Is Locums Tenens a Smart Long-Term Salary Strategy or a Short-Term Tool?

The belief that locum tenens is “only a short-term stopgap” is wrong—and it can cost you hundreds of thousands of dollars.

Locums can be a brutally effective long-term salary strategy for some physicians and a terrible idea for others. The trick is knowing which camp you’re in and how to run the math like a business owner, not like a tired employee daydreaming on call.

Let’s walk through it like that.

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The one-sentence answer

Locum tenens is a great short-term income accelerator and a reasonable long-term strategy only if:

• You’re in a higher-paying or in-demand specialty
• You’re willing to travel or accept less-desirable locations/schedules
• You treat it like a business (tax, benefits, downtime, and risk priced in)

If you want stability, local control, predictable benefits, and a clear partnership or leadership track? Long-term full-time employment will almost always beat long-term locums on total life return, even when raw hourly pay is lower.

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Step 1: Understand what you’re really comparing

Most people compare “$250/hr locums” to “$300K salary.” That’s sloppy. You need to compare total economic packages.

Here’s the cleaner way to think about it:

1. What’s your true hourly rate as an employed doc?
2. What’s your true net hourly rate as a locums doc after:
   • Unpaid days
   • Taxes
   • Benefits you now buy yourself
   • Travel/housing gaps
3. What risks are being shifted onto you?

If you don’t do this, any conclusion you reach is basically a guess.

Category	Employed Physician	Locum Tenens Physician
Base pay	Salary / wRVU comp	Hourly or daily rate
Benefits	Included by employer	You pay (health, disability, etc.)
Retirement	Match or pension	Solo 401(k)/SEP IRA (your dollars)
Malpractice	Employer covers	Often covered, but verify tail
Time off pay	PTO usually paid	Unpaid; downtime = $0
Admin/busy work	Often high, unpaid	Usually less, but unpaid
Stability	High	Variable, contract-to-contract

If you can’t roughly estimate each box for your situation, you’re not ready to make a long-term decision.

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Step 2: Run the numbers like a business owner

Let’s do a simple, real-world style comparison.

Scenario A: Employed internal medicine hospitalist

• Salary: $320,000
• Schedule: 7-on/7-off, 15 shifts/month average
• Average work hours: 14 hrs/shift (includes charting, calls, admin)
• Benefits value: roughly $50,000 (health, disability, retirement match, CME, etc.)

Rough math:

• Annual hours: 15 shifts × 14 hrs × 12 months ≈ 2,520 hrs
• Total comp: $320,000 + $50,000 = $370,000
• Effective hourly rate: $370,000 / 2,520 ≈ $147/hr

Not as sexy as “$320K” sounds, right?

Scenario B: Locums hospitalist

• Rate: $230/hr
• Actual booked clinical time: 12 shifts/month average (travel, gaps, cancellations happen)
• Hours/shift: 12 hrs
• Employer covers malpractice but not tail; you buy:
  • Health insurance: $8,000/yr
  • Disability + life: $5,000/yr
  • Retirement: you fund $30,000/yr from your own income
  • Unpaid CME, licensing, accounting, etc.: ~$7,000/yr
• Assume 6 weeks/year without work (contracts in flux / chosen breaks)

Rough math:

• Work months: 10.5 effective months
• Annual hours: 12 shifts × 12 hrs × 10.5 ≈ 1,512 hrs
• Gross income: 1,512 × $230 = $347,760
• Subtract self-paid benefits/overhead: ≈ $50,000
• Net before tax: ≈ $298,000

Effective hourly rate net of benefits cost:
$298,000 / 1,512 ≈ $197/hr

So here, long-term locums beats employed by about $50/hr. That’s real money.

But here’s the catch: if your locums schedule is less full, your rate lower, or your overhead higher, that advantage shrinks or disappears completely.

Estimated Net Hourly Rate: Employed vs Locums

Category	Value
Employed Hospitalist	147
Locums Hospitalist	197

The point isn’t the exact number. It’s the framework:

• Don’t compare “salary vs hourly rate”
• Compare “effective net hourly rates over a full realistic year”

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When locums is smart as a short-term tool

Using locums as a short, focused play is often a very smart move. I’d almost call it underused.

Here are situations where locums shines:

1. Aggressive debt payoff (2–4 years)

   • New attending with $300–500K loans
   • You do 0.8–1.2 FTE of locums, stack high-paid shifts, live relatively lean
   • Knock out a huge chunk of principal early, then pivot to a more stable role

2. Bridge years

   • Between fellowship and permanent role
   • Between jobs if your group implodes or gets bought
   • While relocating for a spouse/partner’s career

3. Testing markets and practice styles

   • Try community vs academic
   • Try rural vs suburban vs urban
   • See how different EMR/culture/admin structures feel before signing a big contract

4. Capital-building for a specific goal

   • Want $300K down payment in 2 years?
   • Want to fund a business, surgery center buy-in, or rental portfolio?
     Locums is a sledgehammer tool for “I need a lot of cash, relatively fast.”

Short-term, you can tolerate:

• Less stability
• More travel
• Higher uncertainty

Because you have a clear finish line and a specific dollar target.

If you don’t define that finish line, short-term locums easily drifts into “I’ve been doing this 7 years and I’m tired” territory.

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When locums can work as a long-term strategy

Spoiler: it’s not for most people. But there are very real exceptions.

Locums can be a solid long-term play if:

1. You’re in a high-demand, high-rate specialty

   • EM, anesthesia, radiology, some surgical subspecialties, hospitalist, critical care, some psych gigs
   • Your locums rates are meaningfully higher than realistic employed comp in your region

2. You value autonomy and flexibility more than stability
   You like:

   • Saying no to bad contracts
   • Walking when administration changes
   • Taking 2–3 months off yearly without negotiating PTO

3. You’re willing to build a pseudo-“panel” of sites
   The best long-term locums physicians I’ve seen:

   • Rotate among 2–4 familiar hospitals/clinics
   • Negotiate repeat contracts
   • Become “their” go-to fill-in
     That solves some of the “I’m always the outsider” feeling.

4. You treat it like a business, not extra shifts
   You:

   • Hire a competent CPA
   • Set up an S-corp or LLC if appropriate
   • Max out solo 401(k) or SEP
   • Keep 3–6 months of cash for dry spells
   • Track metrics: booked hours, collections, tax rate

If that sounds exhausting, you probably want a long-term employed job and maybe dabble in locums on the side.

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When long-term locums is usually a bad financial move

Some people romanticize it. Then reality hits.

Locums is usually a bad long-term salary strategy if:

1. Your specialty doesn’t command high locums rates

   • Some outpatient-heavy fields (e.g., allergy, derm unless cosmetic, outpatient neuro) just don’t get great locums rates
   • You may earn less than a well-structured employed job with productivity or partnership potential

2. You want roots: kids, schools, community, leadership roles
   Locums can absolutely be local and stable in a few markets, but it’s atypical.
   If your life goals require:

   • Being present at home consistently
   • Climbing leadership ladders
   • Building a reputation in a single institution
     Long-term locums usually fights those goals.

3. You need stable, predictable income for mental health or obligations
   Divorce, alimony, complex caregiving, heavy financial responsibilities—these don’t play well with income volatility.

4. You’re not disciplined about money
   The locums trap I see often:

   • Big checks
   • No automatic savings
   • No deliberate retirement funding
   • No tax planning
   • A decade later: high lifestyle, low net worth

If you won’t treat the extra pay as a tool (and not just lifestyle fuel), long-term locums loses much of its advantage.

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Non-financial factors that quietly matter a lot

Money isn’t the only variable here, but it often blinds people to these:

1. Call, shifts, and schedule control

Locums can sometimes offer:

• Better shift mixes (e.g., mostly days)
• Freedom to avoid bad call setups or specific holidays
  But it can also be:
• “You’re here to plug our worst holes” land

This varies wildly by site and specialty. Ask blunt questions up front. Don’t assume.

2. Workload and documentation

Locums gigs can be:

• “We just need warm bodies” with heavy censuses and poor staffing
• Or surprisingly light workloads with strong support

Permanent employed jobs can be:

• Soul-crushing productivity mills
• Or well-run systems where you trade slightly lower pay for sustainability

On paper, two $250/hr gigs look the same. On the ground, one might burn you out in a year.

3. Career trajectory

If you want:

• Chief roles
• Medical director positions
• Ownership/equity in group or practice
• Academic promotion

Long-term exclusive locums will make that harder. Not impossible—but harder.

You’re trading career capital and institutional influence for flexibility and short-term cash.

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Long-term strategies that actually work

Here are a few real-world patterns I’ve seen work well:

Strategy 1: “Sprint then settle”

• 2–4 years heavy locums right after training
• Pay down debt aggressively, build cash cushion, maybe invest in a house or business
• Then transition to a carefully chosen employed/partnership track job with less financial pressure

Why it works: you front-load the grind when you’re young and flexible, then settle into a sustainable path.

Strategy 2: “Employed + selective locums”

You:

• Hold a stable 0.8–1.0 FTE employed role
• Do 1–2 weekends or weeks a month of high-yield locums (taxed as 1099, with business deductions)

Benefits:

• Keep benefits and stability
• Get serious extra cash for specific goals
• Hedge against local job risk

This is arguably the sweet spot for a lot of physicians who can tolerate some extra work in the short to medium term.

Strategy 3: “Long-term locums with intentional life design”

You:

• Live in a low cost-of-living area
• Maintain relationships with 2–3 reliable locums sites
• Work 0.7–0.9 FTE equivalent at high billable rates
• Keep expenses modest, invest heavily, and accept some uncertainty as the price of autonomy

This is niche but can work brilliantly for people who genuinely want flexibility and are good with money.

Relative Income Potential by Strategy

Category	Value
Employed only	3
Employed + some locums	4
Short-term heavy locums	5
Long-term focused locums	4

(Think of this as a 1–5 income potential scale, not exact dollars.)

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How to decide what’s smart for you

Forget generic advice. Ask and answer these, in writing:

1. What’s my top priority for the next 3–5 years?

   • Max money
   • Max stability
   • Max flexibility
     Pick one. Seriously.

2. What’s my realistic locums hourly rate and fill rate in my specialty and region?

   • Ask recruiters
   • Ask colleagues actually doing it
   • Look at multiple offers, not just one shiny posting

3. What’s my all-in annual cost for benefits and professional overhead as a 1099?

   • Health, disability, life
   • Retirement contributions
   • CME/licensing
   • Tax prep and legal

4. What does my effective net hourly rate look like for:

   • Full-time employed
   • Full-time locums
   • Hybrid (employed + some locums)

5. What am I willing to trade?
   Because you’re trading something—stability, control, income, time, or future options—in every direction.

Once you’ve done that, the “smart” choice usually becomes pretty obvious.

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Bottom line

Locum tenens is:

• Excellent as a short-term tool:

  • Debt payoff
  • Bridge years
  • Testing practice environments
  • Cash for specific goals

• Viable but specialized as a long-term salary strategy:

  • For high-demand specialists
  • For people who actually want autonomy more than security
  • For physicians willing to run their careers like a small business

If you’re chasing locums because you hate your current job, fix the analysis first. You might need a better employed position, not a lifetime of contract work.

Open a spreadsheet today and list three columns: “Employed,” “Full Locums,” and “Hybrid.” Fill in real numbers for pay, hours, benefits cost, and time off. Don’t stop until you can clearly see which column you’d bet the next 5 years of your life on.

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FAQ

1. Can locum tenens hurt my CV or future job prospects?
Usually not, if you’re thoughtful. A year or two of locums after training or between jobs is normal and often seen as resourceful. Ten scattered years of ultra-short contracts with no clear narrative can raise questions about reliability or “fit.” The hack: keep some continuity—repeat sites, longer stints—and be ready to explain your choices clearly in interviews.

2. Do locums physicians really make that much more money long-term?
Sometimes, but not always. In high-demand specialties and tough-to-staff locations, yes, you can clear more than employed peers even after expenses. In more saturated specialties or cushy locations, the premium can be small or nonexistent. The main mistake: physicians see the posted hourly rate, forget unpaid downtime and benefits, and overestimate true net income by 20–40%.

3. How risky is it to rely 100% on locums for years?
Risk depends on your specialty, location flexibility, and savings. If you’re a generalist willing to travel, the risk is moderate but manageable. If you’re very niche and location-locked, it’s higher. Either way, you’re taking on contract risk (non-renewal, cancellations, rate changes). A 3–6 month cash cushion and multiple active sites or agencies cut that risk dramatically.

4. Can I negotiate locums rates and terms, or are they fixed?
You can and should negotiate. I’ve seen plenty of physicians bump rates by $20–50/hr or improve call, schedule, and travel terms by simply asking and being willing to walk. You have more leverage if you’re flexible (dates, locations), have an in-demand skill, or are willing to commit to longer stretches. Never assume the first number is the final word.

5. What legal or contract pitfalls should I watch for with locums?
Three big ones:

• Malpractice coverage details (claims-made vs occurrence, who pays tail, coverage limits).
• Restrictive covenants (non-competes or non-solicits that limit you from working in a region or with a group later).
• Cancellation terms (how much notice is required, whether they can cut your shifts last minute, and whether you’re compensated).
  For any long-term or high-dollar engagement, have a healthcare attorney review at least one representative contract so you know what you’re signing.