Burned Out but Not Ready to Quit: Using Locums to Downshift Safely

What do you do when you’re sitting in the call room at 2 a.m., scrolling job sites, thinking “I cannot keep doing this”… but you’re not actually ready to walk away from medicine?

If that’s you, this is the playbook.

You’re not broken. You’re just misaligned. And locums can be the pressure valve that keeps your career from blowing up.

This is not a dreamy “follow your passion” piece. This is “how do I stop the bleeding without detonating my finances, reputation, or sanity?”

Let’s get into it.

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1. When You’re Burned Out… But Still Want to Be a Doctor

You’re past residency. Maybe PGY-5. Maybe early attending. You landed the “good” job—group practice, hospital employment, maybe even an academic title. And you’re miserable.

Typical things I hear:

• “I spend more time clicking boxes than seeing patients.”
• “My schedule is full 5 months out, but I’m still being told to increase RVUs.”
• “I dread logging into the EMR more than I ever dreaded Step 1.”
• “If one more administrator says ‘we’re a family’ I’m going to scream.”

You don’t want to quit medicine. You worked too hard to get here. But you also know this: if something doesn’t change, you’re going to burn all the way out and either rage-quit or implode.

That in-between space—done with the current job but not done with medicine—is exactly where locum tenens can work.

Not as a fantasy. As a structured, time-limited downshift.

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2. What Locums Actually Offers When You’re Fried

Locums isn’t magic. It will not cure a toxic mindset or fix all systemic problems. But if you use it correctly, it gives you four things your current job probably doesn’t:

1. Control over your hours and pace
2. A clean break from your current political/EMR/committee mess
3. A way to earn real money while you reset
4. A safe test run for new practice settings or lifestyles

Let’s translate that into reality.

Key Benefits of Locums for Burned-Out Physicians

Category	Value
Schedule Control	9
Income Flexibility	8
Geographic Freedom	7
Admin Burden Relief	6

What “downshifting” can look like

Downshifting doesn’t have to mean making half the money and moving to a cabin.

Examples I’ve actually seen:

• Hospitalist who was 7-on/7-off, constantly staying late, burning out
  → Went to locums: 7-on/14-off for 9 months. Took home about the same annual income because locums rate was higher and extra shifts were optional—but had twice the off-time.

• EM doc working 15–16 shifts/month with an aggressive RVU system
  → Switched to 8–10 locums shifts/month at a higher hourly rate. Less volume, less drama, no meetings.

• Outpatient FP seeing 24–26 patients/day, drowning in inbox
  → Did rural outpatient locums at 14–16 patients/day, full support staff, no after-hours call.

Is locums always this rosy? No. There are bad assignments. There are dysfunctional places. But—and this is the key difference—you can leave. You’re not locked into a 3-year contract with a punitive non-compete.

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3. Are You a Good Candidate for Locums Right Now?

Before you start firing off your CV to every agency in existence, you need a reality check: are you actually in a position to use locums as a safe downshift?

Here’s the quick filter I use when I talk with physicians in your spot:

Factor	Green Light	Yellow Light
Board Status	Board certified/eligible, no issues	Gaps, expired, or recent exam failures
Licensure	Active state license(s) and DEA	Single license in very saturated market
Financial Cushion	3–6 months expenses saved or low debt	Living paycheck-to-paycheck
Malpractice History	Clean or minor issues	Major claims or open investigations
Flexibility	Can travel, flexible on location	Needs hyper-local, limited dates

If you’re mostly in the “yellow light” column, you can still do locums—it just may not be immediate, or you may have to accept less-than-ideal assignments at first.

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4. Step-by-Step: How to Use Locums to Downshift Without Blowing Up Your Life

Here’s the actual sequence I’d follow if you’re burned out in a permanent job and want to move into locums as a pressure release.

Step 1: Decide your non-negotiables

Before any recruiter talks you into anything, write this down—for yourself:

• Minimum acceptable hourly/daily rate
• Maximum number of shifts/month you’re willing to work
• Procedures you will not do
• Geographic boundaries (how far you’re willing to travel, any “never again” states)
• Deal-breakers: solo coverage, no night backup, unsafe staffing ratios, etc.

If you skip this step, someone else will set these for you. Usually the hospital CFO, by proxy.

Step 2: Build your “locums CV package”

You’re not applying for one job; you’re creating a packet that can be reused 20+ times.

You need:

• Clean, updated CV (straightforward, no fluff, all gaps explained)
• Copy of licenses, DEA, board certification
• Reference list: at least 3 colleagues who will actually answer the phone
• List of procedures/skills you’re comfortable with
• Malpractice and work history with dates accurate to the month

If you keep sending half-finished paperwork, credentialing will drag for months. I’ve seen people stuck because they “forgot” they worked two months as moonlighting staff in residency. That “forgotten” job then triggers extra verification.

Step 3: Decide your exit strategy from the current job

There are three main models doctors use:

1. Cold exit → full-time locums

   • You resign, take a 4–8 week break (if you can afford it), then start full-time or heavy locums.
   • Higher stress initially (income drop while you ramp up), but clean break.

2. Gradual move → per diem / part-time + locums

   • Reduce FTE or negotiate a schedule cutback while you slowly add locums.
   • More complex scheduling, but financially smoother.

3. Bridge job → short-term contract then locums

   • Take a 6–12 month “low intensity” job (rural hospital, urgent care, etc.) and set up locums on the side to test it.
   • Slower transition, but safer if your finances are tight.

If your current environment is toxic, I lean toward option 1 or 2. If it’s just too much but not abusive, option 2 can be a solid move.

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5. How to Work With Locums Agencies Without Getting Steamrolled

Locums agencies are not inherently evil. But they are sales organizations. You need to remember that.

Here’s how to handle them like a pro.

Contact 2–3 agencies. Not 12.

If you blast your CV everywhere, you lose control. Facilities will get “double-submitted,” and you’ll look disorganized. Start with 2–3 reputable, larger agencies that cover your specialty.

Tell each recruiter, clearly:

• Where you’re licensed
• When you’re available (earliest start date, typical availability)
• What kind of assignments you want and what you will not do
• Your minimum rate

Let them know you expect transparency: actual bill rates, realistic staffing ratios, and honest descriptions of the site.

Locums Decision Path for Burned-Out Physicians

Step	Description
Step 1	Current Job Burnout
Step 2	Plan Exit Date
Step 3	Cut Expenses and Save
Step 4	Contact 2 to 3 Locums Agencies
Step 5	Sign First Assignment
Step 6	Adjust Rate or Locations
Step 7	Work 1 to 2 Assignments
Step 8	Continue or Mix with Part Time
Step 9	Reassess Specialty or Career Direction
Step 10	Financial Cushion 3 months
Step 11	Acceptable Initial Offers?
Step 12	Sustainable?

Rate negotiation: stop underselling yourself

You should know what your specialty typically gets as a locums rate. Reach out to a few colleagues, groups, or even anonymous forums (with caution) to get numbers.

Rough pattern: the more rural/undesirable the location, the higher the rate. Nights, holidays, and last-minute coverage also bump pay.

Do not accept the first number without pushing back:

• “That’s lower than I’ve seen for this region and specialty. What’s the bill rate?”
• “I’d be comfortable at $X/hour given the call requirements and solo coverage.”
• “If you can get closer to $Y, I can commit to more shifts.”

If they refuse to move at all, that tells you something about margin—and respect.

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6. Choosing Assignments That Actually Help Your Burnout (Not Just Change Its Flavor)

Classic mistake: you feel suffocated in your current job, then accept the first locums offer that shows up, and you end up in an understaffed rural ED with no backup and worse burnout.

You’re not just chasing money here. You’re designing a lower intensity season of your career.

When looking at assignments, focus on these:

• Volume and acuity: “How many patients per shift?” “How many admissions per night?”
• Support staff: Is there midlevel support? Respiratory? Night-time radiology read?
• Call burden: In-house vs beeper. How often. What’s the realistic call-back rate.
• EMR and onboarding: Nightmare system with a 2-day training or simple and tolerable?
• Coverage: Solo coverage? Second physician on site? Hospitalist backup?

Here’s what a downshifted model can look like side-by-side:

Feature	Permanent Job (Now)	Downshifted Locums Goal
Shifts/Month	15–18	8–12
Patients/Day	24–30	12–18
Call	1:3, frequent callbacks	Mostly no call or 1:6 light beeper
Admin Work	Committees, QI, EHR inbox	Clinical only
PTO	3–4 weeks, pre-approved	Self-created via gaps between gigs

If the locums job doesn’t move at least two of those rows in the right direction, it’s probably not a true downshift.

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7. Money: How to Not Blow Up Your Finances When You Step Away

Here’s the blunt part: a lot of doctors stay in miserable jobs because of money. Mortgages sized for two attendings. Private school. Car leases. Lifestyle inflation.

If you want the breathing room locums creates, you’ll probably need to unwind some of that.

Monthly Budget Shift When Moving to Locums

Category	Value
Fixed Costs	40
Variable Lifestyle	25
Savings/Investments	20
Taxes	15

Build a bare-minimum survival number

Before you resign, sit down and calculate:

• Absolute fixed costs: housing, utilities, minimum loan payments, insurance, food, bare essentials.
• Minimum savings you must maintain (retirement, kids, etc.).
• Health insurance premiums (locums usually means you buy your own).

Add 10–15% buffer. That’s your monthly “must-hit” income.

Now, look at realistic locums numbers. Can you hit that with, say, 8–10 shifts/month? If yes, you’ve got room to downshift. If no, you’ve got two choices:

• Cut expenses temporarily
• Work a bit more (or choose higher-paying, less cushy sites) in the short term

And yes, taxes will be messier. You’re basically a 1099 contractor in most locums setups. That means:

• Quarterly estimated taxes
• Set aside 25–35% of your income (talk to an accountant)
• Potential deductions for travel, housing, licensing, CME

If you’re going to drastically change your work structure, sitting with a CPA who understands physicians is not optional. It’s self-preservation.

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8. Psychological Side: Expect the Weird Feelings

A lot of burned-out physicians fantasize that the day they leave their permanent job, everything will feel light and glorious.

More likely, you’ll feel:

• Panic that you “left a stable job”
• Guilt about colleagues who stayed
• Weirdly empty without the nonstop chaos
• Questioning your identity because you’re not the “full-time, always-there doc” anymore

This is normal. Your nervous system has been in a pressure cooker for years. When you take the lid off, the steam doesn’t instantly disappear.

Locums gives you distance—a different EMR, different nurses, different hospital politics. Sometimes that’s all you need to remember: “Oh. I do like patient care. I just hated the conditions I was doing it in.”

I’ve watched people rediscover that they actually enjoy talking with families, rounding one room at a time, doing a well-run OR day—once they’re not crushed by volume and admin noise.

You’re not weak for needing that. You’re human.

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9. How Long to Stay in Locums Mode—and What Comes After

Locums as a permanent lifestyle is one option. But you’re reading this because you’re burned out and not ready to quit—not necessarily because you want to live out of a suitcase for 10 years.

So think of your first year of locums as a reset year. During that year, you’re doing three parallel things:

1. Stabilizing: proving to yourself you can earn enough and function outside the old job
2. Recovering: using extra time off to sleep, see family, exercise, maybe see a therapist
3. Exploring: testing different practice settings, regions, and schedules

By month 9–12, you should reassess:

• Do you feel more like yourself again?
• What kind of schedule actually feels sustainable?
• Did you find a hospital/group that seems like a genuinely good fit?
• Or do you like the freedom so much that you’d rather stay locums-heavy for a while?

Some people end up:

• Taking a permanent role at a site where they first worked locums
• Negotiating part-time or 0.6 FTE plus occasional locums
• Staying 100% locums but with a stable circuit of 2–3 hospitals

There isn’t one correct answer. The mistake is drifting without deciding. Put a mental “review date” on the calendar at the 12-month mark and actually sit with these questions.

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10. Red Flags and Pitfalls to Avoid

Quick list of things that turn your “safe downshift” into just another nightmare:

• Taking the first offer out of desperation
• Ignoring your minimum rate and overworking to make up the gap
• Accepting unsafe staffing (solo coverage above your comfort level, no backup, ridiculous patient loads)
• Not buying own disability and health insurance when you leave employment
• Letting 1099 taxes blindside you and then scrambling when April hits
• Staying in a toxic locums site because “the money is good”

If a place is clearly unsafe or dishonest, you leave. Your career is long. Your license and mental health are not worth sacrificing for one high-paying but awful assignment.

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FAQ (Exactly 3 Questions)

1. Do I have to quit my current job completely to start doing locums?

No. Many physicians start locums while still in their main job by using vacation blocks, unpaid leave, or reduced FTE. For example, you can drop from 1.0 FTE to 0.6–0.8 and fill the remaining days with carefully chosen locums assignments. This gives you a financial safety net and a test run of the locums lifestyle without a hard cutover. Just be absolutely sure you’re not violating any contractual clauses about outside work or geographic competition—have a lawyer review your contract if there’s any doubt.

2. What if my CV is not “perfect” or I have gaps—will locums agencies still work with me?

Locums agencies and hospitals care most about three things: your license/board status, malpractice history, and whether you can reliably show up and cover the shifts they need. Gaps by themselves are not fatal if you can explain them clearly (family leave, health issues, academic work, etc.). Multiple short jobs in a row or recent performance problems are more concerning but not necessarily disqualifying. Be honest with your recruiter; they’d rather position your story correctly than have surprises come up in credentialing.

3. How long does it realistically take to go from “thinking about locums” to my first paid shift?

If you already have an active license in a locums-friendly state and a reasonably clean file, you’re typically looking at 60–120 days from your first serious agency conversation to your first shift. The slow pieces are credentialing and hospital medical staff approval, not just the agency paperwork. If you need a new state license, it can stretch to 4–6 months depending on the board. That’s why you should start the process before you’re ready to explode or walk out of your current job.

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Open your calendar right now and block one hour this week to do just one thing: write down your non-negotiables for your next 12 months of work—hours, income floor, call limits, and what you refuse to tolerate again. That list is your anchor when recruiters call and burnout is yelling “just take anything.”