Our Locumstory Advisory Board physicians, Dr. Trevor Cabrera, Dr. Nicholas Kusnezov, Dr. Marye McCroskey, and Dr. Rip Patel, discuss what they’ve found are the differences between locum tenens jobs and permanent positions.
Locum tenens providers work at healthcare facilities on a part-time or temporary basis to help fill gaps in coverage. Locums can be a great way for providers to gain clinical experience in new and varied environments, transition to retirement, supplement a full-time position, or still earn an income between permanent positions.
So, locums vs. permanent: How do the two compare? The expert locum tenens physicians on the Locumstory Advisory Board weigh in on the pros, cons, and considerations of each.
Scheduling flexibility and versatility: How locum and perm jobs compare
One of the biggest distinctions between locums and a permanent position is the schedule. Many providers are drawn to locums for the flexibility it affords.
“Having come from private practice, while I could set my own schedule and take off when I needed, there really is no out when you’re in private practice,” says Dr. Marye McCroskey. “With locums assignments, you know when they’re going to be done, and you can guarantee a little bit of time off after an assignment if you want it. You’re not so stuck in the grind. The burnout rate can be especially high in family medicine, and I think that contributes to my desire to do locums.”
Emergency medicine physician Dr. Rip Patel says for him, the biggest difference between locums and perm jobs is schedule flexibility. “On the permanent side, you are guaranteed time, but then you’re sort of at the mercy of the scheduler. I think that’s pretty painful to have somebody make my schedule and then try to work my personal life around that.”
These seasoned locums acknowledge that flexibility and versatility come at the cost of predictability, however.
“The downside to locums is there are no guarantees,” says Dr. Patel.
“In a hospital setting, you have a guaranteed salary. With locums, you have the versatility and the ability to set your own schedule to whatever you want, though it may be at the expense of regular income,” says orthopedic surgeon Dr. Nicholas Kusnezov. “Also, sometimes locums gigs evaporate. Things can change even a week or two out. Locums can definitely be more versatile, but a little less predictable until you have your foot in the door.”
How the administrative responsibilities differ between perm and locum jobs
Another major consideration is the administrative responsibility associated with permanent vs. locum positions. Many locum doctors appreciate the reduced administrative burden that comes with being a temporary employee — including fewer meetings, less billing paperwork, and agency support with credentialing and licensing.
“As a locum provider, you can avoid staff meetings, board of director meetings, chief of staff meetings, and team meetings, and have more time for patient care,” says Dr. McCroskey. “I still go to meetings that deal with patient care, which I don’t mind. But in private practice, we had board meetings and HR issues — hiring and firing — that sort of thing. We don’t have to do any of that in locum assignments.”
“Documentation for patient care is still a focus, but I find I don’t have to go through the same process with billings as a locums provider,” says pediatrician Dr. Trevor Cabrera. “I feel absolved of or outside the concern for productivity and relative value units (RVUs), so I don’t feel that need to grind out every single detail.”
“When you’re in private practice, you get paid by what you bill, and so you’ve got to make sure that you capture everything,” says Dr. McCroskey.
While credentialing and licensing have the potential to be a higher, experienced locum providers say more frequent demand with locums assignments is a major benefit of working with a locums agency and having support in the credentialing and licensing process.
“As a locums provider, credentialing and licensing are a lot more expedited when other people are doing it for you,” says Dr. Cabrera. “The nice thing about locums agencies is they can keep an essential repository of all your documents that you need to get credentialed at different hospitals and they can shotgun you out if there is another job in another state.”
How taxes and benefits work for locum tenens
Locum tenens taxes and benefits — such as health insurance and retirement plans — are other key areas where locum tenens differs from permanent positions.
Full-time physicians are typically classified as W-2 employees, and taxes are taken out of their paychecks automatically by their employer.
Locum tenens providers, on the other hand, are classified as independent contractors and will likely receive a 1099 form to report their income. Unlike permanent providers who are subject to multiple taxes, independent contractors are subject only to self-employment tax but are required to pay quarterly estimated taxes. It’s important to understand your tax obligation as an independent contractor.
“If you’ve never been an independent contractor, you’ve never been an independent contractor. I don’t think it’s hard to do, but sometimes it’s a learning curve for people,” says Dr. Cabrera. “Getting a good CPA is key. Working with a CPA, you can navigate your payments and you can also find great retirement options as an independent contractor.”
Locum physicians will also be responsible for securing their health insurance and other benefits, whereas full-time physicians will often have access to these benefits through their employers. Physicians who work locums part-time to supplement full-time work may be eligible for health insurance through their employed position.
“Comparing a permanent position to locum practice, I think really the main difference is the health insurance, which is something that arguably you can get better independently, depending on the job. Sometimes it’s better to go out and seek your own,” says Dr. Kusnezov.
Recommendations for integrating into new teams and facilities
The need to integrate into new teams, facilities, and workplace cultures is an aspect of professional life that locums are more likely to encounter with greater frequency than permanent providers. While locum providers generally report feeling welcomed and appreciated when they help cover facilities’ gaps in coverage, some also share a sense of being easily replaced.
“Whenever you start somewhere new, there can be the feeling of being on deck. The staff is very much watching you and they can be vocal about not wanting you back if something happens,” says Dr. Patel. “I think it’s crucial to remember that you’re walking into a new scenario. You have to go in, show your competence, and get with their flow.”
Dr. Patel recommends taking the time to meet everyone, learn the commonalities, and give a little, take a little while you settle in. “I can see how starting out and saying, ‘This is my ship; I’m running it’ is going to lead to a lot of problems. You have to be savvy about it as a locums versus being in a permanent position, but ultimately I think it makes you better because you know you’re ‘on’ and they’re looking at your work.”
“When you’re in training or in a long-term full-time position, you’re learning a very specific way and may not realize that people practice differently in other places,” says Dr. Cabrera. “Especially among new providers, they may walk in with new guidelines or new practices that — even if correct — aren’t yet standard for that facility. It’s important to remember that what they are doing isn’t wrong; it may just be different from what you’re used to. It takes some time to understand there’s not only one way.”
Locum tenens: More opportunities to travel and try out different locations and settings
Unsurprisingly, a major difference between locum tenens and a permanent position is the ability to travel. While locum assignments are often available close to home, many locum providers pursue the opportunity to travel to new locations and facilities. Travel is an important consideration when comparing locums and employed positions.
“I think the main thing for me is whether you’re comfortable with being a bit nomadic if you choose assignments away from home,” says Dr. McCroskey. “I have thoroughly enjoyed it, but 20 years ago I probably wouldn’t have. I think the flipside is needing to be okay with not having a permanent home base.”
Dr. Cabrera shares that he enjoys the traveling aspect of locums. “But it’s the difference between being stationed somewhere and having a foothold versus moving from place to place and having a little less consistency,” says Dr. Cabrera. “Being nomadic has also afforded me the opportunity to set my price and then find a job offer that meets what I’m looking for.”