Locum Tenens

 

Helpful Tips for New Locums

Choosing to start or finish your career as a locum is decidedly different from working as a staff physician or owning your own practice. The world of the locum tenens physician is one of constant change, unique challenges, and a plethora of different work environments and personalities.

new-locums.jpg

As a new locum, you will undoubtedly hear lots of advice from seasoned professionals. You might even receive advice from someone who has never worked as a locum before. Your job is to sort out the good from the bad. We would like to offer some advice of our own, so we have put together our list of helpful tips for new locums. We hope you find them useful.

1. Obtain Multiple Licenses

By obtaining and maintaining multiple licenses, you will increase your marketability. Not only that, you will have access to some choice assignments if license issues arise. Maintaining multiple licenses is not hard in principle, but it does require some organizational skills. Some staffing companies, such as VISTA Staffing Solutions, offer license and credentialing services.

2. Hire a CPA

Locums are self-employed contractors who essentially run their own businesses working for medical facilities. Taking just one or two assignments per year might be manageable for accounting purposes; anything more than that can be challenging. Our advice is to hire a CPA to handle your accounting and taxes for you. Otherwise, you will be left to handle all of it yourself – including having to remember to file quarterly estimated taxes with the federal government. One missed payment could cost you more trouble than it's worth.

3. Manage Your Expectations and Find a Good Recruiter

It is important to let recruiters know what your expectations are when you sign on with a staffing company. Be clear and concise as well. As you go from one assignment to the next, be sure to let recruiters know when expectations have been met, when they have not been met, and when they have been exceeded. A regular and open dialogue with your recruiter will lead to an improved relationship over time. Also, every opportunity is different. Some will be undoubtedly better than others, and it is up to you how selective you want, or can, be.

4. Always Be Professional

You will gain a reputation within the industry, for better or worse. Furthermore, you will make your career a lot more enjoyable and productive if you make a point of always being professional in everything you do. Keep in mind that professionalism includes treating your colleagues with respect, following all the rules and policies of the facilities where you work and being cooperative. Maintaining a professional reputation will open doors for the best assignments and make return locum tenens assignments more likely.

5. Embrace the Digital World

If you have not yet embraced the digital world, it is time to do so. With every assignment you accept, there will be additional paperwork that needs to be stored. You will have letters of reference, tax records, professional recommendations, and so on. You will also be updating your CV after every assignment. It's best to store these documents electronically so you can carry them with you wherever you go.

Your time as a locum will be as good as you make it. So learn from these tips as well as information you glean from others. The more you know about being a successful locum, the more enjoyable your career will be. You might even decide you like doing enough to make it a permanent lifestyle. At the very least, make the most of this opportunity to explore new locales and make new friends.

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Minnesota Board of Medical Practice Ceases Operations

VISTA Staffing Solutions wants you to know that if you are applying for or renewing a license in the state of Minnesota; the state government shutdown will affect you.

As of July 1, 2011, the Minnesota Legislature and Governor Dayton have failed to reach an agreement to fund state government. As a result, the Minnesota Board of Medical Practice is required to cease all operations.

The July 9, 2011 board meeting will be postponed and no licenses will be issued and no disciplinary actions taken. Please note the following:

  • All temporary permits expiring on July 9, 2011 are valid until the next board meeting. The new board meeting date will be announced when the board re-opens.
  • During this period of shutdown, online services including online renewal and professional profile will be unavailable.
  • License status is available online at www.docboard.org/mn/df/mndf.htm

If you have any questions, you can reach the VISTA Licensing Department at  800-366-1884.

Locum tenens and the foodie physician: Installment 1

While working in Bermuda, my husband and I enjoyed seeing the local fishermen selling their catches on the side of the road. It happened to be lobster season, and as you can see, they were quite large!  You could either take them home, or they had a steaming pot going to cook them right on the spot.  Our favorite dining spot was right on the deck of our apartment. The sunsets from the deck were the best we've seen.

 connie1

connie2

connie3

Note: VISTA Physician Blog Editor, Carolyn Rose, sent out a request for stories from locum tenens physicians about their eating adventures while on assignment. This is our first response. If you have a story to share please send it (with photos!) to your regular contact at VISTA, or email it to carolyn.rose@vistastaff.com. Thank you!

Excerpts from a Mongolian Mission Journal - Final Part ...for now

Thursday, Sept. 17, 2010

The days have been full since we arrived, and while high-speed internet access has been easier than I expected at times, it is not always available when we might most like it.  The hospital has good connections most of the time, but it is usually late when we are finished with work, and somehow the lines are turned off by that time.

Since the main intent of this trip has been to continue the education of local surgeons in the use of laparoscopic cholecystectomy, that has been the primary aim of all our activities.  Where all of this technology fits into the big picture of medical care in Mongolia remains to be seen, and I have to be honest that there are more than a few times that I have my doubts.  The Russians were the main influence here since the 1920s and while they have left (rather abruptly, I was told, one morning in 1992), their teaching persists in the leadership, both for good and for not so good.  The main connection we have here, both as interpreter as well as for medical and logistical issues, is a very tall man, probably in his early fifties, who is an anesthesiologist and professor at the university in Ulaanbaator. He spent three years learning anesthesia in East Germany in the early 1980s, and later spent time in Arkansas doing additional training.  He is clearly a very bright and delightful person, and it is through his eyes that I get to interpret what I am seeing.  The cleanliness of the hospital, he says, is directly linked to Russian training.  Surgical journals may be available on the internet, but they are expensive and mostly in English.  Since only some of the younger individuals have learned basic English, it will always be a struggle for them to see what is going on outside of the country.  Thus, medical missions such as ours will be the only source of new information that they will get for some time.  Not surprisingly then, I found that the few words of Russian that I do know have gone a long way to bringing smiles to the faces of people around me. 

Food has always been a good reason for me to travel, and I would suggest that there should be no illusions that just because the local customs and traditions might be different from elsewhere, that does not necessarily translate into something that is easy or even pleasurable.  As one can imagine, this is not a very friendly terrain in terms of agriculture or of life in general, and so foods are quite limited.  This is a meat-eating culture, and while we declined the opportunity last night to feast on a freshly slaughtered sheep, to enjoy intestine soup, a meal without meat is not a meal at all.  Lamb and mutton are the most common of these, and while marmot seems to be the second most common of local meats, I actually did eat a stuffed cabbage yesterday for lunch that quite resembled beef and was really delicious.  Mutton soup with vegetables (mostly carrots, a turnip or two, and some potatoes), mutton with rice and potatoes, mutton balls (not the anatomic ones!) with broth, mutton dumplings and mutton soup with noodles have been the mainstay of what we have eaten so far – is there a consistency to this?  I hope that my coronary arteries do not start to complain.  I have not even seen anything resembling the “Mongolian barbeque” that we think of from home, but I do think I will look forward to a scorpion kebab or two at one of the stalls near Wangfujing when I return to Beijing next week.

It is fall here already, and the few leaves that there are, are starting to turn.  With very few trees around, even though they are mostly of the deciduous type, there is not a lot of autumnal color, and it seems that only the setting sun brings out a palette of visual variety to the landscape.  The temperature is still comfortable during day, but drops precipitously at night, and I have taken to wearing my long underwear to bed.  The streets are probably only half paved, and the sidewalks perhaps a third so.  As we were crossing the street the other day, I noted that there was a pipe that seemed to serve as a culvert, through which snaked thick electrical cables whose insulation seemed to suffer the effects of exposure and age.  Most of the people seem to live in compounds defined by five foot high walls made of concrete aggregate, within a combination of gers, frame houses, and housing composed of old, Russian railroad cars, derailed, and de-wheeled.  Probably not surprisingly then, because of the relatively low height of the walls, there are no “extended security means” such as glass shards, applied to the tops of the concrete blocks.  Extended families and resident dogs seem to complete the unit.  A pack of 13 dogs barking in pursuit of something just passed under my window.  Mostly people seem to dress in Western garb, and other than for height, look like everywhere else in Asia.  There must be something in Mongolian genes or nutrition that breeds tall people, for it is not uncommon to see six-footers here at all.  Occasionally, I see people dressed in dells, the traditional long coats with hats that bring a sense of difference to the area.  Lastly smoking, which is so common elsewhere in Asia, is not so common here, and seems mostly to be among the urban dwellers rather than those few I have seen from “the country.”

I have made a few telephone calls during my stay so far, and it never fails to amaze me as to the technologic changes that we have seen in the past few years.  ATM’s have completely replaced traveler’s checks, and internet, Skype or G-chat, and phone cards now are commonplace instead of aerogrammes or letters.  Who ever goes to a post office to find a postage stamp or even postcards?  There must be some who still do, but as a singular innovation, I think that email has changed the face of travel almost more than anything else. 

Breakfast awaits, and we have at least four surgeries to do today:  two pediatric hernias and two gallbladders. Let’s hope that all goes well for all.

73*,

Ivan

 * “Best Regards,” as defined in The National Telegraphic Review and Operators’ Guide, first published in April 1857.

Excerpts from a Mongolian Mission Journal - Part 3

Monday, Sept. 13, 2010

It seems unbelievable to me that I am actually writing from Khovd, in the western part of Mongolia, on my laptop, in a hotel, looking out over the unpaved, dusty streets as the sun starts to rise on another day.  A woman is herding her cow through what serves as a parking lot in front of the hotel, by throwing stones at its rump, as a pack of a dozen large dogs marches around the corner, off to do some damage someplace. From what I saw yesterday, these are not your sweet household pet type dogs, but serious animals who contend with all manner of abuse, from wolves to other animals, as well as competition within the pack.  We are told to grab some stones if we are out walking and come across the dogs.  Life is not easy here.

We arrived in Khovd after our three-hour flight on EZNIS airways, on a propeller driven SAAB 380, crossing a goodly portion of the Gobi desert.  Deserts are obviously not all the same, as the dunes of the Sahara barely resemble anything I have seen of the Mojave, and this one seems to be widely varied as viewed from the air.  There are dune-like areas, with undulating sand banks, to those with vaguely greenish tint which I suppose are grasslands, to lakes, to smooth, Santa Fe stucco-colored sandy flats without obvious changes in elevation.  I was told it was going to be like arriving on the moon when we got to Khovd, and in fact it was. But I now realize that there are many places on earth that must then look like the moon, because it reminded me of the area around Tuba City, Arizona, a lot closer to home than the moon.  Certainly, as the day breaks and I look at the faces of people, the similarities between Mongolian and Navajo visages is quite striking.  Linguistically, of course, there appear to be no similarities, and if anything, one hears syllables that sound vaguely Korean. 

Our hotel is across the street from the hospital where we are working, and of the many hospitals that I have seen in developing nations, this one is about the cleanest yet.  People are constantly washing the floors, and there is no stench that one smells in the tropics.  The only odor one perceives is that of mutton being cooked everywhere, and occasionally, a homeopathic dose of germicide, kept in an assortment of glass bottles everywhere.  The stuff feels and smells like plain water to me, but who really knows?  Ultraviolet lights are turned on in the operating room for example, to help sterilize things. I was told yesterday that the water within the10 liter bottles kept corked in the room becomes sterile through this mechanism.  Interesting.  Intravenous solutions are made in the hospital in on- liter bottles, which are covered with a type of canvas, secured by colorful orange string.

…The young doctor on call, who had been part of the group who had been trained in laparoscopic cholecystectomy last year here in Khovd, had a patient who had been in a truck accident, probably with some broken ribs.  Over the next few days, he developed subcutaneous emphysema.  An unlabeled, unnamed, unoriented CXR was shown to us, which indicated that the left lung had completely collapsed.  The doctor had proposed to take the patient to the operating room to suture the hole in the lung.  The other surgeon in our group, a wonderfully warm and cheery 64-year-old man, has had many years experience working with Italian relief groups in places as disparate as Peshawar, Kandahar, Sierra Leone and Malagasy Republic, looked at me, and it was all we could do to slow down our words to suggest that perhaps placement of a tube in the chest emptying into a water seal bottle might be a better and safer alternative.  Of course, no such chest tube exists in the hospital, and so with the assistance of our anesthesiologist we fashioned one out of an endotracheal tube.  Finding a suitable water seal apparatus was not easy, and we considered cutting apart some strange drainage bottle we found that had been left over by a Swiss team some time ago.  In the bowels of some storage place a single Russian-made thick glass bottle with an appropriate cap was located. With additional tubing rigged from what we had, my colleague directed the Mongolian doctor as he placed this chest tube into the patient’s chest.  Sterile conditions are a relative term here, and it is frequently said, I have learned, that “clean is good enough.”  Maybe, but we offered some antibiotics to go along with what had been done so far.  After some more bleeding than we might have liked, the tube was repositioned and the expected bubbling came from beneath the water seal.  The fellow tolerated this all well, but it remains to be seen as how long it will take for this to resolve. 

Last night, we were taken to the ger of the family of a Kazakh man who is a feldsher, or village medic, about 20 km northeast of Khovd.  I am slowly learning the etiquette of Mongolian traditions, and now understand that what we have been calling a “yurt” is the Russian word for the Mongolian “ger,” and so now, I too shall try to use ger in my vocabulary.  The campsite was on the banks of one of the numerous rivers that traverse the area, and was as colorful as one could imagine, with cashmere goats, sheep, yaks, and a few cattle outside, and inside a warm and toasty comfortable homestead.  It was remarkably warm inside, and with all the Kazakh and Mongolian carpets lining the walls, two beds, a dresser, a wall of medals for horseback riding and family photos, and a central stove vented out the top. I can easily see how the winter can be survived despite the environmental challenges.  The feldsher also captures eagles for training, and we saw at least one nearby, looking well fed and content.  While we were there, a man came up on horseback, complaining of a headache.  Some potion was dispensed, and off he went.  Warm goat’s milk, fried biscuits, fried yoghurt cheese, tallow and yak butter were served, along with local watermelon.  This is not a low fat, low carb diet at all, but if one considers what is available, it seems to work for them over many years.  On the way back, we saw a herd of Bactrian camels (two humpers), and seeing them outlined against the grasslands, the snow covered peaks in the distance, and just the entire sense of foreign, I really did feel that I was on the steppes of Central Asia.  Where was Borodin when we really needed him?

I am off to help with surgery this morning, and need to get going.  I have been served a bowl of hot butter tea with rice, so I had better get my dose of calories early this morning.  A long day awaits.

73*,

Ivan

* “Best Regards,” per The National Telegraphic Review and Operators’ Guide, first published in April 1857.

Excerpts from a Mongolian Mission Journal - Part 2

Saturday, Sept. 11, 2010

We flew out of Beijing Capital Airport yesterday morning. I was impressed at the incredible sprawl that has become Beijing, densely packed areas of industrialization, farming and housing all within short random locations scattered every which way.  For reasons unknown, the pilot flew east, then north, then east again, then north and finally more northwest, and so I used the view to try to see if I could identify the Great Wall, but to no avail.  One would think that if the astronauts could see it from space, I should be able to do the same from 36,000 feet.  With no such luck, I’ll look for it again on the way back next week.  Once over the mountains north of Beijing things settle down to lower level grasslands and finally parts of the Gobi desert become apparent.  It is hard for a non-geologist to characterize the Gobi from the Sahara or even the Mojave but there were certainly only a few manmade structures evident, with some roads and little signs of the presence of anything.  Strangely, as we flew north to Mongolia, the sand took on a vaguely green tint, and one could see that there were grasslands below, amid the bareness, and that must be a part of how the nomadic shepherds exist down there.  Again, I’ll see more today, and as we move on.

Flying into UB was fairly straight forward, and I was actually surprised to see how much air traffic there was in the morning.  It was probably about 75F and with a dry hot breeze, felt not so dissimilar from Arizona or New Mexico.  The hills nearby did remind me of areas in Southern Colorado or Sonoma.  Could they grown grapes for wine here?  Anyone for Mongolian Shiraz in a few years?  We were met by the local members of our team, and taken to the VIP lounge, where our passports were collected and baggage retrieved.  For the 15 or so of us, only one bag was missing, it apparently having been sent from Salt Lake City to Paris, rather than to Beijing – go figure.  That poor surgical resident spent yesterday shopping for new clothes for the trip, something that was not particularly onerous, she said.  We headed to the warehouse where the Swanson Foundation has collected a huge assortment of surgical tools, and equipment over the years, and we began to unpack what had been brought new on this trip, and repackage what we need for our current projects.  The Swansons have apparently done a lot of long-term planning (they have been in Mongolia for at least 11 years) and do understand the need to wean the local hospitals off the Swanson largess, and rather have them step up as equal purchasing partners, to help them develop self sufficiency over time.  It is curious to see what had been a very solidly Marxist-Leninist country now move so far towards a free market economy, and to observe, as we have done elsewhere, the growing pains that this entails. Apparently it was a horrible winter last year, and they lost many head of livestock, so the country is now economically stressed in additional ways. How the Swanson venture will work out for hospitals in Mongolia obviously is unknown now, but it seems like a valiant and fruitful effort to accomplish modern economic goals.

Having reassembled the requisite boxes and bags, I walked around UB for the rest of the afternoon, accompanied by a surgical colleague who is also going to Khovd. He is an absolutely delightful 64-year-old gentleman from Parma.  He is a remarkably kind and generous soul and I am sure that we will spend many hours solving the world’s problems together.  He had been to UB last year for a conference on world health, and together we marched around the somewhat dusty streets to the central plaza, where can be found the Parliament building, the museum, and yes, the opera house.  I’d like to visit the latter on my return here next week, and will try to see what is available.  I’m not into the tourist shopping program, but visited several stores selling beautifully made cashmere sweaters, yak wool goods, camel hair blankets – ah, but if I only felt that I “needed” something like that!  I stopped for a glass of KBAC (Cyrillic spelling)- otherwise known as kvass, a fermented cold brew of yeast, sugar and whatever sold from vats on the street.  I know that perhaps I should be more cautious about things like this, but I wanted to taste it and it was fine – no more, no less.  I know that fermented mare’s milk is on the menu once I get to Khovd, so the relative familiarity with yeast, sugar and water will be mild by comparison.  There are still statues of Lenin, but without a doubt Genghis Khan (Chinngis Khann) dominates everything.  While we in the West may have thought about him as a marauder, a dictator or whatever, here he is revered as the father of the country, and his Grandson Kublai Khan set out to create one of the largest empires ever known.  I am sure that I will get more about this as we go on.  It is an issue of looking at both sides, and there really are two sides to this puzzle, at least.

Its now 5:15 AM and I need to be downstairs to get ready to leave for the warehouse and the airport, so I’ll say 73* again, and try to see what I can learn about the next stage of this venture.  Something different.

Ivan

(to be continued)

* “Best Regards,” per The National Telegraphic Review and Operators’ Guide, first published in April 1857.

Excerpts from a Mongolian Mission Journal - Part 1

Sometimes-locum-tenens surgeon shares his first-hand impressions during surgical teaching mission to Ulaan Baator

Friday, Sept. 10, 2010

…in the few minutes before my plane takes off from Beijing, I’ll try to give you a quick overview of what I will be doing for the next few weeks.

As you know, I had been doing locum tenens work, covering general surgeons in rather rural and remote parts of the US (Ft. Kent and Houlton, Maine, Dansville, NY, Rock Springs, WY).  Last March, I got a call to cover the hospital in Los Alamos, New Mexico, and as you may know, that is very close to everything I have always enjoyed about Santa Fe.  Long story is that after a few visits, I was offered a job at the hospital in Los Alamos, and since November, I have been working there steadily, commuting to and from Los Angeles weekly as needed so that I can also continue my conducting at the Los Angeles Doctors Symphony Orchestra (www.ladso.org). 

During the summer, I got word of a surgical project that caught my interest.  Out of that, comes this email from Beijing.

I am on my way to join with three other surgeons to teach laparoscopic cholecystectomies (removal of the gall bladder through four little holes, rather than the older traditional long incision.)  We are part of a small team of surgeons, nurses, scrub techs and bio-technicians organized by the WC Swanson Foundation of Ogden, Utah, and are headed for Ulaan Baator, Mongolia.  Actually, once we get to UB, as it is more colloquially called, we will spend tonight in orientation with those who have been there before, and in the morning, I am heading with my team of one other surgeon and half the support staff to a town called Khovd, way in western Mongolia, near where Russia, Kazakhstan, China and Mongolia all meet – for me it is a different version of ‘the Four Corners area.”  If you go to Google maps or Google earth, and paste in these coordinates, you will see the hospital where I will be working.  

48.00385, 91.633288

The “kh” sound in Mongolian is pronounced very much like the Yiddish “ch” sound, so saying at least those things in Mongolian may not be so difficult for me.

The team was in Khovd last year, and we are told that over that time, they went from doing five gall bladder operations to 100.  Part of our job will be not only to continue the teaching process, but also to review what they did, and how they might be able to avoid some of the pitfalls of the learning curve which we all have experienced.  There is apparently a little hotel near the hospital where we will stay, and beyond that, I know almost nothing.  Here is a link to a recent TV item in Salt Lake City about the trip: 

http://www.ksl.com/?nid=148&sid=12129702

I am told that after the 3 ½ hour propeller driven plane flight from UB to Khovd, it looks like the moon when you arrive.  So be it.  Over the weekend, I hear tell that the local staff wants to take us on a four-day visit to the hinterlands, and so I suspect that we will go, forsaking two more days of teaching.  It all looks very remote, and I am looking forward to it, of course.  I am reading a wonderful book called “The Wolf Totem” by a Chinese writer Jiang Rong, who was sent to Inner Mongolia (a part of northeast China) during the Cultural Revolution.  He writes beautifully, and if his tales are anything like reality, I am in for something special.

I’m going to be in Mongolia for about two weeks, returning via Beijing for two nights, and then back to Los Angeles for a few days, and will be back in Los Alamos/Santa Fe after that, to begin my weekly commute again.

I had a good breakfast this morning at a Beijing version of quick food, and instead of burgers and other junk, I had congee with chicken, glutinous rice in tea leaves, and some actually not bad Shanghai pork dumplings (not anywhere as good as Hong Kong or Taipei but, hey for the price of one dollar, I was not at all unhappy!)  My tummy is full, and I am looking forward to taking off in less than an hour.

I like the idea of sustainability in medical missions, leaving something more tangible when we depart, rather than just scars and other short term benefits.  I hope this gets fulfilled for me.

73*,

Ivan

 * “Best Regards,” per The National Telegraphic Review and Operators’ Guide, first published in April 1857.

AAAMC Releases Post-Healthcare-Reform Physician Shortage Estimates

Locum tenens can be part of the solution

The Association of American Medical Colleges (AAMC) Center for Workforce Studies has released new physician shortage estimates that are 50 percent worse than anticipated before health care reform legislation was passed.

The United States, like most of the world, is already facing a critical physician shortage. The problem will intensify as 32 million Americans acquire health care coverage, and an additional 36 million aging Baby Boomers qualify for Medicare.

Some key findings of the study include:

• Between now and 2015, the year after health care reforms take effect, the shortage of doctors across all specialties will quadruple. Previous projections showed a shortage of 39,600 doctors in 2015, current estimates bring that number to almost 63,000. The shortage will intensify through 2025.

• Non-primary care specialists will also be in short supply. In 2015, the United States will be short 33,100 physicians in specialties like cardiology, oncology, and emergency medicine.

• Our aging population will simultaneously, and dramatically, increase demand for care. The U.S. Census Bureau projects a 36 percent increase in the number of Americans over age 65. And nearly one-third of all physicians are expected to retire in the next decade.

• The AAMC has lobbied hard to expand the physician training pipeline. The number of medical school students has increased, and will add 7,000 more graduates every year over the next decade. However, the AAMC warns that unless Congress supports at least a 15 percent increase in residency training slots (adding another 4,000 physicians a year to the pipeline), access to health care will be out of reach for many Americans.

The AAMC points out that, “The shortfall in the number of physicians will affect everyone, but the impact will be most severe on vulnerable and underserved populations. These groups include the approximately 20 percent of Americans who live in rural or inner-city locations designated as health professional shortage areas.”1

 Locum tenens physicians have traditionally served “vulnerable and underserved populations.”If a significant percentage of physicians nearing retirement age opt for part-time, flexible locum tenens work instead, agencies like VISTA can help ease the burden and get doctors where they are needed most.

 1http://www.aamc.org/newsroom/presskits/mdShortage1.pdf

Village Garden/Livestock Project welcomes first egg!

We think about more than locum tenens and physician staffing at VISTA. In fact the company encourages community involvement and gives every employee a day of paid time for volunteer work or community service.

I have the great pleasure of sitting on the board of directors for Janus Youth Programs, a large non-profit organization based in Portland.  One of our most exciting programs is Village Gardens, an 85,000 square foot urban agriculture program that uses sustainable organic gardening and farming to increase access to healthy food, improve economic opportunities and build unity with low-income residents of North Portland.

 The program is based in the St. Johns Woods public housing development; New Columbia, the Housing Authority of Portland’s newly built Hope VI development; and on an acre of metro land on Sauvie Island. It offers individual and family garden plots, employment opportunities for adults and teens, after-school and summer activities for children, homework clubs, a mobile market shuttle, a youth-run entrepreneurial business growing and marketing specialty salad mixes at local farmers markets, and our newest venture–livestock.

 In an effort to provide locally produced organic protein to the community while building economic opportunities, a committee of adult community members has partnered with younger members to jointly raise laying hens. The project—or more accurately, one of its participating hens—produced the first egg this month. It’s a great milestone for the program!

First Egg of the Month

To find out more about Janus Youth Programs and Village Gardens, check out these links:  http://www.janusyouth.org/what-we-do/urban-agriculture-services.php  http://villagegardenspdx.wordpress.com/

Report on growing rural primary care shortage lists locum tenens as part of solution

The WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Rural Health Research Center recently released a report on The Future of Family Medicine and Implications for Rural Primary Care Physician Supply.  The study, written by Roger Rosenblatt, MD, MPH, and colleagues at the University of Washington School of Medicine, examines trends in specialty choice among new physicians, the rural primary care physician shortage, and the changing dynamics of rural health care delivery. It includes a list of initiatives and policy efforts that will help ease the shortage of primary care physicians in rural areas, and that list includes providing locum tenens support to protect rural physicians from burnout and isolation.

Here’s a quick rundown of the study. To read the entire document, go to http://depts.washington.edu/uwrhrc/uploads/RHRC_FR125_Rosenblatt.pdf .  

Rural locations rely heavily on family physicians who account for about half of all rural physicians in large rural areas and about two thirds in smaller and more isolated areas.
There has been a sharp decline in the proportion of U.S. medical graduates choosing family medicine over the last decade, with most family medicine residency positions filled by students who graduated from medical schools outside of the United States.
The proportion of students choosing family medicine careers will likely remain far below the numbers required to replace rural and urban family physicians leaving the field because of death or retirement.
The pipeline to attract physicians to rural primary care is dysfunctional; rural youth are not recruited to medical school; women, who make up an increasing percentage of physicians, and international medical graduates, are not attracted to rural living.
The report details several private efforts and federal and state policy options that could help increase and sustain the number of family physicians in rural practice including:

Making it more attractive and financially viable for physicians to practice in rural areas through programs such as improved Medicaid reimbursement, practice development subsidies, tax credits for rural/underserved practice, locum tenens support, malpractice immunity for free care, payment bonuses, subsidies for electronic health records, and Medicaid reimbursement of telemedicine.
Increasing the number of medical students recruited from rural communities by providing education and support that would prepare them for medical careers.
Changing medical school curriculum and admission policies to admit more students from rural backgrounds, providing financial support and helping disadvantaged students get into medical school.
Providing financial support for residency programs that train rural physicians through rural practice training tracks, and focusing on the skills required to succeed in rural practice.
It’s rewarding to see locum tenens recognized as part of the solution to the shortage of rural primary care physicians because, in fact, the locum tenens industry in the US was established to provide respite to rural providers.

In 1976, Therus Kolff, MD, MPH, and colleagues at the Health Systems Research Institute, a non-profit formed by the University of Utah, the Intermountain Regional Medical Program, and the Robert Wood Johnson Foundation set out to develop innovative solutions to rural healthcare challenges. Dr. Kolff led a team that managed 22 clinics and five hospitals in nine western states and served as team leader for Yellowstone National Park Medical Services.

This team realized that their physicians were at risk of quick burnout because they were on call essentially all the time and never felt they could get away from their practices. They decided they needed a “circuit rider” to provide coverage and give these doctors time off with the peace of mind that their patients would be cared for and their practices managed responsibly. Dr. Kolff went on to establish the first commercial locum tenens company in 1979, and is currently a medical director for VISTA Staffing Solutions.

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