20 Questions: Kathie M. Horrace-Voigt, DO, Locum Tenens

Kathie M. Horrace-Voigt, DO, is a locum tenens practicing rural medicine, she has worked in AK, NV, TX, MT, CO, and OR. She and her family reside in Oregon.

Horrace-Voigt grew up in Alaska and earned a bachelor’s degree in biology with a minor in geography (Arctic regions) from the University of Alaska, Fairbanks (1994). She then passed her Certified Nurses Aide Course in Vancouver, Washington (1994). Over a decade later, Horrace-Voigt earned her Doctor of Osteopathic Medicine (DO) from Lake Erie College of Osteopathic Medicine (LECOM) Erie (2006), and served a residency in family practice at Bay Area Family Medicine in Corpus Christi, Texas (2009). She is board certified in family medicine (licensed in Texas, Oregon, Nevada, and Alaska) and osteopathic manipulation.

When did you first decide to become a doctor? Why?

I decided in high school I wanted to be in medicine. I was always fascinated with pathology and the disease process, how the body worked. I wasn’t a great candidate in my early 20s and had many a rude awakening including being told that women don’t belong in medicine. I got married young and things got put on hold when my mom died right before I graduated college. It wasn’t until I got a CNA license and started getting some medical experience that I knew medicine was my calling and I definitely didn’t want to be a nurse. I had plenty of physician friends from working in the hospital, and they rallied to help me with the admissions process.

How did you choose the medical school you attended?

I applied to medical four times, in 1992, 1999, and both January and June 2000. Because I lived in Alaska, I applied broadly to both MD and DO schools initially, then just DO. Many of the doctors I worked with said that I would have the best chance with DO because of my non-traditional status and I was older and I had lived a lifetime before applying (the best thing that ever happened to me). I applied to LECOM because I had friends who lived in Erie and I would have someone I knew there. In the end, they were the only school that interviewed me. I was waitlisted and ultimately declined in May 2000. I talked with the admissions office and was told I didn’t need to change anything, just apply early. So I applied the fourth time on June 1 when the cycle opened, only to LECOM, and was ultimately accepted. At the time there were rolling admissions because applying wasn’t online yet. You saved all your information onto a disk and mailed the disk to the American Association of Colleges of Osteopathic Medicine.

What surprised you the most about your medical school studies?

The sheer volume of the material and how fast the material was covered. It was very scary to go back to school after being out for so long. I was surprised at how much I had to study just to pass. It amazed me how other students had no shame and would do anything to get ahead, have a better grade, be higher up in the class, etc. It was interesting that there really wasn’t a concept of being nice to one another. [Being nice] was always viewed as an ulterior motive to get ahead somehow.

Why did you decide to specialize in locum tenens work?

It started after I was suddenly forced out of my second permanent job. It just came about as a necessity to keep the money coming in. When I tried to make the third permanent job work and ended up resigning, it seemed clear that I just did so much better personally as a locum, where I didn’t have the establishment hanging over me telling me how many patients I had to see, being forced to type my chart notes, having no scheduling freedom, etc. I wasn’t happy with my income and was working a 70 hour week, getting paid for 40 just to keep up on the charting.

If you had it to do all over again, would you still become a locum tenens physician? (Why or why not? What would you have done instead?)

Yes, I would probably never have applied for a permanent job. The pay difference is just so far apart. I have the freedom to work when I want and am off when I want. I usually go where there is a huge doctor shortage so I’m not told I have to see a certain amount of patients in a day. The schedule is reasonable and I get treated very well personally and professionally.

Has being a locum tenens physician met your expectations? Why?

Yes, I love everything about it. I work when I want. If a site gives me any grief, I don’t have to deal with it, the locums company works it out. I can get on a plane the next day and move on without any recourse. I get paid an amazing amount of money. I take as much time off as I can afford. It’s no cost to me–my travel, housing, and rental car get paid by the site. I don’t have to worry about malpractice costs. There are more sites than are doctors available, so there is always work.

What do you like most about being a locum tenens physician?

The flexibility of schedule and the pay. There are so many jobs out there and such a huge need that I generally can get a job in a week with a month to credential. That’s pretty quick.

What do you like least about being a locum tenens physician?

Most of the sites I go to are fairly far from my husband and my kids. It’s always nice to try to work close enough to be able to go home for the weekend. However, those jobs don’t pay as well as those farther out and more rural. Sometimes I have to make a choice of taking a weekly pay cut and being home more or working to maximize my income and going home for a large chunk of time when the kids are out of school.

What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?

Family Practice is a hot commodity right now. There are currently more jobs available than physicians to fill them. Once I put my CV out there, my phone literally rang off the hook. During residency when I was first looking, I had my husband field the calls and set up the interviews. I had a big poster board to compare the offers and packages. In that initial search, I connected with a few recruiters who I really liked and were very aggressive in getting a good package. Whenever I’m in the job market I call them again so I have more control of where my CV goes.

I never really decided to go into family practice. I didn’t match into general surgery and ended up scrambling into a traditional rotating internship in Texas. After the intern year I was able to land a surgery spot in NYC. That turned out to be a disastrous mistake and after a week of crying, I left and went back to Texas to finish family practice.

Describe a typical day at work.

Usually, my time at a locums site is more urgent care type of patients. I see the overflow since the regular providers are booked weeks out because there are so few of them. I also take call and generally cover four days of ER 24-hour coverage but have done up to 11 days in a row. I put patients in the hospital if need be. I read my own x-rays since it may be a full day before I get an official report. I also take care of any issues in the nursing home locally. I may see 15 to 25 patients a day depending on need and who walks through the door. Every day is different, but I do my own biopsies, casts, splints, joint injections, diabetes management, WIC physicals, sports physicals, lots of OMT–especially for back strain and migraine headaches, dental abscesses, sick kids with ear infections, general medication refills. Whatever walks through the door. (I don’t do OB, pre-natal care, or well-child checks.)

On average: How many hours a week do you work?

I work from 50 to 75 hours a week. It all depends on how busy the ER is.

How many hours do you sleep per night?

I only sleep four to five hours continuously at a time. I try to rest at least seven hours total overnight.

How many weeks of vacation do you take?

I take 12 to 16 weeks a year.

Are you satisfied with your income? Explain.

Yes. I have plenty of income to pay my bills and do lots of great things with my kids. I don’t worry about money anymore.

If you took out educational loans, is/was paying them back a financial strain? Explain.

Yes, I took out the maximum loans. My payments are not a strain. I make enough in 1 ½ days of work to cover my monthly student loan payment.

In your position now, knowing what you do – what would you say to yourself when you started your medical career?

Don’t be quick to take the first job that comes your way. I would have done locums first to find a job that fit me and my personality and needs so I could walk away easily if I hated it. I always thought being a doctor, I would be autonomous and I didn’t realize how many people have control over you and your life in a contracted employed position.

What information/advice do you wish you had known when you were beginning medical school?

I was naive and bought into the hype that as a DO you did not need to take the United States Medical Licensing Examination even if applying to MD residency programs. The whole process of the match was so overwhelming you kind of go through it in a daze. I never expected having to scramble and didn’t have a plan for not matching. I hadn’t planned very well for the whole matching process, as I was caught up in parental responsibilities and trying to coordinate rotations to suit my family rather than strategize to be seen for potential residency programs. It was difficult to know where to rotate when I was in a school on the East Coast and I wanted to get back to the West Coast, but there weren’t really rotation sites in locations I envisioned myself living. It all worked out in the end but not without a lot of tears and stress along the way.

From your perspective, what is the biggest problem in health care today? Please explain.

Too many people uninsured. In rural medicine, almost everyone is on Medicaid and they use the ER as their personal clinic. Primary care has a huge burden because of the insurance issues, as many specialists will only see patients will “real” insurance and shut their services off to Medicaid/Medicare. The reimbursement is so low, it’s not worth their time and they can’t pay their overhead otherwise. Not sure how the enforcement of the new Obamacare laws will be implemented when you have families who barely have enough food and gas money, let alone pay for health insurance.

Where do you see locum tenens work in 10 years?

I think there will always be a need for primary care, especially in rural areas. The working poor are desperate for good care. There are not enough PCPs to cover the shortage, so I don’t see locums fading any time soon.

What types of outreach/volunteer work do you do, if any?

I don’t, since I already take care of the poorest patients.

Do you have a family? If so, do you have enough time to spend with them? How do you balance work and life outside of work?

Yes, I have two kids aged 17 and 14. They are engrossed in their school and lives. They made the choice after I resigned from my last job about not moving again because they loved their school in the area we live in. They are ok with me being gone for weeks at a time. I keep in touch via FaceBook and texting. If they need homework help, they email me papers to proofread. My husband stays home and is now retired so they have a parent home all the time. I schedule my work contract to be off when they are off during the school breaks. I do at least six weeks off with them in the summer. My kids are well travelled and worldly. They appreciate it when I’m at home but don’t have an issue with me being gone. When I’m at work, I’m completely immersed in the job. Before I leave, I have all my charts and signatures done, so there are no loose ends since many times I won’t be returning.

Do you have any final piece of advice for students interested in pursuing a locum tenens career?

Locums works if you understand that most of the need is in rural areas of the country. Don’t limit yourself to a single state license and expect to always be employed (I have four active licenses). Not every locum company has contracts with all sites. Have at least two companies you work with for placement, three at the most, otherwise you have too many sites vying for your time. Most sites expect a two-month minimum commitment, sometimes more just because of how much hassle it is to credential a new doctor. That doesn’t mean you can’t take a break in the middle of it. Sometime I work six weeks then take two weeks off and then work another six weeks, etc. Usually the site will work with you. Don’t be afraid to say what time you need off.