WCI #328: A Conversation With Locums Docs

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White Coat Investor podcast number 328, a conversation with career locum stocks. If you're looking to boost returns, lower taxes and build wealth, join the WCI monthly Real Estate Opportunities list for tips and strategies to maximize your real estate returns. And for introductions to exclusive investment opportunities, expect educational emails that introduce you to syndicators, fund companies, online courses, and online real estate platforms. Go to whitecoatinvestor.com reopportunities to sign up today. You can do this and the White Coat Investor can help. Today we're going to be talking about Locums. It's apparently Locums Month. As you're listening to this. I didn't even know they had Locums Month. They got a month for everything these days, I guess. But it's a great time for us to talk about Locums. So today's podcast is going to be a conversation with a couple of docs who are doing Locums. Like that's all they do is locums. So you can hear a little bit about what locums is, what it's like, and maybe dream a little bit about the options for you and how your career might change if you started doing that part time, full time, et cetera. Before we get them on the line, we ought to tell you about a few other things we got going on. First, let's do our quote of the day, and this one's from Dave Ramsey says a budget is telling your money where to go instead of wondering where it went. And I also want you to be aware of a sale we're doing. This podcast drops August 17th and that's the first day of the sale. And this is a podcast sale. Okay? So it's only for you podcast listeners. If you put in code podcast 200. You get $200 off any of our White Coat investor courses from now through the 25th. So. So it's just the next week. $200 off any of our courses, our real estate course, our fire your financial advisor course, the version of that that provides CME so you can use your CME funds, our continuing financial education course for this year. That's CFE 2023 again, that qualifies for continuing medical education funds. All you need to know is the code. Podcast 200, get $200 off. So check that out through August 25th. Also, we're going to try something new on the podcast. We're always trying new stuff. Let us know how you like it, how you don't like it. But we're going to do a little bit of a live speak pipe, if you will. We want people who want to come on and ask their questions directly to me and have the chance to ask some follow up questions. And that's good not only for you, but also for me. I can ask some follow up questions because sometimes on the speak pipe I don't get all the information I need to really give you a good answer to your question. So we're going to spend five or 10 minutes together and we'll put these into the Q and A episodes. So apply for that. Send your question to podcastquestionitecoatinvestor.com that's podcast question just like it soundsitecoatinvestor.com we'll choose a few of you to come on and the rest of you tell us how you like it. If you guys like it a lot, we'll do it more often. If you hate it, let us know that too. All right, let's get our two friends on the line here and we are going to talk about all things locums and get into the nitty gritty details of what their life is really like doing this. All right, our guests today on the podcast are Dr. Chad Green and Dr. Daniel Shin. Welcome to the podcast.

Thanks, Jim.

Thanks for having us.

All right, so both of these doctors have been doing locums now for a while, but we're going to get to hear their stories and then we're going to kind of compare and contrast a lot of things about what they've done. So why don't we start with you, Daniel. Let's start with you telling us a little bit about your career path. At this point, just take two or three minutes and kind of tell us about your career to where you're at right now.

Sure, that's a little bit of a story, but I'll try to be succinct. Basically, I'm a urologic surgeon and I did my training in Southern California in Los Angeles, and I did my residency there and I went immediately into practice in Southern California as a general urologist. And I was good at my job. I liked my patients, my patients liked me. But it was only a couple years into my practice when I started feeling a little burnt out and I wasn't exactly sure what was going on. You know, There was a 10 hour commute in Southern California traffic. And there was a 50 to 60 hour.

Did you say 10 hours?

10 hours, yeah.

So like 10 hours a week.

10 hours a week, yeah.

Okay. All right.

Not every, not every day. You know, it was a. It was about an hour each way or an hour and a half if I got unlucky with traffic. So that on top of a 50 to 60 hour work week, even though things were very good with the job, it started to wear on me. And, you know, just two or three years in, starting to feel a little burnt out was a little bit disconcerting because you don't think that you're going to be experiencing that as a young surgeon. So I think that's really where sort of the roots of my transition to Locums medicine kind of started. Because it was at that point where I started to think of a life where I had a little bit more time for the things that I was interested in. You know, things like looking for things outside of medicine, like real estate investing, which I'm very interested in. And also writing on a blog, which is something that we share. You know, I started a the Darwinian Doctor blog as well. And I started to indulge these passions sort of as a solution for the burnout. And then after a few years, these passions started taking up more and more time. And then as I kind of went along in my career, I didn't really see a way to sort of have everything at once until I sort of had an opportunity for a big change and my wife got offered an incredible career opportunity outside of Los Angeles. And after about six or so years in my job, I decided that it was time to make a shift as well. So we took a leap and moved from SoCal to Tennessee. And I eventually settled on Locums as a way to sort of have it all.

Very cool. All right, let's go to you now, Chad, tell us about your career path at this point just so people can get to know you a little bit.

Yeah.

So I finished my residency in 2019 and actually had planned to practice in Tennessee, the kind of the small town that I grew up in. Interviewed there, interviewed quite a few places throughout the country and really wanted to stay in this small town, stay close to family, and ultimately was able to line up a job with this group that I wanted to get at so bad. However, the kicker was they weren't quite ready for me yet, so. So I had about a six month window to find something else to do. So at the time we had, let's see, two kids and my wife was pregnant with our third, I believe. So we're thinking, what should we do for six months? I definitely have to work somewhere. I trained in Nashville and the academic institution there had offered me a position that I thought about taking. But ultimately, after some thought and prayer, my wife and I decided it was time for an adventure. And I had a friend that practiced up in Alaska, an anesthesia group there. He said, why don't you just come out and work with us, have a little adventure and I bet you'll fall in love with it and want to stay. So I was thinking, well, give that a shot. My wife's from Texas, so I don't quite sure what she's going to think of Alaska as the cold sets in. But make a long story short, we loaded up the car with our two kids, myself and my wife who was pregnant, and we drove all the way from Nashville to Alaska over pier period of two weeks. Had a phenomenal time. Of course we didn't have any money, so we camped along the way with one eye open, hoping no bear, bears or wildlife would come and get us in the tents at night. But we eventually made it to Alaska, had a phenomenal time there. And I had basically just worked directly with that hospital group and then just worked a week at a time, 1099, and then definitely took some time to travel while we were there as well on the weekends. I learned at the time that there's nonstop flights to Hawaii. So towards the end of November there, when it was getting pretty dark and cold, we loaded up, the family, flew down to Hawaii for a week and then came back. So we were there from July all the way to the end of December, after which I went back and had joined this group in Tennessee that I grew up in. So it's of kind, kind of one of those things. Before we settled down and knew that we would likely stay here for the rest of my career. We just wanted a little adventure. And then along the way we really fell in love with that lifestyle and from a family standpoint, just had a great time doing it. So I actually have been going back usually two to four weeks a year to work with that same group just to say hello to everyone and just have a good time, have a change of scenery. So, and that's, that's, that's my story with Locums so far.

You know why those flights are non stop to Hawaii, right?

Yeah, very little land along the way, nowhere to stop.

Yeah. You know, your story almost mirrors my parents. In 1973, they took my two older sisters bundled them up into a camper and bought a trailer and drove the Alcan to Alaska over two weeks. You know, camping and fishing along the way.

How cool is that up there?

My dad stumbled into a job. He's been there ever since. So I was born a couple of years later. But, you know, it's a wonderful place to. To be. So which two to four weeks do you spend up there now? June.

I usually go back for the first salmon run. Really got into fly fishing there. So I'll typically go and do some salmon fishing. And then they did talk me into coming. They had a gap to fill in March at one point. And I'm thinking, oh, March, you know, that's springtime. Well, it's not springtime in Alaska. So I drove to the hospital one night on call in a blizzard, and finally I called and I was like, all right, I don't know where I'm at, the street signs, I can't really tell. And wasn't really prepared for this, but I finally made it. So most of the time, I try to go back in the summer, though.

Yeah, awesome. Well, Alaska, as you know, is near and dear to me. Place I grew up for 18 years, so I know your stomping grounds up there very well. You know, it's interesting. You talk about what you enjoy and all your other interests, Daniel, that commuting was not one of them. You know, it's interesting. The studies show that commuting might be the thing that makes people most unhappy. And yet how many docs are there in Southern California that commute for 45 minutes or 60 minutes or 90 minutes each way? What did you learn moving outside of Southern California and perhaps having a bit of a more normal commute, about how commuting affects your happiness?

You know, I think you're right. I think commuting is actually an incredibly big part of everyday life. You know, and in the beginning, I rationalized it. You know, I said, you know, we don't have to move. And I could. My wife can continue her job, and I could commute to my job, and I can use that time. So I started listening to podcasts, and eventually I got a Tesla so I could put it on autopilot and sort of zone out. And that helped up to a point. But, you know, after a few years, there's only so much you can do. You've listened to all the podcasts, and you've educated yourself as much you can within the confines of the car, and then you just start dreading it because you're tired after a long day, and then you still have to get in the car and you're not going to be home for an hour or two in Southern California traffic. And there's so many advantages in terms of lifestyle to Southern California, but the commuting is certainly one of those big detractors. And it. I moved to Memphis, so we're both in Tennessee now, I guess. But it is eye opening. You know, the fact that you can get anywhere in town in about 10 to 20 minutes is just amazing. And then, you know, you. I somewhat miss that time in the car because it's this alone time when you can have it to yourself and really think about things. But I certainly don't miss it enough to want to go back to that 10 hours a week.

You know, if you think 10 to 20 minutes is good, you should try moving to Anchorage. We thought it was a big deal to have to drive eight minutes. The old joke is that Anchorage is 10 minutes from Alaska. Any direction you drive 10 minutes, you're in real Alaska instead of in the city. Okay, so now, Chad, you are settled down. Sounds like 11 months of the year. You're in this dream job in this small town in Tennessee that you wanted so much.

That's right. Yeah. We had our fourth child now, and we decided probably best just to kind of have a little bit of a more stable lifestyle for them. My wife and I homeschool them. So we do have. And I have about 12 weeks on average of vacation a year, so we still travel a good bit. Some of which is going back up to Alaska and doing some locums, but for the most part, yeah, settled down. My mom and dad are also in this little town I grew up in. My two sisters are here, so it made sense for us to be close to them. And we're pretty close with our family, so it didn't quite make sense for us to. To go back and move up as hard as it was not to do that. Yeah. So we're here. I do a little farming with my dad and help them out. Yeah. For the most part, have enjoyed kind of the stability, but still being able to kind of have my foot in the water as well. Going up and still having a little adventure from time to time.

Okay, so how does this work every time you go to Alaska? Are you working through a locums agency or you just have a relationship now that they just call you directly or how's it work?

Yeah, I've never worked through an agency, so this initial job was through a friend that actually practices in that group. So continued to just do 1099 work directly through them.

So how's this work? Right, you call them up in March and they're like, yeah, we'll have you in June again. We'll pay for a rental car in your Airbnb and we'll pay you so much a shift or how's it work?

Yeah, pretty much. So we pick our vacation weeks for the year every October and then I could pretty sure the gentleman that I work with up in Alaska, he, he has a calendar set or an alert set because I'll get a text the first week of November. He's like, hey, when can you come work? So I usually try to, like I said, section off some time up there. But yeah, they, they pay for my flights. The time we were up for the six months after residency they had rent, did a long term rental on a little townhome there. So that was great. Didn't have to worry about the hotel life. So we had kind of our own little house there. And yeah, so we just. Now I'll go back and stay in a hotel and then just rent a car. However, last time I went found that car rentals, if you book them, the last minute could run out. So that could be a little bit difficult depending on where you go to.

Yeah, for sure. Alaska in June is not a good place to get a car rental. Yeah, it's not, not cheap and not easy to get. For sure.

I remember hearing people renting U haul trucks as their rental cars up there.

Yep. Because it's cheaper. Yeah, exactly. Okay, so does your family go with you every time?

They haven't gone the last two times. But the plan is for this next year for us all to. To go up and enjoy it together.

And how much do you work when you're up there?

Usually I'll try to go for at least two weeks. I have gone for a week at a time. When I go by myself, I burn the candle at both ends. So I fly in, usually catch a red eye Friday night and then I'll take call starting Saturday morning and then usually I'll take a first call the next Saturday if I'm there for a week and then fly out Sunday to get back to work on Monday just to try to make it most worthwhile. But if we go for two weeks and the family's there, I'll usually work for five days, take a couple days to go fish and sightsee and then just work some more before flying back home.

And do you typically get paid more than you do at your regular gig in Tennessee, or is it about the same or is it less or how's it usually work out?

So right now I'm on a four year partnership track with my group and I'll make partner this January, so it'll get much better at that point. But currently, yeah, make a lot more doing locums. Certainly enticing to just, you know, if it were just me and didn't need the stability, that would be a great route to go. Learned a lot about small business management and retirement planning doing the locums route. You could certainly make a good bit of money doing it that way.

Daniel, let's turn back to you. Tell us about your work life. Where do you work?

So I work right now in two locations. I work in Ohio and I work in Oxford, Mississippi as well.

Okay, so how many days a month do you work in Ohio and how many days in Mississippi?

So basically I'm a bit newer to locums than I think my colleague here is because I started it about five months ago, because we've only been in Memphis for about 10 months and it took us a while to get situated and it took me a while to settle on locums as the way to go. But for the last five months, I've been splitting my time. I used to spend about one to two weeks a month in Ohio, and now I've been splitting my time a little bit more evenly some time in Ohio. And I started working with a group down in Mississippi as well. Mississippi is drivable and Ohio I have to fly, unfortunately, and transfer in Atlanta because there's virtually no direct flights from Memphis, unfortunately.

And so total, you're working what, 12, 15 days a month or what's the total amount you're working a month now?

So it was about 14 days a month. So about half the time. I'm trying to scale it back to about seven to day, seven to 10 days a month, actually, to leave the rest of the time for business.

Okay, so, you know, at 14 days, I mean, that sounds almost full time to an emergency doc, but that's probably less than full time for a lot of urologists. But was that deliberate? Was that part of the motivation to go locums, to be able to easily cut back to a part time gig? Or why did you decide not to look for a job in Tennessee, for instance?

So I did, I initially did talk to the private practices here in Memphis. They're great groups and I had a really nice time exploring that option. But when I came down to it and did a little bit of soul searching. I really did want the ability to A, have a lot of control over my day to day, and B, have the ability to spend sort of uninterrupted chunks of time working on things outside of medicine. And it's really tough to do that as a private practitioner, urologic surgeon. You know, you've got clinic, you've got the messages coming in, the results, you've got the surgical center and your scheduled cases. So when I thought about that, I thought that locums would just be much more compatible. And I'm not, I'm not ruling out that life, you know, in the entirety, but I thought it'd be a really great experiment to try and try to gain that autonomy. And it's very efficient, sort of time and income wise to do locums. So we looked very critically at our, our spending and what my wife is making and what I was expecting to make on locums and figured that we could do this where I essentially am just doing about a week or a week and a half of medicine and very easily covering all our, all our bills.

Especially when you get the cost of living in Memphis versus Southern California.

Yeah, certainly real estate is a lot cheaper out here. We were able to buy a house out here for about a third of what it cost in Los Angeles.

Yeah. And the tax savings must be substantial as well. I can't remember, isn't Tennessee one of the tax free states?

Yep.

Yeah, absolutely. Cool. Okay. So how is your practice different? I mean, for an anesthesiologist, for a hospitalist, for an emergency doc, for, you know, radiologist? In some ways, we're plug and play. Right. You get inserted in, you do your shifts, you're done, you walk away, nobody's calling you. That's not the case for most urologists. I mean, when you go to Ohio and you do some operations, who covers those patients after you leave?

So this particular location, there's some permanent urologists who are full time, and then they have full time locums coverage as well. And basically the way it works is that my main role when I'm there is covering hospital call. And that includes seeing the ER consults, seeing the inpatient consults. They do schedule cases for me during the day as well. And I also have some, I see some patients in clinic as well. So it's actually a pretty malleable situation right now. And when I'm gone, it's either the next locums kind of taking care of the patients, or the permanent Urologists, and it's actually pretty seamless so far.

Have you talked to them about why they're using locum docs instead of trying to hire a doc that's living there, that will move there or that will be there full time? What do they tell you in when you have that conversation?

Yeah, we've actually talked about it pretty frankly. And when I first started locums, I also helped a hospital that's very similar to this hospital in sort of the southern tip of Mississippi. And it was actually a very similar story. The places where I'm doing locums in Ohio and that initial place in Mississippi are not. It's not like Cleveland, you know, it's about an hour outside of Cleveland. And this group started out with six urologists a number of years ago and then just through attrition shrunk down to four, and then over the last year shrunk down to two. And this was, I think it's reflective of the physician shortage that's particularly acute in urology. But I think it's also just telling that the towns outside of the main cities sometimes struggle to attract full time people. And they saw locums as a way of basically getting the coverage they needed. And it was a very, very similar story to the first place where I did locums as well.

It's not that the job is bad, it's that nobody wants to live in the town. Is that fair to say?

Well, yeah, I guess the job is not bad. The job is very busy and like all hospitals, I think there are challenges that they're working through. You know, various things could be tuned up, but I do think geography does play a big role, for sure.

And when you go out to these gigs, whether in Ohio or Mississippi, how do you feel like you're treated? Do they welcome you? You know, open arms? Glad you're here. Thanks so much for being here. Lots of respect. You're the expert coming in from outside or are you the chump? The, you know, the Locums guy, they don't even talk to him. He's going to be gone next week. Guy, how do you get treated?

You know, I would say that overall the reception's been really good. And, you know, maybe part of it is because that I feel that I had a, a good training and I came fresh and young and energetic. And I think that when I'm doing locums I'm trying to do the absolute best job I can. But I think that the reception has been really good and overall they've been really happy to have coverage.

Now, Chad, kind of the same question to you. You're going back to the same place over and over again. They obviously like you or they wouldn't text you every November. You're helping them, whatever they're doing in June, go fishing or whatever. Do you feel like they treat you like a member of the team or how are you treated?

Yeah, absolutely. I get a Christmas card from the OR staff every year, so I feel like that means I've reached a certain tier there. But, yeah, I stay in touch with a lot of the docs that I've met, as well as some of the nursing staff throughout the year. Even one of the radiology techs, we go down and, you know, do some anesthesia down in radiology from time to time. Befriended him and we. We're still trying to plan a moose hunt at some point and he'll text me from time to time. But yeah, made some lifelong friends that I didn't really expect. Going straight from residency to there. I was super nervous about it and thought I would just kind of go in, do my job and get back out and, you know, rinse and repeat the next day. But along the way, made some great relationships and some lasting friendships. That keeps us coming back.

Very cool. So I think you said earlier, Chad, that you've always been paid on a 1099. Have you always been paid on a 1099 as well, Daniel?

Yeah, it's been 1099 so far. But a new development is that I basically worked out an arrangement with the hospital in Ohio directly. They actually asked me if they wanted to buy me, if I was okay with them buying me out of my contract and contracting with them directly. So starting next month, I'll be a W2 with that particular hospital.

Okay. So are they going to offer you benefits being as part time as you are, or what do you expect from that situation?

So they are offering me some benefits, but I didn't really need health insurance because my wife has that. So it's sort of a bespoke package that is specific to my situation. So I think I get retirement but not health insurance, for example. And they are covering malpractice and transportation and lodging and the rental car as well.

Okay. And I assume, Chad, you're just using the health insurance you have with the regular group since you're only going for a couple of weeks now?

Yes, sir. Currently I'm doing that. I will say that wasn't something I really thought of when I stopped residency and before I started with my other groups. So health insurance, we had to just visit the marketplace and that was quite expensive from what I remember. So thankfully don't have to do that anymore.

Have either of you opened a Solo 401 for the 1099 income you've had?

So I haven't yet, but this is the first year that I'm doing this, so I'm curious to see what Chad has to say about that.

Yeah, so as a medical student, started reading White Coat Investor and then also throughout residency would visit the forums from time to time and knew that was something that I probably should do. And so, yeah, the first paycheck, I opened up a solo 401k at eTrade at the time and started contributing to that. And now it's still something that I'm able to contribute to from time to time, depending on how much 1099 work I do and able to save a little bit more.

Very cool. Now, Daniel, you've got a blog. I don't know how much money the Darwinian doctor makes. And also a growing real estate empire on the side. Without those two side gigs going, do you think you'd be able to do locums?

Yeah, for sure. I mean, you know, I. I'm very transparent in my writing on the blog and I basically make twice as much per hour as I did as a well paid, full time urologist in Southern California. And I think that's pretty typical for Locums. So totally without the real estate investing, without the blog. The blog doesn't make much money, to be honest. We would be totally fine with me still doing the same amount of locums as I'm doing now.

Very cool. It helps to double your income, at least on an hourly basis, even if you're working less. Very cool. All right. Do you feel this is probably more for you, Daniel, because you're now all over the place, but you've experienced staying in one place for a long period of time. Do you feel like you're missing anything in your career by giving up that experience of being one place where everybody knows you, et cetera?

You know, that's a good question, and I think you're right. So I think a large part of the enjoyment of being in medicine is having a team, especially if you're in a specialty that has a clinic or if you're in the operating room. A large part of the joy is interaction with your coworkers. And I really enjoyed that part of my job in SoCal because I had a team, a department of 14 urologists, and we had so many team members. And it was really a joy just kind of socially interacting with them on a day to day basis. And you do miss that. When you're on hospital coverage or when I'm on hospital coverage, for example, it's pretty much me. You know, I'm the person. I'm going around seeing the consults. I do have some mid level support in Ohio, which is great, but after rounding, it's pretty much me. And certainly in the middle of the night, it's just me. And you know, I think that is one of the downsides of doing purely hospital coverage type locums. You know, it's. It can be a lonely existence. Honestly, one of the reasons why I started and exploring this other locums gate down in Mississippi more recently is that I am in the clinic and I am doing very typical sort of regular urology things. And that interaction with patients in the clinic setting when they're not in extremis from renal colic in the er, you know, that can be a lot more rewarding, I think. So I think you do lose a little bit by going locums, depending on the way it's configured.

But I imagine you don't have that same concern, Chad, given that you're only there for a few weeks now.

Yeah, not necessarily that I have started. There's another locums gig that we've been asked to pick up also in Tennessee, helping with some weekend coverage. And so I will say, you know, I feel like locums is very different from site to site. And it's probably one of those things where, you know, once you get to know everyone, you know, things fall into place. But there's certainly different environments and different flavors of hospitals and groups. And I think it's just one of those things where you have to kind of go and see if you're a good fit for each other.

Let's talk about malpractice. What kind of malpractice coverage do you guys have when you do locums?

Yeah, so the, the group that I worked with up in Alaska just took. Took me in under their group's malpractice. I know some other places you're required to provide your own. That was something that was a little bit kind of scary, I guess I could say coming out of residency and you're thinking, well, I'm brand new to this. I want to make sure I've got good coverage in. Then in the back of my mind I think, oh, I'm going to Alaska. I don't know, you know what all Resources there's going to be there. But some certainly was something that was good knowing that there was malpractice coverage in place, didn't have to use it.

Thankfully for me, the malpractice was covered by the locums companies and that's still the case. And they contract out to whatever companies provide this type of insurance. And it seems fairly typical. They include tail coverage and all that. And since I'll be employed directly from the hospital in Ohio starting next month, I'll be on sort of their physician hospital plan.

Let's talk about control over your schedule. I mean this is a big reason why people go do locums is they want control. They want to know what weeks they're going to be working, what months they're going to be working. How much control do you actually have over your schedules when it comes to your locums work?

Well, for me that's one of the best things about it. You know, I think on a day to day basis I'm much happier because I do feel much more in control over my schedule. And I think autonomy is this really big, big component of happiness. And I basically tell them when I'm available and they have preferences and they may make some asks in terms of scheduling, but in the end it's pretty much up to me. I can say I'm available these dates and we'll kind of craft a schedule around my availability. So in terms of control, I think that's one of the benefits of locums for sure.

Yeah. And for me I think it's really a two edged sword. I do miss the ability to create my own schedule. And if we wanted to take a week to go to Hawaii, you know, can't necessarily do that since we pick vacations a week, I mean a year in advance now. But at the same time I found myself when I was doing locums just trying to work every possible week and almost felt a slight sense of guilt. And when we would take some time off to travel knowing that I could be working and making good money. So for me the stability and organization that comes with being in a group and having kind of a equitable amount of vacation weeks and shifts already predetermined for me kind of gives me just the kind of good system to stick to.

I think a lot of doctors feel that guilt. Do you have any tips for them for getting over that?

Yeah, for me just looked, looked kind of down knee level at my kids and I was like this is, you know, this is for them creating memories. It's More important than money. Just trying to be the best dad that I could be for them and good husband for my wife and just making memories that they'll never forget.

I'm curious what your biggest surprise has been about Locums and Daniel, why don't we start with you? What surprised you the most when you started doing locum?

You know, I think the biggest surprise is that, you know, you can. You can do too much. And, you know, obviously it depends where you're doing locums, but I would say the biggest downside of Locums for me is that I'm away from my family. And, you know, like Chad, I've got two young boys. They're five and nine years old, and I've got a wife, and my parents are with us here in Tennessee as well. And when I'm gone, I'm completely gone. You know, I can't contribute to sort of their day to day, and I miss them. You know, as I said, it can sometimes and lonely experience. And when I was doing two weeks a month of locums just last month, it surprised me how easily it kind of tipped over into too much time away from the family, you know, but quickly we realized that that balance was not so good. So that's why I'm kind of scaling back now. But, you know, that's what surprised me, that, you know, how much I would miss being away from my family.

Chad, what surprised you the most?

Okay, my biggest surprise, and this is going to probably crack y' all up, but it was estimated quarterly taxes. I didn't really. That was kind of something that was sort of foreign to me. So the first kind of set through or I talked with our accountant. He was like, yeah, you've been, you know, setting aside, you know, your. Your estimated quarterly taxes. Right. And I'm thinking, well, definitely forgot that I'm setting aside some for retirement and things. But that was. That was a big surprise for me and something that's important to think about when you see the money coming into your paycheck. So it's kind of tough to really get into the mindset of creating those subsets instead of just saving all or spending too much money and having to really curtail yourself from doing that.

I bet that was really depressing to have that conversation, huh?

Yes, very, very depressing.

Interesting. Okay, so what should those considering locums be warned about? I mean, there's downsides to everything we do. What warnings should be given out now that you guys have had some experience doing this for a while?

Yeah, I Think it's important to really ask questions and to vet the facilities, the hospitals or the groups that you're going to be working with. You want to make sure that there's going to be good support system. For me, like I mentioned, coming straight out of residency where I had an attending and several other residents, you know, right there at an academic institution, going straight off to Alaska, it was a great learning opportunity for me, but something, you know, that you have to really consider. So the support system and you know, the work environment that you're in. So don't be afraid to ask questions. Knowing that I feel like we as physicians are in a position, whenever those negotiations are taking taking place, to just say no sometimes.

Daniel, what would you warn somebody about? They come to you and say, sounds awesome what you're doing with locums, but tell me, what should I be worried about? What am I not thinking about? What would you tell them?

No, I think that's right on the money. Because every Locums position is so different that a lot of your success as a Locums is going to depend on how you're regarded by the other physicians there and what kind of support they can offer you. So, for example, last night's in Ohio, I got called as a emergent consultant to the OR to reimplant a ureter that had been cut during a gynecologic procedure. And this is something that if I had encountered in southern California, I just would have called one of my, one of my buddies, you know, say, hey Amir, hey Justin, can you help me, you know, reimplant this ureter? But in this instance, you know, depending on the place that you are, you may have, maybe you're going to have to handle it yourself. You have to basically figure out what your capabilities are. And in a lot of places you may actually be stretched even more than you're used to. I think I'm very lucky in both of the places I've gone to that the local urologists, they're great, they're very supportive and they're more than welcome to give backup if necessary. Wasn't required in this case. But you know, I think that's one of the things you have to really evaluate as much as possible each locums gig separately. And the thing about it though is that if you find that it's not to your liking. What I found is that most of the contracts have a 30 day out. So you can change your mind and you can switch things up, but there is kind of a startup cost and A switching cost if you do that.

Have either of you worked a little bit with agencies? What was your experience with Locum's agencies and the good and the bad of doing that?

I've gone through agencies so I could speak a little bit to that. The agency situation is very interesting. I think there's more than you can count. And as an employed physician I would get cold calls and emails every single week from Locums agencies looking for coverage here. And I would get tired of saying, look, I'm employed, I don't have time nor the inclination to go cover a week of Locums in South Dakota or North Dakota. But the fact is afterwards it's a lot of trial and error. So I didn't really have a great way of figuring out which agencies had the best gigs, the well paid gigs. So there was a lot of trial and error. And I actually did end up switching agencies because I felt like the first one that I was contracting with was honestly not paying high enough. As I sort of learned and saw more gigs coming in, I said, well, this doesn't really seem to be a good compensation rate. And then when I challenge them on it, they, they talked about, you know, I, I wasn't satisfied with their response. So basically I went to another agency that I thought was being a bit more fair. But the thing about agencies is I think it's very routine for them to take 30 to 60% of the fee to cover their overhead. And I think there's much more upside if you can work directly with the hospital. But I think initially that's a little bit daunting for people who are just starting out. Certainly it was for me.

You think it's pretty common for people to initially work through an agency and then either have the hospital buy out the agency or wait until the contract's up and then go directly if it's going to be a regular thing.

I suspect it to be the case. I honestly haven't spoken to 100 locums urologists, but I think that's the case.

Yeah, I haven't worked directly with an agency on any particular assignments, but do get text messages quite often. And it does seem the rates are considerably lower even for the same geographic locations. And so, yeah, just human nature thinking, well, someone's getting paid as the middleman there. So if I'm going to take the time to go, I'd rather just work directly with the hospital. But you know, sometimes those relationships between the agencies and the hospitals are already there and maybe it makes sense to go that route. For some people.

Very cool. All right, well, our time's getting short. I want to give you each a chance to tell us anything you haven't had a chance to talk about, particularly with regards to Locums, but about anything really. You got the ear of 30 or 40,000 people, mostly docs. And what have we not talked about that you think we ought to talk about today? Daniel, why don't we start with you?

Sure. I think in closing, you know, I would just encourage everyone to think about your career and your life sort of as a trajectory. And the thing that really has affected my career over the last few years is that I started thinking of my timeline, not in chunks of one to five years, but sort of in a arc of 20 and 30 years. And I saw where I wanted to end up and I started making very deliberate changes in my day to day to try to inch towards that vision. And some of that ended up manifesting as a move out of the comfort of my employed physician to Locums. But a lot of that also ended up changing my focus from 100% medicine to business and things outside of medicine like writing and real estate investing. So I would just encourage people to take the long view and see where you want to end up and just make sure that the things that you're doing on a day to day are getting you towards that eventual vision.

It's a good tip. Chad, what have we not talked about you think we ought to cover?

Yeah, so for me, I think just the change of scenery was worth a lot. We get in the Dr. Grind, so to speak, from time to time in our practices and our jobs in the same rhythm. So I encourage anyone that is feeling burnout or feeling like they need a move or, you know, something different just to potentially explore doing one Locums assignment for a change of scenery. It's something I didn't expect to do that much for me mentally, but it certainly brought our family closer together, created lasting memories, and then also just provided, like I said, a growing number of new relationships that you can build on and have for years to come.

Now, part of what you did it for was the adventure. Have you thought about going for a bigger adventure? Picking a smaller town in Alaska or going to a foreign country or something like that?

I have thought about that as a pre med, actually. My wife and I met in college and we had planned to do just mission work through our church and then along the way decided I liked medicine. And so from then on, we think, and we're still not going to rule out the fact that one day we might go for a bigger adventure and try to retire a little bit early from my clinical practice here and do medical mission work with our family one day. So we'll see what's coming down the pipes.

Awesome. Well, it's been a pleasure having both of you on. We've had Dr. Chad Green, Dr. Daniel Shinn, aka the Darwinian doctor, here with us talking about their experiences with locums. Thank you, gentlemen, for your information and willingness to come on the podcast.

Thank you, Jim. It was a pleasure.

Thanks for having me. It was really nice talking to you.

All right. I hope you enjoyed hearing from those two docs, two different experiences about locums. It's one of those things that you want to mix your career up a little bit at the beginning, at the end, in the middle. I know Dr. Leif Dahlin, who started the Physician on Fire blog. He started his career doing locums. I think it was four or five years or something. He did locums and eventually one of those gigs transitioned into his longer term gig. But he loved it for getting a jumpstart financially because they paid all his living expenses. So he moved his young little family around with him and they put him up and he got to make a little bit more money than he probably otherwise would have been making. He saved a whole bunch of it and the rest is history. Other people, they kind of turn to locums when they get into mid career. You know, they're feeling burnout. They're like, is this all there is? And they want to mix it up. They want to go have an adventure. They want to go to Alaska, they want to go to New Zealand. They just want to go to a different part of the country and try something unique, change their practice up a little bit. And so they do that in mid career. And others I've met, like Corey Fawcett, he did a bunch of locums at the end of his career because he had so much control over the schedule. He was a general surgeon. He could swoop in and do 10 days of work as a general surgeon and then move on. And sometimes he moved on. A week later he was working again. Sometimes he moved on four months later and he was working again. And he loved having that control at the end of his career, which he had not gotten to enjoy as a busy general surgeon with a regular practice. So lots of different reasons people choose locums. But I just love the idea of docs having control over their career. That's my favorite part about it. If you're looking to boost returns, lower taxes and build wealth. Join the WCI Monthly Real Estate Opportunities list for tips and strategies to maximize your real estate returns and for introductions to exclusive investment opportunities. Expect educational emails that introduce you to syndicators, fund companies, online courses, and online real estate platforms. Go to whitecoatinvestor.com reopportunities to sign up today. You can do this and the White Coat Investor can help. All right, don't Forget about our $200 off. Any course special August 17th through 25th put in podcast 200 as the code and our online courses are $200 off. Thanks for leaving us five star reviews. A recent one came in from Blue 12345, who said best podcast in his class. I really enjoy listening to this podcast twice a week. A definite bright spot during my long commute. He's really going to enjoy this one where we talked about shortening his commute. I've learned so much from these episodes. I started with the original White Coat Investor book. I'm so grateful for the lessons learned by listening to this podcast and as so many financial principles are reinforced every week, especially the Q and A where so many interesting scenarios are discussed. Thank you so much for what you've done. Continue to do five stars. Thanks for that great review. All right, don't forget about the Milestones podcast. We've added some stuff to it. Hey, we've gotten great feedback. It's almost a little bit of back to basics with each episode. The one I recorded earlier today, I talked about cash after our interview with the person who had hit their milestone. But if you're interested in being on that whitecoatinvestor.com milestones those drop on Mondays. The regular podcast drops on Thursdays. So be sure to follow along and enjoy those podcasts. Tell your friends about them. Thanks so much for being here. This is driven by you. We are interested in what you think about it, what you want to hear on the podcast, guests you're interested in. We take your questions on the speak pipe bytecodeinvestor.com speakpipe and we want to make this a useful resource for you. We're here for you. I kind of already got mine. I'm already enjoying the wonderful benefits of having financial literacy, having my financial ducks in a row, being able to do whatever I want with my life by mid career. I want that for you too. That's what this podcast is all about. Keep your head up, shoulders back. You've got this and we can help. We'll see you next time on the White Coat Investor Podcast. The hosts of the White Coat Investor are not licensed accountants, attorneys or financial advisors.

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