A few years ago, the physicians at the Haig Clinic, in Lethbridge, Alberta, realized they needed to bring in some outside help to fill a temporary gap in their coverage, so they placed an ad for a locum in the classifieds section of the Alberta Medical Association's MD Scope newsletter. "On-call one-in-nine weekends or as busy as you may want to be," the ad said. "We offer electronic medical records. We are close to golfing, skiing and summer resorts. One hour to the Rocky Mountains." It was quite an attractive offer, they thought. They would just sit back and wait for the calls and emails to pour in.

But there were no calls; there were no emails. "It didn't create any interest at all," says Dr. Howe Leam. Either the offer wasn't good enough or no one had read the ad -- regardless, Dr. Leam and the other doctors at the clinic began to realize that finding a locum wasn't going to be nearly as easy as they had thought it would be.

That's something many other Canadian physician are struggling with now, as this era of doctor shortages and burnout has spawned high demand for temporary help, creating a level of competition in recruiting locums unlike that of past decades. Looking for a locum has never been so hard.

HOW TO FIND A LOCUM

Many rural doctors, of course, get subsidized locums sent to them by the government. But for MDs excluded from that increasingly valuable service, finding a locum might take a bit of elbow grease.

Like a fisherman trying to land a trout, you have to cast your line in the right place to hook a great locum. But unlike the angler, you have the advantage of being able to look in several places simultaneously.

The first, and most traditional, method is to put your contacts -- colleagues, hospital admins, former med school classmates, former residents -- to good use and hope you come across a locum simply by word of mouth. Word of mouth is free and only requires a minimal amount of work emailing or calling people to ask if they know someone you can hire.

Another common strategy is to place ads in the professional magazines and newsletters. Buying classified ad space in CMAJ, Canadian Family Physician, The Medical Post, or the provincial medical associations' publications won't cost you much and will get your message out to doctors across the country. Some of those publications, as well as some of the provincial health ministries and regional health authorities across the country, also offer free message boards on their websites for doctors to place and read ads. Keep in mind that regional publications only reach regional audiences. Bonnie Shave, a clinic manager at a Pincher Creek, Alberta, group practice, says her clinic didn't get much response from the ads they placed in an Alberta doctors' magazine. "We did get a locum for one year, but it was a local boy and he came looking for us," she says.

"It's not easy," says Ms. Shave. "It's a tough battle." But given how easy it is to place a quick ad, what should you say for the best shot at success? Write a short, simple message: where is your practice, what kind of work do you do, how long will you need a locum, and what are willing to pay? (For more on contracts and pay, see below.) One other thing you might consider mentioning in your ad, especially if you're looking to hire someone to fill in for you for more than a couple of weeks, is what kind of community they'll be living in. Is there good skiing nearby? Great sailing? The country's finest lobster market? These are, as often as not, the kind of things that could sway a locum one way or the other.

A more recent trend in locum searching has seen the arrival of two new types of search tool, both online: the Craigslist spin-off, and the freelance broker. The former, of which locums.ca is the best example, offer well-organized central destinations for searching doctors and for locums. These sites are not dissimilar to the message boards offered by provincial health ministries and health authorities except that your ad may reach a larger audience across the country, and they typically charge a small fee for posting it.

Companies like CANAM Physician Recruiting Inc., on the other hand, function as brokers, act as middlemen, connecting doctors with locums. CANAM, which operates the website canamrecruiting.com, is fairly expensive -- they charge a fee of $2,500 to $3,000 for facilitating a month's placement. That price is worth it, promises the company's CEO, John Philpott. "We have a database of over 320 docs looking for work in Canada," he says. "We have a long list of locums, from family practice to cardiology, radiology, anesthesia."

Spending thousands of dollars to hire a recruiting firm to handle the locum search for you may not sound attractive at first blush, but the rise in popularity of these companies only confirms the growing problem that finding a locum has become. If you can pay someone to do the often laborious work of finding and hiring a locum for you, some time-crunched doctors are thinking, then it may well be worth the price.

The best way to recruit depends in part on how urgently you need to find a locum. Dr. Barbara Watts, a GP from Orangeville, Ontario, recommends not limiting yourself just to one method. "The best way is all of them," she says. The more you get the word out, the better.

THE HIRING PROCESS

Hopefully your search has yielded a potential locum. Now what?

Even in these days of scarce locums, you should try not to be too desperate if you can avoid it: don't guarantee anyone the job until you've spoken with them on the phone and confirmed for yourself that this is indeed the person you want to entrust your patients and your office to for however long you'll be gone.

Once you've decided to hire the locum, you'll have to draw up a contract. Don't let this part get you down -- it doesn't have to be a huge hassle. Ask some of your colleagues if you can crib off their locum contracts, and maybe just make a couple of changes where you need to, or call your provincial medical association for advice or a sample contract you can adapt. Basically, you'll need to decide on the locum's responsibilities and the payment structure.

There are three different types of pay for locums in Canada: split pay, minimum daily pay, or a combination of the two. Split pay means that a locum gets X percent of the billing fees for patients she sees, whereas a minimum daily amount gives her a flat rate for the date. A combination of the two, or blended pay model, can balance your concerns (paying a flat rate for potentially only a dozen patients a day if business is slow) with those of your locum (getting X percent of the billing fees for potentially only a dozen patients a day if business is slow).

How do you know how much to pay? The best bet is to ask around to get a sense for the going rate in your community for your practice type. "There is local and regional variation, but patterns get established," says Dr. Joshua Tepper, an assistant deputy minister of health for health human resources in Ontario and a family doctor who estimates he's done around 100 locums in his career, from northern Ontario to Nunavut to British Columbia.

"I guess arrangements are as varied as the doctors," says Dr. Watts. "But obviously you have to pay something commensurate with what everyone else is paying."

Don't forget to outline the payment for non-clinical tasks, like filling out an airline pilot's physical for his employer, or completing patients' insurance forms, says Dr. Tepper. "It's important there is a clear understanding about the compensation and conditions. You want to have clarity." For some uninsured work, payment may not arrive until months after the locum has gone home. A clear agreement, as Dr. Tepper urges, is indispensable in those cases.

KEEP THEM COMING BACK

Assuming your time away from the office went smoothly and you hope to someday take another vacation from work, you'll have to go through the locum-search process all over again. But if you can establish a good working relationship with a few locums, and ensure that they are happy with their experience at your practice, your job finding a locum in the future will be far easier.

Of course, as hard as it is to find a locum, it's even harder to find a locum who's eager and available to come back again and again when you need them. Which is all the more reason, if you find one, to make sure she enjoys herself, earns a decent amount of money, and doesn't have any major complaints.

Dr. Tepper, who's done his fair share of good locums and bad, has a list from his own experience of things not to do if you want your locum to return. Don't let all your regular staff go on vacation when you're away. Don't "forget" to mention that one of your patients is about to die and the family is in the midst of a major fight about the patient's advance directive. Don't neglect to prep your locum about that patient -- yes, that one -- whose addiction issues bring him to your office again and again. And don't gloss over important things like your colleagues' crazy habits or the local hospital's awful cafeteria food.

So what should you do? Besides a clear, fair contract and organized medical records, Dr. Tepper says much of what makes a locum experience a positive one is the social aspect of the situation. Relieving the stress of having to figure out the travel arrangements and finding some temporary housing for your locum can be a major boon. And putting some thought into what kinds of things your locum might be interested in doing in her downtime is a nice gesture. For instance, you could set up some dinners with local docs, print out some information about local music or art events, or leave behind some contact numbers for the local pick-up hockey league or hiking group.

"I have had a lot of really great experiences," says Dr. Tepper, "and it's the ones that have been well organized, with a place to stay, and where the clinic is well run and set up and anticipates the challenges of being new person in town."