[Editor's Note: Every year as part of our scholarship competition, we solicit sponsors. The most generous donors are the Platinum Sponsors and contributed at least $3,500 to the scholarship competition (100% of which goes to the winners). As part of their sponsorship package, each of these donors gets a sponsored post, the only sponsored posts that ever appear on the site. This post is by Locumstory.com, a local company and long-time sponsor of both this site and a number of live speaking events I have done. Congratulations to the 2017 Scholarship winners and thank you to LocumStory.com for sponsoring the scholarship. This post is a Q&A about locum tenens with a number of docs who have enjoyed their experience doing locums.]
Why Did you First Start Doing Locums?
“Way back I initially started doing locum tenens because I wanted the freedom to work when I wanted to work and not work when I didn’t want to work. I did most of my initial locums work in a very metropolitan area. I then decided that instead of using it as a stopgap I wanted to use it as a career. I have gone back and taken a couple of perm jobs which didn’t really fit me very well, and I have now come to the decision that locums is where I want to be.”
– Dr. Beverly Ricker, pediatrician
What is the Best Part of Doing Locums?
“Locum tenens really fits in with the ebb and flow of life; there are times in which you are uber available and you can work hard, and there are times where you just don’t want to work. You want to do other things. I think that the misconception is that you can’t make locums into a full-time lifestyle. I like to work hard when I’m available to work. When I am not available to work I want to be free. If you are good at finding a schedule that works for you, you can actually do extremely well as a full-time locums doctor.”
– Dr. Mandaar Gokhale, emergency medicine
What is the Worst Part of Doing Locums?
“The start-up was difficult at first just because there was so much credentialing paperwork for that very first time. I had a lot of help going through that. That made it easier but since I hadn’t really done any of this before and it had been years since I had done any credentialing because I had been with my old job for so long it did seem a little daunting at first. But after that first time, everything has been pretty easy. Once I got my whole file set up then every time I’ve applied for a new state license or a new hospital credentialing packet it’s been much simpler.”
– Dr. Madeline Geraghty, neurologist
What Was Your Biggest Surprise?
“I think one of the nicest surprises for me about working locums was the reminder that there is more than one way to do things. When you stay at one place for a long time you get used to doing things one way until it becomes a habit and you don’t realize that you’ve been stuck in a rut. I didn’t know that this was going to be one of the nicest benefits of locums for me; just the reminder when I went to new places that there were other ways of doing things, people had different practices, and that kind of shook me out of my rut. I didn’t even know I was in that rut. It shook me out of it and gave me some new perspectives.”
– Dr. Madeline Geraghty, neurologist
Do You Ever Go Back to an Assignment?
“Repeat assignments allow a familiarity with the facility and staff and allow planning of elective procedures. It also allows tailoring a practice focused around your area of interest. Other medical providers, if they know you are returning, may also be able to plan patient care, surgery, etc., after consultation, for when you return.”
– Dr. Laura Bruse, orthopedic surgery
How Do You Explain Locum Tenens to Family and Friends?
“My girlfriend’s mother keeps asking why I don’t have a job. They think that I’ve graduated residency and I don’t have a permanent job and they’re wondering whether it’s because I’m struggling to find something. I’m telling them no, it’s the exact opposite. I get to choose when I work. I get to find my jobs and I get to have a week off. I think that’s a misconception about locums, and they don’t really understand and can’t wrap their heads around the flexibility that I have.”
– Dr. Johnny Shen, family medicine
How Does Locum Tenens Help Your Work/Life Balance?
“Most jobs you can’t just say, ‘I’m going to take these two months off and then I’ll come back after those two months.’ It didn’t work that way before locums. I can now basically schedule in advance, so that if I’m going to be moving, traveling, or vacationing for a month or two this year, I would tell myself, ‘I’ve got to work harder these next couple of weeks.’ It really, really works out. I have time to spend time with my family, I have time with my girlfriend, and I have time with my hobbies outside of work.”
– Dr. Johnny Shen, family medicine
How Does Locums Work Financially?
“Financially locums works for me because in the field of emergency medicine you can work long shifts. If you have a small hospital that allows you to work anywhere from 24-, 48-, to 72- hour shifts, then you can work straight. You can make quite a bit of money if you’re doing a 96-hour shift, which only takes four days of your life. I think the misconception is that if you work that way that you will not have all the benefits that you need from a full-time stable job.”
– Dr. Mandaar Gokhale, emergency medicine
How Do You Handle Paying Taxes as an Independent Contractor?
“As an independent contractor I have to facilitate all of my own benefits and all of my own tax reporting, and I have done that by finding a CPA who only takes care of doctors and she does all fifty states worth of taxes. She does my estimated taxes for all the different states I work in. I live in Minnesota, which is a fairly high tax state, so if I work in a state that has no state income tax I have to pay Minnesota income tax on that. If I work in a state that has a lower rate than Minnesota I can pay that lower rate and she works that all out. If I work in a state that has the higher rate then I pay the Minnesota rate. I also have a financial person who does my 401(k) and my SEP, and she’ll call me up and says, ‘Can I do this, can I do this, can I do this?’ And I say, ‘Yeah, sure.’ You have to have people you can trust to do that.”
– Dr. Beverly Ricker, pediatrician
What Advice Do You Have for Physicians Considering Working Locum Tenens?
“If I was talking to a physician thinking about going into locum tenens, I would tell them to give it a try. Take a weekend or a week assignment. What’s the worst that could happen? You went and did a weekend or week assignment. If you didn’t like, you didn’t like it. So what? But if you do like it, it’s going to open up the world to you”.
– Thomas O’Mara, pulmonologist
Does anybody have a good idea of how the money compares with a regular gig? Should one avoid an agency?
An agency provides a service for a cost. If the service isn’t worth the cost to you, then don’t use them. But I think most people find it is worth it.
The money is HIGHLY variable, but if it isn’t enough, you can turn the job down and wait for another.
Middle men cost money. Doesn’t matter what they’re selling or coordinating. I almost took a job through a physician placement company but thanks to a comment by someone in the forum, I contacted the prospective employer directly and discovered the placement company would have helped themselves to 40-60% of my hourly rate for up to two years. Ouch!! A couple phone calls and a couple months saved me a ton and I learned a great lesson in the process.
To be clear, I have no experience with Locumstory.com
Middle men also provide a service. What’s Amazon? A middle-man. As both a seller and a buyer their services have been well worth the price. It’s your job to make sure the middle man’s take isn’t worth more than their service to you.
I’m not quite certain what prompted WCI’s response. I did not implicitly or explicitly state that middle men do not provide a service. I plainly stated their assistance would come at a cost and sometimes it is quite steep. Regarding doing due diligence, my example showed that doing so let me see “behind the curtain” which meant I was able to avoid a predatory arrangement. Regarding the unnamed placement company, I spoke to another doc who did sign with them for the same gig and he was disappointed and upset once he discovered how much money they took from him per patient. There are ways out of the arrangement but they take some time so it’s best to simply avoid entering into them when possible.
As a more positive counter example to company #1, another prospective placement company would have only taken 20-25% per hour and the relationship would have lasted 3-6 months with dissolution of my relationship with the placement-company if I signed on permanently with the arranged employment opportunity giving me 100% of my hourly rate. That seemed to be more appropriate as a short-term “finder’s fee.”
Ultimately, my experience with these two companies highlights the range of fee structures and commitments one may encounter when dealing with physician placement companies.
You definitely get what you negotiate. I’m always surprised to run into docs who have no idea what they’re really worth. With all the salary surveys and data out there, it would seem like a huge red flag for me for a locums company to be offering me 50% of what I’m worth. Maybe that’s what happens when docs go for years without knowing what is being billed in their name.
It is nice to have a permanent job and a few weekends of locums. You have your permanent job giving you the health insurance and you get the higher hourly rate at your locum job. My locum stint pays more than twice my regular Hospitalist jobs. You can also get to open your solo 401K to add that 18K employee deferral and 20% of your salary after the self employment tax!
Remember only one $18K employee contribution no matter how many 401(k)s/unrelated employers. For most docs with a side gig, they’re only putting their 20% employer contribution into their individual 401(k)s.
I didn’t realize there were docs doing so much locum. I get regular emails for locum opportunities. But those gigs are usually in random areas around the country and for long time periods i.e. An entire summer or season. I wouldn’t mind doing a day or two on a monthly basis if the price was favorable.
they pay you an hourly rate and put you in the hotel. What is never counted is the time away from your home and travel, which is reimbursed, but only for the cost of the ticket, not that hourly rate of work for your travel time, which can be easily be equal to a cost of one shift.
Lawyers on assignment away from their home town bill for 24 hrs/day of being away.
I wonder if it is a valid type of work when one is starting to downshift into early-ish retirement and just needs a bit more income. Less sure about l. tenens as a main type of employment during your prime years
Thanks for donating to the WCI Scholarship!
Anyone know if this exists for dental? Don’t need it right now, but after I “retire” I would love to spend some time moving around and working. (Had to use the quotes so the retirement police don’t get mad at me working for fun/money still.)
Re locums getting their cut: it’s fair that if you learn of a job through a source you can’t drop the source and get a higher pay. Can’t list your home with a realtor and then do FSBO with someone the realtor attracted with their adverts or help. Having gotten $55/hr long ago as a subcontractor while the military contractor made $105/hr on me (I did a FOIA to learn their contract details) I hate paying too big a commission but acknowledge the rules. It’s the reason why, when I get an email that sounds like it’s for a job in my area, rather than contact the sender, I check on other job sites. If I hear it’s Dr Jones’ clinic in next town over from the recruiter, Jones and I have to give them their cut. If Dr Jones is also advertising elsewhere I can ask to be hired directly. Of course I’m overlooking some groups and places that prefer a locums or headhunting firm to do their prescreening and don’t advertise elsewhere nor want me to coldcall them (and I’d have to call every office anyway since I don’t know who it is from the doctor search company’s email). For instance the Army will not do a personal services contract with me as a doctor- either they’ve been told there’s corruption or they are too sickened by our high pay, or maybe the contracting officer hates that there’s no gratitude from the middle man.
Anyone do locums GS work for the VA or military? That’s what I’d like, but I wouldn’t be GS if I was a locums company employee or subcontractor.
What is the thinking regarding working in locums as a 1099 independent contractor in regards to taxes? Is it better to just pay the self employment tax or form an LLC and go about it that way. I am specifically talking in regards to reducing the tax burden. Any insight would be appreciated.
You have to pay SE tax with or without an LLC. In fact, an LLC is a disregarded entity by the IRS. They are taxed as sole proprietor, partnership, or corporation.
Thanks for the info WCI. So just suck it up and pay the SE tax? Any advice? From what I was reading the SE tax is 15% is that correct?
Yes, I recommend you pay the taxes you owe. SS is 12.4% on your first $130K or so earned per year and Medicare is 2.9% on everything you make. The employer half is deductible.
We are considering hiring a locums without going through a company. Doing it this way, who is responsible for the malpractice ins?
Whatever the contract says, but in my experience, the employer usually pays.
I just finished residency and started doing locum full times. I am an independent contractor and paid as 1099. I am also planning to buy a house/apartment as an investment property. Banks require 2 years income as a 1099 to fianance a mortagage. Is there anyway I can get a loan sooner than 2 years? I just opened an S corp and pay myself W 2 salary. Would that help getting a loan since now I have “a W2 income”?