Unlocking Locum Tenens Opportunities: A Complete Guide for Surgery Residents

Locum tenens work has moved from a niche option to a mainstream career strategy for many surgeons. As healthcare staffing needs grow and practice models diversify, locum tenens opportunities in general surgery can offer flexibility, excellent compensation, and unique clinical experiences—if you understand how to navigate the market.

This guide walks you through what general surgery residents, new graduates, and practicing attendings need to know to successfully incorporate locum work into their careers, while supporting long‑term goals like academic appointments, private practice, or leadership roles.

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Understanding Locum Tenens in General Surgery

“Locum tenens” comes from Latin, meaning “to hold the place of.” In modern healthcare, a locum tenens physician is a temporary provider who fills staffing gaps in hospitals, group practices, or surgery centers.

What Locum Tenens Looks Like in General Surgery

In general surgery, locum assignments commonly involve:

• Covering for a surgeon on extended leave (FMLA, sabbatical, medical leave)
• Bridging gaps during recruitment for a permanent surgeon
• Supporting surgical services during seasonal volume spikes (e.g., trauma season, tourist regions)
• Providing coverage in rural or critical access hospitals that cannot recruit permanent staff easily
• Filling in during transitions such as mergers, EMR conversions, or service line changes

Typical service settings:

• Community hospitals (most common)
• Rural critical access hospitals
• Trauma centers (Level II–IV; Level I more selective)
• VA hospitals or military facilities
• Occasionally academic or hybrid community–academic settings

Types of General Surgery Locum Assignments

Assignments vary widely, but can often be grouped as:

1. Bread‑and‑Butter General Surgery Assignments

   • Appendectomies, cholecystectomies, hernia repairs, bowel resection, basic endoscopy
   • Mix of elective and emergency cases
   • Often in community or regional hospitals

2. Acute Care Surgery / Trauma‑Heavy Assignments

   • High volume of emergency and trauma consults
   • Night call focus, less elective block time
   • Level II/III trauma centers, sometimes Level I with prior experience

3. Rural, Broad‑Scope Assignments

   • Wide scope: endoscopy, basic orthopedics/OB backup support, minor urology, limited plastics or vascular depending on hospital resources and your training
   • More independent practice with limited specialty backup
   • High impact roles in small communities

4. Subspecialty‑Friendly Assignments

   • For surgeons with additional training (MIS, colorectal, surgical oncology)
   • May incorporate specific case types while still doing core general surgery
   • Useful for maintaining subspecialty skills post‑fellowship

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Why General Surgeons Choose Locum Tenens

The decision to pursue locum tenens opportunities in general surgery can be driven by financial, lifestyle, or career strategy considerations. Many surgeons combine several motivations at once.

1. Transitioning After Residency or Fellowship

Immediately after completing training, some surgeons use locum work to:

• Explore different practice settings (rural vs urban, private vs employed)
• Gain additional case volume and autonomy before committing to a permanent job
• Pay down educational debt quickly with high‑earning assignments
• Bridge a gap between graduation and a delayed permanent start date

From a surgery residency match standpoint, it’s useful to know early in training whether flexible or non‑traditional career paths like this appeal to you, so you can plan your skill development accordingly.

2. Mid‑Career Flexibility and Burnout Prevention

Locum tenens can be an effective tool for:

• Stepping away from a stressful or toxic practice environment without leaving surgery altogether
• Reducing administrative and committee burdens that often accompany permanent roles
• Negotiating a semi‑sabbatical: working a few intense weeks, then taking extended time off
• Testing new geographic areas or hospital systems before relocating

A common pattern: a mid‑career surgeon leaves a demanding full‑time role and spends 1–3 years doing travel physician jobs as a locum tenens surgeon while they reassess long‑term goals.

3. Late‑Career and Pre‑Retirement Strategy

Senior surgeons often use locums to:

• Gradually taper their clinical volume instead of abrupt retirement
• Work only specific months or seasons (e.g., spending winters in warmer states with contracts aligned to that preference)
• Maintain skills and license activity while stepping down from leadership roles
• Supplement retirement income with intermittent high‑pay assignments

4. Financial and Lifestyle Advantages

Common benefits reported by surgeons doing locums:

• Higher effective hourly or daily compensation compared to many employed positions
• Reduced call frequency in some assignments compared with understaffed home practices
• Control over when and where you work
• Separation of work and home life—when the assignment ends, so do the local politics
• Travel opportunities, with housing and travel often covered

For residents and fellows, hearing about locum options early can shape how you think about career flexibility after the surgery residency match and beyond.

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The Locum Tenens Market for General Surgery

Understanding the market structure helps you negotiate better and choose quality assignments.

Who Hires Locum General Surgeons?

Typical clients include:

• Small to mid‑size community hospitals with 2–6 general surgeons
• Rural hospitals with 1–2 full‑time surgeons that need backup
• Hospitalists programs that rely on surgeons for emergency coverage
• Critical access and frontier hospitals
• Some large systems bridging gaps during recruitment or expansion
• VA or government facilities (with different credentialing processes)

Assignments may be arranged through:

1. Locum Tenens Agencies

   • Most common route
   • They contract with hospitals and present you as a candidate
   • Handle logistics (travel, lodging, malpractice claims‑made coverage)
   • Take a margin on your billed rate

2. Direct Hospital Contracts

   • You or your group contract directly with the facility
   • Potentially higher pay (no agency cut)
   • You may need your own malpractice coverage and to manage logistics

3. Hybrid Models

   • Large groups or staffing companies that specialize in surgical coverage and may function like agencies with more clinical oversight

Demand Patterns in General Surgery Locums

Several trends fuel demand:

• Persistent shortage of surgeons in rural and semi‑rural areas
• Retirement of senior surgeons without adequate replacement
• Growing hospital consolidation and service line restructuring
• Increasing vacation/FMLA coverage needs in group practices
• Burnout‑related turnover leading to interim vacancies

General surgery remains one of the core specialties in locum tenens staffing. Bread‑and‑butter skills (lap chole, lap appy, hernia, basic colorectal, endoscopy) are consistently in demand.

Compensation Ranges and Structures

While rates vary by region, acuity, and urgency, typical structures include:

• Daily rates (e.g., 24‑hour call with or without in‑house requirement)
• Hourly rates for in‑house coverage or scheduled blocks
• Call‑only rates plus fees for each case (less common but still used)

As of recent market trends:

• Daily 24‑hour call with possible OR: often in the mid‑ to high‑ four figures per day, depending on case volume and location
• In‑house 12‑hour shifts: an hourly rate that scales with trauma level and expected workload

Rural or high‑need hospitals may pay premiums, especially for last‑minute coverage. However, “highest rate” is not always the best assignment—support, backup, and case mix matter greatly for safety and satisfaction.

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How to Get Started: From Resident to Locum Surgeon

Whether you’re a finishing resident, fellow, or established attending, a deliberate approach will make your entry into the locum market smoother.

Step 1: Clarify Your Clinical Scope

Before applying, define what you are truly comfortable doing alone:

• Core procedures you can perform independently and efficiently
• Emergency operations you’re competent to manage without immediate subspecialty backup (e.g., perforated viscus, incarcerated hernia, SBO, emergent laparotomy)
• Endoscopy skills (diagnostic and therapeutic)
• Procedures you will NOT do (e.g., complex hepatobiliary, major vascular, advanced thoracic)

Create a personal “scope of practice” document. It will guide your conversations with recruiters and hospitals and can later be incorporated into privilege requests.

Step 2: Strengthen Your CV for Locum Work

A CV tailored for locum tenens opportunities in general surgery should highlight:

• Case volume and breadth from residency and any fellowship
• Trauma level experience (Level I–IV) and call exposure
• Independent attending experiences (moonlighting, chief resident autonomy)
• Endoscopy numbers and competence
• Any rural or resource‑limited setting experience
• Leadership roles that suggest reliability (chief resident, QI projects, committees)

Include clear dates with no unexplained gaps and current references from program directors, chiefs, or recent supervising attendings.

Step 3: Licensure and Credentialing Strategy

To maximize travel physician jobs options:

• Start with full, unrestricted licensure in your primary state
• Consider obtaining one or two additional state licenses where demand is high (many agencies can advise on this)
• If eligible, explore the Interstate Medical Licensure Compact (IMLC) to simplify multi‑state licensing
• Maintain a clean NPDB (National Practitioner Data Bank) history and be prepared to explain any malpractice cases transparently

Hospital credentialing for locum surgeons often requires:

• Case logs from the past 12–24 months
• Documentation of board certification or eligibility
• ATLS, ACLS, BLS (keep them current)
• Immunization records, TB testing, and background checks

Start gathering and organizing these documents early; delays usually come from incomplete paperwork rather than lack of jobs.

Step 4: Working with Locum Tenens Agencies

When you engage agencies:

1. Interview the Recruiter

   • Ask about their experience specifically with general surgery
   • Clarify how many active surgery clients they have
   • Gauge responsiveness and transparency

2. Understand the Contract Basics

   • Pay rates and structure
   • Overtime or extra call compensation
   • Cancellation policies (by either party)
   • Malpractice coverage terms (limits, tail coverage if relevant)
   • Who arranges travel, lodging, and car rental

3. Be Clear About Your Preferences

   • Geographic limits or visa considerations
   • Trauma level preferences
   • Desired call frequency and schedule (e.g., “7 on / 7 off”)
   • Preferences regarding teaching responsibilities

You can and often should work with more than one agency, as long as you:

• Avoid duplicate submissions to the same facility
• Keep track of which agency showed you which job
• Maintain professional communication with all parties

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Evaluating and Negotiating Locum Assignments

Not all locum jobs are equal. A structured evaluation approach helps you find safe, sustainable, and rewarding roles.

Key Clinical Questions to Ask

Before accepting any assignment, ask:

1. What is the typical case mix and volume?

   • Elective vs emergency percentages
   • Types of cases you’ll be expected to perform
   • Expected number of consults per day / per call shift

2. What backup is available?

   • Are there other general surgeons on site?
   • Is there 24/7 anesthesia coverage?
   • Availability of subspecialists: GI, ortho, OB/GYN, urology, vascular, interventional radiology
   • Access to transfer centers for higher‑acuity or subspecialty cases

3. What resources and support staff exist?

   • OR schedule and block time
   • Experienced surgical techs and nurses vs high staff turnover
   • Imaging capabilities (CT with on‑call radiology, ultrasound, MRI)
   • ICU level (open vs closed, intensivist coverage)

4. How is call structured?

   • In‑house vs beeper call
   • Is call shared or solo?
   • What is the historical call burden and response time expectation?

These questions directly impact your patient safety, stress level, and malpractice risk.

Safety Considerations for Locum Surgeons

As a temporary provider, you may be at higher risk for:

• Limited familiarity with local systems and protocols
• Unclear expectations about what you will or will not handle
• Being pressured into high‑risk cases outside your comfort zone

Mitigation strategies:

• Insist on a detailed orientation (even if brief) when you arrive
• Clarify your scope with local surgeons, ED physicians, and hospital leadership
• Learn transfer procedures and contact information on day one
• Document your clinical decisions and rationale carefully, especially for transfers or declined cases

You always retain the right—and obligation—to decline a case that is outside your safe practice scope given the resources at hand.

Negotiating Pay and Terms

When negotiating, consider:

• Total compensation = daily/shift rate + overtime/call + any stipends
• Call intensity: a lower rate may be acceptable for very low‑volume call; conversely, high‑volume trauma call should pay more
• Location desirability: very remote or challenging sites may warrant premium rates
• Duration and stability: longer assignments may justify slightly lower daily rates in exchange for fewer gaps in your schedule

Negotiation tips:

• Be professional and data‑driven (“Given the solo call coverage and trauma volume, I would be comfortable at X rate”)
• Know your walk‑away point in advance
• Consider non‑financial perks (first‑class flights, upgraded housing, licensing cost reimbursement)
• For high‑quality, long‑term sites you enjoy, moderate flexibility on rates can be worthwhile

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Integrating Locums into a Long‑Term Surgery Career

Locum tenens is not “all or nothing.” It can be a short‑term bridge, a parallel track, or a full‑time lifestyle.

Locums Immediately After Training

For new grads:

• Pros:
  • Rapid financial gains to manage loans
  • Exposure to multiple systems and practice styles
  • Faster transition to independent practice
• Cons:
  • Less mentorship than in structured junior attending roles
  • Potential gaps in academic productivity if you aim for an academic career
  • Perceived instability by some future employers (though this is changing)

To preserve future options:

• Keep a detailed case log
• Stay engaged academically (online CME, virtual conferences, research collaborations if possible)
• Maintain strong references from supervising surgeons and chiefs at locum sites

Combining Permanent Roles with Locum Work

Some surgeons maintain a primary employed or private practice while doing occasional locums:

• Use vacation or unpaid leave to take short assignments
• Provide weekend or holiday coverage for nearby hospitals
• Help colleagues in underserved areas while preserving your home base

If you choose this model:

• Confirm your primary employer allows external clinical work and clarify malpractice coverage arrangements
• Avoid conflicts of interest with nearby competing hospitals
• Monitor your workload carefully to avoid burnout

Locums and Career Branding

The narrative you present matters. Locum experience can be framed as:

• Evidence of adaptability and broad clinical exposure
• Demonstrated ability to operate safely in varied environments
• Commitment to serving underserved or rural communities

On your CV and in interviews, be prepared to describe:

• What you learned from locum assignments
• How you maintained quality and continuity of care
• Why you are now seeking a permanent (or different) arrangement, if applicable

For residents thinking ahead during the surgery residency match, it helps to treat locum work as a strategic tool in your overall career story, not a fallback plan.

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Practical Tips for Success as a Locum General Surgeon

To translate theory into daily practice, incorporate these concrete strategies.

Professionalism and Relationship‑Building

• Arrive early on day one for orientation and introductions
• Learn names of key OR staff, hospitalists, ED leads, and nursing supervisors
• Communicate your preferences clearly but respectfully (e.g., OR setup, documentation style)
• Be visibly engaged in patient care, not just “there for the paycheck”

Positive relationships:

• Lead to repeat invitations and extended contracts
• Generate strong references for future opportunities
• Make your on‑site life significantly easier

Personal Logistics and Lifestyle Management

• Maintain a “go‑bag” with essentials: stethoscope, loupes, scrubs, comfortable shoes, reference materials, chargers
• Use digital tools to track expenses, assignments, and licensing renewals
• Consider a travel credit card and loyalty programs to maximize benefits
• Develop routines for exercise, sleep, and nutrition on the road—burnout can sneak up during intense blocks of call

Financial and Tax Considerations

Locum work often involves 1099 independent contractor income:

• Set aside a portion of each payment for quarterly estimated taxes
• Work with a CPA who understands physician 1099 income
• Track deductible expenses: licensing, board exams, CME, travel not reimbursed, home office costs if applicable
• Consider disability and own‑occupation insurance if stepping away from employer‑provided benefits

Risk Management and Documentation

• Be meticulous with operative notes and discharge summaries, especially in unfamiliar systems
• Document discussions about risks, alternatives, and transfers thoroughly
• Clarify handoff processes for post‑call or end‑of‑assignment transitions
• Engage with hospital quality and safety teams when concerns arise; this reinforces your professionalism and protects patients

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FAQs About Locum Tenens in General Surgery

1. Can I do locum tenens work right after general surgery residency?

Yes. Many new graduates take locum assignments immediately after residency. You should:

• Ensure you have a robust case log and strong references
• Be honest about your comfort level, especially for solo or rural positions
• Start with assignments that align closely with your recent training (e.g., similar trauma level, robust backup)

Some graduates mix a short period of locums with early job searching to better understand what they want in a permanent role.

2. How does locum work impact my chances of getting a permanent job later?

Locum experience usually does not harm your prospects and can help, provided that:

• You maintain a consistent practice record and avoid large unexplained gaps
• You frame your locum work as deliberate (exploring practice types, serving underserved areas, managing family or geographic needs)
• You keep good relationships and references from locum sites

Some employers may ask why you did not accept earlier permanent roles; be prepared with a clear, positive explanation focused on fit and exploration rather than conflict.

3. Do locum tenens agencies provide malpractice insurance for general surgeons?

Most reputable agencies provide malpractice coverage for assignments arranged through them, typically:

• Claims‑made coverage with specified limits
• Coverage limited to work done under that agency’s contracts

Ask explicitly about:

• Policy limits and whether they are shared or per‑provider
• Tail coverage if claims‑made (and what happens after you stop working with them)
• Whether you need additional personal coverage for non‑agency work

If you contract directly with hospitals, you may need to secure your own malpractice policy.

4. Is locum tenens compatible with an academic surgery career?

It can be, but requires planning:

• Pure academic tracks often emphasize research productivity and continuity of teaching responsibilities
• Short‑term locums between academic appointments, during sabbaticals, or in off‑service blocks can be compatible
• For early‑career academic surgeons, extended full‑time locum periods can make it harder to build a continuous research and mentoring record

If you aim for academic general surgery, treat locum work as a complement or a temporary phase, and maintain connections with mentors, collaborators, and academic projects while doing locums when possible.

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Locum tenens opportunities in general surgery can provide financial strength, professional growth, and lifestyle flexibility at every career stage—from just after the surgery residency match through pre‑retirement years. By understanding the market, defining your scope of practice, and approaching each assignment strategically, you can use locum work not just as a temporary job, but as an intentional, powerful part of your broader surgical career.