Why Work Locum Tenens? Physicians Find Plenty of Reasons

Are you fiercely independent or famously indecisive — perhaps not ready to commit long-term to any person or place?

Or are you a bit of an idealist who’s encountered enough disillusioned or disgruntled doctors to wonder if this is your destiny after a decade of education and training (along with the accompanying student-loan debt)

At mid-career (or later), are you fed up with where your years of hard work and sacrifice have gotten you to this point?

Or perhaps you find yourself in limbo and longing for a way to re-energize?

What if you’re ready to work less, but not quite ready to retire?

Or maybe you’ve spent most of your life in one geographic area and you yearn to learn about new locales.

For those with families, is your significant other tired of hearing you complain about what some patient or administrative jerk did to disrupt your day?

If you can identify with any of these scenarios, perhaps a “walk on the wild side” of locum tenens medical practice is just what the doctor ordered.

Beyond your personal reasons for wanting to “shake things up,” why bother trying locum tenens?

Writing for the Advanced Practice Provider Association of America (APPAA), Kathryn Martin, PA-C, lists four primary reasons:

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1. Travel

“There are options to work on the other side of the country, or one county over,” Martin notes. It’s a way to experience a new place differently than as a tourist, offering a chance to “test-drive” areas where you might want — or need — to live.

In his PhysicianOnFire (PoF) biography, “PoF” Leif Dahleen writes, “My numerous locum tenens stints (before, in between, and sometimes during my “permanent” jobs) took me to hospitals in southwest Florida; central Wisconsin; northern Minnesota; Pittsburgh, PA; and many parts of Michigan from near the Indiana border to the UP (Upper Peninsula).”

In a post discussing the pros and cons of locum tenens work, Dahleen notes, “You can also find work in Australia, New Zealand, and other far-flung international destinations. A U.S. medical license is quite valuable globally.”

Although this doesn’t happen with every locum tenens assignment, Dahleen boasts, “My experience with locum tenens (temporary work) began the Monday after I finished residency. 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, Dahleen boasts, “My experience with locum tenens began the Monday after I finished residency. I practiced exclusively as a locums doc for nearly two years, and was offered a job in just about every place I worked.”

Echoing PoF’s experience, CompHealth shares pulmonologist Dr. Thomas O’Mara’s story about a locum tenens assignment in Boise, Idaho, that began in March 2020 — fairly early in the COVID-19 pandemic. “ ‘We didn’t know a lot about COVID-19,’ O’Mara says. ‘How it really spread, how dangerous it was. We didn’t know what to do or what to expect. How are we going to deal with massive surges? What if we all start dying? There was just the stress in not knowing.’ ”

O’Mara was surprised to find the expected wave of coronavirus patients didn’t happen at St. Luke’s in Boise. He described it as “not quite like what you’d expect based on what you hear on the news.” Although he’d agreed to a schedule of two weeks on, one week off, during which he could return home to New York, he and his wife decided it was probably best he stayed put during the “off” weeks to play it safe. That meant he could fill in when another scheduled locums physician couldn’t get to Boise.

Ultimately, his performance during the assignment led the hospital to offer him a full-time position — one that allows him the flexibility to work what’s considered a full-time job without uprooting his entire family. “I really, really like working at St. Luke’s,” O’Mara says. “They’ve treated me so decently…I am still able to go out and work for a couple of weeks and come home for a couple of weeks. It’s considered a full-time night position, so it’s exactly what I was doing as a locums. No clinic, no daytime. I really like working nights.”

Of course, not all locum tenens assignments result in full-time employment, by any means. But there are plenty of positive stories.

International Travel

Posting less than a year ago on Kevin MD.com, John Gallehr, MD, shared an experience from his second extended-stay locum tenens assignment in New Zealand with his family. He told the story of his most memorable day.

“It began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of snow.

“The transition from sunrise surfing to afternoon skiing felt like something out of a fairy tale, but it was the very real charmed life we were living in one of the most beautiful countries on earth.”

Gallehr was working in New Zealand as a child psychologist. The point of his blog post was that a physician’s taking his or her family along was key to ‘traveling doctor’ success. “How is it possible to have such amazing adventures in another country with my family while maintaining a very busy and high-stress job? The answer is locum tenens,” he said.

2. Try It Before You Buy It

Often locum tenens clinicians provide temporary coverage for a permanent position a clinic or hospital wants to fill. Maybe patient volume grew beyond the staff’s bandwidth — or the facility expects to expand. From the place-holding provider’s perspective, it’s a chance to check out not just the location, but also a practice setting where he or she might want to work permanently.

“Working locum tenens allowed me to work in a wide variety of places and practices both large and small, urban and rural,” PoF Dahleen says. “I had a chance to be assigned to work hands-on in one room every day, and to supervise three or four. 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.”

Reality Check

However, Suzi Richards, now president and founder of Best Locum Tenens, LLC, cautions against selling the ‘test-drive’ benefit of locum tenens. In a March 22, 2020, blog post on KevinMD.com, Richards takes issue with the permanent-placement fee most locum tenens agencies charge if a facility — or its affiliates, or any healthcare facility within a certain-mile radius of the facility last placing the locum tenens clinician — wants to hire the ‘fill-in physician’ full-time.

“Some agencies refer to this as a permanent-recruitment fee or a conversion fee. It’s essentially in place to cover lost revenue when the locum fees end and a viable locum resource is lost,” Richards said. “It’s meant to be a deterrent in most cases, and these fees can be $10,000 to $40,000 or more, depending on the specialty and other factors. Without this ‘deterrent,’ hiring a locum provider might even prove less expensive than paying the locum fees.”

Countering that argument, Interim Physicians CEO Tim Hand promotes and justifies the conversion fee as an effective way to ensure facilities don’t use locum tenens agencies merely as a contingent search firm for their full-time hiring needs. “A lot of work goes into finding and delivering the right locum provider to a facility for an assignment. On the physician side, there’s a differing mindset when it comes to accepting a full-time position with a facility versus working locum tenens for them,” Hand says. “Physicians working locum tenens don’t want to feel pressured into accepting any position as a precondition of helping a facility out in a time of need.” As proof he notes that less than 1% of Interim Physicians’ $37-plus-million in revenue comes from conversion fees.

Tim Hand, CEO of Interim Physicians, LLC, promotes and justifies the permanent-recruitment conversion fee as an effective way to ensure that facilities don’t use locum tenens agencies merely as a contingent search firm for their full-time hiring needs. “A lot of work goes into finding and delivering the right locum provider to a facility. And there are definitely two different physician mindsets when it comes to accepting a full-time position with a facility versus working locum tenens for them,” he says.

3. Income

While APPAA’s Martin said locum tenens compensation is “comparable to the norm for that position and location,” many times the clinician makes a higher hourly or daily rate than his on-staff colleagues. On its “locumstory.com” website, CompHealth indicates physicians willing to take locum tenens assignments can make between $90 and $300 hourly 1 , depending on specialty demand, the assignment’s location and other factors.

Physician Tycoon Catherine Carroll, MD, says the earning potential is “up to 50% above the average pay rate for a full-time physician.”

Physician Validation

On the blog he started three years ago, Vlad Dzhashi, MD, The LocumTenensGuy, a hospitalist who quit his full-time job and started working locum tenens in 2014, suggests, “ Think about it: with 15 shifts a month on average, you can make as little as $280K/year with $130/hr, or as much as $430K/year at $200/hr.”

Check out Vlad’s blog and podcast: ‘The Guy’ offers “real-life numbers” and, more recently, coaching to help prevent his fellow docs from making the same mistakes he did when he quit his full-time job and started ‘the locum life.’

Ditch the Debt

Are you ready for what hospitalist Dzhashi calls a “radical solution to crush your student debt FAST!?” In a blog post from August 2019, he wrote, “The obvious reason is that it pays better than a permanent job, especially for somebody fresh from residency.”

Dzhashi offers a step-by-step guide for paying off student loan debt within a year or two by working locum tenens assignments, preferably either straight out of residency or within a few years of graduating. He suggests this because

  • “You still have the spending habits of a resident.
  • You have fewer obligations (family, mortgage, etc.).
  • It’s easier to adopt a ‘nomadic’ lifestyle.”

Dzhashi tells the story of a young physician he encountered during a locum assignment who “plunged into locum tenens as soon as his residency ended” and completely paid off his students loans within a year.

“If you’re currently practicing medicine and are already working full-time, you could still consider adding locum work to your schedule. During a week of vacation, you could choose to work a temporary assignment,” internist Carroll writes. “If you have a debt you’re trying to tackle or a vacation you’re saving for, adding a week or two of locums work will allow you to reach your savings goal much faster.”

Case in point: in a recent “Anesthesia Success” podcast LocumTenens.com Associate Vice President Kyle Hadley described an anesthesiologist who took a house-call obstetrics shift for six months and paid off his student loans in a year.

Show Me the Money (or “How Much $$$ Can I Make Doing Locum Tenens?”)

Factors most affecting a locum tenens clinician’s compensation rate include:

  • demand for the specialty,
  • how well a provider’s skills/experience match client needs,
  • interpersonal and clinical skills a provider exhibits during the assignment
  • the facility’s location and patient volume, and
  • the assignment’s time demands.

For example, CompHealth indicates that because of high demand, emergency medicine physicians willing to take locum tenens assignments can make between $160 and $300 hourly, depending on the assignment’s location and other factors. Typically, these doctors work 12- or 24-hour shifts, covering an average 4-12 shifts per month for up to 6 months or longer, according to the website’s specialty tracker.

“There are also certain states that pay providers more than others,” CompHealth points out. 2 According to Medscape, here are the states with the highest average salary for all physicians: Indiana, Oklahoma, Connecticut, Wisconsin, Nevada, Arkansas, Louisiana, Alabama, Kentucky and Florida.

4. Flexibility

“When working temporary assignments, you can take time off in between, and the length of that time off is up to you!” APPAA’s Martin said. “Sometimes there’s also flexibility on the length of an assignment, such as a 6-month minimum with potential to extend to one year. And if doing locums full-time isn’t a good fit, moonlighting as a locum some place nearby could also be possible.”

PoF Dahleen writes, “As a locum 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 schoolteacher and take your summers off.”

Flexibility = Time Mastery

Locum tenens hospitalist Dzhashi, The LocumTenensGuy, notes, “Flexibility is the main reason why I’ve been practicing locum tenens, since it allows me to create a schedule that fits my lifestyle. It feels great being able to decide for myself if I’m willing to make a nice lump sum in the next several months or to take off and travel. I know I can do it without asking anyone’s permission – this is the greatest thing of all!”

Dzhashi acknowledges a permanent hospitalist schedule, like the one he left in Washington State to do locum tenens, offers greater flexibility and perceived time off than, say, doing outpatient work. Still, “locum tenens takes it to a whole new level and makes you a true master of your time.”

He describes the schedule he works around his kids’ school breaks: “I tend to work more in the spring and fall when I make probably close to 70 percent of my annual income. I schedule fewer shifts during the winter and pretty much take the whole summer off. Since the weather in the Pacific Northwest is extremely depressing in winter, I take my family to Hawaii for about a month to recharge and relax.”

Scan the locum tenens agency websites and you’ll find dozens of similar stories.

On September 11, 2020, Weatherby Locums highlighted a gastroenterologist who, after closing his 26-year practice, decided to hit the road with locum tenens. “I could consolidate as much work as possible into a 20-day span, then be home for about ten days a month,” Robert Brenner, MD, said. “My priority is to make as much as I can in as short a time as possible and still have time to go home and be with my family.”

List Edits

In his list of reasons for choosing a locum tenens job, MedsNews.com Chief Medical Writer Claudio Butticè, PharmD (a pharmacist), replaces “travel” in PA Martin’s list with ‘gaining more contacts and experience.’ He observes, “Since each facility that you work in will offer a new experience and contacts that you can learn from, you’ll grow much faster in your chosen field than you would have otherwise.”

Physician Tycoon Carroll calls it “the ability to network.” She writes, “While your primary goal is seeing your patients, one of the many advantages is working for a practice or hospital type you would otherwise not have the chance to experience. You will meet other physicians and staff members and develop a strong network of physician peers around the country.”

Physician Tycoon Carroll says, “One of the many advantages of locum tenens is working for a practice or hospital type you would otherwise not have the chance to experience. You will meet other physicians and staff members and develop a strong network of physician peers around the country.”

Butticè adds a fifth reason for working locum tenens: ‘avoiding administrative work.’ Noting the nonclinical aspect of medical practice often keeps patient engagement low, he writes, “by working as a locum, there’s no need to get involved with the business side” of providing healthcare.

A practicing internist in Southern California, Carroll asks, “Can you imagine a day in your life as a physician where you’re not worried about administrative meetings? It’s almost impossible to believe, but when you’re a locum tenens physician, you can concentrate exclusively on caring for your patients…Your job as a locum tenens physician is to accept the assignment, show up to the office, and treat your patients to the best of your ability.”

¹ Healthcare employers’ compensation packages generally include the option of employer-subsidized health insurance and retirement benefits, things locum tenens work doesn’t provide.

² Article posted July 23, 2018.

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