuck in that 150 zone . So that's why it's super important that , yes , you can work with different agencies . That's great . I actually recommend that .
But the key thing is to always email them and say please , do not send out my CV without my written how do you say it ? Use your my expressed written consent , right ? So that means they got to email you and ask for your permission before they submit your cv , and usually that's .
It usually works like this okay , like we got this job that I think you'll be perfect for . Um , they do x , y and z . Can we submit your cv there ? And then you think about it and then you write back yes or you say no , and that's it yep anything you want to add on that .
Yeah , I mean it's not just for locums jobs either , right , so you have to be really careful , even if it's just regular recruitment , right . If you have different recruiter agencies that potentially are looking for jobs for you , for even permanent positions , you have to be very careful about that as well .
Yeah , because that's how they make the money .
Yeah , the fortune is in the referral . Yeah , right , the fortune is in the referral . So you just have to be really careful . So this is you know . This is where we say , yeah , we talk about locums a lot . Right , like we said . Dr Love said oh , we talk about locums a lot .
We do talk about locums a lot , but there are some , there's some overlap with permanent positions and you know , you just have to know . Just because you know . Let's say , for example , you say you know what I'm going to do , locums . You decide that you're going to sign up with an agency or agencies and you submit your CV to the agency .
The agency asks hey , can you , you know ? Can I submit your CV to this hospital ? You say , yes . You decide , however , you want to work permanently at that hospital , for whatever reason . You're like , oh , bump , locums , don't want to do that anymore , I want to work here .
You're going to have to talk to somebody because you can't just decide that well , this was for locums and now I don't want to work locums anymore . You're going to have to talk to somebody because potentially , this happens a lot .
They might have to buy you out . Right yeah , the hospital usually has to buy you out . Yes . So the agency has a , has a relationship with the hospital , says hey , listen , we're going to send you this doc , but you can't just take them Right .
You can't just let's say because this happens , people will come and be like yo , I really like it here , like this is amazing . I know I lived in New York city , but I really like it in Blackfoot , idaho . I want to live here , I want to work here permanently , no-transcript and all these different things . You like it here .
And you'll be like yeah , that's great , I'll do it . And it's like but you can't do that .
Guys , you cannot do that because you're there under the auspices that you're working with an agency , right , and in order for the hospital to hire you permanently , they got to pay Yo , they got to pay that agency off , and sometimes that might be like 50K , 50 stacks or 100 stacks , right , the agency wants their money .
So if you're not going to be working for them anymore , you won't . We don't have to need some type of compensation . It's like the music industry .
It's a damage , right , it's a . It's a damage to the agency , right ? That you were going to work and now they are losing you as a source of income . So it's a damage , so they essentially have to get compensated for that .
But I think sometimes people listening to this they're like man , there's just so many things that I got to , there's so many things I got to worry about with locals . Maybe I shouldn't go into it Like guys . It's not like that , like there are things that you got to worry about , but there are
¶ Hospital Buyouts and Permanent Positions
things you got to worry about if you was employed also . It's just . It's just something to just keep in the back of your mind . You know , and you can ask people , you can ask us . Don't be afraid . Don't be afraid to jump into logos just because it's just certain things that you weren't anticipating . But I know there's a lot of people who are like that .
Yeah , there's no problem . Free . There's no problem . Free industry , right , like you're just going to . It's just a question of which problems are you going to encounter , that's all . But this was a really good question because I think a lot of people don't necessarily realize , when they start working with recruiters , exactly what is happening .
You know what is happening ?
And so engaging with a recruiter , you know . You just need to know , you need to understand what is the agreement by which you are working with this agency , by which you are working with this recruiter .
So be careful . One thing I would say , too , is listen y'all . Like . I think the advice we give to Mona this is good , right ? She's probably listening like y'all ain't saying my name , right ? Y'all , you should write you should when you write in next time and let us know we're not saying your name .
Right , like like record like pronunciation yeah , Give us a pronunciation if we're saying it wrong . So we we apologize if we say it wrong , but Mona .
Damn . I'm just saying , you just had to say it like that , but Mona .
Listen , I would say this Remember , you are in control , you are always in control of this situation and you should act appropriately , Right ? So you know , when you're talking with a , when you're talking with a representative of the agency , just make sure this is more of a partnership .
Make sure you are like really directing what you really want , Right , Don't be led lead . Okay , and I'll tell you about my example of how I didn't lead . So you know I was working when I first started after fellowship . You know I said I'm going to do locums and listen , like I had never made more than what ? $50,000 .
Right , I never made more than $50,000 being in residency . And then I started doing um , I started working with a locums company and , you know , at the time trauma surgery was really like in need . It still is really in need .
But I was young , I wasn't married , I didn't have any kids and you know , they would tell me about all these different jobs and I would just let them kind of just lead me to all these different places without really necessarily thinking about what it's doing to me .
And there was that one point where I just said look , here's my calendar , you can fill it up , you can fill it up for me , right . And that was a big mistake , guys . That was a big cause . I was like yo , I'm just trying to make money , yo .
And that was a big mistake because what ended up happening at one point is I worked at one hospital and I worked a night shift . Sorry , I did a 24 hour shift , right , I worked on a , I think it was like a Monday or Tuesday . I worked Monday 7am and I finished . No , no , sorry , I fit .
I worked for a whole week , right , not straight , but I worked for a whole week . And then the last shift was was like on a Tuesday and I did a 24 hour shift and I finished Wednesday morning and I was supposed to be at a place two hours away and work starting at like one o'clock PM , right . So I want you guys to follow me .
Right , I was supposed to be finishing my job at 7am on Wednesday morning and I was supposed to be finishing my job at 7 am on Wednesday morning and I was supposed to be at a place two hours away and start working at 1 pm , right .
So you know and the locums person knew this , but you got to remember , like , their focus is how much throughput can I get this doctor , this nurse practitioner , this PA , this respiratory therapist , how much can I get this person to work ? Right ? There's no way that that person didn't know that and ultimately , it's my fault .
I should have checked the calendar , but I was so big on like I gotta make money .
Ultimately , it was your fault . You should not have given him your calendar . That was your first mistake
¶ Taking Control of Your Schedule
was giving him your calendar .
Look at Renee reading me . Look at Renee reading me .
Absolutely . You should not have given him . Let the record show . Can you say that first Let ? The record show that you gave him the calendar . You opened yourself up to a vulnerability right .
Yes , I did , yes , I did .
He essentially took advantage of that .
Like we say ain't nobody , you can't your money . Nobody's going to care about your money more than you , and nobody's going to care about your schedule and your working life more than you Exactly .
Nobody's going to care about your time more than you , and so you know . What you don't want is , like you said , to be led . You want to be able to lead and you can say no If someone calls you and says , hey , you know , I have this , I have that and I can't do it . You know , I just I can't do it . Here's when I'm available .
That's what I do love about locums . Is it really ? After you get into the groove of it , you really start to understand what your time means to you .
Coming from medical school and residency , or if you're doing fellowship , you're always on someone else's time , right , and every time that you're on someone else's time or rather , I should say any time that you decline being on that time on someone else's time you are always worried that it is going to cost you something . It's going to cost you an opportunity .
It's going to cost you , you know , clout . It's going to cost you clout . It's going to cost you appearing to be a really good resident or a really good fellow . It's going to cost you something . What's great about locums is it's not going to cost you anything . It's not to say no and decline to be on someone else's time .
It's not going to cost you anything , because here's here's what you need to understand . If you can't work in the way that someone wants you to work , then that wasn't the work you supposed to be doing in the first place . That's it , and so there are plenty of other opportunities out there for you to be able to be very efficient with your income .
You got to practice that muscle .
You got to practice that muscle early on , early on . To say no , but I can do this or no , I'm just not available .
Right .
And that's it . It takes a while , it takes a lot , you know , but you can do it and it helps you in the rest of your life also . Um , I remember there was one place that I was working locums at and it was , let's just say , time . It was time for me to move on to another job . Like , emotionally , it was just too much .
And there was a point where , um , from a working with coworkers , I just did not enjoy it . And there was a point where , from a working with coworkers , I just did not enjoy it . And there was a point where I was just like getting upset at them and Renee had picked up on that and she was like , just don't go back anymore .
And I was like , well , I can't . She's like , but you're a locum , so you could just say you don't want to go back .
You don't want to go back there .
I don't like it and I , like , had dates coming up like several weeks in advance . It was outside of the 30 day window , but I had weeks that I already set up and everything . And I remember I called him and I said you know what guys , I'm not going to work X , y and Z anymore , I'm done . You know what they said OK , thanks , and that was it Right .
And I spent so much time focusing on what they're going to say . If they're disappointed , are they going to be mad about it ? All these different things . And I just learned , right , they don't even care , they just want a warm body to cover whatever it may be .
And probably they also knew that look like this relationship is not really working anymore and I was glad to leave that place . And you know what ? That program doesn't even exist anymore . So , yeah , you know what . But the most important thing is this listen the way how they treat people they know who they are the way how they treat people .
You just gotta you can't treat people like that , right . But the most important thing is this guys , like you know you're in control , particularly once you finish , excuse me , actually , to be honest with you , you're in control , even in residency , right . It's just , you really got to start practicing that muscle , right , you got to start practicing that muscle .
I know I know you don't , but you are , you know , like , because you can , you can , like we talked about , even in that bullying episode , right With Dr Bill Brew , right , which was amazing .
Yeah , right , there are times when you come in there's certain power dynamics , hierarchical dynamics , but you can still let it be known that look like you're not the one .
Yeah , I mean always set boundaries for sure .
Right , You're not going to come in like Denzel Washington . Like yo , I'm King Kong and I'm putting everybody in Pelican Bay . You motherfuckers will be playing basketball in Pelican Bay when I get finished with you . King Kong ain't got shit on me . You're not going to come in like that in your residency .
But also , at the same time , I think there's a way that you can learn to be . Look at that . Oh man , I hope he's not like that in Black
¶ Setting Boundaries and Comic Relief
Panther . Don't let him do that in Black Panther . He's a coogler . Don't let him do that in Black Panther .
Yeah , I need to see . First of all , hold on , hold on , I'm going to go off on a tangent real quick . Ok , listen , denzel . If you are out there listening , I want you to get with Zooming on Renee Keep talking .
Zooming on Renee . Alfred Zooming on .
I want you to hook up with the coach , your African dialect , african accent coach now .
Oh , but he did it with Stephen Biko . He did it before with Stephen Biko . It was good , it was all right , that was like 30 years ago for Cry Freedom , but he did it with Stephen Biko .
He did it before with Stephen Biko . It was good . That was like 30 years ago for Cry Freedom , but he did it . It was all right . It was all right , but I want him to do that today .
Wait hold on ?
Didn't he do a Jamaican accent once , don't you notice ? I've gone down road until 4 pm , which is at least five hours away , seven days a week for the last 10 years . So what are you doing , coming up it ?
Hold on a second . Who's the guy who got killed ? Who's the guy who got killed by Killmonger ? What was his name ? Forrest Whitaker .
His African accent is an accurate Listen , this is why they killed him off .
Yo listen , nothing can be as bad Guys , nothing can be as bad as Will Smith's African accent . All right , if you continue to deny my work , the world will deny my work . But , men , you're a man . Continue to die , tell the truth . Nothing can be as bad as that . So Denzel Washington has the floor is really low .
Okay , so all of this , like you can't do none of that , no , no , no , it goes like this , like this this is a Denzel finger .
You think you could do this to me , black Panther ? And then no , but sometimes he does both .
That's not allowed . You can't do that . You can't do that .
Sometimes he does like a like , like he's typing Like this , like this , but it has to go like this . It's got to come up and drag a little bit like that .
All right . Now you dragging it out too much . You dragging it out too much , all right . So let's get back to answering this question . Oh , where was I at ? I forgot where I was at . Listen , mona , you got this . You got this , mona , you're in control , you're in charge .
Listen , everybody who wants to write in and ask us some questions , renee , tell them how to , how to .
So you can do like Mona did and text us . She texted us , both of us .
How did she text ?
She texted us both of those questions , so you can text us like Mona did um Limith Rock , land it on us . You can text us like Mona did .
Plymouth Rock . Land it on us .
Land it on us . You can also send us a message in our DMs on Instagram , tiktok . You can write a comment on any of our questions or , excuse me , write a comment on any of our posts on YouTube , on Instagram , tiktok , or you can go to our website , docsoutsidetheboxcom .
Or , if you just go down below , you'll see our fan mail as well as our text number that Mona used . So you can do that , but there are lots of different ways to get in contact with us , and we love , love , love , love , love , love , love getting questions from you guys and answering those questions . So keep them coming .
We have so many questions that we need to answer , I feel like I'm Batman .
I feel like we're Batman . We're going to answer those questions , guys . We'll talk to you guys later , peace .
Peace .