Direct Contracting: Why I Skip the Agency
"What agency should I work with? What recruiter do you recommend?" These are questions I’ve been asked by other BCDs looking to do locums. Many dermatologists start their locum search by reaching out to a staffing agency. Recruiters are the standard entry point for these positions. But I don’t feel this should be the default route for a BCD considering locum work. I prefer direct contracting with clinics.
The most significant reason is the financial cost of the middleman. Agencies charge the clinic a substantial fee. This means a lower hourly rate is offered to you because the agency and its personnel absorb the rest in exchange for securing the position and helping with some of the logistics. When you contract directly, you eliminate that extra expense. This is a win-win for both you and the clinic you’re working with. Because they aren't paying a recruiter markup, you're a more cost-effective option for them. You're solving their staffing problem without adding a huge administrative fee to their overhead. In return, you’re able to request a higher hourly rate.
Privacy and maintaining my peace was another factor. Think about all the random job offers you get texted and emailed to you even when you aren’t looking for a job. Now, imagine that you willingly provide your CV and contact info to large agencies. This can result in years of unsolicited communication. Some of my colleagues in other specialties have stories about recruiters bombarding them with phone calls, texts, and emails years after they’ve finished their work. For this reason, some people advocate getting a separate Google email address and phone number just for the purpose of sharing with recruiters. I decided to avoid this issue entirely by direct contracting.
Direct contracts also provide a level of flexibility that isn't typically available through an agency. When I work directly with a practice owner, we can tailor the arrangement to suit both of our needs. We can adjust clinical expectations or schedules without waiting for a third-party representative to mediate the discussion. This direct line also extends to logistical details like malpractice insurance and credentialing. While agencies claim to handle everything, you're still the one providing the documents. Direct contracting allows you to verify your own coverage limits and tail requirements personally. You also aren't waiting on agency billing cycles which could result in faster payment.
There's a common misconception that agencies have access to some secret job market. This is inaccurate. The openings found on national boards are often the same ones recruiters are attempting to fill. In fact, while monitoring the listings of multiple locum agency websites, I sometimes see the same listings removed and then reposted to look like new opportunities. This is a deceptive trick I see with Zillow and Redfin listings too, but I won’t get too off topic. If you know where you want to work, cold calling a practice in a specific geographic area is a highly effective way to find a position. There are other ways to find job opportunities too.
Ultimately, if you decide to work with an agency, understand that it shouldn’t be considered the default option for locum work. You should seriously consider direct contracting before you make that choice.
