How does locums work for neurology?
Sandeep K. Aggarwal, MD, a general neurologist with subspecialization in electromyography, shares his thoughts on how to be successful as a locum tenens neurologist.
Locums tenens affords opportunities for all medical and surgical specialties. Neurology is no exception, and locums work can be quite rewarding and fulfilling.
Demand for neurology services in rural areas
Most neurologists tend to work in urban or suburban centers, and there is a dearth in rural areas or smaller cities. Unless you grew up in these smaller areas, neurologists don’t tend to apply for full-time positions at these facilities or practices. Why is this? For some, there is a certain angst of the unknown. Furthermore, most physicians were raised in larger cities and tend to work in proximity to their sites of training.
Apply your skills to a wide spectrum of patients
Due to this saturation of physicians in large urban centers and increasing interest in sub specialization, there is an opportunity for those interested in applying their skills from general training in areas of shortages to provide care to a wide spectrum of neurologic patients. This may be difficult for a sub specialist as they may not be as comfortable or interested in disorders outside their scope of practice. But for those who have enjoyed working in a general neurology capacity or are interested in re-expanding their skill set, traveling to remote areas can be a way to serve as the main point of contact for these patients.
Travel and explore
The demand for neurologists who are willing to travel may be particularly appealing to young physicians as they search for geographic areas of interest and job opportunities. Some facilities use locum tenens as another marketing tool for recruiting physicians who come as locums and decide they want to stay.
For a locum tenens neurologist who has interests in outdoor activities, there are plenty of opportunities for recreation available with most locum tenens assignments. The staff can also be a tremendous resource in learning about the local communities and their customs and culture.
The flexibility of being able to work full-time, part-time, inpatient or outpatient, or a mix of the two can provide ample opportunities to both experience new clinical settings and enjoy your time off discovering the area.
Most general neurologists can diagnose and treat many of the common disorders as the first stop in the patient’s course of care. There’s a certain satisfaction knowing that a patient can be treated locally.
With the increasing push to fellowship training by neurology residency programs, a general neurologist can incorporate some of these skills into their practices to provide a broader spectrum of coverage. For example, those who completed neurophysiology training can provide additional diagnostic and treatment options for epilepsy and peripheral nervous system disorders. Those who have subspecialized in headaches or movement disorders can set up practices that incorporate these skills and develop a subspecialty clinic within their general practice for the surrounding communities as a catchment area.
Expansion of neurology practice
With the wider extension of the internet to rural areas, additional services can be provided to the community through telehealth. There is always the possibility to refer to tertiary care centers for further subspeciality evaluation as well. With advanced technology and therapeutic modalities, these centers can further optimize treatment once initial treatment paradigms have been exhausted. Indeed, epilepsy patients who have failed two or more medications would benefit from more detailed evaluation (i.e. inpatient epilepsy monitoring) to better characterize the semiology of the seizures, and then consider more advanced level treatments such as multimodal stimulation therapy and surgical intervention. Some locum tenens neurologists work exclusively as neurohospitalists, while others work in the outpatient clinics. This can serve a community very well with dedicated coverage of each part.
Coverage and continuity of care
Given the nature of locums, which is typically a temporary stint or part time work, there is always the question of patient coverage for phone calls, insurance questions, and messages by other providers or patients when the physician is away. In larger centers, employed neurologists, nurse practitioners, or PAs can assist with coverage as needed, whereas in smaller facilities, the internist may have to take on this role.
Prior to signing up for an assignment as a locum, it is always helpful to clarify these duties to allow for a smoother transition. In some settings, providers have arranged to field the calls and messages after completing their regular duties at their present assignment until they return to the original facility or a replacement is found. In other situations, they may receive a phone call by the staff if the message is urgent or cannot be handled by the staff, though these are rare. Either way, this ensures continuity and good will in the community.
Do you have questions for Dr. Aggarwal? Ask them in the comments below.