PART 1
Loco What??! What the Heck is Locum Tenens?
In this part: What locum tenens medical practice is; how this way of practicing works; and why, at various stages of your career, you might want to consider it.
Introduction
A little-known fact for a lot of patients checking into a hospital for the first time: Sometimes hospitals and other healthcare facilities use temporary or ‘fill-in’ physicians, otherwise known as “locum tenens doctors.”
And it’s crucial to note that the locum tenens industry is booming. During 2023, locums is the only healthcare sector projected to increase revenue. In fact, it’s estimated to generate a whopping $4.7 billion in revenue, for a 7% year-over-year increase. Whew. Such a hot industry deserves its own spotlight to give you ALL the nitty gritty.
Cue our No-BS Guide.
Sometimes doctors and nurses leave their employers. Maybe a significant other took a job elsewhere, or a family situation demands their full attention. Or perhaps the internal politics proved untenable.
Let’s face it. To succeed in any business today — especially in healthcare — you need a “Plan B.”
Enter locum tenens.
Yeah, Yeah. We get it. No hospital or healthcare facility wants to acknowledge using “temp” clinicians. But how many patients, many of whom are using paid time off (PTO) to see a doctor, would prefer to reschedule or go elsewhere if their designated doc is unavailable for some reason unforeseen when the appointment was made?
‘Care continuation’ is one of the sometimes-life-and-death reasons the locum tenens industry evolved in the first place. Locum tenens clinicians are willing to be there for patients when staff or routinely contracted providers can’t or won’t.
For that — and for other considerations such as their willingness to put their private lives on hold, or to travel across the country, risking their health, during a pandemic — they generally get paid better on an hourly basis than their permanently employed counterparts. However, locum tenens doctors are “free agents” placed there for a certain number of days, weeks or months — and usually without health insurance or other benefits included with most full-time, staff positions.
Of course, not every assignment is a bowl of cherries, nor is every clinician perfectly matched to every assignment. Also, sometimes even the best-laid plans get changed at the last minute. That’s why flexibility is both a benefit and a requirement for working “locums.”
With that said, let’s break down the bare essentials of locum tenens medical practice.
In Part 1 of Locumpedia’s No-BS Guide to Locum Tenens, we’ll cover:
Section 1: So what is "locum tenens"?
“Locum tenens” is a fancy Latin name for a “temporary physician.” The Latin term literally means “a place (“locum”) holder” (“tenens”). Roughly 6% of US physicians — or about 52,000 of them — chose to work this way. And 88% of health care facility managers report utilizing locum tenens providers, up 4% in the last year.
Locums help reduce staffing gaps during vacations and sudden medical leave. They also ease the burden during staff turnover and seamlessly maintain the facility’s patient census until the facility can find a permanent physician.
But working locum tenens doesn’t just help the facility. A whopping 90% of locum tenens providers enjoy working locum assignments as much or more than permanent practice. We like those numbers.
Bottom line: Over the last few decades, practicing locum tenens has become more popular due to healthcare industry challenges like:
- Physician burnout rates skyrocketing to 63%. Thankfully, locum providers assuage attrition by providing a needed respite for existing hospital staff.
- Rural communities struggling to recruit new providers and provide enough care due to geographic challenges. The flexibility of locum tenens has helped attract doctors to deliver essential care without requiring relocation.
- The administrative burden encroaching on physicians’ precious time with patients. Physicians have recognized locums’ benefits, including the ability to explore the country, receive a pay boost, and gain exposure to different practice environments. This can improve the well-being of the overall physician workforce.
Section 2: How Does Locum Tenens Work?
“Locum tenens” is a fancy Latin name for a “temporary physician.” The Latin term means “a place (“locum”) holder” (“tenens”). Working locum tenens is not new, but the trend of physicians working locum tenens is on the rise. Approximately 7%, or 50,000 physicians, have worked at least one locum tenens assignment in the past year.
Locum tenens staffing agencies are the middleman for providers. They get paid a percentage of the assignment’s agreed-upon cost by a healthcare facility for identifying, communicating with, vetting, contracting with, delivering, and compensating the physician for each facility as efficiently as possible.
For the fee it earns (which is generous — more on that later), the staffing agency serves as a one-stop-shop for the client facility. Agencies assist in a facility’s credentialing process and arrange the physician’s assignment-related transportation, housing, and professional liability coverage (PLI, or medical malpractice insurance).
The bottom line for the doctor: a locum tenens assignment is pretty much like “temping” or contracting your services to employers in other fields. Of course, extensive education, multiple licenses, and rigorous screening make things just a bit more complicated.
Put more optimistically, it’s a way for a physician — or an advanced healthcare practitioner like a physician’s assistant, nurse practitioner, or a certified registered nurse anesthetist (CRNA) — to make good money without committing to a facility long-term, creating financial entanglements, or paying for her/his medical malpractice insurance.
For those less materially motivated, locum tenens doctors provide care for an estimated 7.5 million Americans every year, many of which live in rural America. The patient-to-primary care physician ratio in rural areas is just under 40 physicians per 100,000 people, compared to about 53 physicians per 100,000 in urban areas. The impact locum tenens physicians make on the health of the rural population can be pretty gratifying — and lucrative, at least for the right doctor in the right place at the right time.
Section 3: Why Work Locum Tenens?
Let’s provide some typical answers in the form of a rapid-fire list of questions. Ready?
- 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 and high expectations)?
- 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 change of pace to re-energize — or a reason to ‘get outta Dodge?’
- 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.
- More realistically for those with “family ties,” is your significant other ‘sick and tired’ of your coming home complaining about what some patient or administrative jerk did to disrupt your day?
If you can identify with any of the scenarios above, 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?
For the sake of time, we’ll give you five solid reasons. (But there’s plenty more. Promise.):
1. Travel
Locum tenens allows you to experience a new place without commitment. Not sure if you’ll like Colorado? That’s OK. Work a few shifts, hike a few mountains, and make your decision later.
Throughout the course of a provider’s locum tenens career, there could be opportunities to travel to communities in all four corners of the US. But those opportunities aren’t just limited to the states – a US medical license can get a provider’s foot in the door to work in places like Australia, New Zealand, and many other far-flung international destinations.
Locum tenens allows you to experience a new place without commitment. Not sure if you’ll like Colorado? That’s OK. Work a few shifts, hike a few mountains, and make your decision later.
CompHealth shared a story from pulmonologist, Dr. Thomas O’Mara, about a locum tenens assignment in Boise, Idaho, early on in the COVID-19 pandemic. Dr. O’Mara says that none of the doctors knew what to expect.
Dr. O’Mara was surprised to find the expected wave of coronavirus patients didn’t happen at St. Luke’s in Boise. He said it wasn’t quite what he had expected to see from what he had heard on the news. Although he’d agreed to a schedule of two weeks on, and one week off, during which he could return home to New York, he and his wife decided it was probably best to just stay put during the “off” weeks to play it safe. That meant he was able to fill in when another scheduled locums physician couldn’t get to Boise.
He noted that, although there has been a learning curve in dealing with COVID-19, he and his colleagues had become much wiser and more efficient in their approach to treating coronavirus patients over time.
Ultimately, his performance during the assignment led the hospital to offer him a full-time position — one that allowed him the flexibility to work what’s considered a full-time job without uprooting his entire family.
Of course, not all locum tenens assignments result in full-time employment, but you can still collect plenty of positive experiences.
International Travel
Dr. John Gallehr shared a story from his second extended-stay locum tenens assignment in New Zealand with his family. He told the story of his most memorable day. His three teenage sons woke him up early to surf in the South Pacific Ocean. After having a little taste of tropical paradise, the boys jumped into Dr. Gallehr’s car and the four of them drove to a local ski resort where they found 10 feet of snow.
He said it “felt like a fairy tale” to live in one of the world’s most beautiful locations. And locum tenens allowed him to have that experience with his family – having amazing adventures and maintaining a busy schedule without the stress of full-time practice obligations.
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 they might want to work permanently.
Working locum tenens lets providers work in a wide variety of places and practices — urban, rural, big, small, you name it! That gives you the chance to become more well-rounded and learn which kind of practice best suits your preferences.
If you’re just starting your locums journey, you can gain valuable experience, which makes you a prime candidate to slide straight into a full-time role.
Reality Check
However, the desire to test-drive locum tenens might not be the best reason to take the assignment. There’s a 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.
Agencies refer to this as a “permanent-recruitment fee” or a conversion fee. It’s essentially in place to cover lost revenue when a viable locums resource is lost.
It’s meant to be a deterrent in most cases because fees can cost $40,000 or more, depending on the specialty and other factors. Without this as a “deterrent,” it might even be cheaper to hire a locum provider instead of paying the fee.
Countering that argument, Tim Hand, CEO of Interim Physicians, LLC, promotes and justifies the 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 two different physician mindsets when it comes to accepting a full-time position with a facility versus working locum tenens for them,” says Hand. “Physicians working locum tenens don’t want to feel pressured into accepting any position as a precondition of helping out a facility in a time of need.”
As proof of that, he discloses that less than 1% of Interim Physicians’ $37+ million in revenue is attributable to 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
Locum tenens compensation is comparable to the norm for a full-time position in the assignment’s location, but the clinician often makes a higher hourly or daily rate than their on-staff colleagues. Some physicians willing to take locum tenens assignments can make between $90 and $300 hourly, depending on factors like specialty demand and the assignment’s location.
Physician Validation
Dr. Vlad Dzhashi, The LocumTenensGuy, a hospitalist who quit his full-time job and started working locum tenens in 2014, says that with 15 shifts a month on average, providers “can make as little as $280K/year with $130/hr, or as much as $430K/year at $200/hr.”
Ditch the Debt
Speaking of income as a motivator for locum tenens work, locum tenens is a great way to achieve a financial edge. Namely, zapping your student loans.
Simply put: Locum tenens pays better than a permanent job and can pay even more for someone fresh out of residency.
If you focus all of your energy on making extra payments on your loans (without the later-in-life commitments of a home or children), then you could easily pay off your loans a few years after graduation. Now THAT’S a critical financial edge.
Even if you’re currently practicing medicine full-time, locums can still fit into your schedule. During a week of vacation, you could choose to work a temporary assignment. Or, you can moonlight at a nearby facility.
If you have specific debt you’re trying to tackle, or a vacation you’re saving for, adding a week or two of locums work allows you to reach these goals faster.
Case in point: in this “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.
4. Flexibility
When working on a temporary assignment, the time a provider chooses to take off between assignments is entirely up to them. There’s also flexibility on the length of the assignment, such as a 6-month minimum with the potential to extend to one year.
Locums docs can choose to work as little or as much as they like and can work in large metropolitan areas or secluded mountain towns.
Remember the days as a young child, when the final school bell would ring on that May afternoon signaling the start of summer? Take yourself back to the glory days and enjoy summers off if you want — make each locums experience exactly what you want it to be.
Note: Healthcare employers’ compensation packages generally include the option of employer-subsidized health insurance, a benefit locum tenens work doesn’t provide.
Flexibility = Time Mastery
Dr. Dzhashi notes that flexibility is the main reason he chose to practice locum tenens.
He loved making his schedule fit in with the lifestyle he wanted. “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,” he says. “I know I can do it without asking anyone’s permission – this is the greatest thing of all!”
A permanent hospitalist schedule offers greater flexibility and perceived time off than, say, doing outpatient work. But locum tenens takes it to a whole new level and makes each provider the “master of [their] time.”
Providers can work around their children’s school breaks, schedule fewer shifts around the holidays, and take as much time off as they desire. Scan locum tenens agency websites and you’ll find dozens of similar stories.
Weatherby Locums highlighted a gastroenterologist who, after closing a 26-year practice, decided to hit the road with locum tenens. Dr. Robert Brenner was able to consolidate as much work as possible into 20 days and then head home for the remainder of the month because his priority was to make as much as quickly as he could and still have time at home with his 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” with “gaining more contacts and experience.” And it’s true. Each facility that you work in offers new networking opportunities.
The primary goal of a physician is to see patients, but one of the many advantages is working for a practice or hospital you may not otherwise ever get the chance to work with. By working in locum tenens, providers get all kinds of exposure to colleagues with different backgrounds and specialties.
5. Avoid Admin Work
Butticè adds a fifth reason for working locum tenens: “avoiding administrative work.” The non-clinical aspect of medical practice can make patient engagement at a healthcare facility low.
But when providers work locums, they don’t have to worry about the day-to-day business side of healthcare, just treatment. Imagine a day when you don’t have to worry about those pesky administrative meetings. What would that day look like? Pretty sweet, right?
Locum tenens physicians can concentrate exclusively on caring for patients and get back to practicing medicine for the love of the game. The only job you’ll have as a locum tenens physician is to accept the assignment, show up to work, and treat your patients to the best of your ability.
Section 4: What Are the Disadvantages of Locum Tenens for Physicians?
This wouldn’t be a “no-BS” guide if we didn’t address the “cons” of working locum tenens as well as the “pros.”
Locum tenens opportunities can sound ideal when you consider patient care, flexibility, and higher pay. But it’s not always sunshine and rainbows.
1. Lack of Stability
The same opportunity that affords you the luxury of flexibility also comes with a lack of stability. In a locum tenens role, you will not always have work lined up, and you may have to wait months for credentialing to be finalized.
You also miss consistency moving from place to place as a locum tenens worker. Since each locums provider is a temporary contract worker in the healthcare industry, you are only committed to a specific healthcare facility for a set time. Each provider has to constantly adapt to different organizations’ systems and infrastructures.
2. Lack of Benefits
This is one of the biggest downsides of locum tenens practice: Great pay, but no benefits. Unless you can access health insurance (and possibly other benefits) through a spouse or partner’s employer-subsidized plan, you’re on your own for health, dental, vision, and life insurance.
Unless you can access health insurance (and possibly other benefits) through a spouse or partner’s employer-subsidized plan, you’re on your own for health, dental, vision, and life insurance.
It can be a bit of a challenge, but you are also making a much higher salary in this situation than you would normally under a contract. Benefits should not be the main thing that keeps you away from locums. It takes a bit of research, but it is possible to get a plan that works for you and saves you a bit of money, too.
As a locum tenens clinician, you won’t have access to group life or disability insurance plans through your job — although some locum tenens firms can recommend affiliate companies through which you can get this coverage.
3. Does Not Count Towards PSLF Qualification
If you’re a provider with federal loans and want to qualify for Public Service Loan Forgiveness through the PSLF Program, locums work (or any 1099 job) doesn’t qualify. Only full-time W2 workers can have payments to count towards PSLF.
It might be a stumbling block for providers, but it’s also possible that not ALL of your loans would be eligible anyway. Plus, there’s still a surplus of income that comes along with the locums contract, and the extra income can help pay off debts faster.
According to the Consumer Financial Protection Bureau, the PSLF program helps you manage student loan debt while you pursue a career in public service. It’s available to employees working in all levels of government, school districts, public hospitals, nonprofit organizations and more.
The PSLF Program would forgive any remaining balance on federal direct loans after a provider makes 120 qualifying monthly payments while working under a qualifying plan full-time for a qualifying employer in the field of public service.
Don’t let this become a locum tenens obstacle, though. The 120 loan payments threshold isn’t based on consecutive payments, but cumulative payments and they don’t have to be made exactly 10 years in a row. Also, there are federal PAYE or REPAYE student loan repayment plans that can help you even if you are working as a 1099 employee.
4. Lack of Long-Term Commitment
You’re just a short-timer when you choose to work locum tenens, and being a transitory figure can be challenging, especially if you’re used to being in an authority role in your previous facility.
Because you are not committed for the long haul, your input may not be sought or taken seriously, so that requires you to adapt to the local facility’s culture. Lacking that long-term commitment can be hard. Socially, the fact that you’re only a temporary employee may leave you excluded from work parties or other gatherings for permanent staff.
So, if the continuity of patient care and long-term colleague relationships are important to you, then you may wish to pause before signing the proverbial dotted line.
5. The Locums Agency Will Receive a Cut Of Your Pay (Sort Of)
Most locum tenens doctors work through a staffing agency, and the agency takes a cut.
Although agency fees can seem exorbitant at an individual level, locum tenens agencies are operating a full-time business, paying for a provider’s medical malpractice insurance (where one bad outcome/payout could imperil an agency’s survival) and guaranteeing the provider their pay rate, even though there is no guarantee that the facility/practice will pay them.
The staffing agency also pays their own internal staff’s full-time wages every day to search for and arrange the provider’s next assignment.
6. The Application and Credentialing Process Can Be Exhausting
The credentialing process can slow down any locum tenens assignment–even when agencies market themselves as one of the faster agencies in regards to credentialing, that can still take weeks or months.
Credentialing and licensing are even more difficult if a physician plans to accept locum assignments outside the state where they reside. That’s where The Interstate Medical Licensure Compact Commission (IMLC) comes in. The IMLC was created to help locum tenens providers complete the physician licensing process for participating states in a matter of days or weeks instead of months.
But not all states are covered by the IMLC, which can be frustrating for locum tenens providers looking to practice in a particular location.
7. Your Home Life Will be Impacted
Locum tenens assignments are contracted for varying periods, so if you have chosen to travel for work, but you have a family at home, it creates an added layer of difficulty being away from them.
For many people who chose locum tenens opportunities, it can be “a way to explore the country,” but a lot of that exploration can be done on your own. That’s something to consider if you have a partner, kids, or fur babies at home waiting on you.
Speaking of your family and fur babies, they’ll have to make some sacrifices. Are they prepared for you to leave for extended periods? Are YOU prepared to leave THEM?
FaceTime is a beautiful thing. But it’s still important to consider the impact of distance on your relationship. In addition to the emotional toll, you have to consider expenses. Do you have to set up additional childcare or pet care? And does that negate the potential financial benefit of practicing locums? Only you can decide.
