What If Locum Assignments Dry Up? Planning for Down Markets

The locum market will not be “safe forever” just because there’s a physician shortage.

That’s the lie a lot of recruiters and forums quietly lean on. “Docs will always be needed, you’ll be fine.” Maybe. But what if you’re not? What if the assignments slow down right when you’re depending on them?

If you’re even thinking that question, you’re already ahead of most people who plunge into full‑time locums without a parachute. Let’s pull that worst‑case scenario all the way into the light and actually plan around it.

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The Fear You’re Not Saying Out Loud

Let me phrase the thing that’s probably running in the back of your mind:

“What if I go all‑in on locums after residency, refuse (or lose) a permanent job, and then… the phone stops ringing? Assignments dry up. New grads are cheaper. Visa docs flood the market. Reimbursements drop. I have loans, maybe kids, maybe a mortgage. What happens to me?”

You’re not crazy for thinking this. You’re just more honest than most.

Here’s the truth that no recruiter will volunteer: the locums market can slow down. It’s regional, it’s cyclical, and it’s vulnerable to:

• Hospital hiring sprees (they suddenly fill their “chronic vacancy” and you’re out)
• New residency programs dumping fresh grads into previously desperate markets
• Reimbursement cuts that make locums rates “the first thing to trim”
• Big systems buying up small hospitals and standardizing staffing (with employed docs)
• Telemedicine and midlevel expansion plugging some coverage gaps

I’ve watched people go from “booked out six months” to “I’ve had one offer in eight weeks and it’s trash” when a single hospital system changed strategy.

So no, your fear isn’t irrational. But it is manageable if you treat locums like a business, not a vibe.

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How Often Do Locum Markets Actually Tighten?

Let’s look at this a little more clinically.

Locum Tenens Demand by Year (Illustrative Trend)

Category	Value
2018	70
2019	75
2020	90
2021	100
2022	85
2023	80

This is a simplified version of what I’ve basically seen:

• Pandemic years: pure chaos, huge demand, insane rates, everyone short‑staffed
• Post‑pandemic: hospitals panic‑hire employed docs, sign heavy bonuses, try to cut locums spend
• Some specialties (EM, anesthesia, hospitalist) get squeezed first
• Other specialties (rural primary care, psych, heme/onc) stay fairly robust but get pickier

The point isn’t the exact numbers. It’s that the graph is not a straight line up and to the right. It has spikes. It has dips. If your entire life depends on the spike never dipping, that’s a problem.

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Worst‑Case Scenario: Locums Really Do Dry Up—Then What?

Let’s actually run the nightmare you keep replaying.

You’re 1–3 years out of residency. You chose full‑time locums. Maybe you said no to a couple of permanent offers because the RVU requirements sounded insane, or the non‑compete was garbage, or the pay was insulting.

Then suddenly:

• Your main site gets a new CMO who hates locums and wants “stability”
• Another hospital in your rotation signs two new grads and closes their open shifts
• The agency that used to call you weekly now says, “We’ll keep you in mind” (translation: nothing decent right now)

You’re sitting at your kitchen table with:

• Fixed expenses: rent/mortgage, car, insurance, loans, childcare, whatever
• Variable income: that just went from “plenty” to “uh… sparse”

Here’s what your future self really cares about in that moment:

1. Do I have at least 6–12 months of living expenses sitting somewhere I can touch?
2. How toxic will it be for me to go get a permanent job quickly if I need to?
3. Do I have any non‑locums income at all, even small, that takes the edge off?
4. Do I have enough recent, clean experience to still look hire‑able?

If you build your life so the answer to every one of those is “no,” then yeah—down markets are terrifying.

If you deliberately structure things so those answers are mostly “yes,” the “dry up” scenario turns into “annoying and stressful” instead of “life‑ruining.”

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Concrete Ways to Protect Yourself (Before the Market Turns)

This is where people usually want a magic trick. There isn’t one. It’s a set of pretty unsexy moves that compound into real security.

1. Treat your first 2–3 years like a “fragile market,” even if it’s booming

Assume the current demand is a high, not a baseline. That means:

• Live on 60–70% of your average locums income, not your best month
• Put the rest into:
  • High‑yield savings / money market (for 6–12 months of core living expenses)
  • Retirement/investments after that buffer is secure

Your goal: if assignments disappeared tomorrow, you’d be more “annoyed” than “panicked.”

Category	Target Percentage
Core living expenses	60%
Emergency fund build-up	20%
Taxes set-aside	10%
Retirement/investing	10%

You can tweak percentages. But if you’re at “I spend 95% of what I make because I finally can”… that’s playing chicken with the market.

2. Keep at least one employment door cracked open

You don’t have to love the idea of a permanent job. You just have to keep it possible.

That means:

• Keep your CV updated and readable. Locums assignments listed with clear dates, no weird gaps.
• Maintain relationships with at least 1–2 attendings, medical directors, or chiefs who like your work and will answer a reference call.
• Don’t torch bridges at locums sites. I’ve seen people do this: “I’ll never work here again, screw it.” Two years later, they’re emailing that same medical director begging for a permanent spot.

And yes, you may have to stomach one of those “less than perfect” employed jobs temporarily if things get really tight. It doesn’t have to be forever. But it’s a lot easier to get hired if you haven’t been drifting with giant gaps and inconsistent stories.

3. Diversify type and geography of your assignments

If you’re relying on one small rural hospital in one state as 80–90% of your income, you’re basically an employee without benefits. That’s risk disguised as freedom.

Spread yourself out a bit:

• Two or three different systems if you can
• Multiple states licensed (especially one or two that are locums‑friendly and historically short‑staffed)
• A mix of types if your specialty allows (e.g., inpatient/outpatient combo, telehealth plus onsite)

That way, when one place tightens up, you’re not starting from zero.

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The “I Need a Job Now” Escape Hatches

Let’s say you didn’t do all of that. Or you did, and things still got tight. What are your emergency exits?

1. Short‑term employed roles or “try‑and‑hire” setups

Some systems will do 6–12 month contracts, or “employed but we both know it’s temporary.” It’s not always advertised as such, but on the inside everyone knows. I’ve seen people:

• Take a 1‑year “help us launch this new clinic” job
• Join a hospitalist group on a 1‑year contract specifically to cover a gap

You may hate it. But it keeps your skills active, money flowing, and your CV from turning into Swiss cheese.

2. Telemedicine as a pressure valve

No, it probably won’t replace a full locums income (except in some niches like psych). But having:

• 1–2 telemed platforms you’re credentialed with
• A small panel or at least the ability to pick up shifts

…can be the difference between “I’m drowning” and “I can at least cover my basic bills while I hunt for something better.”

3. Academic or community “bridge” positions

Sometimes programs that are opening new residency slots or community hospitals tied to academic systems are desperate for a warm body with a decent CV. They’re slower to hire than locums but often less picky when they’re scrambling.

If you’ve kept your references alive and your malpractice clean, these can be your safety net.

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Reading the Warning Signs Before It Gets Bad

You don’t have to be blindsided. Downturns in a local locum market almost always show cracks first.

Red flags I’ve actually heard people mention right before their market softened:

• “They used to beg us for extra shifts, now they’re telling us to take less.”
• “Rates dropped 15–20% this year and they’re saying ‘budget constraints.’”
• “The recruiter who called me weekly is suddenly ‘waiting on new postings.’”
• “They hired a new chief who’s obsessed with ‘cost containment.’”

When you start hearing those things, that’s the time to:

• Increase your savings rate for a while
• Look for secondary sites or additional states
• Quietly poke your network about more stable roles, even if you’re not ready to jump yet

Don’t wait until you have literally no offers and your checking account is screaming.

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Psychological Prep: Locums Without the Fantasy

There’s a subtle trap here. A lot of people go into locums as an escape: from residency trauma, from toxic attendings, from feeling owned by a hospital. Totally valid.

But if you attach your entire identity to being “the free locums doc who doesn’t answer to anyone,” any move back toward structure will feel like failure. So you’ll avoid planning for it. Which is exactly how people end up in the worst version of your nightmare.

You’re allowed to say:

• “I like locums, I want to do it as long as it serves me.”
• “If the market shifts and I need something else, that doesn’t mean I ‘lost.’ It means I adapted.”

The goal isn’t “never take a permanent job.”
The goal is “never be forced into a terrible situation because I refused to see risk.”

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What I’d Do If I Were You (Post‑Residency, Considering Locums)

If I were finishing residency right now, anxious about the market but still really drawn to locums, I’d probably:

1. Do locums, but assume it’s a 3–5 year phase, not a forever guarantee.
2. Build a 12‑month bare‑bones emergency fund before upgrading my lifestyle.
3. Get at least one “good enough” permanent offer to the point of a written contract, even if I don’t sign it. Just to know what’s available.
4. Keep a running list of 3–5 locums‑friendly states and work on at least two licenses.
5. Keep up CME, quality metrics, and references so I’m never radioactive if I need to pivot.

That way, if assignments dry up, I’m not starting from nothing. I’m executing Plan B or C that I already thought about when I was calm.

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Quick Reality Check (Because You’re Probably Spiraling)

You’re not wrong to worry that the locum assignments could slow down.

You are at risk if:

• You’re spending as if every year will look like your best locums year
• You’re not building cash buffers
• You’re relying on one site or one recruiter for all your work
• You’ve convinced yourself that needing a bridge job means you “failed”

But you’re already way ahead of most people because you’re asking, “What if this goes sideways?” before it actually does.

Use that anxiety as data. Let it push you to set up buffers, alternatives, and exits, so that if the market turns, you’re inconvenienced, not destroyed.

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FAQ (4 Questions)

1. Is it a bad idea to go straight into full‑time locums right after residency?
Not automatically. But it’s risky if you have high fixed expenses and no savings. New grads often underestimate how volatile scheduling can be. If you go straight to locums, do it with a brutally honest budget, a 6–12 month emergency fund target, and at least one realistic backup plan for a permanent role if things tighten. The mistake isn’t doing locums—it’s pretending they’re as stable as a W‑2 when they’re not.

2. How much savings should I have before relying on locums as my primary income?
If you’re genuinely worried about assignments drying up, aim for at least 6 months of core living expenses (not your current lifestyle—your “keep the lights on” number), and 12 months is ideal. That’s rent/mortgage, food, insurance, loans, basic transportation, childcare. If that number scares you, good. It should. Build toward it aggressively in your first high‑earning year instead of inflating your lifestyle.

3. Will doing locums hurt my chances of getting a permanent job later?
It can, but usually only if it looks chaotic or unexplained. A CV that shows 1–3 years of locums with consistent work, reasonable references, and clear explanations (“I wanted geographic flexibility early in my career, now I’m ready to settle”) is usually fine. Where people get burned is with unexplained gaps, tons of very short stints, or documented behavioral issues. Those raise red flags regardless of whether the work was locums or employed.

4. What if I’m already in a down market and barely getting any locums offers now?
Then this is triage mode. Cut expenses hard. Pick up anything reasonable that keeps you clinically active—even if the pay or schedule isn’t your dream. Get your CV in front of hospital recruiters and groups directly, not just through agencies. Consider very unglamorous options (rural, underserved areas, temporary academic roles, telemed) as bridges, not life sentences. Your first goal is to stop the financial bleeding and keep your skills fresh; refining your career path comes after you’re stabilized.

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Key things to remember:

1. Locums isn’t fragile if you treat it like a business with buffers and backups.
2. You’re allowed to love the flexibility and still quietly build an escape hatch.
3. Planning for down markets doesn’t make you pessimistic—it makes you someone who sleeps at night.