Frank Aprile, BBA, LP, CCP Editor in Chief / Founder / CircuitSurfers.com
Welcome to the 2019 WPPC 🙂
“My life is Family First and then Perfusion. I switched from staff perfusionist to becoming a Locum’s traveler to make sure my kids and family would have a solid place to call home. I travel because it puts me in charge of my life, it is challenging, and I enjoy learning new techniques, other ways of doing things, as well as getting exposure to alternate approaches and paradigms.
So I took my show on the road. End result? 20 new clinical sites in the last 3.5 years. Wow!
52 hospitals at which I have actually pumped– Another 12 in the USN scrubbing/1st assisting.
Why am I a locums?
Depending on where you enter perfusion in the career timeline in your life, your goals for yourself will have different imagined endpoints and their subsequent challenges.
Married with family? You probably won’t want to travel.
Young and single? With out a doubt you are filled with excitement and imagination in terms of what you offer to the profession as well as what you hope to experience from it. No doubt the clinical arena is a challenge to be mastered, many pathways are available, some of which include working over seas, in remote areas in your own country, or perhaps as part of a cutting edge academic institution, and the very distinct opportunity to get involved in mission work- and help the helpless that would otherwise never be served.
In it for the money $$ ? Well I won’t get into that, because it is a poor motivator, and you are most likely better served pursuing a different calling. PERfusion begins with the same 1st three letter as PERseverance. Optimism and idealism most likely trump the pursuit of money in this profession.
“I do it for the challenge and the change of pace. There is a profound difference when you walk into a new clinical arena- and basically just show up and get the job done- as well or better than it was done before“
“In my case, I was fired from a position and that was the only recourse:
When I look back I see a pool of water with everyone looking for a life preserver. And I was glad to walk away from it and preserve myself.”
“I enjoyed the challenge. Perfusion is cool, and yeah I wasn’t afraid of new things- but got tired of the same day-in day-out scene…”
“I saw a lot of unhappy people in an environment of stress. I figured this was a better OP for me 🙂 “
“It is a total rush to just go to a new place- suck up how they do things- and prove myself to be a huge difference maker…”
Have You Got What it Takes to be a Locum’s Perfusionist?
By: Frank Aprile, BBA, LP, CCP
This presentation is dedicated to the few of us that do locums perfusion and choose it for whatever reasons:
It is easy to use the label of “Nomad: to emphasize some of the superficial aspects of Locums Tenons work in the field of perfusion, however the pictures don’t tell the full story- as superior outcomes are suggested here- because when we are all challenged to prove ourselves- I believe we pay more attention and try just a little bit harder to demonstrate our worth.
Nomads Disappear… OUR outcomes don’t
There is a certain unbridled freedom to being a locums perfusionist. It is free because ultimately you are the designer of your own course. It is always with challenges that the more stolid and rigid in our profession- prefer not to engage in due to either inflexibility, or perhaps just a lack of enthusiasm to challenge the status quo of their particular department and cardiac world.
Neither is better or worse. Perfusionists in general are well equipped to adapt to new environments, technology, and changes.
There is no denying that the term “Locums” comes with preconceptions both positive and negative. Either way it is synonymous with uncertainty of the brand of the individual in front of you.
In all respects you are under the initial microscope- scrutinized and judged- and rightfully so. You are about to walk into a clinical situation where you certainly have a person’s life in your hand, and well- that is a very big deal.
A locum is a person who temporarily fulfills the duties of another. For example, a locum tenens physician is a physician who works in the place of the regular physician when that physician is absent, or when a hospital/practice is short-staffed. These professionals are still governed by their respective regulatory bodies, despite the transient or freelance nature of their positions.
Locum tenens, roughly translated from Latin, means “to hold a place.” Locum tenens perfusionists fill in for other perfusionists on a temporary basis for a range of a few days to up to six months or more. When a healthcare employer faces temporary staffing shortages due to vacancies, illness, or other causes, they hire locum tenens perfusionist to fill those vacancies and maintain patient care quality.
Prejudices, Preconceptions, and Misconceptions
- Stereotypes need to be overcome:
- Questions of reliability
- Work Ethic???
- Questions regarding “WHY” are you a Locums?
- Questions of your competence
- Questions of skill set
- Questions regarding your ability to work well with others-
- Dedication? You’re in it for the $$$
Your Frame of Mind and Approach to New Clinical Settings
A Note To Perfusion Locums:
There are walls that you stare at occasionally in this subset of our profession. As a Locum’s certain barriers that need to be (first of all- recognized), then assessed, placed into proper context, negotiated, and NOT taken personally.
The first thing to recognize and identify, is the level of staffing frustration that the perfusion group you are helpling is dealing with. This ALWAYS has a lot of components associated with it. Clearly you wouldn’t be there but if not to fill a staffing gap. The cause, duration, and solution to the gap, are all issues that are brewing and circulating right behind the doors you are about to open- the second you are credentialed, clinically available, and have gotten all your access codes, passed the POC requirements, and have been introduced to a wary (usually) and weary (sometimes) staff- the second your are to pump cases etc- you will be pressed to do so. In the beginning- usually lighter cases due to the surgeon’s hesitancy to entrust you with his patient’s life- in other cases- you will work like a dog- simply because you are a well paid TEMP.
Equally paramount is the frustrations of the surgeons, that are viewing you as a “patch” to fix a bad water leak– and that the quality of that “patch” is as of yet undefined, untested, unproven, and you will find yourself most likely placed on the same level as purchasing a pair of old used shoes…
Of course you are going to be under a magnifying glass. You don’t just casually walk into an OR and place someone on bypass just because you have the credentials “CCP” after your name. (Shockingly- that still happens a lot.) You will be looked at thoroughly and that circumspection comes with the territory yielding no place to the timid.
The bottom line is that there is no room to walk in with hesitation. You are what you are- AND who you are regardless of whatever clinical uncertainty you come across due to equipment you haven’t seen before, tests you haven’t run before, or procedures you weren’t a part of before, these are all part of the process, and it is up to you to grab that opportunity to build on your clinical skill set and ultimately meet the challenge you signed up for when you just got into the profession.
Go with it, have fun with it, and don’t doubt your ability to meet the challenge.
The Challenges in Front of You
A few things to consider about doing Locums for a long period of time: The stress of integrating into new accounts is pretty high-
My observation over the past 5 years of doing Locum’s, is that every perfusion group I have assisted is stretched pretty thin (based on a series of six in 8 months that I have encountered). I guess that would beg the obvious conclusion- no one uses Locum’s unless they absolutely have to.
One common denominator?
The level of expectation on perfusionists is so high- that entry level perfusionists (new grads), and even experienced travelers, are seriously behind the eight ball in terms of being able to get up to speed and garner the confidence of the surgeons/residing perfusion staff quickly enough- to warrant the investment of money and time.
Not everyone is going to meet that standard. Thus, the staff may expend quite a bit of energy, stress, and time, trying to get a new member up to speed- only to have to re-engage the entire process should things not work out (for whatever myriad of reasons that can resonate- personality, perception, pissed off surgeons, bad-day, whatever).
And sometimes, not due to performance issues, things aren’t going to work out- plain and simple.
It can make it a long day and a long haul for the perfusion group that desperately needs a break, and can’t seem to find one. That cycle can be a result of short visits by multiple replacement perfusionists that out of necessity, incur basically the same level of scrutiny and orientation as a new hire would- but the luxury of time (for economic or coverage effectiveness) just isn’t there. Try doing that 3-4 times a year. And maybe consider the fact that a person coming to relieve you for a week-will take at least that long to get to a point where you would trust them enough to put your loved one on bypass?
Rule # 1? Trust your instincts and your skill set. The rear-view mirror is good place to leave unpleasant personalities or situations behind. Don’t run and hide cuz you had a bad day, but at the same time, recognize the limitations in yourself or the people you are dealing with- in terms of confronting whatever crap is being laid in front of you, and if it really sucks and keeps you up at night because you are worried about personality issues or continued BS- then it’s time to go ?.
Rule # 2: If you get blindsided once, let it go- and come back the next morning and smile your way through it.
Rule # #3 Blindsided twice? Just let it go- and cut the cord. End of story.
IF It’s “Adios Amigos”: Just make sure you gave it a 100% and gave it a fair shot. If you can answer yes to both those questions in the mirror, then whatever decision you make- is the right one for you 🙂
The Pros & Cons of being a Locum’s Perfusionist
- Contractual Independence
- You Make Your Own Schedule
- Economic Advantages
- You gain new clinical experience(s)
- You master new techniques
- Travel to New or Exotic Places
- You can pick where you want to work
- You can pick when you want to leave
- Sources of Anxiety
- Leading a seperate life away from your family
- Represents a lot of down-time- ALONE
- Can stretch your perspective of what is REAL and meaningful in your life?
- Can be incredibly lonely
- Requires a brief period of you getting used to being home in your “real world” and your Spouse and children getting used to you being in their lives again.
- It requires a lot of faith in yourself- your family- and a strong conviction that the END GOAL is worth it
- You don’t have a guaranteed source of income
- No healthcare
- No Disability of FMLA
- No paycheck when you aren’t working
- A New Environment
- An Unfamiliar City/Hospital
- Overcoming Preconceptions
- Proving Yourself
- Personal Interactions
- Leading a seperate life away from your family
Locums Prep 101
- Finding an Opportunity
- Perfusion Contract Groups
- Individual Hospital Contracts
Economics: 1099 0r 1040?
- Becoming an LLC
- Liability Insurance
- Professional Networking
Legal and Economic Issues
- Your Locum’s Contract
- Reimbursement and what to Establish
- Pay Yourself every 2 Weeks!
- Don’t Become “LOST” as a Vendor
- Weekends and Call Coverage
- Travel: Time and Pay
- Reimbursement and what to Establish
- Conflicts of Interest
- Non-Compete Clauses
- Your Locum’s Contract
- Referral Do’s & Don’ts
- Your Reputation is Linked to those you Recommend
- BE Objective and Honest!
- Referral Do’s & Don’ts
- Personal Finances
- A Minimum 3 month Financial Cushion
- A Total Line of Credit with $20K or more
- A Solid Vehicle
- 1099’s- Beware of Taxes- You NEED an Accountant!
- 1040’s- Claim Max dependents
- Expenses: Discuss with your Accountant-
Paperwork & Credentialing
- Your CV
- Background Checks
- Organizational Continuing Education/Learning Modules
What to Bring
By: An anonymous Locums
“So I put together a few pieces at a time on a table (the “Launch pad”) a few days before actually heading out to a new clinical site. DO NOT wait until the last day, as most likely you will be leaving your family behind- and that is something that you need to be prepared to deal with- because in all actuality- you are doing it FOR THEM- and you have to leave them behind in order to accomplish it…”
Basically the concept is to pack early and give yourself a couple of days to hang out with the Fam- (or friends and pets- whatever/whomever you are leaving behind).
Obviously the following are included:
- Health and Hygiene products
- Business attire
- Clothes to “Chill” in
- A favorite pillow
- A sharp looking attache case
- A leather portfolio for resume’s and credentials
- A couple of pairs of different style OR “Hoofs” (shoes)
- Items are separated into different cases or bags-
- A Laptop
- Cell phone
- Drivers License, SSN card, maybe a passport.
- Alarm clock
- Your favorite things to do (I brought camera gear etc…)
- Perfusion Swag Bag
The Swag Bag …
What’s In It ?
Contents: from top left to right:
- OSHA glasses
- Phillips and Slot screwdrivers
- Compact adjustable wrench
- Tape measure (ECC modifications and changes)
- S Hook- for supporting lines, or IV bags
- The BADGE
- Very Cool flexible cord with memory (more on this below)
- Mini flashlight (Lowes)
- Hexhead and Alyn head wrenches
- Sticky notes (Duh…)
- Sharpie (Syringe labeling etc-)
- Scissors with badge holder strap- (The strap is cool on the side of your scrubs)
I got this malleable band at Lowes. It is excellent because it is strong and the memory is superb. I attached a Quadrox Oxygenator to the post of an LVAD/ECMO cart because we didn’t have the holder.
Anyway, if you travel, you probably have something like this- it comes in handy especially for solo accounts.
The Portable Office:
You will need a computer or access to one!
This is a huge priority. Credentialing is a potential barrier for transitioning into a new hospital, and there maybe a ton of forms and things that need to be signed, printed, scanned, and emailed.
As well, you will also be adhering to the the administrative standards and requirements from whoever hired you to be a locums (or if it is a self contracted position)- so be prepared to punch out some paperwork 🙂
- Lenovo LapTop
- External CD drive
- Universal file transfer cable
- Wireless keyboard and mouse ($33 at Best Buy)
- Wireless Scanner/Copier/Printer ($90 at Sam’s Club)
- Extra printer cartridges ($55 at Sam’s Club)
- Quality (Hammer Mill) printer paper
- Folders and files for receipts)
- 2- 64 GB zip drives for file transfers.
I noticed I hated typing on my laptop- so trust me when I say it is well worth it to purchase the remote keyboard and mouse. It transforms the laptop into a desktop and increased my productivity immensely.
- Fly or Drive or Ride Your Horse In?
Where to Stay
- Consider your Response Time
- Limit drive time to 10 min or less
- Enroll in a Hotel Rewards program
- Where NOT to Stay
Know Your Environment
- The City
- Essentials: Food, Groceries, Post Office/UPS, Office Max
Reporting to the Hospital
- Parking Passes
- Drug Testing
- Education Modules
- Parking (Chart your fastest route to the OR- KNOW your available “Off Hour” access points!)
- Practice/Rehearse this at least once prior to taking call
- Security passes and Access
- Shipping & Receiving
- BioMed is YOUR FRIEND
- Extension Cords/Fuse Boxes/20 Amp Outlets/Gas Cylanders
- PM of devices
- Security is an Even BETTER Friend
Clinical Awareness & Responsibilities
- The Hand off is CRUCIAL!
- KNOW your Equipment
- Double check your backup systems
- Have A Perfusionist You Can Contact for Q’s
- Pyxis or Medication Access
- Pt Charting/Billing/Awareness
- Clinical Responsibilities?
- Swann and Lines
- Lab QC’s
- Anticoagulation Management
Maximizing Your Smart Phone
Things I use my I-Phone for:
- Perfusion calulations (i-Pump)
Perfusion Calculator: (BSA, BMI, EBV, RCV, HCT on Pump, Heparin Dose, Protamine Dose, Cardiac Index, Flow Rates.
News, Articles, Video Presentations from Perfusion.COM.)
Videos are HTML5 for iPhone and iPad compatibility.
On the fly conversion for height and weight.
Searchable articles, news and videos.
Job feed and press release feed added.
Save calculation data for one hour.
- USE YOUR CELL PHONE
- Save Mapquest Directions to Important Destinations
- Take Pics of Setups and Disposables
- Save Passwords and Access Codes
- Buy a Perfusion App
- Surgeon Preferences
- Prime Constituents
Use Google Docs to Stay Organized
Use Google Docs for:
- ABCP Case Tracker
- Expense Tracker
- Daily Schedule
- First Impressions
- What to Say
- What NOT to Say
- Director of OR
- Cath Lab
- CV Surgeon
- OR Nurses and Techs
- 30 minute Response Time
- Know the Schedule!
- Call OR Every Evening for Changes
- Arrive an Hour before the Pt hits the Room
- Have your Pump Setup for SPEED
Wrapping it up
Locums is a really fun and exhilarating job, and sometimes it’s not.
Every once in a while you are going to run into a situation that you are not so prepared for – most often it is personalities, then that can be compounded with new equipment, or equipment you may have used before that is so far in the past in terms of when you used it last, that what you need in all honesty becomes a refresher course.
As a Locums, I’ve learned to parcel out what I choose to commit to memory, what is most relevant in front of me in terms of keeping patients alive, the equipment that I may or may not be familiar with, and ultimately the personalities of the staff and the physicians that I engage.
There are preconceptions established for Locums. It’s the elephant in the room so to speak, people want to know what you did before coming here, but at the same time are curious why you’re doing it now, and obviously for very good reasons, they’re going to wonder if there are gray areas in your past or your career that brought you to the point where you are targeted to be their new backup perfusionist.
The way I look at it is- most of the time that you find yourself traveling and going to new clinical sites you can count on having to overcome quite a few obstacles. Some of those potential bumps in the road will present themselves as new equipment that you may or may not be familiar with, equipment used 10 years ago and now requires a little bit of a refresher course, or flat out – equipment that you just are using for the very first time. These are all things that you process immediately when you show up at a new site. The onus is on you to not let yourself be afraid to ask questions (that could be misinterpreted as uncertainty or unfamiliarity) about the equipment and the processes that the hospital that you are- in engages in day by day.
There is no roadmap on how to negotiate a new perfusion environment, but there certainly are some prerequisites that I think that everybody should adhere to; first of which is learn how to navigate the operating room. That involves knowing where things are, introducing yourself to the people that you will be working with when you look for those pieces of equipment that you are about to use. In other words, you’re not only navigating new personalities that you encounter at your new clinical site, but you find yourself having to prove yourself, sometimes to people that you have no clue on whether or not they have the wherewithal or insight to make an informed and sound assessment of your skill set, your clinical judgment, or how you will react under pressure.
- The Appropriate Goodbyes
- Institutional Discretion
- Don’t Gossip or Disseminate Disparaging Comments
Keeping Your Homelife Intact
- Facetime and FB Baybee!
- Coming Home and Decompressing
- Planning Your Next Destination