番茄社区

Sonya Sloan, MD, is a traveling orthopedic surgeon, a locum tenens physician, an author, a speaker, and a mother. In her work across the U.S. for more than a decade, she has seen and treated just about everything. She was also the first African American female intern in general surgery and the first African American female orthopedic surgery resident at the Baylor College of Medicine in Houston.

Sloan holds a regular contract with an Indian Health Service hospital on the Navajo reservation in New Mexico, where she treats multi-generational families with an eye toward cultural sensitivity and mutual respect. Her journey hasn't been without its roadblocks, and she'll be the first to tell early-career doctors what they can do to overcome theirs -- and blaze their own trail in medicine.

番茄社区 sat down with Sloan to learn more in an interview, which has been edited for length and clarity.

I've written a bit about travel nursing, but not locum tenens. So how did you decide to do this at first?

Sloan: There's only 6% women in orthopedic surgery. And as far as African American women, there's less than 100 of us in the country. So we're like 0.7% of the 30,000 that are out there practicing.

So residency was pretty hard -- a very white, male-dominated field that wore on me, and so I had difficulty getting pregnant, and I had a miscarriage and couldn't even talk about it. And then when I almost finished, I was told that I had to do extra months for the time that I took off from maternity leave.

Which was fine; I didn't care, but after I finished, I took a practice here in Houston -- it's right near Baylor -- and got blackballed. Basically, I did not get business, either consults in the hospital, or being referred out to some of my partners or the guys at a different practice that had trained me. And so I'm like, 'This is not what I want to do. I don't want to kill myself trying to get business.'

What are the other options? I still wanted a life, I still wanted to spend time with my child, I wanted more children. It became a lifestyle choice.

My husband is a pastor. We have a very large church here in Houston -- over 5,000 members and I do a lot with that. I had a couple of nonprofits that I wanted more time with. Being a full-time orthopod was not going to allow me to do that. So locums was an option. They gave me the opportunity to do all things, if you will.

The only problem was at that time in 2006, 2007, when I first started, it was not accepted in the surgical field. It was more of a 'How dare you? That's not a real job. What are you doing?' kind of thing.

And now fast forward 15 years, I'm pretty much a well-sought-out orthopod for locums as well as a speaker for locums and how to build the lifestyle that you want for medical students and residents. So, everything has worked out for my benefit, but it was really a choice of lifestyle for me.

It's interesting that you mentioned lifestyle -- can you say a little bit more about how it actually works? Wouldn't it be hard to travel a lot and have that unpredictability, or can you make your own schedule?

Sloan: So you do make your own schedule. When I first started, I took a 3-month job in the middle of Kansas in the winter, no less, and Sarah [my daughter] was 15 months old, and so I took her with me.

When I went up there, one of the nurses had a nanny. That was great. She would even come to my hotel when I was on call so I didn't have to wake Sarah up, when I had to go in in the middle of the night. I had to either take people with me, like a nanny a couple of times, or I found resources where I was.

The other ones, I would just go for a weekend or 1 week, and because my husband has a great job as well, I would be able to hire people here. So we had a full-time nanny usually. It has had its ups and downs.

I choose now not to do more than a week or 10 days at a time, just so I'm not away from them too long, because their activities are so much right now. My daughter is about to be a senior next year in high school and I don't want to miss any of those moments with contracts that I can avoid. But at the same time, it affords me the ability to go and work a week and make a month's salary and I can be home the other 3 weeks out of the month.

Do you get the sense that more people are kind of curious about doing locums? Are there more doctors taking on this lifestyle?

Sloan: You've got the millennial crowd that definitely has started to look in that direction. When I was in residency, I was the last class that had unlimited work hours. But around 2003 the ACGME, the Accreditation Council for Graduate Medical Education, enforced the 80-hour work week for safety reasons. So that group started looking at lifestyle and quality of life, which was different from residency training from when I was there.

It has lended itself to a different type of doctor. You have doctors that don't want to be in a hospital for 3 days straight. And there's doctors that say, 'I just want to work part time and I want to be a mom,' or 'I want to be a dad who's able to be around my family.'

You definitely have the entrepreneur physicians now, like myself, where we have side hustles, everything from the telemedicine that really has boomed during COVID, but also other things that they're doing business-wise that have nothing to do with medicine. This newer generation has [leaned toward] a quality of life and lifestyle choices where there's not so much burnout.

What do you tell people who are curious about locums? What are the pros and the cons?

Sloan: So right now, the pros definitely would be, if you're just now coming out and you're not obligated or tied down to a spouse or children, or even have to worry about a huge amount of debt, which can be deferred as well, take the time to travel.

Because you go to undergrad, you go to medical school, you go to residency, and you come out and you start working, and you have no downtime. You have no time to have a real life. It's a great time to explore, to travel, to do some other things in the interim while you're trying to figure it all out. A lot of people will feel like they have to come out and start right away because of boards or whatever else. So I'd say that's the advantage. You basically are a creator of your own fate at that point.

And then the other thing is, it's big money. It's actually pretty decent money if you can negotiate and you're not shy to negotiate. I learned early, they need you -- you don't necessarily need them, so you can negotiate up or down. Even the government contracts. I've been one of the few that have been able to negotiate up on a government contract, which is really hard to do, but because you didn't have an orthopod that was willing to travel into trauma, you can negotiate.

One of the best contracts ever I did was in North Dakota, in March. It was a freakin' blizzard, -9 degrees. But I was the only orthopedic surgeon that was locums licensed in North Dakota willing to travel and do trauma for a 4-day stint. I was able to write my ticket and charge over $3,000 a day. And I sat in a hotel room and didn't do anything. So in 4 days, I made $12,000. So those are the times that you're like 'Okay, this was worth it. This was totally worth it.'

And then I took off another 2 months with my kids and we traveled, went to Hawaii. In medicine, we are so stuck in the tradition of, 'Okay, you've got to do X, Y, and Z and you've got to do it in one, two and three,' and everyone is in that hustle, this rat race. We have been on this wheel, and anyone that is outside that norm is either ridiculed or looked at, but now it is flipped. And it's like 'Yeah, no, that's not what I want to do.' So it's an ideal time.

Now, the downsides to locums would definitely be the large volume of money that you get in a short amount of time, because you're contract, right? People don't necessarily tell you or prepare you for making a quarter of a million dollars in 6 months. If you're working full time in ortho, you could possibly do that. So you're like 'What am I going to do?' And so then, you get an $80,000 tax bill. I got into trouble the first 2 or 3 years before we started figuring out we need to have an LLC [limited liability company] or an S Corp [subchapter corporation], where you are employing yourself.

All of that was not something we're taught in medicine. And then after I learned those things, then it's like, 'Okay, put money away into paying the government quarterly or in installments' and if you overpaid them, they pay you back. But these are hard lessons I learned, that no one told me because, again, not a lot of people are in locums. So that's what I would definitely say: the tax side of it, the business side of it, be smart about it. And then also negotiating for yourself. [The locums company] is trying to get you a job, but remember, they're also making money off of you.

It sounds like a really interesting lifestyle. If you don't end up working and you travel somewhere, you're just on call then?

Sloan: It's been very diverse. The first job I ever took, the one that was 3 months, it was a small town, level 2 or 3 trauma in central Kansas. It's very, very busy. They had big contracts -- like Tyson Foods was there -- so that was one of their big employers, and Walmart was there. You basically covered those entities, on top of anything that was on the interstate, on top of hospital employees, and then the town. So you were it.

The doctor that was there died, his partner didn't want to take call and was about to retire in like 3 months, and they were trying to onboard two new people. That was going to take 4 to 6 months. So in the interim they hired a locums person, and I was it. So I helped close out a practice as well as start up a new practice so these other people that came in could walk into it and it was functioning well. So that's one way of doing it.

Now, I'm on the Indian Health Service that's in New Mexico, and I go in one week out of the month. I see clinic on Monday and Wednesday; I do surgery on Tuesdays, Thursdays; I do post-ops on Fridays; and I cover the ER on the weekend -- I actually cover four hospitals on the weekend. If anyone needs surgery, I take them to surgery, and then I fly home Monday morning.

But now I've had that contract for almost 5 years, and I've only missed a few months. I have now three generations I've been treating. I've treated Grandma, the mom, and the kid.

This is an entity of people that really depend on trust and relationships because of what they've been through with medicine. Therefore, they love someone that is a return person, versus new people. So that has benefited me. I've gone other places. They just wanted me to cover the ER and I'd fly in, and Friday, Saturday, Sunday. In Kansas, I never got a call. Like I called the operator and was like, 'You do know I'm on call, right? I'm at the hotel if y'all need me.'

In Minot, North Dakota, I was 7 months pregnant and I operated all night long. I kid you not. It was one of the hardest locums jobs I ever did. But at the same time, I made probably almost $25,000 in a week because of the call schedule, because I was operating all night, and the way that we did the contract, after 8 hours of work, anything over that was $250 an hour. And they couldn't be limited because they needed the work. So it was a great week for me, and then I took maternity leave after that.

How did you stay awake?

Sloan: I was napping in between, I had snacks, and the nurses were great. This is another great thing with locums. If you're open to it, you meet so many different people in different places -- and very diverse. And that's not for everybody. Some people are creatures of habit and don't want change. But if you're amenable to new things and new people, and you have that personality that you can pretty much mesh with anybody, this is definitely something that's doable.

There's been places that the ER people and the nurses were feeding me or would tell me where to go eat in the town, or invite me over to their house, before COVID. It's like, 'Just come out and hang out, we want to have dinner with you, you're such a nice person.'

I've made great relationships and friendships -- still to this day, all across the country, which has been really good.

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