Residency Advisor
47% of physicians doing locum tenens report being more satisfied with their work-life balance than they were in their prior permanent job.
That alone blows up the laziest myth in medicine: that locums is what you do when you are burned out, washed up, or in “time-out” between real jobs. The stereotype is the 62‑year‑old doc who hated his last hospital, stormed out, and now drifts from rural ER to rural ER under a cloud.
That person exists. But he is not the center of gravity anymore.
Locum tenens is quietly becoming a strategic career tool, not a shame-based fallback. And the people who thrive in it are not who you think.
Let’s separate story from data.
| Category | Value |
|---|---|
| Higher pay | 60 |
| Schedule control | 55 |
| Avoid politics/admin | 45 |
| Travel/variety | 35 |
| Bridge between jobs | 30 |
The Myth: Locums = Burnout, Trouble, or “Couldn’t Hack It”
I have heard the same lines in lounges from Boston to Bakersfield:
“Locums? That’s for docs who got fired.”
“Programs won’t like seeing a bunch of locums on your CV.”
“Locums means unstable, desperate, or problematic.”
These are emotionally satisfying explanations. They also conflict with actual data from major staffing firms and surveys by groups like CHG Healthcare, CompHealth, and NALTO.
Across multiple reports:
- Most locums physicians previously held standard employed or partnership-track jobs.
- The top reported reasons for going locums are money, autonomy, and flexibility — not “I got canned.”
- Satisfaction with schedule control and burnout scores often improve after moving to locums.
So no, locums is not the professional purgatory some people imagine. It’s more like a pressure relief valve for a rigid system that keeps asking physicians for more RVUs, more metrics, more inbox, more meetings.
The people who do well in locums are the ones who understand that — and use it.
Who Actually Thrives in Locum Tenens
Let me be direct: not everyone should do locums. Some people are wired for one hospital, one system, one path. That’s fine.
But there are clear profiles of physicians who don’t just tolerate locums; they thrive in it.
1. The Autonomy-Maximizer (Usually Mid-Career)
This is the physician who hit the classic mid-career wall:
- 8–15 years out of residency
- Maybe a mortgage, maybe kids, definitely a stack of admin emails
- Watching compensation flatten while workload climbs
- Constantly told “we hear your concerns” by leadership that changes every 18 months
They are not burned out so much as fed up with the tradeoff.
Locums gives this group something their health system will never voluntarily hand them: real leverage and optionality.
You see it in survey data. When physicians who switch to locums are asked what improved most:
- Control over schedule and time off
- Freedom from meetings and nonclinical “initiatives”
- Ability to say no to unreasonable demands
And yes, also income. Mid-career IM hospitalists, anesthesiologists, EM docs, and certain surgical subspecialists can legitimately earn 20–50% more working fewer weeks — if they are willing to travel, be flexible, and take high-need assignments.
These are not failed physicians. They are the ones who finally did the math and stopped accepting the default.
2. The Early-Career Explorer (Post-Residency and Unsure)
Here’s a group almost nobody warns you about in residency: the people who match into the right specialty but the wrong practice environment.
You finish IM. You think you want hospitalist work in a large academic center. Then you realize you hate endless committees, hate nights, and hate living in your overpriced coastal city.
Or you’re EM, and the corporate group that took over your shop turns the place into an RVU sweatshop.
The traditional playbook says: suck it up, work for a few years, then try to lateral to another job that looks exactly the same in a different zip code.
The smarter move for a decent chunk of new attendings? A planned 1–3 years of locums as structured exploration.
I’ve seen it work like this:
- A new FM doc does locums in a rural FQHC, an urgent care-heavy clinic, and a suburban primary care setup.
- They track what they actually enjoy: panel continuity vs. procedures vs. acute care.
- They discover they love procedure-heavy, low-bureaucracy environments and negotiate a permanent job with that exact profile — with receipts from prior locums contracts to anchor compensation.
This is not drifting. It’s test-driving practice models while getting paid (usually above market) and avoiding being locked into a toxic first job with a restrictive covenant.
New attendings who thrive in locums share a few traits: they’re organized, adaptable, and unafraid to ask uncomfortable questions about call, volumes, staffing, and culture before they sign anything. In other words, overrepresented group: people who watched seniors get burned and learned from it.
3. The Geographically Flexible High-Demand Specialist
Some specialties are simply over-leveraged in locums. Not every field, not every location. But hospitalist medicine, EM (even post-COVID contraction), anesthesia, some surgical subs, psych, and certain IM subspecialties can command hefty rates in the right markets.
The ones who really win here are:
- Single or geographically flexible
- Willing to fly to less sexy locations
- Comfortable with different EMRs and systems
You’ve seen the postings: fly-in/fly-out block schedules, 7-on/7-off, premium for weekends and nights, housing paid, travel paid, per diem. Run the numbers cleanly — actually subtract tax, unpaid time, and travel fatigue — and for the right doc it still beats standard employed comp.
But the key difference is attitude. The ones who thrive treat it like a business, not a gap year:
They track their effective hourly rate, including travel days and cancellations. They negotiate. They keep a spreadsheet of every site’s staffing ratios, culture, and EMR misery score. They know which recruiters waste their time and which ones bring real offers.
Locums rewards this kind of informed ruthlessness.
4. The Physician Who Refuses Hospital Politics
Another big, under-discussed group: people who love clinical medicine and have zero interest in being part of the “physician leadership pipeline.”
These are the ones who glaze over during “strategic retreat” PowerPoints, who don’t want to be section chief, and who truly do not care about the hospital’s five-year plan for “service line integration.”
Locums is basically engineered for them.
You still have to work well with staff and colleagues, obviously. But your exposure to long-game politics plummets:
- No tenure track to protect
- Very limited involvement in endless committee work
- Far fewer “optional” meetings that are absolutely not optional for partners or employees
That’s why, in survey after survey, locums physicians score higher on “time spent on direct patient care vs other work.” They’re paying a price in continuity and prestige maybe, but they win back a chunk of their day that most employed docs will never see again.
5. The Transitional Physician (But Not How You Think)
Yes, there are people in locums because something went wrong: contract disputes, mergers, closures, personal life disasters. They use locums to bridge.
Here’s the twist: a substantial portion of those “bridgers” end up never going back to a standard employed model.
The sequence looks like this:
- Job implodes (hospital sale, new CMG, call change, whatever).
- Physician picks up locums “just for a few months.”
- They notice their stress is down, their control is up, and their paycheck is not worse.
- They try half-heartedly to look at permanent jobs again and realize they have zero desire to attend another “vision and values” interview panel.
- They formalize locums as their new default.
These are not broken career stories. They’re physicians using a forced transition to renegotiate what “normal” is allowed to be.
| Step | Description |
|---|---|
| Step 1 | Residency grad |
| Step 2 | Traditional job |
| Step 3 | Stay employed |
| Step 4 | Short term locums |
| Step 5 | Long term locums career |
| Step 6 | Select targeted permanent job |
| Step 7 | Planned locums exploration |
| Step 8 | Satisfied? |
| Step 9 | Prefer locums? |
Who Struggles in Locums (Even if They Won’t Admit It)
Let’s flip the lens. Because for some personalities, locums is a terrible fit and does make them worse.
The Stability-Maximalist
If you need:
- The same team, same nurses, same rooms
- Deep long-term relationships with patients
- A clear, predictable 5-year plan
You are going to hate most locums setups. There are stable, recurring assignments and long-term contracts, yes. But they are still built on someone else’s staffing instability. That instability wears on people who crave fixed routines.
These docs often bounce into locums, feel unmoored, and retreat back to a permanent role — which is completely rational. Stability is not a moral failing, it’s a preference. But pretending you “should” like the freedom of locums because everyone on Reddit says so is just as dumb as pretending locums is only for failures.
The Disorganized or Conflict-Avoidant Physician
Locums is small-business medicine. You are:
- Handling multiple contracts
- Tracking licensure, credentialing, and expiring paperwork
- Negotiating rates and expenses (or at least reading the fine print closely)
If you hate paperwork so much you never open your own benefits emails, you’re going to bleed money and opportunities in locums. Agencies will happily treat you like the “just send me whatever” doc — and guess who gets the worst rates and least favorable terms.
Conflict-avoidant physicians also struggle. Because thriving in locums requires saying:
- “No, that rate is not competitive for this region and specialty.”
- “No, I’m not taking 24-hour home call for that.”
- “No, I won’t accept responsibility for X without Y support.”
You do not need to be a jerk. But you do need a spine.
| Factor | Thrives In Locums | Struggles In Locums |
|---|---|---|
| Personality | Independent, assertive | Conflict-avoidant, passive |
| Structure Needs | Tolerates variability | Needs high predictability |
| Career Stage | Early or mid-career, flexible | Late-career wanting to coast |
| Admin Tolerance | Low tolerance for politics | Likes titles and committees |
| Money Mindset | Tracks and negotiates rates | Avoids finances and contracts |
The Data Reality: Locums Is a Market, Not a Moral Category
One more myth to kill: that time spent in locums “taints” you for future jobs.
In the 1990s, maybe. When locums had a stronger association with disciplinary histories and problem physicians. But credentialing and reporting systems are much tighter now, and hospitals are terrified of bad hires regardless of employment type. Locums agencies actually screen quite heavily because sending a nightmare doc to a small hospital is bad for business.
Today, what hiring committees and chiefs mostly look at is:
- Are you clinically competent and current?
- Are your references solid?
- Did you hop every six months because of problems, or because that was the contract structure?
I’ve seen physicians go from 2–3 years of full-time locums into:
- Academic jobs
- Partnership-track private groups
- Direct hospital employment at major systems
Hiring committees actually value some of what you pick up in locums: adaptability, exposure to varied systems, survival in under-resourced environments. If your story is coherent — “I used locums to test environments and now know exactly what I’m looking for” — that reads a lot better than “I took the first job I was offered and stayed miserable for ten years.”
Where you will get side-eye is if your CV reads like chaos and you can’t explain it. That’s not a locums problem. That’s a narrative problem.
| Category | Value |
|---|---|
| Locums - satisfied/very satisfied | 72 |
| Permanent - satisfied/very satisfied | 58 |
The Real Upside: Optionality in a System That Gives You None
Hospitals and large groups are structurally set up to benefit from your inertia. Once you’re settled, kids in schools, partnered, embedded in a community, it becomes harder and harder to leave—even if compensation erodes and workload creeps up.
Locums is one of the few levers left that shifts power back toward you:
- It gives you portable income not tied to a single institution.
- It gives you real market data on what your skills are worth in different places.
- It lets you walk if a site becomes unsafe or unreasonable.
Does it fix all of medicine’s structural dysfunction? Obviously not. But for the right person, in the right phase of training or career, it prevents one big self-inflicted wound: waking up 12 years into attending life wondering how you got stuck in a job you never really chose, only slid into.
You do not have to love locums. You do not have to do it long term. But you should stop swallowing the story that it’s only for burned-out, bottom-of-the-barrel physicians.
The reality is sharper than that.
Some of the most deliberate, least burned-out physicians I know are the ones rolling a carry-on through an airport on a Sunday night, headed to a week of work they picked, for a rate they negotiated, at a hospital they can leave whenever it stops making sense.
They’re not running from medicine. They’re just refusing to play it on someone else’s terms.
Key Takeaways
- Locum tenens is not a repository for burned-out or failed physicians; data shows many use it to gain autonomy, better pay, and improved work-life balance.
- The people who thrive in locums are organized, assertive, and comfortable with variability—especially early- and mid‑career docs using it as a strategic tool, not a last resort.
- Locums experience does not “taint” your CV; if anything, it broadens your options—provided you can tell a coherent story about why you chose it and what you learned.
