Unlocking Locum Tenens: Explore Benefits & Challenges for Physicians

The Allure of Locum Tenens: Balancing Benefits with Hidden Challenges

Locum Tenens work has become an increasingly visible piece of the modern physician employment landscape. As healthcare systems struggle with staffing shortages, rising patient volumes, and burnout among permanent staff, temporary providers are more in demand than ever. For residents finishing training and early-career physicians exploring post-residency options, locum tenens can look like the perfect solution: higher pay, more control over your schedule, and the opportunity to experience a variety of practice environments.

Yet, as attractive as this path can be, it brings its own set of complexities. Understanding both the rewards and the hidden challenges is essential if you want to integrate locum tenens into a sustainable, satisfying healthcare career.

This guide expands on the core ideas of the original article, giving you a more detailed and practical framework to decide if locum work fits your personal goals and professional stage.

---

Understanding Locum Tenens in Modern Healthcare Careers

What Does “Locum Tenens” Really Mean Today?

“Locum tenens” is Latin for “to hold the place.” In the context of healthcare staffing, it refers to physicians and advanced practice providers (such as nurse practitioners and PAs) who temporarily fill in for other clinicians or support facilities with staffing gaps.

These assignments can range from a single weekend to several months or longer and occur in nearly every practice setting:

• Academic medical centers
• Community hospitals
• Rural critical access facilities
• Outpatient clinics and urgent care centers
• Telemedicine platforms
• Correctional medicine, occupational health, and more

Locum tenens has evolved from a stopgap measure into a strategic component of physician employment. Many health systems build locum coverage into their staffing models to address seasonal surges, maternity/parental leave, recruiting gaps, or rapid service expansion.

Who Typically Works Locum Tenens?

Locum tenens can fit a variety of career stages and personal situations:

• New graduates testing different practice types before committing to a long-term position
• Mid-career physicians seeking more medical flexibility after burnout in traditional employment
• Late-career physicians who want to scale back hours without fully retiring
• Physicians between jobs or relocating who need income and ongoing clinical exposure
• Subspecialists filling niche gaps or covering procedural services at multiple facilities

Knowing where you are in your career and what you need—stability vs. exploration, income maximization vs. lifestyle—will shape how (or whether) locum tenens makes sense for you.

---

Major Benefits: Why Locum Tenens Appeals to Many Physicians

1. Flexibility, Autonomy, and Control Over Your Schedule

One of the primary attractions of locum tenens is the degree of control it can give you over how, when, and where you work.

Key aspects of flexibility:

• Choose assignment length (weekends, several weeks, months)
• Select geographic regions that fit your personal life or travel interests
• Take extended breaks between assignments for research, travel, or family time
• Adjust work intensity (heavy call and high-volume shifts vs. lighter outpatient roles)

For many physicians, especially those coming out of demanding residencies or rigid hospitalist schedules, this level of autonomy is transformative. It allows you to design a work pattern that aligns more closely with your values—whether that’s being available for young children, doing global health work, or living in multiple places during the year.

Example:
A new emergency medicine graduate might work 10–12 shifts per month as a locum in a high-volume ED for a few months, then take a month off to travel or pursue a side interest such as medical education or content writing. That level of flexibility is difficult to achieve in most permanent roles.

2. Diverse Clinical Experiences and Rapid Skills Growth

Locum tenens is a powerful way to accelerate your clinical maturity, especially early in your career.

You may find yourself:

• Managing a broad spectrum of pathology in an under-resourced rural ED one month
• Working in a highly sub-specialized, protocol-driven academic center the next
• Providing telemedicine visits to patients across multiple states
• Covering inpatient services with very different support structures (e.g., varying APP support, consultant availability, or ancillary services)

This variety forces you to:

• Learn multiple EMR systems and documentation workflows
• Adapt to different team cultures and communication styles
• Become comfortable practicing in settings with variable resources
• Develop confidence in decision-making without always having your usual back-up resources

These experiences are incredibly valuable for long-term career development, even if you ultimately settle into one permanent role.

3. Potential for Higher Compensation and Financial Leverage

From a financial standpoint, locum tenens can be one of the most lucrative models of physician employment, particularly in high-demand specialties and underserved areas.

Why pay is often higher:

• Facilities may pay premium rates to fill urgent gaps
• Short-term commitments carry a “temporary premium” compared to long-term contracts
• Rural or hard-to-staff locations frequently offer higher rates, travel stipends, or housing
• You may be able to negotiate overtime, call pay, or procedure-based bonuses

This can be especially powerful if you have:

• Significant student loan debt—using 1–3 years of locum work to aggressively pay it down
• Savings or investment goals—such as a home down payment or early retirement planning
• Desire for part-time work while maintaining robust earnings

Of course, higher pay must be weighed against the lack of traditional benefits and potential income gaps between assignments, which we’ll explore later.

4. Networking, Reputation Building, and Career Optionality

Every locum assignment is both a job and a live audition.

Over time you can:

• Build a reputation for reliability, clinical skill, and collegiality
• Become a “go-to” provider that facilities request specifically
• Receive offers to convert to permanent employment at sites where you thrive
• Gain trusted references and mentorship relationships across multiple institutions

For residents and fellows uncertain about their preferred practice setting—academic vs. community, large group vs. small private practice—locum tenens can serve as an extended, paid “try-before-you-commit” phase.

5. Reduced Administrative Burdens and More Direct Patient Care

Many physicians are drawn to locum tenens because it can, in some settings, reduce exposure to the non-clinical burdens of modern medicine:

• Less involvement in long-term committee work, quality projects, and hospital politics
• Limited responsibility for billing optimization or practice management tasks
• Fewer meetings and less organizational bureaucracy

You are often brought in specifically to help with direct patient care, not to carry the administrative weight of long-term strategic initiatives. For clinicians burned out by endless meetings and inbox management, this focus can be refreshing.

That said, not all assignments are free of administrative work; expectations vary by facility, so it’s critical to clarify this upfront.

---

Hidden Challenges: What Many Physicians Don’t See at First

For all its appeal, locum tenens comes with real trade-offs. Being aware of these early puts you in a stronger position to decide whether and how to use locums in your broader healthcare career strategy.

1. Inconsistent Work and Income Volatility

Locum assignments are not guaranteed, and demand can fluctuate by:

• Season (e.g., higher winter volumes in some specialties)
• Regional economics and hospital budgets
• Shifts in staffing models, mergers, or new permanent hires
• Changes in licensure or payor rules

This unpredictability can lead to:

• Gaps between assignments with no income
• Short-notice cancellations by facilities
• Difficulty forecasting your annual income for budgeting or loans
• Stress around major life events (home purchase, family planning, relocation)

To manage this, many successful locum physicians:

• Maintain 3–6 months of living expenses in an emergency fund
• Keep multiple state licenses active to broaden their marketability
• Work with more than one locum agency or maintain direct relationships with hospitals
• View their annual timeline and income in quarterly blocks rather than month-to-month

2. Frequent Adjustment Curves and Onboarding Fatigue

Every new placement comes with a learning curve:

• Different EMR systems and order sets
• Unique policies for admissions, transfers, consults, and handoffs
• Local protocols (sepsis bundles, stroke activations, opioid prescribing rules, etc.)
• New nursing workflows, ancillary services, and hospital layouts

Even when orientation is offered, it’s usually compressed. You may be expected to be maximally productive within a shift or two.

Over time, this can lead to:

• Cognitive fatigue from constantly “re-learning” your work environment
• Inefficiencies as you adapt to yet another system
• Frustration when documentation or ordering takes longer than usual
• Anxiety about missing local nuances (e.g., which cardiologist prefers which consult pattern)

Planning for this reality—by arriving early, asking targeted questions, and keeping highly organized—is critical for both patient safety and your own stress level.

3. Limited Integration and Professional Isolation

Because locum providers are temporary by design, it can be harder to feel fully integrated into:

• Long-term patient relationships
• Multidisciplinary teams
• Quality improvement initiatives
• Hospital culture and social life

This may manifest as:

• Feeling like a “perpetual outsider” when colleagues reference long-standing processes
• Missing out on the informal mentorship and camaraderie of stable teams
• Less continuity of care and fewer opportunities to see long-term patient outcomes
• Emotional fatigue from repeated introductions and goodbyes

Some physicians thrive on this independence; others find that over time it leads to loneliness and a sense of professional rootlessness. Being honest about your social and professional needs is key.

4. Travel Demands and Personal-Life Disruption

Travel can be a perk—or a burden—depending on your circumstances and preferences.

Common challenges include:

• Extended time away from partners, children, or aging parents
• Repeatedly setting up “temporary lives” in new cities (housing, transportation, routines)
• Jet lag, commute fatigue, or long drives after night shifts
• Difficulty maintaining regular hobbies, community ties, or local support systems

Physicians with young families, dual-career household dynamics, or strong community roots often need to negotiate creative solutions—shorter local assignments, block scheduling, or regional locums within driving distance.

5. Navigating Licensure, Malpractice, and Legal Complexities

Each assignment exists within a unique legal and regulatory context:

• State medical licensure requirements and timelines
• Hospital credentialing and privileging processes
• Specific malpractice coverage terms (claims-made vs. occurrence, tail coverage, limits)
• Supervision requirements for APPs and trainees, if applicable
• Reporting obligations for adverse events or board issues

Although most locum agencies or hospital employers assist with these logistics, you remain ultimately responsible for understanding:

• Who provides your malpractice coverage
• What exactly is covered (including telemedicine, procedures, multiple sites)
• Whether you are named individually and what happens if you leave
• What your role is in documentation and incident reporting

Ignoring these details can create long-term professional risk far beyond the duration of a short assignment.

6. Benefits, Insurance Gaps, and Retirement Planning

Unlike traditional employee positions, many locum tenens arrangements classify physicians as independent contractors (1099) rather than employees (W-2). This typically means:

• No employer-sponsored health, dental, or vision insurance
• No paid time off (PTO), sick leave, or paid parental leave
• No employer contributions to retirement accounts (401(k), 403(b), pension)
• You are responsible for your own taxes (including quarterly estimated payments)

While the higher hourly rate compensates for some of this, it places the burden of planning on you. You’ll need to:

• Secure individual or marketplace health insurance
• Set up and regularly fund retirement accounts (e.g., SEP-IRA, Solo 401(k), or traditional IRAs)
• Maintain disability insurance and life insurance as needed
• Budget for unpaid time off, CME, and any professional memberships or board fees

Proper financial planning can turn this from a liability into an advantage—but it does require deliberate effort.

---

Practical Strategies for Success in a Locum Tenens Career

If you decide to pursue locum tenens—either as a primary career strategy or a temporary bridge—proactive planning will dramatically improve your experience and outcomes.

1. Research Every Assignment Thoroughly

Before accepting, ask targeted questions about:

• Workload and schedule

  • Typical patient volume and acuity
  • Average admissions, discharges, or procedures per shift
  • Call responsibilities and backup support

• Team and culture

  • APP support, nursing ratios, consult availability
  • Coverage by key specialties (ICU, cardiology, surgery, OB, etc.)
  • Expectations around cross-coverage and handoffs

• Systems and logistics

  • EMR system and orientation plans
  • Onboarding timeline and credentialing support
  • Housing, travel reimbursement, and per diems

• Legal and compensation details

  • Hourly rate, overtime, and call pay
  • Malpractice terms and tail coverage
  • Contract length, termination clauses, and cancellation policies

Clear answers to these questions help you avoid mismatches between expectations and reality.

2. Build a Strong Financial and Administrative Foundation

To manage medical flexibility without financial chaos:

• Create a robust emergency fund (at least 3–6 months of core expenses)
• Work with an accountant familiar with 1099 physician employment
• Set up a system for:
  • Quarterly estimated tax payments
  • Tracking business expenses (licensure, CME, travel not reimbursed)
  • Retirement contributions and investment planning

Over time, you can structure your financial life so that volatility in monthly income doesn’t create volatility in your lifestyle.

3. Cultivate Professional Relationships and Reputation

Even though assignments are temporary, how you show up matters.

• Be reliable, on time, and communicative
• Treat nursing and ancillary staff with respect—they often drive re-booking decisions
• Ask for feedback and adapt to local practice norms when safe and appropriate
• Keep in touch with colleagues and administrators at sites where you enjoyed working

This network can lead to repeat assignments, better negotiating power, and even offers of permanent positions if and when you’re ready.

4. Proactively Manage Insurance and Risk

Do not assume others are handling everything.

• Review your malpractice policy documents for each assignment
• Keep a personal record of facilities and dates where you practiced
• Maintain your own disability and life insurance policies independent of any single job
• Ensure your health insurance coverage works in the states where you plan to work

If you’re unsure, consider a brief consultation with a healthcare attorney or risk-management expert, particularly if you work across multiple states or in high-risk specialties.

5. Protect Your Well-Being and Personal Relationships

Locum tenens offers freedom but can also strain your personal life if unmanaged.

Consider:

• Setting maximum travel distances or time-away limits that align with your family’s needs
• Planning recurring “home weeks” or scheduled downtime
• Using technology (video calls, shared calendars) to stay connected with loved ones
• Establishing routines (exercise, sleep hygiene, hobbies) that can travel with you

Your career is a marathon, not a sprint—burnout can happen in locum work, too, if you constantly chase higher pay at the expense of rest and relationships.

---

FAQs: Common Questions About Locum Tenens Careers

1. Is Locum Tenens a Good Option Right After Residency or Fellowship?

It can be, but it depends on your goals and personality. For new graduates, locum tenens offers:

• Exposure to multiple practice settings before committing long-term
• Opportunities to rapidly grow clinical confidence and procedural skills
• High earning potential at an early stage

However, you should be comfortable with:

• Less structured mentorship than you may have had during training
• Quickly adapting to new systems and teams
• Managing your own finances, benefits, and career planning

If you crave stability, dedicated mentorship, or a clear academic path, a traditional first job might be better—and you can always transition to locums later.

2. How Much Do Locum Tenens Physicians Typically Earn?

Rates vary significantly by:

• Specialty (e.g., emergency medicine, anesthesia, radiology, psychiatry, hospitalist medicine)
• Location (urban vs. rural, coastal vs. Midwest, regional demand)
• Shift type (days, nights, weekends, holidays, call coverage)

Hourly rates commonly range from $80 to over $250 per hour depending on these factors, with some subspecialties and hard-to-staff locations paying more. Remember to adjust for:

• Lack of employer benefits
• Taxes on 1099 income
• Travel days that may not be fully compensated

Calculate your effective annual income and compare it to W-2 offers when evaluating your options.

3. Do Locum Tenens Providers Receive Benefits?

Most pure locum tenens arrangements—especially when you’re hired as an independent contractor—do not include:

• Health insurance
• Retirement contributions
• Paid time off or sick leave

Some agencies or hospitals may offer limited benefit options, but you should generally plan to:

• Secure your own health and disability insurance
• Establish and fund your own retirement accounts
• Budget for unpaid time off and CME

The higher pay rates are intended to compensate for these added responsibilities, but it’s up to you to manage them effectively.

4. How Do I Find Reliable Locum Tenens Opportunities?

You can find assignments through:

• Locum tenens agencies specializing in specific specialties or regions
• Direct hospital or group outreach, especially in areas with known shortages
• Physician job boards and professional society listings
• Networking—colleagues or mentors who already do locum work

When working with agencies:

• Ask about their experience with your specialty
• Clarify what they handle (licensure, travel, housing, credentialing)
• Compare offers from multiple agencies to understand market rates
• Read contracts carefully before signing

Over time, you may choose to build a mix of agency-arranged and direct contracts with facilities you know well.

5. What Licenses and Certifications Do I Need to Work Locum Tenens?

At minimum, you need:

• An active, unrestricted medical license in the state where you will practice
• Current board certification or eligibility in your specialty (often required, sometimes preferred)
• Standard clinical credentials (DEA registration, BLS/ACLS/ATLS/PALS as applicable to your field)

Key points:

• Many locum agencies help with obtaining additional state licenses, as multi-state licensing expands your opportunities.
• Some states participate in the Interstate Medical Licensure Compact, which can streamline multi-state licensing for eligible physicians.
• Each hospital or facility will have its own credentialing and privileging process, typically taking weeks to months.

Always confirm licensure timelines early to avoid delays in starting an assignment.

---

Locum tenens can be an excellent tool in your overall healthcare career strategy—whether as a short-term bridge, a medium-term debt-repayment phase, or a long-term lifestyle choice. By understanding both the powerful benefits and the hidden challenges, you can make informed, intentional decisions that support both your professional growth and your personal well-being.