Ever wonder what it would be like to live and work in a remote village in New Zealand, or to travel around the United States practicing medicine along the way?

Since leaving his practice in June 2006 for a locum tenens position, Dr. Joshua Gutman said he has become more energized.

Currently living in Providence, R.I., Dr. Gutman practiced in South Attleboro, Mass., before taking up a locum tenens lifestyle. “After 29 years of practice, it was much easier for me to get down in the dumps and discouraged about the medical environment, or about issues with patients, or referrals or billing or personnel issues at work. With the administrative burdens gone, I feel much happier taking care of patients.”

Locum tenens work allows him to fulfill a lifelong dream to travel while maintaining and stretching his clinical skills. His assignments have included a 7-week stint working in a health center on a remote Navajo reservation in Arizona, where he learned splinting techniques that are typically performed by orthopedists, and a 4.5-month assignment working in a health clinic in Reefton, a small town in New Zealand, where he learned how to use an electronic medical record and how to remove foreign bodies from a cornea. His wife, Eva, who teaches English, French, and Spanish, traveled with him for the assignments and found teaching work in both locales.

Dr. Gutman said he was impressed with the universal health care system in New Zealand, where every citizen receives basic primary care. “They do have limitations of access to tertiary care and elective surgical procedures, but the health care system works so much better than here and it's so much less expensive,” he remarked.

It also helps that medical malpractice is virtually nonexistent. “Patients there don't sue doctors,” he said. By contrast, the litigious nature of Americans is renowned. On learning he was from the United States, his patients' reaction was often: “Don't worry, doc. We're not going to sue you.”

A locum tenens recruitment organization (VISTA Staffing Solutions) arranged the assignment, and Dr. Gutman worked under a contract with the New Zealand government, which provided a week of paid vacation for every 8 weeks he worked. This enabled him and Eva to enjoy a 2-week paid vacation traveling the country.

Dr. Gutman noted that locum tenens work isn't suitable for everyone; flexibility is essential. “When you move into locum tenens, you have to be willing to do things their way,” he said. “I've found people have been wonderful mostly because I'm willing to function within their system.”

In summer 2008, they will travel to Fairbanks, Alaska, for a 9-week assignment. Meanwhile, he keeps busy doing locum tenens work locally 2–3 days a week.

Dr. Gutman's annual income is about two-thirds of what it was when he was in full-time private practice, “but I haven't made an effort to work 48–49 weeks as I did when I was in my own practice,” he explained. “I have taken a few weeks' break between assignments.”

That allows him more time to read, a favorite pastime. “I've also been spending much more time in the gym,” he said. “I'm much more [physically] fit than I was when I was in my own practice. We rediscovered skiing this winter, which we hadn't done for the last 8 years.”

Dr. Monica Speicher entered locum tenens work right out of residency in 2003 because she was not sure where she wanted to work. It “gave me a chance to bounce around and see several different areas of the country,” said Dr. Speicher, who spent 4 years on assignments in Alaska, Arizona, Maine, Washington state, and New Zealand before accepting a full-time position on the clinical faculty at Washington (Pa.) Hospital. “Almost everywhere I worked, I was offered a permanent job, so it's a good way to test-run a practice,” she said.

She accepted assignments primarily in rural locations where specialists were sparse. As a result, she said, she quickly gained confidence in her clinical skills, although she admits to being rattled during her assignment at the same clinic in Reefton, New Zealand, where Dr. Gutman worked. There, she routinely rode along with emergency medical staff on ambulance calls, responding to car accidents and other emergencies.

Working at a remote clinic on Prince of Wales Island, Alaska, also tested her mettle. The clinic receives so few critical cases that when one came in, the support staff “tended to panic,” she said.

She echoed Dr. Gutman's sentiment that locum tenens work best suits physicians who are flexible. “If you're a flexible, more laid-back type of person, you will really enjoy it,” she said.

For more information, visit the Web site of the National Association of Locum Tenens Organizations at www.nalto.orghttp://locumlife.modernmedicine.com

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Dr. Joshua Gutman and his wife, Eva, kayaking in New Zealand, where he did locum tenens work at a clinic. Courtesy Dr. Joshua Gutman

Flexibility Is Key to Locum Tenens Work