Locum tenens contract negotiation: Tips for success

Illustration locum contract negotiation

There is much more than pay that goes into what makes a good contract, and learning how to navigate the negotiating process as a locum tenens physician can mean more money in your pocket. Learn how to make the most of your locum tenens contract from four veteran locum doctors across four different specialties, who share their knowledge, experience, and advice.

Here, they answer four of the most common questions about negotiating a locum tenens contract.

1.What is negotiable in a locum tenens contract?

Although this may surprise you, orthopedic surgeon Dr. Nicholas Kusnezov says that everything on a locum tenens contract is negotiable.

Pull quote Dr Kusnezov

From schedules to shifts to pay, Kusnezov has found it all to be adjustable based on what he wants to get out of the contract. “I usually try to get an idea of what other providers before me have worked, what the volume is there, how long I would expect to be at the hospital, and then I run some numbers and figure out what I can expect to make in a given day. I have a number in my mind with every job, and I negotiate aspects of the contract to make sure that it meets that daily number,” he says.

According to our Locumstory Advisory Board, you can negotiate how long you want to work, what kinds of shifts, and flat-rate pay versus hourly. There’s also information you can use to leverage for more pay, like knowing the market rate of different specialties; if a hospital has productivity expectations or is in dire need of staff; if the location is far away, inconvenient, or undesirable; if administrative time is covered or not; and if the schedule is challenging.

And while doctors don’t always get paid for their travel time, you can protect your time and money spent by setting limits on where you travel, how far away you have to drive, or how many flight connections you’re willing to make to get there.

2. What isn’t negotiable in a locum tenens contract

Some of the non-negotiables of a contract are pretty straightforward. If a hospital’s budget doesn’t match what you’re asking for, it’s unlikely you can negotiate for higher pay. Similarly, if their scheduling needs just don’t match up with what the locum can do, there’s no way around that.

Additionally, Dr. Marye McCroskey shares that for her, “A big red flag is that the company that’s going to hire me keeps changing what they want when in the negotiation process.” If it’s wasting too much time going back and forth with a company, that’s when it’s time to stop negotiating toward a contract.

3. When and how to negotiate your locums contract

Pull quote - Dr Cabrera

A basic tip offered by Dr. Cabrera is to remind hospitals that since they aren’t paying benefits or bonuses to locum physicians, they must pay the physician a percentage above what they’d pay a staff physician. It’s a hard point to argue with unless a hospital just physically does not have the money to pay that higher percentage, he says.

When figuring out what that percentage should be, Dr. Cabrera recommends looking up the average amount of money made in the specialty that you’d be working in, and then adding 30% to that to use as your beginning negotiation figure. And, he explains, at the start of the negotiation process, your first offer may be less than you’re worth — so keep pushing.

You can negotiate on your own, or with the help of an agency. Emergency medicine physician Dr. Ripal Patel explains, “it can be easier to go right to a hospital to work out your contract, especially if you see longevity for yourself in that position. It can also be easier to negotiate a higher rate.”

Pull quote Dr Patel

However, as Dr. Cabrera points out, it’s only easiest to negotiate directly if you already know how. “If you don’t, working with an agency can cut out a lot of the awkwardness of negotiations,” he says.

You can also negotiate a contract after getting to the actual site. “There was one job where I felt out the assignment — it was like, ‘no, this is not it, I’m not getting paid enough to do this.’ And that gave me leverage; they actually increased the rate,” Dr. Cabrera says. There is also room to change a contract if you arrive at the location and the hours, work, or other parts of the contract are not as agreed.

And importantly, Dr. McCroskey advises, “Be very, very straightforward, with both your recruiter if you’re working with an agency and the client if you’re negotiating on your behalf. It’s got to be, ‘This is what I’m willing to do, this is what I’m not willing to do, this is the pay rate I’m willing to take.’ I think for a new locum, you really have to think about that and decide how you want to structure your life as a locum.”

Pull quote Dr McCroskey

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4. When you should back off in your negotiations

As frustrating as it can be to start a contract only to realize the pay, expectations, or work are not as expected, it’s important to manage the situation with tact. “If I have a recruiter or an agent I would call them, but often, whether I’m with one or not, I’ll call the director,” Dr. Patel explains about times he’s been in this situation. “And in a very diplomatic way, I just say ‘look, I’m happy to stay, I’m here to take care of the community, but these issues are concerning me.’ It’s a very fine line to walk because if you cause drama at a place, they’re not going to want you to come back.” If a hospital isn’t open to negotiating, you can see if your locum company will throw an incentive bonus to you to keep doing a contract, which comes out of their cut, he says.

Some specialties just don’t offer negotiating room as much as others, which new locums should do research on. “I’ve found the window is pretty narrow, and I just shoot for the upper end of the window, but there’s probably not as much room for negotiation in primary care,” explains Dr. McCroskey.

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It’s also important to consider what other bonuses there are to a contract beyond pay. Dr. McCroskey accepted less pay once for a three-month job she enjoyed that was in Guam. For Dr. Patel, positives beyond pay can include liking and trusting his coworkers, feeling comfortable in the hospital, and being close to home. “If you’re happy there, and you feel like you can practice good medicine, and you don’t feel like you’re getting taken advantage of, it’s something to keep in mind,” he advises.

Negotiating can lead to new opportunities

Negotiating contracts isn’t a skill that comes easily to everyone right off the bat. But as a locum physician, knowing the ins and outs of negotiating your locum tenens contract is important, whether you’re working with an agency or on your own behalf. Effective contract negotiation can help to ensure you’re paid as much as you’re worth and allow you to work in your ideal clinical setting, with the patient census and procedures you’re most comfortable working with for each and every assignment, as our Advisory Board have discovered after years of working locum tenens.

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