Top 5 Additional Reasons to Be a Locums Doc

vista-staffing-250x250-001Today’s post is a guest post that riffs off my original Top 5 Reasons to be a Locums Doc. As I’ve shared, I was a full time locums doc for a couple years after residency, and have worked as a locum in between jobs and on vacations at various times throughout my career.

Brittney River from VISTA Staffing Solutions offered to share five more reasons to be a locums doc, and I liked what she had to say. VISTA is a site sponsor, helping support this site and its charitable mission, but I accepted no payment for this post. Take it away, Brittney.

Presenting: Five Additional Reasons to Be a Locums Doc

 

1. You Value Real-Time Learning Experiences

 

Doctors go through a tremendous amount of training during the seven to ten or more years it takes to get from medical school to the end of residency. They undergo additional formal training in various stages of their careers to keep us up-to-date on the latest practices and technologies. Yet all the formal training in the world can never replace the real-time training received during the actual practice of medicine.

Locum tenens work is an incubator of real-time training by virtue of the fact that it exposes the doctor to different ways of doing things, different work environments, different patient personalities, and even different 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 takes place.

 

2. You Don’t Want to Spend Your Life Paying Student Loan Debt

 

In the initial Top 5 post, PoF made mention of boosting your income through locum tenens work. Locums income can be disposable income that allows you to live a more comfortable lifestyle. But there is another important financial factor to consider: working as a full-time locum for the first several years of your career could help you put a serious dent in your student loan debt.

Bear in mind that competition for qualified locums is stiff. Therefore, locum tenens agencies are known to offer generous benefits to qualified doctors willing to sign on. Often among those benefits is housing. Whether an agency provides direct housing or a housing allowance, working as a full-time locum may eliminate the need to maintain a permanent residence. All the money that would otherwise go to the mortgage or rent can be put toward debt. The same is true for money that would otherwise be spent on medical malpractice insurance and travel.

 

3. Medical School Has Not Diminished Your Wanderlust

 

It has been said that one of the nicest fringe benefits of locum tenens work is the 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 have an opportunity to combine their love of medicine with their wanderlust.

Travel appears to be a universal desire ingrained in humans. Though I claim no ability to explain why, I have observed how much we love to visit new places and see new things. I know that a lot of people would love to spend their lives traveling but are simply unable to do so because having to pay the bills get in the way.

The full-time locum has an advantage in that he or she can travel far and wide. Locum work doesn’t have to be confined to a single state, region, or even a country. Qualified locums can literally work anywhere in the world.

 

Surfing Goat Dairy Maui

How about Hawaii?

 

4. You’re Not Thrilled About Other Options

 

In the absence of locum tenens opportunities, doctors who still want to be engaged in clinical practice have but two options: establish a private practice or accept permanent employment. Locum tenens work combines the best of both.

For example, in the original Top 5 post, you learned how locum tenens work is generally free from the politics of institutionalized medicine. That’s absolutely true. But it is also free of the hassles that come with running your own business, which is essentially what you’re doing if you open a private practice.

I would encourage any doctor not interested in private practice to consider locums work over being employed. Listen, it’s not easy being employed either. When you work as a locum, you are essentially a self-employed doctor working on a contract basis for other medical facilities that handle all the business issues. You simply check in, do your work, and go home. And if you don’t like the facility for whatever reason, you can simply walk away once your contract is finished.

 

5. You Are Afraid of the Rut

 

Every career choice has potential pitfalls. In the world of medicine, one of the easiest pitfalls to succumb to is the proverbial rut. The doctor can go to work as an employed clinician, start earning a paycheck and paying the bills, and slowly get entrenched without recognizing it until decades later. By then the rut is fairly deep.

Locum doctors truly have the most control over their careers. They can choose assignments based on their needs and preferences; they can take short or long breaks between contracts; they can negotiate pay and working conditions. With all the opportunities available to locum doctors, the only way to get into a rut is to purposely go there.

 


PoF: I hope you enjoyed today’s guest post, the third on this site about locum tenens work. I’ve also written about the pros and cons of locums, but I will say that I’ve had largely positive experiences.

Recently, my employer enacted a policy that effectively bans employed physicians from doing any locums work outside of our health system. If I weren’t so close to a potential retirement, I’d be up in arms over what I think is a short-sighted decision meant to exert more control over us.

I still might raise a fuss — locums was good to me. Working many places exposed me to a varied patient population. I’ve given anesthesia for procedures my hospital doesn’t offer, and I’ve seen innovative ways of approaching perioperative workflows that have made me a better, more well-rounded physician.

There may be strategic reasons for administration to limit certain specialties from benefitting competitors, but I see no good reason an anesthesiologist should be told how to spend his free time. I spent some of mine working elsewhere, and I’ve brought back and implemented ideas that have benefitted my employer and my patients.

Have you worked as a locum tenens doc? What were your reasons? Feel free to share your experiences, both good and bad, below.

 


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26 comments

  • Locum tenens makes a lot of sense for specialties that do not have longitudinal patient care, like anesthesia, emergency medicine, or radiology. You get all of the benefits of locum tenens work, while being able to have all of the job satisfaction of your specialty. In radiation oncology, however, if you are doing one – two week assignments, typically you are providing vacation coverage and won’t be able to have the job satisfaction of caring for a patient from initial consultation to the completion of radiation treatment. This is not a problem if you are doing long-term locums work or just doing occasional short assignments while having a regular full-time job.

    Thanks PoF and Brittney for this article. I think it is completely messed up that your hospital is banning locums work. It is essentially adding a noncompete clause to your contract, that you did not sign when you originally joined the hospital.

    • You are correct, WaSP — some specialties are better suited than others, but opportunities do exist in all specialties.

      I know that my contract had some similar language, but locums work was allowed if approved by the employer. Other physicians had no such language, depending on when they joined.

      The new edict is pretty lame, indeed.

      Best,
      -PoF

  • Since I am not a physician, I had no idea that this was even an option for you. It definitely makes sense though and I love the idea of you having more control over your life and choices with locums work. I guess I am in a similar position now as an “interim” school administrator. As you pointed out in your first post, I love that I don’t have to be involved in the politics either. I need to do more research on this in my field. It is very likely I could do this kind of work at least throughout my state (to continue to earn retirement system credit) or throughout the world (in IB schools).

  • 6) You made a late career change and need a job.

    I gave up my Interventional Cardiology Fellowship 3 months before starting date. That left me jobless as most people line up their first job 6 months before the start date. We knew we were moving to New Orleans, so I needed a job in a very specific area. 3 months of scrambling I had some interviews but no actual job. So I started locums work.

    I would drive 3 hours from New Orleans to the lovely town of Lake Charles. Work for a week as a hospitalist and drive home for a week with my wife. By January my new job in New Orleans was ready for me. I said goodbye to the locums life for now.

    So number 6, poor planning and income needed!

    -EJ

    • Glad you were able to find your way out a bind with locums, DD&D. I’ve had a couple instances where locums kept me in the paychecks. Once, a long-term locums contract was canceled on me, and I was going to be spending 9 months in that city either way (wife’s internship). Fortunately, I found another facility that needed help, and I didn’t really have any downtime.

      A second time was when our hospital was facing bankruptcy. I was let go rather abruptly, but was working locums within a couple weeks. I worked a couple jobs until we figured out where we would land next.

      Cheers!
      -PoF

  • One of the things that is so unique about the medical field is this ability to do locums work. Seems extremely helpful for folks just starting out there career, and since it’s independent contractor work (I think?), it means you can save even more money by throwing a portion of your locums earnings into something like a Solo 401(k). That’s a huge advantage.

    For whatever reason, it’s really hard for lawyers to do the same thing. We’re basically only allowed to work at one place.

  • MBM

    Would you consider posting the “Top 5 Pitfalls of Locums” to shed any light on what regrets, practical issues, expected/unexpected disadvantages you might face if you jump out of an employed job into locums. Some decisions have a bit of a one-way valve attached. Not sure if this is one of them.

    • I can help you there, MBM. I incorporated those that I’ve come across in a Pros & Cons of Locums post.

      It’s definitely not a “no looking back” type of leap. I’ve worked locums before, during, and after standard positions. As long as you do your job well, you’ll only gain experience and good references along the way.

      Cheers!
      -PoF

  • PICU MD

    I’ve heard anecdotally that if you do locums work for a long period time (say a few years) it’s hard to get back to having a permanent job since people think you’re not committed or can’t hold a permanent job? In my line of work I know many folks who do locums stuff on the side or a few who do it as a bridge between jobs but never anyone doing it for more than a year or two.

    • I think it depends entirely on your references and your reasons for doing locums.

      You could be “profiled” in that way, but honestly, I’ve been at least softly recruited to stay or come back full time at pretty much every locums job I’ve had, even if I made it clear it wasn’t an option.

      If anything, the networking and experience you get from doing locums only enhances your ability to land a good job.

      Best,
      -PoF

  • My various turns as a locum tenens physician have been quite positive. A competent physician with the ability to easily adapt to new surroundings can be in high demand.
    Anesthesia lends itself well to fill-in work, as do other specialties where established relationships between physician and patient are not the norm, such as emergency medicine, radiology, pathology, etc… That being said, opportunities exist in every specialty.

  • Syj

    My friend did three years of locums work in oncology after fellowship (including one year in Maui) and landed a “normal” oncology practice when she was ready to settle down. Just to show that traditionally non-shift work specialties can work for locums and it’s does not necessarily bar you from a permanent position even after a long stretch of locums.

  • It must becoming more common for employers of physicians to ban them from locums work. We are currently banned from doing any form of locums work. I never had the opportunity to try it yet but will likely give it a go when I move on from this current job.

    I usually remind residents who are stressed out about finding the perfect job right out of training to keep this as an option before signing a bad contract just to have a job when they are done.

  • There is a part of me that has always wished I’d done some Locums work but it never happened. I’m glad that I’ve spent my career in one place as I think my family has benefit from it and the long term relationships we have cultivated. We travel a decent amount and have a lot of fun doing it but I’ve been trying to figure out a way to combine the two and I work a bit while we really soak in the fun of where ever I happen to be. Of course I will need a license wherever I practice and that is a whole other bag of worms if it isn’t the state I currently reside in.

  • POF,

    Good stuff here. As I contemplate my retirement from practice as a physical therapist, I am not sure that I want to give up my license completely. We also want to try moving to a different part of the country, but are not sure we are ready to commit to putting down roots anywhere yet. The more I think about all of the benefits of a traveling position including the ability to have a more flexible schedule, try out different practice and geographical areas to escape the “rut” cited (which I am currently feeling big time), and getting the housing and moving benefits while further padding the next egg all are starting to sound pretty good. Thanks for sharing this guest post. Lots to think about there.

    • It’s a great way to see the country while having your expenses paid and earning good money. I’ve worked as an anesthesiologist in six states, and had a number of additional licenses that I ended up not using.

      Cheers!
      -PoF

  • Baseballmom94

    My husband is an EM doc “on the other side of the curve” as he likes to say LOL. I still think he’s kind of hot so he’s not an old guy hobbling around the ED quite yet;). 26 years of experience, still passionate to a nerdy degree about medicine and teaching residents, retirement nearly fully funded, and college educations for 2 kids paid for with $ left in 529 plans for 2 years of grad school for each. He would like to do part time locums in about 4 years but the huge question that constantly looms is “what to do about health insurance”? Currently, he receives this benefit through his group . A high deductible family plan would currently run about $25,000 with the deductible. Hate to think what it will cost in the next four years. Other than making his own schedule and working less hours, it’s difficult to justify the idea of locums when as a full time employees, he receives health/dental insurance plus a 401k match. What are independent contractor docs doing about health/dental coverage?

    • Working for the health insurance is becoming more and more common these days. I would hope if you shop around, you could do better than $25,000 for HDHP. I’ve looked on the exchanges, and have seen better prices for our family of four. There are alternatives, as well, such as health care sharing ministries that might be worth looking into. Lots of docs have to pay for their own insurance — I did the first half of my career when I was an independent contractor, and I plan to do so again when I retire early.

      Best,
      -PoF

  • MT

    My hospital wouldn’t drop the “no outside work without approval” language. I told them that I was willing to sell my time but not my training and walked. In the end, they came back to me and dropped the clause.

    POF, do you have a breakdown (or could you do a post) on the financials of a short-term locums assignment as an otherwise W-2 employee? For instance, if you are:
    – Making $20,000 as a locums 1099
    – In 33% federal bracket with no state income tax
    – Licensing/credentialing covered by an agency
    – On your own for housing (because you want to take the family along)
    – Traveling 1000 miles round-trip

    What is the tax breakdown as a 1099? What is deductible (travel, lodging, per diem, etc.)? How much can you put in a Solo401k? What is your “net,” including Solo401k contributions. A breakdown, whether anecdotal or hypothetical, would be a helpful post, I think.

    • Good for you, MT. You gotta fight for your rights!

      What you propose would make for a good post. I was an independent contractor for the first half of my career, so I’ve got plenty of familiarity. I’ll have to make some baseline assumptions if I write it up, but I wouldn’t make too many assumptions for yourself. For example, I would think a place that wants you would find suitable housing for your family. When we had one toddler and one dog, the agency I worked with found us a dog-friendly hotel with two adjoining rooms. With AirBNB, VRBO, etc… now, it should be even easier to find a place that would work.

      Best,
      -PoF

  • dmal

    I’m in that position now where locums is keeping me afloat due to sudden, unexpected change in plans for fellowship. Was recently about to sign for a permanent job that I initially thought was perfect. Job fell threw once I started asking questions, like MT, asking for the “no outside work allowed without approval” The minute I asked for this to be removed, they said no, and they rescinded the job offer (after months of being heavily recruited, wined and dined etc). Beauty of locums for me has been a descent fall back during the times life has decided to repeatedly throw rocks at me and my plans this past year :)I’m loving the flexibility of locums, too.

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