5 Things to Know Before You Start Out as a Locum Tenens Physician.
I was a second-year resident when my department chair asked me if I would be interested in joining the faculty group. I played coy, saying I would have to look around at other jobs before making a decision, but I’m sorry to say I never really explored career options - I didn’t even think about private practice. And while I got tons of those calls and text messages from locum companies, it took several years before I ever investigated locums as a career option. Now that I have been working locums for a few years, here are 5 things I learned along the way that I wish I knew at the beginning.
Locum tenens is viable career option.
If you don’t personally know anyone who does locums, you probably have (or have heard) some preconceived notions about what kind of doctor chooses the locum life. Maybe your department or practice has been understaffed and considered hiring locums, but only half-heartedly: “Our patients deserve better.”, “Can we really trust those doctors to take good care of our patients?”, “If they are good doctors why can’t they get a full-time job?”. Medicine is still a very traditional career path in many ways, and since most physicians can’t imagine leaving the security of their employed positions even if they are sometimes losing autonomy, fighting burnout, or struggling not to be treated like cogs in a giant corporate wheel, they often come up with outlandish assumptions about those of us who have chosen differently.
The locum physicians in my networks are early-career and figuring out what style of practice they would prefer, mid-career and making room to take care of their children, partners, elderly parents or themselves, and late-career gradually phasing toward retirement. We’ve worked in private practice and academic centers; some of us are employed full- or part-time and picking up locum shifts for extra cash. If you are considering locums but are scared to make the leap because you think locums is a last resort for doctors who have a black mark that prevents them from obtaining traditional employment, I’m here to tell you there is a thriving community of docs who do locums by choice.
You are more than qualified.
I was lucky to transition into locums from a busy, high-acuity practice so I felt confident in my clinical skills even after a few months off on sabbatical. Now when I hear from physicians who are starting on this path, they are worried about all the things they imagine are missing from their resume-
“But I haven’t taken my boards yet”. “I’ve only worked in a small private practice”. “I haven’t seen a patient in six months.”, “I’m a general practitioner, I don’t have a subspecialty or a certain area of expertise.”
Physicians are trained to look for external validation. Someone else had to accept us to medical school, then residency, or fellowship and we struggle when there is no test or application to tell us where to go or what to do. But your training IS you expertise. There is a nationwide physician shortage, hundreds of hospitals and practice and need YOUR help. If you qualify for a physician license, then you are qualified to work locum tenens, no matter what your locum agent tries to tell you. Which brings me to my next point . . .
That “friendly” locum agent is not your friend.
I was probably in my chief year of residency when I started receiving messages from the big-three locum agencies:
“Hi Dr. I have a facility looking for coverage in your specialty. We’ll pay for lodging, travel, and malpractice. Interested?”
I ignored their messages for years and once I started engaging with them later in my career, I quickly realized they are like any other kind of salesperson. They may seem friendly, they may spin a nice yarn about their passion for helping doctors live their best lives or helping facilities find good physicians, but they have one job and one job only: to make their employer as much money as possible.
Here is how a locums works: The agencies go to potential clients (facilities or practices that have gaps in their staffing) and negotiate a contract saying the facility will pay them for $X per hour of physician time they can source. Then they agents start sending those texts trying to find a doctor to fill the role. The less money they can convince you to take, the more of that $X they get to keep for themselves. And many agents will say ANYTHING to get you to settle for lower compensation. I’ll do a deep dive into some locum agent “greatest hits” in a future post, but for now assume they’re offering you much less money than what is avaiable for a position, question anything they tell you about required patient experience or procedural numbers, and don’t share your CV until you have everything you need to be reasonably sure that you want a position and you want that agent to be the one who represents you.
You need a physician network.
I had been in my first locum job for months before I found an online community of locum physicians in my specialty, and it took less than a half hour scrolling through the posts to realize I’d been had. The rate I had negotiated (a little lower than what the blogs that came up in my internet research to support my negotiation stated was average, but pretty good IMO for my first outing) was $40 lower than the average hourly rate for my specialty. The blogs were actually run by locum agencies or their parent companies; the doctors in this community were asking for more - and getting it! My agent had claimed the client rejected by initial rate proposal, but it turns out the client in a locum agreement has no idea what the agency is paying the contracted physicians. My agent had claimed the real money was in out of state jobs and I would just need to paid less as a local physician, but practice volume and acuity and the level of need are actually bigger factors in determining pay. I got on the phone immediately and negotiated a pay raise, but it was the beginning of the end for my partnership with that company.
Since then, my networks have been an invaluable source for job leads, marketing tips, negotiation advice, new friendships, even informal clinical consults. I reach out to my groups with questions before I talk to my agents, some of the docs I’ve met are references for upcoming job opportunities, and I’ve even built up the courage to branch out into direct contracting based on their examples. The locum life can feel lonely, but it doesn’t need to be. Consider a search of general or specialty-specific locum groups on social media sites before you sign on to an agency.
Everything is figureoutable.
Switching to locums has been great in so many ways: I work less than I did before, and when I’m at work I am able to be present with my patients in a way that had become incredibly challenging in my full-time role. I spend more time with family and friends. I’ve explored new hobbies that I would never even have had room to consider a few years ago. But more than anything my time as a locum doc has reinforced my own belief in my ability to do new and hard things. After just a few years I am a confident negotiator and boldly market myself and my skills to potential partners. Even the things I was afraid of messing up - health and liability insurance, retirement savings, tax preparation - are now just run of the mill tasks for me. As a physician you are capable of so much more than following the rules and doing what you are told; you are capable of building the life and career of your dreams, on your terms.
Thanks for reading! Have thoughts, questions, suggstions for future posts, or your own story to share? Drop a comment below—I’d love to hear from you. And if you’re into real talk about reproductive health and the reality of locum work, hit subscribe to stay in the loop.