Emergency physician Jay Blankenship remembers the exact moment he and his wife—also a physician—knew it was time to make a change. It was when their family Christmas lasted all of 15 minutes as they passed their young kids off to each other on the side of an interstate highway.
After weighing the pros and cons of locum tenens work, they both left their jobs to become independent contractors. Becoming a locum tenens physician, Blankenship said on an episode of the Emergency Medicine News (EMN) “Everyday Medicine for Physicians” podcast, gave him his life back.
Taking on temporary medical work is an increasingly popular option. Between 2002 and 2016, the number of U.S. doctors working in locum tenens positions almost doubled, reaching 48,000, according to a Staff Care survey. That same survey found that 94% of healthcare facility managers worked with contract physicians in 2016.
The pros and cons of locum tenens
Is locum tenens right for you? Here are a few of the key benefits and drawbacks.
Pros
Battle burnout with flexibility and autonomy
Emergency physicians like Blankenship may be more susceptible than most, but burnout is a growing epidemic among all clinicians, affecting more than half of those surveyed in a recent Stanford-led study. This has repercussions for patient safety: The risk of medical errors doubled among physicians suffering from burnout.
In Blankenship’s experience and based on what he’s heard from colleagues, scheduling contributes greatly to burnout, so greater work flexibility can help.
With locum tenens, you control your own schedule. You can plan your calendar out months ahead or wait for last-minute assignments, which are often more lucrative. You work largely when and where you want. It’s a terrific opportunity to see the country or even the world while still earning a good living.
Earn a better hourly or per diem rate
Your hourly or daily rate will likely be higher than that of a full-time permanent doctor at the same facility. If you work through an agency, it will likely cover additional costs, from malpractice insurance and licensing, credentialing and privileging to travel and accommodations, Physicians Practice reports.
And while freedom and flexibility may be attractive aspects to many doctors, others like the ability to earn supplemental income on top of their stable paycheck. Almost half of locum tenens physicians hold permanent positions, augmenting their income with the occasional temporary assignment, according the Staff Care survey.
Cons
Negotiating paperwork
This con can alternatively be a pro depending on your agency, if you choose to go that route. But in either case, some extra due diligence on your part is required.
Your agency is often likely to handle the paperwork related to privileging, licensing and so on, but you’ll have to ask. Be sure that all of that is included in the contract, especially medical malpractice insurance, which most agencies provide. Find out what is included and excluded in the policy. For instance, if there’s a deductible, who pays? If an agency is unwilling to answer your questions in detail, it may be best to walk away.
In general, you should never have to fill out your own paperwork. Your job is to review and correct, Geeta Arora, MD, writes in the Hospitalist. But you’ll still need to deal with the paperwork associated with being your own boss.
Find your own benefits
If you don’t have a permanent position in addition to your locums work, you are responsible for your own health insurance coverage. Unless you have a spouse who can add you to their plan, you’ll need to find your own health—and, if you want it, dental, disability and life—insurance. Of course, it’s not hard to find insurance, though it does take some work. Options abound, from the American Medical Association to HealthCare.gov to a local broker. You’re also responsible for your own retirement plan. For that, you should talk to your financial planner.
Paying for intermediaries
Most locum tenens doctors work through a staffing agency, and the agency takes a cut. That covers the administrative costs described above, as well as contributing to the agency’s profit.
One problem, says Blankenship, is that doctors don’t know how this breaks down. They don’t know what the hospital is offering, and the hospital doesn’t know what the doctor is being offered.
His advice: Figure out what you’re worth for each assignment, and stick to it. “Don’t let a middleman dictate the rate,“ he said.
Three steps for getting started with locum tenens
It isn’t for everyone, but the beauty of locums is that you can take it for a test drive and then decide if it’s a fit.
That’s true whether you come to it later in your career or start right out of your residency, as Dr. Johnny Shen discussed doing on Locumstory. This is an excellent opportunity to try out various work settings and locations. If locums isn’t for you, you’ll leave with better insights into where you do want to spend your career. Here are three tips for getting started.
1. Make some decisions
Whether you are fresh out of residency, mid-career or looking for a glide path into retirement, decide what you want from locums work. Do you want to supplement your income? Do you want to work part-time? Or do you plan to freelance full-time? How far and how often are you willing to travel? An honest self-assessment up front will allow you to take full advantage of locums opportunities.
2. Choose wisely
If you decide to use an agency—and most first-timers do—choose one that you feel comfortable with. Be sure to select one that’s willing to answer all your questions. And bigger isn’t necessarily better: Arora warns against “factory mill” companies, where overhead is higher and each recruiter has more physicians, making the experience less personalized and more prone to mistakes. Consider also looking into online platforms like Lucidity, which EMN compares to Uber, saying that it’s designed to bypass “the inefficient and expensive legacy locum tenens agencies.”
3. Ask around
Everyone’s experience will vary but hearing from friends and colleagues abot their experiences with locum tenens will give you a better idea of the reality. Many physicians who have gone the locum tenens route are eager to spread the word, as Dr. Edward Leap’s locums-focused column in EMN attests.
If you’ve considered the disadvantages and decided that this is still the best career path for you, you’re ready to enter the world of freelancing.
