With a menu of options for their first physician role that includes private practice, hospital employment, academic medicine and more, residents and fellows increasingly are considering temporary assignments in a locum tenens capacity.
And while locum tenens work isn’t the right fit for everyone, it’s one physicians should know about as they launch into practice.
The phrase locum tenens, in Latin, means “to hold the place of,” and in medicine refers to a physician who is temporarily filling in for another physician.
One benefit to locum tenens work that is “really attractive to a resident is getting that diverse clinical experience and exposure. You have the ability to sort of date before you marry,” said Brian McKillop, president of locums at physician recruiting firm AMN Healthcare. “What type of clinical exposure or practice do you want to go into? Do you want to be in a group? Do you want to be in a hospital setting or clinic? So we have locum’s ability to give you that level of exposure.”
For nearly 25 years, AMN has surveyed physicians in locum tenens work to find out more about the practice. AMN’s most recent locum tenens survey is from 2024 and includes data culled from surveys of 589 physicians and other non-physician health care professionals who had worked on a locum tenens basis in the previous 18 months.
The survey reveals a great deal about the types of physicians choosing locum tenens and what reasons they give for eschewing or adding to a permanent role.
What kind of physician works locum tenens?
Increasingly, physicians outside of primary care specialties are turning to locum tenens work, the AMN survey shows. Only 11% of respondents were family physicians, internists or pediatricians, down from 21% in 2016. That share marked the lowest percentage of respondents who were primary care physicians since AMN first conducted the survey in 2001. In 2006, 40% of survey respondents were primary care physicians.
Meanwhile, the demographics of locum tenens work is also changing. Once almost strictly the purview of physicians approaching or already in retirement, it is more often being taken up at earlier career stages. With the Association of American Medical Colleges projecting that the U.S. will face a shortage of up to 124,000 physicians by 2034, more health care employers may be looking to locum tenens to fill gaps.
“We’re still seeing the majority of folks [locum tenens physicians] who are late-career stage” physicians or other health care professionals, McKillop said. “However, the mix in the dynamic is shifting tremendously.”
When asked at what stage of their career they first worked in locum tenens, the percentage of respondents in AMN’s survey who said “right after training” rose from 15% in 2016 to 18% in 2024. Those who said “midcareer” climbed from 49% in 2016 to 63% in 2024, and those who said “after retiring from permanent practice” fell from 36% in 2016 to 19% in 2024.
Some physicians do locum tenens work in addition to their primary employment, with 37% of those surveyed reporting that they also held a permanent position.
Other physicians are deciding to explore different practice settings and geographic locations before settling into a long-term job. Research shows that many physicians emerging from residency training end up in a transitional job anyway, often leaving within just a couple of years. Locum tenens work gives the opportunity to turn that transition into a more thoughtful change.
McKillop said a common path for physicians with whom AMN works goes from starting as locum tenens to accepting a permanent job. He calls that “positive turnover.” It means, McKillop said, “we found a good fit on both sides of the coin.”
If you are in the market for your first physician job after residency or fellowship training, get your cheat sheet now from the AMA.
Why consider locum tenens in early career?
Higher compensation draws many physicians to locum tenens. McKillop estimated a 30% increase in salary over traditional permanent employment. He added that some health care employers will also provide travel or housing stipends, medical student-loan repayment or medical professional liability insurance.
The chief reasons cited by respondents of all ages in AMN’s survey, though, were work conditions and burnout. Of the factors that influenced the respondents’ decision to do locum tenens work, they listed the following issues as either “most important” or “moderately important” (the survey allowed more than one choice):
- 86% wanted a better schedule.
- 80% sought to reduce or address feelings of burnout.
- 75% were tired of falling compensation.
- 71% said they were dissatisfied with being an employee.
- 68% were tired of payment challenges.
Nearly all respondents, 97%, said that “freedom/flexibility” was either the “most rewarding” or a “moderately rewarding” part of practicing medicine in a locum tenens capacity.
A plurality of the respondents, 45%, said they would stop working locum tenens if they were offered a permanent position with a favorable schedule, compensation and other factors that were important to them. But 43% of those surveyed said they would not.
That burnout should be a considerable factor should come as no surprise, given that physician burnout poses an ongoing challenge, despite recent improvement. A nationwide survey of thousands of physician residents and fellows found that 50% reported symptoms of burnout in 2023, a drop from the 60.3% burnout rate found in a similar survey led by the same research team in 2012. Burnout rates for practicing physicians also have fallen from the historic highs seen during the COVID-19 public health emergency.
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Dive deeper with this AMA issue brief (PDF) on the campaign to support the health and well-being of medical students, residents and physicians.
Where locum tenens road can get rocky
There are, however, complications to locum tenens work. The AMN survey found that the top five challenges reported, with the percentage of respondents who rated them as either “most challenging” or “moderately challenging,” were:
- Credentialing process—81%.
- Uncertainty of assignments—80%.
- Being away from home—77%.
- Quality of assignments—76%.
- Lack of benefits—71%.
McKillop said physicians also should be cognizant of how they might be perceived by co-workers or supervisors when they are in a temporary role.
“That tide is also turning. The hospital systems and the other clinicians or providers are seeing the value of locums and what they do to help create continuity of care,” he said. “That's helping to offset that, however, there's still a bit of an old-school stigma there that these physicians have to understand. It's not a huge mountain to climb, but you have to be aware of that.”
The AMN survey directly addressed that, asking, “As a locum tenens provider, how well are you accepted by each of these groups?” The answers were:
- By colleagues—80% of respondents said “accepted,” 18% said “tolerated” and 2% said “not accepted.”
- By administrators or department heads—68% “accepted,” 28% “tolerated,” 4% “not accepted.”
- By patients—91% “accepted,” 8% “tolerated” and 1% “not accepted.”
The ratings of morale in locum tenens varied, with 57% of respondents saying “high,” 38% saying “medium” and 5% saying “low.”
When locum tenens work is right for you
Ultimately, it is up to each physician to determine whether locum tenens work meets their personal and professional needs.
“Some people like being able to go and do locum tenens so that you have a lot more flexibility,” said Anna Yap, MD, an assistant professor of emergency medicine in Sacramento, California. “To some people, stability is much more important to them and so the W-2 sort of job and knowing what your salary's going to be monthly—that’s really important to them. To others, independence is really important—maybe going out and doing private practice.”
Dr. Yap, who is chair-elect of the AMA Young Physicians Section Governing Council and has years of experience mentoring doctors, said a physician cousin of hers has adopted locum tenens work as a means to meet his financial goals.
“His value is that he wants to retire early and then travel the world,” she said. “He's working locums in a rural hospital … and just working really hard, grinding really hard, and that makes him happy.”
If you’re deciding on your first physician job out of training, learn more with the AMA STEPS Forward® toolkit, “What to Look for in Your First or Next Practice. Evaluate the Practice Environment to Match Your Priorities.” It is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™. Read up on AMA CME accreditation.
