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 seem to be 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 who is serving as a temp doc in an interim role may be referred to as a “locums doc,” or simply “a locum.”
I’ve personally worked as a locum 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. I detailed those experiences in a guest post at the White Coat Investor. Today, I’d like to discuss some of the pros and cons of locum tenens work and talk about why someone might pursue this option.
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.
It’s also a mistake to assume that only certain specialties can work as a locum tenens physician or advanced practice provider.
While specialties like anesthesiology and emergency medicine do lend themselves well to temporary practice, I’ve known locum doctors in the fields of radiology, obstetrics & gynecology, psychiatry, family medicine, critical care medicine, pediatrics, and oncology. I’ve also come across quite a few locum surgeons and hospitalists in my travels.
Locum Tenens Pros & Cons
Pro: Locums Gives You Freedom
Freedom is something I write about a fair amount. An oft-used synonym for Financial Independence is Financial Freedom. Choosing to work as a locum gives you a whole lot of freedom, a freedom that can be gained without choosing to retire.
As a locums doc, you can choose to work as little or as much as you like. You can work in major metropoles or podunk mountain towns. You can make like a teacher and have summers off to enjoy the sunshine or 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.
Con: Freedom isn’t Free
Freedom can come with a hidden cost, the lack of job stability. You know the tablecloth trick, the one where you pull the tablecloth out really fast, and usually the dishes all stay put? But 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 a locum tenens assignment. Your temporary employer usually retains the rights 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 wasn’t about to accept the agency’s “solution” of an extended unpaid vacation.
Knowing that at least two staffing firms had recruited for the position, I reached out to 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, so I did get a long weekend off, but the offending agency agreed to pay me for the days I missed, so all was well in the end.
I ended up working for the second agency for two weeks, and I finished out the contract under the first agency. If I hadn’t stood up for myself, no one else would have.
On another occasion, my dishes were left more or less intact when the tablecloth vanished. A nine-month assignment 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, at the Pittsburgh PA while my wife was interning as a dietitian in town. In the end, the new job was probably better than the first, and it offered more flexibility.
A third time it happened to me was a bit frustrating, as I had requested a specific week off from my full-time job to match another facility’s need. The need went away, and I had a nice little staycation with my young family.
Pro: 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, you will find working a similar schedule as a locum can be quite lucrative.
With most locum tenens contracts I’ve signed, every quarter-hour you work beyond an 8-hour day is rewarded with additional pay. Call coverage can generate additional income. A hard-working locum can probably earn close to double that of a colleague putting in his or her time in hopes of becoming 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 availablity and time is valuable. On short notice, some 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.
Some doctors, PAs, and NPs will moonlight as a locum in addition to the steady job they are holding down. Locums can be a great way to earn extra income to more quickly pay down student loans or save up for a down payment on a home.
Or maybe you just want a Tesla, a second home, or to build one of those amazing treehouses Pete Nelson tosses up on TV.
You can’t justify the cost based on your current income, you may be able to use locum tenens work to give your income a boost. You might work on your own vacation to cover someone else’s (been there, done that). You might work evenings at an urgent care, read EKGs or EEGs on weekends, or cover extra call for your senior colleagues.
Using only the after-tax take-home pay from locums work makes it easier to justify what might otherwise feel like an extravagance. Of course, if one luxury need begets another, you could be locking yourself into a higher standard of living, and a decidedly longer career, or at least delaying financial independence, so proceed with caution.
Con: 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 as a locum, but the most remunerative jobs are going to 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.
Pro: You Only Pay for the Benefits You Want
As a locum tenens provider, you are an independent contractor, and you choose your own benefits. Most physicians who are employed or part of a larger group will be assigned a benefits package. The options and flexibility of these benefits vary widely, but the options can be limited.
For example, when I was employed, I had an excess group life insurance policy as part of my benefits package. I didn’t choose it and didn’t need or really 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.
Similarly, an employed physician will have access to defined contribution and / or defined benefit retirement plans, but the investment options can be limited to lousy investments. As an independent contractor, you can start a solo 401(k), stashing away up to $58,000 tax-deferred in 2021, choosing any investments you wish.
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Con: 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. Yes, there are good people 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’re on your own, for better or for worse.
Pro: 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 steer clear of many of the non-clinical duties that are increasingly expected of more permanent “providers.” If meetings and conflict resolution are not your thing, locums might be for you.
The buck circumvents you and lands squarely on someone else’s desk. You’re there to practice medicine, and that’s pretty much all that will be expected of you.
As a physician who has previously served as a department chief, committee chair, and president-elect of the medical staff, I’ve been immersed in medical staff politics. I’ve also spent about 20% of my career as an anesthesiologist working as a locums doc.
Freedom from the entanglements of local hospital politics is a vastly undervalued benefit of being a locum.
You won’t be expected to attend early morning or after-hours meetings. Your input on policies won’t be sought. I’m talking about the policies and bylaws that live in a binder (or folder on the intranet) that are rarely seen or used but require revision and renewal at regular intervals.
Con: You’re just a short-timer.
Being a transitory figure isn’t always a blessing. If you’re 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 taken seriously 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 when it comes to work parties and social gatherings. Some functions are reserved for the active medical staff, a mailing list you probably won’t be on.
If you’re in a specialty that relies on continuity of care, you’re not going to be very well able to deliver it unless it’s a very long-term position.
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.
Why Work Locum Tenens?
Having discussed some of the pros and cons, let’s take a look at some of the reasons physicians and other healthcare workers consider locum tenens work. Career timing, career burnout, wanderlust, an interest in expanding your skill set, or a simple urge for a change of pace can all be factors in this decision.
You are Just Starting Your Healthcare Career
When you finish residency and sign on for a “permanent” job, there’s a decent chance the job won’t last. It’s a roughly 50 / 50 proposition that you will remain in your first job for more than a few years.
While I can’t speak for every specialty or residency program, it’s fair to say that for me, residency didn’t teach me what sort of job might be a good fit. My program did a great job preparing me to be a capable anesthesiologist in any setting, but the exposure to the variety of workplaces and work styles simply wasn’t there.
I trained at a tertiary care facility. Most likely, you did too. I had no exposure to rural medicine, minimal experience supervising nurse anesthetists or other residents, and I only had to cover the OR or OB, but never both.
Working locum tenens allowed me to work in a wide variety of places and practices both 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.
If you are just starting out, working in a few places as a locum can gain you valuable experience and 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 potentially transition into something more long-lasting.
You Crave 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 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. 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 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.
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.
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Medical School Has Not Diminished Your Wanderlust
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 have an opportunity to combine their love of medicine with their wanderlust.
You might be looking to work in a different locale. 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 far away places like Australia, New Zealand, the Caribbean, Tasmania, and Guam.
Travel appears to be a universal desire ingrained in humans. 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.
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.
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, and it may be one component of a larger burnout problem.
Locum tenens 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 locums, the only way to get into a rut is to purposely go there.
You are Winding Down Your Career
Years of 50 to 60-hour workweeks may have taken its toll on your well-being. If you are financially secure, you could easily afford to scale back. If your current job doesn’t offer the option, or you’re looking for a change of scenery, locums work can deliver the schedule or beachside location you’ve longed for.
The twilight of one’s career rivals the dawn as the best time to practice full-time (or part-time) locums. If you have an empty nest and the freedom to travel, you can carve out a working life that appeals to you. You may even find yourself reinvigorated professionally as you meet new people and discover novel ways of delivering care. If not, you can wind your career down completely, and walk away for good.
Retiring as a locum, you are in an enviable position to make a stealthy exit. You don’t even have to tell anyone you’re calling it a career. Just buy doughnuts on the last day, say thank you and goodbye, and stroll on out with a big smile on your face and perhaps a small tear in your eye.
I think that’s a good way to go out.
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Have you worked as a locum? If you’ve got a pro or con to add, please do so below.
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70 thoughts on “Locum Tenens Pros & Cons”
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.
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.
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!
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
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.
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?
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..
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…)
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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.
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.
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.
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.
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!
Email: [email protected]
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.
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.
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!