By Dr. Leif Dahleen, Columnist
I've been a practicing anesthesiologist for about 10 years. For the last couple years, I’ve been an employee of a health system, practicing in a small community. Earlier in my career, I practiced as a locum tenens physician for several good reasons. Now, locum tenens is an option I keep in my back pocket in case the need or desire arises again. Although it is not ideal for everybody, locums work can be rewarding and useful at any point along one’s career path.
Defining Locum Tenens
What exactly is locum tenens? The words are Latin for “one holding a place”. When you are hired as “a locum”, you are holding the place that might otherwise be filled by a local physician. Locums are hired for a host of different circumstances. Vacation coverage, extended leave, inability to fill a position, and increased demand are among the most common reasons. Assignments range from a few sporadic days, to several months, or even years. Many locum positions can be parlayed into a permanent position if it’s the right fit for both parties. Some specialties lend themselves more readily to locums, but there are needs in all specialties.
Locums Straight Out of Residency
I first learned about locum tenens opportunities in anesthesia when I attended the large national meeting as an intern. I talked to a number of the staffing companies and did some online research. I liked what I learned and figured I knew how I would start my career 4 years later. When my friends were applying for full-time jobs, I was applying for 10 state licenses. When they were interviewing with potential partners, I was interviewing staffing companies. Before I finished residency, I had my first three assignments lined up.
I was a full-time locum for nearly two years after residency. This was great for me personally, professionally, and financially. I worked in five states with assignments lasting as little as one week and up to nine months. I even did locums within locums, leaving my regular locums job one week a month to work elsewhere. I learned the ins and outs of the locums life pretty well.
Personally, I was engaged when I finished residency and we were married a year later. As a free agent in the workforce, I was able to find work close to the internship into which my wife matched. If I had taken a full-time job, we might have spent 9 months apart, delaying the ability to start a family of our own. We both enjoy travel, and being a locum allowed us to “slow travel”, living like a local for the amount of time my services were needed in a location that we chose. We made great friends as we traveled. We are now Godparents to 5 children in 2 families in the places we did locums in those 2 years.
Experiencing Different Styles of Practice
Professionally, I was able to “hold a place” in a range of different practice environments. I worked in a large, government teaching hospital. I spent time in rural critical access hospitals, and other places in between. I supervised anesthetists and residents, I taught, and I provided in-room, hands-on anesthesia. I saw more clearly firsthand what I had been taught in residency, that there are “many ways to skin a cat”, although I’ve never had a reason or inclination to actually do such a thing. Nevertheless, locums gave me an education that helped me discover how I might best spend the rest of my working career. It was like a 2-year fellowship with an attending’s salary.
Banking the Cash
Financially, locum tenens can be lucrative. Some positions may pay less than a partnership position in private practice, but you can do quite well for yourself. There is some overhead that the hiring group or hospital needs to pay, much of which benefits you, but essentially comes out of your pay. If you go through a staffing agency, the company gets its cut too. In terms of expenses, I was able to live like a resident for a couple years, but with housing, travel, and a rental car provided. Since we took mostly long-term assignments, we were able to score furnished apartments rather than hotels. Food was paid for with a per diem, and the paychecks piled up. I had incorporated an S-corp and worked with a CPA to pay myself a salary and distribution (there is some tax benefit to the distribution). I started a SEP-IRA and was able to sock away $45,000 a year, tax deferred; today the limit has been raised to $53,000. A solo 401(k) is another [better-ed] option.
Locum tenens work has other positives. You can largely avoid the local politics that inevitably come with a permanent position. You can deduct any expenses related to your work and travels, lowering your taxes. Typically, you are paid by the day and by the hour. A longer than average workweek is quickly rewarded with a larger than average paycheck. You have a say in the assignments you accept. If you want no call, you take a job with no call. If you want lots of hours so you can afford to buy that boat, you can find a job with a boatload of call.
Downsides of Locums
What are the negatives? Some are obvious; if you’ve got a family, it’s tough to be away. Assignments can be cancelled after you’ve signed or even after you’ve started. You can’t always rely on a steady paycheck. If you are doing locums exclusively, you are responsible for providing your own benefits package. On assignment, you’ll be “the locum” and may be treated differently than other physicians, although I’ve always felt I was welcomed and treated quite well.
Post-Locums Life
As I mentioned earlier, I eventually transitioned from a locum to a “permanent” physician after a couple years on the road. As was the case with most places I had worked, there was a position available to a willing and competent physician. After a few months as a locum at this hospital, having had the opportunity to “try before you buy”, I signed a contract to return full time. I started the job and started a family and all was well. The position offered a fair amount of time off and of course I used some of this vacation time to work locums elsewhere a week at a time. I used the extra money I earned to pay down a mortgage and start my first taxable investing fund.
Bonus Points for naming the 5 peaks in this picture
Locums in Mid Career
After a few years, all was not so well. I used quotation marks around the word “permanent” earlier because the hospital went bankrupt and the permanence of the position vanished into the ether. Did I panic? No. I went back to what I knew well, locum tenens work.
I was able to spend a couple weeks at a hospital down the road as a working interview. Prior to those two weeks, we were seriously considering that job. Two weeks was enough time for me to realize that it wasn’t the best fit for me. I spent a couple more months at another hospital further down the road to keep a steady paycheck coming in. But locums was no longer personally rewarding. I had a wife and two very little boys back home and I was gone 24 days a month.
After another semi-permanent job (during which I did more locums), I settled into my current and presumably final permanent full-time position. How did I find this job? I worked as a locum here seven years earlier, and they happened to remember me in a favorable way.
My current contract doesn’t allow for locums work without an extensive approval process, and I’m OK with that. When I was younger, the experience and money were what I needed professionally and financially. Today, I’d rather spend my time off at home with my family, or typing words onto a screen for you all to read.
Locums At Career End
One last time that locum tenens can be a great option is at the tail end of one’s career. Taking your skills and experience on the road might be an ideal way to spend your last few years as a physician. You can work as little or as much as you like, and be picky when choosing your destinations. Consider working in places you might want to retire to find out what life is like there. Work in places you might otherwise never visit. Alaska is lovely in the summertime. I hear good things about Australia and New Zealand, and yes, there is locums work there. Have stethoscope, will travel.
What do you think? Have you done locums? Did you enjoy it? Was it at the beginning of your career, at the end, or after trouble at your real job? Comment below!
Going through an agency is always a huge pay cut. With that said, if you have issues with your payment then they will sort it out.
No doubt, Rex. I’ve never been on the hiring end, but I’m sure other readers have and could weigh in on the agency fees. I usually worked with an agency, but there were a couple times that I contracted directly with the hospital / group.
Financially, I wasn’t in a good position to negotiate, as both were positions I requested / created. Financially, neither of those stints worked out well for me, but there were fringe benefits. One was the working interview I mentioned, and the 2 weeks was valuable in our decision making. The other got me a foot in the door in the place I call home today.
I have been doing locums exclusively out of residency for 2 years and have found the opposite to be true for my specialty. I make more than 100k over what I was offered at the institution where I did residency and 75k more than the local community hospital there; and that is factoring in taking 4 weeks off a year plus every night, weekend and holiday (I work for a state institution). I also have the benefit of not starting low on the totem poll and getting all the undesirable work in my field and covering for everyone while they take vacation and I am offered far less time off.
However, I use my husbands health insurance benefits which also helps financially. I do think locums is a great option in particular for married folks who want flexibility and have a partner with job benefits.
The benefits early on in the career seem favorable for the networking potential and for those with flexibility travel wise. Its nice that there was a buffer on the personal end of things to be able give it a go, thats always an important factor. From a logistical standpoint, the paperwork requirements for going through the state licensure process to be much less cumbersome coming out of residency, assuming you have spent the majority of residency at one institution. Although there are options to help outsource some of the leg work, I know a doc that went that route and it sounded a bit more economical to just take the time and do it yourself if able.
You bring up a great point, Dr. J. When you are in residency, you probably have only 1 state license and little work experience as a physician outside of residency. If you’re considering doing locums and you’re a resident, NOW is the time to apply for any state licenses you think you might want to use later on. There will be some carrying costs, and you may never use them, but they are simpler and cheaper to attain now versus later.
Once you’re out in the real world with some work experience behind you and a handful of licenses, not only do the applications become more cumbersome (listing all dates and contact info for hospitals and references where you’ve worked), but you also need to contact each state where you have a license, and pay a fee to have that state send a verification to the state you’re applying to, stating that you have a license with them in good standing.
For these reasons, I chose to apply for 10 state licenses as a resident. I had to apply for one more after about 6 years of work, and it was not fun. Of those 10, I believe I used 5 (never worked in Hawaii, darn it!), and I’ve let most of them lapse now that I’m (presumably) in my final permanent job.
If I do any locums as I wind down my career, it will probably be overseas to create an awesome experience for my family and me. I’m currently 40 (like Dr. Dahle I believe) and looking to retire from clinical medicine within 10 years (unlike Dr. Dahle), probably in closer to 5.
Best,
POF
Interesting perspective. Thanks. Another option for docs with less ability to be mobile is telemedicine. The Interstate Medical Licensure Compact (read about it here: http://licenseportability.org) is making it much easier to get multiple state licenses. So far, 12 states have enacted the process with 14 more soon to do so. If Alabama is doing it, I feel it is likely just a matter of time until it is available everywhere as we are almost always the last to do anything new or progressive. Best wishes.
Thanks for sharing the link, Dr. Mom. The Licensure Compact is an idea that is long overdue. I hope for others’ sake that you are right about other states joining in. The 12 that have probably represent 5% of the US population.
Telemedicine is an intriguing option for many. It’s too bad I can’t easily place art lines and endotracheal tubes that way. I do know of an anesthesiologist who has incubated remotely via robot though, so never say never!
I think that our governor being a dermatologist may responsible.
Possibly. More doctors in the state legislature helps too. Just glad to see us leading the way in anything positive. While only 12 states have enacted it, 14 more plan to this year. That’s got to help make multiple state licensure easier. It is also a lot of ground to cover if one is looking for interesting new locations to try out.
Regarding the solo 401k versus SEP- I currently have a SEP IRA as a locums and was under the impression that it was more expensive to maintain/have a solo 401k so I went with the SEP. Now I am having serious second thoughts.
Will the solo 401k allow for a backdoor roth while a SEP does not?
What are the other solo 401k benefits I am not realizing? Is it that you are able to contribute more if you make less? For example, if I made 100k in a year I could only contribute 25k to a SEP.
I do not anticipate, barring any huge emergencies, requiring a loan from a solo 401k which looks like another benefit.
Yes.
You can max it out on less income.
You might get a little more asset protection in your state from a solo 401(k). And the loans.
Remember that you can basically contribute 20% of your gross to either as an employer contribution, but a solo 401(k) can also take an $18K employee contribution if you haven’t used it elsewhere.
thank you! I am going to switch over asap since I just paid off all my loans and am now working on maxing out my retirement for the year.
Awesome, thanks for sharing! Can you comment more on the finances involved with agencies? I did locums out of residency and skipped the middle man–unfortunately, I think my sights were too low and I significantly undernegotiated.
For a year, I got to see different hospitals and different systems, which made me realize the value of the gem I found with my permanent job. From my memories, the biggest downside is not knowing the staff. Now, I can call up my hospitalist and get a patient admitted because I’m worried about them even if their numbers are acceptable–try that with someone you don’t know. Also, if a nurse that I’ve know forever says you need to get in here now, I know exactly how to interpret that.
Anytime, G!
As I wrote to Dr. J, I didn’t do well financially the couple times that I worked outside of an agency, but that was mostly due to circumstances that prevented me from being in a position of strength to negotiate, and at least a whiff of naivety.
I’m hoping to hear from some readers who have hired via agencies. I don’t know what the typical take is, but based on the referral fees they advertise, I would guess it’s a fair amount. I heard a ballpark figure of about 30% once, but some of that was spent on my hotel, rental car, per diem, etc…
Good call on another drawback – the lack of familiarity with the hospital, its people and culture can make your job more difficult. It’s less of an issue with longer term assignments. My longest was 9 months, and I worked several others for 3 to 5 months. But I still remember people from my 1-week assignment nearly ten years ago. When you work in an OR, you get to know your coworkers quickly.
Best,
-PoF
I have been a locum for about one year. I have now worked with several agencies, and talked with many more. I highly recommend staying away from agencies. Their cut is unreasonable, and you are not their client. First, PoF’s response of 30% of your base pay is the minimum that these companies take, most of these companies attempt to take more (from 30 to 100% of your base pay for as long as you work there). These agencies clients are the healthcare systems -not the clinicians. This is abundantly clear, as no agency representative is trying to negotiate on your behalf to increase your pay. On the contrary, the agencies are motivated to get you to accept the job at the lowest rate (the lower your base pay-the more they make). What do agencies offer to justify such a hefty fee? They provide malpractice, travel, and housing. All of these expenses are easily covered with 10% of your base salary. So what do you get from the agency for the other 20 to 90% of your base salary that they are making? Notification of jobs that are posted on public websites, and help with paperwork/licensing…NOT WORTH IT. I recommend just calling up the clinic/hospital/organization where you want to work directly and ask for the person in charge of clinician hiring. Fill out the paperwork/licensing yourself, and provide your own malpractice insurance. This will allow you to negotiate directly and increase your salary by 30 to 100%.
I find it unlikely that a locums provider can collect 100% of your base pay unless the base pay is a relatively small amount of the total compensation. 30%, however, seems very likely and about what I would expect. That’s about how much a corporate EM contract management group skims off of physician earnings. Whether that’s worth it to you or not probably depends on the person and how good you are at finding the job yourself.
Are their more chances of getting sued? As you are moving from one place to another and may not know where all the stuff is or may not have access to stuff like glidescope. Plus who provides the tail coverage for so may States?
Yours are valid concerns, Dr. PK.
One agency I worked with had occurrence coverage. The others had claims made coverage with tail provided. If you contract directly with a hospital or group, you may be able to be covered under a policy they provide (happened for me the 2 times I did that) or you can purchase your own coverage, which I believe can be paid for a day at a time, but it’s not cheap.
Be sure to obtain a “face sheet” outlining your malpractice coverage when you start an assignment. You will need it in the future for credentialing purposes.
Are you more likely to be sued as a locum? The best protection is to be humble, friendly and competent, and know where your emergency equipment is. If you are well prepared, I would content you are not increasing your likelihood of a malpractice suit just by being a locum.
Contend, not content. DYAC!
I’m about to enter my 3rd year or internal medicine residency & am seriously considering locum tenens.
I have a few questions that I’ve been having a hard time finding good info on:
1. Anybody have thoughts on how locum tenens affects student loan repayment? I don’t think there’s anyway I could make that time work toward PSLF, and I wonder if that tradeoff is worth it.
2. Has anybody ever tried doing locum work as a two-physician family? My wife is family medicine, and we’d be interested in doing locum work together (or in the same region) if possible.
3. Any general tips on choosing a staffing agency?
Thanks!
My best tip would be to talk to the folks a few years ahead of you that did locums. Hopefully in a big program like IM, there will be a few. For me, that gave me leads on a few different gigs in town, so I just shacked up in a buddy’s spare bedroom and moved my limited possessions into a storage locker for the next year while I travelled. Branching out from my home, I found places that were advertising for need and I just got in touch with the hospital directly.
1. Independent contractor jobs are not going to count as 501c jobs even if you work there.
2. Yes. It works and is not difficult.
3. Search around. There are hundreds of agencies, thousands of recruiters, taking us around the globe. We enjoy the process of interviewing, so it is fun for us.
You’ve gotten some good answers, but I can speak a bit more to #3. Before I started, I thought I would choose a handful of agencies and take the work that they had to offer. I chose about 5 that seemed to have the most work in the states I was licensed and chatted with them and sent in all my credentialing information to streamline the process when the jobs came in.
I think I only worked with one of them once. I ended up finding jobs that I wanted, and going through the agency that was offering it. The agencies are not all identical, but I didn’t find them to be all that different, either. If given the option (and some jobs will be represented by multiple agencies), I’d go with the agency that has a longer track record and offers more jobs.
http://gaswork.com was the go-to locums board in anesthesia, and I believe it still is.
Being on a credentialing committees and executive committee one big issue with locums is the credentialing process. You need to document every place you have been in and every license you have. The list can become huge making the credentialing process very time consuming for you as well as for the medical staff office. if normally it takes 2-3 months to get credentialed, it may take 3-5 for a locums physician.
Lastly, as someone who hires physicians, I am always skeptical of a doc who has had multiple jobs. This always becomes a topic of conversation during the interview process. I need a damn good reason to hire you if you can’t keep a job for more than a year or two. I see two kinds of locums docs. Ones who do it because they want to, and those who do it because they must. What I mean, is that they are either really good docs who just love to be in different places and like the variety. Or they suck and can’t keep a job and therefor must travel to get paid. This requires a good interview process and calling places they have worked in the past to figure out who they really are.
If that dichotomy is all that you see, then it must be pretty easy to separate the two.
Weird that you are so skeptical…but whatever.
Enjoying life is important.
I’m sorry it came out appearing skeptical. I am not skeptical at all. I have met and worked with excellent locums physicians. Just want people to realize how they are viewed from the hiring side.
Hmmm…
First it was: ” I am always skeptical”
Now it is: ” I am not skeptical at all.”
Buyer beware of anything you are selling.
Physicians are in demand and I definitely turn away many many offers from those who have poor/prejudiced hiring practices.
Ok, let me explain so there is no confusion. As someone who hires physicians I am skeptical of docs who have had multiple multiple jobs. These docs are either physicians who like to work at multiple places or physicians who can’t keep a job at a single place. It requires some serious research to figure out who they are.
Obviously I have offended you by my skepticism which was not my intention. I am sorry. Unfortunately many share this thinking. Believe me or not, but it is reality.
Lastly, yes there are plenty of work for a physician, I have nothing to sell you, nor are we hiring.
I feel the same way when I see a CV with a bazillion prior jobs. I’ve hired docs in two different scenarios. If someone is looking for a long-term job two states away from where he lives (and not planning on moving), there is probably something wrong.
Odd, WCI. Two states away is just a matter of minutes on the East Coast. And then there is the whole gamut of telemedicine which it appears you are not familiar with.
Look. I had to manage the doc. He was a terrible doc. The reason he was commuting to a job two states away (and no, it wasn’t minutes, it was a solid 8+ hour drive) was because he had burned all his bridges locally. After a few months, it became clear why no one who knew him would hire him. We weren’t hiring someone to do telemedicine. We weren’t hiring someone to come work in Hawaii for three months. We weren’t hiring someone to fill in for someone else’s maternity leave. We were filling a slot in a lousy ED that wouldn’t offer the going rate for good docs. And what did we get? A doc who commutes two states away because he has to. What does his CV look like? 6 months at a time at 25 different jobs. That’s a huge red flag and you’d better have a good explanation if that’s what your CV looks like. That explanation might be “My spouse and I love to travel so we do a lot of locums.” Fine. If I’m desperate, I’ll call a few of the old hospitals and see if your story shakes out or if they had problems with you. If I’m not desperate, I’m probably going to move on to the next CV. It’s a fact of life among docs who hire other docs and just because you don’t like it doesn’t make it any less true. The job I’m in now is filled of docs who have been here their entire career or perhaps one other place before coming here or perhaps a few years in the military. Hiring and firing isn’t much fun. We don’t want to have to do it any more than we have to. When I see you haven’t spent more than a year at any of your last 10 jobs, I figure you’re probably not going to spend more than a year here and I take a pass.
Or, if you’re not particularly desperate to hire, you just move on to the next CV and don’t worry about it.
Alex, you get to be on Credentialing and Med Exec? Lucky you! Well, somebody’s got to do it, so thank you.
You are right about the credentialing being cumbersome. I’ve noticed that the packets have gotten thicker over the years. When I started 10 years ago, most applications were fewer than 10 pages. Now, they seem to be more than 20. And as the locums doc’s work history grows, so does the verification process. Try getting a verification from a hospital that went belly up.
There is some truth to the dichotomy. I believe I’ve been among the former, but I’ve worked with some docs whose skills or bedside manner were noticeably lacking. I think they are in the minority, but their existence causes locums physicians to be “profiled”. The best you can do is put your best foot forward and lead by example.
I think this is a valid concern for the potential locums physician. I do think there is a certain wisdom to being able to say I’ve had a solid long-term relationship with Group practice X or Hospital Y, and they are my best reference, also I have had short-term locums assignments as well. I think there is value in maintaining some type long-term employer relationship so that you can show evidence of staying power, dedication, loyalty–all these qualities have value.
PoF,
Believe it or not, I really enjoy being I those committees. It’s fun.
That’s good to hear! I’ve served on them out of a sense of obligation, but I can’t say I enjoyed them. Hearing that others do makes me feel less guilty for avoiding them like I tend to do these days.
Here are some of the places that we have already worked: Alaska, Antarctica, New Zealand, Saudi Arabia, Tahiti. We are selective but it has been awesome for our family.
How do you find the overseas jobs? Are there licensure issues with them?
There are lots and lots of recruiters out there.
Every international company wants American-trained physicians. There are no issues except for some paperwork that takes a little time. It is worth it to us as we have always felt well taken care of.
Guest post!
I second the request for guest post!! Remember I did for you when you asked. ?
How to do you find international locums? I would love to find some Australian or European locums. Any advice how to look for foreign locums?
Off the top of my head, Global Medical Staffing (http://www.gmedical.com/) and medrecruit (http://www.medrecruit.com/) are a couple that have been around awhile. Dr. Google can probably point you to some others.
Another great option to look at when investigating medical locum agencies is [my company] which just turned 20 years old and mainly focus on providing locum placements for doctors as well as regulatory and migration services to help doctors live and work overseas.
Definitely worth a look: ———- [spammy link removed]
Any particular reason you posted this with your personal email address instead of your business one that would indicate you work for said locums company? Please don’t sockpuppet on this site.
Sorry, not trying to sock puppet, I have just been working very heavily in this area over the past few months and feel as though at least in terms of the Australasian region I have a pretty good understanding of the best options present for locum opportunities.
Would you like a list of all the Medical Locum Agencies that I have found within the Australasian region? (I can simply send it through to an email or alternative contact method if that is better).
Thanks!
It’s fine to share information, but if your goal is to advertise your company, I can put you in contact with my advertising manager [email protected].
What is not allowed on this website is pretending you are offering unbiased information while not revealing your position as the “digital marketing coordinator” of the company you are plugging. That’s sock puppeting, i.e. pretending you are somebody that you are not. I don’t have a problem with conflicts of interest; I do have a problem in not revealing them clearly. I shouldn’t have to Google your name and the company you’re plugging to figure out who you are.
That’s awesome! If I may ask, do you travel with children? How long has your typical overseas assignment lasted? And how was Saudi Arabia? I’m not sure how I would feel about working in the middle east.
Tahiti on the other hand…
We have done all work (and play) as a family– all children in tow. Shortest international was 3 months in Antarctica and longest has been 24 months. Saudi was rich. There is deep respect for American physicians, dentists and educators there. We had a gardener, chef, and weekend use to a private yacht. It was posh. The best part of Saudi was the kids’ school “field trips”: a week to the Swiss Alps, a week to Japan…you know, just a little jaunt.
Travel is not for everyone, but it is definitely how we live.
Wow, your life sounds amazing! The most “exotic” place I’ve worked is Naples. Florida, not Italy 🙁
This is a long shot considering how old this post is, but I’m considering a locums assignment in New Zealand and I’d love to get your take on your experience if you have the time!
Hello,
I’m in the process of reviewing a locums contract with a hiring agency for my Dr. husband and I was wondering if someone could tell me what the “market terms” are for contracts with an agency. For example, this contract:
1) does not offer a per diem for food
2) says that if he cancels with less than 30 days notice, he has to pay the agency for “lost profits” along with other damages
3) has a very broad non compete clause in that it prevents (i) working as an employee for a Client hospital of the agent (FINE SEEMS FAIR), (ii) providing locum tenens services through another agency to the Client (SEEMS UNFAIR AND UNDULY RESTRICTIVE).
4) The insurance is $1mm per incident and $3mm in the aggregate (is that too low or standard?).
Can someone let me know if these are standard terms or if I need to do a really good job of negotiating?
1. I guess if they’re paying enough, that’s fine. Don’t know what standard is, but who cares?
2. Seems reasonable to me. 30 days isn’t much time to get another doc.
3. Neither of those seem unduly restrictive. Just go to another hospital if you change locums services.
4. That’s pretty standard. My policy is $1M/$2M.
1) I wouldn’t worry much about a per diem if the pay rate is fair.
2) Not good. Not good at all. I’ve never seen a clause like this.
3i) Typically, if the physician were to become employed by the contracting group / hospital, the group / hospital would pay a recruiting / finder’s fee to the hospital. Forbidding employment is a lose lose. Your husband loses any chance to potentially work there permanently, and the agency loses a chance to collect a recruiting fee, which can be huge depending on the specialty. I don’t understand this one.
Note that if you are in fact hired by a hospital / group for which you did locums, the agency’s finder’s fee may reduce or replace any potential signing bonus. This is a downside to using an agency in a working interview situation.
3ii) This is common and not unfair in my opinion. If Agency A recruits you and does all the legwork, then Agency B contacts the physician after they’ve started and says they can pay an extra $50 a day, the physician might jump from agency to agency in a bidding war. Or the physician may renegotiate his or her own deal. You can go with any other agency at any other place, but I can understand the agency’s point of view here. They are providing a matchmaking service, and they do need to profit to exist.
4) It’s standard in anesthesia, and I’ve heard similar numbers for other specialties.
Good luck!
-PoF
The cancellation within 30 days is not good. I would strike that.
Thanks, everyone. I appreciate your feedback.
1) Also, I don’t think the food per diem is standard. But travel, housing and a rental car are.
2) If you can’t strike it completely, have them add a waiver for illness, injury, inclimate weather, etc.
3) Noncompete clauses are standard, but generally (somewhat) negotiable, the contract usually comes w/ a 2 yr clause, but you can easily negotiate it down to 6 months, if not away completely
Great post PoF.
I did locums as an RN straight out of training for several years, all the way through my last day of medical school, which I started 4 years later. From one day shifts up to 9 month stints on sites varying from ICU/CCUs, to shipyards, giving me great exposure as you also mentioned, meeting many people, landing a few FT jobs, moving on for reasons such as start of med school. I always experienced being welcome because needed and, indeed, never had to deal with the political nonsense of a site. Now after 20+ years in medicine, FI, and thinking about early retirement with my physician spouse, I’ve had a few brief conversations with international recruiters (AUS/NZ indeed appealing) but wouldn’t mind traveling some of the beautiful states in haven’t seen yet. The licensure for other states seems somewhat cumbersome and since I did a lot of moonlighting during residency in 4 hospitals, and had multiple (longer term) jobs as contractor since then, I assume that it will cost time and effort. My wife and I would both work (same specialty) and from what I understand from recruiters that would not be a problem. Dr Mom’s posted link is great, but our state is not part of it yet.
Very cool, Traveldoc. The freedom from local politics was one of my Top 5 Reasons to Be a locums Doc in a companion post @ physicianonfire. http://www.physicianonfire.com/1015-2/
The licensure requires time. If you’ve kept good records of your work experience with dates and addresses, it will be easier. We strongly considered NZ between jobs, but a perfect local job opened up close to my family, and I couldn’t pass it up. I may have another opportunity to go for a locums stint when I am ready to retire. My boys should be in middle school then; it could be a great family adventure.
Locums is great for networking. When I make it to the ASA annual meeting, I often run into, or make plans to meet up with, friends from my days as a locum.
Grand Teton, Middle, South, Teewinot, and Mt Owen. I’m 100% on the Grand Teton, less confident on the others. What is my prize!?
If you’re right, bonus points. Enjoy them!
🙂
-PoF
You’ve got 4 out of 5. You can’t see Mt. Owen from there, there being the summit of the South Teton. That last one is kind of tough. Technically it’s part of one of the other mountains and it’s blocking your view of Mt. Owen.
All I could see was snow, but no skis 😉
I have a bit of perspective to offer on a few of the above comments. My wife and I did locums (together) for about 6 months, between residency and fellowship. Mind you, this was about 13 years ago, so I hope I’m not relaying information that has become dated…
With respect to licensure, if you do locums for a Veterans Administration (VA) hospital/clinic, you can use any state license you hold. So we applied for licensure in the state in which our fellowships were scheduled, and we used that license to work in a VA hospital in a different state.
As far as salary, I believe we were making $50-55/hour, which we were told was less than we could have made at a private practice. But, all of our expenses were covered by the company (apartment, cars, etc), so at the time, it seemed like a ton of money for us. I will say, however, that the locums company tried their hardest to short-change us (tried to put us in an apartment big enough for one person, only pay for one rental car, etc) wherever they could, clearly in an effort to boost their net profit from their contract with the VA. We negotiated hard, to the point where we actually threatened to not get on the plane, the night before we were supposed to leave for the assignment, until they agreed to give us what we needed, in writing. Moral of that story: once you’re at the job, you’re in a weak negotiating position, so get everything in writing before you leave for the job.
The job wound up being great, though dealing with our handler at the locums company was so unpleasant throughout the assignment that my wife had to assume all communication responsibilities. I couldn’t speak with our handler without wanting to let loose with a barrage of expletives. Thank goodness for at least one cool head in our relationship.
I really never considered locums in OB/GYN. I have met one doc who was doing it 6 months at a time after he retired. He was finding jobs in Australia and New Zealand. Evidently in some single payor systems elective surgery piles up and this is what he was hired to do. I would be afraid to do it in the US because of medicolegal issues.
OB/Gyn as a specialty is a target for lawsuits, unfortunately. The 2015 Medscape Malpractice Report showed 85% of surveyed OB/Gyn physicians have been sued. Ouch. For anesthesiologists, it’s 58%.
One downside to Australia or New Zealand at the moment is the exchange rate. With a strong US dollar, getting paid in AUS or NZ dollars isn’t as attractive as it was 5 years ago. Of course, if you take a stint there, it’s for the experience and scenery, not the money.
Best,
-PoF
I’ve started to think about the Locum world. As it is now I’m a recent partner in a local Anesthesia group. The last year however has brought many changes to hospitals around me. I can think of seven groups that have either been taken over by national companies or merged with larger hospital systems. These events make me nervous for the future.
If my group becomes destabilized I’d give Locums serious consideration. Even further I’d look into becoming my own Locums entity. I’m sure it sounds easier than it is but the additional income and scheduling flexibility look appealing.
The anesthesia landscape has been changing fast. At least you’ve made partner. If your group is purchased by a large group or venture capitalists, you might see a sizable chunk of change.
Locums in anesthesia is very easy to get into, and can be a good option if you are in transition. There is plenty of work available. I probably get 20 e-mails a week from recruiters looking for help somewhere, and I haven’t done locums through a recruiter in four and a half years. Chalk that up to one of the downsides of locums; once your contact info gets out there, you’ll get e-mails and phone calls for years!
I’m sure you’ve seen http://gaswork.com. It appears to remain very active, with over 500 anesthesia locums jobs posted.
Good luck and I hope your situation remains stable. If not, locums remains a viable option.
Thanks for the info.
The credentialing process is a nightmare. 75 pages to fill out. 3-5 months to get credentialed, with multiple follow-ups. The longer you do locums, the more the paper work seems to increase. Your agency will not help you through this, its basically all on you.
If there was a way to streamline the process, I’d consider it again.
This has not been my experience. Definitely receive lots of secretarial assistance and not that many pages.
I don’t doubt that one credentialing process was a nightmare, but I’ve never seen anything nearly that bad!
I have noticed it becoming a it more cumbersome, from fewer than ten pages to twenty-some, but nothing approaching 75. I can’t imagine what they would be asking.
If you keep records (Word document or Excel) listing each hospital where you’ve worked with dates, address, phone number, e-mail and/or fax, and a reference, it makes the process pretty straightforward. Fill out “see attached” and attach your file.
You should have something similar listing your school(s) and training program(s) with graduation dates, addresses, phone number, etc… Every application wants the same info.
Be organized and it’s not a big deal; just takes a little time.
I’m an anesthesia resident at a great program.. I’m actually entering fellowship soon as well (interventional pain), but due to some illness in family that lives further away than I’d like and in a place I can’t see myself settling down in yet, I’ve started to think about doing locums.
Is there a resource you would suggest to help figure out what is the best and most economically efficient way to be a locums? I would be willing to do the work to be self-employed and not go through a company if that meant that I would make significantly more money. Now, I have absolutely no understanding of the financial aspects of it work and I would really need a step by step guide for dummies like me if I’m going to do it right!!
Isn’t that what a locums company is for? To help people who don’t know what they’re doing in exchange for a cut? Why not start there and then move out on your own later once you learn the ropes.
Haha. This is what I wanted to say, but couldn’t come up with the nice wording. Exactly. 🙂
Dr. Dahle makes a good point. I came out ahead by working with the locum tenens agencies. The first couple contracts that I negotiated on my own, I negotiated poorly, although I wasn’t in a strong position in either situation.
A starting point for you could be to look at what the rates are on http://www.gaswork.com. The range is probably $1200 to $1600 for an 8-hour day doing general anesthesia. Pain might offer more. Assume the locums agencies are keeping a decent cut for the work they do, and the reimbursements for your expenses, and you should have a decent idea of what to charge.
Another resource worth checking out is Locum Life. I used to receive the print magazine, and they have a website. http://locumlife.modernmedicine.com/ You may find some good information there.
Best of luck and congratulations on your upcoming graduation and fellowship!
-PoF
First time posting on WCI- this is a FANTASTIC website (Thank you, Dr. Dahle) and an excellent, balanced article on the merits of LT work (Thank you, PoF).
PoF, I especially enjoyed how you framed your perspective of LT work at different stages of one’s career. Of course, the benefit of incorporating and the HUGE contribution limits to the Solo-401(k) itself is also a big deal….especially for people interested in FI/RE! I will be a regular visitor to your blog and will be sharing this post with my friends.
Thanks, Nikhil! You can thank the good Dr. Dahle for adding the headings to frame the different career points. I wrote it as a narrative, and the subheadings break up the prose nicely. I broke it down in a similar fashion in a Top 5 Reasons to do Locums post on physicianonfire.com.
Thanks for visiting both sites; we’re glad you enjoy them.
Best,
-PoF
Thanks for a great post, I look forward to checking out your blog too!
A few questions, I’m thinking seriously of doing Derm locums part-time in about 3 years, when my office lease is up coinciding with my youngest heading off to college. I don’t expect to need the money, just enough to live on and let the retirement accounts coast (derm is so fun, why retire ?). It would be an opportunity to check out possible retirement spots, my wife and I could travel (hopefully Australia/NZ!) etc.
So my questions:
1) if you incorporate as an S-corp, do the agencies contract with you directly, or with the corp? Seems it would be advantageous the corp gets paid, then you put yourself on salary and could also hire an administrative assistant (spouse?) to coordinate travel arrangements etc – allowing a little more 401K dollars (or would that mess up a solo 401K option?)
2) Any tips for avoiding stepping into a hornets nest? Would you typically interview medical directors / potential immediate supervisors to decide in advance if you even wanted to accept an offer? How feasible is it to get out if there’s a “mismatch” and things aren’t as described?
Thanks again,
1) They would contract with whatever entity you use- sole proprietor, LLC, C Corp, S Corp etc. You don’t need to incorporate to hire your spouse. Yes, you could do more solo 401(k) dollars that way, but you would also likely pay more payroll tax.
2. I’ll leave that for someone else since I’ve never done locums. But I don’t think it’s all that hard to get out. It’s short term anyway, right?
I’ll address #2. I haven’t had to do that, but the agreements generally have an out clause for both parties.
I never interviewed anyone in advance. If it’s tolerable and short term, you might be able to stick it out for a four-figure sum per day. If not, you could work either through the agency contact to resolve issues, or directly with someone you might have some rapport or trust with. Generally, someone will be there to show you around the first day, help you get oriented, etc…
I would love to go to AUS / NZ and it is a consideration before I retire from medicine completely. For anesthesia, there tends to be more critical care responsibility down under, which is not my cup of tea, so it’s best to do some homework to know the expectations ahead of time, of course. If I can find an outpatient surgery center in need of a locums, I may be throwing some shrimp on the barbie in a few years.
Cheers,
-PoF
I’ve done some locums, and been happy. The biggest pain, by far, is the paperwork. Many, (it seems all) hospitals want your history *on their forms*…and specifically say “do not say ‘see attached’…”. A real pain, as I’ve got it all down on a file that can easily be sent to them.
As POF said, getting records from a hospital that has long since gone out of business (one I worked at in 1988….) becomes a major problem.
Centralized credentialing would be outstanding….
How many locums agencies is safe to sign up with? And what is the downside to signing up with more than 3-5 different agencies? (I signed up with one that even after 3 months have no job offers. I signed on with the promise that they had jobs with in my area, but since then apparently all those jobs have fallen through. Even though I’ve mentioned I’m willing to travel, they have insisted on concentrating on finding work in my state which traditionally never really has locum opportunities in my specialty and I feel like I’ve wasted a lot of time with them. Can I cancel my contract with them? I’m getting calls from other agencies with multiple job opportunities and thinking going ahead and signing up with them.
Never had that question. I suppose it comes down to the contracts you sign and whether they’re exclusive or not.
At first, I thought it was best to sign up with several agencies. I believe I submitted all my information to five of them. None of the jobs I took in two years were with those five.
I learned that it’s best to find the assignment you want, and use the agency that has the job. If you can find the job on your own, more power to you. There are numerous job boards, many of which are specialty specific, and newer platforms like Lucidity that promise more transparency
Thanks for the info. Unfortunately for me, it has been an off putting experience dealing with agencies, especially when trying to negotiate pay. I feel like I’m being played with each job that is presented to me. I’m not sure on how to pick what’s fair and what’s not. Do you know of any resource that lists average hourly rate per specialty. It was mentioned in one of the previous posts that 1200-1600/8hr is average for anesthesia. What about for gen surgery? Also, do you have any experience with IHS locums?
That data is available from MGMA and similar. Blog advertiser Contract Diagnostics purchases it regularly and uses it in advising its clients about potential contracts. Might be easier and cheaper to hire them than to buy it yourself.
Surprised this isn’t common knowledge among surgeons. It very much is among emergency docs, although there is a lot of variation.
I appreciate that you explained to us what a locum tenens is, which are dentists used for vacation coverages and the inability to fill a position in case your dentist is not able to. I never took in to account the importance of using this type of service until an emergency happens. Thank you for helping me learn more about this type of service to use in case we are found in an emergency to be ready for it.
Hello
Hypothetical scenario… I take a locums job in another job through a locums company. The locums company pays for travel, and housing, and a car. Please assume the assignment is 4 months.
I assume the following:
1) The rental car miles to work and from the housing (housing which they are rented for me during my assignment) are not tax deductible
2) Paying meals while I am living in the housing the locums company is providing are tax deductible are not? Are unreimbursed meals from my home in another state while traveling to the new state tax deductible?
If my wife has health insurance but does not put me on it, and I buy my own on the healthcare exchange, then is that tax deductible?
Thank you
Here’s the resource:
https://www.irs.gov/taxtopics/tc511
Deductible travel expenses while away from home include, but aren’t limited to, the costs of:
Travel by airplane, train, bus or car between your home and your business destination. (If you’re provided with a ticket or you’re riding free as a result of a frequent traveler or similar program, your cost is zero.)
Fares for taxis or other types of transportation between:
The airport or train station and your hotel,
The hotel and the work location of your customers or clients, your business meeting place, or your temporary work location.
Shipping of baggage, and sample or display material between your regular and temporary work locations.
Using your car while at your business destination. You can deduct actual expenses or the standard mileage rate, as well as business-related tolls and parking fees. If you rent a car, you can deduct only the business-use portion for the expenses.
Lodging and non-entertainment-related meals.
Dry cleaning and laundry.
Business calls while on your business trip. (This includes business communications by fax machine or other communication devices.)
Tips you pay for services related to any of these expenses.
Other similar ordinary and necessary expenses related to your business travel. (These expenses might include transportation to and from a business meal, public stenographer’s fees, computer rental fees, and operating and maintaining a house trailer.)
Instead of keeping records of your meal expenses and deducting the actual cost, you can generally use a standard meal allowance, which varies depending on where you travel. The deduction for business meals is generally limited to 50% of the unreimbursed cost. For information on a temporary 100% deduction for food or beverages provided by a restaurant paid or incurred after December 31, 2020, and before January 1, 2023, refer to Notice 2021-25
1. Yes, assuming you’re an IC.
2. 50%
3. Yes if you’re an IC.
Hello
I reviewed what you sent me.
I most likely need to speak with a tax accountant. Everything that I read states to be a qualified traveler you need to be away from your “tax” home. The home where the business is located. This is not the same thing as your home even if in another state. So if you are on a locums assignment and the company pays for housing and car in another state, the IRS will not let you deduct part of your grocery bill from what I gather because that technically your tax home.
If you work in multiple locations, I can’t imagine the IRS will consider anything but your home to be the tax home of the business.