
In my first post on The White Coat Investor as a columnist, I detailed our retirement drawdown strategy. In that piece, I mentioned that, if an unexpected cost came up, we could adjust our budget, or I could do a locum job or two. A couple of comments pushed back on that, suggesting that the costs associated with maintaining credentials to do a locum were too great or that doing a locum would constitute “work” and so I wasn’t really retiring.
This is my effort to give clarity on this issue for others who are interested in retiring relatively young.
First, we have to address the Internet Retirement Police. Back in 2013, Mr. Money Mustache called out the myriad of people who said that, if you do anything for money, you’re not really retired and that calling yourself retired was disingenuous. There is an implication that, if you earn money after leaving your full-time job, you didn’t run your numbers correctly and, therefore, anyone else who wants to retire shouldn’t, because they can’t afford it. These people are fearful or naysayers or those who have a traditional perspective on retirement. I’m not going to argue with the Internet Retirement Police.
For everyone else—those who are curious and want to learn more—I write this column to you.
Why Locums Isn't Like a Full-Time Job
Doing a locum is basically a paid vacation. I most commonly do locum gigs of 2-3 weeks. Yes, I have to go to the hospital to manage cases and teach. Yes, I have on-call responsibilities. But I always bring my wife with me, and it’s almost always somewhere interesting or different—like Minneapolis or Saskatoon. Because of on-call responsibilities, we can’t take an hour-long boat tour or drive far away for a hike, but we can explore the local area easily enough. My wife has been using my locums for the past few years as retirement practice, and she’s learned exactly how to fill her days with engagement and meaning.
The experience of doing a locum differs substantially from my full-time job as a professor of veterinary anesthesia in the following ways.
- No administrative responsibilities: During locums, I’m not on committees that require me to read grant applications or deal with patient safety problems. I’m not on search committees with no applicants that involve sending out letters and emails to anyone who might possibly be interested. I don’t have to attend department or section meetings. I don’t have to try to schedule other committee members for a meeting because I’m the chair and that’s a lot of what the chair does. I don’t have to promote faculty development opportunities. I show up, I help patients and students, and I go home.
- No resident responsibilities: Yes, I may teach residents on clinic duty, but residents take up so much time other than clinical teaching. It's reading all of the applications, conducting interviews and doing the ranking, going to journal club, choosing articles to present, and teaching their higher-level classes. Most of them are inexperienced researchers, and many of our residents have English as a second language. The amount of time and energy to mentor them through their research projects was substantial.
- No classroom or laboratory teaching: Although the workload is shared well, taking most of your afternoon to supervise students in the surgery lab is a real drag on productive time. Writing lectures, delivering lectures, writing exam questions, and dealing with student accommodations takes time, and, more importantly, it's emotionally draining.
- No research responsibilities: Although I thoroughly enjoy doing research, the vast majority of my work these days is supervising mentees—students, grad students, residents, and junior faculty members. That is rewarding on its own, but I’m not sure I would do that if it weren't a requirement. I would probably conduct my own research projects on my own time, but taking care of everyone else’s projects is largely a collegial responsibility.
- Independence: My full-time job does not really allow for a part-time option. Even if it did, we want to live somewhere other than where my full-time job is. We can retire and move to our preferred residence, and then I can fly out to locums when I am interested. It’s a way to step down your full-time work if your job doesn’t allow for a part-time option.
More information here:
Locum Tenens: What Physicians Need to Know
How to Get Locums Work Without a Locums Agency
The Financial Benefits of Locums?
For me, a locum is not like doing full-time work. In addition, depending on your discipline, it may be more lucrative. In my field, we usually get between $5,000-$8,000 a week on locum. If you multiply the bottom of the range by 49 weeks, you have $245,000, which is about $50,000 more than I was earning working a full-time job. Of course, that would require your schedule to line up perfectly for multiple locums, which is unlikely in my discipline.
We also need to look at the impact of earning extra income on your Financial Independence Retire Early (FIRE) finances. If I do just two weeks of locums a year ($10,000) for 30 years, it’s as if I had an extra $350,000 of invested assets (based on a 3.5% withdrawal rate). How long would I have had to work to earn that additional $350,000? Assuming our historical savings rate of about 50%, I would have had to work another 24 months. So, in return for 2 weeks × 30 years = 15 months of lifetime work, I could retire 24 months earlier. Now, it’s unlikely I will want to be doing locums into my 70s, but the point is that earning additional income after retiring from full-time work can have a substantial positive impact on your bottom line.
Let’s look at a more realistic scenario.
Currently, using the Rich, Dead, or Broke data, I have a 98% chance of being dead at 97 (a 50-year retirement). Using Big ERN’s SWR toolkit, a 4% withdrawal rate gives an 8% failure risk. Assuming I do two weeks of locums a year for $10,000, taxes and other costs end up being $3,000, and I do this for the first five years of retirement, how much impact does that have? The 8% withdrawal rate failure risk goes down to 4.8%. That means for 10 weeks of “work,” which is largely engaging and enjoyable for me, my chance of being broke is reduced by 40%. Maybe that’s worth it to you, maybe it’s not. But it’s wise to run the numbers. We’ve decided it’s worth it to us.
Another financial benefit from doing locum work in retirement is keeping your taxes low. Since you are running a business, you can now deduct expenses associated with it, including your maintenance of specialty certification, continuing education expenses, and—most importantly—health insurance premiums. Even though you have earned income, you may not have to pay any more in taxes.
More information here:
Lessons Learned from Achieving Financial Independence
Retirement Income Strategies — And Here’s Our Plan for When We FIRE
Keeping Up Your Skills with Locums
Doing locums work also allows you to maintain your clinical skills. This will vary by industry or specialty. But maintaining some clinical skills may be worthwhile if you decide you want to take on a full-time job again or if something drastic happens requiring you to go back to full-time work. This won’t hold true for decades of only doing a few weeks of locums a year, but, for a few years after leaving full-time work, keeping some skills may be helpful. Furthermore, it keeps me somewhat plugged in to my industry and aware of changes that I may want to be aware of for my own purposes (e.g., my pets’ care).
The other great potential opportunity, at least in my field, is to do a longer locum in a distant land. Every now and then, locums for 3-9 months (usually to cover parental leave) come up overseas, such as in New Zealand and the UK. Not having a full-time job allows the chance to spend a longer period of time in another country, which could be a fun adventure.
I don’t consider doing some work in retirement being “not retired.” The point of leaving full-time work is to spend more of your time how you want, but it doesn’t mean spending every minute doing nothing. In fact, having time for more and longer locums is a motivation for my retirement. I believe locums work is dramatically different from my full-time job, and I am happy doing a locum here and there to get a “paid vacation.” I don’t consider doing a locum or two to help pay for a roof repair to be a catastrophic failure of retirement.
If your vision of retirement is to sit on the beach and slurp down tiki drinks all day every day, that’s great. If you want so much money that you will have a sub-2% withdrawal rate, that’s great. Personal finance is personal, so everyone’s decision has to be unique to them. We decided we would rather stop full-time work relatively young and have a very comfortable lifestyle rather than continue to hoard money.
Do you consider locums work to be on the same level as a full-time job? Would you participate in locums even if you're retired? Why or why not?
I’d be interested to know if any human doctor locum jobs allow you to do specialty-specific work with only two weeks a year of practice. Because there is zero chance you would get credentialed at my hospital.
Also, you work for two weeks a year and deduct a year’s worth of health insurance premiums? Tell me more.
I’m not sure there is a minimum amount of work requirement to deduct your health insurance as a self-employed person. It goes on Line 17 of Schedule 1. The instructions for that line say:
Line 17
Self-Employed Health Insurance
Deduction
You may be able to deduct the amount
you paid for health insurance (which includes medical, dental, and vision insurance and qualified long-term care insurance) for yourself, your spouse, and
your dependents. The insurance can also
cover your child who was under age 27
at the end of 2024, even if the child
wasn’t your dependent. A child includes
your son, daughter, stepchild, adopted
child, or foster child (defined in Who
Qualifies as Your Dependent in the Instructions for Form 1040).
One of the following statements must
be true.
• You were self-employed and had a
net profit for the year reported on
Schedule C or F.
The insurance plan must be established under your business. Your personal
services must have been a material income-producing factor in the business.
If you are filing Schedule C or F, the
policy can be either in your name or in
the name of the business.
But if you were also eligible to participate in any subsidized health plan
maintained by your or your spouse’s employer for any month or part of a month
in 2024, amounts paid for health insurance coverage for that month can’t be
used to figure the deduction. Also, if
you were eligible for any month or part
of a month to participate in any subsidized health plan maintained by the employer of either your dependent or your
child who was under age 27 at the end
of 2024, don’t use amounts paid for coverage for that month to figure the deduction.
I see nothing in the instructions to suggest a minimum amount of work. I don’t think you even need to earn more than the premiums cost to deduct them, although businesses must eventually make a profit or they will be reclassified as hobbies.
As far as how much work in the last year to get credentialed, 2 weeks probably isn’t enough at most hospitals I agree.
I haven’t heard of any veterinary hospitals doing credentialing, so this is definitely a difference. We discussed it at one academic institution where I worked but it never evolved. In some ways veterinary medicine is highly developed and advanced (3T MRI, intracardiac fluoro procedures), in other ways it’s 20+ years behind human medicine (esp. patient safety culture and communication IMHO).
I am “semi-retired” as an anesthesia provider. I work less than 60 hours a month at a surgery center close to my home and I am a W2 employee. I am over 65. I contribute maximally to my 401k, and contribute to Roth . I am contributing hours towards a small pension and my social security is going up yearly as my earned income is high enough to subtract out some low income years from my work history . Yes my social security income is taxed, which is true for most who have saved and invested for retirement. I did try the 1099 route for a while but it was too stressful for me
My job is very flexible, I work when I want. It keeps me mentally engaged and is a social outlet. I have disabled family members and these extra funds help me to save for their futures. I am also able to travel with my wife and pursue other interests for weeks at a time.
Nancy, that sounds like a nice balance! One of the nice things about financial independence is the ability to work _if you want_ and as much as you want.
As a fellow anesthesiologist, I worry about losing my skills just by decreasing from full-time to part-time. How rusty do you feel working less than 20 hours per week?
I’m at around 80 shifts a year in EM at a busy trauma center. I wouldn’t say I feel rusty, but I generally feel more stressed than I felt when I was working 16 shifts/month and doing literally 2.5x more of [whatever]. Then again, a difficult dumpster fire of an airway was stressful back in the old days too. I think a solid foundation at a busy shop for many years has been the key to success. A lot of it is just logistical stuff and not mission critical, such as the new paracentesis tray doesn’t have lidocaine.
This is a legit concern for long term part-time work and something I have thought about a lot. I think there are a few keys.
# 1 Don’t go part-time at the beginning of your career. It takes time to solidify skills and knowledge.
# 2 You need to work a certain amount. Working 0.4 FTEs (6 shifts a month) like I do is very different from working 2 shifts a month. My partnership passed a rule long ago that you couldn’t work fewer than 6 shifts a month and remain partner.
# 3 Even at that minimum amount, there is no way you stay as good as someone working full time and every year it gets worse. What is probably fine for 2 years at the end of your career may not be fine for 20 years. I think I’ve been at 6 shifts a month now for 5 years. I’m not sure I should do it for another 15-20. My original plan was to go part-time in my fifties but probably not to work at all past 60. I think that sort of thing is fine. But starting at 42 and still at it very part-time at 62? I’m not sure that’s okay. Probably varies by specialty, person, and job though.
Great comments. We also have a 6 shift minimum but you have to be at 15 years of seniority to take advantage of that. I am also at 5 years of this; I had not considered your third point. If things come together as planned, I will have 7 years of this before transitioning to something different (i.e. not the busy trauma center). So far, that seems okay.
All that said, I accept a lot of transfers from folks who have never had any training at all in EM. So how bad could it be to work in a rural critical access where the alternative is a “provider” who has also not done X procedure in the last year…in fact, they’ve NEVER done it.
I think it’s definitely important to reflect on the possibility of skill deterioration. As a single anecdote, I’ve been off clinical responsibilities for 3 months and this week all my blocks were successful and my first at-bat was successful for a central line and art line in a 2.8kg cat. Maybe I got lucky.
There’s actually not much research on this phenomenon in late-career practitioners. There’s plenty of evidence in students and residents that more practice results in less degradation of skills. It seems to be in the 6-12 month range after the last training opportunity. After a lifetime of practice? Maybe it’s the same degradation, maybe it’s not. There’s a significant confounding factor of increasing age, which definitely degrades skills.
I would not suggest a single 2-week locum a year would be sufficient for maintaining skills for any length of time. Doing several of those a year for 3 years? Doing a 6 month stint a year after retiring? Definitely depends on your specialty and age, but I can’t find compelling evidence that, after a lifetime of practice, your skills fall off cliff.
https://journals.lww.com/academicmedicine/fulltext/2004/10001/deliberate_practice_and_the_acquisition_and.22.aspx
https://pubmed.ncbi.nlm.nih.gov/32968968/
https://pubmed.ncbi.nlm.nih.gov/31046500/
https://pubmed.ncbi.nlm.nih.gov/34099989/