Locum tenens is an extremely flexible and lucrative way to practice medicine. You become your own boss and can plan your schedule and lifestyle to fit your own needs. Here are real life examples from hospitalists that I have worked with who chose a locum tenens lifestyle for different reasons:
How to Pay Off Your Medical School Loan in a Year
During one of my first locum tenens assignments, I met a young physician who had just graduated from his residency. In his third year of residency, he decided that he would pay off his student loan as soon as possible. He plunged into locum tenens as soon as his residency ended. “I hated the idea of having a medical school loan looming over my shoulders,” he said. “I wanted to get financially free as soon as possible.”
He worked in the rural area of Washington state as a hospitalist and negotiated a nice pay rate of $190/hr. He picked up 17 shifts a month on average (which is just slightly more than a full time position) and made $450K+/year. All of his living expenses were completely covered by the locum tenens agency, which included rent for a studio apartment close to the hospital and monthly car loan payments. The only thing he had to pay for was lunch at the hospital and dinner at a local restaurant. Needless to say, he completely paid off his student loan in less than a year.
Not surprisingly, he has continued practicing locum tenens since then and last time I heard from him, he had bought several investment properties in Southern California.
How to Set up Your Own Schedule, Work Less, and Still Make a Full-Time Salary
When you practice locum tenens, you set your own schedule, allowing you to make more while working less. A doctor and a busy mother of three children was able to take more time off without sacrificing her salary. By working with local hospitals and switching to the locum tenens practice, she was able to make more per shift, taking on fewer shifts than in her permanent job.
She approached several local hospitals directly and found three hospitals that agreed to sign a contract with her as a per-diem staff hospitalist. All the facilities were within driving distance from her home and she aggressively negotiated a very nice pay rate. Averaging 10 shifts a month, her annual income totaled 250K. Essentially, she worked one week on and two weeks off. “My current lifestyle is really great!” she told me after I mentioned that I also work full-time locum tenens. “I take time off during my kids’ school breaks and all holidays, including Christmas and Thanksgiving.”
“I make my own schedule,” she told me. “What can be better than that? No more scheduling hassles with my hospitalist program when submitting vacation requests at the beginning of the year, only to wait to see if they graciously approve it. I used to get vacation time when my employer allowed, now I make that decision. I work less and still make a full time salary”. She also added: “Besides, I don’t have to participate in monthly hospital meetings, so I stay away from hospital politics which is nice”.
Live Where You Want, Don’t Settle for a Lower Income
In addition to making your own schedule, locum tenens allows for flexibility in work location. Instead of settling in an area, a locum tenens position will allow you to work where you want, when you want.
A young physician that recently graduated from a residency program who burned out a year after working as a hospitalist at a prestigious facility in the downtown area of the large city explained the situation that led him to consider a locum tenens position: “You see, my salary was quite low. My hospital was the one that everybody wanted to work at because of its location, but the trade off was a low salary and very high census.
Unfortunately, the program was not interested in reducing the census or adjusting the salary since every time a burned out physician left, it was so easy for them to find a replacement.”
He switched to the locum tenens practice and started working for two hospitals, one in a nearby small town within a commutable distance, and another downtown that had several “permanent” locum tenens doctors. When questioned, he explained how the new position affected his life: “This way, I made 350K last year and ended up working 15 shifts a month on average. My new schedule made it so that I was able to travel quite a bit as well.” He added: “The nice thing about working locum tenens is not only that I made 50% more compared to my full time job, but I can still live in a nice downtown area. I have easy access to what the city has to offer and don’t have to relocate in order to find a good job with a nice salary.”
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I’m currently a second year resident, soon to be a third year, in family medicine. I’m thinking about become a locum teen as soon as I graduate next July 2020. I’ve been trying to get in contact with a locum tenen to get some advice and see what they think about becoming a locum tenen right out of residency?
I also have a list of other concerns.
1st: I’m concerned about the constant change between hospitals or clinics and the different EMR systems. I briefly worked with a traveling doctor who was covering an OB/GYN shift at my hospital during one of my night shifts. The patient had a recent miscarriage and was hemorrhaging and the traveling doctor didn’t know our EMR, our Codes, didn’t know how to put in orders or how to contact any specialists or how to get the OR setup for a D&C. This was very frightening to me and makes me wonder how difficult it is to work in different hospitals/clinics as a locum tenen. Besides, getting familiar with your hospital, any other advice?
2nd: Would you recommend starting in a clinic or a hospital or both.
3rd: I’ve seen a lot of med students and residents drop out or fail boards and they can’t get back into medical school or residency. I have the same fear when it comes to not immediately getting a full time job after residency. But I would really like to take some time off and being a locum tenen gives me that option. Still, I wonder how hard is it to get a locum tenen job or any job for that matter after taking a few months off. I’ve also heard it’s hard to get a job as a hospitalist after spending several years in a clinic because you lose your hospital skills. What do you think about this?
4th: I’ve also spoken to a concierge doctor and he definitely recommended getting some experience first before starting your own practice or going off on your own as a locum tenen. What do you think?
5th: One of my colleges, told me about a locum tenen working in a rural hospital over a 4 day weekend/holliday and she ended up admitting around 40 patients to their service. She had no help and didn’t sleep for 4 days. Do you think locum tenens are sometimes taken advantage of and do you have any advice on how to avoid this?
Thank you very much for answering my questions!
Sarah, Hi!
Those are all great questions!
I’ll answer them one by one.
Locums after residency?
I’ve started locums after practicing as a hospitalist for 2,5 years. I think the fact that I had previous experience helped a lot. Although I thought I knew everything and felt very confident even in my 3rd year of residency, I definitely learned a lot in my first a couple of years as a fresh-minted hospitalist .
Having said that, I’ve known lots of docs who did it straight from the residency, so I know it’s doable.
1st – this locum doc you describe seemed to be clueless.
The only way to avoid this is to have a really good and thorough orientation before you start: make sure they teach you how to use the EMR, electronic orders, give you a tour around the hospital or clinic, introduce you to the key people as well as axillary staff.
Also, you always want to make sure you’ve got all the important phone numbers on you, although in the worst case scenario you can call operator or ask RN if you are totally lost.
I typically take a screen shot of all the important data during my orientation – this way it’s always with me and I think this saves time.
As to the EMR, every time I learn new system, I almost feel physical pain. But once you work in different places and use different EMR’s, you’ll be comfortable with all of them, since there’s only 3-4 major ones.
2nd: Would you recommend starting in a clinic or a hospital or both.
It really depends on what you like to do and what your long term plan is. It may be easier to start from the clinic since you’ll see lower acuity. On the other hand hospital work probably pays better.
3rd:
Sarah, I think it’s totaly find to take a few months off. The demand for physicians is so high, that they won’t have any problems with finding a locum or permanent jobs after a little break.
5: Are locum tenens are sometimes taken advantage of and do you have any advice on how to avoid this?
Yes, those things may happen but they are uncommon in my experience.
Few things you can do to prevent this from happening:
1 – You have to know what you are signing up for and communicate the expectations with your locum company/hospital: the average census, the average number of admissions.
2 – If you are working much harder that you’ve been told – call your recruiter and explain what you are going through.
You can tell them you are not seeing more than X number of patients. This also should be communicated to the local leadership – hospitalist director, team lead, CMO.
3 – If they are still trying to give you more work than you are agreed on, you simply leave!
You are not a slave, you can leave anytime and it doesn’t matter what your contract says, if you feel you are not able to practice medicine safely, you quit right there on the spot!
I hope it helps.
4th: I think the experience always helps. Personally, I started locum after almost 3 years in a permanent role.
Having said that I’ve seen a lot of freshly-minted hospitalists, taking on locum gigs straight from the residency.
I think you have to be smart about what locum assignments you sign up for. For example, I would not sign up to work at the critical access hospital straight from the residency.
I would stick to the hospitals that are mid-size with reasonable subspecialty coverage. I would also avoid crazy busy places e.g.>20 patients a day.
These are all specific to the hospitalists but you get the point.