Perhaps more than ever before, resident physicians in the transition to practice are considering locum tenens work to either supplement or replace permanent positions. Once the purview of those nearing retirement age who wanted to continue practicing, it’s now a consideration for physicians in all stages of their careers.
“Every place I went, they [physicians in permanent roles] always wanted to know what it was like. Every contract doctor was thinking about doing locums,” said Adam Roussas, MD, MSE, an emergency physician in Arizona who has worked in locum tenens roles since finishing residency training. “It has definitely exploded.”
Before diving in, though, residents can learn from the experience of physicians such as Dr. Roussas, an AMA member who also has an MBA, to explore both the benefits and the challenges of locum tenens work.
A different kind of physician role
The Latin phrase locum tenens means “to hold the place of,” and in medicine refers to a physician who is temporarily filling in for another physician.
A 2022 survey by physician recruiter AMN Healthcare found that nearly 90% of hospitals, medical groups and other health care facilities used locum tenens hiring to fill roles while permanent searches were under way for physicians and nonphysician health care professionals.
Dr. Roussas said that as an emergency medicine PGY-4, he moonlighted at rural Midwestern hospitals and learned from other travel physicians what locum tenens was about.
“I realized how flexible it can be and how really lucrative it can be if you have the time to really do it,” he said, ultimately deciding “this was actually probably the best thing for me in terms of what my life was like at the time.”
Locum tenens can pay well
The pay for locum tenens work can be a bonus for early-career physicians, especially those with substantial medical-student loan repayment obligations.
Brian McKillop, president of locums at physician recruiting firm AMN Healthcare, estimated that physicians in locum tenens work can command 30% higher salaries than those in traditional permanent employment. McKillop also said that some health care employers will also provide travel or housing stipends, medical student-loan repayment or medical professional liability insurance.
“You can work a lot less because the pay can be so much higher,” Dr. Roussas said. In his experience, he could work “anywhere from eight to 10 shifts a month,” or even as few as six, depending on the rate, travel expenses and financial goals.
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Freedom and flexibility are on offer
When it comes to choosing locum tenens, physicians often mention two words: flexibility and freedom.
A 2024 survey by AMN of 589 physicians and other non-physician health care professionals who had worked on a locum tenens basis in the previous 18 months found that work conditions and burnout were the most commonly cited reasons for eschewing or adding to a permanent role. And nearly all respondents, 97%, said the “freedom/flexibility” of locum work was rewarding.
Dr. Roussas was no different.
“One of the big things was not tethering myself to a potentially convoluted or more-binding-than-I-might-want-it-to-be contract,” he said, adding that with the way his personal life was going to be evolving, he knew a noncompete clause would get “very complicated, and I just didn't want to deal with that.”
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Locum tenens job satisfaction can be high
Health care employers in rural areas often rely on locum tenens work to temporarily or permanently fill roles. Providing care in more remote locales wound up being “exceptionally rewarding” for Dr. Roussas.
“As someone who went into emergency medicine wanting to serve underserved communities, you really are going into places where you may be the only doctor these humans ever interact with,” he said. “Multiple times, I would have the opportunity to speak with patients who just never had an MD in front of them.”
Dr. Roussas remembered sleepier ER shifts in rural Indiana when he was able to sit and talk for 45 minutes with a family with a sick infant, answering all their questions about vaccines, Tylenol and autism spectrum disorders.
“I think they left feeling more secure in their decisions to complete the vaccine series as recommended by their pediatrician and to feel comfortable using Tylenol to treat the fevers that their baby was certainly going to have with the little virus that she had,” he said. “You're really filling a need in a lot of these places that just wouldn't get filled otherwise.”
Transitions can be complicated
But going from workplace to workplace has its consequences, particularly when doing locum tenens work in multiple states. Those physicians should research the Interstate Medical Licensure Compact, Dr. Roussas recommended, which can streamline licensing.
The pain of undergoing the credentialling process at more than one job site is also something physicians should plan for, and Dr. Roussas added that there’s more than one variety of red tape.
“It is definitely unpaid work that you have to deal with,” he said. “You're going to spend hours filling out the same paperwork and doing the same Epic training or the same Medicaid and Medicare dance that you have to do in every state.”
He said that physicians can spend “thousands of dollars on licenses and DEA [Drug Enforcement Administration] fees,” getting the money back only if they report the expenses properly on their income-tax filings.
He also said that it can be tough to learn—or relearn, if you’re returning to a place you haven’t worked at in some time—a different set of regulations, protocols and EHR systems, and your connections with other members of the care team will never be as solid as they would be if you were in a permanent role.
“That, especially for emergency medicine, can be something that a lot of people don't want to do without, because it really does make the trauma of what you go through shift to shift a little easier to deal with if you've got people around you who you know well and will commiserate with you, especially on the hard days where you've had something—or multiple horrific things—happen.”
Travel, instability can be tough to manage
The freedom of locum tenens work cuts both ways, Dr. Roussas said, and the tradeoff can be a lack of stability in a physician’s professional and personal life.
“There can definitely be weeks, if you're not in a position where you're actively on the schedule a few months in advance, where you're waiting to hear if there's work,” he said. “You're almost certainly not going to be home for dinner with your family for several nights in a row, depending on how you set up your schedule and how far you’re traveling.”
Though Dr. Roussas doesn’t have children, he said the travel “actually ended up being the most challenging part for me as a younger physician,” particularly when something stressful happened.
“Spending so many days traveling can be fairly exhausting if you're not excited about it or motivated enough either by the prospect of the money or the prospect of working fewer days.”
You can always transition out of locum tenens
Though Dr. Roussas said he appreciated the benefits locum tenens work afforded him, he recently accepted a permanent role. Though he plans to still occasionally work at nearby Indian Health Service and rural facilities, he’s ready for more stability.
“I don't need to be flexible anymore,” Dr. Roussas said. “I just want to go home and begin to establish myself with my family and friends again, and there are great hospital systems here where I can start doing that.”
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