For years, the majority of physicians have taken the traditional path forward after residency: find a full-time position, and try to work their way up within a hospital or group practice.
But the medical landscape is shifting—and amidst an ongoing shortage of physicians, many newly anointed attendings are embracing the autonomy and flexibility of working locum tenens immediately after residency. (The paid travel and increased pay rates are pretty nice, too.)
Let’s take a closer look at locum tenens, the benefits of working locums as a new physician, and why it’s an increasingly popular choice for both physicians and healthcare organizations.
What is locum tenens?
Translated from Latin, locum tenens means, “to hold the place of.” Put simply, locums physicians work temporary assignments in healthcare facilities that need extra staffing support.
Locums assignments can be as short as a single shift, or last for several months. Many healthcare facilities use locum tenens to keep up with patient demand until they can hire full-time physicians, or to fill in for current staff on vacation or parental leave.
While locum tenens physicians are considered independent contractors, most of them work with a staffing agency to handle things like booking assignments, licensing and credentialing, and travel arrangements. And unlike permanent positions, locums give you the final say over where, when, and how much you want to work.
Can any physician practice locum tenens?
The growing locum tenens industry means there are plentiful opportunities for physicians at every stage of their careers.
In CHG Healthcare’s 2024 State of Locum Tenens Report, almost half of surveyed organizations reported a year-over-year increase in their use of locums physicians. The same report shows nearly one-third of all physicians in the U.S. currently work locum tenens (or have done so previously).
Regardless of how long you’ve been practicing, locums can provide more control over your schedule, your finances, and your lifestyle.
Recent graduates
For physicians fresh out of residency, locum tenens gives you the chance to test-drive different practice settings and workplace cultures. It helps sharpen your clinical skills in varied environments, and allows you to learn from a broad range of colleagues. The extra income can also be useful to quickly pay down student loan debts.
Mid-career physicians
Established physicians frequently work locums to boost their income for major life events like purchasing a home or sending a child to college. Many physicians also find locums assignments offer a refreshing break from the red tape and administrative pressures that hinder permanently employed physicians.
Late-career physicians
Physicians nearing retirement age often choose locum tenens as a bridge to semi-retirement, as it comes with greater flexibility than even a part-time position. Your status as an independent contractor also comes with some potential advantages in reducing taxation and maximizing retirement contributions.
Which specialties are in highest demand for locum tenens?
Locum tenens opportunities are available for physicians in every specialty, though some are in higher demand than others. Demand for any given specialty can vary from year to year based on overall industry trends and market factors.
According to the 2024 State of Locum Tenens Report from CHG Healthcare, the highest-demand specialties in 2023 were primary care, internal medicine subspecialties, surgical specialties, cardiology/pulmonology, and oncology. Although there were some pandemic-related shifts, these have remained fairly consistent over the past five years.
If you’re interested in researching the demand for your specialty, this handy trends-by-specialty tool can help you get a better idea of the current locum tenens market for your area of expertise.
Benefits of practicing locum tenens
About 40% of locum tenens physicians work locums full-time, while the other 60% work locums in addition to their permanent employment or private practice. No matter which group you’re in, locum tenens offers some noteworthy benefits and opportunities.
Increased earning power
On average, locums physicians are paid more per hour than their full-time colleagues. Whether it’s paying off loans, planning for a major purchase, or investing for the future, you can speed up progress toward your financial goals.
The chance to be your own boss
Take as many or as few assignments as you like. Locums puts you in charge of your own schedule and workload, and lets you take time off whenever you need it.
More fulfilling patient care
Locum tenens physicians typically have fewer administrative responsibilities, which means more time to spend with patients (and less time worrying about workplace politics).
Paid travel opportunities
If you love the idea of exploring new places—with fully covered travel and housing expenses—working locums is a fantastic way to nurture your nomadic spirit.
Varied work environments
One assignment might be in a major trauma center, while the next takes you to a small rural clinic. Working with different equipment, procedures, and colleagues keeps things interesting, and develops well-rounded skills that are valuable to employers.
Professional development opportunities
Taking temporary assignments in varied facilities helps you build a strong professional network, and offers the chance to learn something new in every clinic.
Test out potential employment arrangements
Locums assignments can also serve as a trial period of sorts before committing to a permanent position. Especially for new physicians with limited experience in different clinical settings, locums can be useful for figuring out your own preferences and where you’re most likely to thrive.
Considerations and challenges of locum tenens
Compared to full-time employees, locum tenens physicians face some unique challenges and considerations. Still, many physicians consider the benefits of locum tenens to be more than worth it when weighing the pros and cons.
Change is a constant
Some people find the regular cycle of new places, faces, and facilities invigorating, while others find it draining. Adaptability is one of the most important qualities of any good locums physician.
No standard benefits package
If you don’t already have benefits like health insurance or retirement accounts through a spouse or current employer, you’ll need to arrange those on your own.
You’re responsible for paying taxes
You’ll need to put aside a portion of your income to pay your tax bill, since independent contractors don’t automatically have part of their paychecks withheld for taxes.
Locum tenens doesn’t count toward PSLF
Locum tenens assignments don’t meet the requirements for Public Service Loan Forgiveness programs. However, many physicians find the increased earning potential of locums outweighs the chance at loan forgiveness through PSLF.
Paperwork and licensing challenges
Practicing medicine in multiple locations usually means coordinating multiple state licenses and all the necessary credentials to obtain them. Top-tier locums agencies can take this burden off the physician with a dedicated in-house team to streamline the process.
What do I need to know about being an independent contractor?
Taxes and benefits for locums physicians
Locums physicians are responsible for paying their own taxes, since they don’t automatically have a portion of their paychecks withheld. You’ll need to put aside part of your locums income for your tax bill, and make quarterly payments to the IRS to avoid penalties come tax season.
You’ll also need to secure your own benefits like health insurance and retirement savings accounts, if you don’t already receive them through a full-time position. The federal health insurance marketplace is a popular choice for locums physicians to choose their own coverage. If you have a spouse that works full-time, you may also be able to access health insurance through their workplace benefits package.
While it does add a layer of responsibility to handle your own taxes and benefits, it also comes with the chance to claim more deductions, and to customize the healthcare coverage and financial plan that makes the most sense for you. And it’s important to remember that you don’t have to do everything by yourself—a good CPA and financial advisor can help you understand your obligations and identify potential opportunities.
How locum tenens physicians get paid
Locum tenens physicians are usually paid by the hour, day, or shift as 1099 employees of a staffing agency. Some locums contracts also include sign-on or completion bonuses. Payment structures vary between agencies, but weekly or bi-weekly direct deposits are generally the industry standard.
Factors influencing pay for locums physicians
Several market factors will influence how much you can earn working locum tenens.
Relevant skills
Experience with relevant procedures and patient populations can boost your negotiating power.
Location
Cost of living and other local economic factors also influence pay rates. At the same time, locations with severe shortages may pay more to attract skilled physicians.
Specialty
The harder it is to fill an open position in your specialty, the higher your earning potential as a locums physician.
Patient load
Locums assignments with a high volume of patients generally pay more than those at slower-paced facilities.
Shift type
Weekends, holidays, and overnight or call shifts often lead to higher hourly rates, compared to shifts with more standard business hours.
No matter your medical specialty or the specifics of an assignment, a great locums agency will negotiate on your behalf to secure more favorable terms, since a win for the physician is also a win for the staffing agency.
Business entities for locum tenens physicians
While it’s not necessarily required, setting up a business entity like an LLC helps separate your personal finances from your business finances. Business entities may shield you from certain legal issues, and can also come with tax advantages depending on your situation.
Sole proprietorship
This will be your default business structure if you don’t set up a separate entity for your locums practice. It’s a common choice for physicians who work locums in addition to a full-time position, as it allows reporting your business income on your personal tax return.
Limited liability corporation (LLC)
An LLC protects your personal assets from business debts and certain types of lawsuits. While it doesn’t necessarily offer tax advantages over a sole proprietorship, it’s a common choice among locums physicians to keep their finances separate and organized.
S corporation
By forming an S corporation, you’ll function as both owner and employee, and receive a W-2 salary from your own business entity. As the owner, you’ll also receive any profits beyond your salary as a business distribution, which can offer significant savings on self-employment taxes. An S corp is a great choice for physicians who work locums full-time, but less ideal for those working locums in addition to a permanent position.
As always, a trusted accountant or financial advisor can help you choose the business structure that makes the most sense for your locums practice.
How to get started with locum tenens
Deciding if locums is right for you
If you’re considering locum tenens after residency, there are a few important questions you should ask yourself to determine if it’s a good fit for your lifestyle and ambitions.
Do you want more autonomy in your career?
Some people enjoy the routine of showing up to work in the same place every day without thinking about it. But if you’d rather have more control over your schedule, workload, and earning potential, locums can be an excellent option.
Do you enjoy traveling for work?
If you’re fulfilled by exploring new places and meeting new people, you’ll likely enjoy working locums. Keep in mind you may also be able to take on short-term assignments within driving distance from home if your personal situation isn’t ideal for extended travel.
Do you thrive in changing environments?
It can be a challenge to constantly learn new names, facilities, and equipment. On the other hand, it’s also a fantastic way to supercharge your professional network and gain valuable experience in a variety of clinical settings.
Still trying to decide if locums is the right choice for you? This quick 10-question quiz can help you make a more informed decision.
Working with a locums agency
Most physicians who practice locum tenens work with an agency to secure assignments and streamline the credentialing process. Partnering with a well-established agency offers several benefits for physicians.
More job options
Agencies with a bigger reach have access to more available job opportunities, which means more places and assignments to choose from.
Negotiating power
Reputable agencies can help their physicians negotiate better pay and more favorable terms for locums assignments.
Legal protections
From malpractice claims to other disputes, locums agencies have contracts in place to protect physicians from various liabilities.
Licensing and credentialing
Agencies who have established relationships with state licensing boards can streamline an otherwise time-consuming process.
Travel and housing arrangements
Locums agencies typically cover travel and housing for their physicians, though some include more extras and thoughtful touches than others.
How to choose a locums agency
When considering different locum tenens agencies, there are several factors to keep top of mind that can affect your experience and your earning potential.
Variety of opportunities
Consider the variety and volume of job opportunities available from any given agency, and how they align with your goals and preferences.
Understanding of your specialty
Leading agencies usually train their recruiters to work with specific medical specialties, as a neurosurgeon working locums will have distinctly different needs from an ER doc.
Agency reputation
Firsthand recommendations are tough to beat. Check out online reviews, and ask around with colleagues and mentors for their experience working with different locums agencies.
Malpractice insurance
Most agencies offer malpractice coverage, though not all of them include ongoing tail coverage against future claims. Be sure you know what’s included and any limitations.
Service and support
Pick an agency that works to understand and accommodate your needs, rather than trying to pressure you into taking assignments. And remember that the more support they offer for travel, licensing, and other logistics, the less you’ll have to worry about.
How does the locums agency process work?
Every agency does things a little bit differently, but here’s a general idea of what you can expect after reaching out to a locums agency.
Match with a recruiter or consultant.
A great locums recruiter will get to know you and what you’re looking for in a work environment. They’ll be your primary point of contact for finding assignments and coordinating logistics.
Receive and review potential assignments.
After an initial conversation with your recruiter, you’ll receive assignments that could be a match, based on your preferences for things like location and length of assignment.
Choose an assignment you’re interested in.
Once you’ve selected a locums assignment, top agencies will help you complete the necessary paperwork and secure additional state licenses if necessary.
Your agency coordinates travel arrangements.
Leading agencies usually prepay for travel and housing expenses, so there’s nothing coming out of your pocket.
Complete your assignment, and plan for the next one.
Your recruiter should be in touch throughout an assignment to see how things are going and address any issues. They may also reach out with opportunities for future assignments, so you can plan out your schedule for the coming months.
Tips for success as a locums physician
Research the facility
Before you arrive, it’s wise to review details like where you’re supposed to park, the general layout of the facility, and any key contacts you may need throughout your time there.
Ask lots of questions during onboarding
Be sure you understand your schedule and expectations, and any particular goals the facility has for your time on assignment.
Be flexible
Chances are, you’ll need to quickly learn a new EMR system and workflow at just about every facility. Stay open-minded about new processes, even if they’re different from how you’ve done things in the past.
Stay positive and professional
Remember that your professional reputation is just as important as your clinical skills. Always be punctual, communicative, and pleasant to work with—you never know who could end up on the hiring committee for your dream position years down the road.
Explore more resources for your medical career
Beyond Residency offers useful resources to help you launch your career, and to understand your options in an evolving healthcare landscape. From blogs and downloads to webinars and in-person events, we’re here to help you make the transition smoothly and successfully.
Explore more complimentary career resources for physicians, or stay up to date on our upcoming events.
