Live Way Better Than a Resident… On Much Less

Stop me if you’ve heard this one before. The best way to get a head start on a better financial future is to “live like a resident” for the first couple years out of residency. That’s right. Take that six-figure job, the fat signing bonus, and pretend nothing has changed.

Park your K-car between the Lexus and the Land Rover. Just be sure not to leave any door dings. You could cause thousands in damage to a vehicle like the one to your left or to your right.

It’s actually good advice, but living like a resident is much easier to say than do, particularly when your new colleagues have years and decades of real-world experience under their gold-buckled belts, and big, beautiful homes with three-or-four-car garages in which to park their luxury fleet.

They might not actually be wealthy, but as a reader of this and similar blogs, you already suspected that all that glitters may not be gold. You may be dealing with some “all hat, no cattle” types. You don’t want to be like that, and you certainly don’t have to.

What if I told you there’s a way to live far below your means, while actually living quite well, and saving practically every after-tax dollar you earn? That you wouldn’t have to worry about any real or perceived pressure from partners to live more like them? “The Firm encourages children…” or something along those lines.

I managed to pull it off. I was the last of my classmates to take a real anesthesia job, and the first to start working. I was a locum tenens anesthesiologist starting on Monday, July 3rd, just a few days after my final day of residency. I remained a locum for nearly two years, and it was the best career move I could have made.

 

Live Way Better Than a Resident

 

When you work as a locum tenens physician, you are living better than a resident. You can expect better working conditions, fewer hours, better pay, and more respect.

As a locum, you are filling a position in an area of need. You are there because your services are desired. Required, even. The facility wants you to be happy, and will make efforts to make sure that is the case, particularly if you’re a good doc (and you know you are). The last thing anyone wants is for you to leave prematurely.

In residency, there is an 80-hour work rule that is sometimes viewed as a rough guideline. When you’re a locum, you’ll most likely be paid by the hour. I don’t know many facilities or groups that are interested in paying anyone for 80 hour weeks at locums rates. If you do end up working long hours, you will be rewarded handsomely.

Three weeks of a schedule like that could net you as much or more than you earned in an entire year as a resident.

 

Earning Way More Than a Resident

 

Be prepared to see you hourly rate jump at least 10 or 20-fold. Locums rates vary by specialty, but as a physician, I don’t imagine you’ll see anything less than $100 an hour. Rates of $200 to $300 an hour are not unusual for some specialties, and holiday pay or urgent short-notice needs may command even higher rates.

I earned more in my first six weeks as a locum than I did in an entire grueling year of residency, and that was without ever clocking more than a forty-hour work week, a reduction of 25% to 50% of the hours I typically put in as a resident.

You’re an attending now. You may look young and be young, but your knowledge base is sound, and you know how to care for patients. You may not garner the same respect as the physician who just retired after 30 years and whose job you’ve taken over temporarily, but you’ll be more respected than you were mere months ago when you were a resident.

Our good-natured neurosurgical colleagues used to refer to me and my anesthesia colleagues collectively as JAFAR (just another [f$(#!&] anesthesia resident] when speaking to the doctor behind the curtain. You’ll be more respected than that, I promise you.

 

On Much Less

 

It costs very little to be a locum tenens physician. The expenses you do incur that are related to work are tax-deductible. You can easily live well for much less than you did as a resident.

As a locum tenens physician, you can choose to work with a locums agency or go solo and negotiate your own deals. A third, perhaps more attractive option has emerged, which could transform the industry. Lucidity is a platform that allows for direct communication and negotiation between physicians and facilities at a small fraction of the cost of traditional locum tenens agencies. The technology is new to medical staffing, but the concept has proven disruptive elsewhere. See Uber, Lyft, and AirBNB for examples.

Most of my experience is with agencies, which for the most part, served me well, and I did not fare so well when I struck out on my own a couple times.

Having worked as a full time locum tenens physician for two years, and intermittently throughout most of my career, I got used to the following perks as an agency locum:

  • Lodging. You will be put up in hotels, condos, or even a house / apartment in a long term setting.
  • Transportation. Your flights are generally covered, or you are paid mileage for driving your own vehicle. If you need a rental car, that will be provided, too.
  • State Licensure. If you do not have a license, and there is enough lead time, the agency will help you secure the needed license.
  • Malpractice Insurance. Most agencies will offer claims-made with tail coverage, and at least one agency offers occurrence coverage. Be sure to inquire first, and keep a copy of the face sheet, which will be important for credentialing later on.
  • Food. This isn’t necessarily standard, but I received a per-diem of $25 a day for meals on some of my jobs.

 

How Much Will You Spend as a Locum?

 

There are some expenses you will incur as a locum. You’ll want to check out the local scene. You might spend a little money on area attractions, like museums, festivals, and honkey tonks. You’ll also need an occasional vacation, and unless you’re traveling back home, you’ll be on the hook for those, too.

Some other expenses will be on your bill, but can be tax-deductible, including:

  • Cell phone. You need a phone to run your little locums business
  • Clothing. Professional clothing is tax deductible, too.
  • Food. If you don’t have a per-diem, you can deduct at least some of your nourishment expenses while traveling for work.
  • Laptop. Another necessity for running a business.
  • Health Insurance. If you’re providing your own health insurance for your business as an independent contractor, you can deduct that, too.

 

When you consider the fact that some of your biggest expenses will be covered by the agency (and ultimately the group or hospital you work for), the life of a full-time locum can be outrageously inexpensive. Some months, your expenses may add up to only a few hundred dollars, or roughly 1% of your gross income. That’s a 99% gross savings rate, ladies and gentlemen!

I had months like that when my then-fiancée, now-wife and I were traveling the States, using locums jobs to explore different practice styles in hospitals and cities large and small. My one-bedroom residency condo was rented, and our few belongings were stored in a relative’s garage.

 

Atrani At Dusk

 

Of course, you don’t have to live an uber-frugal lifestyle. When nearly all of your expenses are covered, an occasional splurge isn’t going to set you back much. I didn’t take a full week’s vacation for the better part of that first year, but when I finally did in the spring, we spent three weeks in Europe, exploring Reykjavik, London, Dublin, Italy’s Amalfi coast.

 


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For More Information on Locum Tenens

 

If you’re a resident, I strongly recommend you consider launching your career as a locums doc-for-hire. It will benefit you both professionally and financially, and can be a fun adventure. You’ll meet people you’ll never forget who will never forget you. The networking can come in handy — I was a locum in my current job seven years before I interviewed to join them permanently, and that gave me a huge advantage.

This isn’t the first time I’ve written about locums. For more posts on the subject, see:

 

While it’s tempting to take a “permanent job” out of residency, which has about a fifty / fifty chance of lasting more than a couple years, consider full time locums, too. There’s no better way to live better than a resident, while spending even less.

 

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28 comments

  • Very interesting. I have never heard of locums. Getting your employer to pay for most of your living expenses is a great way to increase your net worth after college. In the engineering field something similar would be working at a remote site. All living expenses are paid for, so you can quickly amass a big nest egg.

  • ENT Doc

    Great post. I forgot about the meals deduction. Will definitely have to take advantage of that this year. I think the rate is 50% if I’m not mistaken. Also, locums allows for travel hacks if you either pay for flights/hotels and get reimbursement, or if you use a specific hotel honors program and request to only stay at those hotels. Even though the locums company I work with pays for my hotel the hotel accepts my wife’s hotel honors card.

    • Yes, 50% of your meal costs are tax-deductible. I also deducted half the expense when I would treat the OR crew to lunch or dinner.

      You can definitely rack up some points, too. I know I scored some free nights. The downside is hotel living. After a few weeks, it gets really old. Pro tip: Stay in a three-star place with a nice breakfast spread. The fancy hotels never have a free buffet.

      Cheers!
      -PoF

  • Not a resident, but living as if you’re still in school is something I wish I’d done right out of school. Now that I live frugally and on much less each month, I realize the impact this would have had on my younger self.

    • It’s natural to up your spending when you have a much larger paycheck. Many of us realize later on that it was somewhat reckless. Fortunately, I didn’t have a lot of opportunity to spend a lot of money. I was too busy making it!

  • Strider_91

    This appeals to me as someone who plans to leave his home town once I finish this marathon we call medical school (seems like a lifetime from now as I’m supposed be memorizing biochemical pathways). I don’t think you can really know what it is like to live somewhere just by vacationing to a location. Being able to live and work somewhere while getting paid a nice wage seems like a great way to decide where to lay ones roots.

    • I heard nothing about locums as a medical student. It wasn’t until I went to the ASA Annual Meeting as an intern that I visited the booths in the exhibition hall and learned how I could travel the country and even the world as a locums doc. I’ve entertained the idea of going to Australia or New Zealand as a doc, but fear I won’t have time to enjoy it if I’m both working, parenting, and blogging while I’m there!

      Best,
      -PoF

    • That’s how we approached it. Most locums jobs were either in a place we wanted to visit, or as a trial for a potential full time job. We also traveled to where my wife had a 9-month internship. I was able to find work there while she completed her education.

      Cheers!
      -PoF

  • I worked locums for 6 months post fellowship and loved it. I am not sure why I did not continue working that way, but I think it had something to do with wanting to be an academics doctor. I think once I am a little older I will do locums a few weeks a year and be semi-retired the rest of the time.

    • I may use locums to keep my skills sharp after I leave my permanent job, but I’m not going to plan on anything right off the bat. If I get the itch, I’ll give it a shot. If I don’t have that itch and don’t need the money anymore, I might just enjoy life as a Dad and world traveler.

      Cheers!
      -PoF

  • NH

    I haven’t had much luck with lucums inquiries. Many of the hospitals seem to be offering market rates but in undesirable locations. I few that I know are truly desperate and offer “shift bonuses” that can amount to a few thousand dollars per shift and bump hourly significantly, but always last minute and not a regular gig. Also, I happen to be living in California, so unfortunately all income earned, even in no income tax state will be taxed back home in CA, diminishing returns. It seems like a better deal to find a practice that you love that pays well and has a partnership track. Full partner seems to always make more than locums (except truly desperate and very short term gigs) and allows you to have more direct input into the quality of your local practice, peer group etc.

    The other big question I have always had, is how do you value your time traveling? Sure, they pay you back for expenses. But I don’t want to be in an airplane flying overnight to rural Nebraska to stay in a motel 6 (or even Sheraton etc). In my calculations, if money is the issue then working even 1 or 2 more shifts per month can usually make up for a difference in hourly offered by a locums job with far more time available near family and a place you actually want to be.

    I just checked out Lucidity- the locums company referenced in this article. All the posted offers are about 10% below my base rate, and 30-40% of my full partner rate on an hourly basis. Ouch!

    • It sounds like you’ve got a great job, and traveling elsewhere to make less doesn’t make a whole lot of sense.

      Regarding Lucidity, the published rates are a starting point for negotiation. In their e-mails, they’ve encouraged physicians to treat them as such.

      The point of this article was to highlight the benefit of locums directly out of residency, before starting a full time job. It can be a great way to find your first job. Try before you buy — both the position and the location. It worked pretty well for me.

      Cheers!
      -PoF

  • EnjoyIt

    My god, making $250k+/yr, saving 90% after taxes for just a few years will create instant financial security for life. I have an ER doc friend who did locums in Texas. He credentialed at many hospitals in the state and more or less created his own schedule among the several institutions. Many times he would be paid an extra $500-$1500 per shift for emergency coverage. Every now and then he would take an entire month off just to travel. Not a bad life and he got paid very well for it.

    • When you can be flexible, you’ve got the ability to take advantage of those shift differentials and holes in the schedule to earn extra $$$. It sounds like your friend did just that.

      Most of my assignments were long-term (months) and I was traveling with my fiancee / wife and a dog, so we were usually put up in furnished apartments. I was responsible for my own benefits package, but I made a lot more than $250K and expenses were next to nothing. Of course, I sunk most of it into a house that we ended up selling at a large loss, but that’s life.

      Best,
      -PoF

  • Not only is this a great way to start your practice, it is a great way to end it as well. I spent my last three years doing Locums or Locums like work as I worked my way down from full time to retired with a slow progression. It is hard to quit cold turkey. Locums can allow you to slow down at your pace. Just take on as much work as you want and every few months, take it down a notch.

    I laid out the full story of how I did it in my latest book, “The Doctors Guide to Smart Career Alternatives and Retirement.”

  • Great post!

    Locum tenens is an alternative that every physician should at least know about…

    I’ve been working locums for the last decade or so. The flexibility intrinsic to locums has allowed me to write articles and a third book, participate in medical missions in the Philippines, develop my underwater photography hobby, and work at several terrific hospitals. I’ve even been faculty at the Mayo Clinic!

    From a financial point of view, I agree with PoF. The money I’ve made from locums has been on par with other salaries. (It is also true that if I was a partner in a thriving practice with passive income, my take-home would be higher, but those opportunities are few and far between and come with strings attached.)

    I’ve spent more time in airplanes and hanging around airports than I wanted to, but now I’m upgraded to a front seat (not first class yet, though).

    I apologize for the following self-promotion, but this forum appears an appropriate place for it…

    With any luck, I’ll finish writing my new book, The Locums Life, A Physician’s Guide to Locum Tenens in about 6 months.

    Anyone interested in looking at a first draft and making comments will be entitled to a free copy of the published book. Just contact me: [email protected]

  • snowcanyon

    Looked at Lucidity and was initially thrilled about the site. However, they ask for a photo, which unfortunately opens up both the possibility of unconscious racial/gender/ethnic bias on the part of the employer, and also leaves them open to accusations of such (this is why job search sites do not request photos).

    Guess I’ll stick to the old fashioned locums life!

  • snowcanyon

    Yup, it is optional. But others will upload one, and employers will most likely prefer those candidates, as that tends to be how humans operate. Both the site and the prospective employers are putting themselves at risk with this request.

    Locums companies NEVER request a photo, nor do job search sites like Monster – why should this site be different? It’s not a social networking or dating site- it’s a job site, so I find the photo request/option extremely troubling, especially since I have never had a photo request for any physician job, locums or permanent. It’s just opening the door wide both for actual (if unintentional) discrimination and also to accusations thereof.

  • While I have zero medical expertise, I can definitely relate to the idea of living like a student even after getting that big payday. I was the guy parking my old beat up car between the Lexus and Land Rover. I remember a couple partners asking me when I’d get rid of my car and start leasing a Benz. Lifestyle creep can be a sneaky, dangerous thing!

  • Hatton1

    I am friends with the president of the anesthesia group here. I asked about locums. They never use them. The hospital employs the CRNAs and they do use locums. In Ob/Gyn I have never known any locums. I think it is feasible with hospitalists and laborists. I did know a retired ob who did locus in Australia and NZ. He said the money was not good but he was doing it for the travel.

  • Similar to this, try to live with your parents as long as they can…or until they wanna kick you our 😉
    You’ll save a ton, get free gourmet meals and will or should be helping them out in the process.

  • Stop me if you’ve heard this one before. The best way to get a head start on a better financial future is to “live like a resident” for the first couple years out of residency. That’s right. Take that six-figure job, the fat signing bonus, and pretend nothing has changed.

    It’s my dream to have all doctors feel like they’ve heard this one before.

  • Pingback: Journal Club 9-8-17 | Passive Income M.D. | Passive Income for Physicians

  • Amanda Gerber

    I am in the process of opening my own family practice in a rural area and I have been working locums for about 2 years now in the interim to build wealth, pay down loans and take care of my family. While my expenses are not quite as low as quoted in this article, as I have pets and kids and a wife, we do quite well. My kids have some special needs and I am home way more now than I used to be. I will be working at a location next month where I will earn more in 7 12 hour shifts than I did in 3 months at my last job and more than I earned in 9 months as a resident. And that gives me 24 days at home!!! Locums has been huge for me to go where I am needed, keep up my emergency skills, and more. My agency has paid for two state licenses, my DEA registration needed for one of my jobs, travel, ATLS certification and more. The one downside is paying my own taxes since I work as an independant contractor, but a very good CPA and I have worked that out for now.

    Great article!!!

    • If you can earn that much in seven 12-hour shifts, I’m not sure why you’d want to do anything else! There are some advantages to owning your own practice, too, of course. best of luck with the new venture.

      I worked locums before, during, and in between jobs throughout most of my career. I would guess my gross from locums exceeds a million dollars.

      Cheers!
      -PoF

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