Unlocking Locum Tenens Opportunities in Emergency Medicine: A Guide

Understanding Locum Tenens in Emergency Medicine

Locum tenens work—temporary clinical assignments to fill staffing gaps—has become an integral part of modern emergency medicine practice. For many physicians, especially those early in their careers or considering a transition, locum tenens offers flexibility, financial upside, and a way to explore different practice settings without long-term commitment.

In emergency medicine, where 24/7 coverage is non-negotiable and staffing needs can shift rapidly, locum physicians play a critical role. Whether you are still planning your emergency medicine residency, just navigating the EM match, or already practicing and exploring travel physician jobs, understanding locum tenens opportunities can meaningfully shape your career trajectory.

This guide walks through how locums works specifically in emergency medicine, when to consider it, how to evaluate offers, and how to use locum work strategically throughout your career.

---

Why Locum Tenens Fits Emergency Medicine So Well

Emergency medicine is one of the specialties most compatible with locum tenens work. The structure of EM practice—shift-based, relatively independent, and less dependent on building a panel of follow-up patients—naturally lends itself to temporary staffing.

Key Reasons EM Is Ideal for Locums

1. Shift-Based Scheduling

   • ED coverage is organized around discrete shifts (8-, 10-, or 12-hour blocks).
   • This allows hospitals to plug locum tenens physicians into specific gaps without overhauling schedules.
   • Physicians can accept defined, predictable windows of work rather than open-ended coverage.

2. Team-Based and Protocol-Driven Care

   • Emergency departments typically have established protocols, order sets, and triage pathways.
   • Locum physicians can onboard quickly and still provide safe, high-quality care.
   • You are often supported by a stable core team of nurses, APPs, and staff who know local workflows.

3. Limited Longitudinal Continuity

   • While EM physicians care deeply about patient outcomes, they are not typically responsible for long-term follow-up.
   • This makes temporary practice more feasible than in specialties dependent on longitudinal relationships.

4. High Demand Across Settings

   • Rural hospitals, critical access facilities, community EDs, and even academic centers have ongoing staffing needs.
   • Seasonal surges (e.g., winter respiratory illnesses, tourist seasons) create additional short-term needs.
   • This translates into consistent locum tenens opportunities for emergency medicine physicians.

5. Compatibility with Career Flexibility

   • EM physicians often value flexibility, travel, and diverse clinical experiences.
   • Locum work can fit between full-time jobs, during geographic moves, or as an adjunct to permanent positions.

---

Types of Locum Tenens Opportunities in Emergency Medicine

Locum tenens in emergency medicine is not one-size-fits-all. Understanding the different types of roles and settings will help you match opportunities to your goals.

1. Rural and Critical Access Hospitals

These are among the most common sites for EM locum assignments.

Characteristics:

• Smaller ED volumes, often 5,000–20,000 visits per year.
• Limited on-site specialty backup; transfers are frequent.
• May involve solo coverage or very small teams.

Pros:

• Higher autonomy; you practice across a wide range of acuity.
• Often higher pay rates compared with some urban centers.
• Strong appreciation from communities with limited access.

Challenges:

• Fewer resources: limited imaging, in-house specialty support, and ancillary staff.
• Potentially long transfer times and high-stakes decision-making.
• Greater professional isolation during shifts.

Best for: Physicians comfortable with broad-based emergency care and independent decision-making, including new graduates who had strong training in community or rural EM settings.

---

2. Community and Suburban Emergency Departments

These are mid-volume EDs that serve as the backbone of U.S. emergency care.

Characteristics:

• Volumes typically 20,000–60,000 visits per year.
• Often staffed by democratic groups, national EM groups, or hospital-employed models.
• Varying levels of trauma and specialty support.

Pros:

• More predictable flow and resources than smaller rural hospitals.
• Robust nursing staff and advanced practice provider (APP) coverage.
• Good baseline systems for triage, observation, and admission.

Challenges:

• May have complex departmental politics and variable support for locums.
• Documentation and throughput pressures can be higher.
• Shifts might be tightly monitored for productivity and metrics.

Best for: Physicians seeking stable, recurring locum shifts or “try-outs” before permanent employment.

---

3. Urban and Academic Centers

While less common than community or rural assignments, there are locum roles in high-acuity, large-volume EDs.

Characteristics:

• Volumes frequently >60,000 visits per year.
• Residents and medical students present in many academic settings.
• Tertiary or quaternary referral centers with advanced trauma, stroke, and cardiac services.

Pros:

• Complex, high-acuity cases and robust specialty backup.
• Opportunities to teach if residents or students are present.
• Exposure to advanced protocols and subspecialty EM services.

Challenges:

• Complex workflows, electronic health records, and hospital bureaucracy.
• Slower onboarding due to credentialing and teaching responsibilities.
• Intense shift environment and pressure to meet institutional metrics.

Best for: Physicians comfortable with academic or tertiary-care settings, or those seeking high-acuity experiences.

---

4. International and “Travel Physician” Jobs

Some emergency medicine locum tenens assignments take physicians abroad.

Characteristics:

• Assignments through global health organizations, private companies, or governmental programs.
• Work in clinics, EDs, urgent care, or humanitarian settings.

Pros:

• Unique cultural and clinical experiences.
• Contribution to underserved populations on a global scale.
• Skill development in resource-limited environments.

Challenges:

• Licensing and credentialing in other countries.
• Variable pay and sometimes more volunteer-oriented structures.
• Need for adaptability and comfort with limited resources.

Best for: Physicians interested in global health, travel physician jobs, or integrating humanitarian work into their careers.

---

When to Consider Locum Tenens in Your EM Career

Locum tenens can be relevant at multiple career stages, from immediately after emergency medicine residency to late-career practice.

Locums for Residents and New Graduates

Although you can’t practice independently until licensed and board-eligible/certified, thinking about locum work while you’re still in training can help you plan ahead.

During EM Residency:

• Keep locum tenens in mind as a post-residency option if:
  • You’re unsure about where you want to live long-term.
  • You want to aggressively pay down loans early.
  • You enjoy variety in practice settings.

Immediately Post-Residency: Many new graduates pursue locum work for 1–3 years to:

• Explore different geographic regions and practice models.
• Clarify preferences for urban vs. rural, academic vs. community.
• Negotiate stronger permanent offers later based on better market awareness.

Key Considerations for New Grads:

• Some employers value stability; extensive locum history can raise questions about long-term commitment.
• However, carefully chosen locum roles can signal adaptability, broad experience, and confidence.

---

Locum Tenens Mid-Career

For mid-career physicians, locum tenens can serve several purposes:

1. Bridge Between Full-Time Jobs

   • When leaving a group or relocating, locum work can provide stable income and maintain clinical skills.
   • Short-term commitments allow time for a thoughtful job search.

2. Supplemental Income

   • Many physicians maintain a core full-time job and pick up locum shifts on off weeks.
   • This can accelerate loan repayment or fund life goals (home purchase, college savings, sabbatical).

3. Shift Toward Part-Time or Flexible Schedules

   • For those experiencing burnout or life changes (family commitments, health issues), locums can allow reduced but targeted clinical time.

---

Late-Career and Pre-Retirement Locums

Older physicians may use locum tenens to:

• Gradually reduce hours without fully retiring.
• Travel and selectively work in desirable locations.
• Shift away from administrative burdens while keeping a hand in clinical practice.

Locum tenens also allows senior physicians to bring their experience to underserved communities, functioning as a highly valued resource.

---

Practical Steps to Getting Started with Locum Tenens

Transitioning into locum work involves several discrete steps. Approaching them systematically will make the process smoother and safer.

1. Clarify Your Goals and Boundaries

Before talking to agencies or hospitals, define what you want:

• Clinical environment: Rural, community, or academic? Trauma level? Pediatric volume?
• Geography: Specific states or regions? Willingness to travel long distances or fly regularly?
• Schedule: How many shifts per month? Permanent vs. intermittent locum work?
• Acuity and independence: Comfort level with solo coverage or limited backup?
• Financial goals: Minimum acceptable hourly rate or shift pay?

Write these down; they will guide your discussions with recruiters and your evaluation of offers.

---

2. Understand the Locum Tenens Ecosystem

Most emergency medicine locum tenens roles are brokered through staffing agencies, although some physicians work directly with hospitals or groups.

Staffing Agencies:

• Match you with open positions, help coordinate licensing and credentialing, and negotiate contracts.
• Provide malpractice coverage (occurrence or claims-made).
• Arrange travel and lodging for travel physician jobs.

Direct Contracts:

• You negotiate directly with the hospital or EM group.
• Potential for higher pay (no agency overhead) but more administrative burden.
• Common when you have local relationships or are repeatedly working at the same site.

Actionable Tips:

• Speak with multiple agencies to compare responsiveness, transparency, and opportunities.
• Ask other EM physicians about their agency experiences—word of mouth is powerful.
• Clarify whether the agency has an exclusive agreement with certain hospitals (this can limit direct contracting options later).

---

3. Licensure, Credentialing, and Hospital Privileges

Every locum assignment depends on timely licensing and credentialing.

State Licensure:

• Some states are part of the Interstate Medical Licensure Compact, which can streamline obtaining multiple licenses.
• Prioritize states with high EM demand (e.g., rural-heavy states) if you are geographically flexible.
• Budget both money and time; some states take months to process licenses.

Hospital Credentialing:

• Typically 60–90 days, though “expedited” processes sometimes exist.
• You will repeatedly submit:
  • CV and explanation of any gaps.
  • Training and board certification documentation.
  • References (usually two or three physicians).
  • Procedure logs and case volume if requested.
• Keep a digital folder with updated versions of these documents to speed every new assignment.

Tip: Be scrupulously honest. Credentialing departments share information, and inconsistent reporting of employment dates, malpractice history, or disciplinary issues can cause long-term problems.

---

4. Evaluating Locum Tenens Contracts in EM

Before accepting any assignment, review the contract carefully. Even if pay looks attractive, the details matter.

Key elements to examine:

1. Compensation Structure

   • Hourly rate vs. shift rate vs. RVU-based productivity.
   • On-call pay (if any) and overtime policies.
   • Holiday or night differentials.

2. Scheduling Terms

   • Minimum number of shifts per month.
   • Flexibility around which shifts (days, nights, weekends).
   • Cancellation policy: How much notice is required? Is there guaranteed pay if the hospital cancels?

3. Coverage and Expectations

   • Patient volume per shift, average and high-end.
   • Number of providers per shift; presence of APPs.
   • Support services: RT, ultrasound techs, CT 24/7, lab turnaround times.
   • On-call specialty backup (surgery, OB/GYN, pediatrics, anesthesia, etc.).

4. Malpractice Insurance

   • Who provides coverage (agency, hospital, group)?
   • Type (claims-made vs. occurrence).
   • Tail coverage expectations if claims-made—who pays for tail if needed?

5. Non-Compete and Restrictive Covenants

   • Time and geographic limits on working at the same facility or nearby hospitals.
   • “Conversion” clauses if you later take a permanent position at the site.

6. Travel and Housing

   • Reimbursement for flights, rental cars, mileage, and meals.
   • Provided housing (hotel vs. apartment vs. stipend).
   • Travel days: Are they paid or unpaid?

If you are new to locum work, consider having an attorney familiar with physician contracts review your first few agreements.

---

5. Day-to-Day Realities of EM Locum Work

Once on site, your primary goal is to provide safe, high-quality care while integrating quickly into the local ED team.

Before Your First Shift:

• Request an orientation: EMR walkthrough, physical tour, and introductions.
• Ask for written protocols (stroke, sepsis, STEMI, trauma, pediatric resuscitation).
• Clarify:
  • Admission workflows and hospitalist coverage.
  • Transfer procedures for higher-acuity cases.
  • Consultant expectations (who to call when).

During Shifts:

• Over-communicate early: ask nurses and charge nurses about local preferences.
• Document clearly and defensively—malpractice risk can be higher for locum physicians simply because they may be perceived as outsiders.
• Be proactive in team-building with permanent staff; your reputation will influence whether you are invited back or recommended for other sites.

After Shifts:

• Debrief with yourself: Was the volume safe? Were resources adequate? Did anything concern you legally or ethically?
• Provide feedback to your recruiter or group about any significant issues.

---

Financial, Lifestyle, and Career Implications

Locum tenens in emergency medicine can significantly shape your finances, lifestyle, and long-term career trajectory.

Financial Considerations

Income Potential:

• Locum emergency medicine rates are often higher per hour than many employed positions, particularly in high-need regions.
• However, benefits (health insurance, retirement match, paid leave) may be limited or absent.
• You may work as an independent contractor (1099), managing your own taxes and retirement accounts.

Taxes and Benefits:

• Independent contractors are responsible for self-employment taxes.
• You can, however, leverage:
  • Solo 401(k) or SEP-IRA plans for retirement savings.
  • Business deductions for certain work-related expenses (consult an accountant).

Stability vs. Flexibility:

• Income may fluctuate month-to-month if assignments change.
• A diversified mix of contracts or maintaining a small permanent position can stabilize cash flow.

---

Lifestyle and Work-Life Balance

Pros:

• Control over when and where you work.
• Ability to cluster shifts and enjoy long stretches of time off.
• Opportunity to explore new regions, from urban centers to scenic rural communities.

Cons:

• Travel fatigue and time away from family or support networks.
• Less integration into hospital culture and less opportunity for long-term leadership roles at any single site.
• Administrative burden of multiple licenses, credentialing cycles, and different EMRs.

---

Long-Term Career Impact

Locum work can be positioned as a strategic, not haphazard, choice in your career narrative:

• Positive framing for future employers:

  • Broad experience with diverse patient populations and systems.
  • Demonstrated adaptability, rapid onboarding skills, and resilience.
  • Evidence of continued full-time practice and skill maintenance.

• Potential concerns you must manage:

  • Perception of lack of commitment or frequent job changes.
  • Gaps in academic or research productivity if that is a career goal.
  • Need to maintain strong references who can vouch for your performance across sites.

Intentionally curating assignments—documenting your accomplishments, volumes, and case types—can help you later if you transition back to a single-site role.

---

Using Locum Tenens Strategically Around the EM Match and Early Career

Even though locum work typically starts after training, your approach to the emergency medicine residency and EM match can influence future locum options.

During the EM Match and Residency

• Choose a residency that offers:

  • Strong exposure to a variety of ED settings: county, academic, community, and rural.
  • Procedural independence and comfort with limited-resources settings.
  • Diverse EMR systems and workflows.

• Ask current residents and alumni:

  • Have any graduates gone into locum tenens work?
  • Did residency prepare them well for rural or solo coverage sites?

• Build broad competence:

  • Master bread-and-butter EM and high-acuity resuscitation.
  • Gain comfort with pediatric and OB/GYN emergencies; these are critical for rural locum assignments.

---

Transitioning from Residency to Locum Work

If you plan to start your career primarily as a locum tenens physician:

• Begin the licensure process in 1–2 key states during your final year of residency.
• Reach out to locum agencies 4–6 months before graduation to:
  • Understand typical contract terms.
  • Begin credentialing at likely first sites.
• Consider a mix of:
  • Stable, recurring locum slots at a primary ED.
  • Occasional travel assignments to explore different practice settings.

By planning ahead, you can avoid large gaps between graduation and your first paid shifts.

---

FAQs About Locum Tenens in Emergency Medicine

1. Can I do locum tenens work during residency?

No. Independent locum tenens roles require full, unrestricted medical licensure and typically board eligibility or certification. However, you can prepare during residency by exploring different ED settings, talking to mentors who have done locums, and starting licensure applications before graduation.

---

2. Is locum tenens work safe from a malpractice perspective?

Locum tenens emergency physicians are exposed to the same malpractice risks as other EM physicians. In some ways, risk can be higher due to unfamiliar environments and workflows. You can mitigate this by:

• Ensuring you have adequate malpractice coverage (with tail when appropriate).
• Being cautious in solo or low-resource environments until you fully understand available support.
• Documenting thoroughly and following local protocols carefully.

---

3. How does locum pay compare to a permanent EM job?

Per-hour or per-shift pay for locum tenens emergency medicine work is often higher than employed positions, especially in high-need locations. However:

• Benefits (health insurance, retirement contributions, paid time off) are usually less generous or absent.
• Income can be variable depending on the consistency of assignments. Weigh total compensation, not just the hourly rate, when comparing with permanent offers.

---

4. Will doing locums make it harder to get a permanent emergency medicine job later?

Not necessarily. Many EM groups and hospitals hire former locum tenens physicians, especially if they have already worked at the site. Challenges arise if your CV suggests instability (short stints at many hospitals without clear rationale). To prevent this:

• Be intentional in your assignment choices.
• Maintain good relationships and references at each site.
• Be prepared to explain your locum period in terms of exploration, geographic flexibility, or specific life goals.

---

Locum tenens opportunities in emergency medicine can be a powerful tool—for financial flexibility, professional growth, and lifestyle design. By understanding how locum work fits into the broader landscape of EM practice, from the EM match through late-career decisions, you can decide when and how to use locum tenens strategically in your own career.