Locum tenens, or temporary physician staffing (Latin for “in place of”), is a model where physicians work on short-term work assignments sometimes away from home. It offers several benefits, such as flexibility, the opportunity to explore different geographical areas and medical settings, and generally higher pay rates than equivalent employed positions. However, there are some potential pitfalls and challenges that physicians should be aware of before engaging in locum tenens work.

After finishing residency in 2012 - I took on my first locums assignment in Maine at a small 65-bed hospital. I had been making around $68,000 as a senior resident, so the $120/hour hourly rate for 12 hour shifts seemed amazing at the time. I wish I had realized that staffing companies usually make at least double this rate from the healthcare institution where you will work, and hence you can and should negotiate. In fact, some physicians working the same job at the same facility may be contracted at a higher rate than you! I later learned one of my colleagues had negotiated $150/hr for the same job in Maine! Overall, from 2012-2014 I worked locums gigs as a hospitalist in four hospitals across three states.

Locums companies routinely pay for your hotel, car, and flights. If you commit for a long enough period or for a set number of shifts, some staffing companies will also pay for your state license and DEA. However, remember that since you're going to be an independent contractor (rather than an employee) you will be responsible for paying your own health insurance, choosing to contribute to some sort of retirement savings plan, and paying your own taxes (often quarterly estimated tax payments are required). You may find you require a little more organization to stay on top of your administrative and financial responsibilities during the year.

Things To Consider About Locum Tenens

1. You Must Save and File Your Own Taxes:

You need to be organized. You’re an independent contractor and will receive a 1099 instead of a W2 detailing your income. Save 30-35% of each paycheck, and then submit your state and federal taxes each quarter. Remember, unlike a salaried employed position where taxes are automatically withheld and filed on your behalf, as an independently contractor – it is your responsibility to file your own taxes. Be smart and automatically separate estimated taxes every week into a separate checking or savings account so that you cannot touch this money. Come April, you may get a refund, or owe even more in taxes depending on your other income streams.

2. Be Careful About Malpractice Insurance Coverage:

Although malpractice insurance is universally provided, be careful to ensure that tail coverage is included and paid for by the staffing company. If it is not, you’ll be on the hook for an expensive policy once you leave work in order to protect yourself for any cases that arise from your time on the job.

3. Future Paperwork Will Haunt You Forever:

Every job you take in the future will require you to chase down people to help you complete paperwork. Your new employer will want a letter from your insurance carriers to verify you don’t have cases pending, and you will also have to contact medical staff offices to ask for verifications of good standing. I mention this because the temptation to switch locums assignments frequently should be weighed against the future hassle of completing such verification. Believe me, it takes real effort to contact companies and individuals you no longer have ties to.

4. Uncertainty and Instability:

Locum tenens work is by nature temporary, which can result in uncertainty and instability. This can be stressful for some physicians, especially those with family or other commitments. It is likely more economical for a facility to find a full time employed physician, so shifts may eventually dry up when they have optimized their staffing model. 

5. Integration Into Teams:

As a locum tenens, you might face difficulties integrating into existing healthcare teams. I have felt some animosity myself at a few places since the full time doctors knew they were being paid about 50% per shift what I was making. Generally they warmed us since most physicians are professionals and they realized it was the staffing company middlemen and their own employers that had created this situation - and not me.

6. Lack of Benefits:

Locum tenens physicians are typically classified as independent contractors, which means they will not likely have access to benefits like health insurance, retirement plans, and paid time off. Health insurance is generally a costly expense and one of the main reasons why all healthcare workers are interested in jobs with benefits. If you don't have a partner/spouse - you will need to consider how you will secure coverage.

7. Administrative Burdens:

Depending on how many locations you end up working at, locum tenens physicians often have to deal with significant administrative burdens, including obtaining licensure in multiple states, keeping track of various credentialing requirements, and providing multiple people all your documents from your CV, residency completion certificate and board certification. I've worked with three locums companies and without being too snarky I can say that their staff wasn't the best at staying on top of this stuff. They even spelled my name wrong on multiple forms despite me providing them with my CV and certifications!

8. Travel fatigue and Isolation:

While the opportunity to travel can be a benefit for some, frequent travel can lead to burnout and fatigue over time. After leaving NYC for Maine during my first assignment, I felt quite isolated and lonely. I would dread an empty day or two between shifts, and my day to day literally involved work, a quick meal, then hotel for tv and sleep, and then repeat the next day. It just wasn't sustainable for me personally. My next assignment was about a 90 minute drive from NYC and I didn't feel quite as isolated as I could just drive home if I didn't feel like sticking around the hotel between shifts.

9. Best Tips for Negotiation:

• Be clear about your requirements: Before you start negotiating, have a clear idea of your needs and expectations. This includes your preferred geographical locations, your availability, the types of medical settings you're interested in, whether you will be responsible for procedures and running codes, and of course your pay rate expectations. 

• Understand the contract: Before signing, make sure you thoroughly understand the contract, including the specifics of the assignment, your responsibilities, compensation, and any provided benefits. I would also highly recommend finding out what services are available for backup within the healthcare system. For instance - as a hospitalist working night shifts earlier in my career - I wanted to know whether Anesthesia was in house for intubations or whether the ER had a physician to come up to floors if necessary to help.

• Negotiate compensation: Don't hesitate to negotiate your pay rate. In addition to your hourly rate, consider other factors that impact your overall compensation, such as travel and housing stipends )even food!), and reimbursement for licensure and credentialing fees.

• Secure malpractice coverage: Make sure you understand what malpractice insurance is provided, and negotiate this if necessary. Look for a contract that provides occurrence-based malpractice insurance, which covers incidents that occur during the contract period, regardless of when a claim is made. If that’s not on the table - at the very least you need the staffing company to provide and pay for your tail coverage in full.

• Get everything in writing: Verbal promises are not enough and neither are past emails. Make sure every aspect of your agreement, including your schedule, on-call duties, and compensation details, is clearly defined in writing on the contract that you sign.

• Involve a lawyer: If you're not comfortable reviewing and negotiating contracts on your own, consider engaging a lawyer who is experienced in locum tenens contracts.

• Be prepared to walk away: If a contract doesn't meet your needs or expectations, be prepared to walk away. There are many locum tenens opportunities available, and it's important to find one that's a good fit for you. Locum tenens staffing is a booming industry, and as a physician you are in demand!