September 9, 2025 • 16 mins
In this episode, Sam Ashoo, MD interviews Ali Chaudhary, MD about the benefits of working Locum Tenens in Emergency Medicine.
- 00:00 Introduction and Welcome
- 00:54 Meet Dr. Ali Chaudhary
- 01:41 The State of Emergency Medicine
- 03:29 Understanding Locum Tenens
- 05:45 Financial Benefits of Locum Work
- 08:40 Balancing Family Life with Locum Work
- 12:54 Locum Work Logistics and Misconceptions
- 17:34 Maximizing Travel Perks as a Contractor
- 18:07 Adjusting to New Hospitals and EMRs
- 19:32 The Hassles of Credentialing
- 20:48 Navigating Locum Staffing Companies
- 22:27 Understanding Your Worth and Negotiation
- 25:14 The Importance of Organization
- 27:41 About Our Locum Staffing Company
- 29:59 Practical Tips for Malpractice Insurance
- 31:09 Final Thoughts and Contact Information
For more about Dr. Ali Chaudhary: https://thelocums.com/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ali (00:00):
So extremely important for us to approach our careers, not on
autopilot, but thinking intentionallyabout what it is that I'm doing, why
am I doing it, and is it going to leadto fulfillment in 10, 15, 20 years?
Sam (00:13):
Hi everyone, and welcome to another episode of EMPlify.
I'm your host, Sam Ashoo.
Before we dive into this episode, Iwant to say thank you for joining us.
I sincerely hope that you find it tobe helpful and informative for your
clinical practice, and I want to remindyou that you can go to ebmedicine.net
where you will find our three journals,Emergency Medicine Practice, Pediatric
(00:34):
Emergency Medicine Practice, and EvidenceBased Urgent Care, and a multitude of
other resources, like the EKG course,the laceration course, interactive
clinical pathways, just tons ofinformation to support your practice
and help you in your patient care.
And now, let's jump intothis month's episode.
Ali (00:54):
I'm Ali Chaudhary, board certified emergency physician.
I live in Allentown, Pennsylvania.
I did my medical school out inthe Dominica, Ross University,
did my residency out in Akron,Ohio, Summa Health System.
And I've been here onthe East coast since.
Originally from California,born and raised.
Sam (01:11):
Awesome.
Thanks for being on the podcast.
I really wanted you to have a time toshare with us, because you have a very
unique perspective on emergency medicine.
So all our listeners who are in trainingand already out there in their careers
may not realize, but you have kind ofmade it your passion to talk about.
(01:32):
The locums life and what it's like tobe sort of your own business and the
freedom that that brings in your career.
Is that right?
Ali (01:40):
Absolutely, man.
I mean, look, I graduated in 2014 fromresidency and it's been about 11 years
now, which it seems like a lifetime.
But I argue now that emergencymedicine, the way that it
is structured today is dead.
It's beyond broken, it's actually dead.
It's not sustainable as a career anymore.
Just about everyone that I work withwho isn't a 10 99 locum is burnt out,
(02:02):
is depressed, is seeking a way out.
Sam (02:05):
Yeah.
Ali (02:06):
So I've been able to find freedom , and be able to live
a life that is fulfilling andmore enjoyable and adventurous.
So I just wanna share with otherdoctors that like what it is that
I'm doing and how I got here.
It's not some sort of secrethack or some trick that only I
knew somebody who can get me in.
This is available to everyone who'sa mercy doctor and other specialties.
I don't know if there's other specialtiesthat listen to this podcast, but it does
(02:27):
apply to anesthesia, GI, and some otherspecialties that are procedure based.
But my heart really goes out to ER docsbecause no one gets what we go through,
Sam (02:35):
Hmm.
Ali (02:35):
Not our spouses at home, not our kids, not our other
colleagues, not other specialties.
I see what we go through and justthe stress of the job itself, the
psychological stress, the emotionalstress, the physical stress of nights
and days and going back and forth,and somehow it's normalized that we
just accept that and work 14 days amonth doing that every single month.
(02:58):
I just don't understandhow that became normal.
And so I'm surprised more people aren'tburnt out and you know, we're a specialty
that has the highest burnout rate.
Why aren't we addressing these issues?
Why aren't emergency physicianstaking control of this or having
a voice that actually matters?
And for me, locum tenens is a wayto actually take back control,
take back freedom, and operate andapproach your career in a way in
(03:20):
which you have the autonomy andfreedom, but also at the same time,
practicing as an emergency physician.
So there's a lot to say about this.
We can go in many different directions.
I could keep going.
Sam (03:29):
So if you're listening to this podcast and you don't know what locum
tenants is, it's a form of working whereyou're not employed by just one person.
You're kind of an independentcorporation, and you get to pick
and choose where you're gonna work.
And you're not a standard W2 employeeof some healthcare system or a hospital
or an urgent care center or whereverit is that you're currently working.
(03:51):
Now tell me when did you getyour start doing locum work?
Ali (03:54):
And I wanna maybe just add a little bit more color to that because
that key difference, what you justdescribed, the difference between an
employee and a independent contractoris the reason why emergency physicians
are feeling trapped and burnt out.
That's the reason why we arenot living life to the maximum
potential that we possibly can.
That's the reason why emergencydoctors aren't making half a
(04:15):
million dollars every single year.
That should be baseline.
So it's a very simple difference.
It's not like, again, you don't haveto read it in some thousand page
book in the middle somewhere whereyou can't get this information.
It's very straightforward.
It's very easy to understand.
Once you understand it, you willstart to approach the way that you
are practicing differently, becausenow you'll recognize the difference
(04:36):
. W2 employment is a standard approach that every doctor, when they graduate from
residency, is what they're gonna get into.
So whether you're an employee at ahospital, contract management group,
usually is W2, some are 10 99 though, ifyou join like the travel team or whatever.
Or if independent group, there's alittle bit of a different structure,
but a lot of doctors go into employmentbecause it's the most common and
easiest way to practice medicine.
(04:57):
Why is it easy?
Because you get yourbenefits handed to you.
You don't have to think about them.
And you get paid your check, yourschedule is made for you and you
can make requests here and there,but it's pretty much handed to you.
And so you're kind of like onautopilot in your career, right?
But that's the problem.
When we go into autopilot and because ofhow stressful our career and our job is
and no one actually understands how it is.
(05:17):
That's what leads to burnout anddiscontent with our life and our career.
What 10 99 does, and what practicingas a locum does is it gives you, in the
word itself, independent contractor,you're now independent, right?
You're not dependent on a singlehospital to take control over you
and give you your schedule and giveyou your hours and all this stuff.
(05:38):
You're taking control back now.
Now you have control over yourschedule and how much you get paid.
Sam (05:43):
Hmm.
Ali (05:44):
I'll touch upon this now.
Last year I made over $550,000working the same number of hours
my W2 colleagues are working.
Sam (05:51):
Hmm.
Ali (05:51):
They're not making more than 350.
Almost 200 K more.
But what about the benefitsand all that stuff?
Yes.
Benefits don't cost me $200,000 a year.
Okay?
And so I did a presentation recently at aresidency program in Modesto, California,
and I showed them the difference interms of just income, even taking into
account for benefits and things likethat, over the course of 10 years,
(06:12):
you're making over a million dollarsmore as a 10 99 locum than an employee.
Sam (06:18):
Yeah.
Ali (06:18):
So again, this is a whole topic and I have a section on my book about this.
I have a section in my course about this.
I can go into a lot of depth,but we'll leave it there.
Sam (06:26):
So if you are someone who is interested in locums, is it something
you'd recommend doing directly outof residency or do you need a certain
amount of time at a hospital or as a W2employee before you should venture out
and start being an independent contractor?
Ali (06:40):
I think it's important to know where your shortcomings are.
I think that for some doctors comingoutta residency and we have a few
that work with us right out, get theresidency , and they're killing it.
They're doing a great job.
The directors love them, but there'sa few others and my experience has
been much less of these two maybestruggle with the single coverage sites.
(07:00):
Right.
And so it's important to kindof know where you fall in that.
So if you find yourself that, youknow, you maybe need a little bit more
encouragement or maybe a little bit moretime to just start getting independent
on your own, in those scenarios, I wouldsay maybe start working as a W2 or you
get a locum job in a place that hasdouble or triple coverage during those
shifts where you're not just by yourself.
Sam (07:21):
Yeah,
Ali (07:22):
I think that kind of scares us sometimes.
So it is very possible, but it's importantto be honest with yourself as well.
Sam (07:27):
And if you're looking for locums opportunities, do they
generally tend to be more of thesingle coverage type because they're
in different types of hospitals?
Ali (07:36):
Can be, but not necessarily.
Critical access hospitals and hospitalsthat are remote generally tend to
have a higher need, but not always.
Oftentimes there are satellitehospitals to a main center.
Right.
So it's just about lookingaround, it's about being informed.
That's the one thing I tell doctorscoming outta residency and as attendings
who've been in the game for years,you have to be informed about your
options and know what's out there.
(07:57):
If you don't know what's out there, you'regoing to undervalue yourself, or you're
gonna put yourself in a position whereyou're underpaid, put at the wrong site
that's understaffed and get screwed.
You can walk on some landminesif you're not informed.
That's why it's important to educateyourself about the career options
that you have in front of you.
You don't have to take the locums,but you should know what it is.
You should understand whatthe benefits are, what the
(08:18):
disadvantages are, and so on.
When you're not informed is when youmake decisions that can compromise your
wellbeing and your happiness and couldlead to burnout and things like that.
So extremely important for us toapproach our careers, not on autopilot,
but thinking intentionally aboutwhat it is that I'm doing, why am
I doing it, and is it going to leadto fulfillment in 10, 15, 20 years?
Sam (08:40):
So if someone is considering a locums career and then say, has
a family, do you have a family?
You have children.
So how do you handle that with locums?
Does that have you traveling more saythan a W2 position might and how do
you work that into your family life?
Ali (08:54):
Great question.
I get this all the time, Ali, Ido locums, but I have a family.
Okay.
Now everyone's family is different.
I can't say that each situationis copy and paste and you
can do the exact same thing.
But I'll tell you this, yes, I'm a father.
I travel.
I'll tell you example ofa mom that works with us.
She has five children.
She works full-time locums now because shesays it gives her actually, so two things.
(09:18):
One, it gives her time todecompress between shifts.
Again, ER, no one understands what we do.
When you go home from an ERshift, you need a breather.
You need to take a littlebit of time to relax.
I still work clinically.
I still work a hundred hours a month.
So your family, when you get home,is expecting you to be on the
moment you walk through the door.
Your kids aren't gonna give you sometime to just chill and relax and
(09:39):
drink your tea and whatever, right?
You gotta put 'em to bed.
You gotta make them meals.
They're waiting for you.
You've been gone all day.
You got responsibilities themoment you walk through that door.
Your spouse may not understandwhat you're going through.
If they don't work in the ER as a doctoror a nurse or something, they don't
get it, and you can't expect them to.
So they're not gonna understandthat they need to give you a little
bit of time to decompress as well.
So she said, this is the only timeI get to myself and I love it.
(10:02):
So in between shifts, you'll worklike four or five shifts in a row,
stay at the hotel, and guess what?
She has time to herself.
She never gets time to herself besidesthe locum shifts that she's working,
and so she absolutely loves it.
Now what a lot of doctors do, andI did this as well, is that during
the times that we're away, we'llget additional help for our spouse.
Her spouse works from home.
(10:22):
His job is remote, and they're able toget a nanny or babysitter or some extra
help or extra care during those days.
So that's one way to do it.
Another benefit of that is I think itactually helps strengthen relationships
Being gone for a period of time.
When you come back, you look forwardto seeing your spouse and your kids.
It is a little bit stressful whenyou need to decompress and you can't.
Right.
And you're just all in eachother's faces all the time.
So I've actually found in myexperience and other people who've
(10:45):
done it, like it actually helps.
Have a little bit of distance,a little bit of time away.
Then when you come back, you're,you know, they say absence
makes the heart fonder, right?
And so that's anotherbenefit of it as well.
And not to mention, that waslast year, I told you how
much I made 500 plus thousand.
This year I'm working onlyeight shifts a month and I'm on
target to make over $380,000.
(11:06):
Eight shifts a month.
So I wish I could show you my schedule,but I work them all in one block.
I'm in the middle right nowof a five week vacation.
Sam (11:15):
Wow.
Ali (11:16):
And I do this every other month now.
I take four weeks off at a time.
I work my block.
So I'm working until, I'moff until August 23rd.
I think 24th is my first shift.
I've been off since I think early July.
I don't even remember.
I traveled the world.
I was in Tunisia, I was in London,I was in Switzerland, Portugal.
I just got back.
I still have two weeks off.
Do you understand?
Sam (11:34):
Yeah.
Ali (11:34):
I have more time with my family than any one of my colleagues does,
and I get paid more than them.
So I can do whatever I want.
I can work eight shifts amonth and still make more.
Or if I wanna make more moneyand just stack up my cash and,
you know, invest or buy a houseor whatever, I can do that too.
Sam (11:50):
So when you work your eight shift, you're doing that in one large block to
accumulate that the rest of the time off.
Ali (11:56):
Eight, 12 hour shifts.
I make $330 an hour, and over thecourse of a year, if you just add
that up, do the math, it's $380,000.
And people might say, well,I can't do eight shifts.
You can, if you know you have fouror five weeks off right after that.
Right?
And in between shifts,I optimize for sleep.
For recovery.
I'm not doing a lot of things between onthose shifts, that eight shifts block.
(12:16):
I work some nights as well in that block.
You know, there's notenough productivity on me.
I don't see my family sure for eightdays, but for 30 plus days, I am.
Right.
And I'm actually there.
So people talk about this idealike, are you really present
when you're home between shifts?
Oh yeah, I wanna be home every day.
Okay.
Is that just something you were toldbecause that's what the expectation
is, because that's what the norm is?
(12:38):
Or is it actually good for youbeing home after a shift when
you're tired and burnt out.
Sam (12:42):
Hmm.
Ali (12:42):
I just need a freaking break versus working a stretch of shifts
being away then coming back and being,Hey, I'm home for 30 days, I'm good.
Right?
I don't know.
I think people have it twisted.
They just don't know what they don't know.
Sam (12:54):
And when you do your stretch of eight, for example, is that
all in one facility, one location?
Ali (12:59):
So I've been fortunate.
I've been at this site in Delawarefor about six years as a locum.
Sam (13:04):
Wow.
Ali (13:04):
The last three years as pretty much full-time, meaning
I work there exclusively.
I am credentialed at a couple ofother sites and the game for locum
is always, you gotta be credentialedat least two, ideally three sites at
any given time in case one dries up,you can always work at another one.
So you're never out of a job.
That's what people say,oh, locums is unstable.
It's not if you play the game and I'vebeen playing it for 10 years and I'm a pro
(13:24):
at it, so I can teach you a thing or two.
Sam (13:27):
So when you say you've been at the same facility for six years, are
you the only locums person and iseverybody else a W2 or is it just kinda
a mix or how does that work exactly?
Ali (13:35):
Well, I've been there longer than most of their full-timers
Sam (13:38):
Wow.
Ali (13:38):
I'm definitely not the only locum there.
So yeah, there's a bunch of other locums.
As a matter of fact, I havea staffing company as well.
It's called Locum United.
I started that eight years ago.
And so we have a few other docsthat work there through our staffing
company to help, and people alwayshave this idea, if I may add that,
locum is only at dumpster fire sites.
This is another common misconception.
I think a lot of residents, when I seethem they ask me this question, Hey,
are they only at dumpster fire sites?
(13:59):
Because I think that's thething that gets passed around
Sam (14:01):
Sure.
Ali (14:02):
from attendings who don't know any better, who've never done it.
And I've been at, if I've been doingit for 10 years full time, now it's 11.
I've been at a dozen plus sites inthe last 10 years, and only one,
which was the first one I went to,was a dumpster fire site, which was
understaffed and just complete chaos.
And that was from another companythat is big name company that's out
there that put me at this place.
(14:22):
And that's the reason why Iactually started my own company
because like, you know what?
I'm not gonna do anydoctor like they did me.
You know?
And so I started my own.
I was like, yeah, I'm gonna paymy doctors good and I'm gonna
send 'em to sites I would work at.
Sam (14:33):
So I could see maybe years ago where, you know, staffing shortages were
not as bad and people could become W2employees and stick around for a while.
The only sites that couldn't hirepeople would be those dumpster
fire places, as you said.
But now, you know, nationalshortage, emergency physicians
are in high demand everywhere.
(14:54):
So you're saying you could actuallyget a locums position in a larger
city, maybe like an urban center even.
And sometimes they're temporaryand sometimes, like in your
Delaware case, they're not.
Ali (15:04):
Most of the sites I've worked at and everything's about geography,
so like you said, there's a supplyand demand tension here, right?
Less supply of doctors, high demand.
Now doctors, we don't understandor we've forgotten basic economics.
When that happens, youcan demand a higher price.
But we let the hospital dictate tous what they're gonna pay us and
take a fraction of what we deserve.
(15:25):
And so we're not playing that supplydemand tension in our own favor.
And I'm not saying we shouldgouge the hospital and make
a thousand dollars an hour.
No, I don't think that's necessarilyit either, but I think what we
do, the work that we do, we needto get compensated more for.
I just don't think anyone else getsit, again, not admin or anything else.
So this supply demand tensionthat exists, it means that there's
(15:46):
gonna be hospitals all across thecountry that are short staffed.
Now, if you go to maybe Hawaii, you'regonna have a hard time finding a locum
need there because everybody wants, ifthey can be there and they'll take a
much smaller salary than anyone else.
But the big metropolitan cities,maybe just an hour, two hours
outside of that, you'll find alot of hospitals that need help.
There's nothing wrong with these places.
They run very well.
They're actually very functionalplaces, but they don't have the desired
(16:11):
geography for people to wanna live there.
I'll go out there and work someshifts, but I don't wanna live
in small town, Alabama, right?
It's just not what Iwanna raise my family in.
I don't want to build like asocial network there necessarily.
'cause all my friends live here.
I wanna live in one place.
I'll go work there for like fouror five shifts and then come back.
You see what I mean?
Sam (16:27):
Yeah.
Ali (16:28):
So that's really what the situation is for.
The vast majority of sitesin my experience is that
they're just short staffed.
They're all functioning places, but justcan't find doctors who wanna stay there.
They'll get doctors outta residency,they'll come and stay there for
a couple years, and then they'relike, what am I doing here?
I need to go back.
I have a kid now I need to goback to our parents where they
live and all that stuff, you know?
Sam (16:46):
So in your personal geographic region, how far are you traveling
routinely for your locums jobs?
I mean, you're going,like across the country.
Are you more regionalized?
What's it look like for you?
Ali (16:58):
I've done it all and I've been fortunate.
I live in Eastern Pennsylvania and 90%of my jobs have been within driving
distance, meaning that I could drivethere, stay there for a couple days.
I couldn't drive thereevery day between shifts,
Sam (17:10):
Sure.
Ali (17:10):
But driving within two to three hours tops.
So I would usually go drive and doa stretch of four to five shifts
in a row and then come back.
There are sites that I've goneto in Michigan and in California.
Those are short term.
I didn't do them as much, but somepeople like doing that because
maybe they have some family or somerelatives in California or they
just wanna go visit and stay there.
Whatever.
Totally possible.
And guess what the hospital paysfor your travel and for your hotel.
(17:33):
And guess what?
This year, because the hospitalpays for my travel, I have over
a million Hilton Honors points.
Which I can use for, youknow, when I travel book like
five star hotels for free.
And that adds up to about $20,000 a yearand just free travel stipend essentially.
There's all these cool little perksthat you can do and you don't have to
get on a plane if you don't want to.
(17:53):
It depends where you do live, butmost places, say you live in Dallas.
I get jobs, opportunities, and things, you know, we're an hour outside of
Dallas, two hours outside of Dallas.
So you can live there if you seethat you want to, but just drive
out, stay there for a couple daysand come back and you're done.
Sam (18:07):
All right, so let's talk about some of the practical day-to-day matters
of being a independent contractor.
So you've been fortunate enough togo back to some of the same hospitals
again and again, but let's say you'rein this position and you're working
multiple hospitals, how do you adjustto different EMRs and different
consultants and trying to understandthe flow of and how things are done at
(18:29):
each department without being someonewho's been there for a while already.
Ali (18:33):
You're gonna get butterflies for your first shift or two.
And it's because you know the medicine,but you don't know the system, so you
just kind of feel somewhat handicapped.
Sam (18:40):
Yeah.
Ali (18:40):
I, again, having done it for at least 12 times in the last 10
years, it takes about two weeks.
Two weeks of consistency working there.
You will get a hang of the system,who to consult, what the EMR is like.
And you'll be more or less independent.
And usually hospitals, when you comeon early, they recognize that you're
gonna be somewhat handicapped becausethey know it's a new system for you.
So they'll usually have some leeway.
(19:01):
So yeah, it's not that hard.
I mean, we're smart people generally.
The EMRs, yeah, some are harder tolearn than others, but as long as you're
going there consistently and not takingmonths off between shifts for your
locum, because then you're not gonnaremember the system when you go back.
Right?
Sam (19:12):
Yeah.
Ali (19:12):
So there has to be some level of consistency.
But if it's Epic and you useEpic at home, then it shouldn't
be that big a deal, right?
Or whatever EMR that you use.
Sam (19:20):
So after say two weeks of being at a facility, then there is some advantage
to going back to that same center, youknow, a few more times if you have the
option to in your locums geography.
Ali (19:32):
Yeah, and also remember, credentialing takes forever.
It's a pain in the butt, dude.
If there's one negative tolocums, it's credentialing.
I hate credentialing.
It's the most painful thing that Ithink physicians have to do, even the
ER work is less painful in my opinion.
I guess that's debatable.
And the reason is because thesehospitals have these antiquated
credentialing requirements forthe most ridiculous things.
And then you'll send it to them andthen they'll say that they didn't
(19:54):
get it, but you sent it to 'em twoweeks ago, you can show 'em the email
like, oh, well can you send it again?
And so the way that I tell doctorsand the way that I train them inside
our training community Locum OS iscreate a Google folder and have sub
tabs in that folder for each thing.
So for licenses, your DEAs, your residencydiploma, health documents, all those
(20:15):
things, so that way anytime you starta new credentialing package, you have
all that data ready and it's easy toplug and play because otherwise, if
you're trying to figure out throughyour emails, try to find all this
stuff, it's never gonna get done.
Sam (20:25):
Yeah.
Okay.
So it takes a little organization.
I can see that.
Ali (20:29):
A bit
Sam (20:30):
It takes a little bit
Ali (20:31):
Organization and you'll be done, you'll be set for life.
Sam (20:34):
Okay so you have an interest.
Maybe you are ready to dosome traveling or you're not
objecting to any of the traveling.
You gotta spend a couple of weeks at eachplace to kinda get the lay of the land.
You've got your EMRs you can adjust to.
Do you think the majority of independentcontractors are out there working on
their own, or are they working with saylike locum staffing companies where you
(20:55):
get to know some people who are kindof regionally doing the same thing?
Or in your experience,how has that worked out?
Ali (21:01):
Usually it's through locums companies.
And I've tried going directly as well.
This was one of the things, 'cause whenI had my first job and my bad experience,
I was like, you know what, I'm justgonna contact hospitals directly.
And I tried doing that and that'sa big pain too because you can't
find the right person to talk to.
Also if you do, they'll say, well,we don't contract directly and you
have to work through X locum companyor this vendor management system.
Sam (21:22):
Okay.
Ali (21:22):
Some hospitals will take you directly.
And so I know doctors that do do thatand they'll spend the time to do it.
But the land mind of what working withthe locums companies is getting underpaid,
getting sent to the wrong sites andthen playing games with you, right?
I know many doctors who I've workedwith side by side at sites and they're
getting paid $50 per hour less thanI am because I take care of my docs.
I make sure that we get paidtop dollar going in, right?
(21:43):
We don't have to negotiate orfigure out what your worth is.
Whereas this other locums company,remember traditional locums companies,
they have recruiters on their team, right?
Sam (21:51):
Right.
Ali (21:52):
I don't have any recruiters on our team.
I am the recruiter.
So their incentive is, okay, so say adoctor says I'll take 200 per hour, but
say they're billing the hospital 400.
Huge commission, right?
If a doctor says, Hey, I want 300.
So there's a smaller commission there.
Sam (22:08):
Yeah.
Ali (22:08):
Their goal is to low volume and pray and hope that you
don't know what your value is.
Sam (22:13):
Wow.
Ali (22:14):
And so most doctors, like myself, I was a sucker.
I didn't know what my worth was.
I took the $200 per hour job.
I did.
That was my first one I took.
And later on I was like, oh dude,I probably left 50 to a hundred
thousand plus on the table.
Just 'cause I didn't know Ishould have asked for 300.
Right?
Sam (22:27):
All right.
Ali (22:27):
We're not good negotiators.
We've been in medicine.
Sam (22:29):
Yeah.
Ali (22:30):
One way thinking we don't know negotiating skills and all.
I mean, we're very much in many waysinfantile and very juvenile in many ways
because we've trained very highly and verydeeply in one thing, but nothing else.
Sam (22:43):
Yeah, I mean, we don't go to business school, so it's not in the curriculum.
Ali (22:46):
Very underdeveloped in other ways.
And so that's part of the thingI'm also teaching doctors is start
developing yourself in other realms.
Whatever it is.
Just like in terms of leadership.
In terms of entrepreneurship,in terms about just setting
boundaries for yourself and knowingwhat your're worth actually is.
Right.
And because you miss out on that for10 years of things that you would
learn in the real world I guess.
If you were to take a job ortake an offer, do a counter
offer, things like that.
(23:06):
We don't think that way because we'rejust thinking about how to save lives
Sam (23:09):
Yeah.
Ali (23:10):
And how to do this intubation.
And if this doesn't gowell, what's my next step?
All those type of things.
We're thinking algorithmically,what are we doing next?
And so there's no training fordoctors once they graduate residency.
After you're done you're on your own.
Sam (23:22):
Right.
Ali (23:22):
So now you have to just figure out things and trial and error.
That's what I did.
I didn't know any better.
But it's important to try to find,I think, people who are where you
want to be and try to see how theydid what they did, because otherwise
you're gonna make the same mistakes.
And those are costly mistakes that I made.
I'm just trying to teach people how not tomake those mistakes that I made because I
(23:44):
could be much further ahead if I didn't.
Sam (23:46):
So then picking the right locums company is critical in this scenario.
Like one you can trust, but also oneyou can negotiate with in this, and
one that you're not desperate for.
Ali (23:56):
And to be clear, look, I would love for people to work with our company, but
I logistically can't place every singledoctor because we have limited number of
jobs and we do get those placed quickly.
But what's more important is that you knowwhat your worth is and what your value is.
Sam (24:07):
Hmm.
Ali (24:08):
Right, so I tell ER docs, if you're working at a site,
generally speaking, don't takeanything less than $300 per hour.
If it is 10 99, don't takeless than $300 per hour.
Now, the caveat to that is ifyou're working at a 24 hour shift
at a small critical access hospitalthat only sees four patients a day.
Those are sometimes a little less thanthat, like maybe in the two hundreds
or so, but beyond that, 300 should beyour baseline and then go up from there.
(24:30):
I dunno if you're familiar withthe EM doc jobs Facebook group.
And on our newsletter as well.
So we post these jobs inthere and our jobs have been
up to 330, 350 per hour, 75.
We even posted one last year for 400.
My goal is to just pay docs whatour value is, what our worth is.
So that way, honestly, like we can setourselves up for success outside of the
walls of the hospital because I want us tohave good, happy, long fulfilling careers.
Sam (24:55):
So when you, as a independent contractor, register with a locums
company, you're contracting with themand then they go off and contract
with the hospital for howevermany hours you're going to work.
But does that require any kind ofexclusive agreement with a locums company?
Or can you contract with multiple ones?
How does that generally work?
Ali (25:13):
Very good point.
Caution to everyone.
Do not share your CV with anyrecruiter until you're a hundred
percent sure that you want to beworking at that particular site.
And also make it clear to them thatyou only want your CV presented
to that one singular site.
There's so many shady tacticsthat I've seen in the industry.
(25:33):
What some rookie recruiters will do isthat they'll take your CV and they'll
just shotgun it to a bunch of placeswithout your permission, or maybe
you said, Hey, you can send this onesite, but let's send it to a bunch.
Sam (25:42):
Hmm.
Ali (25:42):
What that does is once your name has come across a credentialing
site or facility, they have your namenow on a file and now for two years,
you cannot work at that site withany other locums company except for
the one that presented you initially
Sam (25:55):
Interesting.
Ali (25:56):
It locks you in.
I've had that so many times.
I'll post one of these high paying jobs onthis Facebook group and in my email list.
And doctors will say,Hey man, I saw this job.
Can I apply?
I'm like, sure.
So they apply and then we get amessage back from the site like, Hey,
this doctor's already in our system.
They can't work there with us.
So I message the doctorback, Hey, what happened?
Yeah, man, like X company and I don'twanna name names, but this company
(26:16):
presented me like two weeks ago for300, but I saw the job on yours for 350.
I'm like, yeah, unfortunatelyI can't do anything about that
.The bylaws are what they are.
And I wouldn't, becausethat's what the rules are.
I cautioned docs to do your homework.
Make sure you know where you're going,how much you should get paid, do some
research, go to Facebook, join ournewsletter, just so you know what is
out there and what rates are going.
(26:38):
'cause otherwise you'regonna sell yourself short.
Sam (26:40):
So in that scenario, you send your CV to Locum Staffing Company
X, they give it to the hospital, andthen the hospital says the only way
you can work for us is now throughthis company for this period of time.
Ali (26:53):
Usually it's a two year clause for that.
Sam (26:54):
And that's a clause between the hospital and the locums company.
Ali (26:57):
Yes.
Sam (26:58):
Okay.
Ali (26:58):
It's a standard clause.
And the hospital enforcesthat, not the locums company.
So technically, if the locumscompany didn't know about you.
And say, for example, I justpresented and the hospital said
Yes, okay, we could do that.
Sam (27:10):
Right.
Ali (27:10):
I wouldn't, but I'm saying that's possible.
But the hospital itself has itin their bylaws, in their system,
like anyone that's been presented.
'cause they have a relationshipwith these companies too.
And they don't wanna burn anybridges and they don't want to do
things that are outside 'cause thenthey won't get good candidates.
So they enforce this.
Sam (27:24):
Gotcha.
But there's nothing in the contracts thatmakes you exclusive to a locums companies.
Ali (27:30):
Yeah, no.
You can work with any company aslong as you haven't been sent to
that particular site, or your namehasn't been sent over to them.
You can work with anycompany at any time really.
Sam (27:39):
Awesome.
Awesome.
And then, all right, so nowtell me about your company.
You are staffing locums in aspecific region of the US or
how big of a blanket is it?
Ali (27:49):
So we're national.
We're national.
We have contracts in California, Arizona,Oklahoma, east coast, northeast, and now
starting to venture to the south as well.
And yeah, we have contracts all overand our contracts come and go pretty
quickly because we post high paying jobs,like they get taken very, very fast.
And yeah, I mean, it's aphysician founded company.
Myself and my brother, who's not aphysician, we started the company
(28:11):
eight years ago because of my firstexperience that I talked about earlier.
It was horrible.
Sam (28:14):
Hmm.
Ali (28:15):
And I said look man, at this point, no one's watching out
for us doctors, and no one will.
I realized early on that noone really cares about us.
And I don't mean that in some sort ofcliche, but it is what it is, right?
I'm not gonna try to fight the system.
The hospital system, the corporatesystem doesn't care about us.
We're just cogs in the wheel.
We get called into the office for apotassium that we didn't correct, that
was 3.3, you know, some BS stuff, right?
(28:36):
And my same experiencewith that locum company.
So I'm like, you know what?
I've always been the type ofperson, like things don't have
to be that the way that they are.
And so what can I do to changethem and I was fortunate that
my brother has a business andfinance background because I don't.
I'm just a doc.
I just fix people . And so we partneredup to build something that was gonna
favor our doctors and not have themtry to play the games that they had to
play with these other locums companies.
(28:58):
We're just direct.
I still work clinically.
Like I said, I'm not some person who'smade a bunch and now I'm just chilling.
I work clinically still.
I make sure that we are very high touch.
We pay them what they're worth.
And you'll see on these variousforums that people love us.
I come to conferences, peoplelove meeting me and saying hello.
And you know, we post sometimesthese funny little AI images
that people like and stuff too.
So we have a good time with it.
I love it because I get to meet peopleand honestly get to change some lives.
(29:22):
That's been the biggest part of andrevelation for me, this year and
last year, where I started seeingpeople who actually messaging me,
saying, man, you changed my life.
Sam (29:28):
Wow, that's awesome.
Ali (29:30):
And I was like, wait, I thought I was just gonna do this locum thingy
and now it's coming to something else.
'cause it changed my life.
So I guess I shouldn't be surprisedthat it's changed other people's lives.
But I wasn't consciouslythinking about that.
And so now it's giving me evenmore meaning behind what I'm doing
because sometimes I take it forgranted what I'm doing now, having
a month off for me is norm now.
But seeing my colleagues and whatthey're going through I think that it
(29:51):
hits home now when I see them saying,Hey, actually, you helped me a lot.
It means a lot.
Sam (29:54):
Yeah.
Okay, so one more question, sorry, aboutthe practicality of how this is done.
So when it comes to the malpracticeinsurance portion of it, is that
something that's typically covered bythe locums agency, or do you have to have
your own as an independent contractor?
Ali (30:07):
It should be covered by your locums agency.
Yes.
And you know, there's been a lotof issues with malpractice with
various large companies goingunder and things like that.
Just make sure that you ask yourcompany to offer you a certificate
of insurance that says that, hey, ifanything happens to our companies,
that you'll still be covered.
Yeah you shouldn't have to pay for that.
And most companies have similar largeorganizations that are out there.
(30:28):
They'll have a similarkind of insurance policy.
So just make sure thatyou're aware of that and
Sam (30:33):
Keep track of that.
Ali (30:33):
Keep track of it.
Yeah.
Oh, and one thing is that whenyou're doing your credentialing
on all that, make sure you have afolder for certificates of insurance.
It's called a COI for short,because those things are almost
impossible to chase down later on.
Sam (30:46):
Hmm.
Ali (30:46):
Sometimes hospitals shut down or someone else is coming in and you
can't get a hold of the right person.
You'll always get one when you firststart working at a new site from the
locums company, or say you're workingwith a large contract management group
or independent group or something else.
Just make sure every time you work ona new site, you get that certificate
of insurance and you put it in afolder because otherwise it can be
impossible to try trace those down.
You'll thank me for that later.
Sam (31:08):
Awesome.
Awesome.
All right, well, so if someone'slistening and they wanna reach out
to you, how do they get ahold of you?
How do they learn more about your company?
Ali (31:14):
I'm not hard to find.
I have various socialmedias and things like that.
I'm on Facebook as Ali Chaudry.
My Instagram is @therealtopdoc.
I have my company, which is Locums United,my staffing company, but I also have a new
training platform that I just launched.
And we're doing our first livewebinar this month on August 27th.
You can find out more information atthelocumos.com and you can forward slash
(31:40):
workshop and you can sign up there and I'mgonna do my first live workshop where I'm
gonna be giving away a lot of free valueand a free gift for everyone who joins.
Something I've been workingon for over two years.
I'm gonna give it away for free.
So make sure you comment.
I wanna see you there too, Sam.
Sam (31:53):
Awesome.
Awesome.
Hey I'll be there.
I'm looking forward to it.
All right.
Well, Ali, thank you for takingthe time, you know, in between
your multiple weeks off to cometalk to us about the locums life.
This is some precious informationfor anyone who's listening, who's
feeling the crunch in whateveremergency department you're in.
We all feel it.
Definitely some food for thought if you'renot out there working locums already.
(32:14):
And even if you are, whether you'rea physician, really a PA, a nurse
practitioner, any type of traveling locumsclinician this is some solid sound advice.
Actually one question for you.
Are you staffing non-physicians aswell, like nurse practitioners and PAs?
Ali (32:28):
We do APPs, so PAs, NPs, CRNAs as well.
They kind of fall underthe locum demographic.
Nurses we don't do because they're acompletely different kind of system.
And I'll be at ACEP as well this year.
We have a booth there.
You can come find me ACEP
Sam (32:41):
Awesome.
Alright, well thank you very much Ali.
Really appreciate you takingthe time to share with us.
Ali (32:45):
Happy to be on, man.
Really appreciate it.
Thank you.
Sam (32:47):
And that's a wrap.
Thanks for joining us forthis episode of EMPlify.
I hope you found it informative, and Iwant to remind you that ebmedicine.net
is your one stop shop for all of yourCME needs, whether that be for emergency
medicine or urgent care medicine.
There are three journals, there'stons of CME, there's lots of
courses, there's so many clinicalpathways, all this information at
(33:10):
your fingertips at ebmedicine.net.
Until next time, everyone,I'm your host, Sam Ashoo.
Be safe.
So extremely important for us to approach our careers, not on
autopilot, but thinking intentionallyabout what it is that I'm doing, why
am I doing it, and is it going to leadto fulfillment in 10, 15, 20 years?
Sam (00:13):
Hi everyone, and welcome to another episode of EMPlify.
I'm your host, Sam Ashoo.
Before we dive into this episode, Iwant to say thank you for joining us.
I sincerely hope that you find it tobe helpful and informative for your
clinical practice, and I want to remindyou that you can go to ebmedicine.net
where you will find our three journals,Emergency Medicine Practice, Pediatric
(00:34):
Emergency Medicine Practice, and EvidenceBased Urgent Care, and a multitude of
other resources, like the EKG course,the laceration course, interactive
clinical pathways, just tons ofinformation to support your practice
and help you in your patient care.
And now, let's jump intothis month's episode.
Ali (00:54):
I'm Ali Chaudhary, board certified emergency physician.
I live in Allentown, Pennsylvania.
I did my medical school out inthe Dominica, Ross University,
did my residency out in Akron,Ohio, Summa Health System.
And I've been here onthe East coast since.
Originally from California,born and raised.
Sam (01:11):
Awesome.
Thanks for being on the podcast.
I really wanted you to have a time toshare with us, because you have a very
unique perspective on emergency medicine.
So all our listeners who are in trainingand already out there in their careers
may not realize, but you have kind ofmade it your passion to talk about.
(01:32):
The locums life and what it's like tobe sort of your own business and the
freedom that that brings in your career.
Is that right?
Ali (01:40):
Absolutely, man.
I mean, look, I graduated in 2014 fromresidency and it's been about 11 years
now, which it seems like a lifetime.
But I argue now that emergencymedicine, the way that it
is structured today is dead.
It's beyond broken, it's actually dead.
It's not sustainable as a career anymore.
Just about everyone that I work withwho isn't a 10 99 locum is burnt out,
(02:02):
is depressed, is seeking a way out.
Sam (02:05):
Yeah.
Ali (02:06):
So I've been able to find freedom , and be able to live
a life that is fulfilling andmore enjoyable and adventurous.
So I just wanna share with otherdoctors that like what it is that
I'm doing and how I got here.
It's not some sort of secrethack or some trick that only I
knew somebody who can get me in.
This is available to everyone who'sa mercy doctor and other specialties.
I don't know if there's other specialtiesthat listen to this podcast, but it does
(02:27):
apply to anesthesia, GI, and some otherspecialties that are procedure based.
But my heart really goes out to ER docsbecause no one gets what we go through,
Sam (02:35):
Hmm.
Ali (02:35):
Not our spouses at home, not our kids, not our other
colleagues, not other specialties.
I see what we go through and justthe stress of the job itself, the
psychological stress, the emotionalstress, the physical stress of nights
and days and going back and forth,and somehow it's normalized that we
just accept that and work 14 days amonth doing that every single month.
(02:58):
I just don't understandhow that became normal.
And so I'm surprised more people aren'tburnt out and you know, we're a specialty
that has the highest burnout rate.
Why aren't we addressing these issues?
Why aren't emergency physicianstaking control of this or having
a voice that actually matters?
And for me, locum tenens is a wayto actually take back control,
take back freedom, and operate andapproach your career in a way in
(03:20):
which you have the autonomy andfreedom, but also at the same time,
practicing as an emergency physician.
So there's a lot to say about this.
We can go in many different directions.
I could keep going.
Sam (03:29):
So if you're listening to this podcast and you don't know what locum
tenants is, it's a form of working whereyou're not employed by just one person.
You're kind of an independentcorporation, and you get to pick
and choose where you're gonna work.
And you're not a standard W2 employeeof some healthcare system or a hospital
or an urgent care center or whereverit is that you're currently working.
(03:51):
Now tell me when did you getyour start doing locum work?
Ali (03:54):
And I wanna maybe just add a little bit more color to that because
that key difference, what you justdescribed, the difference between an
employee and a independent contractoris the reason why emergency physicians
are feeling trapped and burnt out.
That's the reason why we arenot living life to the maximum
potential that we possibly can.
That's the reason why emergencydoctors aren't making half a
(04:15):
million dollars every single year.
That should be baseline.
So it's a very simple difference.
It's not like, again, you don't haveto read it in some thousand page
book in the middle somewhere whereyou can't get this information.
It's very straightforward.
It's very easy to understand.
Once you understand it, you willstart to approach the way that you
are practicing differently, becausenow you'll recognize the difference
(04:36):
. W2 employment is a standard approach that every doctor, when they graduate from
residency, is what they're gonna get into.
So whether you're an employee at ahospital, contract management group,
usually is W2, some are 10 99 though, ifyou join like the travel team or whatever.
Or if independent group, there's alittle bit of a different structure,
but a lot of doctors go into employmentbecause it's the most common and
easiest way to practice medicine.
(04:57):
Why is it easy?
Because you get yourbenefits handed to you.
You don't have to think about them.
And you get paid your check, yourschedule is made for you and you
can make requests here and there,but it's pretty much handed to you.
And so you're kind of like onautopilot in your career, right?
But that's the problem.
When we go into autopilot and because ofhow stressful our career and our job is
and no one actually understands how it is.
(05:17):
That's what leads to burnout anddiscontent with our life and our career.
What 10 99 does, and what practicingas a locum does is it gives you, in the
word itself, independent contractor,you're now independent, right?
You're not dependent on a singlehospital to take control over you
and give you your schedule and giveyou your hours and all this stuff.
(05:38):
You're taking control back now.
Now you have control over yourschedule and how much you get paid.
Sam (05:43):
Hmm.
Ali (05:44):
I'll touch upon this now.
Last year I made over $550,000working the same number of hours
my W2 colleagues are working.
Sam (05:51):
Hmm.
Ali (05:51):
They're not making more than 350.
Almost 200 K more.
But what about the benefitsand all that stuff?
Yes.
Benefits don't cost me $200,000 a year.
Okay?
And so I did a presentation recently at aresidency program in Modesto, California,
and I showed them the difference interms of just income, even taking into
account for benefits and things likethat, over the course of 10 years,
(06:12):
you're making over a million dollarsmore as a 10 99 locum than an employee.
Sam (06:18):
Yeah.
Ali (06:18):
So again, this is a whole topic and I have a section on my book about this.
I have a section in my course about this.
I can go into a lot of depth,but we'll leave it there.
Sam (06:26):
So if you are someone who is interested in locums, is it something
you'd recommend doing directly outof residency or do you need a certain
amount of time at a hospital or as a W2employee before you should venture out
and start being an independent contractor?
Ali (06:40):
I think it's important to know where your shortcomings are.
I think that for some doctors comingoutta residency and we have a few
that work with us right out, get theresidency , and they're killing it.
They're doing a great job.
The directors love them, but there'sa few others and my experience has
been much less of these two maybestruggle with the single coverage sites.
(07:00):
Right.
And so it's important to kindof know where you fall in that.
So if you find yourself that, youknow, you maybe need a little bit more
encouragement or maybe a little bit moretime to just start getting independent
on your own, in those scenarios, I wouldsay maybe start working as a W2 or you
get a locum job in a place that hasdouble or triple coverage during those
shifts where you're not just by yourself.
Sam (07:21):
Yeah,
Ali (07:22):
I think that kind of scares us sometimes.
So it is very possible, but it's importantto be honest with yourself as well.
Sam (07:27):
And if you're looking for locums opportunities, do they
generally tend to be more of thesingle coverage type because they're
in different types of hospitals?
Ali (07:36):
Can be, but not necessarily.
Critical access hospitals and hospitalsthat are remote generally tend to
have a higher need, but not always.
Oftentimes there are satellitehospitals to a main center.
Right.
So it's just about lookingaround, it's about being informed.
That's the one thing I tell doctorscoming outta residency and as attendings
who've been in the game for years,you have to be informed about your
options and know what's out there.
(07:57):
If you don't know what's out there, you'regoing to undervalue yourself, or you're
gonna put yourself in a position whereyou're underpaid, put at the wrong site
that's understaffed and get screwed.
You can walk on some landminesif you're not informed.
That's why it's important to educateyourself about the career options
that you have in front of you.
You don't have to take the locums,but you should know what it is.
You should understand whatthe benefits are, what the
(08:18):
disadvantages are, and so on.
When you're not informed is when youmake decisions that can compromise your
wellbeing and your happiness and couldlead to burnout and things like that.
So extremely important for us toapproach our careers, not on autopilot,
but thinking intentionally aboutwhat it is that I'm doing, why am
I doing it, and is it going to leadto fulfillment in 10, 15, 20 years?
Sam (08:40):
So if someone is considering a locums career and then say, has
a family, do you have a family?
You have children.
So how do you handle that with locums?
Does that have you traveling more saythan a W2 position might and how do
you work that into your family life?
Ali (08:54):
Great question.
I get this all the time, Ali, Ido locums, but I have a family.
Okay.
Now everyone's family is different.
I can't say that each situationis copy and paste and you
can do the exact same thing.
But I'll tell you this, yes, I'm a father.
I travel.
I'll tell you example ofa mom that works with us.
She has five children.
She works full-time locums now because shesays it gives her actually, so two things.
(09:18):
One, it gives her time todecompress between shifts.
Again, ER, no one understands what we do.
When you go home from an ERshift, you need a breather.
You need to take a littlebit of time to relax.
I still work clinically.
I still work a hundred hours a month.
So your family, when you get home,is expecting you to be on the
moment you walk through the door.
Your kids aren't gonna give you sometime to just chill and relax and
(09:39):
drink your tea and whatever, right?
You gotta put 'em to bed.
You gotta make them meals.
They're waiting for you.
You've been gone all day.
You got responsibilities themoment you walk through that door.
Your spouse may not understandwhat you're going through.
If they don't work in the ER as a doctoror a nurse or something, they don't
get it, and you can't expect them to.
So they're not gonna understandthat they need to give you a little
bit of time to decompress as well.
So she said, this is the only timeI get to myself and I love it.
(10:02):
So in between shifts, you'll worklike four or five shifts in a row,
stay at the hotel, and guess what?
She has time to herself.
She never gets time to herself besidesthe locum shifts that she's working,
and so she absolutely loves it.
Now what a lot of doctors do, andI did this as well, is that during
the times that we're away, we'llget additional help for our spouse.
Her spouse works from home.
(10:22):
His job is remote, and they're able toget a nanny or babysitter or some extra
help or extra care during those days.
So that's one way to do it.
Another benefit of that is I think itactually helps strengthen relationships
Being gone for a period of time.
When you come back, you look forwardto seeing your spouse and your kids.
It is a little bit stressful whenyou need to decompress and you can't.
Right.
And you're just all in eachother's faces all the time.
So I've actually found in myexperience and other people who've
(10:45):
done it, like it actually helps.
Have a little bit of distance,a little bit of time away.
Then when you come back, you're,you know, they say absence
makes the heart fonder, right?
And so that's anotherbenefit of it as well.
And not to mention, that waslast year, I told you how
much I made 500 plus thousand.
This year I'm working onlyeight shifts a month and I'm on
target to make over $380,000.
(11:06):
Eight shifts a month.
So I wish I could show you my schedule,but I work them all in one block.
I'm in the middle right nowof a five week vacation.
Sam (11:15):
Wow.
Ali (11:16):
And I do this every other month now.
I take four weeks off at a time.
I work my block.
So I'm working until, I'moff until August 23rd.
I think 24th is my first shift.
I've been off since I think early July.
I don't even remember.
I traveled the world.
I was in Tunisia, I was in London,I was in Switzerland, Portugal.
I just got back.
I still have two weeks off.
Do you understand?
Sam (11:34):
Yeah.
Ali (11:34):
I have more time with my family than any one of my colleagues does,
and I get paid more than them.
So I can do whatever I want.
I can work eight shifts amonth and still make more.
Or if I wanna make more moneyand just stack up my cash and,
you know, invest or buy a houseor whatever, I can do that too.
Sam (11:50):
So when you work your eight shift, you're doing that in one large block to
accumulate that the rest of the time off.
Ali (11:56):
Eight, 12 hour shifts.
I make $330 an hour, and over thecourse of a year, if you just add
that up, do the math, it's $380,000.
And people might say, well,I can't do eight shifts.
You can, if you know you have fouror five weeks off right after that.
Right?
And in between shifts,I optimize for sleep.
For recovery.
I'm not doing a lot of things between onthose shifts, that eight shifts block.
(12:16):
I work some nights as well in that block.
You know, there's notenough productivity on me.
I don't see my family sure for eightdays, but for 30 plus days, I am.
Right.
And I'm actually there.
So people talk about this idealike, are you really present
when you're home between shifts?
Oh yeah, I wanna be home every day.
Okay.
Is that just something you were toldbecause that's what the expectation
is, because that's what the norm is?
(12:38):
Or is it actually good for youbeing home after a shift when
you're tired and burnt out.
Sam (12:42):
Hmm.
Ali (12:42):
I just need a freaking break versus working a stretch of shifts
being away then coming back and being,Hey, I'm home for 30 days, I'm good.
Right?
I don't know.
I think people have it twisted.
They just don't know what they don't know.
Sam (12:54):
And when you do your stretch of eight, for example, is that
all in one facility, one location?
Ali (12:59):
So I've been fortunate.
I've been at this site in Delawarefor about six years as a locum.
Sam (13:04):
Wow.
Ali (13:04):
The last three years as pretty much full-time, meaning
I work there exclusively.
I am credentialed at a couple ofother sites and the game for locum
is always, you gotta be credentialedat least two, ideally three sites at
any given time in case one dries up,you can always work at another one.
So you're never out of a job.
That's what people say,oh, locums is unstable.
It's not if you play the game and I'vebeen playing it for 10 years and I'm a pro
(13:24):
at it, so I can teach you a thing or two.
Sam (13:27):
So when you say you've been at the same facility for six years, are
you the only locums person and iseverybody else a W2 or is it just kinda
a mix or how does that work exactly?
Ali (13:35):
Well, I've been there longer than most of their full-timers
Sam (13:38):
Wow.
Ali (13:38):
I'm definitely not the only locum there.
So yeah, there's a bunch of other locums.
As a matter of fact, I havea staffing company as well.
It's called Locum United.
I started that eight years ago.
And so we have a few other docsthat work there through our staffing
company to help, and people alwayshave this idea, if I may add that,
locum is only at dumpster fire sites.
This is another common misconception.
I think a lot of residents, when I seethem they ask me this question, Hey,
are they only at dumpster fire sites?
(13:59):
Because I think that's thething that gets passed around
Sam (14:01):
Sure.
Ali (14:02):
from attendings who don't know any better, who've never done it.
And I've been at, if I've been doingit for 10 years full time, now it's 11.
I've been at a dozen plus sites inthe last 10 years, and only one,
which was the first one I went to,was a dumpster fire site, which was
understaffed and just complete chaos.
And that was from another companythat is big name company that's out
there that put me at this place.
(14:22):
And that's the reason why Iactually started my own company
because like, you know what?
I'm not gonna do anydoctor like they did me.
You know?
And so I started my own.
I was like, yeah, I'm gonna paymy doctors good and I'm gonna
send 'em to sites I would work at.
Sam (14:33):
So I could see maybe years ago where, you know, staffing shortages were
not as bad and people could become W2employees and stick around for a while.
The only sites that couldn't hirepeople would be those dumpster
fire places, as you said.
But now, you know, nationalshortage, emergency physicians
are in high demand everywhere.
(14:54):
So you're saying you could actuallyget a locums position in a larger
city, maybe like an urban center even.
And sometimes they're temporaryand sometimes, like in your
Delaware case, they're not.
Ali (15:04):
Most of the sites I've worked at and everything's about geography,
so like you said, there's a supplyand demand tension here, right?
Less supply of doctors, high demand.
Now doctors, we don't understandor we've forgotten basic economics.
When that happens, youcan demand a higher price.
But we let the hospital dictate tous what they're gonna pay us and
take a fraction of what we deserve.
(15:25):
And so we're not playing that supplydemand tension in our own favor.
And I'm not saying we shouldgouge the hospital and make
a thousand dollars an hour.
No, I don't think that's necessarilyit either, but I think what we
do, the work that we do, we needto get compensated more for.
I just don't think anyone else getsit, again, not admin or anything else.
So this supply demand tensionthat exists, it means that there's
(15:46):
gonna be hospitals all across thecountry that are short staffed.
Now, if you go to maybe Hawaii, you'regonna have a hard time finding a locum
need there because everybody wants, ifthey can be there and they'll take a
much smaller salary than anyone else.
But the big metropolitan cities,maybe just an hour, two hours
outside of that, you'll find alot of hospitals that need help.
There's nothing wrong with these places.
They run very well.
They're actually very functionalplaces, but they don't have the desired
(16:11):
geography for people to wanna live there.
I'll go out there and work someshifts, but I don't wanna live
in small town, Alabama, right?
It's just not what Iwanna raise my family in.
I don't want to build like asocial network there necessarily.
'cause all my friends live here.
I wanna live in one place.
I'll go work there for like fouror five shifts and then come back.
You see what I mean?
Sam (16:27):
Yeah.
Ali (16:28):
So that's really what the situation is for.
The vast majority of sitesin my experience is that
they're just short staffed.
They're all functioning places, but justcan't find doctors who wanna stay there.
They'll get doctors outta residency,they'll come and stay there for
a couple years, and then they'relike, what am I doing here?
I need to go back.
I have a kid now I need to goback to our parents where they
live and all that stuff, you know?
Sam (16:46):
So in your personal geographic region, how far are you traveling
routinely for your locums jobs?
I mean, you're going,like across the country.
Are you more regionalized?
What's it look like for you?
Ali (16:58):
I've done it all and I've been fortunate.
I live in Eastern Pennsylvania and 90%of my jobs have been within driving
distance, meaning that I could drivethere, stay there for a couple days.
I couldn't drive thereevery day between shifts,
Sam (17:10):
Sure.
Ali (17:10):
But driving within two to three hours tops.
So I would usually go drive and doa stretch of four to five shifts
in a row and then come back.
There are sites that I've goneto in Michigan and in California.
Those are short term.
I didn't do them as much, but somepeople like doing that because
maybe they have some family or somerelatives in California or they
just wanna go visit and stay there.
Whatever.
Totally possible.
And guess what the hospital paysfor your travel and for your hotel.
(17:33):
And guess what?
This year, because the hospitalpays for my travel, I have over
a million Hilton Honors points.
Which I can use for, youknow, when I travel book like
five star hotels for free.
And that adds up to about $20,000 a yearand just free travel stipend essentially.
There's all these cool little perksthat you can do and you don't have to
get on a plane if you don't want to.
(17:53):
It depends where you do live, butmost places, say you live in Dallas.
I get jobs, opportunities, and things, you know, we're an hour outside of
Dallas, two hours outside of Dallas.
So you can live there if you seethat you want to, but just drive
out, stay there for a couple daysand come back and you're done.
Sam (18:07):
All right, so let's talk about some of the practical day-to-day matters
of being a independent contractor.
So you've been fortunate enough togo back to some of the same hospitals
again and again, but let's say you'rein this position and you're working
multiple hospitals, how do you adjustto different EMRs and different
consultants and trying to understandthe flow of and how things are done at
(18:29):
each department without being someonewho's been there for a while already.
Ali (18:33):
You're gonna get butterflies for your first shift or two.
And it's because you know the medicine,but you don't know the system, so you
just kind of feel somewhat handicapped.
Sam (18:40):
Yeah.
Ali (18:40):
I, again, having done it for at least 12 times in the last 10
years, it takes about two weeks.
Two weeks of consistency working there.
You will get a hang of the system,who to consult, what the EMR is like.
And you'll be more or less independent.
And usually hospitals, when you comeon early, they recognize that you're
gonna be somewhat handicapped becausethey know it's a new system for you.
So they'll usually have some leeway.
(19:01):
So yeah, it's not that hard.
I mean, we're smart people generally.
The EMRs, yeah, some are harder tolearn than others, but as long as you're
going there consistently and not takingmonths off between shifts for your
locum, because then you're not gonnaremember the system when you go back.
Right?
Sam (19:12):
Yeah.
Ali (19:12):
So there has to be some level of consistency.
But if it's Epic and you useEpic at home, then it shouldn't
be that big a deal, right?
Or whatever EMR that you use.
Sam (19:20):
So after say two weeks of being at a facility, then there is some advantage
to going back to that same center, youknow, a few more times if you have the
option to in your locums geography.
Ali (19:32):
Yeah, and also remember, credentialing takes forever.
It's a pain in the butt, dude.
If there's one negative tolocums, it's credentialing.
I hate credentialing.
It's the most painful thing that Ithink physicians have to do, even the
ER work is less painful in my opinion.
I guess that's debatable.
And the reason is because thesehospitals have these antiquated
credentialing requirements forthe most ridiculous things.
And then you'll send it to them andthen they'll say that they didn't
(19:54):
get it, but you sent it to 'em twoweeks ago, you can show 'em the email
like, oh, well can you send it again?
And so the way that I tell doctorsand the way that I train them inside
our training community Locum OS iscreate a Google folder and have sub
tabs in that folder for each thing.
So for licenses, your DEAs, your residencydiploma, health documents, all those
(20:15):
things, so that way anytime you starta new credentialing package, you have
all that data ready and it's easy toplug and play because otherwise, if
you're trying to figure out throughyour emails, try to find all this
stuff, it's never gonna get done.
Sam (20:25):
Yeah.
Okay.
So it takes a little organization.
I can see that.
Ali (20:29):
A bit
Sam (20:30):
It takes a little bit
Ali (20:31):
Organization and you'll be done, you'll be set for life.
Sam (20:34):
Okay so you have an interest.
Maybe you are ready to dosome traveling or you're not
objecting to any of the traveling.
You gotta spend a couple of weeks at eachplace to kinda get the lay of the land.
You've got your EMRs you can adjust to.
Do you think the majority of independentcontractors are out there working on
their own, or are they working with saylike locum staffing companies where you
(20:55):
get to know some people who are kindof regionally doing the same thing?
Or in your experience,how has that worked out?
Ali (21:01):
Usually it's through locums companies.
And I've tried going directly as well.
This was one of the things, 'cause whenI had my first job and my bad experience,
I was like, you know what, I'm justgonna contact hospitals directly.
And I tried doing that and that'sa big pain too because you can't
find the right person to talk to.
Also if you do, they'll say, well,we don't contract directly and you
have to work through X locum companyor this vendor management system.
Sam (21:22):
Okay.
Ali (21:22):
Some hospitals will take you directly.
And so I know doctors that do do thatand they'll spend the time to do it.
But the land mind of what working withthe locums companies is getting underpaid,
getting sent to the wrong sites andthen playing games with you, right?
I know many doctors who I've workedwith side by side at sites and they're
getting paid $50 per hour less thanI am because I take care of my docs.
I make sure that we get paidtop dollar going in, right?
(21:43):
We don't have to negotiate orfigure out what your worth is.
Whereas this other locums company,remember traditional locums companies,
they have recruiters on their team, right?
Sam (21:51):
Right.
Ali (21:52):
I don't have any recruiters on our team.
I am the recruiter.
So their incentive is, okay, so say adoctor says I'll take 200 per hour, but
say they're billing the hospital 400.
Huge commission, right?
If a doctor says, Hey, I want 300.
So there's a smaller commission there.
Sam (22:08):
Yeah.
Ali (22:08):
Their goal is to low volume and pray and hope that you
don't know what your value is.
Sam (22:13):
Wow.
Ali (22:14):
And so most doctors, like myself, I was a sucker.
I didn't know what my worth was.
I took the $200 per hour job.
I did.
That was my first one I took.
And later on I was like, oh dude,I probably left 50 to a hundred
thousand plus on the table.
Just 'cause I didn't know Ishould have asked for 300.
Right?
Sam (22:27):
All right.
Ali (22:27):
We're not good negotiators.
We've been in medicine.
Sam (22:29):
Yeah.
Ali (22:30):
One way thinking we don't know negotiating skills and all.
I mean, we're very much in many waysinfantile and very juvenile in many ways
because we've trained very highly and verydeeply in one thing, but nothing else.
Sam (22:43):
Yeah, I mean, we don't go to business school, so it's not in the curriculum.
Ali (22:46):
Very underdeveloped in other ways.
And so that's part of the thingI'm also teaching doctors is start
developing yourself in other realms.
Whatever it is.
Just like in terms of leadership.
In terms of entrepreneurship,in terms about just setting
boundaries for yourself and knowingwhat your're worth actually is.
Right.
And because you miss out on that for10 years of things that you would
learn in the real world I guess.
If you were to take a job ortake an offer, do a counter
offer, things like that.
(23:06):
We don't think that way because we'rejust thinking about how to save lives
Sam (23:09):
Yeah.
Ali (23:10):
And how to do this intubation.
And if this doesn't gowell, what's my next step?
All those type of things.
We're thinking algorithmically,what are we doing next?
And so there's no training fordoctors once they graduate residency.
After you're done you're on your own.
Sam (23:22):
Right.
Ali (23:22):
So now you have to just figure out things and trial and error.
That's what I did.
I didn't know any better.
But it's important to try to find,I think, people who are where you
want to be and try to see how theydid what they did, because otherwise
you're gonna make the same mistakes.
And those are costly mistakes that I made.
I'm just trying to teach people how not tomake those mistakes that I made because I
(23:44):
could be much further ahead if I didn't.
Sam (23:46):
So then picking the right locums company is critical in this scenario.
Like one you can trust, but also oneyou can negotiate with in this, and
one that you're not desperate for.
Ali (23:56):
And to be clear, look, I would love for people to work with our company, but
I logistically can't place every singledoctor because we have limited number of
jobs and we do get those placed quickly.
But what's more important is that you knowwhat your worth is and what your value is.
Sam (24:07):
Hmm.
Ali (24:08):
Right, so I tell ER docs, if you're working at a site,
generally speaking, don't takeanything less than $300 per hour.
If it is 10 99, don't takeless than $300 per hour.
Now, the caveat to that is ifyou're working at a 24 hour shift
at a small critical access hospitalthat only sees four patients a day.
Those are sometimes a little less thanthat, like maybe in the two hundreds
or so, but beyond that, 300 should beyour baseline and then go up from there.
(24:30):
I dunno if you're familiar withthe EM doc jobs Facebook group.
And on our newsletter as well.
So we post these jobs inthere and our jobs have been
up to 330, 350 per hour, 75.
We even posted one last year for 400.
My goal is to just pay docs whatour value is, what our worth is.
So that way, honestly, like we can setourselves up for success outside of the
walls of the hospital because I want us tohave good, happy, long fulfilling careers.
Sam (24:55):
So when you, as a independent contractor, register with a locums
company, you're contracting with themand then they go off and contract
with the hospital for howevermany hours you're going to work.
But does that require any kind ofexclusive agreement with a locums company?
Or can you contract with multiple ones?
How does that generally work?
Ali (25:13):
Very good point.
Caution to everyone.
Do not share your CV with anyrecruiter until you're a hundred
percent sure that you want to beworking at that particular site.
And also make it clear to them thatyou only want your CV presented
to that one singular site.
There's so many shady tacticsthat I've seen in the industry.
(25:33):
What some rookie recruiters will do isthat they'll take your CV and they'll
just shotgun it to a bunch of placeswithout your permission, or maybe
you said, Hey, you can send this onesite, but let's send it to a bunch.
Sam (25:42):
Hmm.
Ali (25:42):
What that does is once your name has come across a credentialing
site or facility, they have your namenow on a file and now for two years,
you cannot work at that site withany other locums company except for
the one that presented you initially
Sam (25:55):
Interesting.
Ali (25:56):
It locks you in.
I've had that so many times.
I'll post one of these high paying jobs onthis Facebook group and in my email list.
And doctors will say,Hey man, I saw this job.
Can I apply?
I'm like, sure.
So they apply and then we get amessage back from the site like, Hey,
this doctor's already in our system.
They can't work there with us.
So I message the doctorback, Hey, what happened?
Yeah, man, like X company and I don'twanna name names, but this company
(26:16):
presented me like two weeks ago for300, but I saw the job on yours for 350.
I'm like, yeah, unfortunatelyI can't do anything about that
.The bylaws are what they are.
And I wouldn't, becausethat's what the rules are.
I cautioned docs to do your homework.
Make sure you know where you're going,how much you should get paid, do some
research, go to Facebook, join ournewsletter, just so you know what is
out there and what rates are going.
(26:38):
'cause otherwise you'regonna sell yourself short.
Sam (26:40):
So in that scenario, you send your CV to Locum Staffing Company
X, they give it to the hospital, andthen the hospital says the only way
you can work for us is now throughthis company for this period of time.
Ali (26:53):
Usually it's a two year clause for that.
Sam (26:54):
And that's a clause between the hospital and the locums company.
Ali (26:57):
Yes.
Sam (26:58):
Okay.
Ali (26:58):
It's a standard clause.
And the hospital enforcesthat, not the locums company.
So technically, if the locumscompany didn't know about you.
And say, for example, I justpresented and the hospital said
Yes, okay, we could do that.
Sam (27:10):
Right.
Ali (27:10):
I wouldn't, but I'm saying that's possible.
But the hospital itself has itin their bylaws, in their system,
like anyone that's been presented.
'cause they have a relationshipwith these companies too.
And they don't wanna burn anybridges and they don't want to do
things that are outside 'cause thenthey won't get good candidates.
So they enforce this.
Sam (27:24):
Gotcha.
But there's nothing in the contracts thatmakes you exclusive to a locums companies.
Ali (27:30):
Yeah, no.
You can work with any company aslong as you haven't been sent to
that particular site, or your namehasn't been sent over to them.
You can work with anycompany at any time really.
Sam (27:39):
Awesome.
Awesome.
And then, all right, so nowtell me about your company.
You are staffing locums in aspecific region of the US or
how big of a blanket is it?
Ali (27:49):
So we're national.
We're national.
We have contracts in California, Arizona,Oklahoma, east coast, northeast, and now
starting to venture to the south as well.
And yeah, we have contracts all overand our contracts come and go pretty
quickly because we post high paying jobs,like they get taken very, very fast.
And yeah, I mean, it's aphysician founded company.
Myself and my brother, who's not aphysician, we started the company
(28:11):
eight years ago because of my firstexperience that I talked about earlier.
It was horrible.
Sam (28:14):
Hmm.
Ali (28:15):
And I said look man, at this point, no one's watching out
for us doctors, and no one will.
I realized early on that noone really cares about us.
And I don't mean that in some sort ofcliche, but it is what it is, right?
I'm not gonna try to fight the system.
The hospital system, the corporatesystem doesn't care about us.
We're just cogs in the wheel.
We get called into the office for apotassium that we didn't correct, that
was 3.3, you know, some BS stuff, right?
(28:36):
And my same experiencewith that locum company.
So I'm like, you know what?
I've always been the type ofperson, like things don't have
to be that the way that they are.
And so what can I do to changethem and I was fortunate that
my brother has a business andfinance background because I don't.
I'm just a doc.
I just fix people . And so we partneredup to build something that was gonna
favor our doctors and not have themtry to play the games that they had to
play with these other locums companies.
(28:58):
We're just direct.
I still work clinically.
Like I said, I'm not some person who'smade a bunch and now I'm just chilling.
I work clinically still.
I make sure that we are very high touch.
We pay them what they're worth.
And you'll see on these variousforums that people love us.
I come to conferences, peoplelove meeting me and saying hello.
And you know, we post sometimesthese funny little AI images
that people like and stuff too.
So we have a good time with it.
I love it because I get to meet peopleand honestly get to change some lives.
(29:22):
That's been the biggest part of andrevelation for me, this year and
last year, where I started seeingpeople who actually messaging me,
saying, man, you changed my life.
Sam (29:28):
Wow, that's awesome.
Ali (29:30):
And I was like, wait, I thought I was just gonna do this locum thingy
and now it's coming to something else.
'cause it changed my life.
So I guess I shouldn't be surprisedthat it's changed other people's lives.
But I wasn't consciouslythinking about that.
And so now it's giving me evenmore meaning behind what I'm doing
because sometimes I take it forgranted what I'm doing now, having
a month off for me is norm now.
But seeing my colleagues and whatthey're going through I think that it
(29:51):
hits home now when I see them saying,Hey, actually, you helped me a lot.
It means a lot.
Sam (29:54):
Yeah.
Okay, so one more question, sorry, aboutthe practicality of how this is done.
So when it comes to the malpracticeinsurance portion of it, is that
something that's typically covered bythe locums agency, or do you have to have
your own as an independent contractor?
Ali (30:07):
It should be covered by your locums agency.
Yes.
And you know, there's been a lotof issues with malpractice with
various large companies goingunder and things like that.
Just make sure that you ask yourcompany to offer you a certificate
of insurance that says that, hey, ifanything happens to our companies,
that you'll still be covered.
Yeah you shouldn't have to pay for that.
And most companies have similar largeorganizations that are out there.
(30:28):
They'll have a similarkind of insurance policy.
So just make sure thatyou're aware of that and
Sam (30:33):
Keep track of that.
Ali (30:33):
Keep track of it.
Yeah.
Oh, and one thing is that whenyou're doing your credentialing
on all that, make sure you have afolder for certificates of insurance.
It's called a COI for short,because those things are almost
impossible to chase down later on.
Sam (30:46):
Hmm.
Ali (30:46):
Sometimes hospitals shut down or someone else is coming in and you
can't get a hold of the right person.
You'll always get one when you firststart working at a new site from the
locums company, or say you're workingwith a large contract management group
or independent group or something else.
Just make sure every time you work ona new site, you get that certificate
of insurance and you put it in afolder because otherwise it can be
impossible to try trace those down.
You'll thank me for that later.
Sam (31:08):
Awesome.
Awesome.
All right, well, so if someone'slistening and they wanna reach out
to you, how do they get ahold of you?
How do they learn more about your company?
Ali (31:14):
I'm not hard to find.
I have various socialmedias and things like that.
I'm on Facebook as Ali Chaudry.
My Instagram is @therealtopdoc.
I have my company, which is Locums United,my staffing company, but I also have a new
training platform that I just launched.
And we're doing our first livewebinar this month on August 27th.
You can find out more information atthelocumos.com and you can forward slash
(31:40):
workshop and you can sign up there and I'mgonna do my first live workshop where I'm
gonna be giving away a lot of free valueand a free gift for everyone who joins.
Something I've been workingon for over two years.
I'm gonna give it away for free.
So make sure you comment.
I wanna see you there too, Sam.
Sam (31:53):
Awesome.
Awesome.
Hey I'll be there.
I'm looking forward to it.
All right.
Well, Ali, thank you for takingthe time, you know, in between
your multiple weeks off to cometalk to us about the locums life.
This is some precious informationfor anyone who's listening, who's
feeling the crunch in whateveremergency department you're in.
We all feel it.
Definitely some food for thought if you'renot out there working locums already.
(32:14):
And even if you are, whether you'rea physician, really a PA, a nurse
practitioner, any type of traveling locumsclinician this is some solid sound advice.
Actually one question for you.
Are you staffing non-physicians aswell, like nurse practitioners and PAs?
Ali (32:28):
We do APPs, so PAs, NPs, CRNAs as well.
They kind of fall underthe locum demographic.
Nurses we don't do because they're acompletely different kind of system.
And I'll be at ACEP as well this year.
We have a booth there.
You can come find me ACEP
Sam (32:41):
Awesome.
Alright, well thank you very much Ali.
Really appreciate you takingthe time to share with us.
Ali (32:45):
Happy to be on, man.
Really appreciate it.
Thank you.
Sam (32:47):
And that's a wrap.
Thanks for joining us forthis episode of EMPlify.
I hope you found it informative, and Iwant to remind you that ebmedicine.net
is your one stop shop for all of yourCME needs, whether that be for emergency
medicine or urgent care medicine.
There are three journals, there'stons of CME, there's lots of
courses, there's so many clinicalpathways, all this information at
(33:10):
your fingertips at ebmedicine.net.
Until next time, everyone,I'm your host, Sam Ashoo.
Be safe.
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