Locum tenens 101: A beginner’s guide for NPs and PAs

Illustration of locum locum tenens for PAs and NPs

Locum tenens is a term for temporary healthcare jobs for nurse practitioners, physician assistants, and physicians. The locum tenens industry was created in 1979 to provide healthcare coverage for underserved communities and temporarily take the place of physicians needing time off for things such as maternity leave and medical missions. But now, with a growing patient-to-physician gap and unequal access to healthcare in many parts of the country, NPs and PA also work as locums to help fill these gaps and provide much-needed medical coverage.

Is locum tenens part-time or full-time?

Locums can be either a full-time career or a part-time job on the side. Some PAs and NPs work locum assignments on the side to make a little extra income. Others make locums their full-time career, attracted by the high pay, more flexible schedule, and opportunity to travel. Still others use locum tenens to gradually reduce their hours as they transition to retirement.

Tony Martin, PA-C, decided to try locums after working a permanent job for 17 years. “I love to travel, so I signed up for locums. I just didn’t want to take another permanent job; locums has been perfect for me.”

Sasha Dunbar is a NP who has chosen to work locums exclusively because of the schedule flexibility it gives her. “What I like the most is being able to not have work consume my life,” she says.

How PA and NP pay works for locum tenens

The pay for PAs and NPs working locum tenens can vary from location to location and assignment to assignment, but typically it’s higher than what NPs and PAs earn in permanent positions. 

Jessica Bastidas, PA-C, says she likes working locum tenens for this reason. “The pay is much better than I would get just working a regular job. When you look at the curve, I’m always above the average,” she says.

One of the few downsides to locums, according to Bastidas, is that locums don’t get paid time off, so she has to plan accordingly. “You plan your finances ahead, and once you have the dates, you tell your recruiter, ‘Hey, from this date I’m not available to work. I’m going to be off,’” she says. Although you don’t get paid for time off, you have greater flexibility in choosing when and how long you want to take off without worrying about finding someone to cover for you.

How benefits work for locums NPs and PAs

When advanced practitioners choose to work locum tenens through an agency, they are typically hired as a W-2 employee rather than an independent contractor like physicians. For example, at CompHealth, PAs and NPs receive a full benefits package which begins on day one of an assignment. Benefits include things like family medical and dental coverage, 401(k) with company match, and company-paid basic life insurance. Other benefits might include services like Teladoc, a health advocate, or optional pet insurance.

Many locums companies also offer continuous benefits coverage even between assignments. Weatherby Healthcare offers a 30-day bridge period for its benefits — if the time between assignments is less than 31 days, you’re still covered and do not need to re-enroll.

“My agency offers an excellent benefits package and 401(k), plus they’re a big company so I know they’re reliable,” says NP Michelle Freiberger.

Her W-2 employee status means she doesn’t have to worry about taking care of her own tax withholding either, which she really appreciates. “I also get medical and dental insurance immediately, so I don’t have to wait, plus this coverage lasts up to 30 days while I’m between assignments.”

Renee Watson, a NP who’s been working locum tenens for several years, likes not having to worry about the tax requirements of an independent contractor. “I’m not a saver, so being a W-2 employee is very helpful to me because they take the money out for me.”

How to choose a locum tenens assignment

If you choose to work locums through a staffing agency, it’s best to ask a lot of questions and be confident you’ll receive plenty of support from the agency. Once you’ve established a relationship with a recruiter, the next step is finding the right locums assignment.

Your recruiter will need a lot of information from you, including your CV, references, and credentialing information. You should also proactively share your preferences, wants, and needs, such as:

  • The number of hours you want to work
  • Ideal assignment locations
  • Pay requirements
  • Preferred facility setting
  • Hobbies
  • Family ties to a region

The more detail you can share with your recruiter, the more likely they’ll be able to match your preferences.

It’s also important to ask questions about the facility where you’ll be presented.

“I always ask what the patient population is like, what patient load looks like, what the typical clinic day looks like,” says NP Michelle Rensel. “You have to be prepared so I try to ask as many questions about the clinic and the workday and the patients as I can before I go.”

What do locums agencies take care of for an assignment?

Once you have accepted an assignment, your locums agency will book flights, reserve a rental car, and secure comfortable accommodations for your stay. You can even bring family and/or a furry friend with you. However, you will usually have to pay for their travel expenses yourself.

While on assignment, most agencies also provide medical malpractice insurance. The type and amount of coverage may vary from agency to agency, so be sure to check with your recruiter to find out which type of malpractice coverage you have and that you’re fully covered.

Additionally, larger locums agencies often have in-house teams that will help you with all the paperwork needed for licensing and credentialing for the assignment.

Using a locums agency versus going it alone

There are pros and cons to using a staffing agency versus working locums without one. There are those who prefer to hand off the heavy lifting to a staffing agency, so they don’t have to manage the details of things like housing and transportation. They also appreciate having recruiters on call 24/7 to help resolve any assignment-related issues.

“My recruiter was amazing to help me,” NP Linda Bell says. “It’s so nice to have a recruiter contact me every week and sometimes more than that when I need assistance.”

PA Cara Bosco was extremely grateful to have a recruiter when she had a couple of issues with her housing on an assignment. “It was 8 at night, and I called my recruiter and told her this housing just wasn’t going to work because of a mechanical issue. Almost immediately I was relocated to other housing — and I had my dog with me!”

However, there are advantages to working assignments without an agency as well. You may be able to command a higher hourly rate, since the facility won’t be paying a portion of the bill rate to the staffing agency.

Of course, going solo you will be responsible for arranging your own housing, travel, medical and insurance benefits, and tax withholding.  But for those who are detail-oriented, tech savvy, and who are locums veterans, making your own arrangements may be a good fit.

Set yourself up for successful locums assignments

Knowing where to begin, what questions to ask, what to expect, and what your options are can give you a leg up in an industry that can be life changing.

“I absolutely see myself doing more locums in the future,” Bosco says. “Locums enables me to love my job and my life at the same time.”

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