Unlocking Locum Tenens: A Comprehensive Guide to Flexibility in Healthcare

Locum Tenens Careers: Freedom, Flexibility, and the Trade-Offs You Need to Know

In the evolving landscape of healthcare delivery, locum tenens work has shifted from a niche option to a mainstream physician career pathway. For residents approaching graduation, early-career attendings, and even physicians in mid-career transition, temporary positions can offer a powerful combination of healthcare flexibility, competitive compensation, and diverse clinical experience.

But that same flexibility can come with uncertainty, gaps in benefits, and logistical challenges that are easy to underestimate from the outside.

This expanded guide explores the real-world pros and cons of locum tenens in depth—so you can decide if this path fits your goals, risk tolerance, and stage of life.

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The Locum Tenens Landscape: Why Temporary Positions Are Surging

Locum tenens (Latin for “to hold the place of”) refers to physicians and advanced practice providers who work temporary assignments to cover staffing gaps. These gaps may result from:

• Physician vacancies or resignations
• Maternity or medical leaves
• Seasonal surges in patient volume
• Expansion of services before permanent hiring is complete
• Rural or underserved locations with chronic recruitment challenges

According to industry reports and organizations like the National Association of Locum Tenens Organizations (NALTO), a majority of hospitals and medical groups now use locum tenens providers at least occasionally. This is driven by:

• Persistent physician shortages in many specialties
• Increasing burnout and turnover among permanent staff
• Growing patient demand, especially in primary care and behavioral health
• Expansion of telemedicine and nontraditional care settings

For physicians, this creates a robust market for short-term and long-term temporary positions—ranging from weekend call coverage to multi-month contracts.

Who Typically Chooses Locum Tenens?

You’re likely to encounter locum tenens providers in nearly every specialty, but this path is especially common among:

• New graduates bridging the gap between residency/fellowship and a permanent role
• Physicians exploring different practice environments before committing long term
• Mid-career physicians seeking a reset from burnout or administrative overload
• Late-career physicians easing into retirement while maintaining clinical practice
• Physicians with geographic flexibility (single, or with flexible family arrangements)

Understanding your own motivations and constraints is essential before you commit to this model of work.

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The Major Pros of Locum Tenens Work

Locum tenens can be a highly attractive option—especially if you value autonomy and variety. Below are the main advantages, with practical examples and considerations for residents and early-career physicians.

1. Powerful Flexibility in Schedule and Lifestyle

For many, the strongest draw of locum tenens is unparalleled schedule control compared with traditional employment.

Tailoring Work Around Your Life

As a locum tenens provider, you can often decide:

• When you work (months on, months off, or intermittent shifts)
• Where you work (regionally or across the country)
• How intensely you work (e.g., heavy call vs. lighter outpatient roles)

Example scenarios:

• A new attending takes 6–9 month assignments interspersed with 1–2 month breaks for travel.
• A physician parent arranges contracts only during the school year, keeping summers lighter.
• An EM physician stacks shifts over 7–10 days each month, preserving long stretches of time off.

This degree of healthcare flexibility is rare in conventional full-time employment, where your schedule is dictated by the group’s needs.

Work–Life Balance on Your Terms

Locum tenens allows you to redesign your work–life balance:

• Take time between assignments to recharge or attend to family matters
• Avoid chronic committee meetings, administrative duties, and nonclinical tasks
• Pause work to relocate, pursue additional training, or test out a new city

For residents entering the job market, this can be a welcome change after years of rigid scheduling.

2. Competitive Compensation and Earning Potential

Locum tenens is often financially attractive, though the details matter.

Higher Hourly/Per-Diem Rates

Because facilities are filling urgent staffing gaps and not paying long-term benefit costs, locum tenens rates per day or per shift can be higher than the prorated equivalent for employed roles.

You may see:

• Premium daily rates for in-demand specialties or rural locations
• Overtime or extra shift pay at premium rates
• Night/weekend/holiday differentials, particularly in hospital-based specialties

Many assignments also include:

• Paid travel (flights, mileage, rental car)
• Lodging (hotel, apartment, or stipend)
• Covered malpractice insurance (often with tail included)

When you add in reduced overhead (no permanent office, sometimes no housing costs at home if you travel extensively), take-home pay can compare favorably to traditional roles.

Strategic Use for Debt Reduction or Savings

Locum tenens can be leveraged to achieve specific financial goals:

• Accelerated loan repayment: Work a high-intensity schedule for 1–3 years to pay down medical school debt aggressively.
• Building a financial runway: Save for a future private practice, fellowship, or extended sabbatical.
• Testing part-time work: Maintain income while gradually reducing clinical hours.

However, you must also plan for self-employment tax, variable income, and your own retirement savings (discussed below).

3. Diverse Clinical Experience and Career Exploration

For residents and early attendings, locum tenens can be an unparalleled way to accelerate professional growth.

Exposure to Varied Practice Settings

Assignments might include:

• Academic medical centers
• Community hospitals
• Critical access or rural facilities
• Federally qualified health centers (FQHCs)
• Private group practices
• Telemedicine roles

Each environment teaches different workflows, documentation systems, team dynamics, and resource levels. Over a few years of locum tenens, you can accumulate the equivalent of many years of “real-world” experience in different settings.

This diversity:

• Makes you more adaptable and resilient
• Improves your problem-solving skills under varying constraints
• Helps clarify which environment you ultimately want for a permanent role (if any)

Expanding Your Professional Network

Each assignment brings new colleagues, mentors, and potential future employers. These contacts can:

• Lead to permanent job offers in places you might never have considered
• Provide letters of recommendation or references for future roles
• Expand your professional reputation across regions or systems

For physicians early in their career, locum tenens can function like an extended, paid “clinical fellowship” in real-world practice styles.

4. Reduced Administrative Burden and Politics

Many physicians turn to locum tenens specifically to escape nonclinical demands that have eroded job satisfaction.

Focus on Direct Patient Care

As a locum tenens physician, you are usually insulated from:

• Long-term committee assignments
• Extensive quality-improvement projects
• Leadership politics and organizational power struggles
• Complex human resources or staff management issues

You’re typically brought in to see patients, help meet clinical demand, and then hand off when the assignment ends.

This can be especially appealing if:

• You feel burned out by charting, meetings, and productivity pressures
• You value clinical work but not long-term institutional responsibilities
• You want to reconnect with why you went into medicine in the first place

Short-Term Commitments

Because assignments are temporary, you have a clear exit path if:

• The practice culture clashes with your values
• The workload is unsustainable
• The location doesn’t suit your personal life

Most contracts specify defined start and end dates, with renewal negotiable. This gives you negotiating power and psychological safety that can be harder to achieve in permanent roles.

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The Real Challenges and Downsides of Locum Tenens

The benefits of locum tenens are significant—but so are the trade-offs. Before committing fully to this path, you need a clear-eyed view of the downsides and how to mitigate them.

1. Uncertainty, Variable Income, and Job Stability

The same flexibility that makes locum tenens so appealing can also make it stressful.

Inconsistent Work Flow

Locum tenens demand is generally strong, but your personal schedule may not be perfectly filled without deliberate effort. Potential issues include:

• Gaps between assignments when there is no income
• Sudden cancellation of contracts if a site finds a permanent hire
• Seasonal dips in demand in some specialties

For physicians who rely exclusively on locum tenens as their income source, this unpredictability requires:

• A robust emergency fund (typically 3–6+ months of living expenses)
• Conservative budgeting during high-earning months
• Willingness to accept less-desirable locations or shifts during slow periods

New graduates should be prepared for the possibility that the first few months may be spent onboarding and obtaining licenses/privileges before the income stream fully stabilizes.

Job Security and Long-Term Planning

Unlike permanent employed positions, locum tenens contracts:

• Rarely guarantee work beyond a defined period
• Don’t include built-in annual raises
• May be more vulnerable to budget cuts or staffing shifts

This can complicate:

• Long-term financial planning
• Mortgage approval or rental applications (variable income)
• Major life decisions that rely on predictable cash flow

Mitigation strategies include diversifying assignments, maintaining multiple state licenses, and working with more than one medical staffing agency.

2. Limited Traditional Employee Benefits

One of the most commonly underestimated downsides is the benefit gap.

Health Insurance and Disability Coverage

Most locum tenens physicians are classified as independent contractors (1099), meaning:

• No employer-sponsored health insurance
• No employer-paid disability insurance
• No paid parental leave or sick leave

You are responsible for:

• Purchasing your own individual or family health plan
• Securing long-term disability coverage (essential for physicians)
• Budgeting for unpaid time off (vacations, illness, or family emergencies)

While some agencies or large health systems may offer W-2 roles with partial benefits, the classic locum tenens model assumes you’ll self-manage your safety net.

Retirement and Tax Planning

As an independent contractor, you don’t get:

• Employer 401(k) match
• Pension contributions

However, you can (and should) use tax-advantaged accounts such as:

• Solo 401(k)
• SEP IRA
• Traditional or Roth IRA, depending on income limits

You must also proactively:

• Set aside funds for quarterly estimated taxes
• Budget for self-employment tax (Social Security + Medicare)
• Consider hiring a CPA familiar with physician locum tenens work

Without intentional planning, it’s easy to earn a high gross income but under-save for the future.

3. Integration, Onboarding, and Workplace Culture Challenges

Starting as “the new doctor” over and over has its own workload and emotional toll.

Constant Learning Curves

Each new assignment may require:

• Learning a different EHR
• Adjusting to new order sets, workflows, and protocols
• Understanding the capabilities and limitations of that facility (e.g., what can be managed in-house vs. transferred)
• Rapidly building trust with nursing staff and ancillary teams

Onboarding may be condensed into:

• A half-day orientation
• A few shadow shifts
• Or sometimes, minimal formal training—especially in rural or high-need settings

This demands high adaptability and comfort with ambiguity. For some physicians, that’s energizing; for others, it’s exhausting.

Navigating Culture as a Short-Term Colleague

Even in welcoming environments, locum tenens providers may feel like:

• “Temporary outsiders” to established teams
• Less involved in long-term planning or QI initiatives
• Less likely to be consulted on organizational decisions

In less optimal environments, you may also encounter:

• Skepticism or resentment from staff who perceive locums as overpaid “temps”
• Poor communication about expectations or patient volumes
• Limited support when advocating for systemic improvements

Success in these settings requires strong interpersonal skills, humility, and clarity about your role and boundaries.

4. Potential Isolation and Impact on Personal Life

The mobility of locum tenens can be thrilling—or isolating.

Social and Emotional Isolation

If you travel frequently or work in distant locations:

• You may be far from family, partners, and close friends for extended periods
• Weeknights in a hotel or short-term rental can feel lonely
• Short assignments can limit the depth of local friendships or community involvement

Over time, some locum tenens physicians report:

• Feeling “in between lives” with no clear home base
• Difficulty maintaining romantic relationships or parenting routines
• Missing major life events due to travel or on-call commitments

This is especially important to consider if you:

• Have a partner with a geographically fixed career
• Have school-aged children
• Highly value deep community ties or long-term local involvement

Logistics of a Mobile Lifestyle

Beyond emotions, there are practical hassles:

• Finding reliable housing for each assignment
• Managing mail, permanent address, and state residency issues
• Maintaining multiple state medical licenses and DEA registrations
• Navigating varying credentialing requirements and timelines

Working with reputable agencies can streamline some of these tasks, but you’ll still invest time and mental energy managing the logistics of a mobile physician career.

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Is Locum Tenens the Right Physician Career Path for You?

Locum tenens is neither inherently “better” nor “worse” than a traditional employed or partnership track job—it’s simply a different model with distinct advantages and trade-offs.

When Locum Tenens May Be an Excellent Fit

This model often works well if you:

• Crave flexibility and autonomy over your schedule and location
• Want to explore different practice settings before committing long term
• Are motivated to optimize earnings for specific financial goals
• Feel burned out on meetings, politics, or administrative overload
• Have fewer geographic constraints (or a very supportive, mobile family)
• Are comfortable with financial planning, variable income, and self-employment

New graduates often find that 1–2 years of locum tenens clarify what they truly want in a permanent role—and make them stronger negotiators when they eventually seek one.

When a Traditional Permanent Role May Be Better

On the other hand, a stable employed or partnership track job may better suit you if you:

• Highly value predictable income and long-term job security
• Prefer deep, long-term relationships with colleagues and patients
• Don’t want to manage your own taxes, benefits, and retirement planning
• Have family or caregiving responsibilities that limit travel or relocation
• Strongly desire organizational influence and leadership roles within one system

For many physicians, a hybrid approach works well—for example, keeping a part-time permanent role for stability while adding locum tenens shifts for extra income and variety.

Practical Steps Before You Jump In

If you’re seriously considering locum tenens:

1. Clarify your goals: Is this a short-term bridge, a long-term lifestyle, or a way to test different settings?
2. Talk to multiple agencies: Compare rates, support services, malpractice coverage, and assignment types.
3. Start with one well-structured assignment: Use it as a test case to learn about travel, workflow, and how you feel about the lifestyle.
4. Meet with a financial planner or CPA: Optimize your tax strategy, savings, and insurance coverage as an independent contractor.
5. Be transparent with loved ones: Discuss how travel, time away, and schedule variability may impact your relationships and family life.

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Frequently Asked Questions About Locum Tenens

Q1: How do I find reliable locum tenens positions and agencies?

You can find locum tenens positions through:

• Specialized medical staffing agencies
• Major physician job boards with locum tenens filters
• Direct outreach from hospitals and health systems

When evaluating agencies, ask:

• Which specialties and regions they focus on
• Typical rates, call expectations, and assignment lengths
• What they cover (travel, lodging, malpractice with tail)
• Whether you’ll have a dedicated recruiter and 24/7 support

Speak with multiple agencies, compare offers, and read reviews from other physicians in your specialty. Avoid signing overly restrictive non-compete clauses that limit future options.

Q2: Do locum tenens physicians pay their own taxes, and how should I prepare?

Most locum tenens physicians are independent contractors (1099). This means:

• You are responsible for withholding and paying your own taxes
• You must usually make quarterly estimated tax payments
• You owe self-employment tax, in addition to federal and state income taxes

Preparation tips:

• Set aside 25–35% of your gross income for taxes (varies by situation)
• Open a separate savings account just for tax reserves
• Consider working with a CPA experienced with physician contractors
• Use tax-advantaged retirement accounts (e.g., solo 401(k)) to reduce taxable income

If you accept W-2 locum roles (less common), the employer will withhold taxes, but you may have lower flexibility in retirement contributions.

Q3: How long do locum tenens assignments usually last, and can I extend them?

Assignment length varies widely:

• Short-term: Weekend call, 1–2 week blocks, or month-long coverage
• Medium-term: 3–6 month assignments, often to bridge a vacancy
• Long-term: 6–12+ months, sometimes functionally similar to a temporary employed role

Extensions are common when both parties are satisfied. Many physicians start with a 3-month contract that is renewed multiple times. Always clarify:

• Expected start and end dates
• Conditions for extension or early termination
• Minimum upfront time commitment

This allows you to plan your life and income more effectively.

Q4: Who provides malpractice coverage for locum tenens work?

In many cases:

• The locum tenens agency provides malpractice coverage for your assignments
• Coverage is typically claims-made with tail included for that specific work

However, always confirm in writing:

• Policy limits (e.g., $1M/$3M)
• Whether tail coverage is included after you leave the assignment
• Any gaps that might require you to purchase additional coverage

If you do direct contracting with hospitals or practices (without an agency), you may need to secure your own malpractice policy. A physician-focused insurance broker can help you evaluate options.

Q5: Can I work locum tenens while maintaining a permanent job?

Yes. Many physicians successfully blend:

• A part-time or full-time permanent role
• Supplemental locum tenens shifts for extra income or variety

Key considerations:

• Ensure your employment contract does not prohibit outside clinical work or moonlighting
• Verify malpractice coverage—you may need separate coverage for locum work
• Be realistic about work–life balance and avoid overextending yourself

For residents transitioning to practice, starting with occasional locum tenens shifts can be a low-risk way to test this model alongside a primary job.

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Locum tenens can be a powerful tool in your post-residency and mid-career toolkit—offering a level of autonomy and healthcare flexibility that’s difficult to match. By understanding both the opportunities and the trade-offs, you can make a deliberate, informed decision about whether temporary positions should be a short chapter in your career, a long-term lifestyle, or a strategic option you keep in reserve.