Hi guys,

It’s another beautiful day.  We are going to talk about presence.  There are a lot of things that go into this.  We have to really think about this.  In this I would say that perception also plays a key role.

As a locum, key people have to know your presence during the day.  They have to see you working.  They have to see you available and hear that you are ready willing and able to work.  You can’t say yeah in 20 minutes after my break, at least not every time.  By that I mean, if they ask you to break in half every day and every second you get a 15 minute break or your lunch, I would not expect you to give it up.  But, in a special instance of the ICU called needing a stat intubation and you happen to be the only one free and the rest of the staff are saying we are at lunch.  It’s an opportunity to show you are the ultimate team player.  

So much of the time I hear about that locum that always seems to run and hide.  They rarely complain about the rest of the staff that don’t eat in the break room or immediately leave the OR area just after a case and then people are calling and looking for them.  It does seem however that if the rental is missing for 5 minutes they can never find them.   At which point, I say that I had to pee but I am back at their service.  

Presence is also a knowledge presence.  You have to exude the fact that you are knowledgeable regarding the cases.   For example, oh at the last place we only used Isoflurane and we seemed to always use Milrinone.  I hear your CV surgeon doesn’t like Milrinone. What does your surgeon prefer and do you know the rationale?  I hear your total joint guys don’t use Tranexamic Acid, do you find you have higher EBL’s?  What percentage of retro/peri bulbar block need supplemental topical or why does your surgeon require so many blocks on basic cataracts?  I’ve seen complications of the blocks and wonder if your surgeons are newer or older?  One of our cataract surgeons doesn’t do their own blocks and isn’t comfortable with them.  They only use topical and in event of it not working on a prior eye, they ask anesthesia to do them.  

I also venture to state understanding the billing structure and pay ratios is important.  That presence is important in the negotiation of your contract.  If you know the group, agency or people will keep you busy and you know the payer mix is strong, then you know that you will be earning the group 2-5 times what you bill.  If that is the case then you should be able to negotiate a higher rate.  That is typically true unless you are in a high demand area.  CRNA’s are like anyone else, they will take advantage, undercut  the higher person in order to get the life they envision as best.  

So keep a good presence about you and keep your eye, ears and body aware.