The No-BS Guide to Locum Tenens & How it Works - Locumpedia (2023)

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.”

As super-human as many of them become in years like 2020, doctors and nurses sometimes leave their employers for whatever reason. 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:

• What locum tenens medical practice is
• How this 40-something-year-old way of practicing works
• Why, at various stages of your career, you might want to consider it
• The disadvantages of 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 in 2019, according to StaffCare’s“2020 Survey Of Temporary Physician Staffing Trends,”published in January 2020.

That survey also “indicates that 85% of hospitals, medical groups, and other healthcare facilities used locum tenens doctors in 2019, primarily to maintain services until permanent physicians are found and to fill gaps caused by turnover.”

Granted, this is a fairly high percentage of healthcare outlets. (Considering the COVID-19 pandemic of 2020, it might have been higher if the question had been asked a year later.) However, it’s lower by about 9% than what was reported from2016 survey responses(94%), but noticeably higher than the 74% indicated in 2012.

Bottom line: Practicing locum tenens has become more widely accepted over the past decade or two for reasons like:

• Even healthcare organizations struggling financially in the aftermath of COVID-19 still have patients to care for.
• In today’s fast-paced world, only the nimble survive. Locum tenens offers both physicians and facilities a way to become more agile.
• The “new normal,” ushered in by a worldwide pandemic, proved that medical professionals will answer the call for help, even at inopportune times or inconvenient places. Sometimes locum tenens implies a calling higher than just “holding a place.”

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In other words, the locum tenens staffing agency is the “middle man,” who gets 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 that facility as efficiently as possible.

For the fee it earns (which seems generous — let’s be honest, but more on that later), the staffing agency serves as a one-stop-shop for the client facility, assisting heavily in the facility’s credentialing process and arranging the physician’s assignment-related transportation, housing and professional liability coverage (PLI, or medical malpractice insurance).

Bottom line for the doctor (or reasonable facsimile thereof): it’s pretty much like “temping” or contracting your services to employers in other fields.

HOWEVER, because of associated hurdles — like:

• Proving you spent a decade of your life getting educated and trained,
• Becoming licensed in each state or territory in which you want to provide services, and
• Validating your competence to hold other people’s health in your hands

— the path from signup to service point is 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 own medical malpractice insurance.

For those less-materially motivated, industry lore has it that locum tenens providers enable some 20 million people a year to see a doctor, especially those living in rural America. And that can be pretty gratifying — and lucrative, at least for the right doctor in the right place at the right time.

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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?

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

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.”

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 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 have 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 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 quite a number of positive stories.

International Travel

Posting less than a year ago onKevin 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 ofBest Locum Tenens, LLC, cautions against selling the ‘test-drive’ benefit of locum tenens. In a March 22, 2020, blog post onKevinMD.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, Tim Hand, CEO ofInterim 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 points to the fact that less than 1% of Interim Physicians’ $37+ million in revenue is attributable to conversion fees.

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,CompHealthindicates physicians willing to take locum tenens assignments can make between $90 and $300 hourly, depending on specialty demand, the assignment’s location and other factors.

Physician TycoonCatherine 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’sblogand podcast: ‘The Guy’ offers “real-life numbers” and, more recently,coachingto help prevent his fellow docs from making the same mistakes he did when he quit his full-time job and started ‘the locums life.’

Ditch the Debt

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 locums 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.”

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

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 thelocum tenens agencywebsites and you’ll find dozens of similar stories.

On September 11, 2020,Weatherby Locumshighlighted 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

Inhislist of reasonsfor 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 TycoonCarroll 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.”

Butticèadds 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.”

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This wouldn’t be a “no-BS” guide if we didn’t address the “cons” of working locum tenens as well as the “pros.”

“As idyllic as all of the patient care, flexibility, and higher pay may sound, working locum tenens isn’t rainbows and unicorns every day,”Physician Tycoon Carroll writes. “Like any professional setting, there are multiple challenges. The question becomes whether or not these potential drawbacks outweigh the benefits of this type of work.”

In fact, in a July 23, 2018, blog post titled, “Locum Tenens Work: What Is It and Is It Right For Me?” Carroll lists one moredisadvantage than she lists advantages. Here’s her list:

1. Lack of Stability

“This same type of work which offers you amazing flexibility also comes with a lack of stability,” Carroll says. “You won’t always have work lined up. You could end up waiting months for your credentialing to be finalized. The hospital that hired you may decide to extend an offer to another physician on a full-time basis and suddenly cancel your contract.”

Carroll notes that while it doesn’t happen often, you should be aware that last-minute changes do happen. “Working at multiple sites can minimize the possibility of being out of work for any significant period of time,” she suggests.

PoF Dahleen employs the analogy of “the tablecloth trick, the one where you pull the tablecloth out really fast, and the dishes all stay put” to share the story of the first time a late-breaking event affected his well-laid locum tenens planshere.

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.

On this subject, PoF Dahleen shares, “When you consider the fact that I did [locum tenens] for two years and put a lot of hours in, I probably earned a couple hundred thousand dollars for those agencies. It’s no wonder they don’t stop e-mailing, calling, and even texting. Landing one doc for an assignment of several months’ duration can be worth tens of thousands of dollars to the agency.”

It is extremely important to realize that, while agency fees can seem exorbitant at an individual level, locum tenens agencies are operating a full-time business, paying for medical malpractice insurance (where one bad outcome/payout could imperil an agency’s very survival) and guaranteeing the provider their pay rate, even though there is no guarantee that the facility/practice will pay them. And they are paying their own internal staff’s full-time wages every day to search and arrange for the next assignment the provider may take.

6. The Application and Credentialing Process Can Be Exhausting

“There’s a reason it takes time to start working locums, and that’s because the credentialing process takes quite a bit of time. Credentialing is a major factor,” Carroll says. She adds that even when agencies tout ‘fast credentialing,’ the process can take “several weeks to months. The further along you are in your career and the more places you’ve worked, the longer the process will take.” Carroll suggests you expect an even longer credentialing process if you’ve been involved in any type of malpractice lawsuit.

“You’ll need to keep a detailed file of your credentialing documents,” she advises. (Notice staying organized seems to be a theme of succeeding in locum tenens medical practice.)

7. Your Home Life Will be Impacted

“While you’re living out of your suitcase, your family back home will have to adjust to life without you for extended periods. Is your family also prepared to take on the sacrifice?” Carroll asks. She suggests this could mean extra work for your partner or other household members.

“If you have kids or fur babies, they do miss you while you’re gone. FaceTime can help, but there’s no getting around the fact that you will be away from your loved ones.” She points out that beyond the potential relationship damage, paying for childcare or pet care “will eat into your proceeds from locums work.”

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