Ep. 85: Strategy For Steady Locum Tenens

Welcome to the “Sapling Series: Locums Done Right,”  with our hosts, Larson Hicks and Dr. Jason Patten! We will be posting a new episode once a month along with the mini version of a previous “Branch Out” episode. 

Before taking up medicine, Dr. Jason Patten piloted for the Air Force and worked as a firefighter. But after a few years in the healthcare industry, he founded his own successful locum tenens business. Today, he shares his secrets on how to gain flexibility while working at a hospital and how to become indispensably helpful by playing to your strengths (whether they are soft skills or extreme productivity). 

Want to know more? Check out our website: https://sycamoredocs.com/

Transcript

SPEAKER_00 0:09

Um I'm excited to have some with us. It's fun uh fun to get a chance to catch up with you. Um so great, thanks for coming on, man. Yeah, thanks for having me. So so before we get into really what we wanted to accomplish on this um podcast today is just we you're you're a professional, full-time locum tenants doc, among other things. Um and I think you're uh when I think about physicians who have kind of cracked the code and figured out how to do this really successfully, you're kind of the first person that comes to my mind. And so um what we're hoping to do today is just get a little more insight uh from you that we can share with the world uh about how to how to build a successful locum tenons um business. And so um so before we do that though, I'd love to just could you give a little bit of your background, just um introduce yourself?

SPEAKER_01 1:14

You know, I I tell the story as uh I just am a restless heart and like to travel and do all the things. And so my early careers have been doing fun, adventurous things, uh firefighter for a little bit, uh flew airplanes for the Air Force uh for a very long time. And then on the side, I did go to medical school, and I think one of the most important things for me was coming out of medical school. I saw um a lot of unhappy doctors and and they were burnt out. And yeah, and especially when I was rotating in residency and seeing, you know, different emergency rooms and then uh you know moonlighting because it was very much encouraged by our director in residency, and now I know why, because I got to see something different and see how the real world worked. Yeah, um, I saw the writing on the wall then and saw that there are those people who were still in it happy and loving their life, and those that weren't. And I saw the ones that were more in control of their own life, their own schedule, uh, they were happier and they still enjoyed doing emergency medicine. The others didn't.

SPEAKER_00 2:27

Yep. Well, I I mean there's a thousand things, rabbit trails to go down there that that I'd love to do in a longer form interview. Um, but I'll I'll try to control myself and and stay focused on uh the task at hand. But that's a great kind of tee up for this conversation. So the bottom line for you is just that you you decided that, hey, um being a you know full-time employed W-2 ER physician at a single facility, you viewed that as a part of the problem that was leading to a lot of doctors burning out and and becoming dissatisfied with their careers, and so you you you chose to go a different path, do kind of more of an independent approach. And so I I think doctors are really scared, you know, a lot of times. What why do you think it is that that so many doctors are scared of of getting into locums?

SPEAKER_01 3:25

I I think it's an understandable fear. Um if you're sitting there in a life of I went to medical school, everything was well defined. I was to be here at this time and this thing, I had my insurance, I had everything taken care of me for taken care of for me. And when you come out now, for many people who've never had another job before, this is your first time being free. Uh your first time on your own, and that's daunting. Yeah. So it the ease of just transitioning into a contract where you have insurance and disability and everything set up, right? It's it's easy and it's comforting, like I said. The issue is nobody's giving you anything for free. All of this sign-on bonuses and the uh insurance and the liability and all of these things come at a massive cost. And essentially, if you want things for free, then you're paying for them. And that's what nobody understands, is all of these extras these guys give you uh are all on the back end little chunks of your time and money that they are stealing from you. Yeah, yes, it's a little more work to put that together, but I mean Sigamore's been really good about dealing with credentialing and some of the other things and taking some of those pieces out of the way uh that make it a little more difficult. Um, there's certainly you know smaller ways you can get insurance and all of these things and get your own disability. Yes, a little bit of front-end time goes a long way, but increasing your wage 50 to 100%, you know, I can be paid to figure out my own insurance and my own uh you know liability and all the things I need to function in life. I I just got paid to do that. They gave me a lot more money so that I could spend a little bit of time because I had more time too than the regular doctors. They're working double or some triple what I do.

SPEAKER_00 5:19

Yeah.

SPEAKER_01 5:20

And so, and but I make more money than them. So because I have time and money, the decision was very easy for me to just do the work, figure things out, even someone who's from the military and also had my life taken care of for me. Right, you know, in many ways. I I I felt like, hey, I should branch out, I should move on and find a better way to do this because they're essentially paying me to do it by paying me a much higher rate to take care of things myself.

SPEAKER_00 5:48

Yep. Well, well, tell me about so, you know, for doctors listening to this, I mean, what what what's kind of the first step? Like how do you how do you get started? How do you build, you know, how do you start moving towards, let's say, a steady locum tenants kind of schedule and and business?

SPEAKER_01 6:09

I I can tell you the way I did it and how I would have done it. Um the the easiest thing for me was to go do it. I just went and took short-term contracts, meaning I I took a first contract that essentially had a 90-day out where you had to give 90 days notice. I took the contract and I had already been doing uh moonlighting as well. So I have a couple of these small quirk contracts, and my minimums were very low. That was my first thing I had low minimums. I had to work six days a month or four days a month, whatever it was was the minimum. And I found if I didn't like the place, well, I had an easy 90 days, I can just move on. And if they didn't like me, same thing. Yeah. Um what fell into my lap was the realization that as I hit that, all right, well, this has been fun, but I don't like being controlled where they make my schedule. Uh so I said, Well, here's my 90-day notice. Right. And they were wonderfully like, wow, we really liked working with you. Thanks for being here. What would it take to stay? And so that was how I did it. I essentially took these contracts, found out that just being happy, working hard, being uh trained in medicine and doing a good job, right? Essentially, that made them want me to stay. And when that happens, and I've done that at every local contract I've ever had now, is that at the end, when I said, I'm I'm I had a great time, thank you for the opportunity, I'm gonna go do something else. They said the key word, what will it take you to stay? Now I had to learn to negotiate. And the key is everybody has to choose its time and money, and it's a balance of which one you choose. For me, it was hey, I want more money in the beginning of my career when I'm still paying off student loans and doing all the things. So that's what I chose. I said, Well, listen, I'll be happy to come back, but I need more money. I'm gonna be traveling, I need a travel fee, I need all of these things. And each time they came back with, sure, we can do that. How much money? And so I started at one rate, added a new rate, and each time I did this six, seven times in a row, I just kept increasing the number just to see because I had all these contracts now with and and I renegotiated everything with zero minimums. So I'll work for you if it works for me, and you want me to work for you because I've been there and have done a good job, and you appreciate that. So now we had this great relationship of they want me and I want them if the price is right, and because I already know I enjoy working there or it was a good environment for me, whatever it may be. At that point in my career 10 years ago, I wasn't super picky. I enjoyed working at the worst places. I had a blast with a variety and something different, and meeting new people and a bunch of nurses coming in, and you know, they they would see how I did things and we'd have great conversations, and you know, I'd grow as a doctor because I'd see a different way of doing things. They would learn different ways that other doctors can do things from a different environment, different region of the country. Yeah. So that was super enjoyable to me. And my rate kept going up and they kept offering more. And I didn't, I had the flexibility in that I was willing to kind of I just had zero minimums, so I didn't have to give them shifts. But if they would frequently call me and say, Here's I've got all these open shifts. Here they are. I pick which ones fit in my schedule, and then all of a sudden I'm kind of working what I want, sort of, you know, sometimes at nights, sometimes at weekends, uh, but a lot of day shifts. I got to kind of choose what I wanted. And there's opportunity out there with multiple contracts where you can do exactly that. You can still through three or four hospitals find a balance of, well, I want to work these shifts. I don't have to work, so they're just willing to take me, which is nice. The rate is pretty good, it's not the highest of all of them, but they're a little more flexible. That balance has you know evolved as I kind of went through the process.

SPEAKER_00 10:09

Yeah.

SPEAKER_01 10:10

Now I go back, so I had to feel my way through this for many several years. Right. Um there's there's an easy button in what you do because you're offering the the I didn't have I had to do the negotiating myself, and that sucked. I didn't enjoy that on multiple iterations, going back and forth with recruiters and and hospital executives and directors, and trying to make sure they understood my worth. A lot of that kind of you know, that's a difficult process and took a lot of my time. It was somewhat interesting, but after a while became burdensome. Um, you know, you and I have worked together for several years now. So that skipping that that process is very nice where you know you're you guys act as the middleman. So the past several years, uh, you know, as you know, your your company has done that negotiating for me. Well, I'm like, hey, I want this number and this is what I'm willing to work for, and you guys have just dealt with it for me. And that's nice. Like, I'm not gonna lie, that takes such a burden off of me. I'm still getting the rates I deserve. And the go negotiating component has been done entirely by you. And the nice thing is, is I still get to go work at the place, show them I'm worth every penny that what I requested. Right. And then I I can always go back and say, okay, well, that's been a wonderful six months or a year. Let's renegotiate. You know, we still have zero minimums in my contracts. And you know, I you know, I like doing that where now they understand what I'm worth. Right. Now they understand I have a good attitude, always, and I'm happy and I'm pleasant. I will just work and have fun and be there and the nurses like me. And because of that, my negotiation platform is so much stronger. It's so much higher because I've demonstrated it. And because I'm not tied into a contract for three years with some ridiculous signing bonus that isn't worth it, right? Guess what? I can go and renegotiate at any time. Right. And I'm not renegotiating for three-year contracts, I'm negotiating for the next shift. Well, it's been a pleasant time, guys. If you want to see me next month, let's talk about something that's a little more, you know, comparable to what I make at other places.

SPEAKER_00 12:15

Yeah. That's awesome. Um do you, I guess there's uh a couple of questions. One is, well, I've I've got a bunch of questions, uh Jason. One one is um, how do you do you find that um strategically you try to come in at a at a lower rate initially? Like is that is that kind of your foot in the door? Do you feel like that's a good strategy?

SPEAKER_01 12:42

Definitely. That was my definitive answer because I can always renegotiate. And I started low everywhere at the you know, I stand what everybody else is doing. That was always my answer. Um, I think you and I have kind of figured this out. My my transition through a career of doing this has definitely been the balance of time and money, the flexibility versus how much money they're paying me. And I have transitioned my locums career now where I'm a little more consistent at a couple of my sites because of one thing. They have given me the complete control of my schedule. I tell them Tuesday the 23rd, I'll work this shift this time. Wednesday the 24th, this shift this time at this hospital. That's it. And because they give me flexibility, I take a lower rate. When I first started at these hospitals, I started a very lower rate, low rate. And I played that game of you see what I'm worth, let's renegotiate. And every few years, I have renegotiated every hospital.

SPEAKER_00 13:42

I think there's there's so much wisdom there, you know, and and one of the things that's really frustrating to us, like we we Sycamore thinks of ourselves as in some in some ways, we like to think of ourselves as sports agents for great physicians, right? And so like we're we're our our business model is structured to where we actually make more money when our doctors make more money. So we we actually want our doctors to make more money, but there's there can be um there can be this kind of entitlement sometimes where you get doctors who are like, I'm worth X. I've talked to my friend Jason, he makes X, so I've got the same you know credentials as he does. I should be able to demand the same. And and sometimes it's it's hard. Like our job is to try to educate doctors that you can get to that level. It's just you don't get to walk in on day one and demand it. And and you're gonna be in, you're you're gonna have a more uh so what what I find on the alternative that's that happens all the time is you've got a client who's somewhat desperate, and you got a doctor who's holding out for this really crazy high pay rate, and and finally the stars align, they get the really high pay rate, they you know, because the doc the the the employer is so desperate, but then on day one, that doctor has a target on their back, and they're looking to try to cut that doc because they from day one, they're like, this is just a temporary fill-in, you know, it's too expensive, we can't afford it. Where I feel like your strategy is more let me get in and show you how valuable I am, and let me and let me pull the client towards me where they're going, hey, we we're we're excited about the opportunity to pay more for you, it's worth it.

SPEAKER_01 15:28

If all you want is money, yeah, and you're willing to go somewhere for a month and burn that bridge, go do it. I decided very early on in my career that I capped my my last minute emergency rate, and I capped it at a reasonable value, having watched other people put it at $1,000 an hour, some ridiculous number, and they got it. And that place dumped them like a hot coal four weeks later. Who wants to make an extra few hundred dollars when you love the place? It's right next to your house. Right. It's such the perfect opportunity in a great place you want to live, the best nurses, but you're so worried about money. Go win the public game. Go be the personality you think you are. If you're worth that much, go prove it. Go talk to the nurses, make everyone happy. And that's my key is I the charge nurses. Man, I make them appreciate who I am. I'm thankful for being there. I just put on a little bit of a political face, but honestly, I still get to be myself. I still do medicine the way I want to do it. Yep. But in the end, I'm putting on a this is what I'm worth show. And every single time the renegotiation has gone my way. It's never not. A hundred percent of the time they said, There is no way we can afford that. But then they go talk to their nurses and their director, and you know, the administration is just going, but but we're desperate and we don't know what we're gonna get with a locum's doctor. Patton was here, he did it, he worked for cheap, he earned it. This guy's worth it. That's I can't tell people enough. Do that.

SPEAKER_00 17:03

Yeah. How much how much do you think um your just like actual productivity factors in? Like, like, are you like like it not yeah? Is it more like is it more like the the soft skills and the attitude and the and the vibes, you know, that make everyone happy when you're around? Or or is it do you think that they value more the fact that you move the meat and you're just like you're you're you're a machine?

SPEAKER_01 17:30

Um yeah, I'm not the fastest. There's no doubt about it. I'm everywhere I go, there's somebody faster. Yeah. Um, yeah, it's it's the soft skills, right? It's just when you're doing locums, you're doing it for your time and your flexibility and your money and all the things that whatever it is that matters to you. Yeah. And so now that you're happy, show it. That's that's it. Um, can a locums doctor go in and just sh put their head, their nose down to the grindstone and move meat? If you're that kind of guy and not a good communicator, guess what? The hospital's still gonna love you. If you're not getting complaints and you move meat and you shut up and color, as the military would say it, guess what? Your rate's gonna go through the roof. It's it's a negotiating platform that's not just based on the soft skills. So to answer your question, it's both. Yeah, it can be my way, it can be a different way. There is an internalization that each person should do for themselves. Right. Look inside you, find your strengths instead of this my strength is the letters behind my name, it's not. Right. The strength within you is the thing you need to go market. And know that. Walk in, do that, renegatiate six months later, and you win the game the way you want to win it.

SPEAKER_00 18:41

Well, I I I think that I think that um if I were to prioritize one over the other, you know, I you're right that they're all important, and you got to kind of find your sweet spot and your skill. I do know that that the doctor with a bad attitude um with patients and nurses represents this big sort of looming liability, I think, to hospitals. They look at that doc and they're like, I'm just counting down the days before one of my nurses says I'm quitting, or one of my or one of these patients calls with a with a complaint or a lawsuit. And so I think that I think that uh, you know, the soft skill piece is probably um more important than than I think a lot of these doctors um appreciate.

SPEAKER_01 19:26

They can get away with seeing one patient an hour if they have a great attitude, yeah, you know, and are doing it and helping out the nurses, answering questions, you know, moving meat in other ways, right? By helping out the other providers, talking to the mid levels, motivating. You know, again, there's so many ways to do this, but you're right. The soft skill is what gets you the most money. There's no doubt about it.