Are Locum Physicians Always the Leftovers? Data vs Stereotypes

Locum physicians are not the leftovers of medicine. They are the proof that most people in healthcare have no idea how the labor market actually works.

You’ve heard the comments.
“Couldn’t get a real job.”
“Must’ve had red flags.”
“Locum = bottom of the barrel.”

I’ve sat in physician lounges and heard attendings say, “Yeah, that hospital uses a lot of locums… must be desperate.” Then thirty minutes later they complain about burnout, understaffing, and being trapped in a toxic group. The irony is painful.

Let’s strip this down to data, incentives, and outcomes — not ego and folklore.

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The Origin Story of the “Leftover” Myth

The stereotype didn’t appear out of nowhere. It’s built on several half-truths and outdated realities that people mashed together into a lazy conclusion.

1. Locums used to be the exception, not the norm

Go back a couple decades and locum tenens work was mostly:

• Rural backfill
• Seasonal coverage
• Late-career docs doing temporary gigs

So yes, if you only saw locums in bare-bones community hospitals, staffed last-minute, you’d build a mental model: “Locum = desperate hospital + desperate doc.”

Problem: the market completely changed. Many physicians never updated their mental software.

2. People confuse “temporary” with “inferior”

In medicine, we overvalue permanence. Tenure. Partnership. “Full-time.”
We treat it as a proxy for quality.

But in every other high-skill field — tech, law, management consulting — temporary or contract work can actually signal the opposite:

• You’re in demand
• You like leverage and flexibility
• You’re willing to walk away from bad deals

Physicians just… haven’t caught up. So they assume: permanent job = success; temporary job = couldn’t secure permanent.

That’s not analysis. That’s status signaling.

3. Garbage anecdotes passed off as “truth”

Ask anyone bashing locums where their opinion came from. You’ll usually get:

• “I heard about this one locums doc who…”
• “Our group had a terrible locums once…”
• “My program director said locums are where you end up if you have issues…”

That’s not data. That’s gossip wrapped in hierarchy.

I’ve seen stellar locums and train-wreck “permanent” attendings. The employment contract is not a personality or competency test.

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Who Actually Works Locums? Specialty, Age, and Training Data

Let’s talk numbers instead of vibes.

Industry surveys from major locums agencies plus data from organizations like NALTO and CHG Healthcare consistently show a few patterns in locums demographics.

Approximate Share of Locum Physicians by Career Stage

Category	Value
Early career (0–5 yrs)	35
Mid-career (6–15 yrs)	40
Late career (16+ yrs)	25

So no, it’s not 70-year-old semi-retired docs stumbling around unfamiliar EMRs. A big chunk are early and mid-career.

Common profiles I’ve seen over and over:

• Fresh grads who don’t want to marry the first job they see and use locums to test regions, practice models, or hospital cultures.
• Mid-career physicians leaving toxic groups, failed partnerships, or abusive call structures and buying time while they negotiate something better.
• Late-career physicians trimming to part-time while still commanding premium hourly rates.

By specialty, locums is heaviest in:

• Hospitalist / Internal Medicine
• Emergency Medicine
• Anesthesiology
• Psychiatry
• Radiology
• Some surgical subspecialties (esp. trauma, ortho in certain markets)

None of those are “leftover” specialties. Many are highly competitive, highly compensated, or both.

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Are Locums Less Qualified? What the Credentialing Data Shows

Here’s where the “leftovers” narrative really falls apart.

Hospitals and staffing agencies credential locums with the same (and often stricter) requirements as employed docs. Sometimes they’re harder on locums, because they have less institutional familiarity.

Typical locums requirements:

• Board-eligible or board-certified (BE/BC); non-BC exceptions are rare and usually rural/critical shortage
• Clean or explainable malpractice history
• Active, unrestricted state license(s)
• Standard hospital privileging: procedure logs, case volumes, references, training verification

Many large agencies won’t even present you if you’re not BC or clearly BE with a realistic timeline. They’re not interested in getting blacklisted by hospitals for pushing marginal candidates.

Let me be blunt:
Hospitals do not pay a premium hourly rate for “whoever’s left.” Their legal and financial risk is too high. They’d rather run short-staffed than hire someone who will trigger lawsuits, safety events, or regulatory problems.

Now, does every locums doc come from Harvard and Mayo? Obviously not. But the average? Comparable to any other employed doc in that region and specialty.

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Why Some Very Strong Physicians Deliberately Choose Locums

This is the part the stereotype crowd never talks about: the upside calculus.

For a significant subset of physicians, locums is a rational power play, not a fallback.

1. Financial arbitrage

Let’s do some simplified math.

Full-time hospital-employed hospitalist:

• $280–320k salary
• 15–18 shifts/month
• 7 on / 7 off
• “Productivity incentives” you can’t really control
• Admin meetings, unpaid committee work, politics

Strong locums hospitalist:

• $180–220/hour is common; $230–260+ in high-need markets or nights
• 10–14 shifts/month by choice
• No meetings, no unpaid admin, no committees

If someone works 14 shifts/month at $200/hour, 12 hours/shift:

14 × 12 × $200 = $33,600/month → ~$403k/year if they keep that pace.

And that’s before:

• Travel stipends
• Housing covered
• Licensing/reimbursement support
• Ability to target higher-paying regions

Role	Shifts/Month	Rate/Salary	Approx Annual
Employed hospitalist	15	$300k salary	$300k
Locums at $170/hr	12	$170/hr	~$293k
Locums at $200/hr	14	$200/hr	~$403k
Locums at $230/hr	14	$230/hr	~$463k

The actual numbers vary, but the point stands: locums can out-earn “stable” jobs, especially in high-demand specialties and geographies.

That’s not “leftover” behavior. That’s understanding labor markets.

2. Optionality and leverage

Locums flips the usual power dynamic.

Permanent job: they vet you. You hope the group is tolerable. If it’s awful, you’re locked into a contract, non-compete, and relocation you can’t easily unwind.

Locums: you vet them. If the hospital is chaotic, unsafe, or hostile? You finish the assignment and never go back. No drama. No exit interview. No political cost.

I’ve lost count of the physicians who told me:

• “I found my eventual permanent job by doing a 3-month locums stint there first.”
• “I’ll never sign another long-term contract without trying the place as locums or per diem.”

That’s not instability. That’s due diligence.

3. Lifestyle and burnout protection

You know what burns people out?

• Endless nights and weekends
• Office politics
• RVU pressure with no control
• “We’re a family” speeches instead of actual staffing

Locums lets you:

• Stack shifts, then take real time off without begging for PTO
• Avoid hospital committees and unpaid admin work
• Say “no” to garbage scheduling

Typical Time Allocation - Employed vs Locums Physician

Category	Clinical hours	Admin/meetings	Commute/travel
Employed	60	10	5
Locums	55	2	8

Yes, there’s trade-off (travel is real, EMR learning curves are real), but it’s not irrational. It’s a choice.

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“But My Hospital Got a Terrible Locums Once…”

Of course you did. Everyone has a story like this.

Here’s the catch: you also have terrible employed docs. You just normalize them.

The difference is visibility.

• When an employed doc is weak, people say, “Yeah, Dr. X is… not great, but they’ve been here 15 years.”
• When a locums doc is weak, people say, “Locums are trash.”

That’s biased sampling.

Also, many hospitals use locums only when they’re already in bad shape:

• Understaffed
• Messy leadership
• Revolving-door groups
• Bad pay → chronic vacancies

Then they blame the locums for the chaos they walked into.

I’ve watched excellent locums physicians get labeled “difficult” because they refused unsafe ratios or wouldn’t quietly take on 25% more volume than the employed docs. That’s not poor quality; that’s boundaries.

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Where the Stereotype Has Some Teeth

Now for the part people like to ignore: there are situations where the “leftovers” line gets closer to truth — but it’s about the market, not the physicians.

1. Bottom-tier agencies or desperate hospitals

   • A tiny shop that will take anyone with an active license and a pulse? You’ll see more marginal CVs.
   • Hospitals that pay rock-bottom rates and have terrible reputations will attract fewer high-caliber locums. No surprise.

2. Rural or extreme-shortage settings

   • When a hospital is in the middle of nowhere, chronically understaffed, and has been unable to recruit, the locums pool skews toward:
     • New grads trying to pay off loans quickly
     • Docs with fewer options
   • Still not automatically “bad,” but you will see more variability.

3. Board certification gaps

   • Some rural facilities will hire non-BC docs where metros would not.
   • Doesn’t mean incompetent, but yes, you’re now in a slice of the distribution that’s different from typical metro BC-only hiring.

None of these are arguments against locums as a category. They’re reminders that bad environments attract a different subset of any workforce, not just locums.

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What the Physician Workforce Trends Really Say

If locums were just where “problem docs” end up, you’d expect usage to shrink as hospitals “fix” their recruitment and as more residents match into strong systems.

That’s not what’s happening.

Locums usage has been growing for years:

• Aging physician workforce → more retirements and partial retirements
• Rising burnout → more exits and schedule reductions
• Demand spikes in specific areas (behavioral health, critical care, rural EDs)
• More physicians (especially younger ones) refusing rigid, abusive schedules

Hospitals have three options when they can’t recruit:

1. Overwork their existing docs → burnout, resignations
2. Close services or divert patients → revenue loss, community backlash
3. Use locums as a pressure valve

They keep choosing #3, because the economics force them to.

Locums isn’t a weird back corner of medicine anymore. It’s a structural feature of a strained system.

Hypothetical Growth Trend in Locum Usage Over 10 Years

Category	Value
Year 1	100
Year 3	135
Year 5	170
Year 7	210
Year 9	260

(Those numbers are illustrative, but they match the direction every major report describes: steady upward trend.)

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How to Evaluate Locums Work Like an Adult, Not a Gossip Mill

If you’re post-residency and looking at the job market, here’s the rational way to think about locums — not the hallway stereotype version.

Ask three concrete questions:

1. What’s my leverage in my specialty and geography?

   • Strong demand + willingness to travel = locums often pays and treats you better than permanent roles.
   • Oversupplied metros + narrow location preference = locums may be less ideal or require compromise.

2. What’s my risk tolerance and life situation?

   • Heavy family obligations, kids in school, partner’s fixed job → frequent travel might be a deal-breaker.
   • Single, mobile, or willing to travel in chunks → locums becomes extremely attractive.

3. What’s the actual contract, rate, and working condition — not the label?

   • There are fantastic W-2 employed jobs and terrible locums gigs.
   • There are exploitative “partnership track” lies and transparent locums deals.
   • Stop using “permanent” as a synonym for “good” and “locums” as a synonym for “bad.”

For many physicians, the sweet spot is mixed:

• A core job (0.6–0.8 FTE) they like enough
• Locums on top, a few weekends or weeks per quarter, to boost income and keep leverage

Sample Hybrid Career Path Using Locums

Step	Description
Step 1	Finish residency
Step 2	0.8 FTE hospitalist
Step 3	Full time locums year 1
Step 4	Add locums 4-6 shifts per month
Step 5	Try multiple regions
Step 6	Convert to permanent with leverage
Step 7	Continue locums portfolio
Step 8	Take permanent job?
Step 9	Find good fit?

Notice how none of this involves being a “leftover.” It’s strategy.

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If You Choose Locums, Expect the Backlash — and Ignore It Strategically

Let me be clear: if you go the locums route, especially right out of residency, some attendings and administrators will judge you.

They’ll say things like:

• “So you couldn’t find a job?”
• “Locums is fine for a year, then you need something real.”
• “Programs don’t like seeing locums on a CV.”

Here’s what they usually mean:

• “I never understood the business side of medicine and I’m threatened by people who do.”
• “I accepted a bad job and need to believe it was the only respectable path.”
• “Our group relies on people not realizing they have alternatives.”

Academic programs or highly competitive groups may prefer linear, traditional CVs. Fine. If your dream is MD Anderson or Mayo consultant track, pure locums might not be the optimal branding move.

But many community hospitals and private groups love:

• Breadth of experience (“You’ve worked in 10+ systems; you’ve seen everything.”)
• Proof of adaptability (different EMRs, patient populations, team structures)
• Demonstrated autonomy

The real red flags aren’t “did locums” but:

• Burned multiple contracts with complaints that follow you
• Unexplained gaps and poor references
• Repeatedly left before finishing agreed-upon assignments

That’s professionalism, not employment type.

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The Bottom Line: Locums Is a Tool, Not a Personality Type

Here’s the actual myth to kill:
“Locum physicians are the leftovers.”

Reality:

• Locums physicians are a mixed distribution, just like every other physician cohort. Some stellar, some mediocre, some poor.
• The structure of locums work attracts disproportionately high numbers of independent, leverage-aware, and burnout-averse physicians — not failures.
• The places where locums use is heaviest are often where the system is struggling, not where the doctors are worse.

If you take nothing else from this, take this:

Judge physicians — including locums — by how they practice and what they deliver, not by whether their paycheck comes from an agency or a hospital payroll office.

Years from now, you won’t care whether your contract said “locum tenens” or “permanent FTE.” You’ll care whether you built a career that paid you fairly, protected your sanity, and left you with options instead of excuses.