How to become a permanent locum tenens physician

In Latin, locum tenens literally means “placeholder”.  Just like in any profession, there are “placeholder” jobs in medicine.  Corporations, hospitals, and medical groups use locum tenens often as a means to continue their line of business while looking for a permanent solution.  For the locum tenens physician, this can have potential benefits.

You have to be in the right profession.

There are certain specialties in medicine that work well with temporary workers, particularly those where continuity of care is not needed. These specialties include emergency room physicians (like WCI), anesthesiologists (like PoF), interventional radiologists, critical care physician, and hospitalists.  These professionals care for people who are either acutely ill or only need services temporarily (like during gallbladder surgery). Once the patient’s condition changes, this specialist’s services are no longer needed.

Specialties that require no direct patient contact like radiology or pathology also lend to temporary workers.  You can work from essentially anywhere and at anytime.  Radiology works great for those who like to stay up late at night.

If you are in any of these specialties, you have potential to be creative with your life and find an unconventional means to make a living and care for patients.

Locum tenens for the adventurous doctor. 

I know an emergency room doctor who lives in San Francisco but works in Minnesota.  I call that geographical arbitrage for the city slicker.  You get your higher reimbursements in the Midwest but still get to live in a large city with an inflated housing market and nightlife (No offense to everyone in Minnesota).  If he wanted to pick up a few shifts at the local urgent care in Northern California, he can make even more money on the side.

You can’t ice fish in San Francisco!

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As a temporary doctor, you can have great opportunities exploring new cities while still getting paid.  Obviously this works best if you are either single or have no children, but I know doctors who bring their family with them when they take on locums assignments.

Locum tenens as a financial strategy.

If your profession is in high demand, you might be able to find multiple locums position in the same city!  The ability to do this is contingent upon living in a relatively large city or one with populous surrounding suburbs.  Hospitalists come to my mind as a profession that allows for this flexibility.

Most locum tenens positions confer the following benefits:

  • subsidized housing
  • subsidized travel costs
  • subsidized meals

Suppose that Dr. X is a locum tenens physician for four hospitals in Phoenix.  Each hospital subsidizes a fixed cost of $1000 per week of work plus travel expenses.  Let’s say that Dr. X only works at two hospitals in a given month. She has $2000 in housing costs that could comfortably cover a month’s rent in Phoenix! Guess what? She also gets two roundtrip tickets to a city of her choice due to the travel arrangements.  This could be anywhere in the country too! This includes Hawaii or Alaska! (No offense to LiveFreeMD, I’m not sure why anyone would want to vacation regularly in Alaska though) 😃

Best of all, Dr. X is an independent contractor.  This means that she is a sole proprietor who can open an Individual 401k to shell away significant portions of income ($53k!) each year while being a doctor.  This arrangement also allows for more flexible business-related deductions for further income maximization.

The benefit of part-time work is that you can work on your own time.  No, you won’t get dedicated vacation days, but you could theoretically pile up your shifts and take an extended vacation.  Spend a month in Argentina. Hike through the Serengeti. You can’t do that if you’re shackled to a regimented work schedule.

The disadvantages of locum tenens.

The advantage of being a temporary worker is also the disadvantage of being a temporary worker.  You get no stability.  No stability in income, location, or lifestyle.  Your job can be a goldmine for several months and disappear when hospitals find a more permanent worker.  Sure, you get paid a higher rate, but you pay your own taxes, arrange your malpractice coverage, and other logistics.  There are headaches to running your own business. Some doctors simply don’t have the desire or energy to manage logistics outside of medical practice.

Most families with school-aged children aren’t going to be able to travel for weeks at a time without logistical problems.  Sure you can pull your kid out from society and homeschool them, but parents in New York City are already making sure their kids play nicely at their elite private Kindergarten schools so that they can get into Yale for college.  Good luck going up against that crowd.

How does this pertain to me? 

If you’re a plastic surgeon working in a cosmetics practice, there is no financial, lifestyle, or practical gain in becoming a locum tenens doctor.  If you are still in medical school deciding on a specialty, you should be aware that these opportunities exist.  I probably wouldn’t base my residency choice solely on whether you could make a permanent career out of temporary jobs, but rather on your interests both in and out of medicine.  I know doctors who just like to climb mountains and exercise in their free time.  These guys would do great working temporary jobs because they can spend their free time outside of medicine.  I know doctors who enjoy practicing medicine—they probably would not be truly suited for a full-time part-time job.

Have you considered working as a locum tenens physician?

(Photo courtesy of Flickr)

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  • Live Free MD

    Locum Tenens sounds like a great gig for those who can tolerate the unpredictability. For me, I’ll stay up in Alaska, so I can permanently live where (believe it or not) people vacation! : )

    • Smart Money MD

      Dipnets sound cool enough that I’d come up just to experience that! I still wonder how many ways one could cook salmon since it’s so plentiful in your neck of the woods!

  • PICU MD

    I think one thing you lose as a locums MD is a sense of belonging. I’ve never done locums but I’ve done some moonlighting and know some folks in my field who’ve done some locums.. In a moonlighting gig (or locums) you’re there as a “placeholder” until they get something more permanent.

    Part of the joy of critical care (at least for me) is the team work and camaraderie between the nurses and doctors I work with. Also, as an employed intensivist you have a vested interest in the growth and development of your ICU. As a temporary worker you can make suggestions but since you’re not actually part of the system you have no interest or ability to exact change.

    I do think when I get “older” I could see transitioning to either locums or moonlighting as a way to keep my skills up and make a little cash but still have free time.

    • Smart Money MD

      Very true. Most of us prefer to be “in a group”, or considered a permanent doctor within a department or group. I have met some docs who really enjoy being a permanent locums doctor, but I’ve gotten the sense that they are either near the end of their careers or just less engaged as a doctor compared to other things in their lives.