Exploring Locum Tenens: Advantages and Challenges for Medical Professionals

Understanding Locum Tenens as a Modern Healthcare Career Path

Locum tenens — Latin for “to hold the place” — has evolved from a niche staffing solution into a mainstream component of modern healthcare careers. Hospitals, clinics, and health systems increasingly rely on locum tenens clinicians to fill coverage gaps, manage seasonal surges, and maintain service lines when permanent providers are unavailable.

For physicians, advanced practice providers (NPs, PAs), and even some allied health professionals, locum tenens offers a distinctly different way to practice: project-based clinical work, usually at premium pay, with a high degree of flexible work and control over your schedule.

This model can be particularly appealing:

• Right after residency or fellowship, while exploring locations and practice types
• Mid-career, when seeking better work-life balance or recovering from burnout
• Later in your career, as you wind down toward retirement but still want to stay clinically active

Yet the same factors that make locum tenens attractive—freedom, mobility, and autonomy—can also create uncertainty and stress. Deciding whether this path fits your goals requires an honest look at both the benefits and the drawbacks, as well as the practical realities of contract work in medical staffing.

The sections below break down what you can expect, with examples, tips, and questions to ask yourself before making the leap.

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Key Benefits of Locum Tenens Living

1. Flexible Work and Control Over Your Schedule

For many clinicians, the most compelling advantage of locum tenens is genuine control over when and how much they work.

Customize Your Workload

Unlike a traditional employed role, you are not tied to a fixed FTE expectation or long-term contract. You can:

• Work back-to-back assignments for a “full-time” income
• Build in multi-week or multi-month breaks between contracts
• Negotiate short-term assignments to test the waters at various facilities
• Stack shorter locums shifts to accommodate childcare or other obligations

Example:
A newly graduated hospitalist wants to pay down loans aggressively for two years. They arrange several 7-on/7-off locum tenens assignments in different regions, often at higher-than-staff rates. During their weeks off, they travel, visit family, and attend conferences—without needing to negotiate PTO.

Protecting Work-Life Balance

Locum tenens can serve as a powerful tool for rebuilding or preserving work-life balance:

• Say no to call-heavy roles that don’t fit your wellness goals
• Avoid chronic overtime and committee obligations that often accompany permanent employment
• Schedule time for board exams, fellowship interviews, family events, or long-delayed vacations

Actionable Tip:
Before signing any contract, outline your “non-negotiables”:

• Maximum number of shifts per month
• Call expectations
• Required days off between blocks
• Holidays you refuse to work

Share those clearly with your recruiter or directly with the facility. Locum tenens only supports work-life balance if you enforce your boundaries.

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2. Exposure to Diverse Clinical Environments

Locum tenens is one of the most efficient ways to gain broad, real-world clinical experience across the healthcare spectrum.

Variety Across Settings and Systems

Assignments may place you in:

• Small rural critical access hospitals
• Large academic medical centers
• Community-based outpatient clinics
• Urgent care centers or specialty practices
• Government and military facilities, VA hospitals, or tribal health systems

Each type of setting exposes you to different workflows, resource levels, and patient populations.

Benefits of this diversity include:

• Clinical versatility: You learn multiple ways to manage common conditions and system constraints.
• Systems literacy: You experience how different EHRs, protocols, and staffing models affect care.
• Cultural competence: You treat patients from a wide range of socioeconomic, cultural, and geographic backgrounds.

Sharpening Your Clinical Skills

Rotating through multiple environments can highlight gaps in your training and rapidly sharpen your skills:

• In a rural ED, you might become more comfortable with initial stabilization in limited-resource settings.
• In a high-volume urban clinic, you may master efficient visits, care coordination, and population health workflows.

Actionable Tip:
Keep a running log of new procedures, management approaches, and system strategies you encounter at each site. This becomes valuable both for your CV and for later practice decisions, including any future permanent roles.

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3. Strong Earning Potential and Financial Flexibility

From a financial perspective, locum tenens can be a powerful tool—if managed intentionally.

Why Locums Often Pays More

Facilities frequently pay premium rates for locum tenens providers because:

• They have urgent staffing needs
• They avoid long-term salary and benefits commitments
• They need coverage for leaves of absence, rapid growth, or service expansion

As a result, locums hourly or daily rates are often significantly higher than those for equivalent employed positions.

Additional financial advantages:

• No practice overhead (staff salaries, rent, supplies) like in private practice
• Potential reimbursement for housing, travel, and licensing
• Ability to work extra shifts at high rates during peak times (e.g., flu season, holidays)

Building a Financial Strategy Around Locums

However, higher gross income does not automatically equal higher net income. As an independent contractor, you must:

• Pay self-employment taxes
• Fund your own health insurance and retirement
• Budget for time off between assignments
• Reserve for malpractice “tail” coverage if needed and not provided

Actionable strategies:

• Work with a CPA experienced in healthcare contractors to optimize deductions (CME, licensing, travel, equipment, home office where applicable).
• Automate savings into a solo 401(k), SEP IRA, or other retirement vehicles.
• Maintain a 6–12 month emergency fund, especially early in your locums career, to buffer between assignments.

Example:
A family medicine physician uses two intense years of high-paying rural locums work to:

• Pay off high-interest educational debt
• Build an emergency fund
• Accumulate a down payment for a home in their preferred city

Then they transition to a slightly lower-paying but more stable employed role—with far less financial stress.

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4. Travel, Adventure, and Lifestyle Design

For clinicians with an adventurous streak, locum tenens can be a passport to a lifestyle that blends medicine, travel, and personal growth.

Explore New Cities, States, and Regions

Instead of committing to a single location long-term, you can:

• Sample different cities or states before choosing where to settle
• Experience coastal, urban, and mountain towns on medium-length contracts
• Enjoy local culture, food, and recreation during days off

Examples:

• An emergency physician surfs on off-days during an assignment in coastal California.
• A hospitalist takes an autumn assignment in New England timed with peak foliage season.
• A psychiatrist spends winters covering at a southern facility to escape colder climates.

Many locum tenens agencies assist with:

• Furnished short-term housing
• Travel arrangements
• Rental cars or local transportation stipends

Lifestyle Design Beyond Travel

Beyond geography, locums empowers you to design a lifestyle that might be difficult in traditional roles:

• Working 3–4 months a year and traveling internationally the rest of the time
• Living closer to aging family while maintaining income through regional assignments
• Combining clinical work with research, telemedicine, entrepreneurship, or teaching on your own schedule

This flexibility can be especially appealing in the post-residency phase, when you may not yet be tied to a specific city, school district, or partner’s job.

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5. Networking, Reputation Building, and Career Exploration

Every new locums assignment is also a networking and learning opportunity.

Expanding Your Professional Network

As you rotate through different facilities, you connect with:

• Physicians and advanced practice providers across specialties
• Clinical leadership (medical directors, CMOs)
• Practice managers and hospital administrators
• Nurses, pharmacists, and allied health teams

These contacts can:

• Provide strong references and letters of recommendation
• Alert you to upcoming permanent roles in systems you already know
• Connect you to research, teaching, or leadership opportunities

Many clinicians ultimately find permanent positions at sites where they first worked as locum tenens, having already “test-driven” the culture and workflow.

Clarifying Your Long-Term Career Goals

By experiencing a wide spectrum of practice environments, you gain real data on what you do and do not want in a long-term role:

• Academic vs. community
• Rural vs. urban vs. suburban
• Large health system vs. independent group vs. FQHC
• High acuity vs. more outpatient or preventive medicine focus

This can be invaluable after training, when you may feel pressure to choose quickly. Locum tenens can function as a structured “gap period” within healthcare careers, but still with income and ongoing clinical practice.

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6. Reduced Burnout Risk for Many Clinicians

Burnout in medicine is strongly linked to loss of autonomy, inflexible scheduling, administrative burden, and moral distress. Locum tenens can’t eliminate all stressors, but it can mitigate several key contributors.

Ways locums can reduce burnout:

• You can leave a toxic environment once the contract ends—without the friction of breaking a long-term employment agreement.
• You typically have fewer non-clinical responsibilities (committees, ongoing QI projects, EMR optimization meetings) unless negotiated.
• You control your overall workload by accepting or declining additional assignments.

Some clinicians use locums specifically as a “reset” after a difficult prior job, rediscovering aspects of medicine they enjoy when freed from dysfunctional systems.

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Major Drawbacks and Challenges of Locum Tenens Work

For all its upsides, locum tenens is not a universal solution. Understanding the downsides honestly is essential before committing your career to this model.

1. Lack of Long-Term Job Security and Income Predictability

Assignment Uncertainty

Assignments can:

• End earlier than expected
• Be delayed due to credentialing or budget changes
• Be canceled if the facility’s staffing or census improves

Even experienced locums providers encounter dry spells in certain specialties or regions. This unpredictability can be stressful, especially if you have major financial or family obligations.

Mitigation strategies:

• Maintain multiple relationships—with more than one locum tenens agency and with facilities directly when appropriate.
• Plan assignment start dates with margin (credentialing often takes longer than promised).
• Keep your emergency fund intact; avoid anchoring your budget to your best earning months.

No Guaranteed Future Work

Unlike partnership tracks or long-term employment contracts, locum tenens offers no guarantee of ongoing opportunities at any single site. If you strongly value stability and long-term continuity, you may find this unsettling.

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2. Limited Traditional Employment Benefits

As a locum tenens provider, you are usually classified as an independent contractor (1099) or per-diem employee with minimal benefits.

Common gaps include:

• No employer-sponsored health insurance
• No automatic retirement contributions
• No paid time off or sick leave
• Limited or no disability or life insurance coverage

You must proactively secure:

• Individual or family health insurance (e.g., through ACA marketplace, spouse’s plan, or professional association plans)
• Your own disability and life insurance policies
• Self-funded retirement (solo 401k, SEP IRA, etc.)
• Malpractice “tail” coverage if you transition between carriers and it’s not provided

This extra administrative and financial responsibility can feel overwhelming, particularly early in your career.

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3. Constant Adaptation to New Systems and Teams

Locum tenens requires a high tolerance for change.

Steep Learning Curves

Every new assignment may bring:

• A new EHR and order set structure
• Different medication formularies and protocols
• New call schedules, coverage expectations, and documentation norms
• Unique local population health concerns

You must quickly learn:

• Who your key contacts are (charge nurses, consultants, administrators)
• How to navigate local workflows (admission processes, transfers, specialty referrals)
• The cultural norms of the medical staff

For some clinicians, this variety is stimulating. For others, the constant onboarding—sometimes with minimal orientation—can be frustrating and exhausting.

Actionable Tip:
Before accepting an assignment, ask:

• How long is the orientation?
• Will I receive EHR training?
• What support is available on the first few shifts?
• Are there written protocols or quick-reference guides for locums staff?

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4. Potential Isolation and Impact on Relationships

The travel and transience that make locum tenens exciting can also be isolating.

Social and Emotional Challenges

Common issues include:

• Being far from family, friends, and established support networks
• Difficulty maintaining long-term friendships or romantic relationships
• Feeling like an outsider at each new workplace

This can be especially pronounced on longer or more remote assignments.

Mitigation strategies:

• Choose assignments closer to home or in cities where you already know people.
• Maintain regular virtual check-ins (video calls, group chats) with loved ones.
• Intentionally participate in local activities (fitness classes, faith communities, interest groups) to build temporary but meaningful connections.

For some, locum tenens works best in phases: a few intense travel years balanced with periods of more geographically stable work.

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5. Inconsistent Depth of Skill Development and Continuity

The variety of locums work can sometimes come at the expense of depth and continuity.

Potential downsides:

• Limited opportunity to see long-term outcomes of your clinical decisions, especially in outpatient or chronic disease management roles.
• Fewer chances to build longitudinal mentoring relationships with colleagues or trainees.
• Difficulty developing niche subspecialty expertise if you frequently move between generalist or mixed settings.

To counter this, some clinicians:

• Focus their locums work within a specific type of practice (e.g., only ICU, only OB, only inpatient psychiatry).
• Combine locums with part-time academic or specialty clinic roles to maintain continuity and depth.

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6. Licensing, Credentialing, and Regulatory Complexity

Working across multiple states or systems introduces significant administrative overhead.

Multi-State Licensing

Each state has its own:

• Licensing requirements
• Fees and renewal timelines
• CME expectations

While compacts (e.g., the Interstate Medical Licensure Compact for physicians, certain APRN compacts) simplify this for some, not all states participate, and not all specialties benefit equally.

Credentialing and Privileging

For each new facility, you can expect:

• Extensive paperwork and background checks
• Verification of training, employment history, and licensure
• Malpractice history review
• Delays that can range from weeks to several months

Many locum tenens agencies provide dedicated credentialing teams, which helps, but you’ll still invest time in forms, document tracking, and follow-up.

Actionable Tip:
Maintain a well-organized digital “credentialing packet” with:

• Updated CV
• Copies of licenses, DEA, board certifications
• Immunization records and TB testing
• Malpractice certificates and case explanations if needed

This significantly speeds up the process for each new assignment.

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Real-World Examples: Locum Tenens in Practice

Case Study 1: Dr. Johnson’s Rural Transition

Dr. Johnson, an anesthesiologist, left a busy suburban group practice feeling burned out by long hours and heavy call. He took a locum tenens assignment in a rural Montana hospital:

Benefits he experienced:

• Substantially higher per-day rate than his previous employed salary
• Predictable schedule with clearly defined call blocks
• Scenic surroundings, outdoor recreation, and a slower pace of life

Challenges he faced:

• Small anesthesia team meant limited peer support and backup
• Initially felt like an outsider in a tight-knit local medical community
• Missed the camaraderie and professional development opportunities of his prior large group

Over time, he built stronger relationships with the local staff and found a balance—spending several months a year in Montana while doing shorter assignments closer to his home city.

Case Study 2: Nurse Carla’s Cross-Country Experience

Carla, an experienced RN, chose locum tenens-style travel nursing to see more of the country and increase her income.

Highlights:

• Worked in New Orleans, San Diego, and Boston within two years
• Significantly increased her savings while paying down student loans
• Gained comfort with multiple EHRs, ICU protocols, and nursing cultures

Difficulties:

• Frequent moves made it hard to nurture long-term friendships and local routines
• Felt lonely at times, especially over holidays away from family
• Had to coordinate health insurance and retirement on her own between contracts

Carla eventually chose a hybrid approach: one longer-term contract near her hometown each year, supplemented by one “destination” assignment in a city she wanted to explore.

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Is Locum Tenens Right for You? Key Questions to Ask

Before committing to locum tenens as a primary career strategy, reflect on:

1. What do I value most right now—stability or flexibility?

   • If predictability and long-term roots matter most, a permanent role may be better.
   • If you crave autonomy, variety, or a reset, locums might be ideal.

2. What are my financial obligations and safety nets?

   • Do you have dependents, major debts, or fixed expenses that require steady income?
   • Can you build or maintain an adequate emergency fund?

3. How comfortable am I with frequent change?

   • Do you adjust easily to new teams, systems, and expectations?
   • Or do you thrive on familiarity and routine?

4. Where am I in my career timeline?

   • Early-career clinicians may benefit from exploration and income growth.
   • Mid- to late-career clinicians may prioritize flexibility, partial retirement, or reduced administrative burdens.

5. Am I willing to manage the business side of my career?

   • Taxes, insurance, retirement, and contract negotiation require time and attention.
   • If you dislike this, you’ll need professional advisors—or might prefer a more traditional employed role.

Locum tenens is not “better” or “worse” than permanent employment; it is simply different. For the right person, at the right time, it can be an empowering and fulfilling way to practice.

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FAQs About Locum Tenens Careers

Q1: What qualifications are necessary to work locum tenens?
Most locum tenens physician roles require:

• An active, unrestricted medical license in the state of practice
• Board certification or board eligibility in your specialty (strongly preferred)
• Current DEA registration (and state-specific controlled substance registrations where applicable)
• Up-to-date malpractice coverage (often arranged by the agency or facility)

For advanced practice providers and nurses, requirements include appropriate state licensure, national certification, and relevant clinical experience. Some facilities prefer at least 1–2 years of post-training experience, but there are locums opportunities available for strong new graduates as well.

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Q2: Do locum tenens providers have to pay for their own travel and housing?
It depends on the arrangement, but many locum tenens agencies and facilities:

• Provide furnished housing or a housing stipend
• Cover round-trip airfare or mileage reimbursement
• Offer rental car or transportation stipends for the assignment duration

These details are negotiable and should be clearly spelled out in your contract. Always confirm:

• What is covered vs. what is reimbursed
• Daily or monthly caps on housing or travel expenses
• Whether you can opt for a higher rate in exchange for arranging your own housing

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Q3: How can I find reputable locum tenens opportunities?
You can identify locum tenens positions through:

• Specialized locum tenens staffing agencies focused on your specialty
• Direct outreach from hospital or practice recruiters
• Professional networks (colleagues who have done locums may recommend trusted agencies or contacts)
• Job boards that list locum tenens roles by specialty and location

Before partnering with an agency, ask:

• What specialties and regions they focus on
• How they handle malpractice coverage, licensing support, and credentialing
• Whether you’ll have a dedicated recruiter and credentialing coordinator
• How transparent they are about rates and facility expectations

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Q4: Is it common for locum tenens providers to transition into permanent positions?
Yes. Many clinicians use locum tenens as a “trial period”:

• To evaluate a specific hospital or practice group
• To experience the culture, workload, and leadership style before committing
• To ensure the community and region are a good fit personally and for their family

Facilities often view strong locums providers as excellent candidates for permanent roles because they already understand local workflows. If you’re open to this possibility, let your recruiter and onsite leaders know you’d consider a permanent offer under the right conditions.

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Q5: How does locum tenens work affect my taxes and long-term financial planning?
As an independent contractor (1099), you are responsible for:

• Paying federal, state, and self-employment taxes (Social Security and Medicare)
• Making estimated quarterly tax payments to avoid penalties
• Keeping detailed records of income and deductible business expenses (CME, licensing, travel, etc.)

From a planning perspective:

• Consider working with a CPA who has experience with physicians and other healthcare contractors.
• Explore tax-advantaged retirement accounts (solo 401(k), SEP IRA) to reduce taxable income.
• Revisit your financial plan annually, as your income and assignment mix may change.

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Locum tenens can open doors to flexible work, geographic freedom, and robust earning potential within modern healthcare careers. By understanding both the benefits and drawbacks—and planning strategically—you can determine whether this model aligns with your professional goals, financial needs, and desired work-life balance in the post-residency and job market phase of your journey.