Exploring Locum Tenens: The Flexibility Every Physician Needs

Should You Become a Locum Tenens Physician? Pros, Cons, and Career Strategy

The modern medical career no longer follows a single “training–job–retire” template. Physicians are increasingly designing careers that prioritize flexibility, autonomy, and burnout prevention. One of the most powerful tools in this toolkit is Locum Tenens work.

If you’re finishing residency, in early practice, or considering a career transition, understanding the realities of locum tenens can help you make better long-term decisions. This guide breaks down what locum work really looks like, with practical pros, cons, and strategic advice tailored to physicians and senior trainees.

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What Is a Locum Tenens Physician?

“Locum tenens” is Latin for “to hold the place of.” In medicine, it refers to physicians who temporarily cover for other clinicians or fill gaps in staffing.

How Locum Tenens Works in Practice

As a locum tenens physician, you typically:

• Work short- or medium-term assignments (from a few shifts to several months)
• Fill in for:
  • Physicians on vacation, parental leave, or sabbatical
  • Vacant positions during recruitment
  • Seasonal surges (e.g., flu season, tourist areas)
• Practice in a range of settings:
  • Community hospitals
  • Academic centers
  • Rural critical access hospitals
  • Outpatient clinics
  • Urgent cares or telemedicine

Most physicians work locums through staffing agencies, although some negotiate directly with hospitals or groups. Assignments can be local (within commuting distance) or involve travel to other cities or states.

Types of Locum Tenens Arrangements

Locum tenens can play several roles in your medical career:

• Gap year after residency or fellowship
  Try out different practice environments before committing to a permanent job.

• Bridge between jobs
  Maintain income and clinical skills while you search for the right long-term position.

• Side gig / supplemental income
  Maintain a primary employed role but pick up occasional locum shifts.

• Full-time career model
  Build your entire practice around locum work, often with travel and extended blocks of time off.

• Pre-retirement transition
  Scale back, work seasonally, or practice in settings that match your evolving life priorities.

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The Pros of Becoming a Locum Tenens Physician

Locum tenens has grown rapidly because it solves problems for both physicians and healthcare systems. Here are the major advantages, with concrete examples and considerations.

1. Physician Flexibility and Control Over Your Schedule

Locum tenens is often synonymous with physician flexibility. Unlike many employed positions, locum work gives you substantial control over:

• When you work – pick months that fit your life (moves, family events, exams)
• How much you work – from a few shifts a month to continuous full-time
• Where you work – urban vs rural, academic vs community, local vs travel

Examples of how physicians use this flexibility:

• A new attending works three months on, one month off to travel internationally.
• A parent structures assignments to be home for school breaks and key family events.
• A dual-physician couple aligns locum assignments in the same region to avoid long-distance.

This degree of self-determination can dramatically improve work-life balance, particularly compared with rigid full-time positions with limited vacation and call flexibility.

Actionable Tip:
Before starting, decide your non-negotiables: maximum number of nights/weekends, minimum time off between assignments, and preferred regions. Communicate these clearly to your recruiter or potential sites.

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2. Exploring Different Practice Environments and Career Options

Locum work lets you “test drive” multiple practice models before making long-term commitments—especially valuable in the post-residency and job market phase.

You can experience:

• Practice types:
  • Academic vs community
  • Private practice vs hospital-employed
  • Large multispecialty groups vs small practices
• Patient populations:
  • Rural, underserved communities
  • Urban safety-net hospitals
  • Subspecialty-heavy referral centers
• Operational cultures:
  • Highly protocolized systems
  • Start-up clinics or newer programs
  • Mature, stable departments

This variety can clarify what you actually want in a permanent position:

• How comfortable are you with high-volume vs boutique care?
• Do you thrive in large interdisciplinary teams or smaller, nimble groups?
• How much do you value academic opportunities vs pure clinical practice?

Locums can prevent costly mistakes, such as signing a multi-year contract in an environment that doesn’t fit your values or work style.

Career Strategy:
Use early locum assignments as intentional career exploration. Keep notes on what you like/dislike about each site—EHR, staffing, support, leadership, salary models, and community life.

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3. Financial Benefits and Earning Potential

From a strictly financial standpoint, locum tenens can be very competitive—and in some situations, more lucrative than comparable employed roles.

Higher Hourly/Per Diem Rates

Locum tenens assignments often offer:

• Premium pay to cover hard-to-fill shifts (nights, weekends, holidays)
• Higher rates in:
  • Rural or remote areas
  • High-demand specialties (e.g., EM, anesthesia, hospitalist, psychiatry)
  • Short-notice or urgent coverage needs

Even when annualized, your effective hourly rate can exceed that of some full-time positions, particularly if you negotiate well and choose assignments strategically.

Covered Expenses and Reduced Overhead

Many locum assignments include:

• Travel reimbursement (flights, mileage, rental car)
• Housing (hotel, apartment, or stipend)
• Malpractice coverage (often with tail included)
• Sometimes meal stipends or per diem

You avoid:

• Practice overhead
• Costs of hiring staff
• Long-term lease commitments

These benefits can offset not having employer-sponsored benefits—if you plan proactively.

Building Financial Flexibility

Some physicians use intensive locum periods to:

• Rapidly pay down student loans
• Build an emergency fund or down payment
• Save aggressively for financial independence or early career pivots

Actionable Tip:
Work with a financial advisor or accountant familiar with locum tenens. You may be classified as an independent contractor (1099) or W-2; each has implications for taxes, retirement contributions, and deductible expenses.

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4. Burnout Prevention and Rediscovering Meaning in Medicine

Physician burnout is widespread, driven by excess workload, administrative burden, loss of autonomy, and moral distress. Locum tenens can be a powerful tool for burnout prevention and recovery.

Key protective features:

• Control over workload – turn down assignments or high-intensity sites if you need a lighter period
• Built-in breaks – schedule true time off between contracts without guilt
• Reduced committee/administrative load – most locum roles focus on clinical duties
• Fresh starts – if a site becomes toxic or unsustainable, you can choose not to return

For some physicians, stepping into locum work:

• Restores a sense of autonomy and agency
• Allows reconnection with core clinical skills without as much political or bureaucratic overhead
• Provides meaning through service in underserved or high-need settings

Caution:
Locums is not a cure-all. If you simply replicate the same overwork patterns (e.g., nonstop night shifts, no breaks), burnout can persist. The key is intentionally using locum structure to protect your wellbeing.

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5. Continuous Learning, Skill Development, and Adaptability

Every new site brings new systems, colleagues, and patient populations. Over time, this:

• Sharpens your clinical adaptability
• Enhances diagnostic reasoning by exposing you to varied presentations
• Broadens your experience with:
  • Different EHRs
  • Workflow models
  • Procedural expectations
  • Resource-limited environments

You may learn:

• Alternative approaches to common problems
• New protocols or pathways you can use elsewhere
• Strategies for efficiency that improve your practice in any setting

You’ll also gain familiarity with credentialing processes, licensing boards, and payer expectations, which can be invaluable if you later pursue leadership, telemedicine, or multi-state practice.

Professional Growth Tip:
Keep a running list of skills and responsibilities from each assignment (e.g., volume handled, types of procedures, leadership roles). This becomes powerful material for your CV, future interviews, and negotiation.

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The Cons and Challenges of Locum Tenens Work

Locum tenens is not ideal for everyone. The same features that create flexibility can introduce uncertainty and complexity. Understanding these challenges upfront helps you decide whether and how locum work fits your medical career plan.

1. Lack of Consistency and Predictable Routine

The flip side of flexibility is variability:

• Work may be busy for months, then slow if:
  • A site hires permanent staff
  • Budgets tighten
  • Seasonal demand shifts
• Assignments may end earlier than expected or be delayed by credentialing.
• Your schedule might be non-traditional, involving:
  • Block shifts
  • Frequent travel
  • A mix of nights, weekends, and holidays

For physicians who thrive on routine, consistent colleagues, and a stable workweek, this instability can be stressful—especially if you have family responsibilities or financial obligations.

Mitigation Strategies:

• Maintain 3–6 months of living expenses in savings.
• Work with more than one agency or maintain relationships with multiple sites to diversify your opportunities.
• Consider overlapping contracts or securing your next assignment before finishing the current one.

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2. Limited Traditional Employee Benefits

Most locum tenens roles are structured as:

• 1099 independent contractor (common with agencies and direct contracts), or
• W-2 employee of the staffing company (less common, but some agencies offer this)

As a contractor, you generally do not receive:

• Employer-sponsored health insurance
• Employer-paid retirement contributions
• Paid time off (PTO)
• Disability or life insurance

You are responsible for:

• Purchasing your own health insurance
• Funding your own retirement accounts (e.g., solo 401(k), SEP IRA)
• Paying self-employment taxes (if 1099) on top of income tax
• Covering unpaid time off, including vacation, illness, and gaps between jobs

This is manageable but requires deliberate planning.

Actionable Tip:
Before going full-time locums, price out:

• Health insurance (ACA exchange, spouse’s plan, or private options)
• Disability and life insurance policies
• Retirement contributions you aim to make annually

Build these into your target hourly or daily rate and negotiation strategy.

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3. Frequent Adjustment to New Environments and Cultures

Every assignment means:

• Learning a new EHR
• Understanding local protocols, formularies, and clinical pathways
• Navigating a new team dynamic and hierarchy
• Figuring out simple logistics (where to park, who to call, how to order consults)

This constant onboarding can:

• Slow you down initially
• Increase cognitive load and fatigue
• Lead to feelings of isolation if you’re always “the outsider”

You may also encounter wide variability in:

• Staffing levels and support (e.g., availability of APPs, specialists)
• Resource availability (imaging, lab turnaround, subspecialty backup)
• Work cultures (highly collaborative vs siloed, supportive vs strained)

Adaptation Strategies:

• Arrive early on your first day to orient yourself.
• Ask for any orientation documents or quick-reference guides in advance.
• Develop a personal “arrival checklist” (codes, key phone numbers, order sets).
• Introduce yourself proactively—names and relationships matter in new teams.

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4. Credentialing, Licensing, and Administrative Burden

Working across multiple sites and states brings substantial paperwork:

• Separate credentialing packets for each facility
• Multiple state medical licenses
• DEA registrations and state-specific requirements (e.g., controlled substance monitoring)
• Hospital privileging, payer enrollment (for longer assignments), and background checks

Credentialing can take 60–120+ days or more, delaying your start date and income.

Mitigation Strategies:

• Start the licensing and credentialing process early—before you need the income.
• Keep a digital folder with:
  • Updated CV
  • Licenses and certificates
  • Immunization records
  • Board certification
  • Malpractice history
  • References
• Consider multi-state licensure pathways (e.g., Interstate Medical Licensure Compact) if eligible.

A good locum agency can help with paperwork, but you’ll still need to be organized and responsive.

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5. Uncertain Job Security and Income Variability

Unlike a permanent contract with guaranteed FTE and benefits, locum tenens work depends heavily on market needs:

• A hospital might cancel or cut shifts with little warning.
• Economic or policy shifts can reduce elective volume or funding for temporary staffing.
• Regional saturation in your specialty may tighten opportunities.

This unpredictability can make:

• Long-term financial planning more challenging
• Major life decisions (home purchase, relocation, family planning) more complex if you rely solely on locums

Stability Strategies:

• Maintain multiple potential income streams:
  • A part-time permanent position
  • Telemedicine
  • PRN local shifts
• Build a robust professional network so you hear about opportunities early.
• Consider longer-term locum contracts (3–12 months) with renewal options to anchor your schedule and income.

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Is Locum Tenens Right for You? Key Considerations and Decision Framework

Locum tenens can be a powerful way to build a flexible, resilient medical career, but it’s not a one-size-fits-all solution. Before jumping in, reflect on these dimensions.

1. Lifestyle and Personal Priorities

Ask yourself:

• How much do I value schedule autonomy vs routine?
• Am I comfortable with travel and living in different locations for weeks/months?
• How important is being embedded in one community and team?
• What are my family responsibilities and preferences?

For some, traveling to new states, living in short-term housing, and exploring different communities is energizing. For others, repeated transitions feel draining and disruptive.

2. Financial Needs and Risk Tolerance

Consider:

• Your monthly baseline expenses and debt obligations
• Savings and ability to handle income gaps
• Comfort with variable month-to-month income
• Willingness to self-manage insurance and retirement planning

If you have a high need for predictable income and comprehensive employer-sponsored benefits, a hybrid approach (part-time employed + locum) may provide a better balance.

3. Career Trajectory and Long-Term Goals

Think about how locums fits into your 5–10 year plan:

• Are you exploring before settling into a permanent job?
• Do you want long-term geographic flexibility?
• Are you aiming for academic promotion, leadership, or niche subspecialty work that may be easier in a permanent role?
• Do you envision moving towards non-clinical roles (administration, consulting, industry) where locums provides interim flexibility?

Locum tenens doesn’t close doors—but you should be strategic. For example, if you’re interested in academic promotion, make sure you still maintain scholarly projects or teaching engagements where possible.

4. Personality Fit and Professional Style

Locums tends to fit physicians who are:

• Adaptable and comfortable with change
• Self-directed and organized
• Confident managing a variety of clinical scenarios safely
• Skilled at building quick rapport with teams and patients
• Able to set boundaries and advocate for reasonable workloads

If you prefer deep, long-term relationships with patients and colleagues and dislike frequent transitions, a more traditional path might be more fulfilling—or you may limit locums to local, recurring assignments.

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Practical Steps to Get Started with Locum Tenens

If you’re leaning toward trying locums—either as a primary path or as a complement to another role—start deliberately.

Step 1: Clarify Your Goals

Define what you want from locums:

• Extra income?
• Geographic exploration?
• Burnout recovery?
• Skill building in a particular practice setting?

Your goals should guide which assignments you accept.

Step 2: Research Agencies and Direct Contracting

• Talk to colleagues who’ve done locums—ask which agencies and sites they recommend or avoid.
• Consider working with 2–3 agencies to compare offers and avoid over-reliance on a single source.
• Understand fee structures, malpractice coverage, and cancellation terms.

Step 3: Optimize Your Credentials

• Ensure your CV is updated and polished.
• Tidy up licensing issues (no lapses, renew on time).
• Gather key documents in a secure digital folder.
• Identify 2–3 professional references willing to respond promptly.

Step 4: Learn to Evaluate and Negotiate Offers

When reviewing an assignment, look beyond the headline pay rate:

• Patient volume and acuity
• Call responsibilities
• Support staff and available consultants
• EHR system
• Travel and housing arrangements
• Malpractice coverage details (including tail)
• Cancellation and extension policies

Be prepared to negotiate—on rate, schedule, housing quality, or expectations around workload.

Step 5: Start With a “Test” Assignment

Consider beginning with:

• A shorter contract (e.g., 1–3 months)
• A location and practice type you’re likely to enjoy
• A reasonable workload, rather than the most intense or remote option

Use this as a trial to evaluate whether locums aligns with your expectations.

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FAQ: Common Questions About Locum Tenens for Physicians

1. What qualifications do I need to become a locum tenens physician?

You generally need:

• An MD or DO degree
• Completion of an ACGME- or AOA-accredited residency (and fellowship if applicable)
• An active, unrestricted medical license in the state(s) where you’ll work
• Current DEA registration (and state-specific controlled substance registrations when required)
• Often, board certification or board eligibility in your specialty
• A clean or explainable professional record (no major unresolved disciplinary issues)

Some rural or high-need areas may accept board-eligible physicians early after training, but many hospitals now prefer or require board certification.

2. How do locum tenens contracts typically work?

Locum contracts spell out:

• Dates and duration of the assignment
• Clinical duties (inpatient vs outpatient, procedures, call)
• Expected patient volume
• Compensation structure (hourly, daily, shift-based, overtime)
• Coverage for:
  • Travel and housing
  • Malpractice (including tail)
• Cancellation and termination policies (for both you and the facility)
• Expectations around documentation, meetings, and any non-clinical duties

It’s wise to have a basic understanding of contract terms or consult a healthcare attorney for major or long-term agreements.

3. Can I build a stable, long-term career entirely from locum tenens work?

Yes—many physicians build full-time careers from locums. Key ingredients for stability include:

• Maintaining strong relationships with multiple agencies and facilities
• Being reliable and clinically solid, so sites request you back
• Planning ahead to secure the next assignment before the current one ends
• Managing finances with the assumption of occasional income gaps

Some physicians blend longer-term locum contracts (6–12 months) with shorter stints elsewhere, creating a hybrid of stability and flexibility.

4. What specialties have the most locum tenens opportunities?

Demand changes over time, but historically strong locum markets include:

• Emergency Medicine
• Hospitalist/Internal Medicine
• Anesthesiology
• Psychiatry
• Family Medicine and Primary Care
• Radiology
• Critical Care and some surgical subspecialties

Rural and underserved areas often have broad needs across many specialties, offering multiple healthcare opportunities for those willing to travel.

5. Is locum tenens a good option right after residency or fellowship?

It can be—if used intentionally. Benefits for new graduates include:

• Exploring various practice settings before committing
• Earning strong income to address loans
• Gaining experience in different systems and workflows

However, new attendings should:

• Ensure they have good mentorship at initial sites or choose settings aligned with their training level
• Avoid overly isolated roles if they’re the only clinician or specialist on site without adequate backup
• Be cautious about taking on high-risk settings until they feel confident practicing independently

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Locum tenens can be a powerful way to design a flexible, sustainable, and fulfilling medical career—whether as a full-time model, a bridge between jobs, or a strategic tool for burnout prevention and financial security. The key is to approach it with clear goals, realistic expectations, and thoughtful planning.