Vlad Dzhashi, MD
After working for almost 8+ years as a locum tenens hospitalist, writing tens of blog posts about my experience, helping and coaching dozens of other doctors, I decided it is time to present a one- and-only AWESOME LOCUM TENENS GUIDE.
‘Cause you see…there’s more docs than ever contemplating locum tenens and they all need quick answers to those “burning” questions that nobody in the healthcare (except truly yours) wants to cover…
Hey…I get it…our locum tenens physician community is long due for quality info from the “trenches.”
With that said, have your favorite caffeinated (or lightly spirited) drink of choice and dive into the most comprehensive locum tenens guide ever created!
Table of Contents
Locum tenens meaning: what is a locum tenens physician?
Locum tenens definition: locum tenens (or simply locums) is a type of job when a physician works on a temporary basis which can last days to months and sometimes even years while providing medical services at short-staffed medical facilities (e.g. clinics and hospitals).
Because of that, locum tenens also means physicians get paid as independent contractors (1099) as opposed to as employees (W2) (hence different from per-diem — see below).
You can work locum tenens directly with the hospital/clinic/physician practices or through a locum tenens agency.
It’s worth mentioning that the term locum tenens originaly means “to hold the place” in latin and it’s applicable to physician assistants, nurse practitioners, CRNAs and midwifes.
What is per-diem and how is it different from locums?
Per diem refers to the type of direct work agreement between doctors and the hospital/clinic/physician group.
This means staying away from locum tenens agencies, and in this case, a physician becomes a W2 employee for tax purposes (unlike 1099/independent contractors when working locum tenens).
Since this topic may get a little confusing I’ve created a table that goes over the differences between locums and per-diem in more details below.
If you want to learn more about per-diem, read my per diem hospitalist guide. This may be a great option for someone looking to work close to home and avoid travel.
How does locum tenens work?
Unlike a traditional career and because of the “gig” nature of locum tenens, you will need to:
- Search for new gigs (either using an agency or working directly with hospitals).
- Complete credentialing and sometimes licensing paperwork.
- Travel to and from your assignment location.
Look for a new gig when the facility doesn’t need your services anymore (typically when they hire a doctor for a permanent position).
Pros and cons of locum tenens
There are multiple pros and cons of locum tenens that you need to think about before taking a leap of faith and switching to more flexible work.
Why work locum tenens? What are the PROS of locum tenens for physicians?
I switched to locums ’cause I wanted to have more flexible and better paid job I always dreamed of. It allowed me to create a perfect schedule for myself and my family.
The beauty of locum tenens is that, in many ways, YOU decide what you are going to make of it.
Having said that, there are definite “winners” explaining why more and more physicians work full time locum tenens.
Money:
The average hospitalist working 15 shifts a month makes around $280K/year. Working 15 shifts/month as a locum tenens hospitalist, you will be looking at a minimum of $350K annually.
If you know what you are doing (e.g., you learn a “superpower” from a qualified guide) and you don’t mind traveling, you can make $400K and above without working any extra shifts.
Flexibility, schedule:
With locum tenens, you get so much more control over your schedule and lifestyle.
You could work really hard for months and then take months off to do whatever you want, e.g. take an extended vacation.
You could create a very comfortable schedule and work less while making the same amount as permanent docs.
The truth is that, there’s so many options and your schedule depends only on what your priorities and goals are.
Fun and adventures:
Checking out different parts of the country and meeting new people can be so much fun!
Each new place you visit has something worth exploring. In fact, you can easily convert your locum tenens trip into a one-of-a-kind adventure if you plan it ahead of time.
You can even go as far as becoming a traveling doctor in an RV for months or years. (I know a few physicians, PAs and NPs who are actually doing it.)
“Geoarbitrage”:
With locum tenens you can live in a fun city but work in a place that pays you more. This way you don’t have to compromise and be underpaid for a “privilege” of living in a nice city.
What are the cons of locum tenens for physicians?
Like with anything else in life, locum tenens has its flaws:
The most common complaint I hear from other doctors is that even though they’d like to give it a try, they don’t want to travel and stay away from home.
The other issue is that you need to fill out an “endless” number of documents, which is a pain in the butt in itself.
Also, every time you start at a new hospital or facility, you have to learn a new system, which makes your first couple of weeks stressful and your workflow is very slow. This is especially true if you deal with a new EMR.
And of course, a lot of docs are concerned about NOT having enough work.
General Questions:
Does locum tenens exist for all physician specialties?
Although I don’t know about some of the very “narrow” subspecialties (e.g., neurotology comes to mind), you can definitely find it for ALL major specialties.
The rule of thumb here: if you get soliciting emails from recruiters advertising assignments for your specialty, there’s a good chance you can find locum tenens gigs.
The other way to check if locums exist for your specialty is to simply google locum tenens + your specialty to see how many job postings you can find.
How does locums pay and salary work?
Important thing to keep in mind is that you get paid as an independent contractor. It means you will need to pay your own taxes, as they will not be deducted from your paycheck.
Docs working “shifts” like hospitalists, Emergency Medicine, as well as primary care, get an hourly pay rate.
This makes it easy to Calculate salary: simply multiply your hourly rate by the hours you worked (or check out my locum tenens salary calculator)
For other specialties like ObGyn, surgery, IM subspecialties, anesthesiology, you may get:
- A flat rate for each day you work
- “Overtime” pay if you need to come back to the hospital after your standard hours
- A pager fee for holding an on-call pager and responding to calls.
The other thing to keep in mind is that you also can negotiate “holiday” pay (50% extra on top of your regular pay) if you work during major holidays.
As to the paycheck timing, it’s usually biweekly, although I’ve seen some agencies and healthcare facilities pay on a weekly or monthly basis.
How long can a locum tenens work?
You can work locum tenens pretty much forever! In fact, for a lot of doctors like me, locum tenens becomes a career in and of itself. There’s a huge physician shortage in the U.S. as well as shortage of advanced practitioners so you can always find the right opportunity for yourself.
As to the typical locum tenens gigs, they tend to last from weeks to months.
Personally I’ve worked full-time locums/per-diem for almost 7 years now.
Having said that, there are “prerequisites” here: you need to be willing to travel and you should be open-minded to different work settings and environments.
If you don’t want to travel, your options are limited and you may not have enough work. This is especially true if your specialty is not primary care, hospitalist or ER.
And, if you are “set” in your ways, it will be difficult to adapt to the new hospital culture and system every time you start a new gig. You’ll be too frustrated and quit pretty quickly.
What to do before starting a locum tenens career?
Here’s what you need to do once you’ve decided to give it a try:
First, if you plan on working full-time locum tenens, make sure to set up your “Safety net” (locum insurance) which includes life, disability and health insurance, and a cash reserve.
The next step would be to decide on what states you want to work and apply for new state licenses.
After that, you need to decide whether you wanna do the job search directly or using an agency.
Then, contact agencies or hospitals you want to work with at least 4 months before your planned start date to secure the locum tenens job and finalize credentialing.
How do I decide if locum tenens is right for me?
For many doctors like me, it’s a no-brainer:
More $$ + flexibility = 🤩
For others, it may not be as obvious. That’s why you should do your own research, talk to other physicians who’ve done it and read my blog to help with your decision.
If you are still unsure after all that, the best thing you can do is to give locums a try for a few weeks or months without quitting your main job.
This will give you a pretty good idea of what to expect.
Can I work locums if I am not board certified?
Yes, you can find gigs with no problem without your board certification as long as you are considered to be “board eligible”, i.e. there’s been five years or less since the completion of the residency.
If you choose not to take or retake their boards (you let it lapse), you’re going to have a very hard time finding locums work.
How to list locum tenens experience on resume?
I’ve seen it done both ways, you can either list locum tenens agencies you’ve worked with or actual hospitals/facilities. Either way is perfectly fine.
However, if you’ve worked at too many facilities, again either mention an agency or pick two to three hospitals you spent the most time at and include them in your CV.
Just keep in mind if you are completing credentialing or licensing paperwork, you’ll have to list EVERY hospital/facility you’ve ever worked.
I hate dealing with paperwork, how do I minimize the “pain”?
Here’s what I do: I complete this template with all up-to-date info and send it to the hospital credentialing specialist or locum tenens agency I work with. Although they won’t be able to complete 100% of required documents for you, they can help with a significant chunk of it, saving you hours of monotonous work.
Here’s another good resource for organizing your files and documents so that you’ve got more time left to do things you actually enjoy.
Locum tenens after residency/fellowship.
Is it a good idea to work locum tenens straight after residency/fellowship?
Although I cannot decide for you, you should probably know the pros and cons of working right out of residency.
It is definitely easier to work at the same clinic/hospital for a long period of time, ‘cause every time you start at a new place, you go through a couple of weeks of a steep learning curve.
Having said that, working in different environments may be a big advantage: you treat different patient populations, and you get exposed to different environments and hospital cultures. This will definitely make you a better clinician.
Not to mention if you’ve got a “free spirit” inside and enjoy exploring new places and meeting new people (hey, you can even work internationally!), locum tenens will be so much more fun.
After all, the decision is yours.
Personally, I worked a permanent hospitalist job first for almost three years after my Internal Medicine residency, and only then I switched to locum tenens. However, if not for my immigration situation, I probably would’ve transitioned to the locums life after residency.
I’ve heard some young doctors work locums to pay off student loans in a short period of time, is this possible?
Absolutely!
I’ve met multiple docs over the years who were doing exactly this: maximizing their income by working locum tenens with a single goal of getting rid of student debt.
If you are interested, make sure to check out my post that outlines the step-by-step plan on how to pay your student debt as fast as possible (in 1-2 years!!!) while working locum tenens after residency.
Agencies:
What do I need to know about working with staffing agencies?
This is a loaded question, so make sure to check my detailed locum tenens companies article that a lot of newbies find extremely helpful.
There I cover: whether you need to work with agencies, how to find them, how many companies you need to work with, the important differences between big and small agencies.
Also, make sure to read my locum tenens contract post on how to make sense of locums agencies’ agreement to avoid legal troubles.
What agencies do you recommend?
I don’t have any personal preferences here, as most agencies are all very similar in what they do.
My advice is to read my blog to educate yourself about everything locum-tenens-related so that you have a framework for evaluating these agencies.
It’s worth mentioning that one of the biggest mistakes that a lot of newbies make is that they work with only one or two agencies, which limits the number of locum tenens gigs they are exposed to and potential pay.
Another helpful resource I’ve created is my locum tenens companies reviews page, where, unlike many other “rating” sites, doctors leave unbiased reviews.
What do I need to know about locum tenens recruiters?
Over the years, I’ve heard a lot of complaints about recruiters, but like in any other profession, there are good, experienced, inexperienced and sneaky ones.
Here’s what you need to know to understand where a lot of potential issues come from:
First, recruiters DON’T understand all the intricacies of the clinical work we do, and unless asked, they will miss important details when discussing your new gig. This creates a lot of potential issues after you’ve accepted the locum tenens assignment and have to deal with a “crisis” situation on the spot.
For example, when I am told “intensivist backup is available,” I always clarify if this means a backup is available 24/7 or only throughout the day and what the rules are for intensivists to take over the patient’s care.
That’s why you should always SCREEN new gigs extensively, especially if you are new to locums.
Second thing to keep in mind is that recruiters are paid commission based on how much you work, so it’s not uncommon for some of them to get very pushy and try to “sell” you an assignment at all costs. This is unfortunately how the locum tenens industry works.
And lastly, if you ever are not happy with your recruiter, reach out to the agency and ask for another one. It is as simple as that!
1099 physician TAXES:
As an independent contractor physician you have to file 1099 physician taxes, which means you will have to pay tax on a quarterly basis as they will not be automatically withheld from your paychecks (unlike when you are employed).
1099 vs W2 physician taxes
When you work locum tenens, you get paid as an independent contractor (1099).
One advantage of 1099 income is that you can deduct a lot of “business”- related expenses.
The other difference between W2 and 1099, is that when you are an independent contractor, you typically pay to the IRS every 3 months, as opposed to the W2 situation when your employer deducts your taxes from your paycheck every 2 weeks.
This also means you will need to submit an additional form that’s called “Schedule C”.
Now, if you and your CPA decide on setting up a C-Corporation, it will get more complicated: you’ll have to pay yourself as a W2 employee and there are more forms to complete and file with the IRS.
Do you pay more taxes as a locum or W-2 employed physician?
It depends…every tax situation is different.
The good news is that you can use my locum tenens locum tenens tax calculator to estimate your taxes: you can see how much money you would keep after taxes whether you are employed, an independent contractor, or even if you have a combined income (W2 and 1099). You can also input your potential locum tenens expenses for a more accurate estimate.
What can I deduct from taxes as an independent contractor?
You can deduct the following, based on categories:
Education and training expenses:
- BLS/ACLS/ATLS/PALS
- Journal subscription
- Online subscriptions/CME
- Board exams fee
- Board exam preparation course
- Medical books
- Professional membership fees
CME/conferences expenses:
- !Registration
- Meals
- Airfare
- Hotel
- Rental caR
Licensing fees:
- New state license
- State license renewal
- NPDB query
- License verification
- FCVS application
- Interstate Medical Licensure Compact
- Fingerprinting service fees
- DEA registration
- Mail services, e.g. FedEx/UPS
Travel Expenses (unreimbursed):
- Hotel/lodging
- Airfare
- Checked baggage
- Meals
- Rental car
- Gas
- Parking and tolls
Professional services:
- Tax advice, preparation and bookkeeping
- Legal services, e.g., contract revieW
Equipment:
- Laptop
- Cell phone
- Printer/scanner
- Stethoscope
- Headphones
Communication:
- Cell phone usage
- Internet access
- Software/apps
Supplies:
- Postage
- Copy paper
- Printer ink/cartridge
Uniform:
- Cost of lab coat and scrubs
- Laundry services
Car Expenses:
- Auto insurance
- Repair and maintenance
- Gas
Those are all the expenses you MAY be able deduct. However, IRS rules are often confusing for the “general public.”To learn more about when these deductions can be ACTUALLY applied, check out my detailed post on locum tenens tax deductions
Do I need a legal entity (LLC or C-corporation) to start working locums?
No, you don’t.
I’ve been working as a sole proprietor (i.e., independent contractor without LLC or Corporation status) for years. You can use the majority of the tax deductions mentioned above without registering an LLC or a Corporation.
Having said that, depending on your tax situation, forming a corporation may save you money. That’s why it’s always a good idea to get professional locum tenens tax advice.
Another misconception is that you need to form an LLC to protect your personal assets in case a malpractice claim is brought against you and the malpractice insurance doesn’t cover all the payouts.
Here’s a good article that covers it in detail.
If you don’t have time to read it, the bottom line is: it’s highly unlikely that this will happen, hence forming a legal entity (LLC, Corporation) as an “asset protection” strategy is probably overrated.
How is state income tax paid if I work in multiple states?
Here, let me quote a response by Ben Nanney, CPA:
State tax can add an extra layer of complexity if you are traveling from your home state to another state for a locum assignment.
So here’s how state tax works in a nutshell: you owe your home state (or resident state) tax based on income earned in that state and any other state, and you owe the locum assignment state tax only based on the income earned in that state.
It sounds like you end up paying tax twice on the same locum income, but there is good news: your home state credits whatever tax you paid to your assignment state against its own tax due.
Here are two examples:
Example 1:
You live in Indiana (which has a 3.23% flat income tax) but work a locum assignment in Illinois (which has a 4.95% flat income tax), where you earn $10,000. When you file your taxes, you’ll end up owing $495 to Illinois for working in that state and $0 to Indiana as a resident. The $495 you paid to Illinois will be credited against the $323 you owe Indiana, fully offsetting the Indiana tax. The total state tax paid will be $495.
Example 2:
Same facts as above but in reverse. You live in Illinois but work the $10,000 assignment in Indiana. In this case, you will owe Indiana $323 dollars for working in that state and then Illinois $172 as a resident. The $323 paid to Indiana will be credited against your resident state of Illinois tax owed of $495, with the difference of $172 still being due Illinois. The total state tax paid will again be $495.
How do you file your taxes: DIY, use software or your CPA does it?
I would strongly recommend that you work with a knowledgeable CPA, especially if you are just starting out with locums.
Personally I’ve been working with a CPA since the beginning of my locum tenens career.
It not only gives me peace of mind when filing taxes, but I always get professional answers to any of my tax questions that come up.
If you are looking for a CPA, I strongly recommend booking a free consultation with Ben Nanney. He’s focusing on physicians and has years of experience guiding physicians on the locum tenens taxes.
Insurance
When working locum tenens, will I need to purchase my own health insurance?
Yes, you will need to get your own locum tenens health insurance, unless you have a part-time job elsewhere or you are under your spouse’s insurance.
How much will health insurance premiums cost for locum tenens doctors?
In 2020, the average national cost for health insurance was $456 for an individual and $1,152 for a family per month. The average annual deductible for single, individual coverage was $4,364 and $8,439 for family coverage.
These are definitely higher premiums and deductibles than employer-sponsored insurances, but your premiums are TAX DEDUCTIBLE, so you can save 20-30% on them.
Where to shop for health insurance?
Check our your state’s health exchange site. You can see the list at https://www.healthcare.gov.
Also, search for your local broker, who can better explain things to you (some may charge you).
For more details on health insurance, read my post I’ve published on the White Coat Investor blog.
Do I need to buy my own disability and life insurance?
YES!
You’ll need to purchase your own life and disability insurance.
Check out my locums health insurance article where I cover this topic in more detail.
And what about malpractice insurance?
Malpractice coverage is typically provided by your agency or the hospital you work for (if you’ve signed per-diem).
Having said that, sometimes you may end up working with the hospital directly as a 1099 contractor (NOT per-diem), which means the hospital may not want to cover you under their policy.
In this case, you will need to purchase your own locum tenens malpractice coverage.
Hospitalist questions:
How much can you make as a locums hospitalist?
The pay range is anywhere from $150/hr to $200/hr+. It depends on the region, patient workload and many other factors, which are covered in detail in my locum tenens hospitalist salary guide.
What is the typical hospitalist schedule for locum tenens hospitalist jobs?
The vast majority of hospitals require a 7on/7off schedule and 12-hour shifts for both days and nights.
The typical minimum “commitment” they want to see is about 7-10 shifts/month. In other words, you’ll not get credentialed unless you agree to work a minimum of one week per month.
What is the typical schedule for a per-diem hospitalist?
In my experience, per-diem schedules are more flexible since hospitals have direct contact with you and feel they can always rely on your help.
Because of that, you’ll have more “last-moment” openings coming your way, which will make your schedule different from 7on/7off.
How long are typical locum tenens hospitalist gigs?
As far as actual length of your assignments, they can last from a few days to years.
For example, my shortest ever assignment lasted two weeks when I worked in Texas helping with the Covid-19 spike.
At other hospitals, I’ve been working on and off for over 6 years now.
On average, I’d say it’s about 6 months.
Do most hospitals require ICU coverage?
I’d say it is 50/50. The further away you are from a metro area, the higher the chances you’ll need to cover the ICU.
ICU coverage comes in two forms:
- Semi-open ICU, i.e., you are a primary attending on some ICU patients, but there’s an ICU doc who backs you up and takes over the care for your sickest patients.
Open-ICU, i.e., you are TWO-in-ONE: hospitalist AND an ICU doctor: you manage 100% of your ICU patients. Most of the places with this setup will be your rural critical access hospitals.
Do most hospitals require procedures?
No, the vast majority of hospitalist gigs do not require any procedures. Having said that, if you are comfortable with them, you’ll have access to a lot more vacancies.
The long-term challenge for “proceduralists” is to perform procedures at least a dozen times a year to keep your skills sharp and maintain your procedure “logs” for credentialing.
I am a Family Medicine physician, can I work as a locum tenens hospitalist?
Based on my experience, only about half of hospitals will accept Family-Medicine-trained docs without any previous hospitalist experience.
Having said that, the vast majority of hospitals would gladly credential FM physicians with hospitalist experience (typically two years).
And…there’s always about 10-20% of “picky” facilities that will only deal with Internal Medicine- trained hospitalists.
So, if you want to be more marketable for locum tenens gigs, there’s a couple of things you could do:
- Get hospitalist experience for 2 or more years at the “not-so-picky” hospital, whether it is in a permanent or locum tenens role.
- Complete an extra year of “hospitalist fellowship”: here’s a full list of the US programs.
- After graduating, you will be as good as any other Internal Medicine-trained folks. Some of those programs are part of big name academic hospitals, which will “boost” your CV even more.
On the flip side, being an FM graduate, you could work as a Med/Ped Hospitalist. There aren’t too many of those gigs, but at least you won’t have to compete with IM docs.
How to vet locum tenens hospitalist gigs?
It is a good idea to screen EVERY new job you are interested in.
Personally, I use the checklist to screen gigs and to negotiate higher locum tenens pay rates, as it’s so easy to see potential flaws in each assignment once you start using it.
The checklist list is downloadable on the page linked above and has all the important questions you don’t wanna miss and will give you a framework to compare different jobs.
Also, check out my video below on how to easily negotiate the rates.
TRAVEL:
Where to stay while working locum tenens?
There are three main housing options: hotel, Airbnb and the like,and corporate housing.
WIth a hotel, you’ll get a very predictable experience but you typically get less space. This may be especially annoying if you are staying in hotels for many weeks at a time.
Airbnb can give you more space for less money, but can also be unpredictable depending on the host, since some rentals will have lots of unexpected issues, e.g., noise, dirty linen, will look different from the photos listed, etc…
Corporate housing may be great for long-term stays, especially if you pay for your own housing, as you can get a decent fully-furnished apartment or even a house for a reasonable price.
Over the years, I’ve used all the different options and describe all the pros and cons in great detail in my locum tenens housing guide.
Who pays for locums housing?
If you use an agency, they will bill your travel expenses to the hospital, so you won’t have to pay for it.
If you find work directly with facilities, you can either include it in your hourly rate or ask hospitals to provide accomodation or reimburse your expenses.
Where can you recommend to work for a fun travel experience?
It depends on your preference and your interests. You can work anywhere. Here are some examples: Hawaii and CA in winter. If you enjoy skiing, then Utah and Colorado may be a great option. For more ideas, read on here.
I worry that living out of a suitcase will affect my health negatively and I will burn out. What should I do about it?
Let’s face it, travel can be fun but it also throws you off your routine which means less or no exercise, junk food, poor sleep and overall more stress.
Here are a few things you CAN do to prevent the burnout:
- Always book a hotel room with a kitchenette or rent an apartment. The key here is to do some basic grocery shopping and prepare simple meals for yourself every day.
- Get out and do some walking in your spare time no matter how bad the weather is: this will prevent “cabin fever”.
Socialize with your new colleagues: this will make your locum tenens trips 100% enjoyable and memorable. This is how I’ve made a lot of good friends over the years.
Learn more about how to stay sane and healthy while traveling and working locum tenens here.
Travel for locums tenens work during the COVID19 era:
When the COVID19 pandemic started, it changed the way we travel.
There are two potential risks that locum tenens docs can face while traveling:
First, you are tested positive without getting very sick (i.e., admitted to the hospital), which is good that your COVID19 is mild, but it makes it impossible for you to work.
The issue here is: do you get paid while not working (after all, you got sick while traveling to or from your assignment)?
I would discuss this with your agency/hospital to make sure they at least cover your accommodations if you are stuck at the hotel while on quarantine or pay your rental car fees if you can drive back home.
Second scenario: you get very sick and need to be admitted to the hospital. For this type of situation, I would purchase travel insurance that would fly you back home if you get sick. (I use the MedjetAssist travel insurance.)
Now, if you really want to make your income “Covid-proof,” buy short-term disability insurance in advance (I assume you already have long-term disability insurance).
It will pay you in case you get sick. Just make sure that the COVID19 scenario is covered under the policy.
specialty specific Locum tenens guides
If you’d like to dive into details specific to your specialty, I’ve got great news for you!
I’ve started working on the series of guides for the major specilaties and will update the list as I publish them. Please check out my comprehensive guides below:
