Residency Advisor
The biggest mistake physicians make with locum tenens is saying “yes” before they’ve asked the right questions.
If you do not interrogate the assignment up front, you are volunteering to discover the painful parts at 7:00 a.m. on day one, in a place you do not control, with patients already waiting. I have watched smart physicians walk into absolute chaos because they trusted, “Oh yeah, it’s pretty standard,” from a recruiter or onsite contact.
You need a checklist. And you need to actually use it.
Below is exactly what to ask before you accept any locum tenens assignment—especially in your first few years post‑residency when you’re still learning what “normal” should look like.
1. Core Assignment Details You Must Pin Down
Start with basics. If these are fuzzy, do not move forward.
Ask these explicitly:
- What are the exact start and end dates?
- What are the daily hours and total expected hours per week?
- Is call required? If yes, how often and what kind of call?
- Is this coverage for vacation, vacancy, or chronic understaffing?
If they cannot answer those cleanly, that is a red flag.
| Item | What You Need to Hear |
|---|---|
| Dates | Clear start/end, orientation day specified |
| Schedule | Specific clinic/OR/shift hours |
| Call | Frequency, type, in-house vs from home |
| Purpose of need | Leave, vacancy, growth, or chronic shortage |
Push for written confirmation. Verbal “should be” statements are worthless when you show up and they hand you a different schedule.
A simple test: Say, “Send me the schedule template and call rotation you used for the last locum.” If they dodge, ask why.
2. Workload, Staffing, and Clinical Environment
This is where most of the pain hides. You want to know: Am I walking into a manageable clinical setup or a dumpster fire?
Targeted questions:
Patient volume and acuity
- “What is the average number of patients per day/shift?”
- “What’s the maximum I might reasonably see in a busy day?”
- “Are there productivity expectations (RVUs, encounters per day)? If so, how are they tracked?”
Support staff
- “Will I have an MA, RN, or NP/PA support? One-to-one or shared?”
- “Who enters orders? Who rooms patients? Who handles prior auths?”
- “Are scribes available?”
Other physicians
- “How many other physicians are typically on during my shift?”
- “Is there an onsite backup physician or only phone backup?”
Procedures and scope
- “Which procedures are expected? Which are optional?”
- “Are there any procedures they need covered that are outside my comfort/training?”
If they say, “We generally see 20–25” and another locum quietly tells you “it’s 35–40 every Monday,” believe the locum. The recruiter wants the slot filled. The locum wants you not to suffer.
| Category | Value |
|---|---|
| Rural Clinic | 18 |
| Urban Clinic | 24 |
| ED (Low Vol) | 16 |
| ED (High Vol) | 28 |
Ask bluntly about burnout and turnover
You will not get this from HR. Ask:
- “How many physicians have left this department in the last 12–18 months?”
- “Have you used locums continuously here? For how long?”
- “What do the other doctors say are the biggest challenges?”
If you can, track down a prior locum who worked there. Ask them privately:
- “Would you go back?”
- “What surprised you—in a bad way?”
If the answer feels hesitant, pay attention.
3. Pay, Expenses, and Cancellation Terms
Do not just ask, “What’s the rate?”. You care about total effective compensation and your risk if things change.
Compensation questions
You need:
- “What is the hourly or daily rate?”
- “Is there overtime or after‑hours pay? At what threshold?”
- “Is call paid? At what rate for beeper vs in-house? What about call-backs?”
- “Is there a different rate for nights/weekends/holidays?”
Clarify how they define a “day.” Some places call 10–12 hours a “day shift” with no extra pay. That changes your effective hourly rate dramatically.
Travel, housing, and licensing
Ask:
- “What’s covered: flights, car rental, mileage, lodging, meals?”
- “Do you book travel or do I? Is there a cap (e.g., nightly hotel max)?”
- “Do you reimburse licensing/DEA/CSR for this state? Up to what amount?”
Then nail down how and when you get reimbursed.
- “Are expenses prepaid or reimbursed?”
- “What documentation is required and how long is reimbursement taking right now?”
I’ve seen people front thousands in travel/housing and then chase a check for two months. Avoid that.
Cancellation protection (this is big)
Hospitals cancel. Admin changes. Volumes drop. You do not want to be the one holding the bag.
Ask:
- “If the facility cancels my assignment, what guarantees do I have?”
- “Is there a guaranteed minimum number of shifts or hours?”
- “What is the cancellation notice required from the facility?”
- “If they cancel within X days, do I receive a cancellation fee or guaranteed pay?”
You should know exactly what happens if:
- The hospital cancels the entire contract
- They cut your schedule from full-time to half-time
- They cancel a single shift last minute
| Topic | Minimum You Should Know |
|---|---|
| Base rate | Hourly or daily, number of hours per day |
| Call pay | Rate, call type, call-back pay |
| Travel | What’s covered, caps, booking method |
| Housing | Hotel vs apartment, private vs shared |
| Licensing | Fees covered or not, for which states |
| Cancellations | Notice period, fees, guaranteed minimums |
4. Documentation, EMR, and Onboarding
You can survive mediocre pay. You will hate your life with a bad EMR + no training.
You want crisp answers to:
- “Which EMR system do you use? Any major add‑ons or custom workflows?”
- “How long is the EMR orientation? Is it paid?”
- “Will I have templates, order sets, and macros ready when I arrive?”
- “Who handles prior auths, referrals, and messages—me or staff?”
- “How many open charts or unsigned notes do locums usually end up with?”
Then ask about onboarding:
- “How many days/hours of orientation are provided?”
- “Is there a dedicated person I can call on day one when the computer or badge doesn’t work?”
- “Will I have access to all necessary systems (EMR, PACS, lab, order entry, dictation) before my first patient?”
| Step | Description |
|---|---|
| Step 1 | Offer Accepted |
| Step 2 | Credentialing Started |
| Step 3 | EMR Training Scheduled |
| Step 4 | Travel and Housing Confirmed |
| Step 5 | First Day Orientation |
| Step 6 | Independent Clinical Work |
If orientation is “a quick 30 minutes with the nurse” for a complex EMR, expect to spend your evenings fighting the system instead of resting.
5. Malpractice, Tail Coverage, and Legal Protections
You never skip this section. Ever.
Ask directly:
- “Who provides malpractice coverage—the agency or the facility?”
- “What are the policy limits (per claim and aggregate)?”
- “Is the coverage occurrence‑based or claims‑made?”
- “If claims‑made, who is responsible for tail coverage, and is that in writing?”
Occurrence is simpler. Claims‑made without clear tail language is a trap.
Also clarify:
- “Am I covered for telehealth, procedures, or work at other sites under the same system?”
- “Does the policy cover board actions and licensing defense or only malpractice claims?”
If you do not see malpractice details in writing (contract or confirmation letter), you do not have coverage. Verbal assurances from a recruiter do not protect you in court.
6. Culture, Safety, and “Soft” Issues That Matter
You are not just selling hours. You are walking into someone else’s ecosystem. It can be supportive or toxic.
Ask:
Team dynamics
- “How are locums viewed here—temporary warm bodies or part of the team?”
- “Will I be included in huddles, sign-out, and messaging threads?”
- “Who will be my main point of contact on‑site?”
Safety
- “What security is available, especially for nights/weekends or ED work?”
- “Any recent incidents of violence or threats toward staff?”
- “What is the protocol for unsafe patient situations?”
Realistic expectations
- “What have past locum physicians liked least about working here?”
- “What changes are you hoping this locum will help you with?”
Ask the recruiter privately: “What’s the real story here? Why are they having trouble keeping this filled?” There is almost always a story.
7. Contract Nuts and Bolts (Read Before You Sign)
Once your questions are answered verbally, you need to see how much survived into the contract. This is where a lot of people get burned.
Key clauses to examine and question:
Non‑compete / restriction of future work
- “Is there any non‑compete or restriction on working at this facility or nearby facilities in the future?”
- “Is there a buyout clause if they want to hire me permanently?”
Termination
- “How much notice can they give to terminate me without cause?”
- “How much notice must I give if I need to leave early?”
Floating and scope creep
- “Can I be floated to other units/hospitals in the system? Under what conditions?”
- “Is there language allowing them to change my role or site without my consent?”
Payment timing
- “How often are payments issued (weekly, biweekly, monthly)?”
- “What is the lag time from timesheet submission to payment?”
- “Are timesheets electronic or paper, and who signs them?”
You want everything you care about documented. If they say, “We never enforce that clause,” your response should be, “Then remove it.”
8. How to Decide If an Assignment Is Worth It
Once you have all the answers, don’t just go by feel. Do a quick reality check.
Ask yourself:
- At this rate, with this volume and call, is my effective hourly rate acceptable?
- Does this environment sound safe—for patients and for me?
- Am I likely to learn something or at least not burn out in two weeks?
- Would I be embarrassed to tell a colleague I accepted this setup?
If the answers are shaky, walk. There is no shortage of locums work. There is a shortage of good assignments that respect your time and license.
For a rough filter: early‑career post‑residency, I like assignments where:
- Volume is transparent and reasonable
- Orientation and EMR support exist
- Malpractice and tail are clean
- Cancellation protections are in writing
- Culture does not sound like permanent crisis mode
Take one or two solid, well‑vetted locum gigs. Learn from them. Then tighten your standards.
FAQ: Locum Assignment Questions (Exactly 6)
1. What is the single most important question to ask before accepting a locum tenens job?
If I had to pick one, it’s: “What is the realistic daily workload—patient volume, call burden, and documentation time—for the last few locums who worked this exact position?” Then confirm it with a prior locum if you can. Volume and workload will determine your stress, your sleep, and whether the pay is actually worth it.
2. Should I talk directly to the medical director before I accept an assignment?
Yes, you should. Insist on a brief call with the medical director or lead physician. Ask them how they use locums, what they expect, and what they see as the biggest challenges. Recruiters can smooth things over; the person running the service will tell you more straight, even if they sugarcoat a bit. If they refuse to let you talk to local leadership, that’s a bad sign.
3. How can I tell if a locum assignment is “chronic understaffing” versus normal coverage?
Ask how long they’ve been using locums continuously, how many full‑time docs they have vs budgeted positions, and how many physicians left recently. If they’ve had locums non‑stop for over a year, multiple recent departures, and no permanent hires, you’re likely plugging a chronic hole. That doesn’t mean don’t go—but you should expect heavier lift and more chaos.
4. Do I really need to worry about tail coverage as a locum?
Yes. Locum or not, if the coverage is claims‑made and there’s no tail, you’re exposed if a claim arises after you stop working there. You either want occurrence‑based coverage or written confirmation of who buys tail (agency vs facility). Vague assurances like “We’ve never had an issue” do not count.
5. Is it normal for a locum contract to have a non‑compete clause?
It shows up often, but that doesn’t make it good. Many agencies try to block you from working directly with that hospital or nearby for 1–2 years. Push back. At minimum, negotiate clear terms and a reasonable buy‑out so the hospital can hire you if you both want that later. If the non‑compete is broad (entire region, long duration), I’d seriously reconsider.
6. What’s a red flag in how a recruiter answers my questions?
Watch for vagueness (“It shouldn’t be too busy”), minimizing concerns (“Everyone adjusts to the EMR quickly”), or pressure (“This will go fast; you need to decide today”). A good recruiter will give you specifics, admit downsides, and let you think. If you feel like you’re being sold a timeshare instead of a professional job, step back.
Bottom line:
Ask detailed, uncomfortable questions before you accept. Get pay, workload, and malpractice/tail protections in writing. And remember—you’re not begging for work; you’re selling scarce expertise. Act like it.
