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Locum Tenens is simply a fancy Latin way of saying temporary work. Just like curriculum vitae is a fancy Latin phrase meaning résumé.
We, doctors, are fans of fancy Latin words. Why? Nolo contendere – non est mea culpa.
In Latin, locum tenens means “to hold a place.” Often mistakenly called “local tenens” or “local tenums,” it’s just another way to say you’re a traveling or temporary worker. A physician serving as a temp doc in an interim role may be called a “locums doc” or simply “a locum.”
I’ve personally worked as a locum tenens physician in a variety of situations and for a variety of reasons. I did so before I took a permanent job, in between jobs, and even on my “vacations” when I had debts to pay.
In this article, we’ll talk about what a locum physician is, how to become one, and the pros and cons you should consider before deciding.
What is Locum Tenens Physician?
Locum tenens means “to hold a place” in Latin. Locum tenens physicians work temporarily in various healthcare facilities to fill staffing needs.
However, you don’t have to be a physician to work locum tenens. Positions are also available in temporary medical staffing for advanced practice providers like nurse practitioners, physician assistants, and nurse anesthetists. I’ve worked with many a locums CRNA in my day.
Does Locum Tenens Exist for All Physician Specialties?
Yes, locum tenes are available for all specialties.
However, family practice and internal medicine are the specialties most impacted by staffing shortages and have the highest locum tenens. But I’ve known locum doctors in radiology, obstetrics & gynecology, psychiatry, family medicine, critical care medicine, pediatrics, and oncology. I’ve also encountered several locum surgeons and hospitalists in my travels.
According to a 2023 report by Definitive Healthcare, the specialties that have the highest demand for locum tenens physicians are:
- Family practice
- Internal medicine
- Emergency medicine
- Nephrology
- Nurse practitioner
- Orthopedic surgery
- Diagnostic Radiology
- Pediatric medicine
- Obstetrics/Gynecology
- Gastroenterology
Some highly specialized medical fields have fewer locum opportunities due to the complexity and rarity of cases they handle. For instance, specialties like pediatric neurosurgery or interventional radiology have limited locum tenens options.
You may also like: 4 Physicians Revisited: The Impact of Specialty Choice
How Long Can a Locum Tenens Physician Work?
Depending on the position you are looking for, physician locum tenens work can be short-term and long-term. This physician side gig can last anywhere from several days to months and sometimes as long as years.
For example, some facilities may need locum tenes to cover the absence of a physician on vacation. Due to staffing shortages, others may need extended locum tenens. The most common length of a locum tenens position is between two weeks and several months.
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Pros of Locum Tenens
There are many benefits that come with being a locum physician. Here are some I have come to value over the years:
Locums Give You Freedom
Freedom is something I write about a fair amount. An often-used synonym for Financial Independence is Financial Freedom. Choosing to work as a locum gives you considerable freedom, which can be gained without retiring.
You can work as little or as much as you like as a locums doc. You can work in major metropoles or podunk mountain towns. You can make like a teacher and have summers off to enjoy the sunshine, take the winters off to escape the cold, or embrace it as a ski bum.
If you’ve grown tiresome of your surroundings, you can make like a hockey player and get the puck outta here. You can travel the country in an RV, hopping from job to job, or stay put, accepting jobs only in your hometown.
There are typically vacancies across the country. A quick look at Gaswork shows locum work available in nearly every state. You can also find work in Australia, New Zealand, and other far-flung international destinations. A U.S. medical license is quite valuable globally
Travel
As mentioned briefly above, one of the nicest fringe benefits of locum tenens work is the aforementioned ability to travel while earning a living. The travel option may not mean much to some doctors who choose only local assignments, but those who travel across the country as they work can combine their love of medicine with their wanderlust.
If you’re like me and live “Up North,” you might migrate south with the snowbirds to help meet the higher demand for medical care “Down South” in the winter months. Is Naples, Florida not exotic enough for you? Opportunities exist in faraway places like Australia, New Zealand, the Caribbean, Tasmania, and Guam.
Travel is a universal desire ingrained in humans. I know that many people would love to spend their lives traveling but cannot do so because of financial constraints.
Some physicians work locums solely so that they can travel far and wide. As mentioned previously, locum work doesn’t have to be confined to a single state, region, or even a country.
Qualified U.S.-based locums can literally work anywhere in the world – sometimes for pay, other times in humanitarian efforts such as those led by Doctors Without Borders or the one I chose to work with and still support One World Surgery.
Locums Work Pays Well
Unlike positions with partnership tracks, locum tenens positions pay well from day one. If you are qualified to do the job, you are paid accordingly.
If you are a new graduate and used to working like a resident, working a similar schedule as a locum can be quite lucrative.
With most locum tenens contracts I have signed, every quarter-hour you work beyond an 8-hour day is rewarded with additional pay.
Call coverage can also generate additional income. A hard-working locum can earn close to double that of a colleague putting in his or her time in hopes of becoming a partner.
It’s not unusual for a physician to earn $200 to $300 an hour or more. You may get additional pay for being on call for the hospital, even if you’re not called in.
Your availability and time are valuable and short-notice jobs can pay more. Much more.
Travel costs on these medical staffing assignments are typically reimbursed, and you may also receive a per diem for meals and incidentals.
You Only Pay for the Benefits You Want
As a locum tenens provider, you are an independent contractor and choose your benefits. Most physicians employed or in a larger group will be assigned a benefits package. The options and flexibility of these benefits vary widely, but they can be limited.
For example, I had an excess group life insurance policy as part of my benefits package when I was employed. I didn’t choose it and – more importantly – didn’t need or want it, but it was provided to all physicians employed by the hospital.
Although I didn’t directly pay for it, I did pay taxes on the provided benefit.
Also, as an independent contractor, you can start a solo 401(k), stashing away up to $66,000 tax-deferred in 2023, choosing any investments you wish.
Similarly, an employed physician can access defined contribution and/or defined benefit retirement plans, but the investment options can be limited to lousy investments.
Read also: Should You Invest in a Roth or Traditional 401(k)?
Locum Tenens Physicians Can Avoid Office Politics
Healthcare facilities use locum tenens providers for their clinical skills and don’t expect much else from them. A locum tenens physician can easily avoid many non-clinical duties increasingly expected of more permanent “providers.”
If meetings and conflict resolution are not your thing, a locum’s job might be for you.
As a physician who previously served as a department chief, committee chair, and president-elect of the medical staff, I have been immersed in medical staff politics.
I’ve also spent about 20% of my career as an anesthesiologist working on locums assignments.
Freedom from the entanglements of local hospital politics is a vastly undervalued benefit of being a locum.
New and Different Experiences
Your locums experience could be different in terms of the type of work you do, the place you do it, or the schedule you keep.
In anesthesia, you may do some locums work at a larger facility that does a wider variety of cases to keep your skills up to date. A surgeon might do locums to work with surgeons using newer techniques or technologies. A psychiatrist could consider working locums at a facility that offers electroconvulsive therapy to maintain that skill. A clinic-based internist moonlighting as a hospitalist can better maintain her inpatient skills.
Doctors undergo tremendous training during the seven to ten or more years it takes to get from medical school to the end of residency. Yet all the formal training in the world can never replace the rewarding, real-time training received during the actual practice of medicine.
Locum tenens work is an incubator of real-time training because it exposes the doctor to different ways of doing things, work environments, patient personalities, and even rules and regulations. The fact is that no two medical facilities are exactly alike. No two patients are exactly alike. The more exposure a doctor can get to new work experiences, the more real-time learning occurs.
Additionally, your quest for a different experience may be more calendar-related. After years of working 7 to 6 Monday through Friday, you’re ready to try a week-on / week-off schedule. Or work just 10 days a month. You can take the winter off to ski the Rockies or the summer off to take a mighty RV road trip with the family. If you’re working exclusively as a locum, you can better control how much or how little you work.
Cons of Locum Tenens
As with everything, there are some drawbacks to this career as well. Here are a few cons that you should consider:
Freedom isn’t Free
Freedom can come with a hidden cost: lack of job stability. Do you know the tablecloth trick, where you pull the tablecloth out fast and the dishes stay put? Well, sometimes they don’t.
Several times, I’ve had the tablecloth pulled out once I had fully set the table, signed a contract, and even started working on a locum tenens assignment.
Your temporary employer usually retains the right to cancel a job on short notice, a factor to consider when you negotiate a contract via a healthcare staffing agency or independently.
The first time it happened to me, the dishes nearly crashed hard. I was told by the locum tenens agency on very short notice that my agency had a malpractice insurance lapse and that I wouldn’t be able to work for at least a couple of weeks.
This was maybe six or eight weeks into a 25-week locum tenens job, my first long-term assignment in the fall after completing residency. I couldn’t accept the agency’s “solution” of an extended unpaid vacation.
Knowing that at least two staffing firms had recruited for the position, I contacted one of them and found that they could provide immediate malpractice insurance, which would allow me to keep working.
There were two or three days of discussions between the two agencies, the anesthesia group and the insurance companies.
I got a long weekend off, but the offending agency agreed to pay me for the missed days, so all was well.
I worked for the second agency for two weeks and finished the contract under the first agency. No one else would have if I didn’t stand up for myself.
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On another occasion, a nine-month assignment of mine was canceled when a permanent doc was found.
I was given enough notice to find a different job – one that was actually closer to where I wanted to be in Pittsburgh, PA, while my wife was interning as a dietitian in town.
Ultimately, the new job was better than the first, and it offered more flexibility.
A third time it happened to me was frustrating, as I had requested a specific week off from my full-time job to match another facility’s needs. The need disappeared, and I had a nice little staycation with my young family.
Locum Tenens Pay Can Be Bested
While locums can be advantageous, particularly for a new graduate, it can be tough to match the pay of some experienced salaried physicians in private practice.
With hard work, clinicians can make a well-above-average salary of a locum, but the most remunerative jobs will belong to physicians who have reached partnership in an area with a good payor mix.
I’ve done well making a solid income as a locum and as an employed physician, but never as well as the partners in a suburban practice with whom I once interviewed.
Your Benefits Plan Will Be a DIY Endeavor.
While your options for health insurance, life insurance, and disability insurance are unlimited, it is up to you to find them and pay for them. There are professionals out there to help you with the task, but you must take the initiative and make it happen.
A solo 401(k) is a great way to save for retirement while reducing your current tax burden, but you will not benefit from any corporate match or profit-sharing program.
When employed, my employer kicked in about $20,000 a year to my 401(k). The total benefits package was easily worth north of $50,000.
As a locum, you are on your own, for better or worse.
Read also: Recommended Insurance Agents
You Are Just a Short-Timer
Being a transitory figure isn’t always a blessing. If you are used to being an authority figure, you might struggle to work in a facility with shortcomings, particularly if you know how to fix them.
Your input won’t be sought and may not be considered when provided. You will need to adapt to the local facility’s culture, even if it doesn’t jive well with your way of doing things.
Socially, your ephemeral presence may leave you high and dry regarding work parties and social gatherings.
Some functions are reserved for the active medical staff, a mailing list you probably won’t be on.
More informal gatherings might go down with or without you. In my experience, I have felt quite welcomed by my new and temporary colleagues, but I wouldn’t expect that to always be the case.
Recommended Locum Tenens Company
If you are looking for exciting locum tenens jobs but don’t want to sign up on multiple sites, Locumpedia is a great place to start. Locumpedia is more than just a job board – its the ultimate guide to the locum tenens industry.
This company aggregates thousands of fresh jobs and features the largest and most well-known locum tenens agencies, making it easier to find your next opportunity. They also regularly publish career resources for locum tenens physicians, including “Locums CME,” their newsletter covering the news that matters to locums docs.
To help you vet staffing agencies, they’ve created a comprehensive guide to choosing a firm based on its top specialties, malpractice insurance coverage, payment options, and more. You can register with Locumpedia here.
Another great source to find the best locum tenens agencies for physicians is Clearly Rated. They use a Net Promoter-based satisfaction survey tool to measure physician satisfaction with a specific agency. They also release staffing awards for the highest performing locum tenens agencies.
What to Consider When Choosing a Locum Tenens Agency?
Here are some key considerations before choosing a locum tenens agency to work with:
NALTO Membership
NALTO is the National Association of Locum Tenens Organization. They set and enforce industry standards and codes of conduct for locum tenens agencies. When an agency has a NALTO membership, you can be certain that they are following a code of conduct and that you are being treated professionally.
Credentialling Assistance
When working as a locum tenens, you may travel across state lines, which could require you to transfer over your credentials. This process can be complicated and time-consuming to verify. Many agencies offer credentialing assistance to help you ensure you have all the necessary credentials before you start working at your locum tenens position.
Malpractice Insurance
You want to verify whether your agency provides malpractice insurance and the level of insurance provided. Choose an agency that offers malpractice insurance, and if needed, you can supplement it with your coverage. Travel Arrangements
While many agencies cover your travel arrangements, some don’t, so it’s good to verify. Certain travel arrangements that you might want to consider include:
- Car rental or gasoline expenses
- Airline tickets
- Hotel or housing costs
Specialty / Facilities Participation Type
You want to choose an agency with plenty of positions and relationships within your specialty so that you can choose from a locum tenens position that best fits your needs and experience.
FAQ’s
How do locum tenens pay and salary work?
When working as a locum tenens, you are considered an independent contractor. Most facilities will hire a staffing agency to assist them with filling locum tenens positions, which means most locum tenens are paid by their staffing agency.
The key factors to consider on locum tenens salary:
Hourly pay: Locum tenens physicians are usually paid by the day/shift or the hour. The specific type of pay rate will vary by position.
Payment schedule: You should expect to receive your compensation at regular intervals, such as weekly or monthly, as agreed upon in the contract.
Staffing agency pay cut: Locum agencies may take a significant cut, so it’s worth considering bypassing the usual locum agency and negotiating directly with the hospital. We’ve seen our colleagues pay rates’ of $500/day or more by negotiating directly.
Taxes and insurance: The critical difference between salary as a locum tenes and permanent physician is that, as an independent contractor, taxes and medical insurance are not deducted from your pay. You must plan and pay your taxes and insurance as an independent contractor.
Benefits: In addition to locum tenens salary, staffing agencies often provide locum tenens with medical malpractice coverage, travel expenses, housing costs, state licensure assistance, credentialing costs, and privileging assistance. These costs are covered since locum tenens are often required to travel and live outside their home.
Can I work locum tenens if I am not board certified?
Residents or physicians without board certification who recently completed residency training are considered “board eligible” and can work locum tenens.
However, without board certification, you will have fewer options for locum tenes work. As a rule of thumb, you should aim to be board certified to work as a locum tenens.
Can I work locum tenens after residency/fellowship?
Yes, you can work locum tenens after residency or fellowship programs.
Although you may not have as many positions available compared to board-certified physicians, there are many benefits that locum tenens offer to physicians who have just finished their residency or fellowship programs.
Here are some benefits to consider:
Determine long-term practice: If you are just starting out, working in a few places as a locum can help you find a practice that works for you. Fortunately, many of the places using locums would welcome the full-time services of a capable physician, and your favorite locums job could transition into something more long-lasting.
Gain valuable experience: Working locum tenens allowed me to work in a wide variety of places and practices, large and small, urban and rural. I had a chance to be assigned to work hands-on in one operating room every day and to supervise 3 or 4 different rooms. I became more well-rounded and adaptable, and I had a chance to “try before you buy,” learning what kind of practice best suited me.
A path to becoming a permanent physician: Many facilities offering locum tenens work would accept or actively seek permanent full-time physicians. This allows you to turn your favorite locum tenens positions into permanent ones.
A staffing agency can help you find positions that meet your experience and needs. This allows you to turn your preferred locum tenens into permanent full-time positions.
Can I work locum tenens as a resident?
Yes, locum tenens positions are available for residents. It’s common to find locum tenens positions specifically designed for residents. That said, locum tenens positions are available for residents, but you will have fewer opportunities than practicing physicians.
Do locum tenens physicians need malpractice insurance?
Yes, locum tenens physicians need malpractice insurance. But in most cases, if you are working with a staffing agency to find your locum tenens positions, they will provide the coverage for you. One significant benefit of working locum tenes is that, more often than not, you don’t have to worry about getting your coverage.
I recommend you confirm the type of coverage the locum tenens staffing agency provides. If they don’t provide you with malpractice insurance, get your insurance to confirm you are covered.
Who pays for housing as locum tenens?
Housing costs for locum tenes are often covered by the staffing agency working with the facility you will be working at. Staffing agencies will cover locum tenens housing in one of two ways:
- Provide you with your exact housing accommodations and pay for all costs
- Provide a stipend to cover housing costs, and locum tenens choose housing accommodations
What type of housing do locum tenens positions receive?
The type of housing you will receive depends on the length of the locum tenes work. Below is the type of housing you can expect from a staffing agency depending on the length of your locum tenens work:
- Length: a few days to a few weeks – standard hotel
- Length: several weeks to a few months – upgraded hotel with Kitchenette or Airbnb
- Length: six months or longer – apartment or home lease
If your staffing agency is not providing your housing, but they are providing a stipend for housing expenses, you can choose the type of housing you want during your locum tenens contract.
Do locum tenens physicians need disability and life insurance?
As independent contractors, locum tenes physicians must get their own disability, life, medical, and dental insurance. Since locum tenens are independent contractors, the facility you are working for will not offer these benefits.
Do locum tenens physicians pay more taxes than W-2 employed physicians?
Because you are considered an independent contractor when hired as a locum physician, you will pay the employer and employee portions of certain taxes, like Social Security and Medicare (self-employment tax). It is a sharp departure from a W-2-employed physician.
Traveling physicians also have more tax deductions, such as travel expenses or home office deductions.
Do I require a legal entity (LLC or C-corporation) to start working as locum tenens?
No, you don’t need to create a legal entity like an LLC or C-corporation to work as a locum. Most locums doctors operate as independent contractors or sole proprietors.
In such cases, you can use your Social Security Number (SSN) for tax purposes. However, forming a legal entity may offer certain benefits, such as liability protection and potential tax advantages.
The decision to establish a legal entity depends on your preferences, financial considerations, and the advice of a qualified attorney or tax professional.
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Again. I suggest talking to your tax advisor to see if creating a legal entity benefits you.
70 thoughts on “Locum Tenens Physician: A Comprehensive Guide”
Excellent article with good comments. I thought I add my experiences.
I retired. A company asked me to provide a couple of weeks coverage in the fall where my kid was in college. Two weeks work, time with the kid and some unexpected cash. I probably would have turned them down if it had been any other location. Then I got a call from another agency asking me to cover another clinic in another town 200 miles away from the first, between Christmas and New Years at double what the first agency paid. So, I told them sure, 4 days only, knowing how hard it was for me to get Christmas coverage pre-retirement. The second clinic was owned by the same massive multi-state hospital company as the first. the original locums company blocked the second company claiming that because I had worked for them for the first clinic and they were both owned by the same company (as was nearly every clinic in the state for my specialty), I could only work for them and at their rates. Show stopper, and I ended the relationship.
Jump ahead several years, having returned to work for the better part of 5 years post-retirement, retiring again because my wife told me to. I learn from this site, that these companies have pretty bad restrictive covenants. Most of my career was without any restrictive covenant. I turned down a very lucrative contract with one practice because of it, and did far better working for just one practice without any restrictive covenant, after leaving academic medicine. The original locums company called with another low offer, same contract terms as before. From this site, I learned about passive contract renewals, and sure enough, the old contract had just such a clause. I think I’m covered because I sent an email advising them I would no longer work for them after they blocked a second much higher offer and refused to match the higher offer. As I was sort of retired (meaning working full time), I didn’t think about it again, until I completed remedial retirement.
Much as I love my work, and am passionate about it, I’d rather do research (and go fishing) than deal with a restrictive contract that essentially gives the company full say on where, when and who I may work for, and unless I take specific written action to end the deal, which takes up to 3 years, and lives on like Methuselah if I don’t write a letter.
I haven’t researched the various companies out there, but if I do decide to go work some more (wife says naa ahhh!) I’ll do a little better background check on the companies or negotiate a more balanced deal. If there is none to be had, well, there’s plenty of fish in the sea to catch and always a new and better project to build.
I worked with Austin major Group. After I signed Assignment confirmation letter they declined the 30 days notice. They declined to pay me for the notice period as the locum was ended due to I give 30 days notice. I am filling legal action against them. I warn any physician to work with this company.
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Sorry, I know that you receive a lot of comments, but would you think it is inappropriate to want to become a doctor solely because I want to work locums tenens and have a healthy life outside of medicine, too? Medical school/residency is very hard enough and so going through that very arduous process for a very very specific goal feels a bit off to me.
I did nothing but locums for 2 years after finishing residency. It was great!
We did settle into a “permanent” job when we were ready to start a family. My wife was 5 months pregnant when I took that job, and it was a place where I had done locums previously. Years later, I would take a final “permanent” job where the interview was basically a formality. I had done locums there, too, and was well-liked and welcomed back.
Cheers!
-PoF
Hi,
I’ve “retired” from 40 plus years of a busy practice in a single specialty clinic. – psychiatry. I’ve worked three different inpatient jobs of about 8 months duration-various off/on schedules. I’ve found the pay good, the hours long, a steep but satisfying learning curve. I wouldn’t be doing this except that I was divorced after 37 years, 3 kids, irreconcilable differences. The down side is you are paid for work hours, but not the being away from home sitting in a motel watching You Tube not visiting your kids hours. Pick your shifts (7days on, 7 days off, or ???) carefully because you probably won’t have time and energy to see anything but the inside of the hospital. Lots of travel (commuting) possible. The day before and the day after your work period is consumed by travel, even if it isn’t so far. You are dealing with at least 1 or two levels of weasel bureaucrats, who may be ok, or may decide “It’s not a good fit” with out the guts or common curtesy to talk to you about it. Also you can’t just get any job, any place. I, personally, I guess, find all the credentialling humiliating-You are inspected, detected, possibly rejected without telling you why, screened for drugs, TB, whether or not you are have been faking your education and qualifications all these years, etc. As you probably know, the administrators/bureaucrats/weasels do not respect you, even tho they pretend too. You are just a wage slave, a skilled but replaceable worker in the gig economy. Now it’s not all bad-the patients are all familiar-at least to me-99% of the staff are just fine (tho now I find social workers telling me what drugs I should prescribe-Aren’t you going to try Haldol because the Zyprexa isn’t doing anything?) new experiences, new legal systems, new ward cultures, and new EHR’s keep the neurons firing. The pay can be good, -But NO benefits, and a 12.5% self employed tax_but you are giving them your life 24/7, even if it isn’t all in the hospital. You are just passing thru, so don’t expect getting invited to parties-dating? fuggetaboutit.
So think carefully, and remember you are a physician-or RN, OT, etc and the only thing you “provide” is profit for people who know nothing about medicine.
Yes, I sound disgruntled, but I’m really amiable and accommodating-and I’m not the only one who feels the way I do.
Moving out of your comfort zone allows you to have new experiences. It also helps You to Develop your inner strength. When You Overcome Your fears You will ultimately get better results in Life.
I have been doing locums for 2 years in Oncology. What I have learnt is that larger locums companies pay less and often try to take advantage of a situation. As anyone knows that Oncology is a very patient interaction time heavy field. My current assignment after seeing patients, I often spend the evening finishing charting, ordering scans, and tumor sequencing, returning calls to patients, calling patients about results and next steps. However my current locums facility refuses to pay me for my time – instead pointing to patient number. The locums company is playing the devil between by continually asking me to state how I spend my time – I am not sure if I signed up as a physician to give a minute by minute replay of my time. I have provided them with information about how that time was spent; the client has even been present when I am working late. I have in the beginning told them of my concerns about the practice and the issues affecting patient care – the locums company has been no help. This particular practice has seen a heavy turnover of oncologists over the years (I did not know this when I agreed to work there). When working with smaller locums companies I find that they are more responsive in helping to work through issues.
You should absolutely be paid for your time when you’re at the clinic or hospital for patient care reasons, whether you’re directly seeing patients or not.
I can see where you might have better luck with specialty-specific and smaller outfits as opposed to a more corporate agency that works with many different specialties and may not understand what it is that you do in yours.
I hope you’re able to resolve these issues!
-PoF
Natalie
I am a practicing Heme Onc with 25 years experience at same private practice and appreciate your commitment to patient care with your before and after clinic hours patient care efforts!!!
Thinking of Locums in 5 years or so as a way to more gently retire
Can you send me the names of the smaller agencies you mentioned or point me towards resources that you have found valuable
Many thanks and take care
Rich
Getting out of our Comfort Zone Creates good stress to ramp up our focus, creativity, pace, and drive. Leaving your comfort zone allows you to have new experiences and to engage in activities that you haven’t before.
Had no clue there was such a thing. You learn new things every day, don’t you? Temporary work sounds a bit like a contractor kind of work.
POF has provided a very nice discussion above on locums.
Both of your questions are very good ones.
You will discover that many of your attendings advising you on the benefits and risks of locums have no personal experience with locums and have very little idea what they are talking about!
It is true that if you work locums for 10 years and then apply for a full-time job, your potential employer will wonder how serious you are about staying (I know of two such cases.) However, if you experiment with locums in order to try different practice styles, travel about the country, and find your true niche for a year or two, employers that hold that against you are so narrow minded that you wouldn’t want to work for them!
As for your second question, there are two schools of thought regarding locums after residency. The first is that it’s a great idea to hone your skills, travel, and decide what type of practice you like by trying out different practice styles (small vs large clinics, rural vs urban, etc.). The other thought is that newly graduated residents really aren’t ready to make decisions on their own and need a supportive environment with colleagues who can help them mature in their decision-making and clinical practice. It really depends on you, and you need to do some realistic introspection regarding your own clinical skills to decide what to do.
I discuss the topic of “Locums After Residency” in Chapter 5 of my book, “The Locum Life: A Physician’s Guide to Locum Tenens,” available on Audible.com, Amazon.com, and most places you buy books.
If you have any other questions, please feel free to contact me through my website: http://www.andrewwilner.com
Best of luck with locums!
Anesthesiology resident here. The thought of locums and doing a sort of slow travel after I graduate while the housing is paid and loans dissappear sounds almost too good to be true. I have no real roots and my significant other is in software so can work virtually anywhere. A few questions though.
1. Many of my academic career attendings make a point that after doing several locums gigs and not having a steady job for any length of time after I graduate will be a “red flag” and that it will make getting a permanent position much more difficult. Some also expand that references will be harder to come by and that it overall looks shady to a permanent employer and that a huge concern of an employer is that I might leave shortly after accepting a permanent position. Is any of this true and if so is there a way to mitigate any of it?
2. How feasible is it to go out as a new attending and do locums in a practice environment you aren’t used to? I have spent my life in the northeast at academic places for training and hope to depart from both, at least for a while.
Newbee to the locums idea and with questions…
I am a Rural solo family physician of 30 years in one small rural MN town….looking for a way to travel, …see 13 grandchildren scattered across the USA, …and continue doing what I love — provide folks with medical care. I do not wish to retire.
If I would like to focus on RURAL practice needs how best to proceed? Is there a source where one can go to learn the locum / independent contractor ropes? Currently, and for the past 30 years, I have done OB with cesareans, colonoscopies, EGDs, ER, inpatient care, ped’s circs, radio frequency venous ablation, and full time FP.
We have also done overseas medical missions.
My wife and I would really like to travel the USA with an RV, choose our weeks to have me work alone the way, and enjoy our family.
Any advice?
Thanks
People count being out of comfort zone as a Con of Locum Tenens but i believe it is a benefit I mean living in comfort zone a stagnant life what’s the benefit of that?
Having lived in the rural south (not from there by a long shot) I have found your color or gender is not an issue if your behavior is professional and you speak proper English and not the local dialect. You can’t dumb yourself down and be respected. Especially in the ER as people are there because they are in enough discomfort to warrant the visit.
Most all locum contracts I have worked have a 30 day out clause on a longer contract- protects both you and them from a bad job assignment or bad physician. They all have the two year clause non compete or 20K finder fee if you are hired permanently by the hospital. This is known going into the contract and is standard in locum. I LOVE working locus as an OB/GYN- I make double what I made in private practice working significantly less hours. I don’t have to deal with being owned by a large hospital system who wants to cut my salary (again), or a partner who thinks they are a businessman (not). Happy to let the locum company have the 25-30%. Life is good
Be very careful. I worked for a company that threatened me when I found a full-time permanent position. They said that I was being unethical for withdrawing my name from an assignment. They told me that the contract that I signed for the initial assignment would carry ad infinitum, and there was a clause that if I took an assignment I would have to abide by their rules and not break them. I finally got them to agree to 30 days, which turned into 32.
They also had a clause that if the facility liked me, too bad, I couldn’t be hired by them directly for two years. The facilities where I worked liked me and asked me to work for them rather than go through the agency.
I would continue with locum tenens work post-retirement, but I would not work for this one particular agency if I can help it. People, do your homework and ask around.
I am a BC emergency medicine specialist with a full-time opportunity but I am considering locums work to gain additional income. Ive been offered a full-time position as a second job but the scehdule of 5 shifts per week is too hefty. So Im considereng working urgent care locums only for additional work. Im nervous about the transient nature of the work. Also as an African-American provider Im very leery of working in the rural South. What would you recommend?
The beauty of transient work is that it’s transient. You can try it out, see if it’s a good fit, and decide whether or not to continue afterwards. There’s little commitment from either side. That’s the nature of locums.
I would encourage you to give it a shot. What’s the worst that could happen?
Cheers!
-PoF
I work mainly as a Locum GP( FP) in and around London, UK- through 4/5 agencies. We have built up a rapport and in London as well, they probably take a 30% cut. however, finding jobs is very easy and so don’t mind this. I work in many roles, Urgent Care, regular Surgeries, Ambulatory care( walk In centers) Out of Hours and for the London Ambulance services.
This is by choice, as I don’t have to get permission to take my vacations, and am independent.
Of course vacations/indemnity is not covered-but the opportunities are aplenty. Here I am in Boston, MA- can choose when to get back. My thoughts are that this is the way to go for older doctors who don’t want to retire – semiretirement??
Look forward to returning next week for some good work too..
Rebecca,
I am a BC-FP and am approaching the time in my life where this is what I would love to do. Would you be so kind as to give the links or the names of the agencies that you use? It would be very much appreciated.
When you say semi-retirement – do you mean that you’re working less than fulltime hours, or just that you have independence over your schedule and you can take a few months off between posts if you desire? I’m a physician in my 30s and I think part-time is appealing but find it’s not as common.
Be awake about recruiters from locum agencies. I have worked over many years with 5 or 6 agencies and , over time, have been struck by the recruiters increasing disingenuousness and lack of accountability towards “their” providers. This includes not keeping the provider informed of the progress of a job application, “ghosting “, lying about how credentialing is going, resorting to silence rather than passing on any bad news (I think we have raised a whole generation or two which thinks this is OK), poor communication with other departments in their agency (is this because they themselves are independent contractors who are remote from their risk departments?). Promising to reach out for answers and never getting back to you is not acceptable in any role or situation. Receiving an extensive recredentialing application and never reporting back on its tutus to the provider is not OK. I have only ever worked with one single agency which I would rate as even remotely candid. Sadly only one. My assessment of accountability on the part of the locum industry in general is not any more favorable than my assessment of the same by the entities that control the health care industry. I would not expect the latter leopards to change their spots. I would have expected better from the former which seems to claim to be a more personal-oriented game
I think I made a mistake doing locums for the first time this year. I was reeled in by a pretty good rate, free travel to a place I love visiting and the ability to keep doing surgery with minimal commitment.
And the locums agency was desperate to get me signed on. Before I started I asked if the malpractice insurance covered tail. Since I am obgyn, this is extremely important. The locums agency emailed back a simple “yes”. I don’t have the contract I signed. I can’t find it. But I realize they have bought me a claims made policy and now I am anxious because I do not know how to make them pay for my tail based on an email. Anyone ever have this issue? Any ideas how to fix it? I have been working for them for 10 months and it is sporadic work so I probably only made $15k pretax this year and I bet my tail is probably 5 figures already. Which means I am afraid I may have worked for free.
I am an employee of CompHealth and have worked here for 22 years. In the beginning we were on an occurrence based policy but as the number of working physicians increased it became too difficult to underwrite each physician to be sure they were a good risk. We switched to a claims made policy in about 2000. The claims made policy makes it possible to guarantee coverage for every physician as long as they can be credentialed. The tail only becomes necessary if the policy should be discontinued or canceled for some reason. Our contract with our physicians guarantees that should it become necessary we will provide a tail. Anyone who says they can provide a tail up front is mistaken and doesn’t understand how claims made policies work. That is one of the reasons it is wise to work with a locums agency that is financially stable. An agency may tell you they will provide a tail but if a huge malpractice suit wipes them out you may be left holding the bag.
This is actually a very interesting point to consider and I feel like I need to find out more about this tail issue…
EM physician considering locums.
If you were a patient requiring an oncologist, would you seek out a permanent oncologist, or be ok with a locum doctor? Wouldn’t you want the doctor/patient relationship in that life and death situation? What are your thoughts?
I would want a quality physician in that situation (and any situation). I would not be thrilled if I was given a locums providing a week of vacation coverage if major decisions were being made in that week. However, a long-term locum with a good record and references could do a wonderful job.
It’s a bit different in my field (anesthesia). We take care of our patients one episode at a time. That’s becoming more and more true in other inpatient fields where hospitalists and shift-work are common (medicine, ICU, pediatrics, OB, etc…)
Best,
-PoF
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Does an employer of a locums have the right to determine such things as whether or not the locums is entitled to a lunch break, or if the locums must follow a strict schedule and always be within 5 minutes of the home facility if an unexpected demand for a physician crops up?
Just interested in the dividing line between a locums and a true employee.
What’s a lunch break?
You’re typically paid by the shift or by the hour with additional compensation for call. I’ve always had at least a 20 minute window on call for anesthesia, and we do emergency critical cases. A 5-minute leash means staying in house, for which you should get paid even more. Just be sure you understand what the expectations are before signing on.
As for a lunch break, I suppose you could ask to schedule it, but most physicians I know end up working through it anyway and / or eating when they can.
Best,
-PoF
The Real Story
To be a locum provider ask yourself are you OK with 25-35 percent of your hourly wage going to the agency in the form of net profit? If yes, then go for it, there are many opportunities – as some clinics are in dire need of staffing. If no, then it is not a viable alternative career choice for you.
I have one year of locum tenen experience. I have experience with multiple locum agencies and I have worked locum jobs. I have also spent a great deal of time applying for locum work without an agency.
I tried locum work because the responsibility of a full time position did not allow me sufficient time with my young kids. The following is what I have learned. The locum agencies net a minimum profit of 25% of a physicians pay for every hour that the physician works (often the percentage is much higher, as some locum companies advertise an average of 35% net to their shareholders). It can be even higher, if they find a physician to work for less (they start negotiating at little over a third of what the clinic is willing to pay for you). So what do they provide for attempting to hire you at the lowest possible pay scale? They provide malpractice insurance, which comes from the gross money the clinic pays not from the net profit the locum company makes. They provide housing and travel, again this comes from the gross charge to the clinic not the net profit the locum agency makes. Finally, they report that they help with credentialing, which is also misleading. There help consists of passing along the credentialing paperwork for the doctor to fill out. Essentially, these companies do nothing besides leverage access to these jobs for 25-35% of your hourly wage in net profit (the brutal trifecta that allows the current system 1. hospitals do not like to advertise that they need physicians, 2. the hospital has already signed a contract with a locum agency, and 3. many hospitals have outsourced staffing, see below).
Many hidden dangers for doctors… many clinics have signed contracts with locum tenen companies. In those agreements are 24 month clauses that if they were the first to present a doctor’s CV, then for the next two years if that doctor decides to work at that clinic they get a percentage or 20 to 30K permanent placement bonus. For example, many healthcare systems are statewide or include multiple states. If you agree to have your CV sent to one small town clinic owned by a multiple state wide healthcare system, the agency will get a percentage or placement fee if you end up working at another site in another state at another time within the 24 months. Even if you never agreed to that because the clinic already did – remember there are two contracts that the locum agency has – one with you, and one with the healthcare system.
So what is a doctor to do? You can make a living and spend more time with your family, if you are comfortable with these agencies making that type of net profit on every hour you work – otherwise locum tenen work is not for you. As a physician in the current system, you really do not have much of a choice. Someone might ask, “What about contacting clinics directly”? Unfortunately, it is possible to score a locum job, but extremely difficult for the following reason. I have found that many clinics and hospitals have outsourced their hiring to staffing agencies that are independent contractors. These staffing contractors lack the incentive to assist locum providers (very difficult to even get in the front door). Also, if the hospital/clinic has a locum need they sign with an locum agency like comp health as to not directly advertise that they need physicians. Thus, it is very difficult (not impossible) for a doctor to find locum positions without an agency.
As for me, I felt a 25 to 35% of my wage in net profit just to have access to the job was predatory, and I have stopped working as a locum. A job site where locum tenen needs can be anonymously posted by the clinic would change the current dynamic.
I understand your frustrations, Oncologist. Almost makes you want to start your own locums company, doesn’t it? Have four or five docs places and you’re making as much as the docs doing all the work!
I still made what I thought was good money in spite of the fees, and the couple times I negotiated my own deal, I was not in a position of strength and I actually made less than I did in other locums jobs. One was a working interview and the other was a spot where I wanted to be and contacted the facility asking if I could work there over the summer.
A model I really like is the one started by Lucidity Direct. They are relatively new, and most if not all of the currently posted jobs are for ER docs, but they are aiming to be something like the Uber or Airbnb for locums jobs. They allow you to negotiate directly with the group / facility, and rates are transparent. Lucidity does collect a fee, but my understanding is that it’s a small fraction of what the locums agencies typically collect. Hopefully, they will have oncology and / or anesthesia positions soon.
Best,
-PoF
Could you explain how you took less pay while cutting out the middleman?
Both times I worked outside of an agency, I was in no position to negotiate and too trusting. One was a working interview, the other in a place I asked to work when they weren’t advertising. Both places profited off me, but the working interview place really showed their true colors. Being shorted a few thousand dollars kept me from making a much more costly mistake of actually joining them long-term.
Best,
-PoF
Interesting point about being shorted. How do you spot unscrupulous employers, especially if you don’t know anyone in the area?
My thought (which you’ve confirmed) was work on a trial basis before signing on permanently. Is there another way which involves less time?
You could ask to talk to a physician who has left the facility. If they refuse to give you a name and number, that’s probably a bad sign. Also, if you know anyone currently working there, obviously that person could be a great resource.
Best,
-PoF
Yes, Locums companies do make a profit off of the Gross pay of a contract- that being said the percentage that they take has to cover the cost of their overhead. Overhead for Locum’s companies consists mainly of their rent, utilities, Medical Malpractice costs, and the cost of internal employees. Employees that include the recruiters that find physicians and explain the job parameters, the account managers that have weekly conference calls with the facility to ensure that both parties (facility and physician) are happy as well as ensuring that the facility is not skipping the physicians’ breaks or making them stay over their scheduled hours when the contract refuses to cover any over time charges as well as making sure that time cards are turned in and that hotel rooms/ Apartments/ houses are meeting physicians’ standards, and the credentialing team whose process is so much more intensive then just passing along paperwork.
The credentialing process consists of prime source verification, which in most cases means that not only does the Locum Tenens Company have to get copies of a CV, active licenses, certifications, diplomas, and references but, they then have to perform a prime source verification. So if a physician worked for another Locum Tenens company before, they now have to pay the previous company in order to have it verified that you worked under their contract and that there were no issues or reason that you would not be allowed back at the facility. If the physician worked at 3 different locums companies and 7 different facilities in the past year, then those are all going to have to be verified and that costs man hours of phone time and emails sent if not sent FedEx overnight to both facility and physician.
So the 25-35% a locums company makes to help source a position, find a candidate, walk them through the entire job posting, answer any question that they have, usually negotiate a higher pay rate for their candidate, find travel and lodging accommodations that meets all of the candidates’ standards while keeping them within the on call range of the facility, perform consistant check ins with
the facility for quality assurance during the course of the security and credentialing process, complete and submit all required paperwork and verifications of past work history and then continue to do check ins to ensure that both the facility and the placed candidate are happy and performing isn’t an obscene or unexplainable amount.
Why do you care what the agencies charge the hospitals/clients? The agencies have overhead, including hiring recruiters, advertising, help with licensing, client development, etc. They can’t do this for free. Many hospitals/clients don’t care, and are willing to pay it.
My name is Gidna Delorme, and I am a National Recruiting Agent. Anyone who is interested in finding out more about locum opportunities please do not hesitate to contact me, my contact information is listed below. I look forward to working with you all!
—
Gidna Delorme
ASSOCIATE RECRUITER
Phone: 561-348-5566
Email: gdelorme@bartonassociates.com
Fax: 888-730-4328
I have only worked short term locum assignments. The cons concerning locums is the application necessary to receive hospital privileges is the same for locums and permanent physicians. On your CV , you must include the asignment if it is one day or one year.
I agree. Also, after awhile getting professional references becomes problematic. You would think the Locums companies would figure this out.
I appreciate you explaining the benefits of locums tenens work when it comes to benefits, stability, and opportunity. I think that this type of work may be good for doctors who have a very independent personality. It’s a great way to get around and see different facilities as well. I think there is a lot to learn by seeing and working in different locations.
Agreed
Interesting post PoF! Love that pic about selling children to the circus!
That was taken @ Lagunitas Brewing in Petaluma, CA on one of our post-conference excursions outside of San Francisco.
Best,
-PoF
I’m not a physician but I’ve been in healthcare finance and operations for more than 20 years. I am a fan of using locums. In fairness, most of my career has been in workers’ comp which is a good fit for locums as there isn’t the same doctor / patient relationship that you get in other specialties.
It’s great that there is such a strong market for locums. As a FIRE physician, having the opportunity to earn at a high rate on your own terms is very appealing.
Another pro: If you do a good job at a particular locums assignment, the hospital is more willing/flexible to accommodate the schedule to fit yours… I find that to be the case for me and some of my colleagues who do locums work.
Excellent point. A dependable locums doc can be a hot commodity.
In my experience, if and when a permanent position becomes available, a solid locums doc will have the right of first refusal before the search widens. I’ve accepted a couple “permanent” opportunities and turned down many more from facilities where I have worked in the past.
Thanks for chiming in!
-PoF