Exploring Medical Career Paths: Locum Tenens vs. Permanent Roles

Demystifying Healthcare Career Options: Locum Tenens vs. Permanent Positions

In today’s rapidly changing healthcare landscape, physicians and other medical professionals have more career options than ever before. One of the most important early-career decisions—especially in the years right after residency or fellowship—involves choosing between locum tenens work and permanent positions.

Both paths can support a fulfilling, sustainable medical career, but they differ significantly in terms of flexibility, stability, compensation, and long‑term Career Development. Understanding these differences is critical for residents, new attendings, and mid‑career physicians who may be re-evaluating their professional direction.

This guide breaks down the realities of each option, offers concrete examples, and provides a framework to help you choose the model that best fits your goals, values, and lifestyle.

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Understanding Locum Tenens: Temporary Roles with Strategic Flexibility

What Is Locum Tenens in Modern Healthcare?

Locum tenens—Latin for “to hold the place”—refers to temporary clinical positions where a physician, advanced practice provider, or other clinician fills staffing gaps. These roles may last from a few shifts to several months or even over a year.

Locum tenens assignments are common in:

• Community hospitals and academic medical centers
• Rural and underserved clinics
• Private practices needing coverage (e.g., vacations, extended leave)
• Urgent care centers and telemedicine platforms
• Correctional healthcare, Indian Health Service, and VA systems

Most physicians work through locum tenens agencies that coordinate contracts, credentialing, travel arrangements, and malpractice coverage. Some clinicians arrange per-diem or temporary roles directly with institutions, especially in regions where they already practice.

Locums can be a short-term bridge—between training and a long-term job, between fellowships, or during relocation—but many physicians now build an entire career on the locum tenens model.

Key Benefits of Locum Tenens for Medical Professionals

1. High Degree of Flexibility and Control

Flexibility is the defining characteristic of locum work. You typically can:

• Choose when and how often you work (e.g., 7-on/7-off, intermittent weekends, seasonal blocks)
• Accept or decline assignments based on personal and family needs
• Take extended time off between contracts for travel, research, or exam preparation
• Trial different geographic regions before committing to a permanent move

This flexibility can be particularly attractive:

• Right after residency/fellowship, when you’re unsure of your ideal practice setting
• During major life transitions (relocation, partner’s career changes, family needs)
• When you’re testing semi-retirement or reducing clinical load

For some physicians, locum tenens is the key to maintaining work–life integration while staying clinically active.

2. Diverse Clinical Experience and Skill Expansion

Locum tenens roles often expose you to:

• Different EMRs and documentation systems
• A variety of patient populations (urban vs. rural, insured vs. underinsured)
• Different staffing models and team structures
• Variable acuity and case mix (e.g., trauma-heavy vs. elective practice)

This diversity can:

• Sharpen your diagnostic and procedural skills
• Improve your adaptability and clinical judgment
• Enhance your value on your CV when applying for future Permanent Positions
• Clarify what you actually want in a long-term job (academic vs. community; large system vs. small group)

For residents and early-career physicians, a year of locums can be an efficient way to sample multiple practice environments rather than committing too quickly to the wrong fit.

3. Potential for Higher Short-Term Compensation

Locum tenens positions often offer:

• Higher hourly or daily rates compared to base salaries in permanent roles
• Premium pay for nights, weekends, or hard-to-fill locations
• Reimbursed travel, lodging, and sometimes meals
• Covered malpractice insurance (commonly claims-made with tail handled by the agency or facility)

While you must factor in the lack of traditional benefits (more on this below), many physicians find that net take-home pay can be significantly higher, especially if they:

• Are willing to travel or work in rural/underserved areas
• Take on higher-intensity schedules for limited periods
• Combine locums with telemedicine or consulting work

Locum tenens can also be an effective strategy for:

• Paying off student loans faster
• Building an emergency fund or down payment
• Transitioning to part-time or flexible work while maintaining income

4. Reduced Long-Term Administrative Responsibilities

In many locum tenens roles, you are brought in specifically to see patients, not to:

• Join long-term committees
• Shoulder major administrative projects
• Manage staff or handle practice management issues
• Engage extensively in politics within a department

Your main responsibility is clinical care and basic documentation. For clinicians burned out by endless meetings, inbox overload, and quality metrics, this narrowed scope can be a significant relief and a way to rediscover satisfaction in direct patient care.

5. Broad Professional Networking and Career Exploration

Working in multiple institutions allows you to:

• Build relationships with a wide range of physicians, advanced practice providers, and administrators
• Identify mentors and potential long-term collaborators
• Discover subspecialty niches or leadership roles that interest you
• Get “inside views” of different systems before committing to a permanent offer

Some physicians ultimately convert a locum assignment into a permanent role once they confirm the culture, workload, and compensation align with their goals.

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Drawbacks and Risks of Locum Tenens Work

Despite its advantages, locum tenens is not ideal for every physician or every stage of life.

1. Instability and Uncertain Future Income

Assignments can:

• End earlier than expected
• Be canceled at the last minute
• Have gaps between contracts if demand slows or your preferences are very specific

This variability can be stressful if you:

• Have significant fixed financial obligations (mortgage, private school tuition)
• Support dependents who rely on your income
• Prefer predictable schedules and long-term planning

Many successful locum physicians address this by:

• Maintaining a robust emergency fund
• Securing overlapping or backup contracts
• Being geographically flexible to follow demand

2. Limited Long-Term Relationships with Patients

If continuity of care and long-term therapeutic relationships are central to your professional identity, locums may feel unsatisfying. The model generally involves:

• Encounter-based care rather than years-long follow-up
• Handing patients back to permanent staff after your assignment ends
• Less involvement in chronic disease management over time

This is less of an issue in specialties like emergency medicine, hospital medicine, or anesthesiology, but more challenging for primary care, pediatrics, or psychiatry clinicians who deeply value multi-year patient relationships.

3. Fewer Traditional Employment Benefits

Locum tenens work typically means you are:

• A 1099 independent contractor (in the U.S.) or similarly self-employed
• Responsible for your own health insurance, disability coverage, and retirement contributions
• Without paid vacation, paid parental leave, or employer-match retirement contributions

You must proactively:

• Set aside funds for taxes and quarterly payments
• Build your own benefits package (solo 401(k), SEP-IRA, private insurance, etc.)
• Budget for unpaid time off between assignments

Financially savvy locum physicians often work with an accountant or financial advisor familiar with independent contractor issues.

4. Frequent Transitions and Variable Work Environments

Every new assignment means:

• A new EMR and documentation style
• Different clinical workflows and nursing support
• New hospital bylaws, policies, and referral patterns
• Different call structures and expectations

Some clinicians enjoy this challenge; others find it disorienting or emotionally draining. You need a high tolerance for ambiguity and strong interpersonal skills to quickly integrate into new teams.

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Understanding Permanent Positions: Stability, Teams, and Long-Term Growth

What Is a Permanent Position in Healthcare?

A permanent position is a long-term employment arrangement with a specific healthcare organization, such as:

• Academic medical centers
• Large health systems or hospital networks
• Multispecialty groups or private practices
• Federally qualified health centers (FQHCs) or public hospitals

Contracts typically include:

• A base salary (with or without RVU-based productivity incentives)
• Defined clinical and non-clinical duties
• A benefits package (insurance, retirement, CME, etc.)
• Expectations around call, committees, and quality metrics

Permanent roles form the backbone of most Healthcare Careers, especially for those seeking advancement, leadership, and stability.

Advantages of Permanent Positions for Long-Term Career Development

1. Job Security and Predictable Income

A well-negotiated permanent role offers:

• Stable, predictable paychecks (even when patient volumes fluctuate)
• Protection from short-term market dips in locum demand
• More straightforward budgeting and long-range financial planning

This can be particularly important when:

• You’re supporting a family or dependents
• You’re committed to a specific geographic area
• You’re managing large long-term expenses (home ownership, child education)

While no job is completely risk-free, permanent employment generally provides a higher baseline sense of security than serial temporary contracts.

2. Comprehensive Benefits Package

Permanent positions typically include:

• Health, dental, and vision insurance (often subsidized)
• Retirement plans with employer contributions (401(k), 403(b), pension)
• Paid time off (vacation, sick days, holidays)
• Paid CME time and stipend
• Short- and long-term disability insurance
• Malpractice coverage, often including tail

When comparing compensation, it’s crucial to consider total value, not just salary. Benefits in a permanent role frequently represent tens of thousands of dollars annually in additional value compared to independent contractor work.

3. Team Cohesion and Professional Belonging

Being part of a stable team allows you to:

• Build deep, trusting relationships with colleagues, nurses, and support staff
• Contribute to long-term quality improvement and patient safety initiatives
• Have a stronger voice in department culture and policies
• Access informal mentorship and peer support

This sense of belonging is a major protective factor against burnout and can greatly enhance day-to-day job satisfaction.

4. Continuity of Care and Lasting Patient Relationships

In many specialties, permanent roles enable you to:

• Follow patients over years or even decades
• Witness the impact of your interventions on long-term outcomes
• Care for multiple members of the same family or community
• Build trust that enhances adherence and shared decision-making

For many clinicians, especially in primary care, pediatrics, and psychiatry, these sustained relationships are a core reason they chose medicine.

5. Structured Opportunities for Advancement and Leadership

Permanent employment opens doors to:

• Clinical leadership (medical director, section chief, department chair)
• Administrative positions (CMO, quality officer, program director)
• Protected time for research, teaching, or curriculum development
• Mentorship of residents, fellows, and students

These roles are less accessible to strictly locum clinicians. If you are committed to long-term Career Development within a specific institution or academic pathway, a permanent position is typically essential.

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Potential Downsides of Permanent Positions

1. Reduced Flexibility and Control Over Schedule

Permanent roles often come with:

• Fixed clinic or call schedules
• Limited ability to take extended unpaid sabbaticals
• Less freedom to rapidly adjust hours based on personal needs

Vacation requests may be subject to department coverage requirements, and changes in FTE (full-time equivalent) status can be slow to approve.

For physicians who value travel, side ventures, or non-clinical projects, this reduced flexibility can feel restrictive.

2. Ongoing Administrative and Non-Clinical Burden

Permanent staff frequently shoulder additional responsibilities, including:

• Committee work (quality, safety, credentials, etc.)
• Performance reviews and documentation audits
• EMR optimization projects and workflow redesign
• Departmental meetings and institutional initiatives

While some enjoy shaping policy and systems, others find these tasks detract from the joy of direct patient care and contribute to burnout.

3. Risk of Stagnation or Burnout

Over time, a stable job can start to feel:

• Repetitive or monotonous
• Constrained by organizational inertia or politics
• Emotionally draining if workload and staffing are not balanced

If you’re someone who thrives on novelty and change, a purely permanent role without variety can be challenging. Burnout can creep in if you’re not intentional about boundaries, workload, and ongoing professional growth.

4. Geographic and Lifestyle Constraints

A permanent position typically anchors you to:

• One region or city
• A specific commute and local school system
• Limited capacity to relocate quickly for family or opportunities

If your partner’s career is mobile, or if you envision living in multiple regions over your career, a permanent job may feel confining unless chosen carefully with these factors in mind.

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Head-to-Head Comparison: Locum Tenens vs. Permanent Positions

Feature	Locum Tenens	Permanent Positions
Flexibility	Very high (choose when/where you work)	Lower (fixed schedule, less control)
Job Security	Variable; contract-based	Higher; ongoing employment
Income Potential	Often higher per hour; variable annual total	Steady income; strong long-term stability
Benefits	Self-managed; typically limited	Comprehensive employer-sponsored benefits
Patient Relationships	Short-term, episodic	Long-term continuity and multi-year relationships
Administrative Duties	Primarily clinical care; fewer committees	More non-clinical responsibilities
Geographic Mobility	High; frequent travel opportunities	Lower; tied to one region
Career Advancement	Limited formal pathways	Clear routes to leadership and academic roles
Networking	Broad across many institutions	Deep within one system
Work Environment Stability	Variable; new culture each assignment	More consistent and predictable

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Real-World Scenarios: How Physicians Use Each Model

Locum Tenens Case Study: Resetting After Burnout

Dr. Sarah, an internal medicine physician, completed residency and went directly into a busy hospitalist Permanent Position. After several years of:

• High census and frequent night shifts
• Heavy committee involvement
• EMR inbox overload

she felt emotionally exhausted and unsure if she even wanted to remain in clinical medicine.

She decided to transition to locum tenens with clear goals:

• Regain a sense of control over her schedule
• Explore different hospital systems and regions
• Reconnect with the core enjoyment of direct patient care

Over 18 months, Dr. Sarah worked in several states, often in 7-on/7-off blocks, taking weeks off between contracts. She:

• Paid down a substantial portion of her student loans using higher locum pay
• Identified that she enjoyed smaller community hospitals with well-staffed teams
• Realized that she valued collegiality and continuity of a home institution

Ultimately, she accepted a new permanent hospitalist role at a community hospital where she had done a locum assignment, having already experienced the culture and workload firsthand. Locums became a strategic bridge rather than a permanent lifestyle, and the experience allowed her to re-enter a long-term role with renewed clarity and enthusiasm.

Permanent Position Case Study: Stability with Selective Locum Work

Dr. David, a pediatrician, began his career in a permanent role at a community hospital-affiliated clinic. He appreciated:

• Stable income and loan repayment support
• Comprehensive benefits for his young family
• Deep relationships with children and their parents

After five years, however, he felt the need for more variety and additional income to accelerate savings goals. Instead of leaving his permanent job, he:

• Negotiated a slightly reduced FTE at his home institution
• Picked up a limited number of locum tenens weekend and holiday shifts at regional urgent care centers

This hybrid approach allowed him to:

• Maintain continuity with his long-term patients
• Keep the security and benefits of his permanent role
• Experience different practice settings and earn supplemental income

For Dr. David, the ideal solution was not choosing either locum tenens or permanent work exclusively, but rather a custom blend that matched his career and family priorities.

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How to Decide: Matching Career Path to Personal and Professional Goals

Choosing between locum tenens and permanent positions is rarely a purely financial decision. For medical professionals, it’s a complex balance of values, obligations, and long-term goals.

Step 1: Clarify Your Priorities

Ask yourself:

• How important is schedule flexibility vs. predictable routine?
• Do I value long-term patient relationships or prefer episodic care?
• How much financial risk am I comfortable with?
• Do I aspire to leadership, academic roles, or program building?
• How anchored am I to a specific city or region?
• What are my family’s needs and preferences?

Rank these factors; you’ll quickly see whether one model tends to align more strongly with your current phase of life.

Step 2: Evaluate Your Financial Baseline

Before choosing a path:

• Create a detailed monthly budget (including debt, savings goals, and fixed expenses)
• If considering locums, model low, medium, and high income scenarios
• If considering permanent roles, calculate the total value of benefits (insurance, retirement match, CME, etc.)

This helps you avoid overestimating the advantages of higher locum pay or underestimating the value of stable employment and benefits.

Step 3: Consider a Trial Period

You do not have to decide once and for all:

• New graduates: Consider a 6–12 month locums year to explore different settings before signing a long-term contract.
• Current permanent physicians: Try occasional locum shifts to see if the model suits you before leaving your full-time job.
• Locum physicians: If you find an institution where you feel at home, explore converting a locum assignment into a permanent position.

Experimenting in a controlled way often provides more clarity than abstract analysis alone.

Step 4: Reassess Regularly as Your Career Evolves

Career decisions in medicine are not one-time events. Your optimal choice may change over time as:

• Your family structure, caregiving responsibilities, or partner’s career shift
• Financial goals evolve (loan repayment complete, nearing retirement)
• Your tolerance for risk, travel, or change fluctuates
• New Career Development opportunities emerge

Revisit your priorities every few years and be open to adjusting your blend of locum tenens and permanent work accordingly.

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Frequently Asked Questions: Locum Tenens vs. Permanent Healthcare Positions

1. Is locum tenens a good option right after residency or fellowship?

Yes, for many new graduates, locum tenens can be an excellent post-residency bridge. It allows you to:

• Explore various practice settings before committing long-term
• Live in different regions to see what fits your lifestyle
• Potentially earn higher short-term income to address loans or savings goals

However, you should ensure you have:

• A clear plan for managing your own benefits and taxes
• Mentors or senior colleagues you can still lean on for complex cases
• A strategy to maintain strong references and professional relationships

If you crave structured mentorship, research opportunities, or a clear academic progression, going directly into a well-chosen permanent position might be more advantageous.

2. Can I move from a permanent position into locum tenens later in my career?

Absolutely. Many physicians:

• Start in permanent roles to stabilize finances and build experience
• Transition to locum tenens later for more flexibility or semi-retirement
• Use locums during career pivots, such as changing subspecialties or relocating

If you’re considering such a transition:

• Give your current employer sufficient notice
• Understand non-compete or restrictive covenant clauses that may limit local locum work
• Build a financial cushion to manage any income gaps during the transition

3. How do I compare locum tenens pay to a permanent salary fairly?

To compare fairly, look at annual net compensation, not just hourly or daily rates:

For locum tenens, factor in:

• Hourly/daily rate × expected hours/shifts
• Reimbursed travel and lodging (if applicable)
• Self-funded expenses: health insurance, retirement contributions, disability, CME, unpaid time off, taxes

For permanent positions, factor in:

• Base salary + likely bonuses or productivity incentives
• Dollar value of employer-paid benefits (insurance, retirement match, CME, etc.)
• Paid vacation and sick time

Only after calculating total effective compensation can you make an accurate comparison.

4. Are there specialties better suited to locum tenens work?

Locum tenens opportunities exist across many specialties, but they are especially robust in:

• Hospital medicine
• Emergency medicine
• Anesthesiology
• Radiology
• Psychiatry
• Some surgical subspecialties and OB/GYN, depending on region

Primary care and pediatrics also have locum roles, but the continuity-of-care model in these fields means permanent positions may feel more professionally satisfying for many clinicians. Your specialty, desired practice style, and geographic flexibility will all influence how viable locum work is for you.

5. How do I decide whether to pursue a hybrid approach?

A hybrid approach—maintaining a permanent role while doing limited locums—can be ideal if you:

• Want stability and benefits but also desire extra income or variety
• Are testing locum tenens as a future option without fully committing
• Need to stay geographically anchored but can travel occasionally

Before adopting this model:

• Review your primary employer’s policies on outside clinical work
• Ensure adequate rest and guard against overwork and burnout
• Clarify your long-term goals so side work doesn’t simply become unsustainable “extra” labor

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Choosing between locum tenens and permanent positions is ultimately about aligning your work with the life and practice you want—today and in the future. By understanding the trade-offs, being honest about your priorities, and revisiting your choices periodically, you can build a medical career that is both sustainable and deeply fulfilling.