Part 2: Who Works Locum Tenens?

In this part: When in a clinician’s career it’s best to work locum tenens; the specialties that are most in-demand for locum tenens practice; and how to determine if locum tenens is right for you.

In Part 1 of Locumpedia’s No-BS Guide to Locum Tenens, we covered the basic what, how, and why of locum tenens from the physician’s perspective: What is it? How does it work? And why should I consider it?

In Part 2 of Locumpedia’s No-BS Guide to Locum Tenens let’s focus on:

Section 1: When in a Clinician’s Career Is it Best to Work Locum
Tenens?

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Among the myths about working on a locum tenens basis is “it’s predominantly geared to semi-retired doctors,” according to Medicus Healthcare Solutions.

In fact, “the practice alternative has something to offer at every career stage” — from ‘test-driving’ different practice locations before settling down, to avoiding burnout and invigorating passion for medicine as mid-career approaches, to easing into retirement by working ‘part-time,’ the firm suggests.

CompHealth reinforces that message: “Locum tenens can be a good fit at many points in a provider’s career. Some work locums to make extra money on the side, others use it to fill a gap while transitioning between permanent positions, and still others pursue it as a full-time career.”

Especially in the healthcare business where people’s wellness and futures are on the line, timing is everything. However, there’s really no ‘best time’ in a clinician’s career to work locum tenens.

“My [residency] 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.”

— “Physician on Fire” Leif Dahleen, MD

Right Out of Training

“My experience with locum tenens (temporary work) began the Monday after I finished residency,” Physician on Fire Leif Dahleen, MD, says. “I practiced exclusively as a locums doc for nearly two years, trying jobs before buying, and was offered a job in just about every place I worked.”

Although this certainly doesn’t happen with every locum tenens assignment, it does happen. In fact, Dahleen made ‘the locums life’ work so well that he achieved F inancial I ndependence, by age 39 and R etire(d) E arly at age 43 [“FIRE”]! Then the former anesthesiologist started a blog through which he teaches others how to do the same.

“I want to help my fellow physicians and others understand what it means to be financially independent, how to achieve that goal, and why it will benefit you,” Dahleen says.

Like The Locum Tenens Guy Vlad Dzhashi, he appreciates the new physician’s motivation to ‘lose the loans’ as quickly as possible. “The average indebted medical student, which is about 73% of them according to the latest AAMC survey, has around $200,000 in student loan debt when finishing medical school,” Dahleen says. “The balance typically grows during a 3- to 7-plus-year stretch of residency and fellowship training before one can start earning a physicians’ salary.”

Scan through locum tenens agency blogs to find scads of stories about how locum tenens has helped young docs “ditch the debt” in short order.

Earn and Learn

Beyond the financial rewards of locum tenens for new physicians, he notes its benefits as a training ground. “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,” Dahleen writes. “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.”

Like many physicians, Dahleen trained at a tertiary care facility. “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.” He noted working locum tenens for two years right out of residency afforded him experience in different states, practice sizes and settings — both urban and rural. Dahleen believes this helped make him well-rounded and more adaptable.

If you’re a resident, stories like these might have you wondering, “When can I get started?”

CompHealth notes that, while it’s possible for physicians to accept locum tenens assignments in their last six months of residency (in some specialties), some residency programs, hiring facilities or agencies won’t allow it. However, “Physicians pursuing a fellowship are eligible for placement in their residency specialty as long as they’ve been doing clinical work within that specialty.”

Also, while working locum tenens right out of training is possible for physician assistants and nurse practitioners, ”it can be challenging to find locum assignments if you are a new graduate with minimal clinical experience,” according to CompHealth.

Mid-Career Malaise

Locum tenens agency blogs and websites also offer plenty of stories illustrating the value of locum tenens practice for more experienced physicians.

Physician financial advisory group PhysiciansThrive.com suggests: “Doctors in the middle of their careers work locum tenens jobs as a way to get experience in various locations or environments before deciding to take on a new, permanent position. Other physicians work locum tenens as a way to make extra income. In some cases, they’re temporary physicians, moonlighting (working a second or third job) in order to supplement their income or pay off student loans.”

Sometimes it simply offers a welcome change of pace: “In times like these, when you’re asking yourself whether you want to leave for good or just need a break, the opportunity for a temporary change is perfect,” writes David Beran, DO, in a June 23, 2020, blog post on HospitalRecruiting.com. “I agreed to cover a set amount of hours each month for a set period of time and when those months were done, I had no obligation to return. By doing locums, I was able to explore new opportunities without having to commit.”

Focusing on changes in geographic regions or clinical settings, Beran notes, “We get tired of the same old thing—the same broken processes, the same roadblocks. By working in a new system, you get a fresh look at situations that have become your norm…You’ll apply your medical skills in new ways, with different populations, and get a fresh perspective on your career.”

Sometimes [locum tenens] simply offers a welcome change of pace: “In times like these, when you’re asking yourself whether you want to leave for good or just need a break, the opportunity for a temporary change is perfect.”

— David Beran, DO

Fight Physician Burnout

Along those lines, Weatherby Healthcare offers a scenario in which a physician accepts a position at a great facility only to find it’s not what he or she expected. “Maybe the work environment is toxic, or the workload is heavier than described,” writer Arianna Rees suggests. She points to locum tenens as a way doctors can “test-drive” healthcare facilities to find the ideal physician job.

Rees shares the story of general surgeon Demetri Poulis, MD: “In 2003, Dr. Poulis started a job working alongside another surgeon. Within a few years that surgeon left, leaving Dr. Poulis on call for up to 15 hours a day. He didn’t go on vacation, and he didn’t see his kids for two years.”

Poulis observed, “For the last five years, I was the only guy there — summer, winter, it didn’t matter — every day taking call.” Finally even his ex-wife said, “They’re going to kill you. You can’t keep doing this.”

Looking for career alternatives led him to locums and the opportunity to travel, working at different hospitals without committing long-term. “It let me see how it was done elsewhere, how other people handled things,” Poulis said. “I had more confidence in myself, especially after being burned out after that many years of being on call alone.”

Locums work took Poulis to an Adventist hospital where he eventually accepted a full-time position. He credited his locums experience and relationships with equipping him to set his own terms for joining the hospital’s surgical team.

Heading Toward, or During, Retirement

Many physicians and advanced practitioners work locum tenens as a way to wind down their careers or work less as they near retirement, according to PhysiciansThrive.com.

General surgeon Steven Berman, MD, who’s worked locums on and off for the past six years, endorses locum tenens as a great option for physicians further along in their careers. “It allows them to get back to their roots and do what they love, and it’s ideal for anyone transitioning between employment and retirement,” Berman told writer Arianna Reeves.

Having worked in medicine for 35 years, Berman discovered locum tenens when he was recruited by agencies while he was on medical leave recuperating from shoulder surgery and subsequent complications. “Disenchanted by private practice, he decided to pursue locums when he went back to work,” Rees writes.

“I took a couple of weeks’ vacation to do the locums, and when I realized I could enjoy that, I gave notice I was going to leave private practice,” Dr. Berman said.

One job took him to North Carolina for six months, where he traveled twice a month for a week at a time, getting to know the hospital and the community. Berman ultimately accepted the hospital’s offer of a full-time position, crediting his locums work for preparing him for the job.

“I knew what I was getting into. I knew the community. I knew the hospital, I knew the politics of the hospital, so it was certainly much easier to take a job knowing fully what that job was before committing,” he said. Still not quite ready to retire, he returned to locums practice when the hospital closed.

Yes, locum tenens medical practice really can be that flexible.

“I knew what I was getting into. I knew the community. I knew the hospital, I knew the politics of the hospital, so it was certainly much easier to take a job knowing fully what that job was before committing.”

— Steven Berman, MD

Section 2: Are Locum Tenens Jobs Available in Every Specialty?

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“Locum tenens providers come from nearly every specialty and subspecialty in medicine,” according to CompHealth. “They fill an important need by enabling healthcare facilities to provide services that would not otherwise be available to their patients.”

In June 2020, Becker’s Hospital Review noted that locum tenens jobs are available across the US in more than 100 specialties. Editor-in-Chief Ayla Ellison (Twitter) highlighted the top 10 most in-demand physician specialties and their salaries, as follows:

  • Family medicine – $242,352
  • Internal medicine – $254,000
  • Emergency medicine – $336,000
  • Psychiatry – $281,000
  • OB-GYN – $335,000
  • Neurology – $303,000
  • Radiology – $428,572
  • Anesthesiology – $405,000
  • Pediatrics – $223,000
  • Cardiology – $453,515

“Demand for specific locum tenens specialties varies by facility and geographic area, but there is an ongoing need for family medicine physicians, hospitalists, internal medicine physicians, pediatricians, psychiatrists, NPs, and PAs, among others,” Ellison reported.

“Demand for specific locum tenens specialties varies by facility and geographic area, but there is an ongoing need for family medicine physicians, hospitalists, internal medicine physicians, pediatricians, psychiatrists, NPs, and PAs, among others.”

Two reports from healthcare networking company Doximity outlining physician salary and demand provided the data. The company’s US Physician Employment Report 2019 “examined 27,000 physician jobs posted on Doximity in 2018 and 2019, as well as 70,000 survey responses from physicians to determine physician demand,” Ellison wrote. The analysis focused on the top 50 metropolitan statistical areas and the top 10 medical specialties based on the number of job postings on the Doximity network in 2019.

Doximity’s fourth annual (2020) Physician Compensation Report analyzed “self-reported compensation surveys completed in 2019 and 2020 by approximately 44,000 full-time, licensed U.S. physicians who practice at least 40 hours per week.” The company’s methodology included mapping responses across metropolitan statistical areas, and ranking the top 50 by the total number of respondents.

COVID-19 Influence Emerges

The latter of the two surveys offers a glimpse into how the COVID-19 pandemic has affected the healthcare landscape in terms of increased demand for certain medical specialties. Late last year, Fierce Healthcare Executive Editor Tina Reed observed, “The financial pressures presented by the pandemic have put their squeeze on physician pay,” referencing Doximity’s latest physician compensation report.

“Compensation for US doctors grew 1.5% on average between 2019 and 2020,” Doximity reported. “It’s been widely reported since March 2020 that hospitals and private medical practices have seen steep declines in revenue due to delayed or canceled elective medical procedures and treatments.”

In the report Doximity noted that compared to recent years’ raises of up to 4%, and the “2019 headline inflation rate of 2.3%, “physicians on average experienced a decline in real income over the calendar year.”

Fierce Healthcare ’s Reed noted, “While overall compensation among physicians plateaued, some specialties are still seeing increases,” with the greatest average income growth among vascular surgeons (4.9%), physical medicine/rehabilitation (4.7%), geriatrics (4.6%), genetics (4.4%) and emergency medicine (4.3%).

“It’s possible the pandemic has generated more demand in these areas, impacting pay for specialists who treat high-risk patients such as those with severe respiratory complications, those 65 years and older, and patients presenting at the emergency room,” according to Doximity.

For an assessment of demand for your medical specialty, view locumstory.com ’s “Trends by Specialty.”

Section 3: How Can I Decide if Locum Tenens is Right for Me?

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As a certain would-be PR firm account executive was asked once in an interview, “How well do you handle ambiguity?” If you’re a stickler for consistency and routine — and you’re willing to trade off an employer’s structuring your work (and, thus, personal) time in exchange for the security of having that paycheck hit your bank account every two weeks, maybe the sometimes-erratic nature of locum tenens medical practice isn’t for you.

Are you a bit of an extrovert who enjoys meeting new people and exploring new places? If you’re more introverted, are you somewhat adaptable — open to learning new systems and processes and ‘seeing how the other half lives?’

Are you up for a bit of travel and adventure for at least part of a given month? If you prefer staying relatively close to home, are you willing to work extra shifts to back up or fill in for peers within driving distance in your “off-time?”

Do you long to set boundaries for your work life that don’t include office politics, work-related social events or limits on personal/vacation time? Are you willing to provide for your own — or your family’s — health, life, disability and other benefits coverages without an employer’s contribution?

Are you ready and willing to take charge of your career, scheduling when; where; for what duration and how often you will provide medical care for which patient population(s)? Can you manage a barrage of agency recruiters, sifting through the players and opportunities until you boil it down to what works?

Lots to think about, for sure.

If we’ve piqued your interest and you seriously wonder if locum tenens could work for you, visit the National Association of Locum Tenens Organizations website (NALTO.org) or refer to the Locum Tenens Staffing Agencies Directory on Locumpedia. In both locations, you’ll find links to member-agency websites that can give you a sense of possible assignment and service options.

If we’ve piqued your interest and you seriously wonder if locum tenens could work for you, visit NALTO.org or refer to the Locumpedia Agency Directory. In both locations, you’ll find links to member-agency websites that can give you a sense of possible assignment and service options.

At least a few of those agencies offer quizzes or other tools to help you think through the options for working locum tenens. For example, play the “Locums LIFE” game from Jackson & Coker to explore whether your career stage and current priorities match up with locums medical practice. Comp Health offers an online quiz for gauging how good a fit locum tenens might be for you here. Finally, Medicus Healthcare Solutions offers a 16-question self-assessment for your consideration.

This is not to imply that you should think this decision to death. Maybe you should just gather your documents, pick an assignment or two that interest you, and give it a shot!