Locums as an Audition: How Chairs Use You to Test New Service Lines

Last year I watched a locums hospitalist get quietly “auditioned” for a brand‑new observation unit. He thought it was just another well‑paying contract. The chair was using him as a live test balloon: Can this model work? Will the volume hold? Will the politics explode? Six weeks later, they had their answer—and he was gone before he realized he’d been the experiment.

Let me walk you through how that game actually gets played, because you’re going to see more of it, not less.

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Why Chairs Love Locums When They’re Experimenting

When a chair wants to launch a new service line—obs unit, inpatient psych, nocturnist model, neurohospitalist coverage, IR call, surgicalist service—they have three problems:

1. They don’t fully know the economics yet.
2. They don’t know if clinicians will tolerate the workload or schedule.
3. They don’t know how much political blowback they’ll get from other departments.

Locums solve all three problems without tying the chair’s hands.

From the chair’s side of the table, locums are:

• Disposable test pilots
• Politically safer than upsetting entrenched faculty
• Budget line items, not long‑term promises

I’ve sat in those meetings. The language is pretty blunt when you’re not in the room.

“Let’s trial this with locums for a quarter.”
“If it implodes, we just end the contract.”
“If it works, we hire permanently—maybe even one of the locums.”

Notice that last part. Maybe.

What they don’t say out loud to you—or in the contract—is that the “maybe” is deliberate. They want optionality. They want to see you perform in the wild, with their nurses, their consultants, their EMR, their admin chaos, before they decide if you’re worth making a real offer.

You’re cheaper than a failed FTE hire. And infinitely easier to get rid of.

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The Hidden Script: How New Service Lines Actually Get Rolled Out

Here’s the pattern I see again and again when locums are used as an audition for new services.

How hospitals test new service lines with locums

Step	Description
Step 1	Idea for new service line
Step 2	Budget and political approvals
Step 3	Contract with locums agency
Step 4	Short term locums coverage
Step 5	Collect metrics and feedback
Step 6	Cancel or redesign
Step 7	Decide staffing model
Step 8	Offer permanent role
Step 9	Post full time job
Step 10	Did model work
Step 11	Hire locums?

Let me break that into what it feels like for you.

You see:

• A “new” or “expanding” program.
• Slightly vague job descriptions: “helping build a growing service,” “assisting with program development,” “flexible evolving responsibilities.”
• A contract that’s 3–6 months, possibly “with option to extend.”

They see:

• A risk‑free pilot.
• A way to test volumes, staffing ratios, and call burden without locking into FTEs.
• A chance to see if the politics are survivable (cardiology, radiology, surgery, anesthesia—somebody will be mad).

You arrive thinking, “Cool, opportunity to build something.”
They’re thinking, “Let’s see if the model or the doc breaks first.”

And here’s the part no one tells residents: a lot of chairs prefer using locums for this phase, even if they could technically hire.

Why?

Because their internal people are dangerous. Not clinically—politically. If they put an existing partner on this new service and it sucks (too much call, bad pay, toxic scope creep), that person becomes a long‑term enemy. They vote. They sit in faculty meetings. They talk.

You, as locums, do not.

You’re the safest person in the building to experiment on.

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How To Recognize When You’re the “Audition” for a New Line

There are tells. Once you know what to listen for, the whole façade cracks.

1. Vague ownership + very specific metrics

“Help us grow our new nocturnist service” but they’re obsessively tracking:

• Door‑to‑doc time
• Number of patients cross‑covered
• Time to admission order
• Consult response times

Behind closed doors, they’ve already promised the CMO and CFO: “If we create this line, your LWBS rate drops X%. Your transfer leakage drops Y%. Your weekend OR utilization goes up Z%.”

You’re the instrument they measure that with.

Chairs trade in these numbers. They’ll feed you the vision, but they’re watching the metrics like a hawk. If you don’t understand what they actually care about, you can be clinically excellent and still fail the audition.

2. Everyone says “We’re still figuring that out”

Ask about:

• Long‑term staffing plans
• Promotion pathways
• Governance (who decides schedule, policies, workflows)
• Integration with other departments

If the answer is some version of, “We’re still working that out, this is an evolving role,” that’s code for: You are the experiment.

If they were serious about a stable long‑term service, they’d already be talking about hiring committees, reporting lines, how this fits into the department’s 5‑year plan.

Instead, you get half‑answers and enthusiasm. Enthusiasm is cheap.

3. HR postings that don’t match what they tell you

If you suspect you’re the audition, search the hospital’s job postings mid‑assignment.

Brutal example I watched play out:

• Locums neurohospitalist, 7‑on/7‑off, started at a major academic center.
• Chair told him, “If this works, we’d love to talk about a permanent role.”
• Week 4, the hospital posts: “Full‑time Neurohospitalist, flexible schedule, academic appointment, opportunity to build a new service.”

Description matched his exact duties. They never mentioned it to him.

Why?
Because he was the evidence they were collecting to justify the real search. They wanted him to keep working hard, unworried, while they looked for someone with research, grants, and a famous fellowship. He was never going to be their A‑list pick. He was the pilot data.

If you see that mismatch and no one has talked to you? You’re not being groomed. You’re being used.

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What Chairs Are Actually Evaluating When They “Test” You

You think they’re evaluating:

• Intelligence
• Clinical skill
• Knowledge of guidelines

Sure. That’s assumed at a basic level. But when a chair uses you as an audition for a new line, the real checklist looks different.

Category	What they watch in practice
Clinical output	RVUs, throughput, handoff quality
Political damage	Complaints from other services, turf fights
Nurse compatibility	How nurses talk about you off the record
System fit	EMR use, adherence to local pathways
Reliability	Showing up, not calling off, schedule flex

They’ll never hand you that table. But I’ve literally seen versions of it in departmental debriefs.

Let’s go deeper.

Throughput and “friction”

New service lines usually exist to fix some bottleneck:

• Obs unit to free ED beds
• Surgicalist to smooth elective block utilization
• Nocturnist to keep daytime folks from burning out and leaving
• IR call line to stop surgeons from screaming about delays

If the bottleneck doesn’t improve on paper while you’re there, the chair will quietly label the model—or you—as a failure.

That means they’re watching:

• How fast you disposition patients
• How often you cancel or reschedule cases
• How often you “bounce back” problems to other services

You can be clinically right and still get tagged as “not helping” if you don’t understand the operational goal.

Political cost

The chair is counting complaints. A new service line always pisses somebody off.

I’ve heard variations of:

“Cardiology hated the first nocturnist. Felt he was admitting too many.”
“Ortho says the new surgicalist is interfering with their cases.”
“ED says obs is just dumping complex patients upstairs.”

If your name keeps showing up in these conversations, that’s poison for your audition.

You won’t see any of this documented. It’s hallway conversations, sidebars after MEC meetings, text messages between chairs. But it heavily influences whether they keep you, kill the model, or bring in someone else to try again.

Nursing verdict

Here’s a secret you probably do not want to hear:

The nurses’ informal grade on you matters more than your fellowship certificate.

Chairs and service chiefs constantly ask nursing leadership, “So how is Dr. X working out? Are they safe? Are they responsive? Are they a jerk?”

Nursing will never say this to your face, but they absolutely give blunt feedback behind closed doors. The locums who get invited back—and eventually offered permanent jobs—are nearly always the ones the nurses like, or at least trust.

If the charge nurses think you’re lazy, rude, or unsafe, that gets up the chain fast. For a new service where everyone’s nervous, that kills your chances.

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How To Turn a Locums “Test” Into a Real Offer

Now, the part you actually care about: How do you play this game on purpose?

Because done right, being the audition doc can be your fastest path into a desirable job—without 50 applications and a committee dog‑and‑pony show.

Step 1: Force clarity before you sign

When the recruiter says “new service line,” you should hear “I’m the experiment.” That’s fine. But you do not walk in blind.

Before you accept, ask these, word for word if you like:

• “What exactly is the problem this service line is supposed to fix?”
• “What metrics is leadership watching to decide if this model is successful?”
• “If this goes well, what does the 6–12 month staffing plan look like?”
• “Has the hospital already gotten approval for permanent FTEs for this service?”

If they dodge, that’s diagnostic. It tells you you’re a disposable test, not a serious candidate.

If they’re surprisingly transparent, you’ve got leverage. Now you know what you’re being graded on. You can align your behavior with it.

Step 2: Decide your posture on day 1

Most locums walk in like short‑term help: do the work, stay out of trouble, collect the check.

When you’re interested in a permanent role, you have to subtly behave like future core faculty, without being obnoxious.

Concrete ways to do that:

• Learn their local pathways and order sets fast. Don’t reinvent everything “the way you did it at your last place.”
• Pick one or two small, low‑politics problems and quietly improve them. Example: tighten up a handoff template, streamline an obs unit checklist. Don’t start with, “We need to redesign the entire call structure.”
• Show up to optional but visible things once in a while—M&M, service line meetings, quick huddle with the chair.

You’re signaling: “I can slide into this system and make it better with minimal friction.”

Step 3: Manage the rumor mill intentionally

You will get tested in two arenas you probably don’t think about much:

• ED and consult services
• Nursing and mid‑level leadership

You need both on your side if you want the chair to hear good things.

A few insider moves:

• In week 1, identify the most influential charge nurse on your main unit. Make their job easier. Ask them, “What do locums usually screw up here that drives you crazy?” Then aggressively not do those things.
• Be absurdly, visibly responsive to the ED at first. In many hospitals, the ED doc’s subjective opinion of “how fast the new service is” becomes gospel to admin. You can dial this back later. Early on, you want them saying, “These guys actually pick up the phone.”
• Find the PA/NP who has been there the longest. Ask them, privately, “What made the last person in this role fail?” Take notes.

This is how you gather the real expectations—what you’ll never see in a job description.

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When They’re Obviously Using You—and You Should Still Take the Gig

Not every “we’re testing a new service line with locums” situation is a trap. Sometimes it’s transactional and completely worth it, as long as you see it clearly.

The three situations where I tell people: yes, go in eyes open, take the money, skip the future fantasy.

1. High pay, short term, clear sunset.
   They admit: “We’re not sure this is sustainable, but we budgeted three months to test it.” Translation: great locums assignment, no career path. Perfect if you want cash and experience, not roots.

2. You want to build a specific CV line.
   Example: You’re an EM doc who wants “experience launching an obs unit” on your CV to pitch yourself elsewhere. You don’t need this place to hire you. You just want the line and the stories.

3. You’re between serious options.
   You already have real prospects cooking elsewhere (interviews, offers pending). You can treat this exactly as the chair treats you: short‑term optionality.

The danger is when you confuse those with, “This is my secret backdoor into a staff job,” but they’ve never actually signaled that.

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Red Flags That Your “Audition” Was Never Real

There are chairs who honestly intend to use locums as a pipeline to permanent hires. I’ve watched more than a few cherry‑pick their best locums and create roles for them.

But there are also situations where you were never going to get the role, no matter how you performed. You were a placeholder, not a candidate.

Here are the tells.

The replacement is pre‑ordained

You’ll see signs like:

• Job posting goes up before your first month is done, with qualifications you clearly do not meet (e.g., “must have NIH funding,” “5+ years leadership experience” when you’re 1 year out of residency).
• They quietly interview “internal candidates” while you’re still figuring out where the bathrooms are.
• Offers are being discussed in committees without anyone asking, “What about Dr. Locums who’s been doing the job?”

That last part is key. If your name never comes up in the “future staffing” conversation, you were never in the running.

No one discusses the future with you, even when things go well

The chair sees your metrics. They know your reputation with nurses. If they’re happy and genuinely thinking about you long‑term, they drop hints. They’re only human.

You’ll hear things like:

• “If we get the FTEs approved, would you be open to talking about a permanent spot?”
• “We’re thinking about you for X role if you’d consider staying.”
• “Let’s revisit your future here in a month or two.”

If instead all you hear is, “Thanks for helping out” and “We’ll see how things evolve,” with no deeper conversation even after you’ve proven yourself—accept the verdict.

Their silence is an answer.

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One More Level Deeper: Why This Is Getting More Common

This isn’t just a few sneaky chairs. The system is pushing them this way.

Look at the pressure points:

• Margins are thin. CFOs hate being stuck with overstaffed services if volume predictions are wrong. Locums pilot programs are financially safer than permanent hires.
• Turnover is terrifying. Chairs are getting burned hiring someone, promising them the moon, then losing them in 18 months because the role was mis‑scoped. Using locums to test the scoping feels safer.
• Regulatory and payer changes. Value‑based contracts, readmission penalties, ED boarding metrics—these all drive new service lines. But the rules keep changing. Chairs want flexible models they can pivot or kill fast.

Look at this trend visually:

Use of locums for new service pilots

Category	Value
2015	15
2018	30
2021	55
2024	70

That’s not from some glossy brochure. That’s roughly what I’ve watched in multiple systems: what was once “rare and desperate” is now standard strategy.

They test with locums. They collect data. They oxygenate the politically risky idea with your labor. Then—if it works—they decide whether to plug you into the final model or bring in someone designed for the brochure.

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How To Protect Yourself—and Still Use This To Your Advantage

Let me pull this together into a strategy you can actually use.

1. Get the real story from someone not in leadership

Before you commit to being the guinea pig for a new line, find:

• A mid‑career attending not on the leadership track
• A senior NP/PA in that service
• A long‑tenured nurse manager

Ask, very directly:

• “What’s the backstory behind this new service?”
• “Has the hospital tried something like this before and killed it?”
• “What are people nervous or angry about with this change?”

The truths you get from those three beats anything the chair tells you in a formal meeting.

2. Decide up front: audition or mercenary?

Don’t mix the two.

If you are auditioning:

• Invest in relationships.
• Go to key meetings.
• Ask for feedback explicitly: “What would you need to see from me to consider me for a permanent role here?”

If you are mercenary:

• Define your boundaries hard.
• Don’t emotionally invest in “fixing” their system.
• Maximize pay, minimize drama, get in and out.

The mistake is behaving like a mercenary while quietly hoping for an audition result. That disconnect hurts you the most.

3. If you want the job, force the conversation by week 4–6

Don’t wait until they “come to you.” Their priorities change hourly. Finance, admin, politics—they get busy. You’re one variable among many.

By week 4–6 in a 3‑month pilot, ask the chair for 15 minutes.

Say something like:

“I’m really enjoying this work and the team. If this service line gets permanent FTEs approved, I’d be very interested in being considered for one of those roles. From your side, what would need to line up for that to be realistic?”

Their answer will tell you everything.

If they say:

• “We’d love that, let’s…” → you’re in the zone.
• “Honestly, we’re looking for someone with X (that you do not have)” → they’ve already moved on.
• “It’s too early to say, but let’s revisit in a month” → still open, but you need to follow up.

Do not leave everything unsaid and then act surprised when your contract ends and no magical offer appears.

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Final Takeaways

First: when you’re brought in as locums to help start or expand a service line, you are almost always being used as a live experiment. That’s not inherently bad—but don’t confuse optionality for commitment.

Second: chairs are judging you on throughput, political footprint, and nursing/consultant feedback far more than on your board scores or fellowship certificate. Understand the real metrics and you can shape your audition, instead of accidentally failing a test you didn’t know you were taking.

Third: if you want to convert a locums “test” into a permanent role, you cannot be passive. Get clarity up front, behave like a future insider (not a transient temp), and force an honest conversation by the midpoint. If their words and actions don’t line up, take the check, learn what you can, and walk—because in their eyes, this was never your job. It was just your shift.