Residency Advisor
You’ve just finished residency or a fellowship. Your classmates are posting “excited to join the XYZ Medical Group” on LinkedIn. You, on the other hand, are staring at an email from a locums recruiter offering $250–$350/hour, housing covered, flights paid, start next month.
You tell yourself: “I’ll do locums for a year, stack some cash, then get a real job.”
Here’s what no one is honest enough to tell you: those locum shifts are not invisible. They follow you into every future credentialing packet, every staff job application, every reference check. And the way you do locums—how long, where, how it looks on paper—quietly nudges your odds of landing good permanent jobs up or down.
I’ve sat in the committee rooms where your CV gets passed around and people say things out loud you would not believe. Let me walk you through what actually happens on the other side of the hiring table.
What Locums Looks Like From the Other Side of the Table
From your perspective, locums is flexibility, money, freedom, maybe a breather after residency. From a future medical director’s perspective, it’s a data point. Or ten data points.
Here’s how your locum history gets used, whether anyone says it to your face or not.
Hiring committees are lazy in a very predictable way. They use patterns. They rarely have time to call every reference deeply, so they read your CV like a radiologist reads a CT: pattern recognition, quick flags, mental shortcuts.
When they see locums, they subconsciously sort you into one of a few buckets:
| Pattern on CV | Immediate Reaction Behind Closed Doors |
|---|---|
| 6–12 months at 1–2 sites | “Reasonable gap year, probably fine.” |
| 2–3 years, 6+ short-term sites | “Can’t stick. Risk of bolting.” |
| Mix of locums + one solid staff job | “Probably stable, locums was transitional.” |
| Locums only, 4+ years | “Career locums. May not tolerate structure.” |
| Locums at rough/underserved sites | “Can handle chaos. But why no home yet?” |
No one writes this in your rejection email. But I’ve watched CMOs literally circle blocks of time on a printed CV and say, “What was going on here?” when they see 18 months of choppy locums.
You need to understand the mental math they’re doing, because it determines how hard you have to fight to land a good permanent post later.
The “Locums Story” Every Future Employer Will Force You to Tell
Behind every locums stretch, committees want to understand one thing: What’s the story?
No, not the one you tell in your cover letter. The one that explains your behavior.
They’ll try to triangulate this from three places: your CV timeline, your references, and how you answer one deceptively simple question in the interview:
“So tell us about your locum work. What made you choose that path?”
I’ve seen candidates win or lose offers on that single answer.
Programs and hospital groups basically sort your story into three categories:
1. Strategic and finite
This is the one that helps you, if you execute it right.
Example they like: “I finished residency in 2021, my partner was in a fixed-location job, we needed some flexibility for a year while they finished that contract, so I did locums at two sites. Then we moved here and I’ve been looking for a long-term home.”
They like:
- Defined time window (6–18 months, sometimes 24)
- Limited number of sites
- Clear external reason (geography, spouse, visa, academic timing)
- Positive spin: you gained skills, saw different systems, learned what you want
2. Drifting and reactive
This is where people get hurt, and most do not realize they’re drifting until year three.
Example they dislike: “Well, I wasn’t sure what I wanted, so I took some locums, and then kept getting offers so I sort of just kept doing it…”
Translation in their heads: “No plan. No roots. Will probably leave us too.”
They’ll literally say, “We’ll shortlist them, but I’m a bit concerned they haven’t settled anywhere yet.”
3. Escaping and burned
Careful here. This is where your tone derails you.
If you frame it like: “My first job was toxic, administration was incompetent, so I left and did locums while I figured out my next step,” you just told them you might be trouble.
Even if you’re 100% right about the toxic job, the story they hear is: “They left after 9 months and are still bouncing around.”
You can’t change the past, but you can control how it looks:
- “My first job wasn’t the right fit for my clinical interests and schedule needs, so I moved into locum work while looking for a position more aligned with X.”
That subtle shift matters. A lot more than any resident ever thinks.
How Different Types of Locums Assignments Signal Different Things
Not all locums is equal in the eyes of a hiring committee. They know the locums market better than you do. They know which jobs are “gap fillers” for a good reason and which are “nobody stays here longer than 6 months unless they’re desperate.”
Here’s what they read off your assignment list:
High-paying, high-volume community gigs
Example: 7-on/7-off hospitalist locums in a busy community hospital, $220–$250/hour, census 18–20.
They assume:
- You can handle volume
- You’re used to working independently
- You may be a little “productivity-first” in your thinking
If you’re looking at another community job with similar acuity, this actually helps you. Practice leaders have literally said: “They’ve done locums at [name of notorious workhorse site], they’ll handle our volume fine.”
But if you’re applying to a cushy academic job with a teaching focus and reasonable RVU expectations, they may read this as “workhorse, not academic material.”
Rural / frontier assignments
If they see you did a stretch of locums in rural Montana, North Dakota, central Appalachia, Indian Health Service, etc., the reaction is mixed, but often respectful.
I’ve heard: “Anyone who survives six months as the lone doc in [tiny rural hospital] knows how to manage chaos.”
Where it backfires is when:
- It’s a string of very short rural gigs, all 2–3 months
- There’s no anchor job before or after, just more bouncing
Then they start to think: “They go where the money and desperation is, then bolt.”
Last-minute coverage / disaster sites
Every region has a couple of notorious hospitals or groups that have constant locum needs because they’ve burned through staff. Trust me: your future employer knows who they are.
If your locums list reads like a greatest hits collection of those places, you will get questions.
They’ll wonder: did you choose those because of pay, or because no one else would take you? Unfair, but that’s how it’s interpreted.
The Real Gatekeeper: Credentialing and What It Exposes
Most doctors worry about how locums “looks” on a CV. That’s the cosmetic worry.
The real problem is what it triggers behind the scenes: every single locum site is a separate credentialing packet, a separate verification, a separate chance for someone to say something that torpedoes you.
You know that section on staff applications that asks for a full work history and all prior hospital affiliations? Credentialing uses that, then sends forms to every place you’ve ever had privileges.
If you’ve done:
- 7–8 locums hospitals in 3 years
- Plus residency, plus any moonlighting sites
…your next employer now has 10–12 places to get verification from, and potentially 10–12 chiefs or medical staff offices who can say: “Would not reappoint.”
I have seen candidates lose offers because a single locums site wrote a bland but poisonous line like: “Physician did not complete contract term” or “Questions regarding professionalism – see attached.”
They rarely attach anything. The phrase alone is enough to send your packet into “too risky” territory.
More sites = more chances for exactly that.
There’s also a purely practical gatekeeping issue: some medical staff offices see a CV with 10 prior hospitals and just groan. They know it’s months of chasing signatures and forms. I’ve watched a CMO say: “We’ll need to be really sure about this one before we commit to that credentialing nightmare.”
They don’t reject you explicitly for it. They just stall. Drag things out. Quietly prioritize the candidate with two prior jobs over the one with ten locum stints.
The “Commitment Problem” You Don’t Feel Now But They Assume Later
The core fear permanent employers have about serial locum docs is simple: you won’t stay.
They live in constant pain from turnover. Recruiting is expensive; orientation is expensive; filling gaps with locums is expensive. So when they see someone who’s been living in month-to-month contracts, their guard goes up.
Here’s the unspoken logic I’ve heard in committee more than once:
“They’ve been making $250/hour, working when they want. Why would they come here for $180/hour, full call, meetings, and QI projects…and stay?”
They worry that:
- You’ll leave the moment admin annoys you
- You’re not used to being part of a long-term project (quality initiatives, committees, building a service line)
- You’ll balk at the non-clinical parts: meetings, peer review, M&M, hospital politics
If you want a permanent job later, you have to attack that fear head-on.
You do that by:
- Showing depth at at least one location (even as locums – repeated returns to the same site help)
- Getting letters that highlight your reliability and engagement, not just clinical competence
- Articulating in your interview why you’re done with perma-locums and what specifically you want long term
By the way, they can tell when you’re lying about that last part. If you say you want stability but ask zero questions about schedule, committee expectations, or long-term growth, they assume you’re still half in the locums mindset.
Money, Lifestyle, and Why Some Jobs Get Nervous About Ex-Locums
Let me talk about the thing everyone pretends isn’t driving this: money and lifestyle.
Locums often pays more, especially if you’re willing to go where nobody wants to live, or cover nights and holidays. I’ve watched brand-new hospitalists clear $400–$500k doing grueling locums while their classmates make $240k as employed staff.
Future employers know that. They’re not stupid.
| Category | Value |
|---|---|
| New Staff Job | 240 |
| Balanced Locums Year | 320 |
| Heavy Rural Locums | 450 |
Now imagine you’re the medical director offering a permanent job:
- Base: $240–260k
- Modest RVU bonus
- Full benefits
- 7-on/7-off or equivalent
And the candidate has been grossing $350–400k annually doing locums. Your fear is simple: “They’ll either be constantly dissatisfied with our pay, or they’ll leave for more locums the minute they feel squeezed.”
So if you’re coming back from a high-income locums phase and want to land a permanent job, you need a credible, concrete narrative about why you’re willing to earn less.
Not a vague “I want stability.” Everyone says that. You want:
- “My partner and I are committed to this city long term; we’re buying a house and putting kids in school.”
- “The travel burden has gotten old; I care more about predictable time off now than pure income.”
- “I want to build X service line or teaching niche, which requires being somewhere for years.”
Without that, they assume you’re just testing the waters for a year before hopping back to locums.
The Hidden Upsides: When Locums Actually Helps You Land Better Jobs
It’s not all downside. Done strategically, locum experience can absolutely make you more attractive for certain permanent jobs.
I’ve seen it play out a few ways.
1. You prove you can function in chaos
If your locums includes time at understaffed, high-acuity sites, you can sell that as a strength:
- Comfort with limited resources
- Breadth of pathology
- Independence
I’ve heard ED chiefs say: “If they’ve done six months in [infamously rough ED], they’ll adapt to us in a week.”
2. You build relationships that turn into offers
A good number of permanent jobs are basically extended locums try-outs that became “Why don’t you just stay?”
If during locums you:
- Show up on time
- Don’t complain constantly
- Treat staff decently
- Help with small QI projects or show interest in how the place runs
You become the easy answer when they finally get authorization to open a new FTE. That’s the part no recruiter really spells out: some of the best permanent jobs are never posted publicly. They get offered to the reliable locum who’s already there.
3. You refine what you actually want
This is more subtle, but it matters when you interview later.
Candidates who did a thoughtful year or two of locums tend to have very specific, grounded answers to questions like:
- “What kind of schedule have you realized you do best with?”
- “What aspects of your prior jobs did you like or dislike?”
- “What type of culture are you looking for?”
They can say things like: “At Site A, the nocturnist model didn’t fit me, but Site B’s swing schedule did,” or “I learned I hate open ICU without backup.” That specificity reassures hiring committees you’re not going to discover dealbreakers six months in.
Mistakes That Quietly Poison Your Future Job Prospects
Let me be blunt about the biggest self-inflicted wounds I’ve seen locums docs cause for themselves.
1. Leaving mid-contract without a serious reason
Word travels. Locums companies talk. Medical directors talk.
If you bail halfway through a contract because “I was tired” or “I got a better-paid offer,” someone will eventually flag you as unreliable. That can end up in a credentialing form or a recruiter’s private notes.
Later, when a hospital calls the agency asking, “How was Dr. X?,” you don’t hear the part where they say: “Clinical was fine but they left us hanging last minute.”
Committees do hear that.
2. Burning bridges with staff or administration
You think nurses, APPs, and coordinators do not have influence? They do.
Some of the most brutally honest feedback I’ve heard about locum docs has come from nurse managers and schedulers. If you treat them like interchangeable cogs because “I’m just here for a few weeks,” they remember.
If that hospital is ever on your work history, those people can quietly sink you with a one-line comment during background checks.
3. Letting your CV look like alphabet soup
If your CV reads:
2021–2022: Locum tenens, multiple sites
2022–2023: Locum tenens, multiple sites
2023–2024: Locum tenens, multiple sites
…you’re making the committee do the work to untangle your story. They won’t.
You need a clean, organized layout with clear start/end dates and site names. Group work when you can, but don’t hide things. Hiding invites suspicion; clarity invites more trust.
4. Failing to lock in strong references early
Don’t assume locums sites will remember you fondly two years later.
While you’re still there (or soon after), you want:
- An email from a department chief or site director saying they were pleased with your work
- Explicit permission to use them as a reference
Later, when a staff job calls, having two or three locums leads who say, “Yes, we’d rehire them tomorrow” smooths over a lot of anxiety about your hopping.
How to Use Locums Without Killing Your Future Options
The point is not “never do locums.” The point is: don’t stumble into becoming a professional nomad unless that’s genuinely the career you want.
| Step | Description |
|---|---|
| Step 1 | Finish Residency |
| Step 2 | Start Locums |
| Step 3 | Search Staff Jobs First |
| Step 4 | Limit sites to 1 to 3 |
| Step 5 | Risk serial locums label |
| Step 6 | Get strong references |
| Step 7 | Apply to staff jobs |
| Step 8 | Need income immediately |
| Step 9 | Plan defined? |
If you’re going to do locums and still want strong staff job prospects later, here’s the distilled strategy:
- Timebox it in your own head. Decide up front: is this 6 months, 1 year, 2 years? Don’t just “see what happens” for half a decade unless you’re okay being seen as a career locum.
- Limit your sites. 1–3 hospitals you return to are way better than 7 different three-month stops.
- Always leave cleanly. Finish contracts, give reasonable notice, don’t vanish.
- Collect references as you go. Don’t wait until you’re applying to staff jobs to scramble for letters.
- Be honest with yourself about money vs stability. If you’ve gotten used to $400k, be realistic about what a $270k job will feel like, and pick your permanent target accordingly.
FAQs
1. Does doing locums right after residency look bad to future employers?
Not automatically. A single year (even 18 months) of well-structured locums at one or two sites is usually seen as fine, sometimes even as “they got a lot of experience quickly.” It starts to raise eyebrows when it drags into multiple years with many short stops and no clear anchor job.
2. How many locum sites are “too many” if I want a permanent job later?
There’s no magic number, but once you’re past about 4–5 hospitals in 3 years, committees start to see you as itinerant. If you go that route, you need a very clear story and strong references to overcome the pattern.
3. Should I list every short locums assignment on my CV?
For credentialing, yes—hospitals will eventually make you disclose all prior affiliations. For the first-pass CV you send to recruiters and employers, you can group them (e.g., “Locum Tenens Hospitalist, 3 community hospitals in State X, 2022–2023”) but be ready with a detailed list when you get serious interest.
4. Can a bad locums reference ruin my chances at future staff jobs?
It can absolutely hurt you, especially if it involves professionalism, behavior, or failure to complete contracts. One bad site among several good ones can be overcome, but a pattern of “would not reappoint” or vague negative comments is a major red flag for most medical staff offices.
5. If I’ve been doing locums for several years, how do I convince a hospital I’ll actually stay?
You need a concrete, believable story. That usually includes a strong geographic tie (partner, kids, family, house), a clear reason you’re tired of locums (travel, unpredictability), and specific long-term goals that require staying put (building a program, teaching, leadership). You also want references from sites where you returned repeatedly and were seen as part of the team, even as a locum.
Key points to walk away with: locum shifts are not invisible; every site you touch becomes part of your permanent record. Use locums deliberately—limited sites, clear time frame, clean exits—and you can still land excellent staff jobs later. Drift blindly from gig to gig, and you quietly make every future door just a little bit heavier to push open.
