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Christopher H. Loo, MD-PhD: Today we have Dr. Andrew Wilner. And he's really an interesting guest. He's a neurologist. He's a health journalist, and also an avid scuba diver. And he's done so many interesting things. He's written a book, The Locum Life: A Physician's Guide to Locum Tenens. He's also got a podcast, The Art of Medicine with Dr. Andrew Wilner. And he also has his own YouTube channel. And so without much ado, he will bring Dr. Wilner on the show. Welcome.
Dr. Andrew Wilner, MD: Well, thanks, Chris. It's a real pleasure and privilege to be here.
Christopher H. Loo, MD-PhD: We've spoken at some of the same conferences, and that's how we got connected. And you're talking about your latest venture. So tell us all about yourself, your background, I'm always interested in how people got to where they became and you know what they're doing now?
Dr. Andrew Wilner, MD: Well, first of all, Chris, I gotta say that I wish I had met you 40 years ago. It's late in my career now to live financially free at an early age, but it's still a goal. It's still a goal. But yeah, so I have a day job. I work full time as a neurologist, I'm Division Director of Neurology at Regional One Health in Memphis, Tennessee, and Associate Professor of Neurology at the University of Tennessee Health Science Center. And, and I love that. I love to teach and I love seeing the patients we have in the community hospital who are by and large, are indigent and pretty sick. So I feel like I'm not spinning my wheels there. It's really worth it to go in every day because the patients really need you. So that's a lot of fun. And I've had a long career of writing. I don't know when I was like 12 years old or something, I decided that that was what I was born to do. And so it's been many many years of trying to juggle writing, which is demanding. It may look easy, but it's pretty demanding and medicine, which of course if you're going to do it properly, is also demanding.
So having two demanding careers has been a lifelong challenge. And I think that's what led me to locum tenens, which I've worked off and on since 1981. I took my first locum job and an ER job in those days. You didn't have to be an ER doc to work in the ER. And thankfully, they've changed. I delivered babies and set broken bones and removed foreign bodies out of people's eyes. And I did all kinds of things that I kind of learned on the fly. But it was a great year because I was writing a book. I worked three 12 hour shifts, so 36 hours a week, which for physicians is like half time, right? And then I had four full days to myself to work on my book. And a few things happened. I finished the book, although I was unable to publish it. There was no self publishing option in those days. And the reviews I got with this is a great book, Dr. Wilner, but we don't have any titles like it. And I said, Well, yeah, that's why I wrote it. But it turns out that publishers like to have other titles that they can compete with. If you write a book that no one else has written before. They don't want to touch it because they're not sure whether it will sell. It's like wow, what a paradox.
Anyway, the other thing I learned was that I love neurology. I didn't know my plan was to do internal medicine because my role models were all very kind of cognitively excellent Internists. That was the big thing back then. But when I did my internship, it's like, well, everything was the same, cardiology, renal, GI, all interesting. And then I did this year on my own in the ER, and I was like, wow. Came in with double vision or cross eyed or one side of their body was numb, or they couldn't speak properly and 10 minutes before they were fine. It's like, whoa, this, this is pretty interesting, very, very challenging. And so I ended up completing my internal medicine residency and then doing a Neurology Residency in Montreal at McGill and Ontario Neurological Institute, and then staying another year for a fellowship in epilepsy. So seven years of formal training. So the residents don't get any sympathy from me, when they complain about how hard they work, and they leave at five.
Yeah, so along the way, I've written four books. And the last one, as you said, was The Locum Life: A Physician’s Guide to Locum Tenens, I was looking to write another book, and I realized there was nothing there are a couple pamphlets and of course, on the internet, there's a lot of information, but you have to curate it right? Because a lot of it comes from the staffing agencies, and there's nothing wrong with that. But it's like getting information from the pharmaceutical company, you have to sort of look at it critically. So I said I've had a lot of experience. I've worked inpatient locums, outpatient locums, academic locums, non academic locums. So I wrote a book about it. And it was fun to kind of put it all together. Locums, it turned out when I looked in retrospect, helped me enormously.
First, as I said, it helped me figure out what I wanted to do, which was neurology. Later it helped me travel. I had a conventional job, becoming a partner, I became a partner. I was in practice as a neurologist. But I got a little itchy, so it was very hard to take time off. I’m a scuba diver, as you mentioned, and of course, that kind of lay fallow for a while. I was in med school and residency every now and then I'd get maybe a few days in every year. I want to do more than that. So I planned this big trip to Southeast Asia, to Malaysia for 17 days, 17 days. It was like a huge 17 days, I had to plan it out six months in advance. So I didn't have clinic patients coming in. My partners were all in a tizzy that I was going to take so much time off. So I went to Malaysia, it was unbelievable. I'm pretty well traveled. But Malaysia was different. I went to an Orangutan Rehabilitation Center, an island that's surrounded by sharks and dove with the sharks and all kinds of other stuff. And later there was a kidnapping on that island. And luckily, I wasn't there. But it was a great adventure. And I came back and all my patients had survived. There was like a mile-high pile of charts on my desk.
But it was an eye opener, you know, that I really felt constrained, let's put it that way. So when the opportunity came up to do locums, I started working just enough to earn what I needed to live on. And I live a fairly spartan lifestyle. And so I would save money. And then I went back to Southeast Asia, and I'd go back for three months at a time. And then I'd come back and work for three or four months and then go back eventually, I had an apartment that I just kept over there. And I'd fly back and go to my little place. And I would write every day because that's what I always do. And then I take some time off and go diving and it's like I mean, it was unbelievable. It was just like, yeah, I didn't know doctors could do this.
And what worked for me was that, when I'm at work, I like to be 100% present. And so when I was doing my locum assignments for three, four or five months, it's like, okay, this is what I'm doing. This is great. This is a wonderful way to put a spin on it. This is a great opportunity to practice medicine and make some money. And then when the assignment was over, it's like, I'm on my way to the airport. And I don't have to sign charts. I don't have to take phone calls. There's nothing that trails you after a locum assignment, you're just done and you walk away. It's like being in the military. you just transfer from one base to the next and pick up the job and that's what you do. And I did that for about 10 years back and forth. I ended up leading medical missions to the Philippines, getting my dive master certificate and making some underwater movies. I met my wife over there, we now have a baby. And it was life changing, really life changing.
The other way that locums helped me is I mentioned the baby. So when we're thinking about the baby, I was thinking, well, maybe I don't want to travel so much. And I was traveling for locums, I was flying off for a week coming back for a week. So I started looking for a permanent position. I looked for two years for that permanent position, because I decided I wasn't going to take anything that I didn't really want. And what was great about it was, I'd go to an interview and the salary would be pretty good. And the job would be pretty good. And I was like, Yeah, I could do this. This isn't bad. But it's not really what I want. So I would just say no, it's like I got a great locum gig going, I don't need this. Whereas if I hadn't had the locum's kind of fallback position, it's like, Gee, I better take this job. It's a pretty good one. It's not perfect, but I didn't have to, so I didn't. And then finally, I stumbled on the job I got right now. It's like, wow, this is just what I'm looking for. It's academic. It's teaching. It's week on week off, I don't have to travel, the cost of living is not bad. I'm in Memphis, Tennessee. There's a few too many shootings every day.
But there's always a downside. But I've moved out in the suburbs where it's a little safer. And I really love the hospital. But of course, they offered me a very low salary. And so I just said, No. No. And 30 years ago, when I entered academics, for the first time, they offered me a salary. I said, okay, because I figured that's what the job is, it's like you go to the supermarket and the Canada milk is $3.79. You don't say, Well , how about 3.50? Right? I was pretty naive then, but I'd learned. So I just said, No, I said, I'm happy doing what I'm doing. And that's not enough for me to give up moving around. And even though it looks like a cool job. I said, you got to do better than that, give me a call. And I was able to walk away. And of course that's the key to any negotiation, is you have to be willing to walk away. Right? And you always see that in the movies. The guys are bartering. So like, Oh, that's too much and he walks away and then the other guy starts chasing after him. Well, well we could do a little better. So, but I didn't mind because I was happy doing locums and it was just fine. Well, sure enough, about three weeks later, I get this phone call like well it's a long story and they offered me just enough to make it kind of worth my while. So locums give you leverage.
It's one of my favorite TV shows, by the way. It's just great. and it's rare that you have any leverage in this world. So it's nice to have locums and locums. Right now even though I actually do locums presently at the VA, there's a VA two blocks from where my regular job is. And they're really seriously understaffed. So sometimes I help them out. It helps them and I make some extra money and it kind of keeps me in the locums world. But there's such a huge demand. I got a call today, I got a call today at the highest rate I've ever been offered for one week on one week off. It was pretty tempting. And I was like, Oh, but I already have a job. so it wasn't that high that I was going to quit. But that's the other thing every now and then you talk about burnout. I usually have a very good day at work, but every now and then you kind of have a bad day and will just sort of light up. It's like you know what, I can leave no problem.
If I really want to, I can leave and I can just get locum positions that will pay me as much if not more, but a little more hassle. Right. you're traveling, you're negotiating new contracts, you go into new places. New EMRs. Locums is still work right. And whenever you have a lot of first days in locums, and as a resident I'm sure you remember your first day on a new service. Really knowing the rules and locums is like that, a lot of first days. So I had to work pretty hard on my people skills and flexibility skills. Things never go the way you expect. And if they need you as a locum position, they're going to pay you all that money. There's a reason right not the ideal job, or somebody else would be there or they wouldn't have left. Although I have to say that, I was enormously lucky, I worked locum tenens at the Mayo Clinic in Phoenix, it was a wonderful place to work. I learned a lot and I had fun with the residents and they were great patients.
I worked locum tenens at Hennepin County Hospital in Minnesota, great training programs there. It's like every other internist you meet trained at Hennepin, they’re like the biggest training program in the country. And it's a nice County Hospital. I saw a case of Creutzfeldt-Jakob disease in five months there. I couldn't believe it whenever you put crates filled in Iacob and in the differential diagnosis you're usually going to be wrong, because it's pretty rare. I always tell the residents you're probably going to be wrong if that's what you think it is, because it just doesn't happen very often, but sure enough. So locums can be a lot of fun and I think for all the reasons I listed above.
Christopher H. Loo, MD-PhD: So, yeah, this was very fascinating. And then you talk about locums, you have a lot of location, time freedom, a lot of flexibility. It gives you a lot of leverage. So, if people are interested in locums, what is the best way to get their feet in, to get started after their training?
Dr. Andrew Wilner, MD: Yeah, well, the first thing to do is think about why you want to do it. For example, there are three stages of your career. It's like well, I've just finished my residency or fellowship and now I'm going to go to work. Locums for people like that is a chance to explore geography to explore work style. Do I want to be in a big clinic, solo practice, partnership, or academics? Without making too big a commitment. It's another way a lot of people graduating just finishing have a partner who may be a year ahead or a year behind. It's a way to kind of tread water for a year while the other one catches up. So you can both go somewhere together. Mid career guys, it's usually for extra cash. And then late career, it's, well you don't really want to retire, you want to slow down.
So to get started. At the risk of not being humble, I would certainly recommend reading my book, The Locum Life: A Physician's Guide to Locum Tenens. If you don't want to read the book, I have a five minute video on each chapter on my website, AndrewWilner.com. That's available for free, just go to AndrewWilner.com/videos. And there's a video on every chapter: malpractice, credentialing, travel, all the things that you need to learn about. I just did an audible book version of my book. So if you'd like to drive around and listen or workout, I narrated it, 6 hours 45 minutes. There's an audible book, same title. And that was a lot of fun to do. And you can feel free to contact me also through my website and I can refer you to staffing agents.
You don't need a staffing agent, you just put your ear to the ground and say, hey thinking of doing some extra work and it may turn out, you know that the internist next door is going on maternity leave, right. And all of a sudden, there's an opening, and they'd be glad to have you pick up some shifts. So that's the easy way to do it. And that's how I got my Mayo Clinic job, was just a colleague I met at a conference who I knew well. We were chatting and they were understaffed. Or you go to a staffing agency, and of course they have relationships with hospitals and clinics, and they'll tell you what's available. And but it is important to know if you're going to be happy, why you're doing it, are you just doing it to make some extra cash, that's fine. Are you doing it because you're trying to figure out what practice style works for you. You want to be a hospitalist or outpatient. So figure that out, and that'll make everything else much, much easier.
Christopher H. Loo, MD-PhD: Those are some great tips.I know a lot of physicians are interested in the tax benefits. So if you can describe how you set up a corporation. I know some, like a lot of local ER doctors. They set up an S corp and a lot of their travel expenses, etc. They can write off. Talk about that.
Dr. Andrew Wilner, MD: Right. I'll get there in a second. But I don't want to forget that, if you do locums, you should have a CPA, yeah certified public accountant who can help you. And if you contact me, I know of two who specialize in physician clients, one of whom specializes in locum tenens physicians. And he's actually my accountant now for the last couple years and is a wonderful guy, and knows all of the tricks and ropes that you were talking about. So it turns out that if you're a locum tenens physician, you're considered to be your own business, or a self employed person, and self employed people versus employed people. For example you go to work every day, and you get a paycheck deposited every two weeks, and at the end of the year, you get something called a W2, and they take your taxes out of every paycheck before you even see it. Now, that's an employee.
But if you're a self employed person, it turns out not only your employee, right, because you're working for someone, but you're working for yourself. So you're actually the employer. And it turns out that the employer has certain tax advantages. So as the employer, you can put a lot of money away in a retirement fund that you can't put in as an employee, but as an employee, you can also put in what you can put in as an employee. And then, as you mentioned, business expenses when I go to the hospital every day for my employee job, if I buy a computer, so I can get remote access, that's a business expense, but not as far as the government's concerned because I'm an employee. However, if I am a self-employed, locum tenens physician and I buy a computer because I need to keep track of all my expenses for locums, then that is a tax deductible expense. So by having this, even if it's in addition to your other job, like I have two jobs, right, I'm a self employed locum tenens physician, and right now an employee II, you can do it both ways.
So this is where it gets a little sophisticated. I don't give accounting advice. But what I've learned, I have been able to put much more money into my 401k than I would have been able to as an employee. And my income tax has been reduced, because I'm able to deduct my business expenses from my gross income.
In terms of corporation, I talked to my CPA about it a few times, and he didn't think it was necessary in my particular case, right? But finance is never one size fits all, but it's actually not even necessary. So you don't have to concern yourself with that. It may be advantageous in your particular situation, but working locums is basically you sign a one page contract and you show up. And you take care of patients, you sign your charts and you go home and you're done. So the simplicity of it is beautiful compared to owning your own practice, which I did. And all the personnel hassles and politics hassles. I mean, the beauty of it is that you just show up, the place is usually a little bit of a mess, but that's okay. It's not your problem, your job does the best you can, under the circumstances, taking care of patients that you went to medical school for, and then go home, go hiking, save your money for Southeast Asia, has a lot of benefits.
Christopher H. Loo, MD-PhD: So what type of individual like, if you're single or you're married, if you have kids what, what's worse, what are the sort of downsides of locums that you've encountered?
Dr. Andrew Wilner, MD: Yeah, so, of course, there are downsides. I mean, it's obviously perfect if you're single, and you can just do whatever you want without consulting anyone. Cash flow can be an issue. Locum tenens contracts can be canceled up to 30 days before they start and that happens to everyone. I've had two contracts. I was going to start September 1 and on, I guess it sort of would have been July 31. I got an email. The hospital decided they don't need you. And so the whole plan is off. So you have to have, I always recommend six months of money in the bank right for all of your expenses. In my case, if somebody cancels it is like, Okay, I'll go work on my book for a month. So it wasn't a tragedy. But if you're somebody that lives paycheck to paycheck, because you've got three kids in private school and a big mortgage on your house, and six cars, locums may not work for you. And it may just be easier just to have a regular every two week paycheck and just do your job.
So it's certainly not for everyone as a full time gig. It can be good if you are on vacation time or do a little bit, a little bit here a little bit there, like I do at the VA, just to pick up some extra money. And it's kind of fun to take care of the veterans, it's a different environment, they have slightly different problem sets. So it widens your horizons, but certainly the cancellations I would say are a big thing. Getting paid is not a problem. Staffing agencies, they're pretty responsible. They do direct deposit these days. You have to pay quarterly taxes, you have to stay on top of your expenses. And if you're full time, you have to get your own health insurance. And you don't get any benefits with locums. Because, well, as I said, you're the employee and the employer. Right. So unless your employer gives you benefits, which is you, you’re not gonna get any. But the only benefit you really need is health insurance. And, and that's costly. So when I was working locums full time, I went through the, not the Better Business Bureau, it's one of those local business organizations, and I was able to get sort of a discounted rate as an independent business the way you would if you had a little shop. But health insurance these days is very, very expensive. And you have to budget for that. You definitely have to budget for that.
Christopher H. Loo, MD-PhD: Yeah, definitely. You've described a very interesting way of making either main income or side income. So, I know a lot of physicians are interested in, for example, emergency medicine, anesthesia. A lot of specialties are going into this locum model. So, a very fascinating story and just a lot of wisdom. If people are interested in your books or getting in contact with you, how can they contact you?
Dr. Andrew Wilner, MD: Best way is www.andrewwilner.com, of course, the book’s on Amazon, and you can get it at a slightly lower rate if you get it through my website. And yeah, and I'm happy to answer questions. I take questions all the time. I don't charge anything, give you 15 minutes. Great. if that can help you help your life. I'm a doctor, I like to make people's lives better. And if a few words of advice is going to set you in the right direction, I'm happy to provide it.
Christopher H. Loo, MD-PhD: Yeah. For all the listeners. We'll put all of Dr. Wilner’s advice and all of his resources in the show notes and any parting words of wisdom before we call it a day?
Dr. Andrew Wilner, MD: Well, I did forget to mention that I have a podcast, and I often have guests that discuss locum tenens. That's how the podcast started. It was all about locums. And now I've expanded it. It’s The Art of Medicine. So it's The Art of Medicine with Dr. Andrew Wilner. You can watch it on YouTube or on your favorite podcast player, it streams every two weeks. We're up to episode 50 something now. It's a lot of fun. It's about 20 minutes. And I have really interesting guests. And every now and then we have a local person. So that's something to checkout.
Christopher H. Loo, MD-PhD: Awesome. Awesome. Well, thanks so much. And we look forward to having you on the podcast again as a future guest or even for a master class. So thanks so much and we'll see you next time.
Dr. Andrew Wilner, MD: Oh, it's been a lot of fun, Chris. Thank you.
Christopher H. Loo, MD-PhD: Many thanks again for being here. If you’re new, you can find me online at Christopher H. Loo, MD-PhD, where I have links to other episodes or links to online resources that will support you on your financial literacy journey. I’ll see you there in on next week’s show. While I bring you thoroughly vetted information on this show regarding a variety of financial topics, I cannot promise you a one size fits all solution. This is why I caution you to continue to learn. Educate yourself and seek professional advice unique to your situation. If you want to talk to me, I welcome it. Please reach out via my website or email at Chris@drchrisloomdphd.com. I read and personally respond to all of my emails. Talk soon!
Editor's note: This transcript has been edited for brevity and clarity.
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