https://journals.lww.com/em-news/Fulltext/2015/02000/Life_in_Emergistan__The_High_but_Worthwhile_Price.8.aspx

‘Well I know it wasn’t you who held me down

Heaven knows it wasn’t you who set me free

So often times it happens that we live our lives in chains

And we never even know we have the key.’

Already Gone, by the Eagles

While I was a attending ACEP in Chicago, I had a great talk with a fellow locums doctor. We colluded and laughed about the trials, the hassles and the travel. But we came around to something else. We agreed on this ‘mission statement,’ as it were. It could serve as the motto of every physician who works as an independent contractor, who has his or her own practice, or indeed every independent business-owner across the land. ‘Freedom isn’t free, but it’s worth the price.’

Let me explain, but let me first set the stage. Working in the locums world is a fine way to make a living, but it has its own set of struggles and problems. Travel in itself is a delight; I love seeing different parts of the country. I’ve been in five states so far, from the South Carolina low country to the mountains of Colorado. America is incredible; a place of breath-taking beauty. But leaving my wife and kids behind? That always stings a little. Besides, amazing places are always best shard with those we love best.

The logistics of travel pose their own problems, of course. Flights can be delayed (or missed, full disclosure). Baggage can be lost. Rental cars unpredictable. Hotels can be…scary. And food in some locations can be, well, uninspiring.

Another issue? Credentialing is an enormous pain in the gluteus. Between hospitals and state medical boards, I’ve answered questions, filled out forms, been background checked, finger-printed and otherwise evaluated so many times I’m starting to actually feel like I have something to hide. And honestly, I don’t!

Along with credentialing, there’s the endless request for ATLS, PALS, ACLS, BLS and all the other LS’s. Medical school, residency and board certification aren’t nearly as important as a one day course passed by pretty much every nurse in the country! (That stings a little too.)

And there’s the challenge of changing locations. Each hospital has its own culture, its own power-structure. And each typically has some vestige of old, archaic and labyrinthine rules to follow that mesh unnecessary paperwork, inadequate EMR’s and a generally inflexible medical staff office and nursing office. This can be quite frustrating to navigate. But if one likes an adventure, each hospital is its own continent to explore and conquer.

However, one of the greatest challenges is actually financial. Because the good old US of A isn’t all that keen on independent contractors. The self-employment tax is pretty high, given that I’m paying income tax as well as all of my own Social Security and Medicare costs, along with business taxes, disability and health insurance. Actually, this year our family health insurance was slated for a pretty impressive increase. We were insured through the South Carolina Medical Association, which was trying to clear out everyone in its individual market. As such, my monthly premium of $1600 (with $6000 deductible) would have increased in January to $3000-$4000 per month. (Yes, you read it correctly.) Rest assured, I have already vacated that plan for a more affordable option.

But the point is, both the financial and non-financial ‘costs’ of this sort of life are remarkable. On the other hand, there remains the freedom…

Freedom means that I work when, where and as much or as little as I desire. Freedom means that if I find the rules, regulations and culture of a hospital unpleasant or unfavorable, I don’t go back. I needn’t wait a year, or even two months. Freedom means that I arrange my life in the way that is best for my wife and children, my health, my sanity, my ethics and my financial gain.

I can take a month off, as long as I can afford it. I can travel around the nation or around the world. I am, in fact, my most important customer. I please me, and those most important to me. I am wildly unfettered in my pursuit of the best possible ‘me satisfaction score.’

Those of us who practice locums medicine may keep it up, or may change next year! We may take a new job with a new group and stay put or we may travel around the world. But we don’t have to do any of it. Whatever we do, we know the precious truth. We have valuable skills and flexibility. So we don’t have to stay if we don’t want.

The fact is that once you’ve experienced freedom, a thing too many physicians have never known, it’s tough to go back. Freedom is always out there, calling, offering adventure and opportunity and breaking long-forged, but largely imaginary, chains. It’s all there as long as you believe the benefits outweigh the costs.

For you see, freedom is indeed very expensive. But I believe, in my heart, that it’s worth the price.

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