The beginning of a new year brings with it the opportunity for a fresh start and renewed commitment. We make resolutions, but often fail to create a corresponding action plan that will help us reach those goals. By summer, most of us have all but forgotten what it was that we were so excited about changing or accomplishing back in the dark, short days of January. Can 2008 be different? Could this be the year that you succeed in reaching an important professional or personal goal? Very possibly. Consider a few new ideas.

Only set one goal

It is tempting at the beginning of a new year to make a long list of everything we want to achieve—lose weight, work out regularly, get a handle on finances, keep up on medical journals, volunteer at the homeless shelter, start dating again, read the classics. Are you exhausted just reading the list? Imagine setting one important goal this year and really committing to it. What would your one goal be? What one goal, if achieved, has the potential to improve the quality of your life in many other areas? Or what is one goal that would simply be a thrill to reach?

Reviewing and signing a long-term employment agreement can be a daunting experience. Page after page of legal language plus difficult to decipher compensation formulas are enough to give you a headache and heartburn, and that is before your attorney starts poking holes in every other clause. When it comes to reviewing a locum tenens agreement, however, you can leave your analgesics and antacids in the medicine cabinet.

These agreements run, at most, a few pages and you will most likely understand every paragraph even if you don't happen to have a law degree. This does not mean, however, that you should sign an agreement or engagement letter without reviewing it carefully. The short-term nature of a locum tenens engagement and the fact that you are an independent contractor make the agreements fairly straightforward. But you are entering into a contractual business agreement, so it is important to understand what you are signing. Read your entire agreement and pay special attention to the following:

Whether you are a year out of residency or a year from retirement, there are certain career constants that you enjoy - or contend with, depending on your point of view - as a physician. Embracing ongoing career development can help ensure a satisfying and meaningful professional life. Consider these five practice guidelines.

Clinical advances keep you on your toes.

Physicians are fortunate to be in a field that is constantly changing. While it may feel daunting at times to stay up to date, lack of intellectual stimulation is never a problem. Keeping up clinically is easier than ever, thanks to the Internet. Online CME abounds in all specialty areas so that you can earn credit whether you are in the office, at home, in a hotel, or at the airport. Being able to read your favorite journal articles online makes it easy to keep up with the latest medical developments. It is important for physicians to stay current not only in clinical matters, but also with advances in information technology. More and more hospitals and clinics are converting to electronic systems, so being computer-phobic is no longer an option.

This past Spring, at the Annual NALTO® Conference in San Antonio, TX, we held a New Member Orientation Session and Reception. This was successfully attended by over 35 attendees. One of the key topics of interest was the NALTO® Credentialing Guidelines within our Standards of Best Practices. Frank Phillips, President of MDA, Inc., and current Past President of NALTO® gave the presentation.

As NALTO® Member Firms, we have agreed to uphold good industry standards of Best Practices which include the intake, credentialing, and verification of our Physician Candidates.

The interview went great. Your potential new partners were friendly and eager to show you the best of everything - within the practice, at the hospital, and in the community. You were entertained at fine restaurants. A chatty real estate agent drove you around town while boasting about the quality of the schools, the fabulous amenities in the community, and the great climate. You accept the position and 6 months later realize that the practice is on shaky ground financially, your partners are not highly thought of within the medical community, the school board is more dysfunctional than your cousin Leonard's family, and it has not stopped raining since you arrived. If I had only known, you think to yourself.

It is not uncommon for physicians, particularly young professionals, to take a first job (and even a second or third) only to find themselves disillusioned after a relatively short period of time. The reasons may be specific, or it may simply be that the practice was not a "good fit." Jumping too quickly into a permanent job is an understandable mistake, especially for doctors just out of training who are eager to get settled and start earning a living. But even mid-career physicians can be seduced into positions that turn out to be disappointing.

Negotiation often brings to mind complex transactions like selling a house or legal matters like settling a divorce or dissolving a business partnership. Even negotiating something as seemingly simple as buying a car can conjure up images of conflict. Well, there is good news when it comes to negotiating a locum tenens contract. In fact, the process is so straightforward that it usually requires very little negotiation. This is because all of the parties involved want the same thing - a qualified physician to take care of patients on a temporary basis.

The recruiter responsible for matching a doctor with a particular opportunity wants to do a good job for both the client facility or practice and for the doctor. On the one hand, the hospital or clinic has a need to fill; whereas the locum tenens physician wants to practice in a setting and geographic location that will be professionally and personally rewarding. When three motivated parties have a vested interest in seeing "the deal" come to fruition, negotiation really comes down to engaging in open, honest communication that satisfies everyone's needs.

To answer the question, "Why choose locum tenens" requires first addressing the question of who practices locum tenens as either a full-time career or on a part-time or occasional basis. In this article, we break the who question into five categories, each one followed by answers to the why question.

Just out of training

Doctors fresh out of residency or fellowship who have yet to decide where they want to settle down find that locum tenens offers an excellent opportunity to explore different areas of the country. Like the idea of living in Montana but not sure how you would handle the winters? With locum tenens, you can find out firsthand.

Few among us would work without fair compensation, no matter how much we loved our jobs. Physicians who practice locum tenens on either a part-time of full-time basis are naturally interested in earning potential. In this article, we answer some of the most commonly asked questions about pay rates.

Q: HOW ARE PAY RATES DETERMINED?

A: Think back to Economics 101 where you learned about supply and demand. Pay rates for locum tenens physicians – who typically work as independent contractors and are matched to assignments by staffing agencies – are very much market driven. When there is a higher demand for, say, anesthesiologists than there are anesthesiologists to fill positions around the country (or in a particular geographic area), these physicians will command a higher rate than they would if they were in an oversupply situation. Pay rates may vary somewhat by location (i.e., you may earn more practicing in a remote community), but overall specialty demand tends to trump geography. Rates may be higher in practice settings where patient volume is above average, or where a position has been vacant for a long period of time.

Are you a resident or fellow about to complete training? Not yet sure where you want to settle down? Waiting for a new job to start and looking to generate income and gain valuable experience in the interim? Locum tenens may be your answer. Consider these common myths and realities to find out more about this practice alternative.

MYTH: LOCUM TENENS INVOLVES TOO MUCH PAPERWORK.

Reality: It is true that, in most cases, you must secure a medical license for each state in which you practice, and you will likely need hospital privileges as well. These formalities need not be daunting if you give yourself enough lead time. Start by speaking with a recruiter at a reputable locum tenens agency. Companies have full-time staff members who will guide you every step of the way and even do some of the paperwork for you. Online credentials verification resources make the process easier than ever, but the sooner you get started the better. Some states (California, for example) tend not to rush when it comes to processing medical license applications. The bottom line is, yes, there is paperwork involved– but you will have support from your recruiter to get it all squared away.

Whether you practice locum tenens full-time or accept only the occasional engagement, there are ways to make yourself more attractive and marketable to both locum tenens agencies and their client facilities. It is all about flexibility, adaptability, affability, thinking strategically, and staying organized.

Physicians who enjoy steady locum tenens contracts know the importance of being flexible. This means being willing to travel to locations outside your immediate area and to practice in a variety of medical settings. For instance, locum tenens physicians may find themselves seeing patients in a rural community with a 40-bed hospital one month and in a metropolitan university hospital the next. You may think you only want to practice in outpatient settings in California, but opening yourself up to different locations and practice environments can be very rewarding. And, while the majority of locum tenens placements are arranged weeks or months in advance, occasionally an emergency arises that requires immediate coverage in a hospital or clinic. Be that physician if you can.

Type "locum tenens agency" into the search box on Google and you’ll find more than 100,000 website links. Okay, there are not actually that many companies in operation, but they would all like to help you find your next temporary engagement. So how do you choose the best staffing firms for you? Here are some tips that will help.

Talk to colleagues

If you are considering locum tenens for a week, a month, or for the rest of your career, your first step should be canvassing your professional network to find out who has experience, with which agencies, and in what kinds of practice settings. Ask what they know now that they wish they had known when they first began locum tenens practice.

A sizeable percentage of physicians are altruistic by nature and give of themselves—professionally and personally—in various ways throughout their careers. Locum tenens practitioners are in a unique position to take part in volunteer opportunities because they have such flexible schedules. In this article, we explore how you can volunteer at home, away from home, and even during your locum tenens engagements.

As a physician who is away from home for weeks or months at a time, serving on a community board that meets every fourth Wednesday or being a scout troop leader may not be practical. Instead, seek out one-time and short-term volunteer opportunities in your hometown. Go door-to-door or stuff envelopes on behalf of your favorite political candidate. Volunteer to chaperone (and be in charge of cuts, scrapes, and bug bites) for a youth group's weekend camping trip. Sign up to staff the first aid tent at local charity walk/run/ bike events. All of these activities are great ways to meet new people, stay connected in your community, and do a good turn for others.

According to the Association of American Medical Colleges, the average debt for a 2008 medical school graduate is $139,517, and more than 75% of graduates have debt in excess of $100,000. These figures are comparable to a home mortgage in some parts of the country. This enormous debt can be daunting, especially considering that a physician does not begin earning (residency salary aside) until his or her late 20s or even early-to-mid 30s.

Doctors often want to pay off student loans as quickly as possible, but investment executive Joe Potosky of MV Financial Group in Bethesda, Maryland, ( http://www.mvfgroup.com/) says they should approach debt management strategically. "People get psychologically attached to accomplishing an objective that may not be the most sound," says Potosky. "Don't let your emotions get in the way of a good business decision."

There is no shortage of information available today about how to "go green" and reduce your carbon footprint. At home, many people take steps toward this effort by adjusting the thermostat, recycling, combining errands to save gas, or buying locally grown food. But what can you do while traveling to and from locum tenens engagements, and practicing in unfamiliar surroundings? Plenty.

Before you leave home. If your house will be empty while you are away, unplug electronics, put your water heater on the lowest possible setting, adjust thermostats to a "protect the home" level, and suspend newspaper delivery. Do you prefer to prepare your own meals while on location? Then, use the Internet or call ahead to find out where to buy local produce and other goods.

Every physician knows that the process of applying for medical staff membership and privileges can be tedious and time consuming. The forms and photocopies, that long list of yes/no questions, and pouring over the clinical privilege request sheet can take hours. The good news for locum tenens physicians is that, with a little organization on the front end, this process can be streamlined considerably. The best locum tenens agencies do everything they can to reduce paperwork for doctors who are busy traveling the country (and sometimes the world) to practice medicine.

While locum tenens agencies are not in a position to perform formal "credentialing," any reputable firm will do a thorough credentials review based on the same standards as hospitals before presenting a physician to a practice location. Because they not only understand their clients' quality standards, but are also responsible for procuring or facilitating malpractice coverage for the physicians with whom they contract, staffing companies engage only well-trained and highly-qualified individuals.

Much like obtaining staff privileges at hospitals, the process of getting state medical licenses is becoming more arduous for physicians as medical boards tighten standards. As you consider your locum tenens career, think strategically about which licenses you will need. The more places you are licensed, the more choices you will have, but that does not mean you need a license in dozens of states. Depending on the size of the primary states in which you practice—the larger the state, the more opportunities typically available—five to eight is probably about right.

STATE PREFERENCES

When the economy is unstable, as it is now and most likely will be for some time to come, even high-income professionals feel the impact. An economic downturn probably will not mean, as it does for many people, that doctors will have to cut back on essential purchases such as food, clothing, and fuel. But if you are watching your retirement account balance fluctuate wildly and have seen the value of your home decline over the last couple of years, you may be feeling the pinch—if only in terms of your ability to plan for the future and afford a few luxuries.