By Victoria Brown, and Gabriela Ballester with contributions from FlexMedStaff

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For physician mothers in hematology/oncology, work frequently bleeds into personal life. 

Dinner with family is interrupted by a hospitalist calling to ask if a patient emergency requires chemotherapy. Breastfeeding is interrupted by a call from the emergency department to evaluate critical thrombocytopenia. Bedtime with kids is interrupted by an oncologist from an outlying facility calling to collaborate on the case of a hospitalized patient. Sacred sleep time is interrupted by a lonely, terrified patient calling for reassurance.

And yet, I love my work.

I love working up a prolonged PTT and reading about the newest anti-cancer agents. But when I started to look for post-training employment, I knew I needed to spend time with my family. I needed to encourage my 4-year-old daughter’s excitement with reading. I delighted in the special moments when my 18-month-old son would show me his newest “dance.”

Throughout my training and early career, I lived and breathed medicine but loved and missed my family, to whom I was irreplaceable.

As I started my job search, I found the duties required of salaried hematologist/oncologists increasingly untenable. Unpaid obligations such as early morning tumor boards, late staff meetings, committee memberships, teaching responsibilities, and drawn-out research projects are generally expected to be completed outside work hours. Women often bear the brunt of unpaid work, as research shows that we are more likely to be junior faculty (1), answer higher volumes of in-basket messages (2), be asked to do thankless, “non-promotable” tasks such as arranging the office party (3), and consequently have high levels of burnout (4).

To find work-life balance, I explored locums after a trusted fellowship attending shared how she shifted away from a traditional, salaried position.

When I researched locums opportunities, I quickly found a position without a recruiter. It has been life-changing!

This is what I have learned about locums.

#1: Locums is inherently about “consent.” The employer asks.  You agree – or not.  Simple!

#2: There is no assumption that additional work will be undertaken without additional compensation.

#3: Locums permits mothers to respond quickly to unpredictable demands and minor illnesses in the family, particularly in a post-CoVID era.

#4: Locums work allows for day-to-day flexibility to arrange for dental, OB-GYN and other medical appointments without worrying about RVUs or potential lost bonuses, penalties, or the prospect of being denied medical leave requests altogether.

#5: Locums allows for longer-term flexibility. Going on an extended vacation to Italy or attending the whole week of the ASH annual conference is a possibility.

#6: Locums work provides leverage to avoid signing a non-compete agreement, especially when negotiating directly with a group.  There is no need to relocate if the position is not a fit.

#7: Locums positions are generally well-paid and well-appreciated.  Often, a locums gives reprieve to a tired group of oncologists, who are quick to show gratitude.

#8: Importantly, locums allowed me to build confidence. I have identified subtle iron deficiency anemia, new cirrhosis-related cytopenias, and subtle areas of tumor progression, findings that have been recognized by colleagues. This recognition has made me feel even more a part of the “team.”

When I first contemplated working locums, I was uncertain about starting a non-traditional role. However, I had misconceptions about these positions, namely:

#1: Locums is for incompetent doctors. FALSE In my experience, highly qualified and competent clinicians prefer locums over traditional positions. Though not studied in-depth, the care provided by many locums is as good or better than that provided by salaried employees (5, 6)

#2: Locums is not intellectually stimulating. FALSE I collaborate closely with other oncologists to provide second opinions and insight into treatment protocols.  Working with different clinicians at different facilities allows for professional and personal growth.

#3: Locums makes publishing, research, medical education and prospect of achieving a promotion inaccessible. FALSE. I lecture on topics in non-malignant hematology to medical residents. Writing remains a joy.

#4: Locums positions are only found in remote destinations. FALSE Locums work does not have to be far from home. Searching locally, I found work at a hospital and clinic located 6 minutes and 35 minutes away from my home, respectively. 

#5: Locums requires a staffing agency. FALSE Even as a new fellowship graduate, I have been able to directly contract with groups to provide locums coverage.

#6: Locums work will not provide malpractice insurance. FALSE Most locums positions provide malpractice insurance with tail coverage through the employer.  Health insurance may also be negotiated.

Locums is not for everyone. Not everyone can look past negative typecasts. Some clinicians prefer to manage their patients fully on their own, without collaboration.

However, locums has enabled me to enjoy a fulfilling career. I remain dedicated to my field of study, while having more time to spend with my husband and children.

What I do with my free time is limited only by my own imagination.

American author and thought leader Andy Andrews said, “If you are doing what everyone else is doing, you are doing something wrong…because most people are not obtaining results that are considered extraordinary…and to produce results that are extraordinary – you cannot afford to think like average people think.”

As hematologist/oncologists, we are expected to accomplish the “extraordinary” for our patients. As locums, perhaps we can prioritize ourselves and our families to achieve the extraordinary feat of work-life balance for ourselves.

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