Vlad Dzhashi, MD
The US locum tenens industry is worth billions of dollars and locum tenens companies are here to stay as physician shortage is only going to get worse.
There’s probably close to a hundred agencies that compete to find a placement for you.
Since there’s so many of them, how do you find and choose the best?
That’s what I’m going to cover today sharing my 10 years of full-time locum experience as a hospitalist and also several year experience of running my own locums agency.
Before we dive deep, let’s look at two different ways to find locum gigs to understand if you need to use the agency or not. I’ll also explain why this is super-important.
Approach #1 - via a locum tenens agency
A locum tenens agency is probably the easiest way to work locum tenens. It’s also the best way to start.
They search for assignments and take care of the hassle for you (e.g., arrange your locum tenens housing, help with the credentialing).
On the flip side, hospitals are paying at least 25-30% premiums to the agency on top of what you get, therefore the facility cannot rely on you long-term simply because you are too expensive.
So they get rid of you as soon as they get a chance (e.g., they hire permanent physicians or entice their own staff to take extra shifts by paying them premiums, etc.).
Although some rare locum assignments can last for a very long time, usually they’re good for several months to a year.
This creates a situation where you have to change places on a regular basis, which is a good and a bad thing depending on what your goals are.
Working with the locum tenens companies is the best option when:
1 — You want to be a traveling doctor and explore different locations and don’t mind bouncing from one facility to another on a regular basis.
2 — You need to find an assignment ASAP.
3 — You want to do locum tenens for a short time (e.g., a few months in between permanent jobs).
4 – You’re paying off medical school debt as fast as possible.
5 – You’d prefer to get assitance with licensing and credentialing.
6 – You want to maximize your pay (if you work with smaller agencies).
⇒ Pros: Less work on your part and probably the quickest way to find an assignment
⇒ Cons: You will have to travel and change hospitals on a regular basis.
Approach #2 - locum tenens without a locums company
The idea is simple — you contact the facility in your area directly and offer them your services (sometimes it’s called “per-diem” rather than locum tenens). I describe the exact step-by-step process in my per diem hospitalist guide.
The facility can use your services without breaking the bank by cutting off the agency fees. It works even better if you are local and don’t need to have travel expenses covered.
The biggest advantage for you is that this way they are not in a hurry to get rid of you so you can form a long-term relationship that can last for years.
The other advantage is that once you familiarize yourself with your local hospitals (including EMR, overall hospital culture, consultants, admission and discharge process, etc.) you won’t have to go through the somewhat painful process of figuring out the system over and over again.
In my opinion, this approach is a great fit for physicians with families or those wanting to minimize the travel.
⇒ Pros: Allows you to have a long-term flexible job near your home base.
⇒ Cons: The search process is more time-consuming and requires more effort.
My approach:
Personally, when I first started locum tenens I worked only with locums agencies.
When my wife was expecting I really wanted to give her as much support as I could and stopped traveling out of town.
At the same time I made the decision not to go back to permanent job since I absolutely loved the hospitalist lifestyle and freedom of locum tenens.
After making multiple calls and sending a bunch of emails, I was able to get a per-diem contract with two local hospitals and one big hospitalist company (which probably took me 4-5 months)
The hospitals were looking for local doctors to cover “occasional” (turned out to be quite frequent) openings in the several hospitals that were all within 30-50 minutes of driving distance from my home.
Now, after trying different ways to find locum tenens gigs, I use both approaches: I work per-diem locally about 60% of my time and use locum tenens agencies for out of town or out of state gigs for about 40% of my shifts.
If you decided to use locum agencies you will have to make a choice between multiple companies on the market.
What are the best locum tenens companies?
They are all about the same! Honestly!
All agencies operate in a similar fashion and offer a similar service “package”.
Locum staffing agency checklist: read before you decide!
Here’s the checklist of minimal requirement for locum tenens companies before you consider working with them:
1 – Malpractice insurance (at the minimum 1M/3M with tail coverage) – make sure you request the certificate of insurance.
2 – Travel arrangements, which should include car rental, airline tickets, hotel, gas, cab.
3 – Credentialing assistance.
4 – Work with healthcare facilities (aka clients) in the area of your interest.
5 – Nalto membership.
NALTO is the locum tenens agencies’ professional organization. The member firms are supposed to adhere to a high professional level and as the website claims they “enforce strong industry standards and practices for our profession, stressing honesty, objectivity, integrity, and competency “.
The most important thing about the member company is that it is not supposed to present you to any hospital or facility without your permission.
Now, if the agency is not part of NALTO I suggest you to request three references from the physicians that they previously placed and contact them directly.
Bigger vs smaller (National vs Local) companies:
One pattern I’ve noticed is that big-name locums companies tend to be harder to negotiate locum tenens pay rates since they have a larger candidate pool.
On the upside, they tend to have the reach across most if not all US states and work with multiple specialties.
On the other hand, smaller local agencies cover only a certain region or state but may offer a better locum tenens hospitalist salary.
How do you distinguish between the two kinds?
Check out their website and if you see hundreds of job postings across all 50 states, you are dealing with a national company.
If you see only a few states and specialties listed, that’s a sure sign they are small.
Another observation: when dealing with a national agency, you tend to work with multiple people, e.g. recruiter, account manager, scheduler, credentialing specialist and the list goes on.
Local agencies are “leaner” and you typically talk to one person only.
⇒ Big/National companies have access to a lot of locum tenens jobs but may pay less.
⇒ Small/Local agencies only cover a few states or a region but you may get paid more.
So how do I find a locums agency for me?
Probably every MD in this country has gotten a cold call from a locums agency recruiter at least once in their lifetime.
But if you haven’t, you can easily find them yourself.
Referral:
Arguably the best way to find one would be asking around your colleagues who’ve previously done locum tenens work about the referral.
Now it’s important to make sure that your referring colleague has been placed by an agency and not just had a brief phone conversation with one (realize that you get paid for the referral so there’s a clear incentive). It means that your colleague has actually done the assignment, traveled to the facility/clinic, got paid for the job etc.
Online Search:
I suggest you to start with the simple Google search specifying your desired location state (e.g. locum tenens hospitalist job in PA).
You will see multiple links to the job boards or job aggregators.
Please note that most agencies job posts will not typically specify the exact location or name of the hospital. That’s why I like Google’s own job aggregator to be very convenient since it gives you this information.
There are several locum tenens specific job board you could use.
1 – www.locumtenens.com – you will need to register in order to see the posting details with the locum tenens companies names and contact information. The problem with this one – there will be a lot of “junk” postings nonrelevant to your search criteria so you will have to spend more time filtering them through.
2 – Another large job board is http://locumjobsonline.com/.
3 – I would also recommend checking out Locumpedia as it has a neat database listing ALL the US locum tenens companies. You can also filter the listings based on your speciality, which is very helpful.
How many locum tenens staffing companies do you need to work with?
I do recommend reaching out to AS MANY locum tenens staffing companies as possible, my general advise is to reach to at least 10 agencies.
There are several reasons to do that:
First of all, each agency has a contract with a certain number of facilities and although there’s an overlap you’ll realize you’ll get access to more hospitals by working with multiple companies.
Make sure you work with both national and local locum tenens firms and when you first contact them, ask what their geography is.
Second reason: when working with several agencies you have an upper hand in negotiating a good pay rate since you have competing offers.
Third reason is that you’ll be able to compare their level of services and eventually stick with the ones you like and enjoy working with.
There’s no reason to tolerate BS when physicians are in the highest ever demand and there are lots of companies to choose from.
⇒ Work with AS MANY agencies as possible to have access to a good number of jobs (reach out to at least 10 agencies). ⇒ Check out my agency, WhiteCoat Locums. We pay the HIGHEST pay rate in the industry and provide exceptional service you can trust to physicians of all specialties.
Top locum tenens companies: my conclusion
Here’s what top locum tenens companies do:
1 – They are nice to you and communicate well
2 – They pay well. All locum docs discuss the pay rates, so you’ll know if you are paid well or not.
3 – They won’t hold you hostage if things turn sour and let you leave bad assignment right away.
4 – They won’t argue about minor things, e.g. what kind of car or hotel you want to use.
5 – They are really helpful with credentialing paperwork and fill out most of the info FOR you, not the opposite.
Now, after learning everything you need to know about locum tenens job search and locum tenens companies, you are all set to give it a try!
Let me know how it went in the comment section below or drop me a line.
The article says there’s a link to your locum tenens agency checklist but I can’t find it on the page. Other than that, this is a very helpful article.
Sinclaire,
Thanks for pointing this out!
I’ll add the checklist as soon as it’s completed.
locumguy,
Thank you for giving practical advise on how to start looking for agencies and what details to pay attention. Your posts have really helped me on paying more attention to details, and now I can know exactly what to ask when speaking with a Locums agency. I hope you continue providing us with excellent tips. Be great 🙂
DrLitto, hi!
You are welcome!
Let me know if you have any other questions.
Thank you for a very helpful website!
I am new to Locums, I think I am going to love it! I hope..
The contract seems not very favorable to providers that want out of an assigment. You have to pay them up to 30 days if you want out before your done?!
“If you fail to comply or any Client cancels any placement in whole or in part on account of any action or inaction directly or indirectly attributable to you, you shall promptly pay to xxx a cancellation fee” “equal to the total number of days (not to exceed 30)multiply by the agreed-to pay rate plus all costs, expenses,penalties and fees directly or indirectly…..
Have you ever use the *** app?
Thanks again.
Irma,
First of all, let me say: I am not a lawyer. So I’m answering here as another locum doc, not as an expert in physician contracts.
Having seen many locum agreements, this wording seems to be too tough. It sounds too unforgiving.
Normally they say something like: Provider “may be” charged (instead of ‘will be”) for Company’s unrecoverable expenses.
They also should leave a little more wiggle room for you e.g. if you cancel less than 30 days in advance and you’ve got a serious excuse, i.e. sickness, emergency etc. you should be Ok. Life happens and you don’t want to owe thousands if not ten of thousands of dollars in penalties (although I’m not so sure they are really going to enforce it)
The next question is – do you want to ask them to change that paragraph to soften things up, or do you want to hire a lawyer or just leave things the way they are?
Lawyer’s services are pricey, so unless your agency (I assume it is an agency?) is offering you a really good pay rate that can make up for the legal advice fees, I would ask them to add a sentence that would give you a way out if you have a good excuse (sickness, family emergency etc.)
As to the *** app – no I haven’t used it. It looks like a few other platforms that are trying to create “uber” for locum tenens. So far, none of them is very visible. At least in the hospitalist world.
I hope it helps!
Keep the questions coming!
Thanks for a very useful review of locum tenens and per-diem opportunities. I was wondering what is the first step on finding a per-diem job without using agency. Who should I contact in the facility? The CMO?
Thanks again for you help.
Reza
Reza, hi!
Typically, it would be a hospital recruiter. You can find their contact info on the hospitals website or practicelink.
Hi, I’m curious to know what are locum companies making? It seems the companies I’ve worked with seem to be a bit manipulative. Thanks.
Hi, FJ Nowell!
They charge almost 100% on top of what you make. This covers your malpractice, travel etc. As far as I understand their profit margin is 15-20% .
Avoid AB staffing. I left a review on another page but forgot to add (this post reminded me about it) that the guy at AB who tried to recruit me refused to help with the paperwork. Told me they legally couldn’t. Total bull. Also said starting rate was “firm” but another agency at the facility offered over $30/hr more as their initial offer. Other physicians I work with now at an IHS facility are getting shafted by AB (over 40$/hr less than me and refuse to cover travel expenses).
I’ve been doing the locums game (FM doing EM now after a fellowship) since 2014 after I separated from the Air Force. Wish you’d started this blog prior to when I started locums ($75/hr working clinic for my first gig) but it appears we started around the same time. A lot of what you post rings familiar and are lessons I’ve learned along the way as well.
Thank you for sharing this info, Lance!
Hi, thank you for this article. I enjoyed how concise and organized it is.
I’m a dentist, and was wondering if you have any information on dental locum tenens, I imagine it could be different in some key aspects (but hopefully not too much!)
Thanks in advance!