Fill-in ODs: Practice problem or solution

You want to take some time off from your practice, maybe a day or two here and there, maybe for an extended leave, and you want to hire a temporary worker (also known as a fill-in doctor, relief doctor, or locum tenens). The relationship with a locum can be rewarding or frustrating. You have the power to make it successful, but it does take some preparation and planning.

Until the end of 2013, I worked happily in New York in a state-of-the-art practice I shared with two ophthalmologists. It was a dream situation, and the only thing that made me leave was my husband’s decision to retire, and our choice to relocate to Austin, TX, where we had family and could escape the long cold winters.

I found and saved a May 2013 article in Optometry Times by Bill Sharpton, OD, who sold his practice in 2000, and spent the next 10 years working as a locum in Georgia. I thought, “That’s what I’ll do.”

It turns out that there are quite a few practices in Texas that use relief doctors, at least occasionally. Here are a few things that I learned.

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1. Don’t be a cheapskate.

The pay is insanely low. In his article, Dr. Sharpton said that his minimum daily charge was $500. I was offered as low as half that amount. Because I refuse to work for so little money, I have turned down many more jobs than I have accepted.

I spoke to people who wanted to hire me without even meeting me or showing me their offices. Some doctors had their receptionists call, as if it was too much work to be bothered calling a doctor who would be covering their practice for a few days. I figured that I was going to care about their practices more than they did, so I didn't accept those jobs.

Pay your colleagues well, and have a check ready for them at the end of each work day. Remember that people charge for their services what they think their services are worth. You may find someone who’s willing to work for the lowest day rate you can dream of. Is that the person you want representing your practice? Are you going to be surprised when that person’s productivity is low?

Next: Consider who will be representing your practice

2. Consider who will be representing your practice.

If you are interested in hiring a relief doctor, I have some recommendations if you want your days out of your practice to run smoothly.

Consider that the person you’re hiring represents you and your practice. Don’t hire anyone-even for a day-whom you wouldn’t want to be associated with. That means talk to him on the phone, meet him, look over his resume, and discuss your philosophies of care and the expectations you have for someone who works in your office. Make sure that her license is up to date and that she has her own malpractice insurance policy, or that yours covers anyone who works in your office. (I purchased my malpractice insurance through the American Optometric Association. The cost varies by state, but for me it was around $600 for a year.)

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Be clear with yourself and your locum about your expectations around productivity, clinical testing, and staff support. My promise is that I will work hard, see as many patients as the staff schedules for me, and perform testing as indicated. Most offices schedule patients every half hour and schedule an hour for lunch, but I have worked in an office that had only two patients scheduled for the whole day and the first one no-showed!

In my New York practice, I saw four to five patients per hour (not all full exams), but I had a lot of help and knew the electronic medical records (EMR) system really well. I've found that two full exams per hour with the occasional contact lens check or emergency thrown into the mix works well. I'd never turn patients away, so I'll do what's necessary-work through lunch, stay late, whatever is needed.

Show the fill-in doctor your EHR system and how you want things done. Provide EHR training or staff assistance if the person you want to hire is unfamiliar with your program.

While you should certainly expect your locum to know the elements of an exam that are required by state law, he may not be familiar with any special elements that are required by specific insurances you accept. Make a checklist of documentation you want to ensure that each exam is complete.

Next: Make sure your team is ready

3. Make sure your team is ready.

Some doctors’ offices were hard to work in. I worked in an office with pump chairs and a slit lamp that required two hands to focus and move the joystick. (That slit lamp broke while I was working there, so I was also using a transilluminator as a light source that day.) I worked in an office with the patient chair was so ripped up it was embarrassing.

I worked in an office with two exam rooms that had such different equipment and layout that every time I went into the next room I had to figure out how to work the projector or get the chair to move up and down. (I imagine the staff of that office thought I was difficult when I decided to work out of one room.) I worked in an office where the staff thought it was an easy day and slacked off on helping or hid in the break room. (When your staff member tells you that the doctor refused to take an emergency, keep in mind that there may be another side to that story.)

Have a staff member available to answer questions. If a doctor is looking all over the office for alcohol wipes and contact lens solution, or trying to troubleshoot a balky computer, that person will not have a productive day. Motivate your staff to be helpful. Teach them to offer appointments with your colleague in an enthusiastic way. (You want the doctor to be busy, and she won’t be if your staff doesn’t schedule patients for her.)

Make sure your office is clean, neat, well organized, and easy to work in.

Next: Understand they're not just temps-they're your colleagues

4. Understand they're not just temps - they're your colleagues

Ideally, you’re attempting to build a collegial relationship in which you have an associate on whom you can rely when the need arises. I’m fortunate to have built really good relationships with a few practitioners, enabling them to have coverage from someone who knows their offices and staff, and allowing me to work when I want in offices that I like. 

A few months ago, early on a Friday morning, I received a text from someone whose practice I’ve happily worked in because of all the elements I’ve mentioned in this article. She had food poisoning. Could I possibly come in and cover her for the day? Of course, I said yes. I was happy to help.

If you think of someone you bring into your office as a “temp,” a warm body who sits in your office and sees patients on days you can’t be there, you’ll get a minimally productive worker who counts the hours till lunch or time to go home.

But if you hire a colleague-someone you like, trust, and feel comfortable working with-you’ll have an extra pair of hands when you need them, which is an invaluable asset.

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