PART 5

“Money-Money-Money, Mun..nney” ♬ [AKA, Legal & Financial Considerations]

The pay is good, but the life of a locum tenens provider can be confusing, what with all the contract mumbo jumbo, quirky compensation, and “taxing” 1099s. Here, we ♪ “tell you about it” ♪.

In Part 5 of Locumpedia’s No-BS Guide to Locum Tenens we’ll cover:

 

You took the long way and became a doctor. Unfortunately, lawyers still might be required. Needless to say (but we will, anyway), life is complicated in the 21st Century.

As if the student loans (most of) you will drag along for the next decade or so weren’t enough, you must think about ‘real-world’ issues like CONTRACTS and TAXES and INSURANCE — oh, my!

You think, “No problem,” right? You know this is part of adult life today and it’s no big deal. That is until the unanticipated happens and you need assurance your “6” is covered…

Through our No-BS Guide to Locum Tenens, we’re here to help. As long as locum tenens work is “done properly” it can help any provider boost their income.

Here’s hoping we can help with the “done properly” caveat.

Section 1: Locum Tenens Contracts: Maybe Actually READ Them?

How many times in a given week; month or year, do you think, you acknowledge having received and read legal documents you’ve barely skimmed through — if you even opened what you’re “signing off on” at all?

When you want to read an article online or download an app to your mobile phone or computer, do you even open up and scroll through the “terms and conditions” the website or app creator asks you to agree to (or tells you that you are agreeing to) if you continue?

In completing paperwork at a doctor’s office or healthcare facility, do you actually READ the provider’s HIPAA statement and financial policy? Or do you simply sign the documents?

If you’ve ever purchased a home, how many hours did you spend reading through that pile of documents before signing each one? (Personally, I seem to remember a signature ‘assembly line’, with all parties at the table resisting the prospect of said “closing” costing anyone involved an extra minute at the closing table.)

We’ve probably all, at one point or another, been guilty of selecting “I agree” on a legal terms and conditions agreement without reading said terms and conditions.

91% of people consent to legal terms and services conditions without reading them. Younger people ages 18-34 have an even higher rate with 97% agreeing to conditions before reading.

Two researchers from disparate universities studied how far consumers could be “conned” into going. They created a fake social-networking site called “NameDrop,” and wrote up the terms and services agreement for users to agree to before signing up.

In the agreement, the researchers included a disclosure for users to give up a firstborn child as payment. It also said that “anything the users shared would be passed along to the NSA.” Unsurprisingly, 98% of the participants agreed.

While the example is extreme, it further demonstrates the importance of reviewing any document thoroughly before formally agreeing to something.

So… to what extent are YOU willing to ‘expose yourself’ to enjoy clinical practice on your own terms?

Since medicine is a technical, risky business, it’s important to cover your bases and always carefully peruse your locum tenens contract before signing.

The typical physician contract has 3 main components:

  1. Job Description — The job description will dictate where you will work, how many hours a day and days a week you work, and how many patients you will see.
  2. Compensation — Make sure you understand how your compensation is calculated. There are several different ways to calculate your base, including per-shift payment (what if you stay late or do charts from home?), Relative Value Units (RVUs), hours billed, or revenue generated. (For the last 3, — what’s the staff-physician average? Also, ask if you’ll be paid as an employee or as an independent contractor. If paid as a contractor, you’ll need your retirement and benefits. Independent contractors must cover their benefits in addition to paying both employee and employer halves of Social Security and Medicare.
  3. Termination — What happens if you don’t like the job? What happens if they don’t like you? How much notice must you give and vice versa? What happens if you lose your license or hospital credentials? Under what grounds can they fire you “for cause”?

Locum tenens clinical practice can pay you handsomely for practicing medicine within the parameters you set for yourself. Word to the wise, however: Do your due diligence to ensure you don’t compromise your personal or financial life for contracted professional commitments.

“Remember that independent contractors must pay both the employee and employer halves of payroll taxes like Social Security and Medicare, as well as cover their own benefits. That means you need to be paid more as an independent contractor than as an employee for the compensation packages to be equivalent.”

— James M. Dahle, MD, FACEP

Section 2: Locum Tenens Contracts 101

“Too many practitioners sign locum tenens contracts without fully understanding their implications — and some live to regret it.”

For your own professional (and personal) preservation, never sign ANYTHING you, or a business advisor you trust, hasn’t read all-the-way through. (Hard STOP!) Too many practitioners sign locum tenens contracts without fully understanding their implications — and some live to regret it.

Agencies will often market themselves as physician’s advocate, but their primary loyalty is to the client paying their fees. A provider should hire an attorney well-versed in locum tenens agreements. 

Although most locum tenens work comes through staffing firms, sometimes physicians develop networks of facilities that need locum tenens coverage regularly. Of course, the main advantage here is the possibility to negotiate higher pay by eliminating “the middleman.” Some facilities will ask physicians to draft the locum tenens agreement when contracting directly, which means they need to retain counsel that understands the ins and outs of these contracts. 

If the healthcare facility has its form of agreement, then it’s important to make sure the contract is heavily vetted by a knowledgeable attorney.

Each locum tenens contract varies from agency to agency and facility to facility. Some of those agreements will have the same boilerplate service agreements that will need to be signed before a clinician is placed. Then the employer will fill in the important details like the location of the assignment, dates assigned, and compensation. 

Each locum tenens contract varies from agency to agency and facility to facility. Some of those agreements will have the same boilerplate service agreements that will need to be signed before a clinician is placed. Then the employer will fill in the important details like the location of the assignment, dates assigned, and compensation. 

It won’t take long for you to become an expert in reading dense legal contracts, but for the first one or two assignments you take, it’s best to have the contract reviewed by a legal representative in the state where you’ll be practicing or by a national physician contract review service.

The contract review serves four purposes:

  1. Education (as in “interpretation”) about what the contract’s language means.
  2. Problem Identification. These can be items already in the contract or items that should be — things that will need to be changed or clarified through…
  3. Negotiation — highlighting opportunities to avoid ambiguity or better ‘level the playing field.’
  4. Calibrating Compensation — ensuring the offer is competitive with current physician compensation trends.

The contract paints a clear understanding of the relationship between the provider and the agency and it includes a few things the physician must meet like agreeing to complete the assignment conditioned by the contract and providing valid and accurate credentialing information. Some locum tenens agreements will even prohibit physicians from doing things like providing administrative services.

Another SCORE for locum tenens medical practice, right?

Term

So, for what length of time, generally, must a physician commit to “fill in” under a locum tenens contract?

An important provision to a locums contract is its term, or how long the contract lasts. If the contract contains an “evergreen clause” it will automatically renew for a set amount of times. One of the advantages of an evergreen clause is not having to renew the agreement in writing every single time the end of the assignment term approaches.

Locums physicians can have numerous contracts with agencies and healthcare facilities, and it can be a challenge keeping up with all of them. Evergreen clauses don’t eliminate this administrative burden but also help physicians avoid the unintended risk of providing medical services without an active agreement in place.

The attorney-authors say many of their law firm’s career locum tenens clients prefer including evergreen provisions in their contracts.

The downsides of these clauses include physicians’ neglecting to terminate their agreements with agencies that are not providing enough work. This can be a mistake when contract covenants either restrict them from accepting other job opportunities for an extended period or add unnecessary administrative work.

Notifying the counterparty of your intent to terminate a contract can sometimes help restart negotiations. But this sometimes leads to the provider negotiating an unfavorable locum tenens arrangement into a more rewarding one.

Restrictive Covenants

Restrictive covenants prohibit physicians from competing within a fixed geographic area, at certain facilities, or both for a while. These restrictive covenants are governed by state law and vary from state to state.

Providers might have the common misconception that a non-compete clause isn’t enforceable, but in many states — New York and New Jersey, for example — the state will enforce the clause when the restrictions are deemed reasonable.

A non-compete complete clause for a contract restricts you from working with a hospital through another locum tenens company for a certain time.

If the agency you partner with loses the contract you made with the hospital, a non-compete clause also prevents you from working at that facility either on a “per-diem” contract or through another agency’s services.

It’s worth noting that non-compete clauses don’t prohibit you from working for other staffing agencies or recruiting firms. Instead, it just prevents you from working for specific clients you have through the locums agency.

Termination

Termination provisions, which allow either party to end the contract, vary widely based on the reason for termination.

Without cause” means that one party can terminate the assignment for no reason, but this usually follows a specified period of written notice. The standard period for advanced written notice is 30 days in advance, but the main consideration is what works best for you.

For cause” termination means the healthcare facility you’re partnered with can terminate you either immediately, or after a “cure period” of time. If the triggering issue that led to this cure period wasn’t adequately addressed during that time, then the facility could terminate the contract. The standard language of for-cause events is often ”failure to perform physician’s duties to the reasonable satisfaction of the hospital.” A physician should insist on notice for these “curable breaches” so they have the opportunity to address the problem.

Attorney William P. Sullivan relays a story of how a locum tenens contract with a clause allowing immediate termination of a physician’s services resulted in a huge pay loss for that physician.

Sullivan was contacted by a client who consulted him regarding several locum tenens shifts that had been abruptly canceled by the company she was working for. The physician had been offered a bonus as an incentive to cancel previous jobs and take the opportunity at “Company X.” But the night before her shifts began, Company X had asked that the physician be removed from the schedule, Sullivan says. The agency canceled with less than a day’s notice and as a result, Sullivan’s client ended up losing close to $20,000.

Sullivan explains, “Company X’s contract language required that the physician give 60 days’ notice” before canceling a shift. However, the agency could cancel a shift with no advance notice if the hospital requested the cancellation. This sort of language is not uncommon in locums contracts.

Sullivan explains, “Company X’s contract language requires that the physician give 60 days notice before canceling a shift. However, the agency can cancel a shift with no advance notice if a hospital requests such cancellation. Unfortunately, such inequitable language is common in locum tenens contracts.”

He then highlighted several staffing firms with vague — or even predatory — contract language regarding termination that could lead to similar losses if firms choose to exercise their legal rights under the contract.

There’s one provision Sullivan says indicates the agency doesn’t have to pay the physician if the hospital, clinic, or practice doesn’t pay the staffing firm.

Sullivan offered this advice to anyone when reviewing their locum tenens contract:

  • Read contracts carefully.
  • Consider if single locum tenens assignments should be your sole source of income.
  • Consider whether you want to work with a locum tenens company that is not a NALTO member, or that does not adhere to NALTO’s ethical standards.

Another important stipulation in the agreement is the requirement you provide notice if you are unable to fulfill an assignment once you’ve accepted it. Situations arise that are out of your control, and a good agency will do whatever it can to assist you.

Malpractice Insurance

Almost half of physicians 55 or older, 46.8%, reported in 2022 that they had been sued at some point in their careers. That’s compared to about one-third of physicians overall.

When applying for a position, or signing medical employment contracts, physicians need to review what’s called a “Certificate of Insurance” (COI) for the hospital program. Unfortunately, the terminology in the Certificate of Insurance can be difficult to interpret.

The first section of the COI “prohibits you from relying upon the information contained in the COI.” This means the COI is just a summary of the insurance policy, but this language says that the information does not form a contract for coverage between the entity being insured and the insurance company or agent.

You’re at the mercy of the insurance broker’s proper completion of the COI. And if they haven’t, then the terms of the insurance policy are binding, not just COI. The policy language applies regardless of the language about the insurance provided according to your medical contract.

The next section of the COI says if an entity on the certificate is an ‘additional insured’ — not the “Named Insured” on the policy like a business entity you formed as an independent contractor, there must be an endorsement or amendment to the policy to include the certificate holder.

Be aware: The entity may be directly named on the COI, but it doesn’t mean that the person has insurance coverage unless there is an endorsement on the actual policy].

WHAT???

WHAT??? Way to clarify what Shakespeare meant (back in the 16th Century, no less) when “The Bard” wrote in Henry VI, “First…let’s kill all the lawyers,4

Medical malpractice insurance is a standard provision, but which party provides the coverage, the policy type, its term, the policy limits, tail coverage, and other important aspects vary widely.

The threat of a malpractice suit is very real, no matter your age or skill level. That’s why physicians need to know how to interpret and confirm the details of their malpractice insurance included in the locum tenens agreement.

The two main types are “occurrence” and “claims-made” policies, and it’s critical to understand how they differ.

Occurrence policies cover the physician for incidents that occur when the policy is in effect, regardless of when the claim is made, while claims-made policies cover the physician if the policy is in effect when the claim is made.

“Occurrence policies generally offer better protection, with a decreased risk of coverage gaps compared to claims-made policies.”

Claims-made policies, which are the kind often provided by agencies, will cover the physician if the policy is in effect when the claim of malpractice is made. 

For example, if a physician was insured under a claims-made policy effective from January 1, 2023, to December 31, 2023, then there would be no coverage if the incident occurred on February 1, 2023 if no claim was made until after the policy expired, say on January 15, 2024. When the claims-made policy expires, so does the coverage for everything that occurred during the effective period.

If the claims-made policy doesn’t get renewed, a physician will be exposed to a gap in their coverage. Physicians need agreements that include an extended “reporting endorsement,” so they can be covered in any gap period — these policies are commonly referred to as “tail coverage” when the agreement calls for a claims-made policy. 

The “tail” extends a reporting window for malpractice claims that arise when the claims-made policy was valid, but made after the policy’s period had run its course. Tail coverage can turn the claims-made policy into an “occurrence policy” depending on when the claim is made. 

The “tail” extends a reporting window for malpractice claims that arise when the claims-made policy was valid, but made after the policy’s period had run its course. Tail coverage can turn the claims-made policy into an “occurrence policy” depending on when the claim is made.

Since every locum tenens agency operates differently, physicians must analyze the malpractice insurance provisions and specific policies–especially for adequate tail coverage.

Locum physicians need to review contract provisions carefully so they understand what happens to malpractice coverage if the locum tenens agreement is ever terminated. It’s important to note that some standard agreements provide malpractice tail coverage that even “survives” termination, while others exempt the agencies from maintaining tail coverage upon the assignment’s termination. 

Word to the wise, folks (once again): Scrutinize Those Contracts! 

Compensation and Expenses

One of the greatest benefits of working locum tenens is the opportunity to earn compensation based on your hours worked. Locum tenens physicians almost always earn more than their full-time counterparts. One of the reasons locum physicians are paid more is that they usually get paid on a per-diem (daily or shift) or hourly basis, and those amounts are driven by market demands. 

Examples of these variables include:

  • Contracting through an agency or directly with the facility
  • Location and type of facility
  • Demand for, and supply of, the specialty,
  • Physician’s experience and skillset
  • Urgency of assignment
  • Case or patient loads
  • Type of shifts required
  • Assignment length

Pay rates for locum tenens work are negotiable. The first offer is rarely the best offer you’ll get. Knowing this, understanding one’s value, and allowing for the lack of benefits, some physicians are still timid when it comes to negotiating a contract. This works against these physicians’ best interests because the only way you absolutely won’t get proper compensation is if you don’t ask for it.

In this blog post about negotiating locum pay, Dr. Dzhashi acknowledges, “We’ve all been in the awkward situation when we felt we were not getting paid what we deserved, but due to lack of the business training and experience, we just accepted whatever was offered.”

He says his earliest conversations with recruiters were stressful because every time he seemed to fail to get what he considered to be a fair deal for the type of hospitalist gig he signed up for.

“Over the years I got good at negotiating and have been consistently getting higher pay rates than most of my colleagues,” he says.

When it comes to negotiating compensation or any provision in a locum tenens contract, the best negotiator is one who is prepared way ahead of time.

Physicians should consider incorporating provisions — like

  • Rate premiums: for example, shift differentials; holiday, on-call, or “call-back pay”
  • Escalators: automatic pay-rate increases under agreed-to conditions, like a certain percentage increase at the contract’s annual renewal under an evergreen clause
  • Covered expenses: insurance, licensing, credentialing, and privileging fees; travel and housing costs

Physicians should also consider factors such as housing costs when negotiating for higher pay rates.

“Boilerplate” Provisions

Boilerplate provisions are seemingly innocuous clauses usually found at the end of the agreements, which can significantly affect both the locum work experience and the contract’s legal ramifications.

Entire agreement clauses or “merger clauses” state that a written contract is the complete expression of the parties agreement.

Providers shouldn’t expect any statement to be enforceable if it isn’t already included in the written contract.

“Choice of law” and “forum selection” clauses also affect the outcome of a contract dispute.

Substantive and procedural law will vary depending on the legal jurisdiction and court systems. Usually, the governing law and forum are in the same jurisdiction, but they can differ. Physicians might be surprised to find that they’ve agreed to litigate disputes far from either their home or their normal place of work.

Also, a “Force Majeure” clause in a contract would shield a physician against liability from failure to perform if the inability to perform is “caused by a specified event beyond the physician’s reasonable control.”

Conclusion

Physicians need to know that agencies and hospitals hire specialized lawyers to create their locum tenens contracts with their interests in mind. As a locum tenens physician, it’s essential to have your attorney to protect and defend your interests.  Please note, this article is for informational purposes only. It is not legal advice. To find more dissection of physician employment contracts, click here.

Section 3: How Does Locum Tenens Compensation Work?

Most doctors are well-compensated for their roles in keeping patients healthy. They are among the highest-paid and most-educated professionals in our country. Nine out of the top 10 highest paying jobs went to doctors, with physicians reporting a median of $208,000 per year. The high salary makes sense, given their work’s importance and the responsibility and liability that come with it.

In its Annual Compensation and Employment Survey, LocumTenens.com found the average physician salary to be noticeably higher, at $328,025.

Regardless of whether the average (staff/full-time) physician earns closer to $200K or $400K, doctors don’t start out wealthy: The average medical-school debt a physician carries out of medical school and residency is roughly $202,450.

To help doctors decide where to practice (to enable them to pay off that debt), WalletHub compared the 50 states and the District of Columbia across 19 key metrics. Its data set ranged from the average annual physician wage to the number of hospitals per capita to public hospital system quality. Here, you can review the complete ranking, additional expert commentary, and a full description of WalletHub’s methodology.

Believe it or not, the top 5 states in which to practice medicine are Montana, South Dakota, Idaho, Wisconsin, and Minnesota.

Irrespective of where the “mean” and “average” physician salaries fall, most staff physicians are paid similarly, regardless of medical specialty:

  • Annual salary
  • Life, health and disability benefits
  • Retirement plan
  • Other “perks”

Locums Comp Differs

However compensation for locum tenens physicians works a bit differently.

Unlike doctors who work in regular salaried positions at hospitals, locum tenens physicians function as independent contractors. They typically receive a fixed hourly rate for their services, regardless of whether they are covering a weekend shift in the emergency department or working for an extended time.

Unlike doctors who work in regular salaried positions at hospitals, locum tenens physicians function as independent contractors. They typically receive a fixed hourly rate for their services, regardless of whether they are covering a weekend shift in the emergency department or working for an extended time.

Locum tenens physicians are typically paid directly by the locum tenens staffing firm they’ve partnered with and payment rates vary depending on factors like:

  •  Demand for the specialty – With locum jobs available in more than 100 specialties, there’s an ongoing need for internal medicine physicians; hospitalists; psychiatrists; nurse practitioners and physician assistants, to name a few. Typically, facilities will pay more for those practicing in specialties chosen by fewer clinicians.
  • Location and type of facility – here are open locum tenens positions across the country. Generally, rural facilities or those having trouble attracting permanent candidates will pay more than facilities in popular urban locations.
  • Skill set and patient load – Positions requiring complicated procedures or specialized skills often pay more than general assignments. Patient load also plays a role: slower-paced assignments tend to pay less than those with heavy workloads.
  • Type of shifts needed – Assignments can last just a few shifts, a weekend or months at a time. Working weekends or holidays or being on-call may result in a higher hourly locum tenens pay rate for those types of shifts.

All of the above factors determine what the hourly pay rate would be for a locum tenens provider, which means a provider could make substantially more in a rural hospital in North Dakota than in an urban facility in a major metropolitan area.

Because locum physicians are independent contractors that don’t receive traditional benefits, they may be paid a higher hourly rate than their “permanent” counterparts. A locum physician can make up to $50 more per hour than a permanent doctor working under the same roof.

To give you an idea of the hourly pay rates for different specialties, CompHealth offers the following graphic:

 

According to “The LocumTenensGuy,” an experienced locum tenens hospitalist shouldn’t earn less than $150/hr. He shares his complete negotiation process — and even the “scripts” he uses in this blog post. Dr. Dzhashi talks at length about working around barriers often thrown up by agency recruiters or vendor management firms when physicians try to follow the advice he gives to negotiate the highest hourly rate possible.

Non-salary locum tenens compensation considerations include medical malpractice insurance; licensing, credentialing and privileging fees; and travel and housing costs, which the staffing agency typically covers. 

Look Beyond the Paycheck

Non-salary locum tenens compensation considerations include medical malpractice insurance; licensing, credentialing and privileging fees; and travel and housing costs, which the staffing agency typically covers.

An agency takes care of the extra work that taking locum tenens assignments can create. The larger locum tenens companies often have in-house teams that help gather and maintain paperwork for temporary assignments. They also know how to navigate the licensing, credentialing, and privileging processes in other states.

The Interstate Medical Licensure Compact also makes it significantly easier to get a license in over 40 US states.

Just a point of emphasis before we move beyond the “compensation” section: One thing that is often overlooked in considering a locum tenens hourly rate is the lack of “traditional benefits” (like life, health, and disability insurance).

“What is NOT covered by the locum tenens agency?

The independent contractor status of locums means they are not employed by the locum tenens agency or the facilities where they take assignments. So they are responsible for taxes, medical insurance, and benefits on their own.

Taxes – State, federal, Medicare, or Social Security taxes are not taken out of locum tenens paychecks. As a result, physicians are responsible for making estimated tax payments.

And locum tenens physicians generally pay income taxes in each state where they work. However, there’s a state tax credit for nonresident state tax liability that can reduce the home state tax. This credit should fully or partially eliminate any double-state taxation. Read more about locum tenens taxes here.

Medical insurance and benefits – Locum tenens providers are responsible to fund their own benefits, including health and life insurance or retirement plans. This isn’t an issue for any provider who is using locums to supplement their income, but if locums are the primary source of income, they may want to consider a spouse’s healthcare coverage, if possible.

Locum tenens providers will typically have more opportunity to claim work-related expenses than the typical employee, though. That includes things like travel, meals, housing, work tools and supplies, and continuing education.

Section 4: Playing It Smart as an Independent Contractor

“First, if you plan on working full-time locum tenens, make sure to set up your ‘safety net,’ which includes life, disability and health insurance — and a cash reserve.”

– Dr. Dzhashi

So, you’ve decided you’re ready for a locum tenens career? Then here’s what you need to do, according to the “Locum Tenens Guy.”

If you plan on working full-time locum tenens, set up a safety net of life, disability, and health insurance in addition to any cash reserve. The cash reserve is important for both ensuring you feel secure and providing a strong negotiating basis for hourly rates with an agency or hospital.

The rule of thumb regarding cash reserves is to accumulate at least six months of basic expenses. However, it might not be entirely necessary for a physician with a spouse that has a full-time job and benefits.

In addition to the “cash-on-hand” insurance, you should secure disability, life, and health insurance to complete your safety net.

Disability insurance is “an absolute must.” The average American female has a 24% chance of becoming disabled for three months or longer, and males have a 21% chance during their lifetime, according to the US Social Security Administration.

For a top-three locum tenens agency’s perspective on becoming an independent locum tenens practitioner, click here.

Insure Only Against Financial Catastrophes

Insurance is a critical aspect of any financial plan. Even if your employer doesn’t offer it, you still need it.

“Insurance can be purchased to protect you against all kinds of events. However, as a general rule, you should only insure against financial catastrophes.”

-James M. Dahle, MD, FACEP

Insurance can be purchased to protect you against all kinds of events. However, as a general rule, you should only insure against financial catastrophes, Dr. Dahle of the White Coat Investor says.

Financial catastrophes are very expensive possible outcomes that you cannot afford to pay for yourself. Getting into a major car accident that requires weeks of treatment in an ICU qualifies as a financial catastrophe. Losing a phone or breaking an appliance isn’t the same type category.

Here are 5 financial catastrophes that most doctors will need to insure against, at least for part of their lives:

  1. Liability
  2. Illness/Injury
  3. Disability
  4. Death
  5. Loss of expensive property

An insurance company’s source of income is the premiums they receive from policyholders and the investment return on its portfolio of money that has not been paid out as insurance benefits.

With the income these companies take in, they have to pay all of the insurance benefits, cover all of their expenses, and, if it is a for-profit company, leave something extra for shareholders of the company.

So, it can’t pay out benefits for every dollar it receives in premiums. It must pay out less. Since insurance is a losing proposition, there’s no reason to purchase insurance you won’t need.

Dr. Dahle so effectively explains how to protect yourself (as an independent locum tenens contractor), your family and your assets that we won’t attempt to compete with, or even paraphrase, his advice. Check it out yourself by clicking here.

Self-Employment Business Structure

Since locum tenens physicians are paid as independent contractors, neither the facilities in need nor the agencies facilitating their assignments actually employ these physicians. As a locum tenens physician, you’re your own business. The locum tenens agency serves you as a client So, the agency sends your company’s gross paychecks, but they generally don’t provide a traditional slate of benefits.

Since locum tenens physicians are paid as independent contractors, neither the facilities in need nor the agencies facilitating their assignments actually employ these physicians. As a locum tenens physician, you’re your own business. The locum tenens agency serves you as a client So, the agency sends your company’s gross paychecks, but they generally don’t provide a traditional slate of benefits.

As your own company, you’re the one responsible for determining and paying any taxes on your income. An agency will send over the 1099 forms at the end of the year because this is required by law. But doctors are not employees of an agency or facility at all. You’re an independent contractor.

Therefore, you should:

  • Get a federal Employer Identification Number (EIN), available from the IRS here.
  • Open a separate bank account, and perhaps even a credit card, for the business to allow you to keep personal expenses and income separate from business expenses and income.
  • Make quarterly estimated income tax payments to the IRS, since there’s no employer withholding taxes for you.

You can read more about the legal options for structuring your self-employment, with the basic choices including

  • Sole Proprietorship
  • Partnership
  • C Corporation
  • S Corporation
  • Limited liability company (LLC)

The Sole Proprietor

The sole proprietorship is one of the simplest and easiest business structures, so it’s most commonly chosen by doctors.

The sole proprietorship is one of the simplest and easiest business structures, so it’s most commonly chosen by doctors. 

As long as you have no employees, there’s no need for EIN: You can simply give the paying entity your name, address, and SSN on a W-9 form, and the paychecks and 1099s will be issued to you directly.

As a sole proprietor, you report business income and expenses on a “Schedule C” on personal taxes. If your spouse does similar work, they also have their sole proprietorship you’ll each file separate Schedule Cs. Also, it’s important to note that if you do not deliberately choose another business structure, you’re a sole proprietor by default.

Form a Partnership with Your Spouse?

Doctors may wonder if a partnership might be the right business structure, especially if their spouse is doing the same thing, but a partnership files an entirely different tax return. This is a thorough, complex five-page partnership return (Form 1065).

A doctor might also claim spouses do their “admin” work enabling them to set up another retirement account — and perhaps a larger Social Security benefit — down the road.

But you can always just form a sole proprietorship and employ your spouse, or even contract with your spouse’s sole proprietorship, to get another retirement account without having to do a Form 1065.

This is still a bad idea for a one-doctor couple because that’s a high cost to pay for a retirement account. If their spouse doesn’t have any other income then the physician pays “social security taxes (both the employer and employee half, 12.4% total although half of it is tax-deductible) on all of their income.” That cost is likely to be higher than the benefit of having another retirement account.

There are other business-structure options for your self-employment, which you can read more about here.

In some states, a doctor providing physician services is required to form special entities called a “Professional Corporation” or “Professional LLC” (PLLC), but there’s little difference between the two.

Section 5: Locum Tenens Work and Taxes

So now it has come to this: Life’s only 2 certainties = Death & Taxes.

While there’s little we mere humans can do about the former, we at Locumpedia hope to, at least, steer you in the right direction regarding the latter.

A locum tenens clinician will find that they have a lot of new responsibilities as independent contractors, and they may have also worked in different states over the course of a year. Adding to the complexity of locum tenens taxes, there may also be a requirement to file in multiple states, and locums likely deal with expenses that few of their counterparts may ever encounter. But consider if those annual headaches compare to the many, many benefits of locum tenens work.

As a locum tenens physician, you can 1.) Earn more money and gain more control over your schedule and 2.) also enjoy a variety of write-offs designed to help reduce your tax burden.

Most locum physicians that set up some sort of business entity create additional ways to save on taxes. Every would-be locum clinician needs to understand that working locum tenens does make your tax situation a bit more complex, but, some good news: You can use this locum tenens tax calculator to estimate your taxes and see how much money you would keep after taxes whether you are employed, an independent contractor, or even if you have a combined income (W2 and 1099).

You can also input your potential locum tenens expenses to come up with an estimate. Find a list of deductible expenses by category under the subhead “Taxes” here.

Find a straightforward overview of federal tax changes made for 2021 courtesy of Physicians Practice here.

Check out tax intelligence from a (former) fellow physician who utilized locum tenens to achieve “financial independence” at age 39 and retire at age 43 here.

Peruse “Preparing for Tax Season as a Locum Tenens Contractor” by LocumTenens.com here.

Next: How Locum Logistics Work

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