Being a locum tenens physician means working temporarily as an independent contractor for a hospital or medical facility. This means you’ll be signing a locum tenens contract, an agreement between you and the facility directly or between you and the locums staffing agency that helped you find that assignment. The latter details what you can expect from your relationship with the agency (like coverage of housing, travel, and other expenses) and what they expect from you.
Understanding the basics of a locum tenens agreement
A locum tenens agreement, simply put, is made up of your promise of service to a hospital or medical facility, alongside their promises to you about what your job will be, how much the assignment will pay, for how long, and under which circumstances you or the healthcare facility can terminate the agreement. Of course, there are many other nitty-gritty details, and it’s not a one-step process. So let’s break it down.
Assignment length and provisions for physicians
The length of your agreement should align with the length of your potential assignment, and following that, the agreement spells out what it covers during that time. These are the physician provisions, including what travel, transportation, and housing expenses are covered. Medical staffing agencies often also cover malpractice insurance, and the terms about this will be listed in your agreement, too. This is also where the agency will spell out how payroll for your assignment will work.
Conditions for physicians
Following this, physician conditions are pretty straightforward. The main expectations are generally that you’ll provide accurate and up-to-date information to agencies to help them get your application through the credentialing process legally and as easily as possible. After that, agencies also expect you to agree to finish your assignment.
Know the legal lingo:
What we’ve just covered may also be called your “Rights and Responsibilities” in your agreement.
Contract limitations and terminations
A non-compete agreement is a critical limitation in a deal with your medical staffing agency. This is an agreement not to accept permanent or temporary positions directly with the hospital or facility you’re contracting for unless that entity pays a recruitment fee to the agency.
When it comes to the possibility that you or your agency may need to end a contract early, your agreement should outline what this looks like for both parties. For employers, contracts can be terminated if a physician has not met agreed-upon conditions, if their licensure is interrupted, or if they are disciplined while on assignment, among other causes. For physicians, this means that if life happens, many agreements can be terminated with 30 days’ notice, and if it's for health reasons, no notice is required.
Know the legal lingo:
An emergency that forces an early termination without notice may be referred to in your agreement as “Force Majeure,” or emergencies.
Negotiate like a pro: Mastering contract negotiations (podcast)
Accepting your agreement and reviewing your confirmation letter
“The assignment confirmation, I would say, brings the contract to life,” says Natalie Ligett of Weatherby Healthcare. Once you’ve accepted an assignment with an agency, they’ll let the hospital or facility you’re working with know you’re good to go. At that point, you’ll receive your confirmation letter from the hospital or facility—the facility will also receive its own copy from the agency, which functions as a work order for them. The letter outlines the specifics of the assignment, including pay rates, start and end dates, and worksite information.
The letter also outlines what protections are available to you as a physician. These can include guaranteed payment for situations such as canceling a contract with less notice than your contract requires.
“Physicians will want some assurance that if they go down this path, two weeks before their assignment is going to begin, they’re not going to have their assignment cancelled,” says Tim Smart, senior director of Global Medical Staffing.
Identifying red flags in a locums agreement
Reviewing your first locum agreement may be intimidating, but it’s important to ensure you’re getting a deal that works for you. A quick scan for a few red flag items can make a huge difference in your experience.
Make sure your malpractice insurance has a “tail”
While it’s great that most locum tenens agreements from agencies automatically offer malpractice insurance coverage, you may want to look out for whether it’s coverage that has some extra security.
The best kind of malpractice insurance for your type of work comes with a “tail,” where, in the case of your ending your relationship with the agency, or their going out of business, you’re still covered long after care was dispensed. Standard malpractice insurance is claims-based, meaning you’re covered only if the incident and the claim happen while your policy is active. It’s also handy to look for specific offerings like “$1M/$3,” which implies that you’ll get $1,000,000 per incident, and up to $3,000,000 of coverage total—for some locum tenens agencies, these also happen to be standard coverage offerings.
Know the legal lingo:
If you see the word “Indemnification,” don’t panic. Indemnification is a legal term that shows up in all sorts of contracts. In this context, it lays out what compensation for harm or loss there is or isn’t for the parties signing the agreement. It functions as security against any legal liability for actions or events that may happen during your contract. Since malpractice insurance is already there to protect you, you don’t have to worry about liability, and your agency also shouldn’t seek any from you, given that other clauses in the contract protect them.
Cancellations and out clauses should be flexible
As mentioned above, agreements will typically lay out the terms of your ability to end your contract, which is the first thing you should look for. How much notice do you need to give? Got it? Okay, now what if you need to miss just a shift or two? What if you get sick, but not emergency-level incapacitated, and need a few days to recover from a cold? What you need is flexibility. The Locum Tenens Guy shares an example of what a typical cancellation clauses might look like:
“Professional may cancel any scheduled placement less than 30 days in advance by giving written notice…if Professional becomes unable by reason of emergency or medical condition to fulfill an agreed placement.”
Agencies may also require that any cancellation or pause in work with less than 30 days’ notice be submitted in writing—which is a reasonable request.
Know your non-compete clause in and out
Non-compete agreements protect agencies from losing the medical professionals they work with to another locum tenens agency or a hospital that wants to offer a permanent position. But since one of the best parts of working as a locum tenens physician is that you can use it to test out new places you might want to work permanently, you should steer clear of non-compete agreements that are too prohibitive on your time and flexibility.
It’s also important to remember this clause and the binding non-compete period are tied to your agreement, so that when you’ve finished working at a hospital you’d like to do permanent work with, you can. The Locum Tenens Guy explains, “A few years after my last shift at one local hospital, I decided to pick up some shifts there again. This time, I wanted to connect with them directly to have a long-term locum tenens hospitalist gig close to home.”
However, since he didn’t give a 30-day written notice canceling his agreement with the agency when he finished that job, he was still bound to his non-compete. He had to terminate his agreement then and wait for two years to apply to work at that hospital.
The non-compete is a tricky beast, as are termination and cancellation clauses. Review them diligently so you don’t get stuck working somewhere you’d rather not be.
What's negotiable? Tips for locum contract negotiation
Good questions to ask your locum tenens recruiter
Once you have a locum tenens agreement and/or a confirmation letter, you may still have a few questions. Getting clarity is always a good idea if you’re not getting it from your initial read. Don’t be afraid to ask these simple questions, because it could be the difference between a flexible and beneficial contract and one that limits you too much.
Know before you sign: Key details to confirm in your contract
Locums agreement and confirmation letter
- Confirmation letter: What details are included in the confirmation letter?
Getting there
- Travel arrangements: What are the travel arrangements, and are they flexible?
- Travel and accommodation: Are travel and accommodation expenses covered?
The basics of your assignment
- Duration of assignment: What is the duration of the assignment? Is the agreement the same length of time?
- Compensation: How is compensation structured? When and how do I get paid?
- Payment terms: How are payment terms defined?
- Duties and responsibilities: What are the specific duties and responsibilities?
Legal concerns
- Name clearing: What is the process for name clearing in the event of disciplinary action or termination while on my contract?
- Malpractice insurance: What malpractice insurance coverage is provided? Does it have a tail?
- Non-compete clauses: Are there any non-compete clauses? How long are they binding?
Ending your assignment
- Termination conditions: What are the termination conditions?
- Cancellation notice period: What is the standard cancellation notice period?
- Contract buyout terms: What are the terms for the contract buyout, and how is the amount determined?
Locum tenens contracts can seem intimidating, but they are valuable tools for protecting both your interests and the interests of the agency you work for. Taking the time make sure you understand what you are signing up for is the best way have peace of mind before you go to work with a new agency.
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