Dr. Jordan Frey speaks with Dr. Mark Pool, a locum cardiothoracic surgeon, and Dr. John Oglesby, a locum OB-GYN, in a webinar hosted by The Prudent Plastic Surgeon on flexibility with locum tenens. Both walked away from busy, high-volume private practices, and both were candid about what they gained by making the switch and what they gave up.
The conversation covered three things most physicians want a straight answer on before they’ll consider locums:
- How much control you really have over your schedule
- What happens to your income
- Whether it can genuinely reshape your career and your life
Below are the highlights, an FAQ pulled from the live audience Q&A, and the full transcript.
New to locum tenens? Check out our newcomer’s guide to locum tenens.
Watch the webinar
Webinar highlights
How much schedule control do locum tenens physicians really have?
A lot—once you’ve completed a first assignment or two. On a brand-new gig, the facility sets the terms: “If I’ve never worked there before, I’m not going to be able to work there unless I can cover the days they need covered,” says Dr. Pool. The good news is that’s a starting point, not a ceiling.
Both doctors treat that first stretch as a trial, not a locked-in commitment. Dr. Oglesby’s rule, before agreeing to his usual 12 to 15-month schedules: “Let’s try it out, see if it’s a good fit for the facility, see if I think it’s a good fit too.”
Once a relationship is established, the schedule opens up. “Once I’ve been somewhere and established a relationship, there tends to be a whole lot more flexibility,” Dr. Pool says, enough that you can request specific days off three months in advance instead of just covering whatever’s open.
Once that control is established, it pays off at home, not just on a calendar. “I have eight kids, and I’ve been home for every one of their birthdays for the past three years,” Dr. Pool says, something he couldn’t promise in his old practice, where a single emergency could erase any plan. Dr. Oglesby, meanwhile, says finding new work once you’re established has never been hard; when a longtime facility gave him four weeks’ notice that they no longer needed him, he had six replacement offers within the week.
How much do locum tenens doctors make?
It depends heavily on specialty, but both doctors are paid well. For Dr. Oglesby’s OB-GYN assignments, “the base typically runs $1,600 to $2,500 a day, and the hourly rate runs $185 to $225” for call coverage, he says. Dr. Pool’s cardiothoracic assignments are usually built around a day rate with a set number of included hours, plus an hourly rate for anything beyond that. Neither number is a universal rate.
Looking for a full breakdown on pay by specialty? See guide to how locum tenens pay works
Both run their income through an LLC taxed as an S-Corp. “I set up an LLC to funnel my income and account for expenses,” says Dr. Pool.
Health insurance is the tradeoff that neither sugarcoats. Dr. Pool lost his employer-subsidized plan and says, “The open marketplace is very expensive by comparison.” He currently uses a cost-sharing program instead. Dr. Oglesby, on the other hand, says going on the marketplace for his own coverage hasn’t been an issue. A third option, raised by an attendee in the live Q&A: A payroll provider that’s also an insurance agency (Paychex, for example) can sometimes get 1099 physicians into a group plan instead.
For the fuller picture on entity setup and deductions, check out our tax guide.
Does locum tenens pay beat private practice?
For Dr. Oglesby, yes, decisively: “In locums, I probably work about half as hard as I did in private practice, and I easily earn twice as much.” For Dr. Pool, whose productivity in private practice was likely within the top 1% by his own estimate, it’s closer to even: “It’s comparable to what I made before, working about three weeks a month.”
Dr. Pool’s edge comes from how he negotiates, not just what he charges. “My approach has been to agree to three months initially at a new place that’s my trial period,” he says. Once both sides know it’s a good fit, that track record gives him leverage to raise his rate on the next round; a tradeoff of a little scheduling certainty (Dr. Oglesby books 12 – 15 months out for more predictability) for pay that climbs over time.
Can locum tenens prevent physician burnout?
Both say yes, with a real tradeoff attached. “It’s not really about the money,” says Dr. Oglesby. “It’s all about the lifestyle… and being able to do the work again and again without the burnout that’s so prevalent in my specialty.” He’s grown his annual time off from six to eight weeks in private practice to ten to twelve now.
Dr. Pool describes a similar shift in headspace, not just hours. “Now when I’m home, no one can reach me,” he says. He didn’t have this freedom of mind while carrying a near-constant call in private practice. But he’s candid about the cost: “The downside is being away from my wife and kids, which is something of an Achilles’ heel” of doing locums full time. But he says this may be a tradeoff that suits late-career or nearing-retirement physicians especially well.
The pros and cons of locum tenens, from physicians who’ve done it
Neither doctor pretends this is upside with no downside. Here’s their tally, in their own words.
What’s worked well:
- Schedule control that grows the longer you work with a facility
- Pay that matches or beats private practice, for less overall intensity
- Licensing and credentialing that moved faster than expected
- Malpractice coverage, tail included, as standard
- More time for family, further education, and travel
What to watch for:
- Health insurance is on you, not an employer
- A new EMR system at every facility
- Keeping your own calendar
- Adjusting to an existing team’s workflow rather than the reverse, especially for surgeons
FAQ
Is locum tenens work 1099 or W-2?
Almost always 1099. Both panelists work as independent contractors, typically through an LLC or S-Corp.
Should I set up an LLC or an S-Corp for locum tenens income?
Both panelists did, citing cleaner expense tracking and potential tax advantages—worth discussing with an accountant before your first assignment. See Locumstory’s tax guide for the fuller breakdown.
What are my health insurance options as a locum tenens physician?
Options include marketplace plans, cost-sharing programs, or a group plan through a payroll provider—coverage isn’t automatic the way it is with a W-2 employer.
Does locum tenens malpractice insurance include tail coverage?
Reputable agencies typically cover malpractice with tail coverage included. Vet the agency’s financial stability before signing, and confirm the coverage type matches what you’re used to.
How much notice do I need to give to end a locum tenens contract?
30 days is standard industry practice, though terms are negotiable directly with a facility. In practice, panelists said facilities rarely cancel with only the contract minimum, since replacing a locum physician usually takes several months.
How does housing and travel work for locum tenens assignments?
Agencies typically cover flights, rental cars, fuel, and lodging; physicians can often arrange their own travel to keep loyalty points. Some physicians also negotiate directly with homeowners for a long-term rental at a discount.
What does locum tenens look like for OB-GYNs?
Based on Dr. Oglesby’s experience, the call is central to the work, so pay usually combines a flat availability rate with an hourly rate for the time you’re actually called in. He described it as getting paid to be “on call, ready to come in for a C-section or delivery within ten minutes.” Clinic days, when they come up, tend to pay similarly to a call day. He’s focused his assignments on rural, critical-access hospitals that struggle to recruit on their own.
What does locum tenens look like for cardiothoracic surgeons?
Based on Dr. Pool’s experience, assignments are typically built around a 24-hour call window (7am to 7am) plus rounding and operating, with a day rate that includes a set number of “gratis” hours and hourly pay for anything beyond that. He’s mostly covered smaller, rural facilities that have more trouble recruiting and staffing than large hospitals, which also means somewhat more downtime than a busy private practice.
How long does credentialing take for a new locum tenens assignment?
Faster than most physicians expect. Panelists reported that facilities often grant temporary privileges so a physician can start within a couple of weeks, with fuller credentialing following.
Make locums fit your schedule and needs
See how different locums agencies compare on pay structure, malpractice coverage, and support services, the same kind of homework both panelists said mattered most before they picked who to work with.
Full webinar transcript
Speakers: Dr. Jordan Frey (host, The Prudent Plastic Surgeon), Dr. Mark Pool (cardiothoracic surgeon), Dr. John Oglesby (OB-GYN), and a live attendee identified below as “Attendee.”
Meet the panel: Who’s on the call and what is locum tenens
Dr. Jordan Frey: Thank you all for joining. This session is all about locums work, which for the longest time felt like a black box to me. It’s not something I’ve done yet, but it’s something I’m very interested in and have learned a lot about. When I talk to most physicians, the general sense I get is that they’re interested but lack the education or familiarity to feel comfortable — and that’s what this session is about. The folks at Locumstory have incredible resources, and they’re not a staffing agency; they’re truly just a resource for doctors who want to learn about locums and optimize their locums work. With us today are Dr. Mark Pool and Dr. John Oglesby, who both work locums and have done so successfully for some time. We want to run this as an interactive Q&A, so please throw questions in the chat or unmute yourself as we go.
Mark and John, could you give us a quick one-line introduction — who you are, what you do, where you’re from — and share a bit about how you got started in locums?
Dr. Mark Pool: Sure, happy to. I’m a CT surgeon — I do cardiac and thoracic. I had a practice in Dallas, Texas for nearly 12 years and was very busy, doing all manner of cardiac and thoracic work, including robotics and complex cases. I decided to get into locums about three and a half years ago and have been doing it full-time since then. I’ve been to 18 or 19 different facilities. It’s had its highs and lows, but mostly highs — it’s been a really interesting change to my life and practice.
Dr. John Oglesby: My name is John Oglesby. I’m an OB-GYN. I’ve been doing locums for almost five years, and 100% of the time for at least the last three or four. I was in Wisconsin in a management position, working full-time, when the healthcare system — a big national one — decided to sell our hospitals. I felt crushed, because I’d been recruiting people for our hospital right up until the moment they told us. I decided I needed to step away and do something that brought back the reason I got into medicine in the first place. OB-GYN is very blue-collar — you have to physically be there and take the call — and there are so few of us that a lot of practices just need a break: someone to come in for a week or two so they can get some nights off, be with family, or take a vacation. That’s what I’ve been doing, in Tennessee, Kentucky, and now I live on the Oregon coast. It’s amazing how far a PDF can take you.
Dr. Jordan Frey: So just so we’re all on the same page about what locums is and what it looks like: it’s temporary work where you fill a staffing gap for a set amount of time, ranging from a few days (less common) to weeks or months, and it can be anywhere across the US or even internationally. Both Mark and John do it full-time now, but it can be done full- or part-time, whatever fits your schedule and your other practice. Most physicians probably know at least one person doing locums — and it works for every specialty. I used to think it wouldn’t work for plastic surgery until I talked to plastic surgeons doing it successfully. Locumstory itself is an online hub of resources, not a staffing agency, built around real physicians like Mark and John to help you figure out whether locums could work for you, and how.
Schedule control: Setting your own hours
Dr. Jordan Frey: Let’s get into our first topic: schedule control. Mark and John, how does your schedule tend to work with locums, and how much control do you actually have over it? John, I’ll start with you.
Dr. John Oglesby: First off, you set your own schedule and you’re your own person — there’s unlimited demand, so you can literally turn it on or off whenever you want. I decided I wanted to live on the Oregon coast, and that’s where I’ve been exclusively for the last three years, but I can still go anywhere in the country. It’s also very easy to get new work. I had a group that recently hired their third nurse practitioner, so they no longer needed me — I got four weeks’ notice. Within that week I had six offers to fill in. I was already booked out with another group until May, so I thought I’d lost half my employment, but it wasn’t a problem at all — I was back up to full speed very quickly.
Dr. Mark Pool: I’ve had a similar experience. If you want to do it full-time, you can work about as much as you want — you might need to piece together a couple of facilities, which is my model. I usually juggle two or three facilities, working a week or two at each. I don’t aim to work only weekends; that model suits someone who has a practice and just wants to add locums on the side. For me, it’s essentially a day of travel on the front end and a day on the back end, so I don’t want to travel Thursday and Monday just to work three days — I usually target at least a week-long stretch. At the same time, I’ve had great flexibility. In my old practice, I was almost a victim of it: with surgery, you can’t predict when a patient will bleed or an emergency will come in, so it took a lot of call, and even for my kids’ birthdays I’d try to be there but something might come up. With locums, I just don’t work those days. I have eight kids, and I’ve been home for every one of their birthdays for the past three years. That’s something locums and the control it gives me over my schedule has enabled.
Dr. Jordan Frey: With that schedule control, what’s your day-to-day like once you’re actually on an assignment? I think the fear is that you’re consumed the whole time you’re there — constantly on call, working flat-out.
Dr. John Oglesby: In OB, you never really know what’s going to happen — being on call is exactly what helps these groups. I do normal call, but I’ve found clinics are often so understaffed that they appreciate when I do a clinic day too. Some days I don’t have call at all; other days I do, so I juggle that. Clinic days pay just as much as call days, so doing both together pays more. It’s a way to turn on, turn off, and fit the needs of each practice. I tend to choose more rural, critical-access hospitals that have a hard time finding someone to cover them on their own — being older and more experienced, I have that capability.
Dr. Mark Pool: It varies widely by specialty — I can only speak to cardiothoracic surgery. Generally speaking, it’s not an onerous schedule. Call typically runs 7am to 7am, so that’s the window I need to be available for anything that comes in — though that doesn’t mean I operate on everything; sometimes we transfer a patient if appropriate. Beyond call, there’s rounding and operating. Most of the facilities I’ve covered aren’t large, heavy-hitting centers, because those tend to staff more easily — it’s the rural facilities having trouble recruiting that need someone. They’re generally not as busy, so there’s more downtime than I’d have had in a very busy private practice.
Dr. Jordan Frey: Is there room to negotiate what that schedule looks like going in — and have either of you ever turned down an assignment because of the schedule?
Dr. Mark Pool: You can negotiate anything — whether they’re willing to negotiate with you is another matter. What’s worked best for me is understanding that facilities usually have specific days they need covered, often because the permanent physician there has a vacation or is leaving. Those dates aren’t very negotiable — they’re just the days that need covering. Some facilities need locums coverage all the time and are piecing together two or three practitioners to cover the whole calendar; there’s more give-and-take there — I can cover these days, maybe give them an extra day, but get the day I wanted on the front end. Once I’ve been somewhere and built a relationship, there’s a lot more flexibility — I can request time off three months out. But on a brand-new assignment, if I’ve never worked there before, I’m not going to get the job unless I can cover the days they need covered.
Dr. John Oglesby: About the same for me, but I really enjoy being at a place long-term, part-time — you build the relationship and they’re very happy. I usually schedule out at least a year to 15 months in advance, so the institution knows what’s happening, the staff can plan their vacations, and I plan mine, so our schedules mesh efficiently. Institutions like that a lot, and again — you can turn it on or off, and they cover your travel, flights, drive, housing, everything, which they like to plan out weeks and months ahead.
Attendee: Is it ever something that’s offered, or are you ever able to visit the practice or facility first before agreeing to accept the position, especially for a longer-term role?
Dr. John Oglesby: Funny you should ask — that’s exactly what I just did last week. I had several offers, all wanting 2027 coverage, so I said, let’s try it out, see if it’s a good fit for you and for me, and then we’ll map out 2027. But I did that by actually coming out and doing a real assignment, not just showing up for a tour of the hospital. I think that’s the best way to do it, because it has to be a good fit for both sides — you try it out and see if it feels right before committing further.
Income and pay: How locums compensation works
Dr. Jordan Frey: Let’s move to what everyone wants to know about: income control and pay. Mark and John, let us in on how this actually works. What’s the pay like compared to your old practice — are you working the same hours for the same pay, or less for more? I think a big fear is: I’m leaving my traditional job, and locums feels less cemented — what happens to my pay?
Dr. John Oglesby: I was genuinely surprised. I did very well in my practice — I’m also a robotic surgeon and did pelvic pain work, which pays extraordinarily well, along with OB. But in locums, I probably work about half as hard as I did in private practice, and I easily earn twice as much. That’s not because I’m overpricing my time or gouging the institution — it has to be a win-win or it won’t be a sustainable business relationship. One assignment I just finished lasted almost four years because it worked out well for both sides. Most people who do locums find they’re working much less intensely, without the overhead that comes with running a practice, for less stress and more money. But honestly, it’s not really about the money — it’s about the lifestyle, and being able to do the work again and again without the burnout that’s so prevalent in my specialty.
Dr. Mark Pool: Similar experience. I was extremely busy in practice — probably in the top 1% of CT surgeons nationwide for productivity — so I haven’t doubled my income, but it’s comparable to what I made before, working about three weeks a month. There’s a bit less certainty than being employed with a steady paycheck, but because demand is so high and so many facilities need help, I haven’t felt anxiety about that, and I’ve had no trouble finding opportunities. For per-unit work, you almost can’t get paid more than you do with locums, because facilities are — for lack of a better word — in distress, and they’re willing to pay for it. That’s different from a long-term employment relationship.
Structuring the business: LLC, S-Corp, and health insurance
Dr. Mark Pool: If people are interested, I can get into the nuts and bolts — I set up an LLC to funnel my income and account for expenses. I think that’s very helpful for anyone getting seriously into locums; if you’re just doing a weekend here and there it probably doesn’t matter as much, but for me it’s been a big help to keep everything separate from my personal finances.
Dr. Jordan Frey: That’s a perfect segue — how have you each structured things, and what tips have you picked up along the way? Mark, can you elaborate?
Dr. Mark Pool: Sure. I was a W-2 employee of a major healthcare system in practice; now I’m a 1099 contractor on essentially every locums agreement I’ve had — most through agencies, a handful direct, but even those have been 1099 arrangements. I set up an LLC at the outset, with a separate bank account and credit cards in my business name, and my business name is on all my contracts, so that’s where my pay goes. My accountant is happy because it’s all separated. I keep all my receipts — essentially all expenses other than food are reimbursed (only one gig ever covered food): airfare, rental car, fuel, and hotel. One tip: locums agencies have agents who’ll book your travel for you, but I realized I’d rather book it myself and keep the points. I called my agent and asked if I could arrange my own travel, and every agency I’ve worked with since has been fine with that, as long as I stay within their daily expenditure guidelines — you can’t fly first class or stay at the Waldorf, but otherwise they don’t mind. I got a travel rewards credit card and have built up a nice number of points that way. I’ve also met other locums physicians whose spouses travel with them, and one who set up his wife as an employee of his LLC — handling his travel, so to speak — which comes with some tax advantages depending on how it’s structured.
Dr. John Oglesby: I’ve always gone through an agency — I like that it’s clean, with clear boundaries between the employer, the contract, and everything else already set up. I’ve always used an LLC too, so it’s always 1099; you run it through the corporation and your accountant handles the back end. Keep your receipts and it works out very well. About the only real difference from being a W-2 employee is that I had to set up my own 401(k) — I fund it myself — and my spouse does become my employee, since it’s important to have a second person to help with things like a secretary role. I also had to go on the marketplace for my own insurance, which hasn’t been an issue, even with ten kids (though they’re older now).
Dr. Jordan Frey: That’s an excellent point that a lot of people probably don’t think about. [To the attendee with a hand raised] Do you have a question?
Attendee: Yeah — one was about health insurance. I know marketplace plans generally aren’t great. Mark, do you do anything differently there, outside the marketplace?
Dr. Mark Pool: I need to find out what agency John’s using for health insurance, because I think that’s a real sticking point with locums. To be honest, it’s a downside for me — my old employer paid a good part of the healthcare premiums, and the open marketplace is very expensive by comparison. Right now we use a cost-sharing program, MediShare, and ironically that’s actually the main reason my wife might want me to get a full-time job again — not so I’d be home more, but so we could go back to normal insurance and she wouldn’t feel anxious about our coverage. I’ll probably enroll in a standard plan this fall for that reason. Otherwise, the open market is about the only option I’ve found besides cost-sharing programs.
Attendee: Is your wife part of your LLC?
Dr. Mark Pool: No — I did set it up as an S-corp with the IRS, so I pay myself a salary, and there are some tax savings there, though I’m no accountant. We didn’t bother structuring it that way since she and I have a couple of other businesses already.
Attendee: The reason I ask is that I recently learned that if you have more than one person on your LLC’s payroll — whether through the LLC itself or a separate management company — depending on who runs your payroll, you may have access to better group insurance options. I use Paychex, which is a national payroll company that’s also an insurance agency, and at least in Arizona, they were able to get me essentially the same Blue Cross PPO plan I had through my old employer. It’s a bit more expensive, yes, but it’s a genuinely good plan, so I was glad to get it. Just food for thought.
Dr. Mark Pool: That’s a good point — I appreciate that. Might be worth looking at a group policy instead of an individual one.
Attendee: A group is definitely the way to go in my opinion — individual policies are expensive and not great. One more thing, not to get too into the weeds: my understanding is that in many states, if you form an LLC and elect S-corp status like you have, and then work in another state, you may need to register there as a foreign entity. Do either of you know anything about that?
Dr. John Oglesby: I can speak to that — I’ve done Kentucky and Tennessee, and most recently Washington State and Oregon. My accountant handled it, because we had to separate everything meticulously — what came from Washington versus Oregon. I also did a PLLC that’s actually an S-corp, and my accountant tells me exactly what I need to do. I did have to register because Washington and Oregon each wanted to know where my primary residence was, and that actually flipped in the middle of the last couple of years, so I went through that whole process. But at the end of the day, between deductions and everything else, I’m still doing quite a bit better than I was in private practice — it’s more than offset by it. I just pay my accountant well to make sure we’re solidly in the safe zone, with nothing questionable, and it’s worked well.
Attendee: One last question — John, you mentioned a long-term gig. When you sign on with a locums group that wants someone pretty much indefinitely — mine is private-equity backed, with offices in different states, and they want ongoing coverage rather than hiring someone permanently — what have you found for termination notice? What are your termination rights, since you’re not technically an employee?
Dr. John Oglesby: Sure — I can cancel anything with more than 30 days’ notice, no harm done, and they can do the same to me. In one case, they gave me 32 days’ notice because someone else had signed at the last second and already had a license, so they no longer needed me at that facility. That was the fastest turnaround I’d ever seen — usually you see it coming five or six months out. But it wasn’t a problem: I put the word out that I had immediate availability and was snatched up before I could take a breath, with interviews and applications moving fast enough that I started a new assignment on September 11th. Basically no downtime.
Attendee: On per diem rates — I know there’s a range, but is it specific to specialty, or is there a general ballpark? I’m in ophthalmology, so a different specialty, but I’m curious how it compares.
Dr. John Oglesby: I can answer that easily. I use CompHealth exclusively — I like how they handle credentialing, their follow-through, and how thorough they are; I feel well informed about what I’m getting into, and the hospitals I work for are happy with the service too. It’s actually published on their job site: the base typically runs $1,600 to $2,500 a day, and the hourly rate runs $185 to $225. I was surprised recently to see how consistent that is across the country — there might be some fluctuation, but the price per hour was almost identical everywhere I looked.
Attendee: Mark, do you see something similar, or is it different because of your specialty?
Dr. Mark Pool: That’s going to vary by specialty, and I’d hate to speculate on exact numbers outside my own — I think CT rates run a bit higher. I’ve worked with CompHealth and really like their program; my agent there has always taken great care of me, the gigs have been great, and they’ve always paid on time with no issues on reimbursement. I’ve also worked with LT.com, Weatherby, Barton, and MPLT — I like some more than others, but CompHealth has been very good for me, as it has for John. Generally, every contract I’ve had across agencies has had a 30-day opt-out with no penalty on either side; less than that comes with financial obligations, usually on the facility’s side. If a facility cancelled me with only a week’s notice, I’d still get paid even without working — that’s happened to me once, and I was fine with it. It’s rare, though, because most of these places are trying to recruit a permanent replacement, which takes months for credentialing and licensing. So while 30 days is considered standard for the industry, actual notice tends to run much longer in practice. If you’re negotiating directly with a facility rather than through an agency, you can set whatever terms you want.
Attendee: And is it correct that you get an hourly rate on top of a per diem, John — for the actual time you’re working? I’ve only ever seen straight per diem in my searches, never an hourly component.
Dr. John Oglesby: Our call is fairly demanding — I have to be able to get to the hospital within ten minutes on a moment’s notice for a C-section or delivery. Because of that, when I physically come in and do work, they pay me hourly on top of a flat rate for just being available — what I call “breathing air”: having my phone on, a backup phone ready, and being there the second they call.
Dr. Mark Pool: It’s varied for me. Some facilities pay a flat per diem regardless of hours worked. Most have a number of “gratis” hours built in — usually four to eight — where if I work beyond that, say I’m called in after hours and end up working twelve hours, I get paid an hourly rate for the extra four. That’s advantageous at busier facilities. A pure per diem with no hourly component for clinic-only days isn’t really an arrangement I’ve seen in CT surgery — it’s always call, plus or minus clinic on top of it.
Dr. John Oglesby: Same for me — clinic days aren’t that common, since they mainly want me for call, but when I do get a couple of clinic days mid-week, I’m paid similarly to an on-call day, just for an eight-hour shift.
Dr. Mark Pool: One more thing on longer-term contracts, or places having a lot of trouble recruiting: it gets back to that trial-phase idea. My approach has been to agree to three months initially at a new place — that’s my trial period. Pretty quickly, both sides figure out if it’s a good fit. When it comes time to negotiate further, that gives me some leverage, because I have other options and can set the rate I’m looking for going forward. I do sacrifice a little certainty by not booking a year and a half out the way John does, but it’s let me increase my pay over time at facilities I’ve returned to. And because I know I’m only committing three months at a time, I rarely have to cancel on anyone — if I don’t love a place, I can get through three months and then move to somewhere better.
Dr. John Oglesby: Good points. I’ve never cancelled either, aside from the one time I was let go because a facility filled its staffing need. On the flip side — something about housing: what I like to do is find a really nice house and negotiate directly with the owner to rent it for the length of my assignment, say 14 to 16 months. Usually what I’m paid for a week and a half to two weeks of locums work covers a month’s rent, and owners are often happy to have a physician renting long-term, so they’ll give a good price. It’s worked out well — I basically have a second home I rent. In Washington, by contrast, the facility already had housing set up for me the whole time I was there, on a two-weeks-on, two-weeks-off rotation, which also worked out nicely.
Career control: Licensing, credentialing, and life outside medicine
Dr. Jordan Frey: Let’s move to how locums has fit into your lives overall. You’ve each touched on it, but could you share what was going on that made locums the right move at that moment, and whether it’s delivered what you were looking for? John, we’ll go to you again.
Dr. John Oglesby: When my hospitals were sold, I didn’t quite know what I wanted to do, but I knew I still loved clinical practice, and I saw so much need around me — so many practices just needed help. That’s why I jumped into locums, and it’s fit in wonderfully. I like the idea of sharpening the saw so it cuts better — I used to take six to eight weeks off a year in private practice for personal time, vacation, and medical missions; now that’s grown to ten to twelve weeks, especially since becoming a grandparent. It’s fit my lifestyle beautifully, right down to small things — I have a Peloton I ship between assignments (though now I sometimes just sell it to someone local and buy a new one). I’ve discovered amazing food I never would have tried — homemade tortillas in Washington, incredible seafood in Oregon. It’s been a great experience, and I tell people: don’t knock it until you try it. The hospitals I serve are genuinely grateful, too — without locums coverage, some of them would have to shut down services entirely.
Dr. Mark Pool: I appreciate that — John’s had better balance in this than I have. I didn’t take my kids’ or wife’s birthdays off in private practice; I tried to be home but usually wasn’t, and took maybe a week off a year total. I was basically a workhorse. Locums has been a real difference for me — it’s given me a lot more time, though the downside is being away from my wife and kids, which is something of an Achilles’ heel if you’re doing this full-time. I think it’s nearly perfect for physicians who are retirement-age or nearing it — you can stay in the game and keep your skills sharp, but with real control over your schedule, without working yourself to exhaustion. For me, the extra time — especially evenings, and sometimes during the day — let me finish an online MBA last year, something I definitely wouldn’t have done if I’d stayed in practice. I’m now in a doctoral program in leadership. I like to think locums put me on a different path I didn’t know I needed.
One of the things that opened my mind to trying locums at all was learning about the IMLC — the Interstate Medical Licensure Compact. I’d never heard of it before. When an agent first called me about locums while I was still in practice, I brushed it off — I assumed getting licensed anywhere new would take as long as my original Texas license, which took six months, and I couldn’t see how that would ever line up with an actual opening. But once I decided to leave my practice, an agent explained the IMLC: if you have a license in good standing in one member state, you can get licensed in other member states much faster. I applied and was approved in about a week and a half; my next state license, for Michigan, came through in about four days — shockingly fast. It’s worked that way ever since, and the locums agency covers the cost of the license and DEA registration. On the credentialing side, most facilities bend over backwards, since they need you there — most have given me temporary privileges so I can start within a couple of weeks, with full privileges following. Both of the things I assumed would be barriers turned out to have easy workarounds.
Family life on locums
Dr. Jordan Frey: Could you each share how this has impacted your family life? If you’re away for stretches, do your kids ever visit, or travel with you?
Dr. John Oglesby: Yes — depending on where I am, my kids can definitely come along, even if they end up doing the local touristy things on their own while I’m working. My kids visit more than I expected; they love the house I stay in on the Oregon coast — it’s on a cliff with sea lions outside — and honestly, this lifestyle has been much better for our family than before, when my wife and I would each take a car with different kids and never quite know when everyone would be home. Now, if they’re coming out for a visit, I try to take real time off; other times they’ll just fly out for a cheap weekend from Salt Lake City. I love the quality family time this affords, and not having the constant burden of being on call at a second’s notice.
Dr. Mark Pool: My experience has been good in a different way. When I’m home, it’s genuinely great — I used to be tired and, frankly, grumpy, from being on call almost constantly, and there’s a real psychological load to that. Now when I’m home, no one can reach me — the hospital calls, and I can say, sorry, I can’t help right now. That’s a real freedom of mind. Coming home is different, too — everyone’s happy to see me, and the time we do have together is better, even though there’s less of it overall. It’s a bit of a double-edged sword. My family hasn’t traveled with me much, though I keep telling one of my agents he needs to land me a gig in Hawaii, because I know they’d come along for that one. John’s point about older kids and an interested spouse is well taken — once housing is already covered, there’s not a lot standing in the way of a companion joining you.
Audience Q&A: Pitfalls and lessons learned
Dr. Jordan Frey: Let’s move into some general Q&A. If you could each list one or two issues you’ve run into with locums — pitfalls a beginner might not see coming that you’d now know to avoid — what would they be? John, back to you.
Dr. John Oglesby: First: just because a price is listed doesn’t mean you have to accept it. You can counter with what you think is fair for your time. The other pitfall is that every hospital has a different EMR — luckily most of my recent assignments have used Epic, but each build still has its own quirks, and you’re expected to be efficient on it the moment you arrive, so that takes some quick focus to pick up. The only real mishap I’ve had in five years was getting scheduled at two facilities on the same weekend — I’m still not sure how it happened, but it taught me to keep close track of my own schedule rather than assuming the agency has it fully sorted.
Dr. Mark Pool: Great point — I never used to rely much on a calendar, but now I check one every single day, partly because of exactly what John described. I also built a detailed spreadsheet — really a Google Sheet — tracking my assignment dates, expenses, and pay as a personal double-check, and I’ve never had a scheduling conflict as a result. You have to be organized: know your flights, know when call starts and ends. I used to be a spontaneous, let’s-grab-lunch-right-now kind of person, and now I’m scheduling vacations eight months out — it’s been an adjustment, but not a bad one. As for my own one or two issues: insurance has been a real one for me personally, and beyond that, I think locums requires a certain flexibility of mindset — maybe even personality — that doesn’t always come naturally to surgeons used to running things their way. You really can’t insist on doing things your way with a new team; it goes over much better to adapt to how they already operate. I’ve learned to ask upfront, through the agency, about specialty-specific support — how many PAs or mid-level staff are available, whether they cover nights and weekends, whether they help with rounding — since that can make or break the experience depending on your specialty.
Dr. Jordan Frey: Makes sense. One more question we can close on before I share Locumstory’s resources: is there an industry standard around occurrence versus claims-made malpractice coverage with tail coverage — especially relevant given, say, an 18-year statute of limitations in OB? John, this seems directly in your world.
Dr. John Oglesby: Welcome to my world — we’re on the hook forever in OB. Yes, agencies do always offer malpractice coverage, and that’s exactly why I’d say: choose your locums company carefully, and make sure they’re large and well-funded, because you don’t want your malpractice coverage to be lower quality than what you’re used to. In my case, it has to cover everything and last indefinitely, and that’s one reason I went with CompHealth — I’ve never had an issue or had to use it, though of course there are always near-misses in medicine, and I do everything I can to avoid an actual claim. It’s always been covered, and it’s worth confirming the type of coverage matches what you’re used to. It’s also part of why I don’t go out and set up my own direct arrangements with facilities, cutting out the agency — you’d have to arrange and vet that coverage entirely yourself, and in my field that would likely be very expensive.
Closing thoughts and resources
Dr. Jordan Frey: This has been incredible. Mark and John, thank you both so much for sharing your experiences and being a resource for all of us — I know I learned a lot, and it’s given me plenty to think about, even if just for the future. For anyone here, wherever you are in the process — whether you’re just learning, like me, or already doing locums and looking to optimize — I’d definitely recommend using Locumstory’s resources: the podcast is great, the free crash course is excellent, and there’s a lot more from physicians like Mark and John sharing their experiences on the site. Thank you both again for joining, and thanks to everyone who joined live or is watching the recording.