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
- Nurse practitioner
- Orthopedic surgery
- Diagnostic Radiology
- Pediatric medicine
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.
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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
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.
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.
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.
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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 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.
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.
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.
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.
Again. I suggest talking to your tax advisor to see if creating a legal entity benefits you.