Why are so many turning to locum work?

I am sure it can’t have escaped your notice, whether a practice owner, manager or employee, the seismic shift in veterinary employment of recent years away from employee (and long-term employee at that) to a much more fluid employment situation with a growing proportion of those choosing to work as locums or other short-term or self-employed situations. There are many different terms used for the latter, all of which mean slightly differing things, so in order to avoid confusion in this article I will use the term ‘locum’ though we need to realise that this encompasses a wide variety of working forms. I am also equally referring to nurse locums as vet locums.

There is currently a lot of animosity towards locums with suggestions that we are “only doing it for the money” or “shirking the responsibilities” of full permanent roles such as client care and on-call. The reality is though that the increase in vets choosing to locum is a reflection of the lack of choices in employed work and both general dissatisfaction with current employment and additional push factors that drive people away from traditional full-time employee roles. In a way, the rise of locums has been created by deficiencies in meeting the needs of the modern vet workforce as I will go on to explain. Many things are not going well in the profession at the moment, including the increased sense by some that we vets are a commodity to be managed – dispassionate “human resources” instead of “human individuals” – and so vets are switching to locuming in order to take back control of what is important to them. Those who feel this way but remain in their jobs are those who are feeling trapped and becoming disillusioned.

In 2019 the proportion of vets working as independents (locums, independent vet service providers or independent consultants/peripatetic) was 15% as reported in the RCVS Survey of the Veterinary Profession, compared to 52% employed assistants, and this proportion has been seen to increase year on year. In other words, one in four employee status vets (not owners, partners or directors) are working as independents rather than employees. Being a locum is seen by many as a career choice rather than as it once was, a stop-gap or supplement to a permanent position. That’s not always the case though; I switched to locuming about six months ago and in my case it was as a stop-gap while I search for a permanent role and allowing me time to follow additional pursuits and hobbies such as writing this blog. I have found it interesting to work effectively as self-employed and see things from the other side; I don’t know what my income will be even next month and certainly not next year. Every locum has a different reason why they made the choice, but it is rarely purely financial; I personally took a 20% income cut compared to employed work while still working the same hours/days.

We need to look at and understand the push and pull factors that have led to the increase in vets choosing to locum to see why employment situations don’t currently work for a good proportion of the work force and thereby help the recruitment crisis. I would argue that this boils down to the employment market not modernising to cater for the new generations’ aspirations for work and a realisation that vets don’t want to work in the same way that previous generations have. It’s important to note that this is not a problem isolated in the younger vets, many older – sorry, more experienced – vets are also realising that it’s really about time to speak up in their own interests where once that would have been taboo. So what do the modern work-force want from employment that currently is rarely offered?

1. Choice and control
2. Flexibility
3. Financial benefits

Choice and control

As a locum I choose when and where to work and to some degree I get to choose my workload. I can ensure that where I work meets my standards professionally and ethically, either by declining work at places after a visit or trial or by having the option through my service agreement that if these are not met I can terminate the contract immediately (luckily, I have never had to use this). I also have the option of not continuing to work or not booking repeat work in practices with toxic cultures, sticky politics or disastrous management. These things are just not possible as an employee; I and many colleagues have found themselves in compromising situations due to the fact of being a standard salaried employee of the business.

By having the choice over when, where and how we work, locums are in a much better position to have a better work-life balance. But I think the reasons go deeper than this buzz phrase. It has been clearly shown in studies that it is the lack of control workers feel over their work and lives that causes the biggest stress, not the actual work itself. These studies are surprising. Contradictory to our instincts, they showed that workers rising up through management with more responsibilities have less stress because they had more control over their conditions. Leaders have less stress because they feel empowered to make decisions and change things rather than awaiting their employers to tell them what to do. Conversely those that are required to blindly follow rules (practice protocols, prescribed ways of working, reduced freedom to who to refer cases to, how the schedule and rota is run) are the ones with most stress. Being bound by rules is inevitable, of course, but it goes far beyond that. I have worked in practices where even attaching paper towel dispenser to the wall required by policy an active decision from a manager who, naturally, never had the time to attend to that level of demand and so every single task began and ended with “so-and-so hasn’t OK’d it yet”. Despite the fact that they had moved into the building 2 years previously. How many of you are aware of a long-standing problem at work that could be permanently fixed by anyone in the building, if only the boss would get the hell out the way?

I would struggle to think of someone who doesn’t like the actual work of vetting, it is more the circumstances and compromises put on it by the practice and owners that cause the stress. We all know we don’t like the feeling of stress, even though a little is good for us as it stretches us and teaches us to grow. The problem is continued, unrelenting stress – especially when you know it’s easily preventable but you are forbidden to do so – and the health effects it has on physical and mental health.

Sadly though, increasingly vets are feeling trapped in jobs by circumstances they feel they cannot control and like a bad relationship, feel that leaving is either not possible or could be even worse. So people stay in jobs they don’t like, even hate, even actively despise, and this is not good for them or the business. Levels of depression and anxiety are higher in people who are unhappy at work than in those who are unemployed. Now those vets and nurses have a choice to take matters into their own hands; they can leave and locum instead.

So if being a locum means you get to largely bypass or ignore office politics, is there a downside? Well, yes. As a locum you’re always an outsider, never really part of the team. You lose out on much of the positive side of being part of a team as well as the negative side of being part of a team with a lousy manager. You know that you will never be able to influence the practice for the better and, while this removes stress (through not fighting endless unwinnable battles against territorial idiocy), it adds a different kind if you’re the kind of person who instinctively wants to teach, improve and encourage and no longer have that need fulfilled.

Why is control and choice important for vets and nurses? Having a choice means you have control to shape how you work, and how work and life co-exist and integrate. You have control over your working conditions, choice to decline work somewhere that doesn’t fit with your professional, ethical and moral values. And as I have just shown, having control over work and life and the integration of the two means less stress.

Flexibility

‘Flexibility’ is a term often bandied around as a buzzword of the moment by both locums as a reason for working this way and employers trying to attract job seekers to roles they are advertising. But what does it mean to each side and how do we put it in place in the different circumstances of the veterinary profession?

In the 2019 recruit4vets survey of locums, more vets choose locuming because of flexibility (82%) than pay (71%). Also a mini survey I conducted on the Vet Mums Facebook page showed that this particular population of vets valued flexibility over any other employment benefit and for many was the sole reason they had to give up working in the vet profession.

So what does flexibility in working mean for vets? Well it means something a little different to every individual but covers:

• Working shorter days or fewer hours in a week than the business’ standard, for example to achieve effective childcare coverage or for physical or mental health reasons. This may even be because they are self-aware enough to realise their boundaries and that 11 hour days just don’t work.
• Working ‘part-time’ (this term makes me cringe) so they can work on other interests such as voluntary work, alternative or diversified veterinary work, study for advanced qualifications or a PhD, or try an alternative career. “Part-time” in the vet industry seems to be the same as “unsustainable overtime” in many others.
• Having fixed start or end times that are outside the ‘standard’ to enable childcare pickups or accessing after-work classes. Have you tried getting to an evening class? The latest they start is 7pm which is often the theoretical finish time of vet jobs. I say “theoretical” because often the last consult will be scheduled at 7pm followed by normal end-of-day stuff, catching up, doing phone calls and paperwork etc.
• Taking extended breaks from work – for caring roles (children, parents), travel, recovery from burnout, exploring interests outside the veterinary profession, training, sabbaticals.
• Working in blocks – this particularly would suit vets from other countries who come here to work for part of the year then return home to families in blocks or time.
• Choice of the balance of work and life and being able to vary it as it changes throughout life and not have it fixed rigidly forever.

I get a strong feeling – and feedback from those that have tried requesting it in employment confirms – that practices pay lip-service to the term ‘flexibility’. Certainly, when I have approached practices with a request for working hours shorter than 11 hours or to restrict my working hours to less than 40 hours a week and being able to plan my day off in advance, I have met overwhelming negative responses; “These kind of requests are just not possible in the vet profession, they don’t fit with the business model, if they made an exception for me they would need to allow all staff to work like this, this would be part time (in a derogatory tone) so you won’t contribute fully to the practice, you don’t have children so this doesn’t apply.” This is not about being able to work from home or leave work when we feel like it. Do I need to have children to be considered for flexible working? Really?

To the vet business owners, managers and leaders, I put this to you now: unless you modernise your working schedules to cater for how current and future generations of vets want to work, you will continue to have a recruitment crisis. The increasing locum workforce is a symptom of this underlying dissatisfaction with the current status quo.

Financial Benefits

Some vets and nurses choose to locum at least partially to get increased renumeration (see the recruit4vets survey), but it is far from universal. I would say that recent graduates and those from other countries who are competent enough to do a full locum role but not yet specialise, have the potential to earn more as a locum than an employee. However, vets who are well experienced and skilled, perhaps with additional qualifications or take on managerial or leadership roles, are likely to find renumeration better in an employed role once additional benefits such as holiday pay, pension and CPD is taken into account. As I’ve shown above, most locums are unlikely to be working the full 10-11 hour day, 5 days a week, 48 weeks a year therefore this will also impact on their overall income, even if they manage 100% booking of their availability with no cancellations.

For these reasons, it isn’t appropriate to multiply a locum’s day rate by 235 days to work out a comparable annual salary. Additionally locums have no job security, so their pre-booked block of work may be cancelled within days of them being due to start work. Some locums also have to live away from home – away from their partners, pets, families, in unfamiliar and sometimes even dingy accommodation. Try living in a Travelodge for 3 months!

There is also a misconception that the daily rate that locum vets charge is what they take home in income; nothing could be further from the truth. Believe it or not we do pay tax, plus indemnity insurance (VDS), income protection, travel costs, pension contributions, CPD (and not earning on the days they do CPD), radiation badges, accountancy fees, uniform and basic equipment, and a myriad of other things I could not even begin to imagine as costs when I started as a locum! On balance, the veterinary practice is getting a bargain when they employ a locum as they don’t need to pay employers NI contributions (13.5%!), pension contributions (3%), VDS cover, CPD allowance, time off for CPD, holiday pay (paying the employee even though they are not at work), and any other perks and package goodies. You cannot directly compare the daily rate of a locum to the daily rate of an employee; it is like comparing wages in very different countries with different living costs. So when you compare locum rates with the true, full cost of a permanent employee, there isn’t as much difference as you might think. If someone more smart with numbers than me would like to do a calculation comparing the cost of a locum and an employee, they may be surprised to find they have found a new way to cut wage costs – employ only locums!

Other reasons why we locum

Locuming can also increase job satisfaction and the feeling of being appreciated rather than taken for granted. Working independently and being solely responsible for your professional output is empowering and improves self-esteem. All workers in the UK are feeling increasingly replaceable, like a commodity that can be managed and disposed of if things get difficult or the finances need tightening. I feel this is somewhat becoming apparent in the UK vet job market too and may get worse in the future as practices consolidate and improve operating efficiency – the biggest cost to cut is the wage bill. Being an independent worker means we have a chance of starting over if this occurs.

Remember how nervous you feel – or at least most people do – the first day of a new job? How a good practice will give you a bit of time to settle in, learn where things are, meet the team and so on before you’re expected to be at full production capacity? Locums don’t get that. You parachute in and are expected to hit the ground running, taking anything that comes your way. You may only be with this business for a day or two, there’s no time for a gentle introduction. Learning that you can do this, learning to see it as a challenge to your professional abilities and then rising to and defeating that challenge, can be a wonderful confidence booster. If you’ve never worked in a practice that has a culture of thanking you if you’ve done an exceptional job, this is the closest you’re likely to get and it can remove a lot of the anxiety of uncertainty in any situation in the future.

Summary

Unfortunately, some of the bigger veterinary employers have decided that locums cost their business too much and so rather than looking at how they can attract these potential employees to take up permanent employment with them, they have used the blunt wrecking ball of the IR35 changes to force the hand of the independent workforce. They may find it back-fires as the overwhelming reason so many choose to work like this, the freedom, choice, control and flexibility, is removed and a tempting salary is not enough to negate this. Remember, many locums effectively took a pay cut in order to get these things in the first place. Veterinary employment is definitely changing, can we change so it works for more than it currently does? Let’s talk about that next time.