Locum tenens 101 for physicians: A newcomer’s guide

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Locum tenens can be a great option for physicians looking to supplement their income, apply their skills in new settings, or explore alternative career paths. An estimated one-third of physicians are currently working locum tenens or have done so in the past, yet many physicians may not be aware of the opportunities afforded through locums. Read on for your primer on locum tenens.

Think of locum tenens physicians as medicine’s substitute teachers

From the Latin phrase meaning “to hold the place of,” a locum tenens provider is a physician who fills in temporarily for another. What began in the 1970s with the purpose of providing physician staffing services to medically underserved areas of the western United States has expanded to a prosperous industry and an important option utilized by healthcare facilities nationwide. And more and more physicians are turning to locums for the flexibility and control it provides in their professional and personal lives.

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Locum tenens can work at all stages of a physician’s career

Locums can be an exciting catalyst to new opportunities, no matter the stage of your career. Locum physician Dr. Andrew Wilner, author of The Locum Life: A Physician’s Guide to Locum Tenens, speaks to the opportunities available to physicians at each stage of their career.

New graduates

“Physicians just out of residency have discovered locum tenens is a great way to test out different facilities in new geographic locations. A newly graduated physician’s priorities are different than seasoned physicians. They want to refine clinical skills, quickly pay off student loans, and take the time to scrutinize employment options before signing a long-term contract — all of which can be accomplished with locum tenens.”

Mid-career physicians

“Mid-career physicians often employ locums to augment their income. There may be life circumstances that destabilize a household budget — new home, student debt, children — but working locums can help restore financial balance when cash flows out faster than it trickles in. More and more mid-career physicians wishing to leave medicine are exploring non-clinical careers. Locums can be a bridge to a non-clinical job by providing an income stream until the new venture takes off.”

Late-career physicians

“I consider myself to be in the late-career physician category. At this stage of my career, I feel I’m able to preserve my physician identity by working locums if I decide to leave my full-time academic position. Locum tenens is also great for physicians who just aren’t ready to fully retire. Patients and facilities alike will also benefit from skilled, experienced physicians and you’ll be able to continue doing what you love.”

Locum tenens doctors work as independent contractors

Locum tenens providers are considered independent contractors, meaning all expenses related to taxes, insurance, and retirement are assumed by the provider. Taxes are not automatically taken out of a locum physician’s compensation, and they are responsible for making quarterly estimated income tax payments.

Neurologist Dr. Simrah Singh did the research and due diligence to ensure her financial affairs were carefully in order.

“I looked at it as an opportunity to learn,” she says. “As far as health insurance, you can go on the healthcare marketplace and buy health insurance yourself, which is what I do. You can pick high-cost plans and low-cost plans, depending on your needs, and write them off on your taxes if you’re an independent contractor. And you know, it’s really not hard. It just takes a little more time. I also use an accountant, and just have them do it for me.”

Seasoned locum tenens physicians recommend working with an accountant to understand and take advantage of the tax benefits available to independent contractors, including writing off business travel, business meals, continuing medical education (CME), equipment, lodging, and home-office needs.

Dr Patel pull quote about working with a locums agency

Using a locum tenens agency

While providers have the option to research and secure locum tenens positions on their own, experienced locums emphasize the benefits of working with a locum tenens agency, especially when he or she is starting out or working part time.

“If you’ll end up working locums part time, I would say working with an agency is nice because they make sure everything is set up on time, such as travel and housing arrangements. This way, you’ll be all set before you start to work on your first shift,” says emergency medicine physician Dr. Rip Patel.

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Tips for finding an ideal locum tenens agency fit

When it comes to finding an ideal locum tenens agency fit, find an agency with the resources to support both finding and successfully completing a locums assignment.

Questions to consider when choosing a locum tenens agency and recruiter:

  • Are there enough job opportunities to offer a pick of assignments?
  • Do I have flexibility to work as much or as little as I want?
  • Am I comfortable with this recruiter?
  • Can I build a long-term relationship with this recruiter?
  • Does this recruiter understand my needs and put my interests first?

Dr. Patel encourages prospective locums to select an experienced, established locum tenens agency and recruiter.

“Going with an agency that is experienced and an agent who’s experienced makes a world of difference,” he says.

Locum tenens pay

Like any profession, there are many variables that influence locum tenens pay. Rates may vary by specialty, location, shift type, and patient load. An agency can help negotiate pay, as well as shift preferences, housing details, and per diem allowance.

Locum tenens are paid directly by the locum tenens agency and are typically paid on a weekly or bi-weekly schedule, as determined by the agency.

In addition to a provider’s hourly rate, the locums agency will generally cover additional expenses including housing, transportation, medical malpractice insurance, and costs associated with licensing, credentialing, and privileging.

RELATED: How does locums compensation work?

How to choose your ideal locum tenens assignment

When it comes to choosing a locum tenens assignment, there are several primary factors to consider:

  • Location
  • Pay
  • Case mix
  • Patient volume
  • Time commitment

In addition to these considerations, experienced locum pediatrician Dr. Trevor Cabrera encourages providers to think outside the box and ask what he considers to be the most important question.

“My favorite question to ask is why the facility needs a locum provider in the first place,” he says. “If it’s for a simple maternity/paternity leave or a staff member that has transitioned to another job for a personal reason, I’m less dissuaded. If there is a history of running through one provider after another, I am very wary.”

Dr. Cabrera also likes to speak with current locums at the facility, if possible, for additional perspective on the facility and assignment.

International locum tenens

For the adventure-seeker, international locums assignments can be a great way to experience another country and culture while providing needed care. Many locum physicians use this unique opportunity to live like a local and travel extensively before, during, and after their assignment.

With international assignments come important questions and considerations to evaluate in advance, including:

  • How long can I commit to living internationally?
  • Do I have family who will join?
  • If I have pets, will I bring them or leave them at home?
  • Am I comfortable living in new, unique cultures?
  • Does living like a local sound exciting?

For more information and tips on a successful international locums assignment, read Global Medical’s beginner’s guide.

You can advance your career through working locum tenens

Locum tenens can be an effective way to help you achieve professional goals and aspirations that may feel limited or stifled in a permanent position.

Orthopedic surgeon Dr. Nicholas Kusnezov views locums as a strategic opportunity to experience new settings and gain exposure to different ways of practicing medicine. An up-and-coming orthopedic surgeon, for example, “may end up in a practice that confines you to a certain ‘niche.’ You might be the orthopedic ‘shoulder’ guy, stuck filling your schedule with procedures you may not be passionate about,” he says.

Dr Kusnezov pull quote about benefits of locums

“Locums offers the potential to selectively diversify and control the scope of your practice and thereby increase your professional experience and skill set,” says Dr. Kusnezov. “Medicine is a dynamic, ever-changing field that is advancing at an accelerated pace. Locums will expose you to a variety of different settings, medical staff, and novel concepts in diagnosis and management, which will in turn keep you sharp, relevant, and up to date with the state of the art.

Explore new opportunities by working locum tenens

The experiences and opportunities available to locum tenens providers are as varied at the providers themselves.

Dr. James Stone was drawn to locum tenens for its autonomy and flexibility and quickly discovered a love for locum tenens full-time.

“I wanted to be on my own. I was looking to be my own boss and get the opportunity to travel,” says Dr. Stone. “Once I decided to go into being a locum tenens physician, I just went for it and realized I needed to get out and make friends in the industry, and then work as hard as I could. I’ve said yes to practically every assignment I’ve been offered.”

Dr. Chad Koyanagi is a psychiatrist practicing in his home state of Hawaii. In addition to his position with the State of Hawaii Medicaid, his work in a private hospital’s psychiatric unit and medical outreach to individuals experiencing homelessness, he also devotes one week per month to treating Hawaii’s rural population as a part-time locum tenens psychiatrist.

“One of the main things that was particularly appealing about this opportunity was that I’ve always spent some more of my time trying to help address more of the rural shortage areas,” says Dr. Koyanagi. “So the opportunity to help with coverage on the west side of Hawaii Island satisfied my need for something different.

Locum tenens grants Dr. Colin Zhu the ability to live the “nontraditional” life he desires. As a family practice osteopath, he holds a holistic view of medicine – looking at the needs of the individual and their unique body in an integrative, preventative way. He has a passion for the culinary arts and travel, and uses locum tenens as a way to incorporate these passions into his career.

“Locum tenens allows me the freedom and autonomy to be able to dictate the type of lifestyle and work/life balance I seek personally,” says Dr. Zhu. “I have more time to pursue my other passions. The more that I can improve the way I take care of myself, the more I can dedicate more quality time to my patients.”

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Tips for locums success

Locums can be an exciting career path for providers and offer new and uncharted opportunities. With the new can also come the uncertain and even overwhelming. Consider these tips from seasoned locums to set yourself up for locum tenens success:

Communicate your preferences 

Dr. RK Devlin underscores the importance of knowing what you want and clearly communicating your preferences. “The first step to ensuring a positive locum tenens experience is to clearly communicate your practice and travel preferences to your recruiter. Being honest about the type and amount of work you want to do is imperative, as those choices allow your recruiter to match you with a job opportunity that best meets your expectations.”

Be open 

Dr. Devlin also encourages new locums to approach the experience with an open mind and curious nature. “While there is always a bit of anxiety when navigating a new environment, I mostly find locums work to be both interesting and educational. I like learning about patient care in different medical settings and establishing new friendships.”

Get organized

There are many moving pieces to keep organized and the paperwork alone can, at times, feel cumbersome. Dr. Mayre McCroskye shares tips on keeping the paperwork organized for newcomers and veteran locums alike. “You will have paperwork to complete for each locums assignment, but it doesn’t have to be painful if you have all the information you need at your virtual fingertips. And the opportunities that locums provide are well worth the work!”

Be nice

Among all his advice for a successful locums experience, Dr. Patel prioritizes one simple rule above all else: “Be nice. Seriously. It’s really just that simple. Be nice to your staff, be nice to your colleagues, and try your best to be nice to consultants. Sometimes the latter can be difficult, especially — as I have found in rural localities — where standards of practice might be different from your own. But simply put, pick your battles. When you remain committed to this mindset, staff will generally go out of their way to help you, assist you in navigating the system, and make your shifts run smoothly.”

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