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Pros and Cons of locum tenens: Doctor’s perspective

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pro and cons locum tenens
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Vlad Dzhashi, MD

Many physicians wonder about the pros and cons of locum tenens. It can be difficult to find a balanced and objective source that provides this content. Since the pandemic, burnout is increasing and providers are seeking alternatives to full-time work, but many don’t know where to start. 

Look no further…

You will find information on locum tenens jobs, including working with recruiters and staffing agencies and how to negotiate placements. Whether you seek part-time or a full-time job, this short guidebook will give you an advantage when pursuing locum tenens positions. Following this review, you will understand the major differences between working in a healthcare facility as an independent contractor versus as an employed physician. Enjoy this comprehensive review of locum tenens and the work-life balance it can provide.

Locum tenens pros

Locum tenens pros provide many advantages for clinicians seeking autonomy and independence. When you work locum tenens you are in the driver’s seat. You are able to craft your experience to meet your needs. The benefits of control over scheduling, salary, and scope of practice explain why many physicians are choosing full-time locum tenens work.  See the locum tenens guide for a thorough discussion on all locum tenens topics.

Money

Locum tenens jobs provide on average a 30% higher income than many permanent positions. Some high demand specialties such as anesthesiology, emergency medicine and psychiatry may pay 50% to 100% higher. Income also varies by location. Please see locum tenens salary for greater detail. Many early career physicians use locum tenens work to pay off student loans and gain some experience before committing to a permanent position. Please refer to  medical school debt for further discussion.

Independent contractor status

There are many benefits to working as an independent contractor. Here you can create your own benefits package. Nearly every expense can be used as a tax deduction. Locum tenens providers enjoy significant flexibility when devising their retirement contributions, life and health insurance packages. There are additional tax benefits and tips as outlined here Tax Deductions.

Flexibility

There is nothing better than being able to create your own schedule, generate extra income, devise your own benefits package, and take time off at your discretion. The work-life balance of locum tenens is fantastic. You can work really hard for weeks or months, followed by an extended vacation. You can arrange for part-time temporary work in between adventures. You could choose to work less while still making as much as full-time employed physicians. It is possible to work intensely for a period and pay off medical school debt then take off for a sabbatical in Latin America or anywhere else in the world. The possibilities are nearly limitless, depending on your goals and priorities. See flexible schedule for further discussion.

Schedule

No matter if you are in pediatrics, trained as a hospitalist or psychiatrist, you have control over your schedule. Whether you wish to replace full-time hours, work less, or schedule long breaks, your schedule is negotiable. You can choose placements that are short or long-term, that provide extra income or provide a full-time job. You can even elect to start a new job at regular intervals. Not only can you select the duration of a job, you can also negotiate the length of your working day, call schedules and weekend obligations. You are free to negotiate any scheduling terms.

Adventures/travel

The possibilities for travel, checking out new areas of the country and meeting new people are endless. If you crave variety and new experiences, locum tenens assignments are for you. Each new location offers areas to explore. With enough planning, you can combine a job with a customized adventure! Note the section on adventure for some ideas. Some providers fully embrace the notion of the traveler and navigate all around the country in an RV for months, or even years. Get additional tips here: traveling doctor.

Geoarbitrage

As an independent contractor working locum tenens you can take advantage of both the most favorable work and living environments. You can live in a great town that provides plenty of social opportunities while working in a location that offers a higher pay rate. This way you don’t have to accept less pay for living in a desirable location. Take a look at this lifestyle section for more insight.

Locum tenens cons

The cons of locum tenens can be unsettling for some providers. However, with careful planning and understanding, many of the issues can be easily managed or even converted to a benefit. The following discussion will highlight the cons of locum tenens and provide tools to minimize their impact.

Being away from home

The most common criticism of locum tenens I hear from other physicians is that, although the structure is appealing, they are reluctant to travel and have to be away from home for extended periods. If this is a concern, it is possible that you are better suited to a per-diem arrangement at your local facility instead of taking locum tenens assignments in distant locations. Please refer to our section on per-diem for a more in-depth exploration of this option versus locum tenens positions.

Learning new systems

Another big hurdle for some is the need to learn a new system with every move to a different facility. This learning period is always stressful and less efficient. This is particularly true if you are learning a new EMR. Credentialing and privileging may also become tedious.

If you do not deal well with the stresses of a new environment, locum tenens is probably not a good fit for you. However, if you are, say, fresh out of residency and opt to give locums a try, there are useful benefits.

If you change environments and systems often, you will develop handy skills. You will learn to quickly become accustomed to new systems, and you will become a pro at learning new electronic medical records systems. You will become adept at collecting useful information. You will make a habit of getting contact information for key personnel, including both people on the administrative and clinical sides of the facility. You will become a pro at orientations! These skills will help you for not only the rest of your career but for the rest of your life.

“Toxic” environment

There is always a risk of landing in a toxic environment and being miserable. To avoid these situations, it is important to vet the facility thoroughly and gather as much information as you can in advance. Not only will this allow you to make an informed decision, but it provides you with leverage should the information later prove to be false.

You may want to test the waters initially with only a few shifts, allowing you to cancel in advance of 30 days should the experience be poor. With a locum tenens job, if conditions are so bad they pose a threat to patient safety or a risk to your license, you can simply leave. Unlike a permanent position, it is much easier to quit if the locum tenens position is bad.

Continuity of Care

A significant challenge of working short-term as an outside contractor is the potential impact on patient care, including the lack of continuity of care. Coordinating follow-up for patients after you leave can be challenging. Some fields, such as psychiatry or pediatrics, do not work as well with locum tenens assignments. Emergency medicine and anesthesiology work well within the locum model.

It can be difficult to arrange follow-up for test results and specialist referrals. You may need to develop a network of hospitalists and other physicians with employed positions who can follow up on your behalf. Some locums rotate regularly with other providers which allows for better continuty..

In order to minimize issues with continuity, some locum providers avoid outpatient assignments altogether. I know a pulmonologist who solely takes inpatient locum gigs. Also, there are locum tenens assignments that are of longer duration, allowing for greater continuity.

Continuity of Care

Another con of locum tenens is the amount of paperwork required for each position, including credentialing for each facility as well as paperwork for each staffing agency you may work with. The more organized you are, the easier these tasks will be. Helpful tips include maintaining all your documents in one place such as cloud storage, consider hiring a specialist to help you secure new licenses. Please see helpful recommendations and a useful template here stay organized.

Not enough work

One of the top concerns is not being able to get enough work. It is helpful to maximize your opportunities by signing with as many healthcare staffing agencies as possible. Keep a record of all recruiters and the associated placements. Try to apply for local assignments because a local candidate may be preferred over someone who will require travel expenses.

“Sleazy” recruiters

While there are some wonderful staffing agencies, there are other entities who use questionable practices. Tactics range from broken promises to outright lying. Staffing agencies may attempt to undercut you by offering you nurse practitioner or physician assistant salaries or positions. A recruiter might try to convince you to sign an exclusive commitment to their agency at a low rate. Some recruiters will literally say anything to get a contract signed.

Reviews from locum tenens physicians of some agencies (please see agency reviews for a comprehensive collection of hundreds of physicians’ feedback):

“I had two contact lawyers tell me not to sign such a terrible physician service agreement.”

“…they one-sidedly canceled my appointment… pending lawsuit.”

“…in the end, they only care about the money they make…seeking a naive physician to do their dirty work…”

A common tactic of some of the less honest agencies is to present you as their hire without your permission. This practice makes it difficult for you to then sign with a different agency for a possibly higher pay rate. You either wind up stuck working for the dishonest group or passing on the opportunity altogether.

Make sure you always communicate to locum tenens agencies that you may not be presented without your explicit permission. Stipulate this verbally and in writing. DO NOT sign a contract unless you are actively negotiating an assignment.

Locum Tenens Oncology Guide: pay rates, schedule, tips for success

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Locum Tenens Oncology
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Vlad Dzhashi, MD

Dr. VB is a board certified locum tenens oncologist who once accepted a weekend position and never looked back. She found working as a locums to be a perfect fit to maintain a work life balance.

We spoke at length with Dr VB , now in her third year of practicing hematology oncology locums, about why she chose this career.

We discussed the typical assignment, the demand for the specialty and strategies for getting contracts.

We also covered pros and cons of working as a locums Oncologist, and, importantly, addressed pay rates and approaches for negotiating a contract. 

Finally, Dr VB provides advice and reflects on what she may have done differently if she had to start again.

Enjoy reading the interview below, or watch the video.

Why did you choose Oncology locum tenens

I did all of my residency and fellowship at Brown University in Rhode Island, and ended up doing contract work straight out of fellowship for a number of reasons. I wanted to try out a position before committing to any permanent position. I really wanted something that offered me flexibility and the ability to create my own schedule and spend time with my family. 

I originally agreed to one weekend call, and it was a great experience. The flexibility and lifestyle were a good fit for me. I was able to practice good clinical medicine without having to dedicate myself to long periods of time or financial commitments that you might have with private practices. It grew from there and locums has been a dream job for me.

Best way to find locum tenens Oncology jobs

An important part of landing per diem and locum tenens jobs is through your contacts, word-of-mouth. It is helpful to utilize all social media platforms, such as LinkedIn and Facebook. I belong to several groups, including women physicians, mom groups, general physician groups. These groups give you great insight into community needs.

I also pick up the phone and cold call trying to talk to the in-house recruiter, which can be hit or miss.  I use Google maps to identify facilities and send a letter of introduction that includes my name, my active state license(s), experience and availability. Of course, these approaches have mixed success so it is good to set your expectations accordingly.

Demand for locum tenens Oncology

This is an important question. The opportunities vary by geographical location. For example, here in Florida I have on occasion had difficulty finding local jobs. Some areas have better markets for oncology field than others.

Sometimes you have to be prepared to travel, but the further you are willing to travel the more options you have. In general, the demand is there and you can be successful working as an oncology locums.

I am part of a WhatsApp group, HEMOC locums, and there are around 80 or 90 of professionals who share information about positions and support one another. From my time with this group and my own experience I can say that there are regular jobs available.

Now, Hematology Oncology is different from, for example, primary care, because the field is reliant on reimbursement from insurance companies. It is possible that changes within the structures of insurance companies may impact the need for oncology locums but it is difficult to tell.

Typical Hem Onc locums assignment

Hem Onc locums varies in the type of work depending on if it’s clinic, hospital or both. I have found, especially in Florida, a greater demand for inpatient roles. Other states have a greater need for outpatient work. Stepping in as a locum oncologist is tricky because many oncologists have longstanding relationships with their patients.

Working as an inpatient consultant is a good model for a locum because you can step in, provide a consult, and step away. Communication and preparation are key. I review past notes, pathology, imaging, and am ready to go.

Most of my experience is in the community setting. In locations with higher workloads, I may have a resident or PA who helps. Many of my consultations are in hematology, including issues such as thrombocytopenia, anemia, thrombosis, hematologic issues during pregnancy, iron deficiency anemia.

In general, services will usually start you with lower patient numbers, which is common for a specialist. Oncology requires a lot of coordination with other providers such as a radiation oncology, pathologist, surgical oncology. There are multiple moving parts, and this can be true at every visit.

Average patient censes

When you factor in no-shows the number of patients you see during a clinic day is pretty variable. I have seen up to 22 people in a day, but that can be a lot because some visits are very time-consuming. If I just saw all iron-deficiency anemia that wouldn’t take too long. But if a cancer is progressing or someone has a new diagnosis, then you have to, for example, set up a PET scan, a biopsy and provide counseling.

You need to counsel people on the possible outcomes of their cancers, whether they are typically curable or treatable or not curable or treatable. They also need to understand the possible side effects of any prescribed chemotherapy. It is possible they need to be set up for genetic counseling, nutritional counseling.

I have been timing some of my patient encounters because my work is time-based. The longest patient visit I had was around 92 minutes. This visit was for a new diagnosis of lung cancer. On the other hand, I might see someone with, say, pancytopenia from cirrhosis that they have had for the past three years. You tell them what’s going on and they’ll say “yeah, I don’t know why my doctor sent me…” That ends up being a pretty short visit.

That’s the thing – in my specialty you just never know. Seeing a long list of patients on your schedule can be daunting. Often it depends on what’s going on with the hospital, with the weather, etc.

You know, the good days are phenomenal, and the bad days can be very taxing. It does help to have some support in the healthcare facilities to offset the fluctuations in the schedule and at least provide some preliminary triage.

Typical practice settings for Hem Onc locums

There is definitely more demand for oncology locums in rural areas, but I have worked in urban, suburban and rural settings. The rural locations tend to be more laid back, have a bit of a different feel.

In places where you are the only doctor you need to be aware that you will be needed during the entire infusion center time. Much of your value to the facility is being physically present so that chemotherapy can be safely administered.

The urban centers tend to have a higher patient volume with possibly a lot of different hospitals. It can certainly be a mixed bag. I am open to a mix of settings and cases, but I do like my rural centers.

pros of locum tenens for Hem onc physicians

A big plus for me is the flexibility, the shorter schedules and the ability to spend time with my family while still being as busy as I would like. When I have time off I truly have time off. 

The thing about oncology is that you are managing the patient and that can be inescapable. You have to wonder about their pain, headaches, fevers, and when they are sick if they will need to be seen in the emergency department, and if that system doesn’t have access to the chart then the oncologist is the gate-keeper to a lot of information.

In traditional oncology roles you are called for all sorts of things, such as refilling narcotics or patient anxiety, because you have a very specific body of knowledge related to the potential for reactions to chemotherapy or side effects from immunotherapy.

So to be able to triage a patient and help everyone to the best of your ability and then remove yourself from any ongoing needs is really helpful, especially if you have younger children. I really like being able to devote my time to my children when I’m off, and working as a locum has been a very good way to do that.

I also like being able to support other doctors who need vacations, and I really try not to bother them when they’re away. I also like not being bound by non-competes or any convoluted contracts.

For the most part, I’ve had really great relationships with my clients. I have been able to return to these facilities and form long-term relationships with many of them, even though I’m a contractor.

Cons for locum tenens Hem Onc doctors

When I’m helping with locum tenens coverage for vacations I don’t get to choose specifically when I’m going to work and end up working more weekends than I would like. If I am unable to meet the need of the facility then maybe that relationship comes to an end, and that does happen from time-to-time.

Because you’re a contractor, sometimes important information doesn’t reach you in a timely fashion. For example, you don’t always know when there has been an organizational change or a new EMR or a change in practice scope or type of patient being seen.

If you’ve committed long-term to, say, two weekends per month sometimes that kind of schedule can be difficult. If you have not committed long-term you can cut back if it’s too much. I have decided to reduce my weekends, and that flexibility is really great.

I think for someone who has a very defined idea of what they should be doing at work a locums job can be frustrating- you have to have flexibility not only with the patients but also with systems. You may have to, for instance, figure out the EMR after seeing the patients. 

You have to know how to use your resources. If you are having difficulty getting around and putting in orders and finding information, it can be very frustrating. But if one place is not working out you can try an arrangement with a different place.

I do like change, trying new things and going to new places. I also keep a savings buffer. This gives me the freedom to cut back if I need to, or if something comes up and I’m not needed then I can ride that out.

Oncology locums pay rates and salary

The current hourly range for the last few years seems to be between 375 and 550 per hour. I think the very lowest I’ve been offered was for a “babysitting” job quoted at $2,000 for the day, and the highest I have ever heard of for one day was $7,200.

Sometimes the inpatient rates may be a little, but not a ton lower. In very low volume areas people may negotiate a flat 24-hour rate with extra for callbacks. I haven’t worked in very low volume areas. You usually don’t get a lot for overnights, to be honest. For a 24-hour call it might be somewhere between $3,000 to $4,000, but not considerably more.

When I do weekends I cover inpatient consults and patient calls between Friday morning and Monday morning and I get a flat rate for that. It’s a mixed bag. Lately I have been busy but haven’t had a lot of overnight calls, but every system is different.

Pay rate can depend on workload, but not always. There is a lot of inherent variability within the specialty. Sometimes your consult volume is affected by all the things that impact hospitals like a pandemic, the weather, anything shutting down the OR. Some people have trouble figuring out a new EMR. All of these things have actually happened to me.

So pay is very loosely tied to the number of patients seen. I think in general for an outpatient setting they expect to pay you for about 8 or 9 hours. I think though in the future I will try to use a capped rate model, because many of my clients are unable to judge how much work they’re giving me. With a capped rate, they will know in advance how much I’ll make.

To determine my current rate, I take the rate offered by local agencies and then add about 20 percent. I fund my own travel and locum tenens lodging. I handle my own logistics and don’t need anyone to handle that for me.

Negotiation Strategies for medical oncologist

At the beginning, because I didn’t know if I was going to stay or do the job for very long I didn’t really try to negotiate much. As I went along I found I was able to negotiate higher rates because I proved my worth. 

With clients that I might have a long-term relationship with, in a desirable location with a good workload, I may not spend a lot of time negotiating. But if you’re being asked to go somewhere where you don’t really want to go and may not go back, then, yeah, I’ll ask a bit more in that situation.

You need to consider how much you want the work, the nature of the job, the initial offer. It also depends on your geographical area. You will get a different rate in Montana than in Florida than in Pennsylvania. It depends on where the need is.

It is important to understand your options. The situations changes over time, the need for locums changes, so your arrangements are flexible. For a group that I enjoy working with I am more flexible in my rate.

Advice to Oncologists who are new to locum tenens?

I have plenty of advice. I suggest starting out to under commit. You can always take on more. Then keep your commitments, be professional in all aspects. Avoid non-competes.

Learn about finances. Learn about taxes sooner rather than later, learn about business deductions and retirement accounts. They don’t really teach you these things in fellowship.

Don’t hand out your CV willy-nilly. If you are giving out your CV, make sure that it’s watermarked if you are not allowing yourself to be presented. Be very clear in your communications with clients and learn to set boundaries.

I have actually learned a lot from this process, about business, about communications. I think it has made me a better physician and a better person. I have been able to help a lot of patients, which has been fantastic.

I have realized that I love the work I do. A hematologist oncologist that is able to create connections with people. It has been phenomenal, a big learning path, but definitely well worth it.

What would you do differently if you started again?

I would have started looking at contract work earlier instead of exploring options that were clearly a poor fit. Understanding finances is really key. I don’t think I made any terrible decisions, but bookkeeping and business deductions are no small task.

I would have wasted less time with recruiters who have absolutely no idea what the gig involves. Learning to set boundaries is very important.

A few years in, I’ve done that with polite messaging about my availability. Having clear and direct communication is crucial.

Locum Tenens physician guide 2024: Locum Tenens Physician Meaning, Taxes, Insurance & More!

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Locum tenens guide

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?

What is Locum Tenens

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.

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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:

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:

Locum Tenens Neurology Guide

Locum Tenens Psychiatry Guide

Locum Tenens Urology Guide

Locum Tenens Dentistry Guide

Locum Tenens Hematology Oncology Guide

Locum Tenens Neurology Guide: pay rates, schedule, hours, pros and cons.

by

Vlad Dzhashi, MD

Today, I’d like to invite you to learn from an experienced locum tenens neurologist. I interviewed Dr. S.A., a board-certified general and vascular neurologist, who shared insights on how to make the most out of a locum tenens career for neurologists. We discussed why you might want to consider locum tenens, the pros and cons of this career path, and the best ways to find locum tenens jobs. We also delved into whether there’s still a demand for the specialty. Additionally, we covered the nitty-gritty details of pay rates, hours, schedules, and typical clinical settings for locum tenens neurologists. At the end of our interview, we talked about how to avoid some of the pitfalls, and offered a few hacks to improve your job searching.

Table of Contents

Tell us a little bit about yourself.

I’m a board certified general neurologist and vascular neurologist. After completing my residency, I did a year long stroke fellowship, and then I did academics full-time for five years and then part-time for a year. For the last three years I’ve been doing a combination of locums, telemedicine, and then some healthcare consulting work.

Why choose locum tenens as a neurologist

Since I was in my non-clinical fellowship, I needed more flexibility so that I could control how much I work in a given month and make a great income. So locum tenens was a no-brainer.

Between the various gigs, including the locums, I’m making enough income that I have enough personal time for me and my family, and I can also focus on what takes up the majority of my time, which is my climate and health fellowship which is basically an advocacy and policy fellowship centered around the intersection of climate change and medicine.

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Best way to find neurology locum tenens jobs

When searching for a locum tenens job, I would start by asking for recommendations from your colleague. This allows you to determine which agencies are adept at providing ample neurology opportunities while maintaining a low-intrusive approach. 

Additionally, exploring job posting websites like the American Academy of Neurology Career Center or the New England Journal’s job alert site is a useful option, since they often list locums jobs specific to your specialty and subspecialty.

I prefer to work with locum tenens agencies , as I found that working directly with facilities can be quite time-consuming and require a lot of work in terms of negotiations, booking, and paperwork. Furthermore, there is limited assistance available for licensure and credentialing and facilities don’t always cover your malpractice insurance when working directly.

Typically, once I’ve found one or two agencies I like, I tend to stick with them long term. 

Best way to find locums neurology jobs:

♦ Working with agencies is the easiest way to find locums jobs

Demand for locum tenens neurologists:

I think there is a huge demand for both inpatient and outpatient locum tenens neurologists. There’s definitely a staffing shortage of neurologists throughout the country and even in very populous states with a lot of academic centers and a lot of major hospitals. 

I also think that the gigs that are available in the market are pretty diverse. So if you’re looking for neurohospitalist, outpatient, a combination of both, or if you specialize in neuromuscular, epilepsy pain management, interventional , stroke or general neurology, they’re positions out there.

In terms of how much work you’re able to find, it’s largely going to depend on how flexible you are. Also, I’d say the big states like Texas, California, Illinois, Virginia typically have more open positions.

Demand for neurology locums:

♦ Demand remains huge for both inpatient and outpatient neurology

♦ Jobs are available for both general neurology and subspecialties

Neurology locums clinical settings

Personally, I’ve worked in Florida, Kansas, Missouri and Colorado and I’ve exclusively done inpatient locums, because I like to just have the on and off shift work and not have the continuity of care with the clinic that would eat into my time.

Also, because I’m doing inpatient, the cases I’m seeing are mostly strokes. And so when you’re doing any sort of inpatient gig, they prefer that you’re stroke boarded and stroke fellowship trained. Or, at the very least, they expect you to be comfortable with stroke in terms of reading your own, vessel imaging, perfusion scans, MRIs, and making decisions about thrombolytics and endovascular. 

As to the settings, the facilities have been mostly primary rather than comprehensive centers in smaller cities or in the outskirts of larger cities. These hospitals then refer patients to the larger centers, which are most often private or less often academic.

Facilities I worked at are usually staffed by hospitalists and APP’s and usually they offer an exclusive neurology consult service without a primary neurology service. So neurology patients are primarily admitted to a medicine hospitalist service, and then you consult on them.

With that said, I’ve seen gigs out there where they want you to take care of a primary neuro service and then also do some neuro consults “on the side”. If that’s the case, they’ll have an APP working with you.

So I’d say usually locums neurologist would work with a Physician Assistant or Nurse Practitioner, less commonly solo and even less commonly along with another neurologist.

Locums neurology clinical set up:

♦ Most commonly inpatient settings

♦ Hospitals in smaller cities or in the outskirts of larger cities

♦ Neurologists act as consultants not as a primary service

♦ Neurologists typically work with APP or solo, less commonly alongside another neurologist 

Locum tenens neurology hours and schedule

Typically, locums neurologist hours range from eight to twenty four. Most of the time, they want you to do a 10 or 12 hour shift. And then they’ll either have a teleservice to cover their weekends or nights or they might have you take overnight calls which can be just by phone. 

Now, they might ask you to come in person depending on what it is they need. But it’s mostly day shifts, I would say, as they’ll usually employ a less expensive teleservice to cover their nights or they might not even have night coverage

Locums neurologists hours:

♦ Hours range from 8-24 hours

♦ Typically 10-12 hour shifts for inpatient coverage

♦ You may require cover night call over the phone

Pay-rates for locum tenens neurologists

The pay rates for locum tenens neurologists vary depending on the location, workload and the type of settings. Usually I’ll look for an hourly rate of around 250 or above. That’s for hospital coverage on weekdays Monday through Friday. 

So typically in a day, depending on whether I’m just working business hours or taking overnight call, the daily rate would end up being $2,500 to $3000. On weekends and holidays I’m usually aiming for a higher daily rate between $3000 to $5,000. 

If you provide call coverage at night, the agencies will pay for taking the pager anywhere from $200 to $500 simply to be available. And then they’ll pay you extra depending on how many hours you get called back. Usually the call back hourly rates are the same or higher, compared to the daily rate. So if you’re making $250 per hour during the day, it might be between $250 and $350/hr.

Locum tenens neurologists PAY RATES:

♦ $250-350/hr or daily rate of $2500-3000 for regular hours Monday to Friday

♦ $3000-5000 daily rate for weekends and Holidays

♦ Pager fee $200-500/night

♦  Call-back hourly rate $250-350/hr

Pros and Cons of locum tenens for neurologists

As a locum physician, I receive higher compensation for fewer hours, giving me additional time for personal stuff. I also enjoy the flexibility in my schedule and the chance to visit different cities, possibly even extending my stay into a vacation.

Another significant benefit is the potential for 1099 income, which can prompt me to establish an LLC. With the changes in tax laws, many doctors now create LLCs or S Corps and write off various business-related expenses such as licensing, credentialing fees, or equipment costs. This could be anything from headphones and laptops to phone bills and home office utilities, resulting in significant tax savings.

As to the disadvantages, there’s a few. The locum tenens licensing and credentialing process can be tedious as it needs to be redone for every hospital. It also places a burden on my colleagues who often need to provide letters of reference. Moreover, some locums agencies can be quite invasive in their communication, contacting at odd hours or during patient consultations.

Sometimes, I find the information provided by the locums agency about pay, hours, benefits, or hospital resources is not accurate as they receive it secondhand. I prefer getting this information directly from the hospital. Another downside is the need for flexibility and availability for last-minute gigs, which might not always align with my schedule.

A significant risk factor is relying solely on one hospital for work. There are times when I’ve committed to a place for months, only to be dropped when they hire a permanent person. This reality forces me to diversify and not rely solely on one place for income.

Lastly, working locums does not come with the usual benefits such as medical, dental, or 401k. If locums is my only source of income, and I’m not financially independent, that can be a risky proposition.

Neurology locums “hacks”

Before you even consider talking to the locum tenens agency, you need to be very clear about what you’re willing to do, what you’re not willing to do, and what you’re flexible on. This is because you don’t wanna be down the line with the credentialing process, decide “I don’t really want this”, or you go and you don’t do a good job because you’re not really competent in a particular area. So I have that conversation with myself first. 

Once you’ve decided on your preferences and limitations, then you need to create an email template (see below) which you send to the agency to make sure they’re aware of these things. This way I don’t forget to ask anything and we don’t waste our time on going back and forth if the job doesn’t fit my preferences.

EMAIL TEMPLATE

The following is an example of the email you need to send to the recruiter that lists your requirements and preferences:

Hi, Recruiter’s Name here! 

Thank you for reaching out. I’d like to get more details about this locums job to make sure it’s a right fit:

● What specific days and hours need coverage in-person and by phone-only?

● What is the expected total number of patients I would see during the day and get called about overnight?

● Would there be neurologists or APPs working along side me on shift? If so, what hours?

● What is the compensation broken down by guaranteed, overtime, holidays, nights, and weekends?

Also, I’d like let you know my preferences and my requirements for locums job:

● Up to 1 week/month out of state.

● Can do tele or in-person

● Inpatient only, not outpatient

● Inpatient consults only, no primary service coverage where I would have to admit and discharge patients.

● Will see all types of patients with neurological conditions including stroke. I do not see pediatric patients.

● EMRs: will use Epic or Cerner, but will not use Meditech

● If night call is required, I will only cover by phone, not in-person

● I do: perform lumbar punctures, give tPA (alteplase) and TNK (tenecteplase)

● I don’t: read EEG or EMG, perform endovascular procedures or surgeries

● I need a test-out option for EMR training with Epic and Cerner, I am not open to sitting through EMR training for systems I already use.

● If the hospital wants to be compensated or simply have the option to cancel within 30 days of the assignment start date, I expect to have the same privilege. Similarly, I don’t necessitate these conditions if they don’t expect them of me.

Active certifications and state licenses:

● Boarded in Neurology, Vascular Neurology (Stroke).

● Active state medical licenses: (list your licenses here)

● I have 2 active DEAs

● BLS, NIHSS are up to date. I don’t have ACLS, but can get it if needed

● COVID vaccine, flu, PPD, and common vaccinations are up to date

● NPDB with no issues as of Jan 2023 (I check annually)

● No past/current malpractice claims to my knowledge

 As this is just an example, you need to personalize this email to the recruiter based on your situation.

What would you do differently if you started as a locum tenens neurologist again

Reflecting on the last three years that I’ve been doing locums as a neurologist, I would say the first thing that I would do differently is know what I’m worth and I would not take low pay rates.

Because after I did the math, I realized some of the gigs I was doing were making the same or less than my hourly rate when I was working full-time in person. So clearly that’s just not the best use of my time. 

The second thing I would’ve done differently is make that spreadsheet with the list of my preferences and requirements for the agency. This would’ve minimized the communication back and forth and misunderstandings.

The third thing I would’ve done differently is I wish I’d just used my own credit card and book the trips myself to rack up miles and points cuz then I can just use that for, you know, vacations and personal stuff as these miles can build up pretty quickly.

TIPS for locum tenens neurologists:

♦ Know what you’re worth

♦ Be very clear about what your preferences and requiremens are when communicating with agencies

♦ Use your own credit card to collect poitns

Locum Tenens Dentistry: pros and cons, pay rates, tips to succeed.

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locum tenens dentistry

Vlad Dzhashi, MD

I sat down for a detailed discussion about locum tenens dentistry with S.M., DDS., a residency trained dentist who has been practicing for eight years. After spending time in private practice, she decided that locum tenens was a better fit and has been doing this full-time ever since.

We talked about how to best find locums jobs for dentists, types of locums gigs in dentistry, and the demand for locum tenens dentists.

In addition, we discussed examples of a typical locum dentistry assignment, including schedules, procedures, and staffing.

Lastly, we reviewed pros and cons of locum tenens dentistry, pay rates for locums, and touched on negotiation tips

Why did you choose locum tenens as a dentist?

I started doing locum tenens right after I got my license just to get some revenue. Then I joined a private practice, but it wasn’t the best situation. So I parted ways and started doing locums again, and fell into it full-time.

At first I did locums just to keep myself busy, but then I saw the opportunity to gain exposure to different systems, tools and approaches to dentistry. It’s really interesting because you can see regional differences in the patient population. There’s a lot of variety in materials and tools.

Also, I don’t have a family. I don’t have to settle down in one location. I have done a lot of traveling. Many of these communities that I visit are rural communities or places where most people don’t want to go, so dentists don’t go there either. I can leverage that for higher rates.

Best way to find locums jobs for dentists?

I have found that the best way to find jobs is through recruiters. I often look at opportunities offered by locum tenens agencies through Indeed, etc. When a job is finishing I will reach out to them and ask about openings for future dates.

If you have personal connections you might be able to find some opportunities through direct contact with a practice. You would probably be covering for, say, vacations or maternity, and so it would likely be for more short-term.

Demand for locum tenens dentists

There’s definitely a demand for it. It’s just a matter of, how flexible are you, how much are you willing to travel, what kind of lifestyle are you willing to live in. It’s a lot of living in hotels, not having your stuff, being away from family and friends, but again, you can leverage that for higher pay.

The only time I did not have work was during Covid. When Covid hit, I was at a job, but when that contract expired, I couldn’t find another full-time position for six months. But because I was self-employed, I was eligible for a PPP loan- those kept me afloat.

Types of locum tenens dentistry gigs

I would say DSOs (Dental Service Organizations) and FQHCs (Federally Qualified Health Centers) are the ones that are looking for locum tenens the most. Another entity is the correctional facilities. Private practices are typically seeking only short-term coverage for maternity or vacation leaves.

I don’t know if my job experience is typical because I look for long-term positions, but I am open to traveling and serving rural communities. One of my gigs lasted for two years.

Some places have a hard time getting a dentist, and so there is job security. It’s more how long you want to be in that place; do you want to continue being in this particular office or in this particular location, or do you want to go someplace else?

Typical locum tenens dentistry assignment

I dictate my schedule based on what procedures I am comfortable with, how much time I need allotted for a procedure, etc. Sometimes I start a job and appointments and procedures have already been scheduled, but it depends on how trained the staff are as to whether I can keep that schedule.

I am comfortable with my skill set and using different materials and techniques in order to get the results that I need. The weakest link can be the staff. I’ve worked at a practice, for example, where the dental assistants were untrained and I was not comfortable doing some procedures.

What do you do when support staff is inadequate?

My level of comfort really relies on the level of competency and experience of the dental assistants that I work with. Before I go to a site, I always ask about the experience of the staff, but rarely am I able to get an answer.

I am not willing to rush through something if I don’t have the support to get it done the right way, so I’ll hold off things – that’s happened in several practices.

If they’re not able to give me the support, then I’m not able to do the dentistry. I put that on them. I let them know that there is a problem with their staff.

I have actually once quit my assignment because of this problem. At one location I knew it wasn’t going to work out within my first week. I talked to my recruiter because they wanted me to stay for 6 months. I gave it another three weeks or so, but realized it was not a good situation, so I gave my notice.

Pros and Cons of locums for dentists

Some of the pros are what I talked about earlier – being exposed to different ways of doing things, in addition to the flexibility and earning potential.

On the flip side there’s always uncertainty about what you are walking into. Sometimes things are missed or overtreated. It can be difficult to navigate that space and discuss that with patients.

The staff might see that you’re not following a previous treatment plan, and then they question you- that can be a difficult situation. They may see you as transitory. To manage that you have to stand up for what you believe in.

In some situations, they can try to convince you to do procedures or run a schedule that you’re not comfortable with. But in the end, you’re the doctor, it’s your license, and you have to draw the line.

Another caveat is that It is very important to have strong clinical skills before starting locums. Personally, I did a residency, which a lot of general dentists don’t do, so I had even more clinical experience. But even then, I don’t know if I’d recommend this for a new grad. I think this would be a good thing to do for someone that’s been practicing for a couple years.

Locum tenens dentist pay rate and salary

The pay rate on average, if I look through indeed, is anywhere between 90 to $120 an hour. But does that include lodging or miles? I don’t know.

When I started, my pay was $75 an hour. But I didn’t negotiate. After I left private practice I built a reputation. I was able to build my name and could ask for more money. In rural communities I’m able to ask for even more.

I think lots of doctors just accept the rate they are given. They never try to counter or negotiate. The first thing I’ll do is negotiate. Especially in these rural communities, they’re going to have to supplement my income and entice me in some way to get me there. Otherwise, I’ll go someplace else.

When I was at the same place for two years, I asked for two raises. They agreed to it and continued with my contract. If you’re flexible and willing to travel, you can ask for what you want.

Some pay rates are very high, but they include pay for lodging etc. Now my pay rate is 170 an hour, and I get my miles and my lodging paid for or reimbursed. One of my close friends does locum dentistry and makes $200 but she pays for her travel and accommodation.

Also, keep in mind that the DSO’s will typically pay more than the FQHC’s; from what I’ve seen, the DSO’s are more flexible with their rate.

Negotiation tips for locum tenens dentists

It is important to build your relationships, be willing to produce and make money for the practice, earn the reputation of being respectful to staff and patients, be willing to go into those rural communities. As a newbie, maybe use the first job to build your name, and then negotiate a higher locums pay for the next job.

It is important to do your research. For example, if a job has been advertised for a while, and you know there is a need, then even if it’s your first job you can ask for more money, and/or for benefits such as lodging, food and miles. Some things, such as license or DEA renewal, they will cover, but you have to ask for it.

Keep in mind that rural communities tend to pay more and it’s easier to negotiate a higher pay rate as a locums dentist, but they may not be ideal for the new graduate.

Are you looking for a locums job?

My agency offers the Highest Pay Rates
for Urologists

Learn More

Our High-Paying Urology jobs:

$350/hr UROLOGY Locums in Pennsylvania.

$4000/day Urology Locums in York, PA. Clinic only, no call. Close to DC and Baltimore.

$400/hr Urology Locums in Illinois. No call. Clinic/OR.

$5000/day Urology Locums in KY. Call only No clinic.

$4500/day urology locums in SC. 

Urology Locum Tenens Guide: tips, demand, scheduling and pay.

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Locum Tenens Urology

Vlad Dzhashi, MD

I sat down for an in-depth discussion with locum tenens urologist Dr J.W., who almost quit medicine altogether after being hospital employed for three years after training. He knew he never wanted to be employed again but also recognized the struggles of independent practice. He found the perfect solution in locum tenens urology.

We discussed how working as a locum tenens allowed him to keep practicing urology on his terms, touched on how to find positions, demand for locum tenens urology, and typical work settings.

In addition, we reviewed typical pay rates for locum tenens urology, how to negotiate pay and understand how to leverage your position during pay rate conversations, and typical schedules.

We covered the quality of equipment, supporting staff and administration, and the question of patient coverage when the locum job is over.

Finally, we examined troubleshooting locum tenens urology gigs and what he might have done differently in retrospect.

Enjoy reading the interview below, or watch the video here.

Table of Contents

Why choose locum tenens as a urologist?

After training I took an employed urology job, and really came to understand the difficulties within the system, not having a final say or control over a lot of things. I almost had my foot out the door- I got my real estate license and was looking at options other than healthcare because of burnout. I knew I never wanted to be somebody’s employee again, putting myself in a position where I can’t deliver patients the care that I want at the quality that I want.

Thankfully, I found locums; I still love urology and I love helping people through surgery. Also, I was able to claim back some of my time. I’ve been able to make basically the same or even a bit more than I was making as a full-time doc in about half the time.

What is the best way to find locums work as a urologist

While I’ve done some research into direct locums and per-diem, honestly I’ve found that working with a company that already has relationships has been more fruitful and easier.

Trying to figure out what facilities are in need, who to contact and how to get malpractice insurance is not easy, and not the best use of my time, so working with a couple of companies I have been able to maximize my time and minimize the need to do that work myself.

I think having a couple of different companies you have a good working relationship with that send you jobs is in your best interest. Usually the notice for a job ending is pretty short- say, thirty days- and so you can be left scrambling, especially if you have to credential and get a new state license asap.

Working with a couple of different companies gives you some protection from that scenario.

Are you looking for a locums job?

My agency offers the Highest Pay Rates
for Urologists

Learn More

Our High-Paying Urology jobs:

$350/hr UROLOGY Locums in Pennsylvania.

$4000/day Urology Locums in York, PA. Clinic only, no call. Close to DC and Baltimore.

$400/hr Urology Locums in Illinois. No call. Clinic/OR.

$5000/day Urology Locums in KY. Call only No clinic.

$4500/day urology locums in SC. 

What is the demand for locum tenens urologists

Demand for locum tenens urologists is quite high. Urologists are already a critical shortage throughout the country, and about 35% of us are over the age of 65. It’s a numbers game- yes, you’re going to have to find the situation and opportunity that’s good for you, but I still get emails and messages or text messages pretty much every week, if not more.

When I’m talking to hospitals or negotiating, I know they can’t do the work without me, but I can work without them somewhere else. And the reality is, there’s already a huge shortage. 

To a large degree, I think that the urology opportunities that are out there is only going to get more and more numerous.

What is the key to having more locums opportunities

The more flexible you are, the more willing you are to go to different areas or get new state licenses or be that jack of all trades, the more opportunities you will have. 

That doesn’t mean that if you’re uncomfortable doing something that the hospital is going to make you do it- you can tell them, listen, this is off limits, but these are all the things that I will do.

Typical locum tenens urology gigs

There is a big variety- some are just inpatient, some just outpatient, and some are a mix. The need in each place can be very different.  I’ve worked in situations where I was doing clinic and taking call, and I’ve worked in situations where I was just doing outpatient clinic or where I was just doing inpatient call and kind of a condensed half day.

You can often find exactly what you want, but the more flexible you are, the easier it’s going to be for you to find a job and keep cash flowing for yourself and your family.

Also, while it varies, certainly more rural hospitals are struggling, so I think many jobs do tend to be more rural.

Typical schedule for locum tenens urologist

I think they’re looking for consistency- whether you can commit to a week a month or 10 days a month or what have you. Most of the time they’re looking for a consistent commitment for days that you can work within a month to help them fill their schedule.

Once you are credentialed with them and get set up for the assignment, to some extent you’ll be able to pick and choose the dates that are available. If there’s more available and you want to take more dates than what was agreed upon, you usually can. If there’s not or you want to take just what you agreed on, you usually can.

How far out do you book your schedule

That can vary. 

Right now I’m scheduling one or two months in advance, but prior to that, I was actually getting scheduled out about six months in advance. Because the hospitals want continuity, smoothness, no big gaps in their schedule, they want the consistency to be able to make sure that the hospital is covered. 

From that standpoint, for a lot of them scheduling out further in time makes a lot of sense for them.

Pay rates for locum tenens urologists

When I started out, I was basically making about 2,700 for a day of clinic and I think about 3000 or 3,300 or so for a day of call. Now I’m making about 5,500 a day- that includes clinic or outpatient surgery and 24 hour call all in one.

I consider that within the time I dedicate to them there are significant limitations to what I can otherwise do. Therefore, I value my time at about $250 an hour- about $6,000 a day.

Also, you need to understand that it’s a bit of a numbers game- you may expect to get more no’s if you’re asking for higher rates but I think the opportunities are still out there. 

I have it on pretty good authority that the average hospital is paying out about $7,500 a day for call coverage. 

Unfortunately, a lot of the agencies that are out there are not so transparent, and a lot of them are taking 30 to 50% off the top.

Some agencies have deceptive business practices in that regard. But I would encourage folks to shoot high and you may not make that, but if you’re above what they were offering, that’s still a win-win. There is a little bit more work that’s involved, but it also allows you to earn a higher rate.

I don’t mind the agency making money, but I don’t want them to make more money than I’m making based off my work.

Negotiation strategies for locum urologists

I like the idea of anchoring high, as described in the book Never Split the Difference by Voss and Raz. Even if you fall below your anchor, you are still getting more than you were originally going to get. Also, remember, they need you more than you need them.

Again, it’s a numbers game- determine what your worth is to yourself. Analyze the job and determine what the pain points are- if you’re taking call for one hospital, that’s one thing, but if you’re taking call for three hospitals that are around a 10 or 15 mile radius, then that’s going to be a significantly different situation.

I would encourage you not to accept less than you think you’re worth, at least to a significant degree. I mean, if you need to take a job that’s paying a little bit less for a while, great, do it. 

But in the long run I would really focus on deciding what your value is and communicating that. And if they don’t see your value and they’re not willing to work with you on that, then that’s probably not a job you really want to be taking anyway.

I mentioned one situation where I left and there was nobody there for a week afterwards. In that situation, they have to transfer everything out. Think about all the lost revenue, and difficulty for everyone. 

Remember when you’re talking about any type of trauma center, they absolutely have to have subspecialty coverage or they’re at risk of losing their accreditation, so it is an opportunity cost piece. 

If you’re not there and they can’t serve people, then they’re going to lose a heck of a lot more money than they otherwise could potentially be spending to pay you for your wages.

Are you looking for a locums job?

My agency offers the Highest Pay Rates
for Urologists

Learn More

Our High-Paying Urology jobs:

$350/hr UROLOGY Locums in Pennsylvania.

$4000/day Urology Locums in York, PA. Clinic only, no call. Close to DC and Baltimore.

$400/hr Urology Locums in Illinois. No call. Clinic/OR.

$5000/day Urology Locums in KY. Call only No clinic.

$4500/day urology locums in SC. 

Surgical equipment at the hospitals during your locums assignment

Stone disease is one of the most common things that you’re probably going to deal with on these types of assignments. Things you’re going to be doing over and over again, you really want to make it as easy as possible for yourself. 

I think this is something that I would certainly recommend that anybody asks about when they’re considering a job. I always make sure I ask about their ureteral scopes.

Even if they’re older, a lot of the scopes are still functional. I think you do have to be a bit flexible in that again, and to some extent work with what they have. But at the same time, that’s another thing you can inquire about upfront and ask Is there any flexibility or consideration for replacing that?

Quite honestly, I’ve found most of the hospitals are pretty flexible about that type of thing. They realize that you have to be able to have have the tools to do your job.

Do you find supporting staff helpful during your locums assignment?

Yes, most of the places have pretty good support staff in place.  It can vary of course, but most of the places recognize that you need a team around you to be able to serve the best you can. 

The only caveat to that that is a lot of these places are kind of distressed and may not have the best “culture” in the world. 

There also can be some significant turnover in that type of situation, so, that’s something to think about as you’re preparing for an assignment.

Are the administrators supportive and helpful during your locums assignment?

Generally speaking, yes. 

However, there was one situation where I got out pretty quickly because I realized that they didn’t really care about me or trying to help patients. That was one of those places where there was a lot of turnover in the staff too.

That’s where I was like, all right, I’m going to give you my notice and I’m going to find a different situation- that’s one of the bonuses of being an independent contractor- you get to make that decision, to say, yes, I’m going to continue to work here, or no, this is really not a situation that I want to be involved in.

Who covers the urology patients after you leave your locums assignment?

Many places want a schedule commitment per month, so they know when you’ll be back, but I have also been in situations where I left and there was no one else there. The hospital didn’t have anybody to cover, which was concerning for the patients. It’s certainly a big strain on the system because they have to ship out consults. 

But some of these places are distressed and in the grand scheme of things you can only do the best you can.

But most of the time you’re going to have, for example, another doc that is alternating with you. Some facilities have other urologists that are already practicing full-time there. They just need extra help. They don’t have other full-time employees. The full-time docs would be able to cover and take care of stuff if you’re not there.

Troubleshooting urology locums

You have to understand you’re going into a distressed situation, and you can’t expect it to be the most well-oiled machine. There’s certainly any number of different things that could be problematic, including, for example, travel or equipment, etc. Setting your expectations for that upfront, I think is a great way to try to avoid some of the stressors.

Another important point is that communicating with whatever agency you’re working with and with the site is very important.

That’s why I think asking upfront and starting that conversation very early and saying, hey, listen, if things really aren’t working out with the equipment, I’m not able to do my job the way I need to. Is there room for us to maybe make some improvement? The ureteroscope is a significant investment for a lot of hospitals. But there’s a lot of newer technology like a disposable ureteroscope that is just as good or better than the reusable ones and can be much less of an investment for the hospital.

I think there’s always some solution that can potentially be found. I think keeping that conversation going is super important.

Understand that you’re there as a visitor for a defined time. A lot of these places will do whatever they need to do to keep people coming to help.

Remembering your leverage points is a great way to get changes made if they need to be made, if they’re really problematic.

What would you do differently if you started as a locum tenens urologist again

I think probably the biggest thing that I would do differently is just try to negotiate locums pay rate harder upfront. To some extent, I didn’t know much better. As I went along, I learned more about my value and what the industry was paying.

I think otherwise it is like any other journey. You’re going to expect some bumps here in the road here or there, and you’re going to expect to potentially have some shifting in your expectations.

I think, again, just asking as many questions as you possibly can upfront before you ever get into an assignment is the best way.

Also, try to create the relationship early through communicating. It is going to be that relationship with the site and with the agency that will allow you to help them the best that you can. 

From that standpoint, I think it is a very valuable way for you to protect yourself and just make sure that it’s going to be the right situation for you.