A “long commute” once meant 60 minutes of drive time or a long haul on public transit from the suburbs to city centers. That definition has changed quite a bit as the nation’s workforce becomes more mobile.

Take, for instance, hospitalist Yun Namkung, MD, who lives in Queens, N.Y., but works at Leflore Hospital, a 248-bed regional medical center in Greenwood, Miss., about 130 miles south of Memphis. “I’m something called a ‘firefighter’ within the company,” says Dr. Namkung, who’s been traveling long distances to work for his employer, Brentwood, Tenn.-based Cogent-HMG.

Dr. Namkung’s first long-distance commute was an interim assignment: He was an HMG program director in upstate New York anticipating a move to California. The move didn’t materialize, and now, after two years as a “super-commuter,” he says, “Traveling is actually fulfilling. You get to meet different people and supporting staff. You get exposed to a variety of patients, so clinically, you get better. I think I can continue to do this for a while.”

Super-commuters go by various names and monikers—“firefighters,” “travelers,” “vagabonds”—but they share a common reality: one or two weeks a month, and in some cases every week, they’re traveling long distances from home to work. And while it might not be for every hospitalist, this mega-commute phenomenon has pros and cons, hidden costs, and unexpected perks.

Just before I leave for an assignment, my wife’s ready to see me go. And then, when I come home, she’s anxious for me to be there, so it’s sort of like a honeymoon once a month for both of us.

—Charles Barnett, MD, Knoxville, Tenn.

An Upward Trend?

Transportation policy consultant Alan E. Pisarski, author of “Commuting in America (Vols. 1-3),” often testifies before Congress on transportation issues for policy planning and investment requirements. The third volume of his “Commuting in America” series, published in 2006, found that the number of workers with commutes of more than 60 minutes increased almost 50% from 1990 to 2000.¹ That duration probably rose even more following the economic downturn that began in 2008, he says, as the notion of an “acceptable” commute changes when the job market is tight.

The long-distance commuting trend is likely to increase, he says, because highly skilled workers (e.g. physicians) are in short supply. In our mobile society, he adds, “professionals are more willing to accept long distance separation from their families, on at least some kind of scheduled basis.”

In addition, as millions of baby boomers retire, replacing their skill sets is proving difficult. Companies are trying to hold boomers in the labor force longer, offering attractive perks so that they will stay.

Many jobs, even in a telecommuting society, still require in-person deliveries. And for some, super-commuting is a better alternative to relocation. For others, it might be the only alternative, given the poor housing market. That’s the way Anthony Venturato sees it.

“In my business, [we] have to be where the project is,” says Venturato, a project manager for passenger rail projects for STV Inc., a leading architectural, engineering, and construction management firm. “We have virtual meeting rooms, but we’ve got a long way to go before working closely together and being physically far away are equivalent—like that great scene in “Star Wars” where holograms of ‘attendees’ were interacting around a conference table. To run a project, at least in the early 21st century, you’ve gotta be there.” (see “Nomadic Lifestyle Works for Some,”)

Since I’m here alone, we have the chance to have dinner together and spend time. In that way, I bond with a lot more people than I would normally if I stayed in one place.

—Yun Namkung, MD, Queens, N.Y.

Models Differ

Mark Dotson, vice president of recruiting at Cogent-HMG, says his company instituted a “travelers” model in October of 2009 to reduce its locum tenens usage. Travelers, he says, are hospitalists licensed in several states who can be placed in different programs, most within driving distance. Some request a remote location, such as one Cogent-HMG hospitalist who resides in Dallas and has been commuting to Great Falls, Tenn., for more two years.

Dotson explains that the company’s travelers “are not typical locums who may just say, ‘I’ll be here for two months and then I’m out of here.’ They are employed by us, get full benefits [plus a 10% premium over regular employees] and training from our academy,” he says. “They are looked upon as part of the team when we place them in a program, and not an interim solution.”

Listen to Pisarski

Travelers contribute to program stability and improved quality and productivity metrics, Dotson adds. In Great Falls, for instance, the hospitalist team, which includes a traveler on every rotation, has regularly met its quality performance measures and RVU requirements since being fully staffed. Dotson estimates that 10% of the hospitalists hired by Cogent-HMG last year were travelers, and he’d like to see that percentage grow to 25% to meet increasing demand.

EmCare Inpatient Services in Dallas takes a different approach. They use super-commuters only for short-term startups, says CEO Mark Hamm, who’s “never been an advocate of flying people in and out. You don’t ever get the continuity that you need within the practice.”

To establish trust with referring primary-care physicians (PCPs), hospitalist programs need to comprise 80% to 90% of residential hospitalists, he says. Otherwise, EmCare becomes “just a staffing company and not a partner” with client hospitals. This is especially essential when it comes to hiring medical directors, he says, who must be present for meetings and administering program operations.

Dr. Bennett and his wife "on assignment" in Alaska.

A Good Fit

So who are the super-commuter hospitalists? Dotson, of Cogent-HMG, says that the majority of those willing to travel tend to be single. Hospitalists who are in between residency and starting a fellowship find this type of assignment provides consistent scheduling, income, and benefits to them and their families. Another contingent: mature career hospitalists with grown children.

Eric Kerley, MD, FAAP, FACP lives and works primarily in eastern Tennessee, where he is a full-time medical director. He saw his friend and colleague Charles Barnett, MD, taking assignments in Wyoming, and thought traveling for work “sounded interesting.”

“I’m a Southern boy who has lived my entire life between Orlando [Fla.], Tennessee, and Texas,” he says, “so I picked my locations based on places I would want to go.”

Dr. Kerley’s first yearlong assignment, in 2009-2010, was in central Alaska at a 75-bed facility. He worked as a nocturnist. “To see minus-20-degree Fahrenheit temperatures and frozen rivers, and days that are 22 hours long, that was pretty amazing,” he says. Being away for one week a month is really not much different than a week of day shifts at home, he adds.

Dr. Barnett began super-commuting four years ago from his home in Knoxville, Tenn., to Gillette, Wyo. Traveling to Wyoming is his regular commuter gig—he stays at the hospital—and he enjoys working in another environment.

The away time also works for his marriage, he says. “Just before I leave for an assignment, my wife’s ready to see me go,” he says. “And then, when I come home, she’s anxious for me to be there, so it’s sort of like a honeymoon once a month for both of us.”

Continued below...

The METROSouth Light Rail System in Houston, which opened in January 2004, pulled project manager Anthony Venturato away from his home.

Nomadic lifestyle works for some

Anthony Venturato has traveled extensively throughout his career as a project manager for Douglassville, Pa.-based engineering consulting firm STV Inc. “I’m considered the company vagabond,” he says. “I will take assignments wherever I can reasonably fly to.”

He’s currently managing construction of a rail project in Southern California. His longest extended commute was from his home in Tampa, Fla., to London. When it became clear he was needed full-time, he and his wife relocated their family to England.

While his children were growing, Venturato and his wife moved nine times to different states. “To move your household lock, stock, and barrel is really very difficult,” he says. “When the kids lived at home, it was tough on them.”

There’s still the aggravation of flying, but the jobs you get, the opportunities that you have, make it all worthwhile. If you limit yourself to not going to these interesting projects, you’re limiting your career.

—Anthony Venturato, project manager, STV Inc.

Finally, in the late 1990s, he and his wife decided to pick a location near a hub airport from which he could readily commute.

Even though his weekends are short—he’s home every other weekend for about a day and a half—it’s a better alternative to constant relocation, he says.

“I would guess that 10% or less of people in my business are willing to super-commute, and people willing to relocate is probably even lower than that,” he explains.—GH

Pros and Cons

Although he misses his family when he’s traveling, Dr. Namkung now spends more quality time with them, “because I realize how precious that time is.” His wife, a pharmacist, makes it a point to take time off when he’s home, and they do more things together as a family.

Listen to Hamm

Another bonus: “I meet different docs, nursing staffs, and administrators,” Dr. Namkung says. “Since I’m here alone, we have the chance to have dinner together and spend time. In that way, I bond with a lot more people than I would normally if I stayed in one place.”

Dr. Kerley racked up the frequent-flier miles during his one-year assignment to Alaska, which was a plus when it came to financing family vacations.

Working in other states entails meeting state-specific licensing requirements. Some companies, such as Cogent-HMG, pay the costs of obtaining those state licenses. Others do not, and the paperwork, says Dr. Barnett, can be “a nightmare.” Locum Leaders CEO Will Drescher, MD, says his company pays for licenses in some states and assists with paperwork in others.

I’m a Southern boy who has lived my entire life between Orlando (Fla.), Tennessee, and Texas. I picked my locations based on places I would want to go.

—Eric Kerley, MD, medical director, Morristown, Tenn, nocturnist, PeaceHealth Medical Group, Ketchikan, Ak.

Unless hospitalists are full-time employees of the organization, such as Dr. Namkung with Cogent-HMG, their income likely will be considered independent contracting by the IRS. That means you’ll be filing an extra form (1099) with your return, and you may have to pay quarterly estimated self-employment tax. Hospitalists are encouraged to consult their financial advisors to make sure they are set up properly. Hospitalists who live in one state and work in another also need to beware of state and municipal tax guidelines.

One hidden cost of super-commuting is less time for household upkeep. Tony Venturato does not have the luxury of a week-on/week-off schedule, and with travel, his weekends are cut down to a day or a day and a half twice a month. That doesn’t leave much time for household chores and home improvement projects.

“The same way that you cannot run a project from the road, it’s also pretty hard to run a household from remote, and that puts a burden on your spouse,” he says. “That leaky faucet that might have been a small fix-it project? Now my wife has to find a plumber to come fix it. Do-it-yourself home improvement projects? Fuhgeddaboudit.”

Dr. Kerley nearly missed the birth of his first grandchild the first week he had agreed to work in Alaska. However, his state license to practice was delayed, so he was there for the important event. “After that, I realized that I did need to be more intentional about dates and scheduling,” he says. “Since then, the scheduling has become more rhythmic.”

Good Career Move?

Super-commuting adds to the bank account, widens travel experiences, and sharpens clinical skills. But does it work for career advancement? Dotson believes that working with various types of teams in different settings helps hospitalists mature quickly.

Venturato thinks that accepting long-distance assignments will become even more necessary for career-building. “There’s still the aggravation of flying,” he admits. “But the jobs you get, the opportunities that you have, make it all worthwhile. If you limit yourself to not going to these interesting projects, you’re limiting your career.”

Dotson seconds that notion. “If people are willing to do the traveling, and they are good people, there are lots of opportunities for them,” he says.

Listen to Pisarski

The Life of an HM Traveler

From her ranch in North Platte, Neb., Susan Schuckert, MD, is almost equidistant between her two hospitalist jobs. One week a month, she drives 4 1/2 hours to Nebraska Medical Center in Omaha, where she works for IMI Hospitalists. She bunks with friends, whom she’s known since she completed medical training there. Just recently, she began a locum tenens assignment in Scottsbluff, Neb.—a 3 1/2-hour drive to the opposite side of the state.

Dr. Schuckert is building a private practice in North Platte with a partner. She began working as a hospitalist to keep her skills current, and says she is realizing a professional net gain. Being a hospitalist, she says, “is fun. I enjoy getting to know the nurses, seeing different ways of doing things, and the variety.”

Other physicians in town have called the medical center when I’m on as a hospitalist, so it makes it possible for me to make sure that their patients get what they need.

—Susan Schuckert, MD, North Platte, Neb.

In addition to the stimulation and camaraderie of a large medical center, Dr. Schuckert has found that her patients back home in North Platte embrace the fact that she moonlights at Nebraska Medical Center. “If I have to send patients to Omaha, I personally know who I’m sending them to,” she says. “It also makes referrals smoother. Other physicians in town have called the medical center when I’m on as a hospitalist, so it makes it possible for me to make sure that their patients get what they need.”

There are times, of course, when she misses being at home. She recently was working in Omaha and missed the birth of a new colt. Not to worry: Her husband, who is “very supportive” of her super-commuting, texted her photos of little Rudy every day. So for the moment, the mixture of a home practice and working as a traveling hospitalist is a good one.

And the long drives? With a hands-free phone and books on CD, “It’s no big deal,” she says.

Gretchen Henkel is a freelance writer in Southern California.

References

Pisarski, AE. Commuting in America III: The Third National Reporter on Commuting Patterns and Trends. 2006: Transportation Research Board of the National Academies; Washington, D.C.

Sandow E. Till work do us part: The social fallacy of long-distance commuting [dissertation]. Available at: http://umu.diva-portal.org. Accessed June 22, 2011.

Super-Commuters