Ultimate Guide to Locum Tenens Opportunities in Emergency & Internal Medicine

Understanding Locum Tenens in Emergency Medicine–Internal Medicine

Emergency Medicine–Internal Medicine (EM IM) combined training opens an unusually broad range of practice options. One of the most flexible and potentially lucrative among them is locum tenens work. For EM IM graduates, locum tenens can mean working shifts that span the continuum of acute care—from a high-acuity emergency department to hospitalist coverage, observation units, step-down services, and even critical access hospitals with both ED and inpatient needs.

Locum tenens (Latin for “to hold the place of”) refers to temporary physician assignments where you fill gaps in coverage for hospitals, clinics, or health systems. For an EM IM combined physician, this might involve:

• Pure emergency medicine shifts
• Pure inpatient internal medicine or hospitalist work
• Hybrid ED + inpatient coverage, especially in smaller or rural hospitals
• Nocturnist roles in both ED and wards
• Short-term contracts covering staffing shortages, new program launches, or leaves of absence

Because your dual training overlaps with emergency medicine, internal medicine, and often critical care principles, you are uniquely positioned to negotiate more diverse—and more rewarding—locum assignments than physicians from either specialty alone.

In this guide, we’ll walk through how to think strategically about locum tenens work as an EM IM physician, from residency through early practice, focusing on practical, step-by-step advice for finding, evaluating, and thriving in locum roles and travel physician jobs.

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Why EM IM Physicians Are Ideal for Locum Tenens Roles

The EM IM combined pathway naturally aligns with the needs of institutions seeking flexible coverage. Understanding your value is the first step toward leveraging locum tenens opportunities effectively.

1. Breadth of Clinical Capability

As an EM IM combined physician, you can:

• Manage resuscitations and undifferentiated emergencies
• Admit and co-manage complex medical inpatients
• Provide continuity of care between ED and inpatient services
• Interpret complex diagnostic data and manage chronic disease in acute settings

This dual competency is particularly attractive for:

• Community and rural hospitals needing physicians who can cover both ED and inpatient floors
• Critical access hospitals where one or two physicians must manage a wide range of presentations
• Observation units and short-stay units overseen by either EM or IM
• Nocturnist roles where cross-coverage between ED and wards is common

From a hiring perspective, one EM IM physician may replace two narrower-scope physicians, which can make you especially desirable for locum tenens assignments.

2. Multiple Revenue Streams

Your training allows you to explore different pay structures and niches:

• ED-only locums (often hourly with high acuity and shift differentials)
• Hospitalist or inpatient locums (admission-based, census-based, or per-shift pay)
• Hybrid or “split” roles, where you cover both ED and wards during a shift

Savvy EM IM physicians can mix emergency medicine internal medicine assignments across different sites in a single year, balancing:

• Higher-paying but more intense ED shifts
• Steadier, sometimes less-acute inpatient or observation coverage
• Flexible locum work arrangements that support lifestyle needs

3. Built-In Career Flexibility

Many EM IM physicians are drawn to variety and adaptability. Locum tenens aligns well with:

• Portfolio careers (mixing clinical work with teaching, research, telemedicine, consulting, or global health)
• Geographic exploration before settling into a permanent position
• Testing EM-focused vs IM-focused practice patterns in real-world settings

Because travel physician jobs are often short-term (weeks to months), you can “try before you buy” in different practice environments.

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When to Consider Locum Tenens in Your EM IM Career

Locum work can fit at multiple stages—from residency graduation to mid-career transitions. The best timing depends on your goals, tolerance for uncertainty, and financial situation.

1. Right After Residency or Fellowship

Many EM IM graduates consider locum tenens directly after training. Key reasons:

• Exploration before commitment: Compare community EDs, academic centers, and hybrid roles.
• Debt repayment: Some locum tenens physician roles pay significantly more per hour than entry-level employed positions.
• Geographic flexibility: Live in one state but work in others; try rural vs urban settings.

Consider this if you:

• Want to avoid locking into a long-term contract immediately
• Are comfortable with variable schedules and short-term assignments
• Are ready to manage your own finances, health insurance, and retirement (if working as an independent contractor)

2. Early Career: Building a Hybrid Portfolio

If you accept a full-time job after residency, you can still:

• Add locum shifts during off weeks or vacations
• Take seasonal locum assignments (e.g., “snowbird” hospitals with winter surges)
• Use locum work to maintain EM or IM skills if your main job leans heavily toward one side

Example:
You work 0.8 FTE as a hospitalist at an academic center and pick up 4–6 EM locum shifts per month at a community hospital to maintain ED skills and boost income.

3. Mid-Career Pivot or Burnout Reset

Locum work is also a powerful tool if you are:

• Burned out from administrative or academic responsibilities
• Considering relocating but unsure which region or system suits you
• Transitioning between EM-heavy and IM-heavy roles

Shorter commitments and fewer non-clinical duties can provide breathing room while preserving your income and skills.

4. Pre-Retirement and Phased Step-Down

Later in your career, locum tenens allows you to:

• Gradually reduce clinical hours
• Avoid long-term night and weekend schedules
• Focus on specific clinical niches (e.g., observation units, low-volume EDs)

EM IM physicians can especially benefit from shifting to lower-acuity hybrid roles that still leverage both skill sets.

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Types of Locum Tenens Opportunities for EM IM Physicians

Not all locum tenens assignments are the same. Understanding the main structures will help you target roles that fit your training and preferences.

1. Pure Emergency Medicine Locums

These assignments focus exclusively on ED shifts. Typical features:

• Hourly rates, often with night, weekend, and holiday differentials
• Variable acuity: Level I trauma centers vs rural EDs with limited resources
• Procedures: airways, central lines, ultrasound-guided procedures, LPs, reductions, etc.
• Shift-based scheduling; little or no continuity of care after disposition

For EM IM physicians, these roles:

• Keep your EM skill set sharp
• May be especially useful if your primary job is more inpatient/IM focused
• Allow you to leverage your IM depth in complex ED cases and disposition decisions

2. Pure Internal Medicine / Hospitalist Locums

In these roles, you function as an inpatient internal medicine or hospitalist physician:

• Admission and rounding responsibilities
• Day, swing, or nocturnist shifts
• Possible ICU co-management depending on hospital structure
• Emphasis on chronic disease management, discharge planning, and coordination with specialists

Your EM background is a distinct advantage for:

• Rapid assessment of acutely decompensating inpatients
• Cross-coverage nights when ED and wards interact closely
• Comfort with procedures (e.g., paracentesis, thoracentesis, central access in some settings)

3. Hybrid ED + Inpatient Roles

These are often the sweet spot for EM IM combined physicians, particularly in smaller hospitals and critical access facilities:

• One clinician covers the ED and admits/runs the inpatient service
• Shifts can be 12–24 hours, with on-site and on-call components
• Breadth of practice includes resuscitation, floor care, and step-down/telemetry management

Pros:

• Fully utilizes EM and IM training
• Higher compensation due to broader responsibilities
• More control over patient flow and continuity between ED and wards

Cons:

• Can be intense and isolating if support staff is limited
• Requires strong time-management and triage skills

4. Nocturnist and Swing Shift Opportunities

Overnight and swing shifts are common in locum work and can be especially lucrative. EM IM physicians are well-suited for:

• Nocturnist hospitalist roles (cross-covering inpatients + new admissions)
• Night ED coverage with higher acuity and fewer consultants on site
• Combined ED + in-house hospitalist coverage at night

These can be ideal if you:

• Prefer fewer but longer shifts
• Tolerate night work well
• Want higher pay rates that come with night differential

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Finding and Evaluating Locum Tenens Assignments

The process of finding the right locum job is just as important as your clinical readiness. EM IM physicians should approach this strategically to ensure roles are safe, sustainable, and aligned with training.

1. Using Agencies vs Independent Contracting

You can work as:

• Agency-based locum physician: A staffing company matches you with sites, assists with credentialing, and often arranges travel and housing.
• Direct-contract locum physician: You negotiate directly with hospitals or groups, sometimes after being introduced by colleagues or networking.

For EM IM physicians just starting:

• Agencies are a good way to explore emergency medicine internal medicine roles across regions.
• They streamline licensing, credentialing, travel, and malpractice coverage.
• Drawback: The agency takes a cut, so your rate may be lower than a direct contract.

More experienced locum tenens physicians may negotiate direct contracts at higher rates, particularly for hybrid EM/IM or rural coverage where your skill set is rare.

2. Key Questions to Ask Before Accepting an Assignment

Whether through an agency or direct, ask targeted questions to determine if the role is safe and appropriately aligned with EM IM training.

Clinical Scope and Support

• Is this ED-only, inpatient-only, or a hybrid role?
• What is expected daily census (for IM) or average ED volume and acuity (for EM)?
• Are there other physicians on site (e.g., another hospitalist, ED doctor, surgeon, anesthesiologist)?
• What advanced practice providers (PAs/NPs) are present, and how are they supervised?
• Who manages ICU-level patients—do you admit, co-manage, or consult?

Workflow and Logistics

• How many admissions per shift for inpatient roles?
• Is there 24/7 respiratory therapy, radiology, and lab?
• Are specialists on-site, on-call, or telemedicine only?
• For hybrid roles: How is ED coverage balanced with inpatient rounding?

Safety and Backup

• How far is the nearest tertiary care center?
• What are transfer protocols for trauma, stroke, STEMI, and critical patients?
• Are there clear policies and documented support for complex cases outside typical scope?

Compensation and Contract Terms

• Is payment hourly, per shift, or productivity-based?
• Are travel, lodging, and rental car included or reimbursed?
• What malpractice coverage is provided? (Occurrence vs claims-made, tail coverage)
• Cancellation policy: How much notice is required from either side?

3. Understanding Pay Structures and Negotiation

EM IM locum pay varies widely by region, setting, and scope. General principles:

• ED locum roles often pay an hourly rate with shift differentials.
• Hospitalist roles may pay per shift with expectations around maximum census.
• Hybrid roles typically command higher rates due to broader responsibilities.

When negotiating:

• Emphasize your dual-boarded or dual-trained status.

• Highlight comfort with:

  • Resuscitations and procedures
  • Inpatient management of complex medical patients
  • Working in resource-limited settings

• Ask explicitly if the rate reflects dual coverage (ED + IM), nights, or high-volume expectations.

• Compare offers across multiple agencies or hospitals to understand market norms.

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Practical Tips for Thriving as an EM IM Locum Tenens Physician

Success in locum tenens isn’t just about clinical skill; it’s also about preparation, professionalism, and sustainability.

1. Prepare a “Locum Toolkit”

Have a digital and physical toolkit ready:

• Updated CV with clear EM and IM experience, including procedures and leadership roles
• Credentialing packet: Copies of licenses, DEA, board certificates, immunizations, CME logs
• Procedure log (if available) showing recency and volume of key skills (e.g., intubations, central lines, lumbar punctures)
• Reference contacts from residency and early practice, especially program directors and department chairs

Practically, also pack:

• A personal stethoscope, otoscope/ophthalmoscope (if you use them), and penlight
• Any preferred reference apps or digital resources (e.g., UpToDate, EM:RAP, critical care calculators)
• Scrubs and professional clothing appropriate to multiple environments (ED, wards, clinics)

2. Rapid Onboarding at a New Site

On your first day:

• Arrive early to meet nursing leadership, charge nurses, and other physicians.

• Get a walk-through of:

  • Resuscitation bays and crash carts
  • Where to find airway equipment and blood products
  • Telemetry monitoring and ICU/step-down units

• Clarify:

  • EMR basics (order sets, admission workflows, handoff tools)
  • Who to call for transfers, radiology consults, and specialty input
  • Local protocols for stroke, STEMI, sepsis, and trauma

Because you’re EM IM, explicitly ask:

• Where do borderline patients go (ED vs inpatient vs observation)?
• What’s the expectation for you if an inpatient decompensates in the middle of a busy ED shift?

3. Setting Boundaries and Ensuring Safety

As a locum tenens physician, you are often perceived as versatile and “plug-and-play.” Use that versatility wisely:

• Practice within the realistic scope of your training and the resources available.
• If asked to cover beyond safe limits (e.g., too many floors plus the ED plus the ICU with minimal backup), communicate concerns clearly and professionally.
• Document escalation of care and resource limitations when clinically relevant.

Examples of boundary-setting phrases:

• “I’m comfortable managing this patient initially, but if they require escalation beyond our available resources, I will arrange transfer promptly.”
• “Given the volume and acuity tonight, I want to make sure we’re aligned on which patients we can safely manage in-house vs transfer.”

4. Financial and Lifestyle Planning

Locum tenens income can be substantial but variable. For EM IM physicians, especially those juggling multiple sites or roles:

• Create a budget that accounts for potential gaps between assignments.
• Consider setting aside 3–6 months of living expenses as a buffer.
• Work with a tax professional familiar with 1099 income, deductions for travel, CME, licensing, and retirement contributions.

Lifestyle-wise, locum work can:

• Allow long stretches of time off between blocks of intense work
• Support travel physician jobs where you use off days to explore new cities or regions
• Facilitate academic, research, or leadership projects during non-clinical periods

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Common Pitfalls and How to Avoid Them

EM IM locum tenens physicians face some unique challenges. Recognizing them early helps you build a sustainable career.

1. Overextension in Hybrid Roles

Risk: Being the only physician covering ED and inpatient services at a busy site with insufficient backup.

Mitigation:

• Ask specific questions about typical ED volume and inpatient census.
• Clarify who helps during mass casualty events, codes, or nursing shortages.
• Negotiate limits—for example, a maximum inpatient census above which backup is called.

2. Skill Drift in One Domain

If most of your locum work is ED-only or IM-only, your skills in the other domain may diminish.

Mitigation:

• Deliberately schedule mixed assignments (e.g., 2 weeks ED, then 2 weeks inpatient) across the year.
• Maintain CME in both specialties.
• Consider periodic shifts in academic or high-acuity settings to keep up with evolving standards.

3. Credentialing and Licensing Fatigue

EM IM physicians working multiple sites may be juggling several state licenses, hospital credentials, and payer enrollments.

Mitigation:

• Keep an organized, encrypted digital file with all documentation.
• Use agency credentialing teams to ease the burden when possible.
• Focus on a core set of states or regions to maximize ongoing opportunities with minimal renewal overhead.

4. Professional Isolation

Locum tenens work, especially in travel physician jobs, can feel isolating without a consistent team.

Mitigation:

• Make a conscious effort to build relationships with local staff during each assignment.
• Join professional communities (ACEP, SHM, ACP, EMRA alumni, local EM/IM societies).
• Maintain connections to mentors and peers via online communities or regular calls.

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FAQs: Locum Tenens for EM IM Combined Physicians

1. Can I do locum tenens work while still in EM IM residency?

In most cases, true independent locum tenens positions require full licensure and completion of residency, and many sites require board eligibility or certification. However, during residency you can:

• Moonlight internally at your own institution (within program rules)
• Occasionally moonlight externally with supervision, if your state and program policies permit

Always clear any external work with your program director and GME office.

2. Do I need to be board-certified in both EM and IM to get good locum jobs?

Board certification in both is ideal, but not always mandatory. Many hospitals will accept:

• Board certification in one and board eligibility in the other, or
• Recent EM IM combined residency training with plans to sit for both boards

For higher-paying and more competitive positions, especially academic or urban EDs, dual board certification is a strong advantage.

3. How does malpractice coverage work for locum tenens physicians?

Most agency-based roles provide malpractice coverage:

• Often on a claims-made basis with tail coverage either included or negotiable
• Sometimes on an occurrence basis, which does not require tail

For direct contracts, you may need to:

• Purchase your own malpractice policy
• Clarify whether the hospital or group provides it and whether tail is covered if the contract ends

Always confirm coverage limits and whether both EM and IM activities are explicitly included in the policy.

4. Is locum tenens a viable long-term career path for EM IM doctors?

Yes. Many EM IM physicians build full careers as locum tenens physicians, especially those who value:

• High autonomy and schedule control
• Geographic flexibility
• Shorter commitments with less administrative burden

Sustainability depends on:

• Financial planning for income variability
• Maintaining skills in both specialties through thoughtful assignment selection
• Avoiding burnout by pacing shifts and choosing safe, well-supported environments

With deliberate planning, locum tenens can be not just a stopgap, but a long-term, fulfilling career strategy for EM IM combined physicians.