0:00

Did you get additional malpractice insurance

0:02

for your locums physicians , or did the hospital

0:04

add them to their respective policies ? As

0:07

a locums company , you can provide

0:09

medical malpractice .

0:11

Make sure that that medical malpractice is

0:13

like legit Geico doesn't offer

0:15

medical malpractice , y'all . Right , you can't

0:17

do them Geico .

0:18

The general . They don't offer medical malpractice right you

0:21

mean Shaq , don't offer a . Nah

0:24

hey , we

0:27

talk about locum tenants a lot on this show

0:29

, renee and I . We've been doing it for

0:31

well over 10 years now , so

0:34

if you're curious about locum tenants and how

0:36

it might fit into your career , check out

0:38

locumstorycom . That's

0:40

locumstorycom

0:42

and you'll see all the different reasons

0:45

why physicians choose locums and

0:47

how it works for them . Find out about

0:49

jobs , taxes , travel

0:51

and , to me , most importantly pay

0:54

. Visit locumstorycom

0:57

to learn more . This

1:03

episode is brought to you by Set For Life Insurance

1:05

. Listen , docs . One of the first steps

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1:23

. Yo , what's

1:26

good everyone . This is Dr Neum

1:28

, joined by Dr

1:30

Renee , yeah

1:33

, Freakly Air

1:35

Freakly . Shamika

1:37

Keisha , Content

1:40

over everything I see C-O-E

1:42

.

1:44

Nah , this is just me on an everyday basis , Hmm

1:46

okay .

1:47

Well , listen everyone . This is another episode of Docs

1:49

Outside the Box . Once again , I want to give a shout out

1:51

to those who are watching us on YouTube

1:53

and those listening to us on the podcast . Yo

1:56

, mad , shout outs to y'all . But one

1:58

thing , though , before we move on , real quick , one thing Listen

2:00

, ios 17, . There's this

2:03

new update for all you Apple people . The

2:05

new update doesn't allow automatic

2:08

downloads for podcast episodes , and

2:10

you got to go back into the podcast

2:13

app , apple Podcast , and make

2:15

sure you're re-subscribed to us , make

2:18

sure you're telling it that you want automatic downloads

2:20

. Because I'm looking at our download numbers

2:22

and I'm like yo , what's

2:24

going on ? I was kind of taking it

2:26

personal . I was like yo , y'all don't want to listen to us anymore . And

2:29

then I find out I don't like us anymore . Then

2:31

I find out that it's actually they really don't like

2:34

us . Then I find out that it's

2:36

not just us , it's in

2:38

general all of the podcasts

2:40

out there . Then , when this new update

2:42

went out there , apple tried to like , they

2:46

tried to get us yo , they tried to bake shelly

2:48

. They took out the ability to do automatic

2:50

downloads or automatic follows . So everybody's

2:52

download numbers are down . So I'm just reminding you all , if

2:55

you're on Apple Podcasts , just

2:57

make sure you recheck , follow

2:59

or subscribe so that

3:01

we can get our numbers back up , because we appreciate y'all

3:03

, so listen

3:06

. One more last thing too , before we jump into

3:08

this episode . So

3:10

I'm at one of my locum spots and

3:12

I come in I haven't been there in two weeks and all

3:14

of a sudden everybody's like yo

3:17

, the podcast superstar , and

3:19

they're just joking around . But apparently some

3:21

orthopedic trauma fellow , some guy

3:23

who was actually doing an orthopedic trauma

3:26

fellowship , he's looking for a job

3:28

comes to this hospital that I work

3:30

at and I guess he tells them

3:32

that he's heard my podcast

3:35

and is either wanting

3:37

to do locums or that we're talking about

3:39

locums and basically kind of outing

3:41

us to everybody and shit . I'm like damn bro , like

3:43

you know .

3:45

I was he outing us . If

3:47

we are a podcast , well

3:50

you know . Anyway , listen if you are that

3:52

orthopedic surgeon .

3:53

Yo reach out to us , yo let me know what's going on . Hit

3:55

me up on Instagram at

3:58

docs outside the box , or just

4:00

hit us at team at drnedarkocom

4:02

. I want to know what you think . Are you coming ? What

4:04

do you think ?

4:04

I'm going to give you the real scoop All right

4:06

, but yeah , let's

4:09

tell you what's going on over there

4:11

.

4:12

I'll give you the scoop , man , I'll give you the scoop

4:14

. But look , let's , let's jump into this , since

4:17

we're talking about locums . Let's , let's

4:19

wrap this up , because for

4:21

the last several weeks we've been answering various

4:24

points of the questions that were put

4:26

out by these two doctors , these

4:28

two ER doctors who , in essence

4:30

, are tired of being employed and want

4:32

to kind of go and do things

4:34

on their own and they want to work locums . They want to be independent

4:37

contractors . They don't want to be held down by

4:39

the man , so to speak . And

4:41

not only do they want to be independent contractors

4:44

when nobody tells them when to work , how to work , they

4:46

just make as much as they want to make , and so forth

4:48

. They actually want to start their own locums

4:50

agency , which means they want

4:52

to kind of have

4:54

other doctors employed or , sorry , have

4:57

other doctors contracted through them

4:59

. All right , there we go , and then they go

5:01

and send them off to various hospitals

5:03

, and then they're in charge of travel

5:05

, they're in charge of hotel , All those different things

5:08

. They want to do that and they want to know how we do that . So

5:10

we did that . Let's tell them how

5:13

we did it , so that we can break

5:15

this down for them and they will understand

5:18

this forever . And it will be broken down , so

5:20

it will forever be broke . That's it , all

5:22

right .

5:22

OK , all right

5:25

, y'all that's great , but before

5:27

we get started with that , let's actually

5:30

have you guys look in the

5:32

show notes , because we're going to be giving

5:35

you a download on kind

5:37

of our own steps , of how we started

5:40

our locum tenants agency

5:42

. So that way you don't have to keep scrolling

5:45

through the audio or

5:48

the video if you don't have it right in front of

5:50

you . You could just pull it up in a PDF

5:52

file . So don't forget to look

5:54

in the show notes .

5:56

This is important . You guys check out these resources

5:58

, guys . These resources are there .

6:00

We put a lot of work in there .

6:01

I'm telling you , it kind of gives you a 30,000

6:04

foot view as

6:06

to what to look for in

6:08

so many different aspects of whether

6:10

you want to travel , whether you want to start your own

6:12

, be a locum on your own . These

6:14

are really things that you can

6:16

kind of keep in mind

6:18

when you're looking to transition into locums

6:21

, and I think a lot of times people feel like it's

6:23

all over the place . Do I look at this resource ? Do I look at that

6:25

resource ? I got 19 different resources

6:27

. You know how I like to plan or I like to

6:29

research . I'll have a whole map full

6:31

of a whole bunch of different things . Look at this . How does this do this

6:34

?

6:34

I'm like what is ?

6:35

happening . That is amazing , Yo

6:38

. Y'all see this on YouTube .

6:39

What is happening to your background ?

6:41

How do we do that ? Is this like ? I

6:44

don't know ? I don't know why

6:46

it keeps doing that . Remember , when we were meeting with Kiara

6:48

, it was doing that .

6:49

Yeah , I

6:51

think it's in your settings , in your video settings

6:54

.

6:54

It might be .

6:55

Well , whatever you said , it looked really great

6:57

and

6:59

very important .

6:59

I'm trying to see if it does this . I don't

7:02

know Anyway make

7:04

sure you guys check out the show notes and check out our resources

7:07

. We got a lot of great resources there . But

7:10

listen , people want to know

7:12

how we started an agency . They

7:14

want to know how we fucked around and

7:16

started charging over seven figures

7:18

. Remember that one year , yeah

7:21

, fucked around and charged

7:23

seven figures and I was like

7:26

yo , I had never

7:28

seen .

7:28

Literally a million dollar business .

7:30

I want people to understand this . People

7:34

would say did I had a million ? I was like no , we

7:36

charged we charged a million

7:38

, we charged seven . We

7:40

charged seven figures .

7:41

Revenue .

7:43

Gross . Yo , you start to think , yo

7:46

, this is how much they be paying . But

7:50

listen , let's talk about

7:52

how we got into starting an

7:54

agency . We talked about locums and

7:56

all that stuff , and since they contacted

7:59

you first , why don't you take it ? Let

8:01

us know how we started an agency

8:03

.

8:05

Go Well . So

8:08

it all started at

8:10

a point at which I was actually

8:12

leaving my job , my permanent

8:14

job . So we were just for a

8:16

quick backstory for the people who may not be

8:20

too familiar or who haven't listened to the

8:22

previous episodes which you should . But

8:25

I was actually leaving my

8:27

permanent job . So me and I were both

8:29

permanently employed at

8:32

this one hospital . This

8:34

was around the time we had done IVF for two and a half

8:36

years . It had failed . Me

8:38

was like you need to leave your job .

8:40

You need to leave your job . No

8:43

, that's not how I said it , nope .

8:44

That's not how I said it .

8:45

I said listen do you

8:47

think maybe you should consider leaving

8:50

your job ? And I'm like this .

8:52

Yeah , OK , I don't think so .

8:53

Because I didn't want you to throw anything at me . But

8:55

I was very nice about it and I

8:57

just suggested that maybe you

8:59

should take some time off and just focus

9:01

on just getting knocked up Getting

9:04

pregnant . That's all . I said Get knocked

9:06

up , but don't make it like I told you . You need to

9:08

do that , don't do that .

9:11

I need to get you canceled from me or another You're not

9:13

going to make me , the villain in this story . I need

9:15

to get you canceled . But anyway , you

9:17

suggested that I leave my

9:19

job . After some thought

9:21

, I was , like you know , I

9:23

think I'm going to leave my job , and

9:26

that's a different story in terms of how

9:28

I came to that decision for another day . But

9:31

as I was

9:33

leaving actually I think the day

9:36

after the day after

9:38

I left or two days after I left

9:40

I got an email that

9:43

basically said hey , would

9:45

you consider potentially

9:48

putting these private docs that

9:50

work at the hospital through your Locomtenants

9:53

agency ? Because the

9:55

private docs who actually were in

9:57

a practice but not all of them in the practice

10:00

wanted to do

10:02

independent contracting . So

10:04

they decided that

10:06

they were each independently going

10:09

to contract with the hospital . And the hospital

10:11

was like no , we don't do that . If

10:15

you're going to contract with

10:17

us , you need to do it as an entity , not

10:20

as an individual , in other words , not a sole proprietor

10:22

. And so they didn't want

10:24

to form yet another practice

10:27

, if you will , and

10:29

they didn't want to use their current practice

10:31

, since all of them were not going

10:33

to be contracting . So

10:35

I went to me and I was

10:37

like what do you think ? And

10:40

what did you say ?

10:42

I had a lot of questions . I was very skeptical

10:44

. You did . You had a lot of questions . I

10:46

was a big skeptic because , ultimately

10:49

, the last thing that you said to me was hey

10:51

guys , what they said to us was hey guys

10:53

, listen , all you have to do is

10:56

contract these doctors through your company

10:58

. We already had a formed company

11:00

, the hospital . We

11:02

, as the hospital , will pay you

11:04

as your company , and then you use

11:06

that money to pay the

11:08

doctors .

11:10

Which , by the way , is the normal . That's

11:12

the normal way of locust

11:14

.

11:16

But that makes sense . But basically

11:18

they were like , let's say you wanted to . I'm going to simplify

11:21

this very easy If

11:23

it costs $10 to pay

11:25

for a doctor , the hospital wanted to

11:27

give us $10 and then have

11:29

us pay the doctors $10 . And

11:32

we were like hell , no

11:34

, Because , yeah , it sounds easy

11:36

, right , well , yeah , you just take that money and then you give

11:38

it to the doctor . But one thing that people

11:40

don't understand and we're going to talk about this later on is

11:42

you got to create payroll . That costs money

11:44

. You got to create schedules . That costs money

11:47

. You got to pay taxes on some of those things

11:49

. That costs money . You got to get a CPA

11:51

. That costs money . So we had fees . So

11:53

it's not as simple as just , yeah , you give us $10

11:56

and then we give it to the doctor and then it's a clean exchange . It

11:58

doesn't work like that . Actually , we would be going into the

12:00

negative to have this relationship . So

12:03

that was my big question . I was like , okay , well , great

12:05

, yeah , you want us to do this and facilitate

12:07

this for y'all , but it's

12:10

going to cost y'all .

12:11

Yeah , and that was the big hold up . Yeah

12:14

, that was the big question , right , because they

12:16

kept using the word well , it's just going to be a pass

12:18

through . It's just going to be a pass through and it's

12:20

like hold on a second . One of the things that

12:22

you didn't mention , in terms of

12:24

all of the things that we would need to

12:26

worry about and pay for , is our

12:28

time right , because

12:31

our time was worth something as well

12:33

, and so you can't discount

12:35

the time that we were going to be taking

12:37

to be able to provide this service

12:39

that they otherwise would not have been able

12:41

to provide for themselves .

12:43

And so it's like Well , the other thing

12:45

that you didn't mention is they wanted us to do the whole

12:47

schedule . So that's one thing that you guys

12:49

got to realize . So what I mean by that is usually

12:52

what will happen is the hospital

12:54

will go to the locums company and say , hey , here's

12:57

our calendar . We need two weeks

12:59

covered every month . Can

13:01

you provide coverage for that ? We don't care who you bring , just

13:03

make sure you can help us cover two weeks . What

13:06

happened to us is they give us the entire schedule

13:09

and they were like yo fill

13:11

this schedule with either the docs

13:13

that we already have or the docs that you have

13:15

. Make the magic happen , and

13:18

we don't care how it ends up , but just make sure there's

13:20

no holes . Those are two different

13:22

things .

13:23

Right , correct . Well , yes

13:26

, correct . So we ended

13:28

up because they

13:30

technically only had one OBGYN

13:33

on their

13:35

own payroll . The

13:37

rest of the schedule , the majority

13:39

of the schedule was empty , was

13:42

completely empty , so we were

13:44

at times filling over 20

13:46

days in

13:49

a week or , excuse

13:51

me , in a month , of different doctors

13:53

who needed to be on this schedule

13:55

, and so that's essentially what we ended

13:57

up doing All right y'all .

13:59

This is Dr Nate . I've been doing locum tenants

14:01

trauma surgery for well over 10 years

14:04

and I haven't looked back since Best

14:06

combination of lifestyle and income that I

14:09

could ask for . Now , for you , your

14:11

needs , your wants , that's going to be different than mine

14:13

. Maybe you want more control over

14:15

when you work or even how much

14:17

you work , or , look , you're

14:19

just trying to make more money to pay off those damn student loans

14:21

. Now the other thing is pay attention

14:24

. The average locum's doc

14:26

gets paid at least 33% more

14:28

than your average employee doc . You

14:31

got your attention now so look

14:33

, I get it . Sometimes the hardest part is where

14:35

do I start ? You start your research

14:37

at locumstorycom . Once again

14:39

, that's locumstorycom . It's

14:42

an unbiased educational resource

14:44

about locum tenants . There

14:46

you're going to find stories about the different reasons

14:48

why doctors choose locums and

14:50

how it works for them . Locumstorycom

14:53

has tools that let you explore locums

14:55

, pay demand for your specialty

14:57

and even compare different locum tenants

15:00

agencies . So look , stop

15:02

sitting on the fence or just thinking

15:04

about it , start doing . Do

15:06

your own research at locumstorycom . Once

15:09

again , that's locumstorycom .

15:14

It's easy . So let's talk about

15:16

the I guess a little bit

15:18

of the process

15:20

of contracting with them

15:23

. Well , how about this ? Let's talk a little bit about that

15:25

.

15:25

Actually , let's do it over a set of questions

15:28

right , which is one how

15:30

did you decide to pay the doctors ? How

15:33

we decided to pay the doctors plays a major role

15:35

in how we did the contract . So

15:38

that's one of the questions that they ask is how do you decide

15:40

to pay the providers ? Well , in this situation

15:42

, the way in which we decided to pay the providers

15:45

was kind of something that was already predetermined

15:47

before we even got to the point . So , hospital

15:50

was talking to the doctors . The

15:52

doctors were like , yeah , we don't want to be independent

15:54

contractors . Or

15:57

excuse me , we don't want to form another entity

15:59

. We got to figure out something , but we kind of know

16:01

how much we want to get paid , right , and

16:05

we came in and we were like , okay , like

16:07

we understand how much you guys want to get paid , but

16:10

we want to get paid too . Also , since we're going to

16:12

be doing this schedule for you guys , we're

16:14

going to be giving you the I'm talking about to the

16:16

doctors 1099 and then to the hospital

16:19

. We're going to be giving you guys a schedule . We

16:21

got to get something . So that was the first

16:23

thing is one in this situation . We kind

16:25

of walked into a situation that was already

16:27

kind of done .

16:29

Yeah , which is not really the norm , right

16:32

, because if you're starting your own locums

16:34

, your , if you're starting your own , your

16:36

own locum tenants agency and you

16:38

go to contract with a facility

16:41

, typically you are

16:43

putting forth what your

16:45

rates will be to the hospital

16:48

and then you also put a

16:50

rate forth to the doctor .

16:52

Yeah , so we just said hey , this

16:54

is how much you're going to pay the doctor . We're going to add on an additional

16:57

fee and make it a total global

16:59

fee , right ? So if it's $10

17:01

, we actually want to get paid $15 , right

17:04

, and then from that $15

17:06

.

17:06

These are not real numbers folks .

17:08

We'll keep $5 for ourselves

17:10

and then the $10 will go to each individual

17:13

doctor each day . So that was one of

17:15

the first things that we had to get over or

17:17

we had to go through was like , okay , now

17:19

that we know how much the doctors are going to get paid , and

17:21

now that we haven't agreed upon amount of

17:23

what the total amount going to be , we kind of know

17:26

what our profit is going to be . Does

17:28

this work for us ? And we said yeah

17:30

. So that was the first . One of the first big

17:32

hurdles Is this going to financially

17:34

make sense for us to do

17:36

an agency like this ? And

17:39

we decided it would .

17:40

Yeah , and the other thing that I would say about that

17:43

is , again , our

17:45

case study , if

17:47

you will , is a little bit different

17:50

than if you were going to be doing

17:52

this from scratch . But oftentimes

17:54

from scratch , like I mentioned , you

17:56

offer a rate to the hospital

17:59

, then you offer another rate to

18:01

the physician . Usually what

18:04

you're getting paid is going to be some percentage

18:06

of what the

18:08

physician is going to be making , and that

18:10

is taken out from what the hospital

18:13

essentially is paying you . So

18:16

just kind of keep that in mind for

18:18

your agencies that are

18:20

out there , right , like the big agencies

18:22

that are out there . We

18:25

found out at one point , right when

18:27

I was out in Idaho , we found out how much

18:29

I was getting paid and we found out how much

18:31

the agency was

18:33

actually getting paid , because one

18:35

of the administrators unknowingly spilled

18:39

the beans to me and it

18:41

turns out that I think

18:43

that hospital was getting

18:45

excuse me , that agency was getting paid

18:47

40% , yeah .

18:50

I mean , if you look at it , that's crazy .

18:52

It compares into my pay and I was like , wait

18:54

what ?

18:55

Yeah , I mean you found out because

18:58

of that old timely mistake in the office

19:00

, which is you send emails and

19:03

you add people on to the emails who

19:05

shouldn't be CC'd on and they can see the email

19:08

chain , and basically you saw

19:10

the email chain of how much the hospital was keeping

19:12

sorry , how much they had Locom's company

19:14

was keeping and then how much they were paying you

19:16

and it was basically what you were making . You

19:18

kept 50% of the money .

19:20

It was like I think it was like 40%

19:22

to the hospital . Actually

19:25

, you might be right , it might have been about 50%

19:27

. I gotta pull up that email

19:29

one of these days . I actually have that email

19:31

. I need to pull it up one of these days . But

19:34

yeah , but if you think about it .

19:35

That's crazy To me . That's crazy . I'll tell you

19:37

why that's crazy . Like if it's like a 50

19:39

, 40 split or in some places I've seen

19:41

50 , 50 split . I've seen 60

19:44

, 40 split , with the locums making 60%

19:46

and the doctors making 40% . And the

19:48

reason I think that that's crazy ? I'll tell you why . The

19:51

reason I think that's crazy is when you first start working with

19:53

a locums company , yeah , there's some work that

19:55

they do in terms of helping you get your credentials

19:58

, your licenses particularly in states that

20:00

you don't have that stuff helping you

20:02

get onto hospital staff . That takes some

20:04

work , right , you got , they have these big companies

20:07

and overhead . But after that initial

20:09

point , when , like , you're going into month two

20:11

, month five , month seven

20:13

, and you're working at this one hospital or multiple

20:16

hospitals and there's no more credentialing

20:18

that needs to be done , it's smooth sailing , right

20:20

. It's smooth sailing right . It's like , how much

20:22

more work do you need ? And do you necessarily

20:25

need to be getting 50% , 60% of the money

20:27

that I need when I wake up in the morning and go see these patients

20:29

, right ? Why ?

20:30

you taking 60% of that and taking on all the

20:32

liability Each time .

20:33

Think about that , guys . Each hour that you work they're getting

20:35

60% of the cut , or 50% of the cut , or 40

20:37

, that's a large amount , right ? So

20:39

for us we decided that

20:42

since we wanted to be physicians first , since

20:44

we are a physician run company , we

20:46

wanted to make sure that we wanted to maximize the

20:49

most amount of money to the providers

20:51

, whoever it may be right . So

20:53

we use technology

20:55

. We just said look like we're

20:58

in this to make a profit . But also , at the same

21:00

time , we got to realize the sweat equity belongs

21:02

to the person who's actually on call that

21:04

time . And that's how we decided how much we would

21:06

keep right . We kept like

21:08

what ? 10% , if that you

21:11

know . 10 to 15% of that was what

21:13

we kept to keep the doors open , to keep the lights

21:15

on and for us to have a little bit of profit and make

21:17

it work for a while . So one of the questions they asked

21:19

is how do you determine ? How are you gonna pay the

21:21

doctors ? That's up to you , but also

21:23

realize that you can use technology to

21:25

kind of decrease your overhead costs .

21:27

Decrease your overhead .

21:28

And realize that one of the ways that

21:30

you can market

21:32

yourself over all the other agencies

21:35

is that , hey , you as doctors

21:37

, you keep more money , we take a little bit less

21:39

, you know . So that's one of the

21:41

questions they have . But one of the other

21:43

questions that I wanted to shift to real quick , just to kind

21:45

of keep this moving , is she asked , or

21:47

they asked in starting your locums company

21:50

, did you utilize certain lawyers

21:52

to draft contracts or other agencies

21:54

that streamline the process , right

21:57

? And the reason I wanna bring this up is because this is part

21:59

of us how we did our contracts right

22:01

, yeah ? So my answer

22:03

is hell yes , we use the contract

22:05

, we use multiple contracts , right . So

22:07

there's one contract that's between our

22:10

company and the hospital , and

22:12

then there's another contract between our

22:14

company and the physicians right

22:17

Yep .

22:18

You wanna chime in on that . Oh yeah , absolutely

22:20

, absolutely . I mean , you know

22:22

, having a contract that is

22:24

soundly written and

22:27

that really details

22:30

everything . Oh

22:32

my God , people , there's

22:34

gonna be a point where we're gonna have a story for you not today

22:37

, but let me tell you

22:39

something Making sure

22:41

that your contract is well-written , making

22:44

sure that the appropriate

22:46

amount of liability is

22:48

on you as the locums company

22:51

and the appropriate liability

22:53

is on the physician and

22:55

the appropriate liability is on the hospital

22:58

, is extremely , extremely

23:00

important . That's as far as I'll go in the story

23:02

right now . One of these days we gonna tell

23:04

y'all a story .

23:05

Say it again , renee .

23:06

Say it again the appropriate amount of what the

23:09

appropriate amount of liability Because

23:11

, remember , just because you are

23:13

the locums company doesn't

23:15

mean that the physicians are employed

23:17

by you . They're not employed by you and

23:21

therefore you don't dictate anything

23:23

that they actually do in terms of their practice

23:25

. So you just have

23:27

to remember that having

23:31

a contract and having it looked

23:33

at by a lawyer who understands

23:35

the lingo so don't go getting a , you know I'm

23:38

gonna get like a- real estate lawyer

23:40

, don't get a tax lawyer . Right

23:42

, get a tax lawyer , you know

23:44

real estate lawyer , you know music

23:46

industry lawyer . That's not going to help

23:48

you . You need somebody who really

23:51

understands contract law , who

23:53

understands HR , who

23:56

understands medicine

23:59

and how this

24:01

stuff actually works .

24:04

Oh yeah , like so , real quick , without getting too much

24:06

into the weeds , whatever your contract with

24:09

the doctors or the providers

24:11

are gonna be , it's really clear . Like

24:14

you gotta make sure that you're making it

24:16

clear that this is not an employer-employee

24:18

relationship , right . Like we are independent

24:20

contractors and I'm working with

24:22

this agency and we're like a

24:24

staffing company , that's it . That's really

24:27

clear . The other thing , too , is that

24:29

making sure that it's clear that the doctors

24:31

that go to these hospitals they're just contractors

24:33

, they're not employers

24:35

or , excuse me , they're not employees or anything like

24:38

that . And that's very important , right , because

24:40

some doctors may want to know , hey

24:42

, like I just got to this hospital and I don't like it here

24:44

, like I wanna be out , right , or I don't

24:46

wanna go to these meetings , you know , and there's

24:49

certain things that you can get away with if you're an

24:51

independent contractor and there's things that you can't get away

24:53

with if you're an employee . So it's very important to

24:55

kind of delineate that and I

24:58

would say lean on the independent contractor side

25:00

. And then the other thing is you gotta let the expectations

25:02

be known to your providers , and what I mean by

25:04

that is y'all don't trip . Just

25:07

, you know it's not all , like not

25:09

all the responsibility is on the hospital

25:11

. Like you gotta make sure that your doctors

25:14

are finishing their notes , they're

25:16

submitting their notes in a timely fashion , because

25:18

if they can't , then the hospital can't bill

25:20

and they're gonna be upset when , like , you're charging

25:23

them these locum rates and then

25:25

there's notes that are half done

25:27

or notes that are not done and

25:29

they can't bill Medicare or Medicaid

25:31

or whatever third party insurance agency

25:33

that is , and it's gonna come on you guys

25:35

as the company . So just make sure in

25:37

the contractor , making sure that you're holding

25:40

the providers accountable , to make

25:42

sure that if you don't do notes you'll

25:44

get paid . Those are three big things

25:46

, I think .

25:48

Yeah , I would say one more thing

25:50

. You know , in terms of the employer employee

25:52

relationship , just because

25:55

it's written down that you

25:57

are not the employer and the

25:59

contracted physician is not your

26:01

employee , doesn't give you

26:03

a pass to treat them like

26:06

an employee off paper

26:08

, right .

26:10

So in other words so explain what does that mean . What does that mean ?

26:12

Yeah in other words , right , like you can't

26:14

say , well , you have to go and work

26:16

at this hospital . What you're

26:18

supposed to do is you're supposed to put

26:20

forth an offering and say

26:23

, hey , I have a hospital that

26:25

has a need , and here is the

26:27

need , here are the days that are needed

26:29

, here's the rate that they're

26:31

discussing . Would

26:35

you like to do it ? Are you interested

26:37

? You cannot place a

26:39

physician in an

26:42

assignment . You cannot do

26:44

that , so you can't treat them

26:46

like an employee . But then

26:48

say , well , it says on paper

26:51

that you're not an employee , because

26:53

, let me tell you something , paper

26:55

trails , paper

26:58

trails will negate that

27:00

contract immediately and

27:03

, trust me , you don't want the labor bureau

27:05

coming your way .

27:07

I think the same way that you guys would document

27:09

in your notes , right , like

27:11

you know how in medicine everybody documents

27:13

everything , right ? If you don't document

27:15

it , it didn't happen . It's the same thing in business , like

27:17

in this world . You gotta be very

27:20

clear as to how

27:22

you treat people and make sure you are following the law

27:24

, because I'm telling you they will come for

27:26

you . So just make sure you're very clear

27:29

as to what is covered , what is not covered , how

27:31

they work , how they don't work , all of those different

27:33

things . Make sure you're abreast on

27:36

independent contract or law .

27:39

Yeah , read , read , read , read .

27:40

You need to know employee contracts

27:42

also . So here's another

27:44

thing that we had to clarify on our contract

27:47

also . Here's a good question Did

27:49

you get additional malpractice insurance

27:52

for your locums physicians or did

27:54

the hospital add them to their respective

27:56

policies ? So let

27:58

me take it from here . I'm going to be very honest with you guys . As

28:01

a locums company , you can provide

28:04

medical malpractice , right

28:06

. So you purchase medical malpractice

28:08

and then the doctors who

28:10

are contracted with you , they're covered

28:13

under the company's medical malpractice

28:15

. Then they get sent to the hospital . That's

28:17

one way you could do it . Another

28:19

way that you can do it is by

28:21

depending on your relationship with the hospital

28:23

. The hospital could be like yeah , we know that

28:25

they're independent contractors , but we'll provide coverage

28:28

for them . That doesn't happen too much , but

28:30

we'll provide coverage for them . The

28:32

reason why the latter , I think , works

28:35

the best is because the hospital has , like

28:37

, these huge group policies , right

28:39

. So

28:42

having a doctor , an additional doctor

28:44

, added onto our group policy , is

28:47

not that big of a deal , right . But

28:50

if you have to get your own

28:52

insurance , if the company has to get

28:54

their own insurance , a lot of times that may

28:56

increase the rate that

28:59

the agency is charging the hospital

29:01

, right . So what was

29:03

$10 a day is now

29:05

maybe $12 a day and that

29:07

stuff adds up and that's why a hospital

29:09

may say look , screw that , go

29:11

back to $10 an hour and we'll cover the medical

29:13

malpractice of that .

29:15

Again , these are not real numbers .

29:17

This is a caveat . I

29:19

hope we put it down here . You'll disclaimer these

29:21

are not real numbers .

29:24

No , but that's important to know . I mean , remember

29:27

, you're also negotiating , so you can negotiate

29:30

just about anything , right ? I don't know if anybody

29:32

has been following the

29:35

series that we've been doing with John Epino

29:37

, who is the contract reviewer for

29:39

contract diagnostics right , the founder

29:41

of contract diagnostics , but

29:45

we've had some episodes out about

29:47

reviewing contracts and negotiating

29:50

. But in this case , right

29:52

, if you have a hospital

29:54

who says , hey , we want you to provide

29:56

the malpractice insurance , that's absolutely

29:59

what we want . We don't want to put the physicians

30:01

on our own malpractice

30:03

coverage , that's fine . The other

30:05

thing that you can negotiate is okay

30:07

, you will reimburse us for

30:10

that malpractice

30:12

insurance , right , so we can

30:14

keep the rate the same as long as you

30:17

reimburse me for that

30:19

expense that I just made . If

30:21

you don't want to reimburse me outright , then

30:23

the rate has to go up

30:25

, maybe by a certain percentage

30:27

. So these

30:29

are things that you really should think about . Read

30:32

, read , read on how to be

30:34

able to kind of navigate all of these

30:36

situations about employer , employee

30:39

malpractice insurance , all of that stuff

30:41

, because that's going to be really vital

30:44

to your success as

30:46

an agency .

30:48

So in our contract , in

30:50

our contract we had where the hospital would

30:52

pay for the medical malpractice

30:54

for these docs . So

30:57

that was actually in the contract . And

30:59

then in our contract to the doctors

31:01

, we told them that they would have medical malpractice

31:04

. It might be offered by us or it might be offered

31:06

by the hospital , depending right

31:08

. So that's

31:10

a big deal , right , and you also got

31:12

to make sure . Go ahead , ben .

31:14

No , the other thing that I was going to say is

31:16

make sure that that medical

31:18

malpractice which is probably what you were about to say

31:20

make sure that that medical malpractice

31:22

is like legit

31:25

for your physicians , right , because

31:27

you want to make sure that one it has .

31:30

Geico doesn't offer medical malpractice y'all .

31:31

Right , you can't give him Geico

31:34

the general . He

31:38

don't offer medical malpractice right , you mean Shack , don't

31:40

offer no . So

31:48

you want to make sure that it meets the

31:51

criteria of the . What is it like , the

31:53

one million and the three million

31:55

? Whatever it is ?

31:56

right , you want to make sure it's state . You just make

31:58

sure it's the it's state-dependent , it's state-specific

32:01

.

32:01

Yeah , that's it Right , so it's very

32:03

state-specific . You're absolutely right . Right

32:05

, so you want to make sure that

32:07

you go to a broker who's going to be able

32:10

to give you really good

32:12

malpractice insurance . But I

32:14

would argue and maybe everybody's not going

32:16

to agree with me and that's okay , but because

32:19

we are very physician-oriented

32:21

, I would argue that

32:23

make sure that you get either occurrence

32:25

insurance or claims

32:27

made with tail with tail

32:30

, and

32:32

that's something that you should actually

32:34

outline in your

32:37

contract with the hospital . You

32:40

need to be like listen this is the coverage

32:42

.

32:42

I'll put it out there . Anybody right now who

32:44

is practicing either

32:47

as an employee or

32:49

as a private practice doctor or

32:51

whatever you're doing as an independent contractor

32:53

, if you got claims made

32:55

and you don't have tail coverage , what are you

32:57

doing ? Why are you still doing that ? That

33:00

should not be an option whatsoever . I don't care where

33:02

you are , I don't care if you're in Florida , I don't care

33:04

if you're in California , but basically , what's tail

33:06

coverage ?

33:07

Explain to everybody what that is , just in case , because I

33:09

know we talked about it with a John Epino

33:11

episode , but people

33:14

may not have heard

33:16

that one .

33:17

Yeah . So there's two types of medical

33:19

malpractices . For the most part there's

33:21

occurrence-based and then there's claims

33:23

made or claims-based , and

33:26

what that means is , let's say you practice at a hospital

33:28

for five years . Both types

33:30

of coverages are going to cover you for what

33:32

happened over those five years . The

33:35

key thing is what happens when you leave

33:38

that facility and you're no longer working

33:40

there anymore . Occurrence-based

33:42

basically says listen , whether you leave

33:44

there and you're in year six or

33:47

you're in year 40 , we got you

33:49

. If someone comes up with a medical malpractice

33:51

case at year 59 , we

33:53

got you . You . Good , got

33:56

you . That's more expensive , right

33:58

, that's that Cadillac plan , that

34:00

Cadillac guy going insurance over there . Right , it's

34:03

very expensive , but you ain't got to worry about

34:06

if someone tries to call hem you up

34:08

in 50 years . You always got coverage .

34:10

Talking about , my kid didn't go to Harvard . Dr

34:13

Darko delivered my kid and he ain't go to Harvard

34:16

.

34:16

That's not my fault . So we talking about you , they

34:18

talking about you . Okay , yeah , ob .

34:19

Not Dr Darko .

34:20

Yeah , my kid ain't go to Harvard . My

34:25

kid ain't go to Harvard and I want to sue . Well

34:46

, if you just have regular claims made insurance

34:48

and no tail coverage , well , if they come

34:50

to you at year 10 , you

34:52

don't have coverage anymore . They

34:54

just covered what happened , you know

34:57

, during those five years After that , that's it

34:59

. But tail coverage will say , yeah

35:01

, in year 59 , we got

35:03

you Right . So what you end up

35:05

seeing is claims made oftentimes

35:07

is a lot cheaper than a current

35:10

space because you know it's just

35:12

a , it's cheaper and

35:14

you oftentimes have to purchase the tail coverage

35:17

right To cover you separately

35:19

. And what a lot of private practice

35:21

doctors or doctors who work in

35:24

like these group practices that make

35:26

you purchase tail . What they end up finding out

35:28

is in order to cover you for all that back

35:30

stuff that happened before in year one through

35:32

five , you don't have to fork over

35:35

like almost like a hundred percent of

35:37

what the premiums are going to be , or even more so

35:39

. Sometimes you have to fork over like a hundred K

35:41

to get you to cover all your stuff

35:43

, and it's like who's floating around with a hundred

35:46

K Right ?

35:47

And that's not payment . That's a

35:50

hundred grand

35:52

like one time payment

35:54

, yeah , yeah .

35:57

So so that . So listen guys , we're not getting too much . Maybe

35:59

didn't let you pay it over six months . Without getting

36:01

into too much debt . Those are some of the things

36:03

that we hashed out in the contract . And , yeah , we

36:05

went to a lawyer . We got a lawyer that we trust

36:07

to help us do everything . So

36:09

they reviewed our agreement with the physicians

36:11

, they looked at our agreement with the hospital

36:14

and it was a hundred proof

36:16

. It was cash money . Nothing

36:18

is bulletproof . So we covered everything

36:20

. There were times when I was just like why do we have this in here ? Why

36:22

are we going so far in debt ?

36:24

And it's like yo you never know

36:27

.

36:27

Y'all , you never know . Like , even things

36:29

like related to , possibly , covid

36:31

, right . Like you got to cover things like

36:33

those are things that we call force major . Right

36:35

, where natural events occur

36:37

and maybe you can't get coverage

36:40

because maybe all the airlines went bankrupt , right

36:42

. So if you're responsible , if you're a company

36:45

in New Jersey and you got to get people

36:47

over to California , how you go

36:49

cover that right . But , like , you have to be able

36:51

to cover a lot of these different things . But

36:53

if you get a really good lawyer who's worth his or her

36:56

salt they got you and I think it's

36:58

worth it it's going to cost you , but

37:00

if you really willing to get into this , you're going to have to pay for

37:02

that .

37:02

That's what I think yeah and

37:04

be willing to walk away if the terms aren't what

37:06

they should be Like

37:08

you got to be willing to walk away .

37:11

So that's a good point . You got the contract now

37:13

covered and now it's like yo . So now

37:15

it's like we got to provide coverage . So

37:17

the question is is did we hire

37:19

anyone to recruit full time doctors

37:22

, right ?

37:23

And .

37:23

I think I think you got to look at this

37:25

in two phases . So initially we

37:27

came in with a crew already , right , the hospital

37:30

had their crew of people who they wanted us to

37:32

contract with , so we had our crew

37:34

, and then the hospital had one person who

37:36

, combined , could basically fill an

37:39

entire schedule Right , and

37:41

so now our job is is okay , how

37:45

do you properly get these doctors

37:48

to sign up for

37:50

a contract or for a schedule ? How

37:52

do you get them on a schedule ? Right . How

37:55

do you talk to five different people to get them on

37:57

a schedule ? That's hard , right . How do

37:59

you make it automated ? Right , cause now

38:01

you got to scale it , right . How

38:03

do you make this occur so that when I'm sleeping , someone can still sign

38:06

up ? I don't know how to do that . I can't talk to each person

38:08

each way , right . How do you

38:10

make sure that you are confirming

38:12

with these doctors that yo , now

38:14

that you signed up , like this is what you're going to

38:16

do , right ? How do you make

38:18

sure that they don't cancel in 30 days

38:20

? Right ? These are all these different things that you got to think about . Yeah , who's

38:23

going to provide that letter ? So that was the next

38:26

step . You know you want to get it , you want to get into that

38:28

.

38:28

So I think that's the big thing , is how you create a schedule . Right

38:31

. So I realized very quickly that if we don't automate , we were going to

38:33

be in trouble . So I just wanted to leave that as an inner thought . Right , I can share

38:35

what I thought at home Don't بدom , do you think we can make it in time ? Exactly so I

38:37

think you just saw the general idea of multi хотя ride Porsche . If

38:39

we didn't automate this because we started out

38:41

with a crew of , I

38:43

wanna say , was at least four doctors at

38:46

least trying to cover

38:48

potentially 20 plus days

38:51

every single month

38:53

, which means we would have to confirm

38:55

every single day that they were gonna

38:57

be working I'd have

38:59

to look at the holes in the schedule and I was like

39:01

there's no way , like I'm gonna be able

39:03

to just do this . So

39:05

we ended up using a resource

39:07

that helped

39:09

us to put

39:12

the schedule in , to , say

39:14

, the dates that were needed for

39:16

the physician . So there was some back work

39:18

that needed to be done , but it was so kind

39:21

of like what do you call

39:23

that ? It was so repetitive , right

39:25

, the work was so repetitive that it wasn't

39:27

like , oh my God , I got a cater

39:30

to every single person . So

39:32

we used something called

39:34

you Can Book Me and

39:36

we put in the dates for every single

39:38

month that we needed and then put

39:41

it out to the physicians and said , okay , the

39:43

you Can Book Me for the month of December

39:45

is out . Go ahead and start

39:47

picking your dates and then First come first

39:49

serve , first come , first come , first

39:52

serve . And so we put that

39:54

out there . The physicians would choose their

39:56

dates , and once they would choose

39:58

their dates , then I would be able

40:00

to go back and see okay , what

40:02

are the holes that are in the schedule that

40:05

aren't covered ? For the most part

40:07

if something was really easy to cover

40:10

or whatever , even though I was pregnant

40:12

at the time and I should have probably been sitting my butt

40:14

down . But

40:18

if I wasn't traveling and I was available

40:20

, I would actually just take the call , right

40:23

, and just be like eh , there's

40:26

a couple of hours here that isn't covered

40:28

, or there's one night that isn't covered , so

40:30

I would just end up taking the call , which

40:33

was really nice , right , because when you have your

40:35

own LocomTendance agency , especially

40:37

if it's within your specialty , then you

40:39

can do that , and so these were OB docs , so

40:42

definitely I could take the call .

40:45

I think one thing that's clear one thing that's really

40:47

y'all gotta if y'all really are serious about

40:49

this , you gotta be able to make sure you

40:51

create a system in your contract that

40:54

says that they can't cancel within 30

40:56

days or , excuse me , not

40:58

that they can't cancel , but there's gotta be some type

41:00

of way to prevent

41:03

them from your

41:05

providers , the doctors from canceling

41:08

within 30 days . Because

41:10

if you're working with a hospital and the

41:12

doctors are consistently

41:14

cancelling or there's no barrier

41:17

to stop them from canceling , they gonna

41:19

cancel and that's not

41:21

gonna work for you from an agency standpoint

41:23

. So you gotta make sure that you have something

41:25

that's in line that says yo you cancel

41:28

in 30 days . Yeah , you gotta make

41:30

it . You gotta make it hurt a little bit if they cancel

41:32

in 30 days .

41:33

Yeah , I forget what our hurdle was it

41:36

was . I think it was a penalty . It

41:38

was a monetary penalty for

41:41

the next time they would sign

41:44

up with us . Nobody ever canceled

41:46

, actually , so thankfully

41:49

we didn't have to do that . Our doctors were

41:51

pretty consistent . But

41:53

yeah , you wanna create some sort of hurdle

41:55

preferably a monetary hurdle for yourself

41:58

, because what's gonna happen is if

42:00

they cancel , then that increases

42:02

the work on your end to have

42:04

to do whatever you need to do to

42:06

find a person to cover that

42:09

assignment . So

42:11

definitely create some sort of hurdle to

42:13

do that .

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42:38

. So

42:40

what are some of the overhead fees that they

42:42

should be aware of , right ? So I

42:44

think , definitely , yo

42:46

, you gotta worry about software , right , because software

42:49

is gonna be the key to automating this . So for

42:51

us , like you can book me , was like

42:53

over the year , I think it

42:55

was like 200 bucks or even less

42:57

than that .

42:57

Yeah , it was cheap back then I mean , I don't know how

42:59

much it is now , but

43:02

yeah , this is what five , six years

43:04

ago .

43:05

So basically , you can book me . It's a

43:07

scheduler . They go on , they click

43:09

. When they click their dates , they get a

43:12

letter saying that , hey , you confirmed yourself , and

43:14

when somebody else goes and look at the calendar , or

43:17

you can book me , that date is shaded out

43:19

. They can't choose it anymore , right ? So

43:21

that's gonna cost some money . Then you're

43:23

probably going to need some money

43:25

to pay for payroll . Payroll costs money

43:28

, right ? So what payroll is is you

43:30

know , whenever the hospital pays you guys

43:32

as a lump sum , right ? Then

43:35

you pay the doctors . You need a way

43:37

to either automate that or you

43:39

need a way to pay them in a way so

43:41

that at the end of the year the doctors

43:43

can get a 1099 , right ? So

43:45

you gotta be very like . You have

43:47

to figure out a way , a system , so

43:49

as to pay them and keep track of how much

43:51

you're paying them , so that by the end of the year they

43:53

get their 1099s and they're

43:56

happy , right ? So that costs some money , right ? Then

43:58

you're going to have to get a CPA , I think

44:00

. Look , you're going to have to be this is the big boys , yo , big

44:03

girls . You're going to have to get a CPA and that's gonna cost you some

44:05

money right , and I

44:07

think , in general , you might end up needing a VA in

44:09

some form or fashion to do something

44:12

. That may be either getting them some confirmation

44:14

letters to your provider

44:17

saying , hey , you chose this date and

44:19

now that you chose this date

44:21

, you're gonna stick to it . And here are some of the rules . If

44:24

you cancel outside of 30 days

44:26

, this is what happens . If you cancel within

44:28

30 days , this is what happens and

44:30

, great , this is who you contact if there's an emergency

44:32

. This blah , blah , blah , blah blah and we sent this out

44:35

to every doctor every

44:37

month . All the time . You

44:39

have copies of everything all the time , so

44:42

some of the money that you'll spend

44:44

will be on like automating software

44:47

, as well as some things that you

44:49

just really can't do it out , which is like a CPA

44:51

, or even like payroll costs .

44:53

Yeah , the attorney as well is gonna

44:55

be . Yeah , the attorney . You know overhead

44:57

costs you might have depending

45:00

on what you use for invoicing that

45:03

might . You know invoicing and bookkeeping

45:06

that might end up costing

45:08

you , depending on the system that you use . Oh

45:10

, the also thing too .

45:12

The also thing that you're gonna need , too , is the doctors not

45:14

only can need to sign up for it . You

45:16

know the dates that they wanna work . There has

45:18

to be an easy way for the doctors to fill

45:21

out a time sheet so that they can

45:23

document how many hours they worked

45:25

, and then you can show that to the hospital

45:27

and say , hey , they worked this . This is their signature

45:29

. You guys need to look at it , sign

45:32

it or acknowledge it and

45:34

send it back to us so that we can

45:36

book you or , sorry , so that we can In

45:39

voice . And what we would use

45:41

. We would use QuickBooks . We made it simple , simple

45:43

, straightforward .

45:43

Yeah , at that time we were using QuickBooks

45:45

. Now we use QuickBooks

45:48

Timesheetscom .

45:49

Well , to do our timesheets we use , Right

45:52

, I'm talking about the timesheets . Yeah

45:54

.

45:54

Yeah , the timesheets . To do the timesheets

45:57

we use timesheetscom . But right

45:59

, for the invoicing we're still using .

46:02

QB .

46:03

Yeah , quickbooks . There was one

46:05

other thing . Oh , the other thing that I was

46:07

gonna say is and I don't know if

46:09

their questions are

46:11

on this , but onboarding doctors

46:14

is gonna be extremely important

46:16

.

46:17

Tell them , sis , tell them .

46:20

Oh , my goodness .

46:21

So what does that mean onboarding ? What does that mean

46:23

? What does that mean onboarding ? No

46:26

, you are not my sister . What

46:30

does that mean onboarding ?

46:32

So , onboarding the doctors , right . So we talked

46:34

a little bit about negotiating

46:36

, you know , having a contract with

46:38

the doctors or , excuse me , with the hospital

46:40

, and we mentioned very briefly having

46:42

a contract , you know , in agreement

46:45

with the doctors . But that is , you

46:47

can't just be like , all right , sign this , we

46:49

all agree , like that

46:53

is the least of it . Okay , again

46:56

, I got a story for y'all that I cannot

46:58

tell you right now , but I

47:00

will tell you . I promise in

47:03

the coming months I will tell you this

47:05

story . But onboarding

47:08

doctors is gonna be extremely important

47:10

, just in the same way that

47:13

your locums agencies

47:15

the big locum agencies you

47:17

know get people's credentials

47:19

, their license , their , their

47:24

diplomas from medical

47:26

school , their diplomas from residency

47:28

references .

47:30

You gotta make sure people are legit . Y'all Like

47:33

, just because someone is

47:35

saying that they wanna do locums with you , is

47:38

the locums agency have to be able

47:40

to prove five of them , even if you know

47:43

them . You have to be able to prove without a doubt that

47:45

they have all the credentials and

47:48

they're all legit , what med school they went to , what

47:50

residency they went to , what fellowship they went to . You

47:52

need diplomas with the actual stamps on it

47:54

. You need references , and you gotta make sure these

47:57

references are not like you know

47:59

. Craig and them had said that I'm a good surgeon

48:01

, right , you need all of these

48:03

things . You need to know if they've had any medical

48:05

malpractice cases . That doesn't preclude

48:08

anything , but you just need to know that it's been closed

48:10

and what the resolution is . You need to

48:12

know all these , even if they're your friends . You need to know this

48:14

right so that you can put

48:16

this and document this and you can give this to the hospital

48:18

and the hospital can be like all right , cool , no problem , we'll

48:20

credential these people . But you need to know everything

48:23

.

48:23

Yes , do not get fooled by

48:26

you . Know this person and

48:28

nah , that's my man .

48:29

100 grand Like you know

48:31

, I pass my boards and like nah , I

48:33

need to know the score , so you need board certification .

48:35

that's another one right and consistent

48:38

. Right Because , because

48:40

, depending on how long you have this local

48:42

attendance agency , depending on how long you

48:44

have a person working for you remember

48:47

, every couple of years you're

48:49

gonna need that . You know you're gonna need

48:51

your license to be

48:53

renewed , you're gonna make sure that they have a DEA

48:55

number , like all of this needs to be on file

48:58

. You need to make sure that their maintenance of

49:00

certification is where it needs to

49:02

be and you need to be on top of this

49:04

all the time . You need to

49:06

remind them like hey , listen , if you have any

49:08

malpractice suits that came up , whether

49:11

it was through a job that we presented

49:13

to you or not , you

49:15

need to let us know and you need

49:17

to have your due diligence . You need to do your due

49:20

diligence and document that

49:22

you are requesting this information

49:25

and that you are taking the appropriate steps

49:27

, you know to keep this

49:29

physician either working or not working

49:31

with your agency , based

49:34

on the information that you got . So

49:37

if a physician is no longer

49:39

board certified for example , if they

49:41

didn't do their maintenance

49:43

of certification , but that hospital

49:45

requires the doctor

49:47

to be board certified then

49:50

they're no longer eligible for

49:53

that assignment , even if they were on that assignment

49:55

before . So you have to notify

49:58

the hospital and then the hospital

50:00

can make the final determination . But

50:02

you have to do your due diligence and be like

50:04

hey , you know , dr So-and-So is

50:06

no longer board certified . I

50:08

just need to let you know that Now

50:10

, technically , the hospital is also supposed

50:12

to be asking for this information as well

50:14

, but because you

50:17

are the one presenting them with this

50:19

assignment , it's still your

50:21

responsibility , so make

50:24

sure you are accountable .

50:26

Let's shift to travel , right

50:28

? That's a big concern . So they wanna

50:30

know do we work with certain travel

50:33

companies , right ? So , for example , lodging

50:35

hotels , airlines

50:37

, travel agencies , or do you

50:39

always cover travel costs for your doctors

50:41

? That's a good question , right ? So

50:44

in our situation , all the doctors

50:46

basically lived in the same town as

50:48

, or lived nearby .

50:50

Most of the doctors , not all of them .

50:53

When we first started out , all the doctors did . Yeah

50:55

, when we first started , yes , and then

50:57

when we expanded , it changed . But

50:59

initially all the doctors were in the same area

51:02

, so the only thing we really had to

51:04

take care of literally was just

51:06

them working excuse me

51:08

, their time of taking

51:10

care of patient care . That's it , yeah

51:12

. Then we recruited other doctors who were from

51:15

you know further away , and

51:17

that's when we had to make sure okay

51:19

, how are we going to cover the cost ? But because

51:22

our lawyer was dope and our contract was

51:24

dope . In our contract with

51:26

the hospital it always said that

51:28

if we bring locums , if we bring

51:30

doctors from you know outside

51:33

a certain area , a certain you

51:35

know range , you

51:37

the hospital had to pay for airline

51:39

costs , had to pay reasonable airline

51:41

costs , had to pay for the hotel this

51:44

is a reasonable hotel room had to pay for

51:46

a rental car , right , and

51:48

what else did they have to pay ?

51:49

for yeah , just travel and

51:51

lodging for the most part , and that's standard

51:53

guys .

51:54

That's standard , that is very standard

51:56

, so that is just once you guys

51:58

understand that that is standard . So we had that in

52:00

our contract . So when we expanded and brought some doctors

52:03

who weren't in the area to fly them from

52:05

one part of the United States to this

52:07

place , we put up the

52:10

, we put up the money right . And that's the other

52:12

thing , too , you got to think about , too is is , when

52:14

you're doing this , you got to make sure

52:16

that you have enough cash flow to put

52:18

up the money . Initially , whether that's cash

52:20

flow or credit , if you're using a credit card

52:22

, you're going to have to arrange the

52:24

hotel , you're going to have to arrange the rental

52:26

car to flights . Now , if you decide to use

52:28

a travel agency or not , so

52:31

that the you know , so

52:33

that the doctor can make those arrangements , that's up to you

52:35

. But you're going to be putting up , as

52:37

an agency , the money first . Then

52:39

you bill the hospital , hospital

52:42

pays you , you clear up those

52:44

costs and then go from there

52:46

. So just make sure you have enough cash revenue to

52:48

be able to cover that . But yeah it's

52:51

, it's , it's a really good , it's an interesting

52:53

, interesting opportunity with with lodging

52:55

and hotels and airlines

52:57

. That's another set of work and that's where you may need

52:59

a VA .

53:01

Yeah , that you may need a VA , depending on

53:03

how many of those docs are going to be coming in

53:05

and out of , you

53:07

know , of that particular region , that particular

53:10

area and how they're going to be getting there , because if everybody

53:12

is not within driving distance , you

53:15

know , then , yeah , it becomes

53:17

very cumbersome .

53:18

So what is the ? What are the other questions ? There's

53:21

a lot of other questions , but I think the

53:24

key thing is let's , let's wrap it up . But just

53:26

the one question I think is really interesting is what

53:28

is a realistic timeframe to have a locums

53:31

company up and running ? They

53:34

said they already have a few colleagues in mind for

53:36

staffing , so in essence , it's kind

53:38

of like us , right . The question

53:40

that I have for you is is

53:43

how big do you want to be ? Right ? And

53:45

what I mean by that is is like , if you want to be small

53:47

, you're going to move fast and you can

53:49

niche , and there's a lot of things that you can do

53:51

that a larger company can't do . If

53:54

you want to be really big , then you're going to have to hire people

53:56

. There's going to be obviously some economies

53:58

of scale , but you're going to have to front some more money . I

54:00

always say start small , make sure you have

54:02

everything . What is up with my background y'all

54:04

?

54:06

Every time you say something amazing .

54:09

Why does it keep ?

54:10

going , it works , baby .

54:12

Damn , I'm on fire man , I'm on point

54:14

, I got it , I got it Okay . So

54:16

basically , yeah , zoom likes what

54:18

I'm saying , yo . So

54:20

yeah , I think a realistic timeframe to

54:22

have a locums company depends on how

54:24

quickly can you create a contract between

54:27

you and the hospital .

54:29

So that means you have to develop a relationship .

54:30

Yeah , you have to develop a relationship with

54:32

a hospital . How quickly can you develop a relationship

54:35

and a contract with them and how quickly can

54:37

you develop a contract with your providers

54:39

?

54:39

And then from there and onboard them properly .

54:42

Yeah , and then from there kind

54:44

of goes . So I think , realistically we're talking about

54:46

you know , if you want to be really , it's

54:49

going to take six to 12 months , I think you

54:51

know , six to 12 months . Six to

54:54

12 months . You think that's too long ?

54:56

Yeah , especially

54:58

if you have physicians already like

55:01

interested , so

55:06

with us .

55:06

They said that they already have colleagues in mind for staffing

55:09

. They didn't say that they had a hospital in

55:11

mind . So I'm

55:13

just assuming that it's going to take a minute to

55:15

go through the verbal negotiations of

55:17

different hospitals that might have an issue we

55:19

want to engage with you , and then the back

55:22

and forth of you know how it goes the

55:24

back and forth with the contracts of yeah , we want

55:26

to . I see what you're saying I'm a custom

55:28

, that I'm a custom

55:30

, that is , and you're like come on , son

55:32

, the sign this contract Right

55:34

.

55:35

Right . That's what you're saying

55:37

. So you're saying on the side of the finding a

55:39

hospital and then going through that

55:41

with them , yes , that could take long

55:43

. Again , our case was

55:46

very different . We were

55:48

up and running within days

55:50

. Yeah , we were .

55:52

We had to be moving in days .

55:54

I want to say like 14

55:57

days maybe

56:00

.

56:00

Yeah , I

56:03

had to look at those emails again .

56:04

I don't delete anything , but it

56:07

was days . We were up and running within days

56:09

because the need was

56:11

immediately after I left , and

56:13

so it was like

56:15

hold on a second .

56:17

Real quick because we can't we can't go in much longer

56:19

, but y'all don't know . But there

56:21

came a point where we had already

56:23

engaged in the hospital and

56:26

I think the hospital either had saw the first

56:28

bill or had

56:30

a question about , like , I think , the calendar

56:32

. The calendar was completely full and

56:35

they wanted to meet with us about

56:37

ways that we can be basically more economical

56:40

. And you were like one week

56:42

postpartum , Remember that , and

56:46

I was like I'm going to go on this meeting on my hand and you're like , no

56:48

, you're not , I'm coming with

56:51

you .

56:53

I went in there with my freaking

56:55

, you know fundus

56:57

to two . Two

56:59

finger breath under my umbilicus

57:01

, okay .

57:04

Are you walking to that meeting ? I was like yo

57:07

, like I hope you got past .

57:09

I was like yo , y'all not

57:11

about to do that , nope , Nope

57:14

.

57:15

Nope . And so remember , guys , like

57:17

sometimes even you go through that process and the hospital

57:19

may not be prepared for the payments , and it's like yeah

57:21

. But anyway , the point of the matter is is we

57:24

got up and running really quick and

57:26

we figured it out . We made

57:28

a lot of mistakes but we figured

57:30

it out and we fucked around that first year and

57:32

when charged about over seven figures

57:35

for all the work that they did

57:37

and I think when you see those numbers

57:39

you start to realize , like yo , the

57:42

amount , how much us as physicians

57:45

, or what physicians , what their worth

57:47

is and what they provide , the

57:50

hospital still made their money back and billy

57:52

and all those things . Yo

57:54

, I'm telling you all right now like it was crazy

57:57

, but then I think the other thing that had taught me

57:59

really was the

58:01

hospital just really wants warm

58:04

bodies . They

58:06

just want you to fill the schedule widgets

58:09

, which are the equivalent of doctors , and

58:11

we know that that's not that's different

58:13

, but that's how they like it and I was like wow

58:16

, but we

58:18

did it and obviously

58:21

we didn't retain that amount , but

58:23

we , it was just amazing number

58:25

to see , like damn in a year .

58:27

This is how much they pay

58:29

but they had the coverage . And we

58:31

continued . For what three and a half we did it

58:34

?

58:34

for three and a half years , and

58:36

I think at that point , when we started getting towards

58:38

the end , we were like , well , should we expand ? And

58:40

I think for my lifestyle standpoint , for us , it was

58:42

just like yeah .

58:44

I don't know if I want to keep doing this , but then we had our second son

58:46

, we

58:48

were moving and

58:52

we decided , actually , do we

58:54

want to spend more of our time

58:56

doing ? You know well

58:58

, for me anyway , the question

59:00

was did I want to spend more of my time

59:02

doing something that we could pass on to our

59:04

sons , which I mean I guess you could pass

59:06

on a locomoteness agency ?

59:08

but you could pass on any business

59:10

to your children . Of course you could , of course .

59:13

Or did we want to do real estate and

59:16

we you ?

59:17

know , for me anyway , I think our passion changed . The passion

59:19

changed , yeah , and the work .

59:22

And I don't know that doing the locomoteness agency was so much a

59:24

passion more than it was .

59:27

It just kind of fell in our laps and it was like man , this actually

59:29

is fun . It was a passion for me . It

59:32

was a passion for me , yeah , because I was just like you were

59:34

passionate about it .

59:36

Well , yeah , because I remember , like telling

59:38

doctors I'm so passionate about

59:40

becoming a physician the

59:42

passion that I have about

59:44

being a doctor and the passion

59:46

that I have for helping those who

59:49

are underserved and Are

59:52

you making fun of your own clients ?

59:53

Yeah , I'll do that , please , whatever , because we

59:55

all said it , I said it you said

59:58

it .

59:58

Everybody listening to this podcast . I said it

1:00:00

so if anybody want to

1:00:02

come after me and talk about you should be talking about premed , that's that

1:00:04

way , then what I say to you is you shouldn't have been premed . That's

1:00:06

hate , renee .

1:00:07

That's hate . Don't do that , don't do that , don't do it , don't do that

1:00:09

, don't do it , don't do it , don't do it , don't do that

1:00:11

, don't do it , don't do it . That's

1:00:14

hate yo . But

1:00:16

for me , that was a point where I was just really enjoying

1:00:18

teaching these docs . Because , remember , we

1:00:20

would do things like we would do some webinars or

1:00:23

some resources and teach them how to retain

1:00:25

or keep more , basically like tax

1:00:28

strategies and stuff . We would give them books . Remember

1:00:30

, we would give them books . We

1:00:32

would teach them how to make sure that they're properly

1:00:35

utilizing this 1099 money well

1:00:37

, so that it benefits them , and then also , at the same time , we

1:00:39

were teaching them how to advocate for themselves against

1:00:41

the hospital in a positive way . It

1:00:44

was a positive relationship . Those

1:00:46

things I really enjoyed . Then

1:00:48

, after a while , there was some headaches that we had to deal with

1:00:50

. That kind of kept getting bigger and bigger and

1:00:53

bigger and bigger . And then you throw on top of that

1:00:55

, our lifestyle was changing and it was just like

1:00:57

I don't want to deal with this anymore . Y'all driving me nuts . And

1:00:59

then it was like , well , should we try to find another place ? And I

1:01:01

was like I don't know if I want to deal with this .

1:01:03

Yeah .

1:01:04

We out , let's do something different . And

1:01:06

that was it , guys . That's exactly how

1:01:09

we fell into starting

1:01:11

our own locums agency , and

1:01:13

it was the best three and a half years that we've

1:01:15

ever done . It was dope . We

1:01:18

were on our stuff . They

1:01:20

had to be impressed by what two doctors could do

1:01:22

and that

1:01:24

was one of the proudest moments to go ahead

1:01:26

and do that . Like you said , you're right , I

1:01:28

didn't think about that . I didn't think I

1:01:30

forgot that . We did that in what , how many days ?

1:01:33

We did it over like days . I had to look up

1:01:35

the emails but we

1:01:38

solidified that contract . We got all

1:01:40

of the physicians credentials

1:01:43

Because remember everybody just kind of thought

1:01:45

, oh , it's just going to be one , two , three . It was like , and

1:01:47

I was like if you know anything

1:01:50

about me , you

1:01:52

know me and contracts . We

1:01:54

like this . I don't do anything

1:01:56

without a contract . We

1:01:58

like this . And

1:02:00

we have to do things by the book . It has to be documented

1:02:03

because you just

1:02:05

want to make sure that everybody understands

1:02:07

the expectations right . It's not because

1:02:09

you're trying to guilt somebody or you're trying to

1:02:11

. You know , you think somebody is going to try to get over . It's

1:02:14

just that if you don't understand

1:02:16

the expectations , if someone has a different

1:02:18

interpretation of the expectations

1:02:21

that you have , then it's

1:02:23

going to be a problem . That's why I watched so much Judge

1:02:25

. Judy , you sound like a fool

1:02:28

. That's your opinion . My opinion's the only one

1:02:30

that counts .

1:02:30

All right , that's about it y'all . We're

1:02:33

going to wrap this up y'all , because this ain't

1:02:35

going to last as long and I'm tired . I

1:02:37

got locums the next morning , so listen

1:02:39

, guys , make sure you check out our

1:02:41

previous episodes on locums and

1:02:44

to the two doctors and check out the yeah

1:02:46

To the two doctors . Hold on a second To

1:02:49

the two doctors that send us these questions . These are some

1:02:51

great questions and you gave us great

1:02:53

, great ideas and great content over

1:02:55

these last several weeks , so thank you very much

1:02:57

. If there's anybody else who has any questions

1:03:00

on locums or has any questions on anything

1:03:02

that you hear us talk about a lot whether it's real estate

1:03:04

, investing , paying off student loans

1:03:07

, lifestyle , you know , kids

1:03:09

all those different things send us

1:03:11

a question . You know we might be able to make

1:03:14

a really good series out of this and

1:03:16

this was dope . So Dr

1:03:18

Renee is going to be back to normal for us Normal

1:03:21

podcasting schedule , normal podcasting

1:03:23

.

1:03:23

So now I have to deal with your just

1:03:25

randomness . Okay , great .

1:03:29

What's the PDF you want to tell them about ?

1:03:31

So , yeah , don't forget , we're going to detail

1:03:34

a little bit of what we talked

1:03:36

about today , just kind of bullet points . The

1:03:39

other thing that I wanted to mention was that if

1:03:41

you guys are interested in learning more about

1:03:43

locums , you know we have

1:03:45

a little bit of a group

1:03:48

that we're going to be taking on

1:03:50

to teach you and take you through the

1:03:52

locum tenants process , whether that's

1:03:54

you want to just start out

1:03:56

doing locum tenants or you want to

1:03:59

go all the way to starting your own locum tenants

1:04:01

agency . But we're going

1:04:03

to be taking a small group through

1:04:05

that process . So if you want

1:04:07

to be part of that group , when you

1:04:09

click on that link below

1:04:12

, it'll also take you

1:04:14

not just to what we're offering

1:04:16

in terms of the download , but it's also

1:04:18

going to take you to the

1:04:21

I guess , the

1:04:23

interest group , the wait list or whatever

1:04:25

. It's going to be a small group , so I don't know if everybody

1:04:27

will get into it , but

1:04:29

if you are interested , go ahead

1:04:31

and give us your information and

1:04:34

we will contact you to let you know

1:04:36

if you got into the group .

1:04:39

Yeah , that was a pedic surgeon . You better sign

1:04:41

up for this course . He's over here saying what we

1:04:43

doing on our podcast . Sign up for this course , All

1:04:45

right , y'all . We out . We're going to talk to y'all later , y'all

1:04:47

.

1:04:48

Peace , peace , peace

1:05:06

.