1 00:00:00,049 --> 00:00:03,140 Ali: So extremely important for us to approach our careers, not on 2 00:00:03,140 --> 00:00:06,781 autopilot, but thinking intentionally about what it is that I'm doing, why 3 00:00:06,781 --> 00:00:10,621 am I doing it, and is it going to lead to fulfillment in 10, 15, 20 years? 4 00:00:13,487 --> 00:00:16,257 Sam: Hi everyone, and welcome to another episode of EMPlify. 5 00:00:16,257 --> 00:00:17,777 I'm your host, Sam Ashoo. 6 00:00:18,037 --> 00:00:21,777 Before we dive into this episode, I want to say thank you for joining us. 7 00:00:21,827 --> 00:00:25,367 I sincerely hope that you find it to be helpful and informative for your 8 00:00:25,367 --> 00:00:29,797 clinical practice, and I want to remind you that you can go to ebmedicine.net 9 00:00:29,867 --> 00:00:34,017 where you will find our three journals, Emergency Medicine Practice, Pediatric 10 00:00:34,027 --> 00:00:39,177 Emergency Medicine Practice, and Evidence Based Urgent Care, and a multitude of 11 00:00:39,197 --> 00:00:43,547 other resources, like the EKG course, the laceration course, interactive 12 00:00:43,547 --> 00:00:47,987 clinical pathways, just tons of information to support your practice 13 00:00:48,127 --> 00:00:49,737 and help you in your patient care. 14 00:00:50,007 --> 00:00:52,197 And now, let's jump into this month's episode. 15 00:00:54,568 --> 00:00:57,238 Ali: I'm Ali Chaudhary, board certified emergency physician. 16 00:00:57,568 --> 00:00:59,728 I live in Allentown, Pennsylvania. 17 00:01:00,118 --> 00:01:04,158 I did my medical school out in the Dominica, Ross University, 18 00:01:04,428 --> 00:01:07,638 did my residency out in Akron, Ohio, Summa Health System. 19 00:01:08,058 --> 00:01:09,558 And I've been here on the East coast since. 20 00:01:09,558 --> 00:01:11,148 Originally from California, born and raised. 21 00:01:11,658 --> 00:01:12,168 Sam: Awesome. 22 00:01:12,228 --> 00:01:13,848 Thanks for being on the podcast. 23 00:01:13,878 --> 00:01:19,528 I really wanted you to have a time to share with us, because you have a very 24 00:01:19,528 --> 00:01:21,868 unique perspective on emergency medicine. 25 00:01:21,868 --> 00:01:26,968 So all our listeners who are in training and already out there in their careers 26 00:01:27,268 --> 00:01:31,733 may not realize, but you have kind of made it your passion to talk about. 27 00:01:32,438 --> 00:01:37,268 The locums life and what it's like to be sort of your own business and the 28 00:01:37,268 --> 00:01:39,158 freedom that that brings in your career. 29 00:01:39,248 --> 00:01:39,663 Is that right? 30 00:01:40,698 --> 00:01:41,508 Ali: Absolutely, man. 31 00:01:41,508 --> 00:01:46,438 I mean, look, I graduated in 2014 from residency and it's been about 11 years 32 00:01:46,438 --> 00:01:48,028 now, which it seems like a lifetime. 33 00:01:48,088 --> 00:01:51,088 But I argue now that emergency medicine, the way that it 34 00:01:51,088 --> 00:01:52,733 is structured today is dead. 35 00:01:54,053 --> 00:01:55,943 It's beyond broken, it's actually dead. 36 00:01:56,153 --> 00:01:58,523 It's not sustainable as a career anymore. 37 00:01:58,943 --> 00:02:02,813 Just about everyone that I work with who isn't a 10 99 locum is burnt out, 38 00:02:02,873 --> 00:02:05,273 is depressed, is seeking a way out. 39 00:02:05,678 --> 00:02:05,968 Sam: Yeah. 40 00:02:06,053 --> 00:02:09,003 Ali: So I've been able to find freedom , and be able to live 41 00:02:09,003 --> 00:02:11,703 a life that is fulfilling and more enjoyable and adventurous. 42 00:02:12,048 --> 00:02:15,003 So I just wanna share with other doctors that like what it is that 43 00:02:15,003 --> 00:02:16,203 I'm doing and how I got here. 44 00:02:16,203 --> 00:02:18,963 It's not some sort of secret hack or some trick that only I 45 00:02:18,963 --> 00:02:20,283 knew somebody who can get me in. 46 00:02:20,688 --> 00:02:23,838 This is available to everyone who's a mercy doctor and other specialties. 47 00:02:23,838 --> 00:02:27,258 I don't know if there's other specialties that listen to this podcast, but it does 48 00:02:27,258 --> 00:02:31,194 apply to anesthesia, GI, and some other specialties that are procedure based. 49 00:02:31,194 --> 00:02:34,901 But my heart really goes out to ER docs because no one gets what we go through, 50 00:02:35,181 --> 00:02:35,291 Sam: Hmm. 51 00:02:35,291 --> 00:02:38,591 Ali: Not our spouses at home, not our kids, not our other 52 00:02:38,591 --> 00:02:39,911 colleagues, not other specialties. 53 00:02:41,481 --> 00:02:46,096 I see what we go through and just the stress of the job itself, the 54 00:02:46,246 --> 00:02:49,966 psychological stress, the emotional stress, the physical stress of nights 55 00:02:49,966 --> 00:02:54,406 and days and going back and forth, and somehow it's normalized that we 56 00:02:54,406 --> 00:02:57,376 just accept that and work 14 days a month doing that every single month. 57 00:02:58,321 --> 00:03:00,241 I just don't understand how that became normal. 58 00:03:00,921 --> 00:03:04,061 And so I'm surprised more people aren't burnt out and you know, we're a specialty 59 00:03:04,061 --> 00:03:05,231 that has the highest burnout rate. 60 00:03:05,641 --> 00:03:06,901 Why aren't we addressing these issues? 61 00:03:06,901 --> 00:03:10,861 Why aren't emergency physicians taking control of this or having 62 00:03:10,861 --> 00:03:12,241 a voice that actually matters? 63 00:03:12,241 --> 00:03:16,381 And for me, locum tenens is a way to actually take back control, 64 00:03:16,481 --> 00:03:20,964 take back freedom, and operate and approach your career in a way in 65 00:03:20,964 --> 00:03:23,754 which you have the autonomy and freedom, but also at the same time, 66 00:03:24,004 --> 00:03:25,354 practicing as an emergency physician. 67 00:03:25,354 --> 00:03:26,944 So there's a lot to say about this. 68 00:03:26,944 --> 00:03:27,964 We can go in many different directions. 69 00:03:28,014 --> 00:03:28,434 I could keep going. 70 00:03:29,454 --> 00:03:32,274 Sam: So if you're listening to this podcast and you don't know what locum 71 00:03:32,274 --> 00:03:38,014 tenants is, it's a form of working where you're not employed by just one person. 72 00:03:38,014 --> 00:03:41,254 You're kind of an independent corporation, and you get to pick 73 00:03:41,254 --> 00:03:42,574 and choose where you're gonna work. 74 00:03:42,784 --> 00:03:47,524 And you're not a standard W2 employee of some healthcare system or a hospital 75 00:03:47,744 --> 00:03:50,744 or an urgent care center or wherever it is that you're currently working. 76 00:03:51,011 --> 00:03:53,856 Now tell me when did you get your start doing locum work? 77 00:03:54,401 --> 00:03:56,786 Ali: And I wanna maybe just add a little bit more color to that because 78 00:03:57,716 --> 00:04:00,806 that key difference, what you just described, the difference between an 79 00:04:00,806 --> 00:04:05,156 employee and a independent contractor is the reason why emergency physicians 80 00:04:05,186 --> 00:04:06,476 are feeling trapped and burnt out. 81 00:04:07,256 --> 00:04:11,043 That's the reason why we are not living life to the maximum 82 00:04:11,103 --> 00:04:12,373 potential that we possibly can. 83 00:04:13,043 --> 00:04:15,393 That's the reason why emergency doctors aren't making half a 84 00:04:15,393 --> 00:04:16,533 million dollars every single year. 85 00:04:16,628 --> 00:04:17,348 That should be baseline. 86 00:04:18,458 --> 00:04:20,258 So it's a very simple difference. 87 00:04:20,288 --> 00:04:24,398 It's not like, again, you don't have to read it in some thousand page 88 00:04:24,398 --> 00:04:26,678 book in the middle somewhere where you can't get this information. 89 00:04:26,678 --> 00:04:27,758 It's very straightforward. 90 00:04:27,758 --> 00:04:29,378 It's very easy to understand. 91 00:04:29,378 --> 00:04:32,668 Once you understand it, you will start to approach the way that you 92 00:04:32,668 --> 00:04:35,721 are practicing differently, because now you'll recognize the difference 93 00:04:36,356 --> 00:04:39,866 . W2 employment is a standard approach that every doctor, when they graduate from 94 00:04:39,866 --> 00:04:41,636 residency, is what they're gonna get into. 95 00:04:41,636 --> 00:04:44,516 So whether you're an employee at a hospital, contract management group, 96 00:04:44,546 --> 00:04:48,806 usually is W2, some are 10 99 though, if you join like the travel team or whatever. 97 00:04:49,166 --> 00:04:51,416 Or if independent group, there's a little bit of a different structure, 98 00:04:51,416 --> 00:04:55,750 but a lot of doctors go into employment because it's the most common and 99 00:04:55,750 --> 00:04:57,460 easiest way to practice medicine. 100 00:04:57,460 --> 00:04:58,366 Why is it easy? 101 00:04:58,410 --> 00:05:00,180 Because you get your benefits handed to you. 102 00:05:00,300 --> 00:05:01,530 You don't have to think about them. 103 00:05:01,680 --> 00:05:04,570 And you get paid your check, your schedule is made for you and you 104 00:05:04,570 --> 00:05:06,820 can make requests here and there, but it's pretty much handed to you. 105 00:05:06,820 --> 00:05:09,040 And so you're kind of like on autopilot in your career, right? 106 00:05:09,583 --> 00:05:10,393 But that's the problem. 107 00:05:10,790 --> 00:05:15,650 When we go into autopilot and because of how stressful our career and our job is 108 00:05:15,650 --> 00:05:17,060 and no one actually understands how it is. 109 00:05:17,780 --> 00:05:21,770 That's what leads to burnout and discontent with our life and our career. 110 00:05:22,715 --> 00:05:27,465 What 10 99 does, and what practicing as a locum does is it gives you, in the 111 00:05:27,465 --> 00:05:31,455 word itself, independent contractor, you're now independent, right? 112 00:05:31,845 --> 00:05:35,715 You're not dependent on a single hospital to take control over you 113 00:05:35,715 --> 00:05:38,235 and give you your schedule and give you your hours and all this stuff. 114 00:05:38,955 --> 00:05:40,395 You're taking control back now. 115 00:05:40,400 --> 00:05:43,040 Now you have control over your schedule and how much you get paid. 116 00:05:43,455 --> 00:05:43,675 Sam: Hmm. 117 00:05:44,485 --> 00:05:45,445 Ali: I'll touch upon this now. 118 00:05:45,445 --> 00:05:48,985 Last year I made over $550,000 working the same number of hours 119 00:05:48,985 --> 00:05:50,515 my W2 colleagues are working. 120 00:05:51,195 --> 00:05:51,315 Sam: Hmm. 121 00:05:51,865 --> 00:05:53,135 Ali: They're not making more than 350. 122 00:05:53,798 --> 00:05:54,968 Almost 200 K more. 123 00:05:54,968 --> 00:05:56,588 But what about the benefits and all that stuff? 124 00:05:56,708 --> 00:05:57,068 Yes. 125 00:05:57,068 --> 00:05:58,928 Benefits don't cost me $200,000 a year. 126 00:05:58,958 --> 00:05:59,168 Okay? 127 00:06:00,258 --> 00:06:04,708 And so I did a presentation recently at a residency program in Modesto, California, 128 00:06:04,708 --> 00:06:08,443 and I showed them the difference in terms of just income, even taking into 129 00:06:08,443 --> 00:06:12,373 account for benefits and things like that, over the course of 10 years, 130 00:06:12,373 --> 00:06:17,803 you're making over a million dollars more as a 10 99 locum than an employee. 131 00:06:18,238 --> 00:06:18,598 Sam: Yeah. 132 00:06:18,673 --> 00:06:21,893 Ali: So again, this is a whole topic and I have a section on my book about this. 133 00:06:21,893 --> 00:06:23,513 I have a section in my course about this. 134 00:06:23,763 --> 00:06:25,510 I can go into a lot of depth, but we'll leave it there. 135 00:06:26,045 --> 00:06:30,455 Sam: So if you are someone who is interested in locums, is it something 136 00:06:30,455 --> 00:06:34,385 you'd recommend doing directly out of residency or do you need a certain 137 00:06:34,385 --> 00:06:38,838 amount of time at a hospital or as a W2 employee before you should venture out 138 00:06:38,838 --> 00:06:40,558 and start being an independent contractor? 139 00:06:40,848 --> 00:06:44,468 Ali: I think it's important to know where your shortcomings are. 140 00:06:45,078 --> 00:06:48,678 I think that for some doctors coming outta residency and we have a few 141 00:06:48,678 --> 00:06:51,468 that work with us right out, get the residency , and they're killing it. 142 00:06:51,498 --> 00:06:52,548 They're doing a great job. 143 00:06:52,548 --> 00:06:56,578 The directors love them, but there's a few others and my experience has 144 00:06:56,578 --> 00:07:00,118 been much less of these two maybe struggle with the single coverage sites. 145 00:07:00,888 --> 00:07:01,248 Right. 146 00:07:01,308 --> 00:07:04,608 And so it's important to kind of know where you fall in that. 147 00:07:04,758 --> 00:07:07,398 So if you find yourself that, you know, you maybe need a little bit more 148 00:07:07,398 --> 00:07:10,608 encouragement or maybe a little bit more time to just start getting independent 149 00:07:10,608 --> 00:07:16,008 on your own, in those scenarios, I would say maybe start working as a W2 or you 150 00:07:16,008 --> 00:07:20,438 get a locum job in a place that has double or triple coverage during those 151 00:07:20,438 --> 00:07:21,698 shifts where you're not just by yourself. 152 00:07:21,943 --> 00:07:22,093 Sam: Yeah, 153 00:07:22,093 --> 00:07:23,588 Ali: I think that kind of scares us sometimes. 154 00:07:24,378 --> 00:07:27,165 So it is very possible, but it's important to be honest with yourself as well. 155 00:07:27,990 --> 00:07:30,720 Sam: And if you're looking for locums opportunities, do they 156 00:07:30,720 --> 00:07:34,785 generally tend to be more of the single coverage type because they're 157 00:07:35,005 --> 00:07:36,345 in different types of hospitals? 158 00:07:36,780 --> 00:07:38,190 Ali: Can be, but not necessarily. 159 00:07:38,290 --> 00:07:41,710 Critical access hospitals and hospitals that are remote generally tend to 160 00:07:41,710 --> 00:07:43,540 have a higher need, but not always. 161 00:07:43,540 --> 00:07:45,840 Oftentimes there are satellite hospitals to a main center. 162 00:07:45,870 --> 00:07:46,090 Right. 163 00:07:46,090 --> 00:07:48,543 So it's just about looking around, it's about being informed. 164 00:07:48,573 --> 00:07:51,543 That's the one thing I tell doctors coming outta residency and as attendings 165 00:07:51,543 --> 00:07:55,563 who've been in the game for years, you have to be informed about your 166 00:07:55,563 --> 00:07:57,103 options and know what's out there. 167 00:07:57,683 --> 00:08:00,663 If you don't know what's out there, you're going to undervalue yourself, or you're 168 00:08:00,663 --> 00:08:03,663 gonna put yourself in a position where you're underpaid, put at the wrong site 169 00:08:03,933 --> 00:08:05,913 that's understaffed and get screwed. 170 00:08:05,923 --> 00:08:08,413 You can walk on some landmines if you're not informed. 171 00:08:09,103 --> 00:08:12,463 That's why it's important to educate yourself about the career options 172 00:08:12,463 --> 00:08:13,993 that you have in front of you. 173 00:08:14,113 --> 00:08:17,173 You don't have to take the locums, but you should know what it is. 174 00:08:17,173 --> 00:08:18,873 You should understand what the benefits are, what the 175 00:08:18,873 --> 00:08:20,063 disadvantages are, and so on. 176 00:08:20,723 --> 00:08:25,398 When you're not informed is when you make decisions that can compromise your 177 00:08:25,398 --> 00:08:28,218 wellbeing and your happiness and could lead to burnout and things like that. 178 00:08:28,218 --> 00:08:31,998 So extremely important for us to approach our careers, not on autopilot, 179 00:08:32,328 --> 00:08:35,718 but thinking intentionally about what it is that I'm doing, why am 180 00:08:35,718 --> 00:08:39,468 I doing it, and is it going to lead to fulfillment in 10, 15, 20 years? 181 00:08:40,400 --> 00:08:45,270 Sam: So if someone is considering a locums career and then say, has 182 00:08:45,270 --> 00:08:46,470 a family, do you have a family? 183 00:08:46,500 --> 00:08:47,430 You have children. 184 00:08:47,820 --> 00:08:49,440 So how do you handle that with locums? 185 00:08:49,440 --> 00:08:53,500 Does that have you traveling more say than a W2 position might and how do 186 00:08:53,500 --> 00:08:54,880 you work that into your family life? 187 00:08:54,885 --> 00:08:55,695 Ali: Great question. 188 00:08:55,695 --> 00:08:58,605 I get this all the time, Ali, I do locums, but I have a family. 189 00:08:59,205 --> 00:08:59,535 Okay. 190 00:09:00,225 --> 00:09:01,785 Now everyone's family is different. 191 00:09:01,785 --> 00:09:05,115 I can't say that each situation is copy and paste and you 192 00:09:05,115 --> 00:09:06,315 can do the exact same thing. 193 00:09:07,095 --> 00:09:09,135 But I'll tell you this, yes, I'm a father. 194 00:09:09,135 --> 00:09:09,825 I travel. 195 00:09:09,895 --> 00:09:11,515 I'll tell you example of a mom that works with us. 196 00:09:11,515 --> 00:09:12,475 She has five children. 197 00:09:13,095 --> 00:09:17,565 She works full-time locums now because she says it gives her actually, so two things. 198 00:09:18,360 --> 00:09:20,940 One, it gives her time to decompress between shifts. 199 00:09:21,990 --> 00:09:23,970 Again, ER, no one understands what we do. 200 00:09:24,553 --> 00:09:27,193 When you go home from an ER shift, you need a breather. 201 00:09:27,583 --> 00:09:29,593 You need to take a little bit of time to relax. 202 00:09:29,593 --> 00:09:30,373 I still work clinically. 203 00:09:30,373 --> 00:09:31,393 I still work a hundred hours a month. 204 00:09:32,063 --> 00:09:35,743 So your family, when you get home, is expecting you to be on the 205 00:09:35,743 --> 00:09:36,763 moment you walk through the door. 206 00:09:36,763 --> 00:09:39,643 Your kids aren't gonna give you some time to just chill and relax and 207 00:09:39,643 --> 00:09:40,933 drink your tea and whatever, right? 208 00:09:41,743 --> 00:09:42,673 You gotta put 'em to bed. 209 00:09:42,673 --> 00:09:43,593 You gotta make them meals. 210 00:09:43,593 --> 00:09:44,193 They're waiting for you. 211 00:09:44,193 --> 00:09:45,093 You've been gone all day. 212 00:09:45,520 --> 00:09:47,770 You got responsibilities the moment you walk through that door. 213 00:09:48,463 --> 00:09:51,283 Your spouse may not understand what you're going through. 214 00:09:51,313 --> 00:09:53,763 If they don't work in the ER as a doctor or a nurse or something, they don't 215 00:09:53,763 --> 00:09:55,053 get it, and you can't expect them to. 216 00:09:55,533 --> 00:09:57,303 So they're not gonna understand that they need to give you a little 217 00:09:57,303 --> 00:09:58,773 bit of time to decompress as well. 218 00:09:58,773 --> 00:10:01,893 So she said, this is the only time I get to myself and I love it. 219 00:10:02,373 --> 00:10:05,523 So in between shifts, you'll work like four or five shifts in a row, 220 00:10:05,583 --> 00:10:07,263 stay at the hotel, and guess what? 221 00:10:07,263 --> 00:10:08,193 She has time to herself. 222 00:10:09,078 --> 00:10:12,198 She never gets time to herself besides the locum shifts that she's working, 223 00:10:12,556 --> 00:10:14,146 and so she absolutely loves it. 224 00:10:14,146 --> 00:10:18,063 Now what a lot of doctors do, and I did this as well, is that during 225 00:10:18,063 --> 00:10:21,093 the times that we're away, we'll get additional help for our spouse. 226 00:10:21,093 --> 00:10:22,173 Her spouse works from home. 227 00:10:22,763 --> 00:10:27,043 His job is remote, and they're able to get a nanny or babysitter or some extra 228 00:10:27,043 --> 00:10:28,737 help or extra care during those days. 229 00:10:28,767 --> 00:10:29,908 So that's one way to do it. 230 00:10:30,568 --> 00:10:33,358 Another benefit of that is I think it actually helps strengthen relationships 231 00:10:33,468 --> 00:10:34,848 Being gone for a period of time. 232 00:10:34,848 --> 00:10:37,398 When you come back, you look forward to seeing your spouse and your kids. 233 00:10:37,428 --> 00:10:39,978 It is a little bit stressful when you need to decompress and you can't. 234 00:10:39,978 --> 00:10:40,188 Right. 235 00:10:40,188 --> 00:10:42,198 And you're just all in each other's faces all the time. 236 00:10:42,648 --> 00:10:45,138 So I've actually found in my experience and other people who've 237 00:10:45,138 --> 00:10:46,668 done it, like it actually helps. 238 00:10:47,028 --> 00:10:48,858 Have a little bit of distance, a little bit of time away. 239 00:10:49,068 --> 00:10:51,828 Then when you come back, you're, you know, they say absence 240 00:10:52,108 --> 00:10:53,248 makes the heart fonder, right? 241 00:10:53,728 --> 00:10:56,158 And so that's another benefit of it as well. 242 00:10:56,872 --> 00:10:59,052 And not to mention, that was last year, I told you how 243 00:10:59,052 --> 00:11:00,432 much I made 500 plus thousand. 244 00:11:00,882 --> 00:11:04,072 This year I'm working only eight shifts a month and I'm on 245 00:11:04,072 --> 00:11:06,232 target to make over $380,000. 246 00:11:06,982 --> 00:11:07,732 Eight shifts a month. 247 00:11:07,762 --> 00:11:10,852 So I wish I could show you my schedule, but I work them all in one block. 248 00:11:12,352 --> 00:11:15,232 I'm in the middle right now of a five week vacation. 249 00:11:15,972 --> 00:11:16,192 Sam: Wow. 250 00:11:16,992 --> 00:11:18,462 Ali: And I do this every other month now. 251 00:11:18,462 --> 00:11:19,722 I take four weeks off at a time. 252 00:11:19,782 --> 00:11:20,622 I work my block. 253 00:11:20,622 --> 00:11:23,622 So I'm working until, I'm off until August 23rd. 254 00:11:23,622 --> 00:11:24,912 I think 24th is my first shift. 255 00:11:24,912 --> 00:11:26,282 I've been off since I think early July. 256 00:11:26,282 --> 00:11:27,172 I don't even remember. 257 00:11:27,172 --> 00:11:27,712 I traveled the world. 258 00:11:27,712 --> 00:11:31,177 I was in Tunisia, I was in London, I was in Switzerland, Portugal. 259 00:11:31,177 --> 00:11:31,897 I just got back. 260 00:11:31,897 --> 00:11:33,037 I still have two weeks off. 261 00:11:33,637 --> 00:11:34,237 Do you understand? 262 00:11:34,602 --> 00:11:34,662 Sam: Yeah. 263 00:11:34,662 --> 00:11:38,077 Ali: I have more time with my family than any one of my colleagues does, 264 00:11:38,447 --> 00:11:39,537 and I get paid more than them. 265 00:11:40,327 --> 00:11:41,647 So I can do whatever I want. 266 00:11:41,647 --> 00:11:44,257 I can work eight shifts a month and still make more. 267 00:11:44,880 --> 00:11:46,953 Or if I wanna make more money and just stack up my cash and, 268 00:11:46,953 --> 00:11:49,443 you know, invest or buy a house or whatever, I can do that too. 269 00:11:50,418 --> 00:11:54,458 Sam: So when you work your eight shift, you're doing that in one large block to 270 00:11:54,458 --> 00:11:56,078 accumulate that the rest of the time off. 271 00:11:56,168 --> 00:11:57,308 Ali: Eight, 12 hour shifts. 272 00:11:57,388 --> 00:12:01,698 I make $330 an hour, and over the course of a year, if you just add 273 00:12:01,698 --> 00:12:03,858 that up, do the math, it's $380,000. 274 00:12:03,858 --> 00:12:05,538 And people might say, well, I can't do eight shifts. 275 00:12:06,018 --> 00:12:08,598 You can, if you know you have four or five weeks off right after that. 276 00:12:08,598 --> 00:12:08,928 Right? 277 00:12:09,168 --> 00:12:11,178 And in between shifts, I optimize for sleep. 278 00:12:11,538 --> 00:12:12,678 For recovery. 279 00:12:12,948 --> 00:12:16,328 I'm not doing a lot of things between on those shifts, that eight shifts block. 280 00:12:16,698 --> 00:12:18,325 I work some nights as well in that block. 281 00:12:18,365 --> 00:12:19,865 You know, there's not enough productivity on me. 282 00:12:19,865 --> 00:12:24,815 I don't see my family sure for eight days, but for 30 plus days, I am. 283 00:12:25,625 --> 00:12:25,985 Right. 284 00:12:25,985 --> 00:12:27,045 And I'm actually there. 285 00:12:27,695 --> 00:12:30,095 So people talk about this idea like, are you really present 286 00:12:30,095 --> 00:12:31,325 when you're home between shifts? 287 00:12:31,375 --> 00:12:32,545 Oh yeah, I wanna be home every day. 288 00:12:33,265 --> 00:12:33,505 Okay. 289 00:12:33,505 --> 00:12:35,890 Is that just something you were told because that's what the expectation 290 00:12:35,890 --> 00:12:37,720 is, because that's what the norm is? 291 00:12:38,140 --> 00:12:41,067 Or is it actually good for you being home after a shift when 292 00:12:41,067 --> 00:12:42,027 you're tired and burnt out. 293 00:12:42,332 --> 00:12:42,512 Sam: Hmm. 294 00:12:42,552 --> 00:12:45,507 Ali: I just need a freaking break versus working a stretch of shifts 295 00:12:45,507 --> 00:12:49,587 being away then coming back and being, Hey, I'm home for 30 days, I'm good. 296 00:12:49,887 --> 00:12:50,277 Right? 297 00:12:50,637 --> 00:12:50,967 I don't know. 298 00:12:51,027 --> 00:12:52,467 I think people have it twisted. 299 00:12:52,467 --> 00:12:53,517 They just don't know what they don't know. 300 00:12:54,342 --> 00:12:56,802 Sam: And when you do your stretch of eight, for example, is that 301 00:12:56,802 --> 00:12:58,692 all in one facility, one location? 302 00:12:59,142 --> 00:12:59,952 Ali: So I've been fortunate. 303 00:12:59,952 --> 00:13:03,715 I've been at this site in Delaware for about six years as a locum. 304 00:13:04,225 --> 00:13:04,455 Sam: Wow. 305 00:13:04,455 --> 00:13:06,915 Ali: The last three years as pretty much full-time, meaning 306 00:13:06,915 --> 00:13:08,275 I work there exclusively. 307 00:13:08,515 --> 00:13:11,365 I am credentialed at a couple of other sites and the game for locum 308 00:13:11,365 --> 00:13:14,815 is always, you gotta be credentialed at least two, ideally three sites at 309 00:13:14,815 --> 00:13:17,785 any given time in case one dries up, you can always work at another one. 310 00:13:17,785 --> 00:13:18,715 So you're never out of a job. 311 00:13:18,715 --> 00:13:21,005 That's what people say, oh, locums is unstable. 312 00:13:21,335 --> 00:13:24,485 It's not if you play the game and I've been playing it for 10 years and I'm a pro 313 00:13:24,485 --> 00:13:26,315 at it, so I can teach you a thing or two. 314 00:13:27,395 --> 00:13:30,242 Sam: So when you say you've been at the same facility for six years, are 315 00:13:30,242 --> 00:13:33,512 you the only locums person and is everybody else a W2 or is it just kinda 316 00:13:33,512 --> 00:13:35,122 a mix or how does that work exactly? 317 00:13:35,702 --> 00:13:38,012 Ali: Well, I've been there longer than most of their full-timers 318 00:13:38,267 --> 00:13:38,777 Sam: Wow. 319 00:13:38,822 --> 00:13:40,202 Ali: I'm definitely not the only locum there. 320 00:13:40,302 --> 00:13:42,132 So yeah, there's a bunch of other locums. 321 00:13:42,132 --> 00:13:44,189 As a matter of fact, I have a staffing company as well. 322 00:13:44,219 --> 00:13:45,179 It's called Locum United. 323 00:13:45,179 --> 00:13:46,529 I started that eight years ago. 324 00:13:46,879 --> 00:13:49,399 And so we have a few other docs that work there through our staffing 325 00:13:49,399 --> 00:13:52,069 company to help, and people always have this idea, if I may add that, 326 00:13:52,924 --> 00:13:54,724 locum is only at dumpster fire sites. 327 00:13:54,754 --> 00:13:56,224 This is another common misconception. 328 00:13:56,224 --> 00:13:58,594 I think a lot of residents, when I see them they ask me this question, Hey, 329 00:13:58,594 --> 00:13:59,734 are they only at dumpster fire sites? 330 00:13:59,734 --> 00:14:01,444 Because I think that's the thing that gets passed around 331 00:14:01,659 --> 00:14:02,029 Sam: Sure. 332 00:14:02,179 --> 00:14:03,784 Ali: from attendings who don't know any better, who've never done it. 333 00:14:04,541 --> 00:14:07,401 And I've been at, if I've been doing it for 10 years full time, now it's 11. 334 00:14:08,111 --> 00:14:11,921 I've been at a dozen plus sites in the last 10 years, and only one, 335 00:14:11,921 --> 00:14:15,371 which was the first one I went to, was a dumpster fire site, which was 336 00:14:15,371 --> 00:14:17,651 understaffed and just complete chaos. 337 00:14:17,651 --> 00:14:21,251 And that was from another company that is big name company that's out 338 00:14:21,251 --> 00:14:22,421 there that put me at this place. 339 00:14:22,481 --> 00:14:24,371 And that's the reason why I actually started my own company 340 00:14:24,371 --> 00:14:25,121 because like, you know what? 341 00:14:25,511 --> 00:14:27,011 I'm not gonna do any doctor like they did me. 342 00:14:27,131 --> 00:14:27,491 You know? 343 00:14:27,881 --> 00:14:28,721 And so I started my own. 344 00:14:28,721 --> 00:14:31,028 I was like, yeah, I'm gonna pay my doctors good and I'm gonna 345 00:14:31,028 --> 00:14:32,138 send 'em to sites I would work at. 346 00:14:33,443 --> 00:14:39,003 Sam: So I could see maybe years ago where, you know, staffing shortages were 347 00:14:39,003 --> 00:14:44,603 not as bad and people could become W2 employees and stick around for a while. 348 00:14:44,753 --> 00:14:47,753 The only sites that couldn't hire people would be those dumpster 349 00:14:47,753 --> 00:14:48,863 fire places, as you said. 350 00:14:49,133 --> 00:14:52,343 But now, you know, national shortage, emergency physicians 351 00:14:52,343 --> 00:14:54,023 are in high demand everywhere. 352 00:14:54,333 --> 00:14:57,413 So you're saying you could actually get a locums position in a larger 353 00:14:57,413 --> 00:14:59,843 city, maybe like an urban center even. 354 00:15:00,113 --> 00:15:02,723 And sometimes they're temporary and sometimes, like in your 355 00:15:02,723 --> 00:15:03,533 Delaware case, they're not. 356 00:15:04,723 --> 00:15:07,313 Ali: Most of the sites I've worked at and everything's about geography, 357 00:15:07,313 --> 00:15:11,519 so like you said, there's a supply and demand tension here, right? 358 00:15:11,999 --> 00:15:13,919 Less supply of doctors, high demand. 359 00:15:14,469 --> 00:15:17,669 Now doctors, we don't understand or we've forgotten basic economics. 360 00:15:17,699 --> 00:15:20,009 When that happens, you can demand a higher price. 361 00:15:20,259 --> 00:15:23,139 But we let the hospital dictate to us what they're gonna pay us and 362 00:15:23,139 --> 00:15:25,236 take a fraction of what we deserve. 363 00:15:25,746 --> 00:15:29,481 And so we're not playing that supply demand tension in our own favor. 364 00:15:29,541 --> 00:15:31,881 And I'm not saying we should gouge the hospital and make 365 00:15:31,881 --> 00:15:33,351 a thousand dollars an hour. 366 00:15:33,351 --> 00:15:37,401 No, I don't think that's necessarily it either, but I think what we 367 00:15:37,401 --> 00:15:39,621 do, the work that we do, we need to get compensated more for. 368 00:15:39,621 --> 00:15:42,589 I just don't think anyone else gets it, again, not admin or anything else. 369 00:15:43,369 --> 00:15:46,246 So this supply demand tension that exists, it means that there's 370 00:15:46,246 --> 00:15:48,586 gonna be hospitals all across the country that are short staffed. 371 00:15:49,216 --> 00:15:52,046 Now, if you go to maybe Hawaii, you're gonna have a hard time finding a locum 372 00:15:52,046 --> 00:15:54,626 need there because everybody wants, if they can be there and they'll take a 373 00:15:54,626 --> 00:15:57,006 much smaller salary than anyone else. 374 00:15:57,566 --> 00:16:00,646 But the big metropolitan cities, maybe just an hour, two hours 375 00:16:00,646 --> 00:16:02,746 outside of that, you'll find a lot of hospitals that need help. 376 00:16:03,091 --> 00:16:04,591 There's nothing wrong with these places. 377 00:16:04,621 --> 00:16:06,091 They run very well. 378 00:16:06,091 --> 00:16:11,401 They're actually very functional places, but they don't have the desired 379 00:16:11,401 --> 00:16:13,261 geography for people to wanna live there. 380 00:16:13,446 --> 00:16:15,435 I'll go out there and work some shifts, but I don't wanna live 381 00:16:15,435 --> 00:16:17,018 in small town, Alabama, right? 382 00:16:17,018 --> 00:16:19,208 It's just not what I wanna raise my family in. 383 00:16:19,208 --> 00:16:21,688 I don't want to build like a social network there necessarily. 384 00:16:21,688 --> 00:16:22,768 'cause all my friends live here. 385 00:16:22,918 --> 00:16:23,978 I wanna live in one place. 386 00:16:24,508 --> 00:16:26,863 I'll go work there for like four or five shifts and then come back. 387 00:16:26,983 --> 00:16:27,523 You see what I mean? 388 00:16:27,738 --> 00:16:27,938 Sam: Yeah. 389 00:16:28,153 --> 00:16:29,953 Ali: So that's really what the situation is for. 390 00:16:29,953 --> 00:16:32,643 The vast majority of sites in my experience is that 391 00:16:32,643 --> 00:16:33,483 they're just short staffed. 392 00:16:33,483 --> 00:16:36,783 They're all functioning places, but just can't find doctors who wanna stay there. 393 00:16:36,783 --> 00:16:39,393 They'll get doctors outta residency, they'll come and stay there for 394 00:16:39,393 --> 00:16:41,793 a couple years, and then they're like, what am I doing here? 395 00:16:41,933 --> 00:16:42,603 I need to go back. 396 00:16:42,603 --> 00:16:44,823 I have a kid now I need to go back to our parents where they 397 00:16:44,823 --> 00:16:45,783 live and all that stuff, you know? 398 00:16:46,593 --> 00:16:52,953 Sam: So in your personal geographic region, how far are you traveling 399 00:16:52,953 --> 00:16:54,993 routinely for your locums jobs? 400 00:16:54,993 --> 00:16:56,583 I mean, you're going, like across the country. 401 00:16:56,583 --> 00:16:57,843 Are you more regionalized? 402 00:16:57,843 --> 00:16:58,713 What's it look like for you? 403 00:16:58,998 --> 00:17:01,668 Ali: I've done it all and I've been fortunate. 404 00:17:01,668 --> 00:17:05,670 I live in Eastern Pennsylvania and 90% of my jobs have been within driving 405 00:17:05,670 --> 00:17:08,700 distance, meaning that I could drive there, stay there for a couple days. 406 00:17:08,700 --> 00:17:10,260 I couldn't drive there every day between shifts, 407 00:17:10,460 --> 00:17:10,750 Sam: Sure. 408 00:17:10,770 --> 00:17:12,780 Ali: But driving within two to three hours tops. 409 00:17:12,780 --> 00:17:16,300 So I would usually go drive and do a stretch of four to five shifts 410 00:17:16,300 --> 00:17:17,920 in a row and then come back. 411 00:17:18,355 --> 00:17:21,405 There are sites that I've gone to in Michigan and in California. 412 00:17:21,565 --> 00:17:22,615 Those are short term. 413 00:17:22,615 --> 00:17:25,148 I didn't do them as much, but some people like doing that because 414 00:17:25,148 --> 00:17:27,477 maybe they have some family or some relatives in California or they 415 00:17:27,477 --> 00:17:28,707 just wanna go visit and stay there. 416 00:17:28,707 --> 00:17:29,127 Whatever. 417 00:17:29,547 --> 00:17:30,417 Totally possible. 418 00:17:30,477 --> 00:17:33,824 And guess what the hospital pays for your travel and for your hotel. 419 00:17:33,854 --> 00:17:34,544 And guess what? 420 00:17:34,604 --> 00:17:37,154 This year, because the hospital pays for my travel, I have over 421 00:17:37,154 --> 00:17:39,104 a million Hilton Honors points. 422 00:17:39,854 --> 00:17:42,734 Which I can use for, you know, when I travel book like 423 00:17:42,734 --> 00:17:43,904 five star hotels for free. 424 00:17:44,264 --> 00:17:49,694 And that adds up to about $20,000 a year and just free travel stipend essentially. 425 00:17:50,004 --> 00:17:52,464 There's all these cool little perks that you can do and you don't have to 426 00:17:52,524 --> 00:17:53,874 get on a plane if you don't want to. 427 00:17:53,904 --> 00:17:56,964 It depends where you do live, but most places, say you live in Dallas. 428 00:17:57,634 --> 00:18:00,854 I get jobs, opportunities, and things , you know, we're an hour outside of 429 00:18:00,854 --> 00:18:02,054 Dallas, two hours outside of Dallas. 430 00:18:02,054 --> 00:18:04,864 So you can live there if you see that you want to, but just drive 431 00:18:04,864 --> 00:18:07,045 out, stay there for a couple days and come back and you're done. 432 00:18:07,754 --> 00:18:11,114 Sam: All right, so let's talk about some of the practical day-to-day matters 433 00:18:11,114 --> 00:18:12,660 of being a independent contractor. 434 00:18:12,660 --> 00:18:15,570 So you've been fortunate enough to go back to some of the same hospitals 435 00:18:15,570 --> 00:18:19,050 again and again, but let's say you're in this position and you're working 436 00:18:19,050 --> 00:18:25,120 multiple hospitals, how do you adjust to different EMRs and different 437 00:18:25,120 --> 00:18:29,530 consultants and trying to understand the flow of and how things are done at 438 00:18:29,530 --> 00:18:32,960 each department without being someone who's been there for a while already. 439 00:18:33,745 --> 00:18:35,782 Ali: You're gonna get butterflies for your first shift or two. 440 00:18:35,782 --> 00:18:38,742 And it's because you know the medicine, but you don't know the system, so you 441 00:18:38,742 --> 00:18:40,122 just kind of feel somewhat handicapped. 442 00:18:40,392 --> 00:18:40,692 Sam: Yeah. 443 00:18:40,992 --> 00:18:43,272 Ali: I, again, having done it for at least 12 times in the last 10 444 00:18:43,332 --> 00:18:44,652 years, it takes about two weeks. 445 00:18:45,252 --> 00:18:46,962 Two weeks of consistency working there. 446 00:18:46,992 --> 00:18:50,772 You will get a hang of the system, who to consult, what the EMR is like. 447 00:18:51,122 --> 00:18:53,102 And you'll be more or less independent. 448 00:18:53,192 --> 00:18:56,822 And usually hospitals, when you come on early, they recognize that you're 449 00:18:56,822 --> 00:18:59,162 gonna be somewhat handicapped because they know it's a new system for you. 450 00:18:59,192 --> 00:19:01,052 So they'll usually have some leeway. 451 00:19:01,539 --> 00:19:02,409 So yeah, it's not that hard. 452 00:19:02,409 --> 00:19:03,699 I mean, we're smart people generally. 453 00:19:03,699 --> 00:19:06,712 The EMRs, yeah, some are harder to learn than others, but as long as you're 454 00:19:06,712 --> 00:19:10,102 going there consistently and not taking months off between shifts for your 455 00:19:10,102 --> 00:19:12,142 locum, because then you're not gonna remember the system when you go back. 456 00:19:12,142 --> 00:19:12,232 Right? 457 00:19:12,247 --> 00:19:12,697 Sam: Yeah. 458 00:19:12,992 --> 00:19:15,472 Ali: So there has to be some level of consistency. 459 00:19:15,472 --> 00:19:17,662 But if it's Epic and you use Epic at home, then it shouldn't 460 00:19:17,662 --> 00:19:18,472 be that big a deal, right? 461 00:19:18,532 --> 00:19:20,032 Or whatever EMR that you use. 462 00:19:20,817 --> 00:19:26,497 Sam: So after say two weeks of being at a facility, then there is some advantage 463 00:19:26,497 --> 00:19:30,157 to going back to that same center, you know, a few more times if you have the 464 00:19:30,157 --> 00:19:32,217 option to in your locums geography. 465 00:19:32,517 --> 00:19:34,707 Ali: Yeah, and also remember, credentialing takes forever. 466 00:19:34,707 --> 00:19:35,997 It's a pain in the butt, dude. 467 00:19:36,047 --> 00:19:38,327 If there's one negative to locums, it's credentialing. 468 00:19:38,490 --> 00:19:40,350 I hate credentialing. 469 00:19:40,380 --> 00:19:43,679 It's the most painful thing that I think physicians have to do, even the 470 00:19:43,903 --> 00:19:45,253 ER work is less painful in my opinion. 471 00:19:45,683 --> 00:19:46,403 I guess that's debatable. 472 00:19:46,566 --> 00:19:49,246 And the reason is because these hospitals have these antiquated 473 00:19:49,246 --> 00:19:51,667 credentialing requirements for the most ridiculous things. 474 00:19:52,117 --> 00:19:54,097 And then you'll send it to them and then they'll say that they didn't 475 00:19:54,097 --> 00:19:56,437 get it, but you sent it to 'em two weeks ago, you can show 'em the email 476 00:19:56,437 --> 00:19:57,907 like, oh, well can you send it again? 477 00:19:58,327 --> 00:20:00,967 And so the way that I tell doctors and the way that I train them inside 478 00:20:00,967 --> 00:20:06,787 our training community Locum OS is create a Google folder and have sub 479 00:20:06,787 --> 00:20:08,917 tabs in that folder for each thing. 480 00:20:08,917 --> 00:20:15,464 So for licenses, your DEAs, your residency diploma, health documents, all those 481 00:20:15,464 --> 00:20:18,314 things, so that way anytime you start a new credentialing package, you have 482 00:20:18,314 --> 00:20:21,960 all that data ready and it's easy to plug and play because otherwise, if 483 00:20:21,960 --> 00:20:24,090 you're trying to figure out through your emails, try to find all this 484 00:20:24,090 --> 00:20:25,300 stuff, it's never gonna get done. 485 00:20:25,675 --> 00:20:26,065 Sam: Yeah. 486 00:20:26,730 --> 00:20:27,020 Okay. 487 00:20:27,085 --> 00:20:28,375 So it takes a little organization. 488 00:20:28,625 --> 00:20:29,235 I can see that. 489 00:20:29,345 --> 00:20:29,835 Ali: A bit 490 00:20:30,885 --> 00:20:31,585 Sam: It takes a little bit 491 00:20:31,690 --> 00:20:34,270 Ali: Organization and you'll be done, you'll be set for life. 492 00:20:34,943 --> 00:20:36,347 Sam: Okay so you have an interest. 493 00:20:36,487 --> 00:20:39,191 Maybe you are ready to do some traveling or you're not 494 00:20:39,191 --> 00:20:40,781 objecting to any of the traveling. 495 00:20:40,841 --> 00:20:45,011 You gotta spend a couple of weeks at each place to kinda get the lay of the land. 496 00:20:45,371 --> 00:20:47,771 You've got your EMRs you can adjust to. 497 00:20:48,091 --> 00:20:52,256 Do you think the majority of independent contractors are out there working on 498 00:20:52,256 --> 00:20:55,956 their own, or are they working with say like locum staffing companies where you 499 00:20:55,956 --> 00:20:59,556 get to know some people who are kind of regionally doing the same thing? 500 00:20:59,556 --> 00:21:01,186 Or in your experience, how has that worked out? 501 00:21:01,426 --> 00:21:02,926 Ali: Usually it's through locums companies. 502 00:21:02,956 --> 00:21:05,356 And I've tried going directly as well. 503 00:21:05,356 --> 00:21:08,296 This was one of the things, 'cause when I had my first job and my bad experience, 504 00:21:08,296 --> 00:21:10,186 I was like, you know what, I'm just gonna contact hospitals directly. 505 00:21:10,606 --> 00:21:13,246 And I tried doing that and that's a big pain too because you can't 506 00:21:13,246 --> 00:21:14,416 find the right person to talk to. 507 00:21:15,039 --> 00:21:19,239 Also if you do, they'll say, well, we don't contract directly and you 508 00:21:19,239 --> 00:21:22,269 have to work through X locum company or this vendor management system. 509 00:21:22,594 --> 00:21:22,814 Sam: Okay. 510 00:21:22,854 --> 00:21:24,489 Ali: Some hospitals will take you directly. 511 00:21:24,489 --> 00:21:27,369 And so I know doctors that do do that and they'll spend the time to do it. 512 00:21:27,819 --> 00:21:31,749 But the land mind of what working with the locums companies is getting underpaid, 513 00:21:31,749 --> 00:21:34,179 getting sent to the wrong sites and then playing games with you, right? 514 00:21:34,519 --> 00:21:37,399 I know many doctors who I've worked with side by side at sites and they're 515 00:21:37,399 --> 00:21:41,239 getting paid $50 per hour less than I am because I take care of my docs. 516 00:21:41,239 --> 00:21:43,909 I make sure that we get paid top dollar going in, right? 517 00:21:43,939 --> 00:21:45,919 We don't have to negotiate or figure out what your worth is. 518 00:21:46,369 --> 00:21:49,129 Whereas this other locums company, remember traditional locums companies, 519 00:21:49,592 --> 00:21:51,572 they have recruiters on their team, right? 520 00:21:51,872 --> 00:21:52,172 Sam: Right. 521 00:21:52,457 --> 00:21:53,927 Ali: I don't have any recruiters on our team. 522 00:21:53,987 --> 00:21:54,767 I am the recruiter. 523 00:21:54,797 --> 00:22:01,084 So their incentive is, okay, so say a doctor says I'll take 200 per hour, but 524 00:22:01,084 --> 00:22:02,554 say they're billing the hospital 400. 525 00:22:03,014 --> 00:22:04,514 Huge commission, right? 526 00:22:04,864 --> 00:22:06,604 If a doctor says, Hey, I want 300. 527 00:22:06,934 --> 00:22:08,194 So there's a smaller commission there. 528 00:22:08,244 --> 00:22:08,574 Sam: Yeah. 529 00:22:08,694 --> 00:22:11,982 Ali: Their goal is to low volume and pray and hope that you 530 00:22:11,982 --> 00:22:12,912 don't know what your value is. 531 00:22:13,422 --> 00:22:13,782 Sam: Wow. 532 00:22:14,142 --> 00:22:16,152 Ali: And so most doctors, like myself, I was a sucker. 533 00:22:16,152 --> 00:22:16,992 I didn't know what my worth was. 534 00:22:16,992 --> 00:22:18,672 I took the $200 per hour job. 535 00:22:18,672 --> 00:22:19,032 I did. 536 00:22:19,062 --> 00:22:20,132 That was my first one I took. 537 00:22:20,582 --> 00:22:23,442 And later on I was like, oh dude, I probably left 50 to a hundred 538 00:22:23,562 --> 00:22:24,702 thousand plus on the table. 539 00:22:24,702 --> 00:22:26,776 Just 'cause I didn't know I should have asked for 300. 540 00:22:26,776 --> 00:22:27,106 Right? 541 00:22:27,421 --> 00:22:27,721 Sam: All right. 542 00:22:27,796 --> 00:22:28,756 Ali: We're not good negotiators. 543 00:22:28,756 --> 00:22:29,686 We've been in medicine. 544 00:22:29,941 --> 00:22:30,391 Sam: Yeah. 545 00:22:30,556 --> 00:22:32,866 Ali: One way thinking we don't know negotiating skills and all. 546 00:22:33,046 --> 00:22:36,576 I mean, we're very much in many ways infantile and very juvenile in many ways 547 00:22:36,966 --> 00:22:42,409 because we've trained very highly and very deeply in one thing, but nothing else. 548 00:22:43,066 --> 00:22:45,901 Sam: Yeah, I mean, we don't go to business school, so it's not in the curriculum. 549 00:22:46,216 --> 00:22:48,106 Ali: Very underdeveloped in other ways. 550 00:22:48,106 --> 00:22:50,386 And so that's part of the thing I'm also teaching doctors is start 551 00:22:50,386 --> 00:22:52,126 developing yourself in other realms. 552 00:22:52,380 --> 00:22:53,130 Whatever it is. 553 00:22:53,130 --> 00:22:54,450 Just like in terms of leadership. 554 00:22:54,450 --> 00:22:56,750 In terms of entrepreneurship, in terms about just setting 555 00:22:56,750 --> 00:22:58,820 boundaries for yourself and knowing what your're worth actually is. 556 00:22:58,820 --> 00:22:59,120 Right. 557 00:22:59,540 --> 00:23:02,318 And because you miss out on that for 10 years of things that you would 558 00:23:02,318 --> 00:23:03,608 learn in the real world I guess. 559 00:23:03,978 --> 00:23:05,988 If you were to take a job or take an offer, do a counter 560 00:23:05,988 --> 00:23:06,888 offer, things like that. 561 00:23:06,888 --> 00:23:09,530 We don't think that way because we're just thinking about how to save lives 562 00:23:09,885 --> 00:23:10,095 Sam: Yeah. 563 00:23:10,095 --> 00:23:11,185 Ali: And how to do this intubation. 564 00:23:11,210 --> 00:23:12,813 And if this doesn't go well, what's my next step? 565 00:23:12,813 --> 00:23:13,563 All those type of things. 566 00:23:13,563 --> 00:23:15,503 We're thinking algorithmically, what are we doing next? 567 00:23:16,123 --> 00:23:19,923 And so there's no training for doctors once they graduate residency. 568 00:23:19,923 --> 00:23:21,933 After you're done you're on your own. 569 00:23:22,388 --> 00:23:22,718 Sam: Right. 570 00:23:22,823 --> 00:23:26,333 Ali: So now you have to just figure out things and trial and error. 571 00:23:26,333 --> 00:23:26,903 That's what I did. 572 00:23:26,903 --> 00:23:27,743 I didn't know any better. 573 00:23:28,193 --> 00:23:32,103 But it's important to try to find, I think, people who are where you 574 00:23:32,103 --> 00:23:37,733 want to be and try to see how they did what they did, because otherwise 575 00:23:37,733 --> 00:23:39,143 you're gonna make the same mistakes. 576 00:23:39,173 --> 00:23:41,083 And those are costly mistakes that I made. 577 00:23:41,083 --> 00:23:44,263 I'm just trying to teach people how not to make those mistakes that I made because I 578 00:23:44,263 --> 00:23:45,583 could be much further ahead if I didn't. 579 00:23:46,543 --> 00:23:51,453 Sam: So then picking the right locums company is critical in this scenario. 580 00:23:51,453 --> 00:23:55,583 Like one you can trust, but also one you can negotiate with in this, and 581 00:23:55,583 --> 00:23:56,648 one that you're not desperate for. 582 00:23:56,893 --> 00:23:59,758 Ali: And to be clear, look, I would love for people to work with our company, but 583 00:23:59,768 --> 00:24:02,708 I logistically can't place every single doctor because we have limited number of 584 00:24:02,708 --> 00:24:04,268 jobs and we do get those placed quickly. 585 00:24:04,548 --> 00:24:07,273 But what's more important is that you know what your worth is and what your value is. 586 00:24:07,773 --> 00:24:07,893 Sam: Hmm. 587 00:24:08,028 --> 00:24:11,058 Ali: Right, so I tell ER docs, if you're working at a site, 588 00:24:11,058 --> 00:24:13,473 generally speaking, don't take anything less than $300 per hour. 589 00:24:14,122 --> 00:24:16,642 If it is 10 99, don't take less than $300 per hour. 590 00:24:17,062 --> 00:24:19,882 Now, the caveat to that is if you're working at a 24 hour shift 591 00:24:19,912 --> 00:24:22,612 at a small critical access hospital that only sees four patients a day. 592 00:24:22,942 --> 00:24:25,672 Those are sometimes a little less than that, like maybe in the two hundreds 593 00:24:25,672 --> 00:24:30,192 or so, but beyond that, 300 should be your baseline and then go up from there. 594 00:24:30,545 --> 00:24:32,695 I dunno if you're familiar with the EM doc jobs Facebook group. 595 00:24:32,975 --> 00:24:33,965 And on our newsletter as well. 596 00:24:33,965 --> 00:24:36,668 So we post these jobs in there and our jobs have been 597 00:24:36,668 --> 00:24:40,148 up to 330, 350 per hour, 75. 598 00:24:40,218 --> 00:24:41,828 We even posted one last year for 400. 599 00:24:41,878 --> 00:24:45,538 My goal is to just pay docs what our value is, what our worth is. 600 00:24:45,808 --> 00:24:49,908 So that way, honestly, like we can set ourselves up for success outside of the 601 00:24:49,908 --> 00:24:54,528 walls of the hospital because I want us to have good, happy, long fulfilling careers. 602 00:24:55,272 --> 00:24:59,772 Sam: So when you, as a independent contractor, register with a locums 603 00:24:59,772 --> 00:25:03,212 company, you're contracting with them and then they go off and contract 604 00:25:03,212 --> 00:25:05,822 with the hospital for however many hours you're going to work. 605 00:25:06,042 --> 00:25:09,872 But does that require any kind of exclusive agreement with a locums company? 606 00:25:09,872 --> 00:25:11,472 Or can you contract with multiple ones? 607 00:25:11,472 --> 00:25:12,582 How does that generally work? 608 00:25:13,242 --> 00:25:13,892 Ali: Very good point. 609 00:25:14,732 --> 00:25:15,982 Caution to everyone. 610 00:25:16,842 --> 00:25:21,383 Do not share your CV with any recruiter until you're a hundred 611 00:25:21,383 --> 00:25:24,053 percent sure that you want to be working at that particular site. 612 00:25:24,833 --> 00:25:29,213 And also make it clear to them that you only want your CV presented 613 00:25:29,213 --> 00:25:30,563 to that one singular site. 614 00:25:31,058 --> 00:25:33,698 There's so many shady tactics that I've seen in the industry. 615 00:25:33,998 --> 00:25:37,478 What some rookie recruiters will do is that they'll take your CV and they'll 616 00:25:37,478 --> 00:25:40,118 just shotgun it to a bunch of places without your permission, or maybe 617 00:25:40,118 --> 00:25:42,158 you said, Hey, you can send this one site, but let's send it to a bunch. 618 00:25:42,638 --> 00:25:42,718 Sam: Hmm. 619 00:25:42,758 --> 00:25:45,698 Ali: What that does is once your name has come across a credentialing 620 00:25:45,818 --> 00:25:50,798 site or facility, they have your name now on a file and now for two years, 621 00:25:50,798 --> 00:25:54,342 you cannot work at that site with any other locums company except for 622 00:25:54,342 --> 00:25:55,782 the one that presented you initially 623 00:25:55,832 --> 00:25:56,172 Sam: Interesting. 624 00:25:56,172 --> 00:25:57,122 Ali: It locks you in. 625 00:25:57,775 --> 00:25:59,150 I've had that so many times. 626 00:25:59,150 --> 00:26:01,727 I'll post one of these high paying jobs on this Facebook group and in my email list. 627 00:26:02,595 --> 00:26:04,395 And doctors will say, Hey man, I saw this job. 628 00:26:04,395 --> 00:26:04,905 Can I apply? 629 00:26:04,905 --> 00:26:05,445 I'm like, sure. 630 00:26:06,135 --> 00:26:09,465 So they apply and then we get a message back from the site like, Hey, 631 00:26:09,465 --> 00:26:10,695 this doctor's already in our system. 632 00:26:10,695 --> 00:26:11,745 They can't work there with us. 633 00:26:11,745 --> 00:26:13,185 So I message the doctor back, Hey, what happened? 634 00:26:13,525 --> 00:26:16,845 Yeah, man, like X company and I don't wanna name names, but this company 635 00:26:16,845 --> 00:26:21,439 presented me like two weeks ago for 300, but I saw the job on yours for 350. 636 00:26:21,855 --> 00:26:24,895 I'm like, yeah, unfortunately I can't do anything about that 637 00:26:25,134 --> 00:26:26,146 . The bylaws are what they are. 638 00:26:26,756 --> 00:26:28,436 And I wouldn't, because that's what the rules are. 639 00:26:28,766 --> 00:26:30,346 I cautioned docs to do your homework. 640 00:26:30,346 --> 00:26:32,861 Make sure you know where you're going, how much you should get paid, do some 641 00:26:32,861 --> 00:26:36,581 research, go to Facebook, join our newsletter, just so you know what is 642 00:26:36,581 --> 00:26:38,261 out there and what rates are going. 643 00:26:38,261 --> 00:26:39,990 'cause otherwise you're gonna sell yourself short. 644 00:26:40,057 --> 00:26:45,337 Sam: So in that scenario, you send your CV to Locum Staffing Company 645 00:26:45,337 --> 00:26:49,087 X, they give it to the hospital, and then the hospital says the only way 646 00:26:49,087 --> 00:26:52,777 you can work for us is now through this company for this period of time. 647 00:26:53,077 --> 00:26:54,587 Ali: Usually it's a two year clause for that. 648 00:26:54,637 --> 00:26:57,547 Sam: And that's a clause between the hospital and the locums company. 649 00:26:57,835 --> 00:26:58,387 Ali: Yes. 650 00:26:58,447 --> 00:26:58,807 Sam: Okay. 651 00:26:58,937 --> 00:26:59,627 Ali: It's a standard clause. 652 00:26:59,677 --> 00:27:02,527 And the hospital enforces that, not the locums company. 653 00:27:02,837 --> 00:27:05,082 So technically, if the locums company didn't know about you. 654 00:27:05,502 --> 00:27:07,962 And say, for example, I just presented and the hospital said 655 00:27:07,962 --> 00:27:09,868 Yes, okay, we could do that. 656 00:27:10,348 --> 00:27:10,618 Sam: Right. 657 00:27:10,828 --> 00:27:12,238 Ali: I wouldn't, but I'm saying that's possible. 658 00:27:12,338 --> 00:27:15,578 But the hospital itself has it in their bylaws, in their system, 659 00:27:15,578 --> 00:27:16,748 like anyone that's been presented. 660 00:27:16,748 --> 00:27:18,458 'cause they have a relationship with these companies too. 661 00:27:18,728 --> 00:27:20,708 And they don't wanna burn any bridges and they don't want to do 662 00:27:20,708 --> 00:27:22,688 things that are outside 'cause then they won't get good candidates. 663 00:27:23,018 --> 00:27:23,998 So they enforce this. 664 00:27:24,612 --> 00:27:25,122 Sam: Gotcha. 665 00:27:25,822 --> 00:27:30,175 But there's nothing in the contracts that makes you exclusive to a locums companies. 666 00:27:30,185 --> 00:27:30,785 Ali: Yeah, no. 667 00:27:31,145 --> 00:27:34,295 You can work with any company as long as you haven't been sent to 668 00:27:34,355 --> 00:27:36,935 that particular site, or your name hasn't been sent over to them. 669 00:27:37,205 --> 00:27:39,275 You can work with any company at any time really. 670 00:27:39,770 --> 00:27:40,160 Sam: Awesome. 671 00:27:40,700 --> 00:27:41,120 Awesome. 672 00:27:41,240 --> 00:27:43,580 And then, all right, so now tell me about your company. 673 00:27:43,580 --> 00:27:47,725 You are staffing locums in a specific region of the US or 674 00:27:47,735 --> 00:27:49,115 how big of a blanket is it? 675 00:27:49,440 --> 00:27:50,340 Ali: So we're national. 676 00:27:50,470 --> 00:27:51,130 We're national. 677 00:27:51,130 --> 00:27:57,227 We have contracts in California, Arizona, Oklahoma, east coast, northeast, and now 678 00:27:57,227 --> 00:27:58,997 starting to venture to the south as well. 679 00:27:59,447 --> 00:28:02,414 And yeah, we have contracts all over and our contracts come and go pretty 680 00:28:02,414 --> 00:28:06,254 quickly because we post high paying jobs, like they get taken very, very fast. 681 00:28:06,644 --> 00:28:08,584 And yeah, I mean, it's a physician founded company. 682 00:28:08,584 --> 00:28:11,464 Myself and my brother, who's not a physician, we started the company 683 00:28:11,464 --> 00:28:14,244 eight years ago because of my first experience that I talked about earlier. 684 00:28:14,244 --> 00:28:14,724 It was horrible. 685 00:28:14,744 --> 00:28:14,864 Sam: Hmm. 686 00:28:15,694 --> 00:28:18,584 Ali: And I said look man, at this point, no one's watching out 687 00:28:18,604 --> 00:28:19,534 for us doctors, and no one will. 688 00:28:19,874 --> 00:28:22,424 I realized early on that no one really cares about us. 689 00:28:22,744 --> 00:28:25,758 And I don't mean that in some sort of cliche, but it is what it is, right? 690 00:28:25,758 --> 00:28:27,011 I'm not gonna try to fight the system. 691 00:28:27,061 --> 00:28:29,551 The hospital system, the corporate system doesn't care about us. 692 00:28:29,551 --> 00:28:30,581 We're just cogs in the wheel. 693 00:28:30,931 --> 00:28:34,231 We get called into the office for a potassium that we didn't correct, that 694 00:28:34,231 --> 00:28:36,121 was 3.3, you know, some BS stuff, right? 695 00:28:36,641 --> 00:28:38,515 And my same experience with that locum company. 696 00:28:38,515 --> 00:28:39,325 So I'm like, you know what? 697 00:28:40,075 --> 00:28:41,575 I've always been the type of person, like things don't have 698 00:28:41,575 --> 00:28:42,475 to be that the way that they are. 699 00:28:43,048 --> 00:28:46,158 And so what can I do to change them and I was fortunate that 700 00:28:46,158 --> 00:28:48,648 my brother has a business and finance background because I don't. 701 00:28:48,718 --> 00:28:49,362 I'm just a doc. 702 00:28:49,422 --> 00:28:53,426 I just fix people . And so we partnered up to build something that was gonna 703 00:28:53,576 --> 00:28:56,636 favor our doctors and not have them try to play the games that they had to 704 00:28:56,636 --> 00:28:58,066 play with these other locums companies. 705 00:28:58,406 --> 00:28:59,096 We're just direct. 706 00:28:59,096 --> 00:28:59,906 I still work clinically. 707 00:28:59,906 --> 00:29:02,616 Like I said, I'm not some person who's made a bunch and now I'm just chilling. 708 00:29:03,006 --> 00:29:04,146 I work clinically still. 709 00:29:04,206 --> 00:29:06,276 I make sure that we are very high touch. 710 00:29:06,276 --> 00:29:07,366 We pay them what they're worth. 711 00:29:07,426 --> 00:29:09,914 And you'll see on these various forums that people love us. 712 00:29:09,914 --> 00:29:12,194 I come to conferences, people love meeting me and saying hello. 713 00:29:12,194 --> 00:29:15,369 And you know, we post sometimes these funny little AI images 714 00:29:15,369 --> 00:29:16,646 that people like and stuff too. 715 00:29:16,646 --> 00:29:18,026 So we have a good time with it. 716 00:29:18,026 --> 00:29:21,686 I love it because I get to meet people and honestly get to change some lives. 717 00:29:22,103 --> 00:29:24,950 That's been the biggest part of and revelation for me, this year and 718 00:29:24,950 --> 00:29:27,539 last year, where I started seeing people who actually messaging me, 719 00:29:27,539 --> 00:29:28,709 saying, man, you changed my life. 720 00:29:28,819 --> 00:29:29,854 Sam: Wow, that's awesome. 721 00:29:30,304 --> 00:29:33,129 Ali: And I was like, wait, I thought I was just gonna do this locum thingy 722 00:29:33,129 --> 00:29:34,359 and now it's coming to something else. 723 00:29:34,359 --> 00:29:35,289 'cause it changed my life. 724 00:29:35,289 --> 00:29:38,062 So I guess I shouldn't be surprised that it's changed other people's lives. 725 00:29:38,512 --> 00:29:41,092 But I wasn't consciously thinking about that. 726 00:29:41,092 --> 00:29:43,732 And so now it's giving me even more meaning behind what I'm doing 727 00:29:43,762 --> 00:29:46,640 because sometimes I take it for granted what I'm doing now, having 728 00:29:46,640 --> 00:29:48,057 a month off for me is norm now. 729 00:29:48,387 --> 00:29:51,219 But seeing my colleagues and what they're going through I think that it 730 00:29:51,249 --> 00:29:54,369 hits home now when I see them saying, Hey, actually, you helped me a lot. 731 00:29:54,399 --> 00:29:54,629 It means a lot. 732 00:29:54,679 --> 00:29:55,119 Sam: Yeah. 733 00:29:55,502 --> 00:29:59,402 Okay, so one more question, sorry, about the practicality of how this is done. 734 00:29:59,402 --> 00:30:03,032 So when it comes to the malpractice insurance portion of it, is that 735 00:30:03,032 --> 00:30:05,822 something that's typically covered by the locums agency, or do you have to have 736 00:30:05,822 --> 00:30:07,532 your own as an independent contractor? 737 00:30:07,607 --> 00:30:09,591 Ali: It should be covered by your locums agency. 738 00:30:09,591 --> 00:30:10,011 Yes. 739 00:30:10,071 --> 00:30:12,511 And you know, there's been a lot of issues with malpractice with 740 00:30:12,511 --> 00:30:15,121 various large companies going under and things like that. 741 00:30:15,461 --> 00:30:19,291 Just make sure that you ask your company to offer you a certificate 742 00:30:19,291 --> 00:30:21,991 of insurance that says that, hey, if anything happens to our companies, 743 00:30:21,991 --> 00:30:22,801 that you'll still be covered. 744 00:30:23,251 --> 00:30:24,931 Yeah you shouldn't have to pay for that. 745 00:30:25,411 --> 00:30:28,321 And most companies have similar large organizations that are out there. 746 00:30:28,321 --> 00:30:31,161 They'll have a similar kind of insurance policy. 747 00:30:31,161 --> 00:30:33,141 So just make sure that you're aware of that and 748 00:30:33,191 --> 00:30:33,911 Sam: Keep track of that. 749 00:30:33,946 --> 00:30:34,516 Ali: Keep track of it. 750 00:30:34,516 --> 00:30:34,816 Yeah. 751 00:30:34,846 --> 00:30:37,416 Oh, and one thing is that when you're doing your credentialing 752 00:30:37,416 --> 00:30:40,776 on all that, make sure you have a folder for certificates of insurance. 753 00:30:40,776 --> 00:30:44,416 It's called a COI for short, because those things are almost 754 00:30:44,436 --> 00:30:46,056 impossible to chase down later on. 755 00:30:46,446 --> 00:30:46,666 Sam: Hmm. 756 00:30:46,716 --> 00:30:49,506 Ali: Sometimes hospitals shut down or someone else is coming in and you 757 00:30:49,506 --> 00:30:50,766 can't get a hold of the right person. 758 00:30:50,946 --> 00:30:53,606 You'll always get one when you first start working at a new site from the 759 00:30:53,606 --> 00:30:57,261 locums company, or say you're working with a large contract management group 760 00:30:57,261 --> 00:30:58,286 or independent group or something else. 761 00:30:58,666 --> 00:31:01,666 Just make sure every time you work on a new site, you get that certificate 762 00:31:01,666 --> 00:31:04,846 of insurance and you put it in a folder because otherwise it can be 763 00:31:04,846 --> 00:31:06,376 impossible to try trace those down. 764 00:31:06,376 --> 00:31:07,486 You'll thank me for that later. 765 00:31:08,121 --> 00:31:08,601 Sam: Awesome. 766 00:31:09,201 --> 00:31:09,531 Awesome. 767 00:31:09,561 --> 00:31:12,051 All right, well, so if someone's listening and they wanna reach out 768 00:31:12,051 --> 00:31:12,951 to you, how do they get ahold of you? 769 00:31:13,014 --> 00:31:14,244 How do they learn more about your company? 770 00:31:14,499 --> 00:31:15,399 Ali: I'm not hard to find. 771 00:31:15,429 --> 00:31:18,089 I have various social medias and things like that. 772 00:31:18,119 --> 00:31:19,599 I'm on Facebook as Ali Chaudry. 773 00:31:19,619 --> 00:31:22,919 My Instagram is @therealtopdoc. 774 00:31:23,399 --> 00:31:27,689 I have my company, which is Locums United, my staffing company, but I also have a new 775 00:31:27,689 --> 00:31:29,399 training platform that I just launched. 776 00:31:29,639 --> 00:31:33,449 And we're doing our first live webinar this month on August 27th. 777 00:31:33,849 --> 00:31:40,359 You can find out more information at thelocumos.com and you can forward slash 778 00:31:40,359 --> 00:31:44,109 workshop and you can sign up there and I'm gonna do my first live workshop where I'm 779 00:31:44,109 --> 00:31:47,680 gonna be giving away a lot of free value and a free gift for everyone who joins. 780 00:31:47,980 --> 00:31:49,810 Something I've been working on for over two years. 781 00:31:49,810 --> 00:31:50,890 I'm gonna give it away for free. 782 00:31:51,310 --> 00:31:52,120 So make sure you comment. 783 00:31:52,120 --> 00:31:53,200 I wanna see you there too, Sam. 784 00:31:53,480 --> 00:31:53,870 Sam: Awesome. 785 00:31:54,080 --> 00:31:54,380 Awesome. 786 00:31:54,380 --> 00:31:55,120 Hey I'll be there. 787 00:31:55,120 --> 00:31:55,875 I'm looking forward to it. 788 00:31:56,300 --> 00:31:56,540 All right. 789 00:31:56,540 --> 00:31:59,390 Well, Ali, thank you for taking the time, you know, in between 790 00:31:59,390 --> 00:32:03,710 your multiple weeks off to come talk to us about the locums life. 791 00:32:03,710 --> 00:32:06,830 This is some precious information for anyone who's listening, who's 792 00:32:06,830 --> 00:32:09,590 feeling the crunch in whatever emergency department you're in. 793 00:32:09,590 --> 00:32:10,340 We all feel it. 794 00:32:10,500 --> 00:32:13,920 Definitely some food for thought if you're not out there working locums already. 795 00:32:14,070 --> 00:32:17,730 And even if you are, whether you're a physician, really a PA, a nurse 796 00:32:17,730 --> 00:32:23,170 practitioner, any type of traveling locums clinician this is some solid sound advice. 797 00:32:23,170 --> 00:32:24,640 Actually one question for you. 798 00:32:24,640 --> 00:32:28,100 Are you staffing non-physicians as well, like nurse practitioners and PAs? 799 00:32:28,240 --> 00:32:31,600 Ali: We do APPs, so PAs, NPs, CRNAs as well. 800 00:32:31,650 --> 00:32:33,690 They kind of fall under the locum demographic. 801 00:32:33,740 --> 00:32:36,596 Nurses we don't do because they're a completely different kind of system. 802 00:32:36,686 --> 00:32:38,186 And I'll be at ACEP as well this year. 803 00:32:38,186 --> 00:32:39,056 We have a booth there. 804 00:32:39,296 --> 00:32:40,986 You can come find me ACEP 805 00:32:41,501 --> 00:32:41,891 Sam: Awesome. 806 00:32:42,401 --> 00:32:43,841 Alright, well thank you very much Ali. 807 00:32:43,871 --> 00:32:45,361 Really appreciate you taking the time to share with us. 808 00:32:45,361 --> 00:32:45,861 Ali: Happy to be on, man. 809 00:32:45,861 --> 00:32:46,556 Really appreciate it. 810 00:32:46,556 --> 00:32:46,946 Thank you. 811 00:32:47,626 --> 00:32:48,406 Sam: And that's a wrap. 812 00:32:48,446 --> 00:32:51,066 Thanks for joining us for this episode of EMPlify. 813 00:32:51,086 --> 00:32:55,712 I hope you found it informative, and I want to remind you that ebmedicine.net 814 00:32:55,962 --> 00:33:00,822 is your one stop shop for all of your CME needs, whether that be for emergency 815 00:33:00,822 --> 00:33:02,642 medicine or urgent care medicine. 816 00:33:02,922 --> 00:33:06,452 There are three journals, there's tons of CME, there's lots of 817 00:33:06,482 --> 00:33:10,242 courses, there's so many clinical pathways, all this information at 818 00:33:10,242 --> 00:33:13,082 your fingertips at ebmedicine.net. 819 00:33:13,482 --> 00:33:15,922 Until next time, everyone, I'm your host, Sam Ashoo. 820 00:33:16,262 --> 00:33:16,822 Be safe.