Will work
travel
for
Looking for a unique experience? International intrigue?
Consider locum tenens opportunities both home and abroad.
By Karen Edwards
T
HERE ARE PLENTY OF REASONS
physicians pack their bags and head
overseas to practice medicine. Some
have charity at heart, rushing to aid the
earthquake victims of Haiti, for example, or to Third World countries where
doctors and modern medicine are desperately needed. Others are seeking thrills or experience on a locum tenens basis, an opportunity
to travel and work in other locations or with people from other cultures.
Many physicians looking for a chance to practice in an
international environment generally head for one of two
locations: Australia or New Zealand. Both countries welcome American-trained physicians, and both offer a rich,
culturally diverse environment with a common language
and a familiar healthcare system.
That’s not to say other practice opportunities don’t exist,
however. Amy Griffin, director of the international divi42
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FALL 2010
sion of recruiting firm VISTA Staffing Solutions, currently
places physicians in Bermuda, Canada, New Zealand and
Australia, with plans for expansion.
Recently, the United Arab Emirates—especially Dubai
and Abu Dhabi—also has opened its doors to American
physicians. There, new hospitals are being built at a rapid
pace, says Steve Frank, a senior search consultant for the
Missouri-based recruiting firm Enterprise Medical
Services. “Some adventurous American physicians decide
to go there, looking for a challenge,” he says. For the
most part, though, physicians immigrating to the Middle
East are originally from that part of the world and are
heading back to be close to family.
In New Zealand, however, International Medical
Graduates (IMGs for short) are increasingly becoming
the norm. Ian Powell, executive director of the
Association of Salaried Medical Specialists, recently told a
reporter on New Zealand’s TV One that more than 40
percent of New Zealand’s specialist physicians are IMGs.
A 2008 article in the Medical Journal of Australia reports that the IMG population there is steadily increas-
during their stay in new Zealand,
david rideout, m.d., and his family
visited many of the sites from the
“Lord of the rings” trilogy—
including mt. sunday, pictured here.
although a gigantic castle had been
built on this mountain for the
filming, rideout says there is no
longer any trace of it.
ing, comprising at least 25 percent of that nation’s general
practice work force.
There’s no doubt physicians are needed in both
countries, says Saralynn White of the Utah-based recruiting firm Global Medical Staffing. “But there is a
worldwide doctor shortage, especially in underserved
areas,” she adds.
That’s as true for the United States as for foreign locales, however, so what prompts a physician to look
abroad for work?
Photograph submitted by David Rideout, M.D.
Why work abroad?
For David Rideout, M.D., a thoracic surgeon from
Maine, his decision to practice abroad for a year came
from a combination of factors—but burnout figured
high on the list.
“I was working in the hospital 110 hours a week; I was
on call every other day,” he says. And pay was decreasing.
“The year before I left, my business had increased by 25
percent, but I was making 10 percent less.” At that point,
he says, he was ready to leave medicine. Instead, he sold
most of what he owned and signed up for a year-long
locum tenens position in New Zealand.
Kathy Starkey, M.D., a New York obstetrician-gynecolo-
gist, says she wasn’t “burned out” from her private practice. “I still enjoy what I’m doing,” she says, but the long
days were taking a toll on her personal life. “I was ready
for a change of pace to get my life back on track.” Starkey
loves to travel and began working abroad in 2007. So far,
she has worked in the Cayman Islands, Australia and New
Zealand.
Like Starkey, Jennifer Rozum, M.D., a California emergency medicine physician, enjoys travel. And like Rideout,
she had become increasingly dissatisfied with the U.S.
health system—on a number of levels. “I still love medicine, but not the practice of medicine,” she explains. She’s
currently working in New Zealand.
Still others, like Jennifer Scott, M.D., a Massachusetts
obstetrician-gynecologist, go overseas to both practice
medicine and conduct research, with a long-term goal of
improving health care in the area. She has practiced in
Haiti, Ethiopia, Kenya and the Congo.
Money matters
Whatever the reason for change, making the decision to
practice as a locum tenens—internationally or domestically—is just the first step.
Continued
FALL 2010
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43
Will work for travel
Photographs submitted by Jennifer Scott, M.D.
Continued from previous page
Above left, Jennifer Scott, M.D., and
a colleague identify the villages
they will target for an investigation
of gender-based violence and
human rights abuses in the
Democratic Republic of the Congo
(DRC). Above right, a Cesarean
delivery at Panzi Hospital, Eastern
DRC. Left, Scott conducts a training
in Ituri, Eastern DRC, for data
collector teams for a large study.
The next step is to talk with a recruiting firm that
makes international placements. Some agencies, like
VISTA Staffing Solutions and Enterprise, have a roster
of clients looking for physicians, and the recruiter serves
to facilitate the doctor’s direct employment. Global
Medical Staffing places physicians primarily on a locum
tenens basis.
It’s the recruiting agency’s job to find the best qualified
candidates for its clients, so physicians looking for locum
tenens jobs at home or abroad will undergo intensive
screening processes and background checks.
Once a client hires a physician, recruiters are eager to
help them with all necessary documentation and other relocation requirements.
“The relocation packages vary, based on length of stay
and seniority of physician, and some include living expenses such as housing and return air fare,” says VISTA’s
Griffin. The employer also will pay agency fees and often
44
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FALL 2010
for professional liability insurance, which in New Zealand
amounts to about $2,300 a year.
If a physician chooses to go to Dubai, the employer may
also provide a car and education allowances for families
that want their children to attend private schools, says
Frank. “But every facility is different in what they offer,”
he says. (Physicians considering a position in the Middle
East should be aware that the UAE requires passing a licensing exam before practicing there.)
Still, the lack of taxes in the UAE may make that destination especially appealing for doctors who relocate there
permanently, which is what most openings in this area of
the world require, according to Frank.
“Permanently” is the operative word. In locum tenens
positions, no matter where you practice, doctors who are
considered independent contractors pay U.S. taxes on
what they earn overseas. Complicated? “We offer a
tremendous amount of help with taxes and planning,”
assures White.
Cost-of-living expenses and other
perks offered by host countries are
recognition, in part, that the foreign
country’s pay may not be up to U.S.
standards, depending on specialty and
country.
“Base salaries in New Zealand range
between $93,000 and $195,000 with
total remuneration ranging between
$125,000 and $285,000 once the various add-ins are included,” says Griffin.
“These quotes are for public sectors;
private often pays more. For Australia,
our experience is that total remuneration is 30 percent higher than those
available in New Zealand. One factor
contributing to the shortage of doctors
in New Zealand is they often ‘jump the
pond’ for better wages in Australia.”
Rozum says her New Zealand pay is
about $180,000. “The (U.S.) government taxes that at 38 percent, and the
exchange rate is about 0.7 percent. I
worked this out to making about
$6,000 per month take-home in U.S.
money.” Rozum’s take-home pay in
California was more than $250,000.
“U.S. pay and benefits are obviously
much better,” she says.
But because cost-of-living expenses
are paid for by employers, says White,
“whatever you earn is largely
discretionary.”
Those physicians who decide to
move ahead with an overseas job or
other locum tenens position should
notify colleagues and patients as soon
as possible—just as if they were to take
a leave of absence or close a practice.
If you plan to return and are currently
in a group practice, you can refer
patients to other physicians in the
group. If you are in private practice,
however, ask a colleague if he would
be willing to accept patients on a
temporary basis.
“A lot of doctors hire a locum
tenens doctor to fill the void while
they travel,” says White. If you plan a
permanent move, be sure to notify
patients and make arrangements to
transfer or store records before you
leave—and don’t forget to notify insurance carriers. The American
Medical Association or your state
medical board can provide tips on
how to legally close a practice.
Attitude adjustment
Once physicians land at their new
practice location, they need to make
Continued
Photograph submitted by Kathy Fedack, M.D.
kathy Fedack, m.d., on the summit of
mt. Lamlam in guam. The base of mt.
Lamlam rises from the bottom of the
mariana Trench—making it one of
earth’s highest mountains.
FALL 2010
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Will work for travel
Continued from previous page
some adjustments, say those who
have worked abroad.
In Ethiopia and Haiti, for example,
Scott says the healthcare infrastructure is limited both in terms of
staffing and resources. And the culture is radically different. “There is
such inequality for women in many
parts of the world,” she says. “Sexual
violence is common. The women are
strong, yet often dispirited. It’s important to be culturally sensitive
while you’re there, especially in the
area of women’s health.”
Connecting famil
y ph
ysicians
family
physicians
and em
ployers.
employers.
American physicians may be surprised to learn that resources are also
limited in Australia and New
Zealand—though to a lesser extent.
In Rozum’s experience, X-rays were
available only from 8 a.m. to 9 p.m., and
the lab’s hours were midnight to 8 a.m.
“We do bedside blood glucose, and
there is a machine in the department
that will give a hemoglobin. If absolutely necessary, the lab tech can be
called in after hours,” she says. “And
while medicine in the United States
depends heavily on scans, to get a CT
scan or ultrasound here, I have to talk
to the radiologist and justify it.”
That’s part of the reason Rideout
says he needs to shed his Type-A personality when working abroad. “It’s a
different culture, and there are differ-
TIps:
practicing
Immerse yourself in the culture.
In order to fit into any country, think
AAFP CareerLink
like those who live there, suggests
David Rideout, M.D. Immerse yourself
in their culture. Travel the country.
Simplify
S
im plify y
your
our llife.
ife.
It’s an experience that may not
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says Rideout. Nothing will turn off
new employers, co-workers and
patients like arrogance. “A locums
doctor must expect and look forward
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ww.AAFPCareerLink.org
to something different, or this type of
work will not be a good match,” says
Kathy Starkey, M.D.
Talk to a doctor who has worked in
the country. A conversation with a
colleague may help prepare you for
what you can expect abroad, whether
at work or on personal time. “It is
ent expectations,” he says. When
you’re accustomed to having the resources and doing what it takes to improve a patient’s prognosis, it can be
hard to deal with a system that rations
care. “I had an 80-year old patient
who needed an operation to survive,”
says Rideout. “But he knew, at his
age, he wasn’t going to get it.”
Rozum cites a similar case. “I had
an active 75-year-old man who previously had a positive stress test and
was referred for an angiogram. It was
denied by the public health system.
He came in with an acute inferior
MI. In the United States, he would
have been transferred for rescue angioplasty. Here, he just completed his
infarct and lost that part of his heart
muscle,” she says.
Kathy Fedack, M.D., a Colorado
anesthesiologist who worked in Guam
worldwide
different,” says Jennifer Rozum, M.D.
Just be patient and nice to everyone,
she suggests. “Remember, you’re in
their country.”
Think twice before bringing pets.
Physicians who like to travel with pets
and blogged on the VISTA site, says
she sees a wide variety of cases with
many high-acuity patients. That’s why
in international settings, says Fedack,
“flexibility and the willingness to improvise” are important attributes to
possess.
There are pluses to international assignments as well.
Continued
October 1-31, 2010
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bringing them to another country.
Rozum says her husband waited
behind in the united States because
their dogs had six months of testing
before they, too, could come. Once
the two Akitas landed in New
Zealand, they were in quarantine for
a month in Auckland before finally
joining their owners. “By the time we
actually got them, we figured it had
cost $10,000,” she says.
Rideout, too, might have thought twice
about bringing his dogs. He learned
“A national health system is easier
to work under,” says Gregg Shivers,
M.D., an internist/hospitalist from
the Tidewater area of Virginia who
spent a year in New Zealand. “I
didn’t have to worry about getting
paid or dealing with insurance companies or coding.” And there was def-
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only later that dog food in New Zealand
is expensive. “That’s where a lot of my
income went,” he says.
FALL 2010
PracticeLink.com |
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Will work for travel
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Continued from previous page
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FALL 2010
• Pediatric Endocrinology
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initely more free time. “I worked from
8 in the morning until 6 at night,” he
says. He was on call one in six weekends, and had six weeks of vacation
time.
“Patients are respectful and appreciative,” says Rozum, who adds that’s
not always the case in the United
States. “But everyone in New Zealand
is kind, friendly and open,” she says.
As far as the workplace is concerned, Fedack has found surgery personnel to be “hard-working, knowledgeable, cheerful and eager to
assist.”
And in New Zealand, Rozum says
hospitals are much less hierarchical.
“Doctors have to fill out their own
forms for X-ray. They draw their own
blood gases, set up and clean their
own suture trays, and go to the lobby
and bring their patients back to a
bed,” she says.
But even those tasks seem inconsequential in the Congo, where Scott
says healthcare providers are too often overwhelmed by the number of
patients and lack of resources to split
duties. Conditions were even worse
in Haiti, where Scott practiced in a
field tent. “You learn to be humble,”
says Scott. “And to work with what
you have.”
Family and free time
Just as physicians learn to adjust to
their environments, so, too, do physician families. For the most part, say
those physicians who traveled with
family, their loved ones had little
problem fitting in.
Shivers brought along his wife and
three children, ages 15, 12 and 8.
The young Shivers were excited—
and nervous, too—about life abroad,
says their father. “They saw it as an
Staying stateside?
Locum tenens could still
be in your future
f the idea of practicing short term in a new location appeals to you—but you don’t want to travel overseas, there
are plenty of locum tenens opportunities here in the U.S.
I
“You hear a lot about practicing in underserved areas,” says
Saralynn White with Global Medical Staffing, “but the fact is,
there’s a physician shortage in this country, especially in
family practice, so anywhere can be considered underserved.”
The typical contract for a U.S. locum position varies according
to the client hiring the physician. The length could be as short
as one weekend a month or as long as a year. Recruiters work
with you to find the length of service that works best for you.
You could be in
Big Sky Country.
Physicians have different reasons for considering a U.S.
locum position, says White. “We get a lot of physicians straight
out of their residencies. They may not have the money to go
into a practice, but they want to start paying their bills.”
Physician Opportunities
Although money is probably the biggest motivator, it isn’t the
only one.
Some physicians just want to experience a new location,
says White. others want to come out of retirement for a while,
and still others take locum positions because they want to
practice medicine but no longer want to deal with the
business side of medicine. Under a locum contract, whether
domestic or international, the client who hires the physician
takes care of paying the bills, managing the staff and
providing liability insurance as well.
To learn where current locum positions are, contact a
physician recruiting firm, or log on to a Web site such as
PracticeLink.com. “Some physicians try to find locum
positions on their own, but we tell them it’s a more
complicated procedure than it looks,” says White. That’s why
recruiting firms are there.
“We’re always happy to help,” she says. n
important opportunity to learn about life in a different
culture. They wanted to go,” he says.
Part of the reason Rideout chose to practice in New
Zealand was his wife’s profession. “New Zealand is a popular destination for geologists,” he says. He regrets, though,
not taking the overseas assignment when his children were
younger. Instead, they moved as teenagers, and although
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FALL 2010
PracticeLink.com |
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Will work for travel
Continued from previous page
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50
| PracticeLink.com
FALL 2010
everyone wanted to make the trip, the
children found it difficult to fit in at
school. “I wouldn’t take teens again,”
Rideout advises. “I’d take them while
they were between 5 and 12 years, or
I’d wait until they were grown.”
U.S.-born physicians headed to the
Middle East typically live near other
Americans and Canadians, says Frank.
“Western women are becoming more
and more accepted because tourism is
huge in places like Dubai and Abu
Dhabi,” he says. But even then, physician wives are likely to find the
Middle East a more challenging location than their husbands, he reports.
Whether physicians travel abroad
with family or without, all are appreciative of the extra free time in their
schedules. Rideout and his family
traveled nearly every weekend, enjoying activities like bungee jumping and
fishing. Shivers liked to bike and ski
on his days off, and says he came to
enjoy “tramping”—the New Zealand
word for hiking.
Whether Starkey was practicing in
the Cayman Islands, Australia or
New Zealand, her partner enjoyed
swimming at each location. Starkey
herself loves to spend time at local libraries. And Rozum is looking forward to exploring her temporary
home. “I have six to eight (tour)
books about New Zealand that will
take us well beyond our currently
scheduled time here,” she says.
Return home
Once the six-month or one-year international locum tenens commitment is
met, most U.S. physicians return to
their former practices. Still, some will
extend their stay, while others decide
to practice in their new location permanently, says White. Frank says most
of the physicians he places in the
Middle East are permanent.
Rozum currently has a one-year contract to work in New Zealand, and it’s
fairly easy to get a one-year extension
on a one-year work visa, she says. “But
to stay beyond two years becomes
more problematic, especially since I
will be 55 by then and the government
places increased restrictions on those
over 55,” she explains.
That doesn’t mean that physicians
nearing retirement age will not be
good candidates to work abroad, however. Both Griffin and White say the
age of doctors they place runs the
gamut—from residents who want an
international experience before family
ties and a full-time practice, to retired
physicians who decide to spend a few
years working abroad.
Most physicians, however, choose
international posts when they’re
mid-career and looking for something different.
Although Starkey enjoys returning to
the United States between assignments, she says she has never looked
for employment back home. Yet she
has no plans to seek a permanent position abroad, either—she enjoys her
six-month assignments and plans to
keep those for the foreseeable future.
Families have kept both Shivers and
Rideout in the United States recently.
Both have adjusted to American-style
medicine again, yet both are contemplating returning to a practice abroad.
“I’d like to go back to New Zealand,”
says Shivers. And Rideout says you’ll
definitely find him on the road again.
“We plan to go for a six-month position in a couple of years,” he says.
“This time, we’ll go to Australia.” n
Karen Edwards is a regular contributor to
PracticeLink Magazine.
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FALL 2010
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