A few months ago I started reaching out to private urgent cares in the Washington area, looking for a locum tenens gigs. I disclosed my troubles with the medical board and told them that I was interested in only a few weeks worth of work every few months.
I didn’t get any bites until I connected with the owner of a chain of urgent cares in a remote part of Washington. Get this, his daughter is living in Spain, he is a rock climber, and he also lived in California with his family for a while. Brothers from other mothers.
I told him exactly what I was looking for, the kind of volume I was capable of seeing. I sent him all of the details of my medical board trouble and he laughed at the ridiculousness of it. He told me that he had plenty of work for me and that I could fly down immediately for work.
I can’t tell you guys how awesome it is to meet doctors in these positions who totally make up for all of the negativity of the medical system. I hope that I can one day return the favor.
Flight to Washington
I went online, booked my flight from Iberia to LAX and from LAX to Seattle. Before leaving, I sent his HR department all of my information and they started the credentialing process.
Getting a round-trip ticket with a 1-week notice wasn’t all that expensive. And for the opportunity to see some urgent care patients, I would have paid $5,000.
We didn’t think there would be any trouble with credentialing except for the group malpractice policy. He gave me the contact for the underwriter for his practice, just so I could run it by her.
She looked up my medical board case and we hopped on a phone call. The way the case is worded on my records makes it seem as though there was a clinical issue regarding an EKG. She couldn’t make sense of the wording and wanted me to explain it on the phone.
She’d seen a lot of malpractice cases come across her desk and since my case wasn’t a malpractice issue, there was no issues with underwriting. She had never seen a medical license suspension associated even with the worst offenses. Her comment was “You must have really pissed someone off!”
I’m no longer board certified under ABMS. Instead, I have a family medicine certification under NBPAS. I am careful what wording I use because the ABMS has trademarked certain phrases. And they have convinced the medical boards to accept their monopoly.
However, he didn’t care about my board certification. He has military docs working for him who have only completed 1 year of residency. He didn’t even care that I had a certification with NBPAS – he never even heard of them.
Before flying out, he told me that he had multiple urgent care sites and I was welcome to work at any and all of them. He was sympathetic to my situation and told me to sign up for however many shifts I felt comfortable with.
His doctors see about 60 patients in 12 hours. In the summer months, maybe 30-40. But he also does some occupational medicine and workman’s comp – stuff that I did for 3 years in residency moonlighting.
I told him that I could easily see 100 patients in 12 hours, which he didn’t think is possible. I told him that the only bottleneck I usually experience is the number of nurses I have and how many rooms are available. I won that bet.
All of his urgent care sites perform imaging, lacerations, stat troponins, IV’s, fractures, and they see peds older than 2 months.
I could choose a $120/hour straight income as a per diem or a productivity model. The downside with the latter is that there would have been a delay before I could get my paycheck.
25 days of Work
25 days in a hotel and a 25-day car rental. In total I spent about $1,500 on housing and $450 for the car rental (including gas). I spend another $950 on food. The round-trip ticket cost me $2,400.
My shifts were 12 hours. They had their own web-based EHR and I would do all of my own image interpretations. There was a mix of trauma and the typical stuff you see in the urgent care.
I worked every single day because the work was easy and there was nothing else to do in that part of the state. The staff were super friendly and some of the docs wanted the time off for summer vacation for their kids.
25 days, 12 hours per day, $120/hour = $36,000. I haven’t gotten the money deposited into my account yet, but it should be beautiful once I do.
Back to Clinical Medicine
The irony is that I got an email from the Oregon medical board while away in WA: “We have learned that you have been seeing Oregon patients while in Spain…”. I had just returned from WA when I received this email.
I conferred with my attorney regarding this. And in order to stop the harassing communication from OR, we decided it’s best to just stop working in that state.
It’s not easy terminating your medical license once you’ve been investigated by that state. But there are ways of doing it, whether through termination of the license or just letting it lapse.
$36,000 is a ton of money! I don’t know how many patients I saw but I would say I was somewhere in the 75 range. I didn’t want to see more because some of the other doctors and PA’s were on a productivity model.
I saw rhabdo, ACS, fractures, nursemaid elbow, lacerations, foreign bodies, an appy, PID, and pyelonephritis. Was it hard getting back to clinical medicine? Not at all. After the first 2 hours of work I was back in my own groove.
Live in Spain and fly back 1-2 months a year to work at $120/hour? Sure. I had incredibly grateful patients. I worked with awesome docs and a competent staff. And I made a new friend who runs a chain of successful urgent cares in WA.
Guess what, this dude doesn’t even offer telemedicine in his urgent cares. He was approached by a large telemedicine company to farm his patients out to. But that would leave him with almost no income.
We’re going to be talking about ways for him to build out his own telemedicine. His son is an intensivist and will one day take over his urgent cares. Having telemedicine as part of his repertoire is absolutely necessary based on what consumers demand and will increase the value of his business.