Physicians finishing their training may want to consider locum tenens as a career option right out of residency. Locums allows you to experience a wide variety of work settings, have more control over your work schedule, and earn higher pay than your peers just starting.
Why some residents choose locum tenens jobs instead of perm jobs
That’s the career path pediatrician Dr. Trevor Cabrera chose. “Because I chose to work locum tenens, the path less traveled by residents, I was able to broaden my clinical experience, discover flexibility in the way I practice medicine, gain insight into how the healthcare system works, learn the value of humility, and with the great compensation, I had more control over my finances.”
Physiatrist Dr. Mojgan Saber chose the same route. She spent the first eight years of her career in locums after residency. She preferred locums assignments that allowed her to do what she loved most — teaching med students and residents. When she decided to settle down and accept her current job, having locums experience on her CV worked in her favor. “Locums actually helped me at every level.”
What was true for her, she recognizes, may be true for some of the residents she teaches. “If you’re not sure where you want to practice or what kind of practice you want — or if, like me, you want to travel, locums is the best way to go.”
1. Do your due diligence
As a resident, Dr. Saber says she was ignorant about locum tenens. She spent several months post-residency traveling recreationally and was running out of money when a friend told her, “If you really need to work right away, locums is a good way to do it.” She did some research and quickly landed her first locums job in Miami.
For her, due diligence means learning all you can about locums, getting on the phone, calling locums companies, and peppering them with questions. This way, you have the information you need to make informed decisions.
Orthopedic surgeon Dr. Nicholas Kusnezov says one thing he wished he knew as a locum right out of residency was to research what you’re worth before you take assignments. “Coming out of residency, any amount of compensation seems incredible, given the paltry amount you were paid for the colossal amount of work you did during your training. However, you should realize that your time as a trained and skilled professional is worth a certain amount of money, the threshold below which you shouldn’t waste your time.”
Could international locums work for me? 6 reasons to work international locum tenens out of residency (Global Medical Staffing)
2. Get the ball rolling early
Dr. Saber recommends residents to start early if they are interested in locum tenens. “Start early if you’re interested in locums,” she says. “You have to fill out an application and give them your references, and those take time. Locums companies have been great in helping with the process of licensing and privileging.”
Another Weatherby Healthcare manager, John Hunter Jr. of the hospitalist team, recommends starting a discussion with a locums company as early as nine months before you finish your residency.
“Talk with a search consultant as early as September or October,” he says. “That way, you can get an idea of where you want to begin getting your licenses, which really helps your marketability.” Having two licenses increases marketability, as does getting your DEA license set up. The right locums company can help you navigate the required processes, gather paperwork for licensing and credentialing, and meet the specified timelines.
3. Inform yourself on how taxes and benefits work for locum doctors
Locum tenens physicians are considered independent contractors. Rather than automatically deducting their taxes each paycheck, they receive a 1099 and must pay quarterly estimated tax payments.
“Understanding the logistics of working as a locum was one thing, but understanding the tax implications of locum tenens was another,” says trauma/critical care surgeon Dr. Nii Darko.
“Keep in mind that each individual’s situation is unique,” says Dr. Darko. “Be sure to consult with a qualified tax professional to find out how best to use these tax benefits for your particular situation. Ten years into working as an independent contractor, I’ve learned that the tax benefits can be pretty significant.”
Even though taxes as an independent contractor take more work, most locum doctors choose to have an accountant handle it all. As a bonus, locum physicians can write off many business expenses, such as home office, business travel, meals, and Continuing Medical Education (CME).
Another thing to keep in mind is you’ll need to secure your health insurance. However, Dr. Kusnezov and Dr. Cabrera say insurance is available through the Health Insurance Marketplace, and in some cases, they say the premiums are less expensive than work-provided insurance. This can also be a tax-deductible expense.
4. Tap into recruiter expertise throughout residency
An enterprising resident might consider reaching out to a locums recruiter as early as PGY-2 to access the wealth of information that is available free of charge.
For instance, Hunter advises IM residents interested in locums to ensure they have enough ICU experience documented during residency. “Eight-five to 90% of our jobs require ICU experience,” he says. “An added benefit is experience doing procedures like lumbar puncture, central lines, or arterial lines. That puts you at the top when it comes to marketability.”
Brian McCormick, a pediatrics team manager for the locum tenens agency Weatherby Healthcare, tells his pediatricians-in-the-making to focus on getting experience in inpatient care, nursery care, C-sections, and delivery attendance. “The biggest thing is generalization. The more rural we get with a locums job, the more comfortable they will need to be across all those skills,” he says. “I encourage them to get additional NICU rotations. A doctor with a couple of NICU rotations and is comfortable with circumcisions wouldn’t have any issues finding locums jobs.”
Recruiting experts exist for locum physicians in every specialty. Talking with a recruiter early will help you understand what skills and experience hospitals are looking for so you can be more competitive right out of residency.
5. Have the right expectations about locum tenens jobs
Many residents seeking locums opportunities may learn that their dream location doesn’t have locum tenens needs in their specialty.
For hospitalists, Hunter says, “We don’t really get the LAs, the San Diegos, or Houstons. Although we’ve had jobs in New York City and Chicago, a lot of our placements are rural areas or midsize cities, many in the Midwest.”
Physicians open to assignments in various locations are easier to place, says McCormick, who also recommends they be flexible in schedule and work setting expectations. “Honestly, the biggest hurdle is a fixed mindset around how things are supposed to go,” he says. “So I challenge them to be open-minded.”
Hunter agrees. A new doctor looking for night shifts must be aware that new hospitalists are usually assigned day shifts because there would be other hospitalists alongside you. “Most night or solo jobs usually seek somebody with more experience.”
Something else to keep in mind as well, Dr. Kusnezov says, is that you have fewer backups and contingencies than you had in training. “To be successful and avoid disaster, you should remain versatile and expect the unexpected.”
Pros and cons: Working locum tenens right out of residency
Be bold and try something different — consider locums after residency
Finally, Hunter points out how liberating locum tenens out of residency can be. “Residents don’t need to be as hesitant as they would be pursuing a permanent job. Residents can push past what feels like a risk by remembering they have a 30-day-out if the assignment is not right for them.”
That’s been Dr. Saber’s outlook from the start, and she still does locums when she has a few spare weeks of vacation. “I always truly enjoyed everywhere I worked,” she says. “But I figured it’s not permanent. When I go somewhere, the worst is they don’t like me. Or I’m not enjoying working there. After a few months, we’re done. Lucky for me, that never happened.”
Dr. Cabrera, who worked locum tenens exclusively until his fellowship, couldn’t be happier with his choice. “By working locum tenens straight out of residency, I have pushed off to a great start of becoming a better doctor. I’m gaining experience and perspective on how my role as a pediatrician fits into a greater scheme of overall health across a lifetime.”
