The Ultimate Guide to Locum Tenens Opportunities in Internal Medicine

Locum tenens work has transitioned from a niche stopgap into a mainstream career strategy for many internal medicine physicians. Whether you’re a resident approaching graduation, a new attending exploring options before a permanent job, or a seasoned internist seeking flexibility, understanding locum tenens opportunities in internal medicine can dramatically expand your career possibilities.

This guide walks you through how locums fit into an internal medicine career path, including how it influences your trajectory after the IM match, what kinds of roles are available, how to evaluate offers, and practical tips to succeed as a locum tenens physician.

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Understanding Locum Tenens in Internal Medicine

Locum tenens (Latin for “to hold the place of”) refers to temporary physician assignments that cover staffing gaps. For internal medicine, this can include:

• Hospitalist shifts in community or academic hospitals
• Outpatient internal medicine clinic coverage
• Night float or ICU coverage (if appropriately trained/credentialed)
• Rural and critical-access hospital coverage
• Telemedicine internal medicine consults (increasingly common)

Why Hospitals and Clinics Use Locum Tenens

Internal medicine departments rely on locum work for several reasons:

• Physician shortages – Many regions struggle to recruit full-time internists, especially in rural or underserved areas.
• Seasonal surges – Winter respiratory season, flu/COVID surges, and tourist seasons in certain regions.
• Coverage for leave – Parental leave, sabbaticals, extended vacations, and medical leaves.
• Bridge while recruiting – Short- to medium-term coverage while permanent hires are recruited and onboarded.

For residency applicants and recent graduates, this ecosystem creates a robust market of travel physician jobs that can be strategically leveraged at various stages in your career.

How Locums Fits into an Internal Medicine Career Path

Internal medicine offers a particularly flexible foundation for locum tenens because of:

• Broad clinical training
• Comfort with inpatient and/or outpatient roles
• High demand for hospitalists and primary care physicians

Common points in the career timeline where locum work makes strategic sense:

• Immediately after the IM match and residency graduation:

  • Bridge time before fellowship
  • Explore different practice settings before choosing a permanent job
  • Pay down loans aggressively with higher-earning assignments

• Mid-career:

  • Transition period between full-time jobs
  • Supplement full-time work with occasional locum shifts
  • Test-drive new geographic regions before relocating

• Late career / pre-retirement:

  • Scale down hours gradually
  • Work seasonally (winters in one region, summers in another)
  • Focus on clinical work with minimal administrative burden

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Types of Locum Tenens Roles for Internal Medicine Physicians

Internal medicine locum opportunities are diverse. Understanding your options helps you target assignments that match your skills, interests, and long-term goals.

1. Hospitalist Locum Assignments

These are among the most common locum tenens internal medicine roles.

Typical settings:

• Community hospitals
• Academic-affiliated hospitals
• Critical-access and rural hospitals
• Safety-net hospitals

Common schedules:

• 7-on/7-off block schedules
• 10–14 day blocks, often including weekends
• Night-only or swing shifts
• Holiday coverage blocks

Clinical responsibilities may include:

• Admitting and rounding on general medicine patients
• Managing step-down or observation units
• Consults for surgical or specialty services
• Limited ICU coverage (varies by site; some require procedures)

Example scenario:
You accept a 7-on/7-off hospitalist locum in a Midwestern community hospital for three months. During “on” weeks, you live in provided housing near the hospital and focus on patient care. “Off” weeks, you return to your home city or travel elsewhere. This pattern can be ideal early in your career if you want to maximize earnings and maintain extended stretches of free time.

2. Outpatient Internal Medicine Clinics

Clinic-based locum assignments may be half-day or full-day clinics over several weeks or months.

Typical practice environments:

• Private internal medicine practices
• FQHCs (Federally Qualified Health Centers)
• Academic primary care clinics
• VA internal medicine clinics
• Concierge or direct primary care practices

Scope of practice:

• Chronic disease management (HTN, DM, CAD, COPD, etc.)
• Preventive care and annual wellness visits
• Acute care/same-day appointments
• Coordination of specialty referrals

These assignments suit internists who prefer longitudinal care patterns—even if they’re temporary—over fast-paced inpatient work.

3. Hybrid and Niche Assignments

Some locum tenens internal medicine roles blend multiple settings or focus on specific niches:

• Hybrid inpatient/outpatient roles – Especially common in rural settings where internists cover both hospital and clinic.
• Post-acute and SNF coverage – Managing transitions of care, SNFs, rehabilitation units.
• Nocturnist-only positions – Night-time coverage with premium pay differentials.
• Telemedicine internal medicine consults – Remote chronic disease management, urgent care, or hospital consult coverage.
• Academic locum positions – Covering teaching wards, supervising residents, or interim faculty roles.

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Pros and Cons of Locum Tenens in Internal Medicine

Before committing to this path, it’s essential to weigh the advantages and potential drawbacks—especially if you’re transitioning directly after the IM match.

Advantages

1. Financial Flexibility and Earning Potential

Locum tenens rates in internal medicine can be highly competitive, especially for hospitalist roles and hard-to-staff locations.

Common financial benefits:

• Higher hourly or daily rates than many employed positions
• Travel and housing covered (or stipends)
• Potential for overtime and extra shift incentives
• Ability to negotiate rates directly or via your recruiter

For residents finishing internal medicine training, a year of focused locum work can:

• Jump-start loan repayment
• Provide a cash buffer before committing to a long-term job or fellowship
• Allow you to test different compensation models (wRVU-based, shift-based, salary + bonus)

2. Geographic and Lifestyle Flexibility

Locum work is ideal if you:

• Haven’t decided where you want to live long-term
• Have a spouse/partner whose career is flexible
• Enjoy travel and exploring new communities
• Want to live in one city but work periodically in another (e.g., high-paying rural sites)

As a travel physician, you can intentionally align assignments with lifestyle priorities—for example, coastal locations in the summer, ski towns in the winter, or major cities if you enjoy urban life outside of work.

3. Professional Exploration and Skill-Building

Locums exposes you to:

• Different EMR systems
• Diverse patient populations
• Varied practice cultures and resources
• Different hospital sizes—critical access vs. tertiary referral centers

This breadth of experience:

• Strengthens your adaptability and problem-solving
• Makes you more marketable for future permanent roles
• Helps clarify what you want (and don’t want) in a long-term practice

4. Reduced Administrative Burden

Many internal medicine locum tenens physicians cite:

• Less involvement in hospital politics
• Fewer meetings and committees
• Limited long-term administrative tasks, quality projects, or non-clinical demands

This allows you to focus on clinical care and reclaim mental bandwidth that might otherwise be spent on bureaucracy.

Challenges and Considerations

1. Lack of Longitudinal Relationships

In outpatient internal medicine, continuity relationships are often a major source of professional satisfaction. With locums:

• You may not follow patients over years
• Long-term management plans might be initiated by others
• You’re often an interim provider maintaining stability

Some internists find this limiting; others appreciate the clear boundaries and episodic nature of care.

2. Variable Support and Resources

Hospitals and clinics vary widely in:

• Staffing levels (nursing, case management, allied health)
• Consultant availability
• EMR efficiency
• On-site resources (ICU, specialties, imaging)

You need to:

• Be comfortable walking into new systems and quickly assessing support levels
• Advocate for safe staffing and appropriate scope of practice
• Decline assignments that expect unsafe coverage (e.g., high-acuity ICU without adequate backup)

3. Benefits, Insurance, and Taxes

Most locum tenens physicians are paid as independent contractors (1099). This has implications:

• No benefits by default (health insurance, retirement, disability)
• You are responsible for taxes—including quarterly estimated payments
• You must manage your own:
  • Health insurance (e.g., via spouse, ACA marketplace, or private plans)
  • Retirement accounts (SEP IRA, Solo 401(k), etc.)
  • Disability and malpractice "tail" when applicable

Some agencies offer limited benefits for high-volume physicians, but you should not assume benefits are comparable to full-time employed positions.

4. Credentialing and Licensing Complexity

Each assignment might require:

• Hospital medical staff credentialing
• State license (if new state)
• Payer enrollment (Medicare/Medicaid, private payers)

This process can take weeks to months, especially for your first few assignments. Over time, maintaining multiple active licenses can open more travel physician jobs but requires planning and organization.

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How to Get Started: From Residency to Locum Tenens

For internal medicine residents nearing the end of training, it’s entirely possible to transition directly into locum work post-IM match and graduation. The key is advanced planning.

1. Clarify Your Short- and Long-Term Goals

Ask yourself:

• Is locums my main career path, or a 6–24 month bridge?
• Am I considering fellowship, and if so, when?
• Do I want inpatient, outpatient, or hybrid roles?
• How important are geographic options vs. stability?
• Do I have personal commitments (family, partner, children) that limit travel?

Your answers will shape:

• Which positions you target
• What questions you ask recruiters and facilities
• How you structure your schedule and financial planning

2. Understand the Market and Compensation

Research typical rates and conditions for internal medicine locum tenens:

• Hospitalist: Often paid per shift or per day, with higher rates for nights, weekends, or ICU coverage.
• Outpatient: May be hourly, session-based, or daily rates; sometimes with productivity components.

When comparing offers, look beyond the headline rate:

• Is housing included or stipended?
• Are travel costs covered (airfare, mileage, rental car)?
• Is malpractice insurance (with tail coverage) provided?
• Are there guaranteed hours/shifts per contract period?

3. Work with Reputable Locum Agencies (or Direct Hire)

Most internists start locum work via agencies that:

• Market your CV to hospitals/clinics
• Negotiate rates and terms
• Assist with credentialing and licensing
• Arrange travel and housing

To choose an agency:

• Ask colleagues for recommendations
• Research online reviews and forums
• Speak with multiple recruiters; assess transparency and responsiveness
• Avoid signing overly restrictive non-compete or exclusivity agreements

Some large health systems also hire locums directly, especially for internal float pools. Direct hire may offer slightly higher rates (no middleman), but you’ll manage more logistics yourself.

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Evaluating and Negotiating Locum Assignments

Whether you’re a fresh graduate from internal medicine residency or an experienced attending, evaluating locum offers requires a structured approach.

Key Clinical Questions

Before accepting any assignment, clarify:

• Patient volume:
  • Average daily census (hospitalist)
  • Number of clinic patients per day
• Acuity and scope:
  • Do you manage ICU patients? Run codes?
  • Are procedures required (intubation, central lines, paracentesis)?
  • Is there intensivist or specialty backup on-site or via tele-ICU?
• Support staff:
  • Availability of NP/PA support
  • Nursing ratios and experience levels
  • Case management, social work, and pharmacy support
• Call responsibilities:
  • In-house vs. home call
  • Frequency and expected call volume

Red flags include vague answers, consistently unsafe-sounding volumes, or expectations clearly mismatched with your training and comfort level.

Contract and Logistics Considerations

When you receive an offer:

1. Compensation specifics

   • Rate (hourly/daily/shift) and overtime policies
   • Bonuses for extra shifts or holidays
   • Payment schedule (weekly, biweekly, etc.)

2. Scheduling and term

   • Length of commitment (weeks/months)
   • Minimum number of shifts per month
   • Cancellation policies (for both parties)

3. Malpractice coverage

   • Occurrence vs. claims-made coverage
   • If claims-made, who pays for tail coverage?
   • Limits and scope of coverage

4. Travel and housing

   • Who arranges housing? Quality and proximity to the workplace
   • Airfare and rental car vs. mileage reimbursement
   • Per diem or meal allowances (if any)

Negotiation Tips for Internists

Internal medicine is in demand, giving you leverage:

• Politely ask: “Is there flexibility in the rate given my [specific skills/ICU experience/board certification]?”
• Negotiate higher rates for nights, weekends, or additional responsibilities.
• If a site is remote or has challenging conditions, push for premium compensation or better schedule guarantees.
• Consider negotiating for:
  • Travel upgrades when longer-term
  • Dedicated time for orientation
  • EMR training before clinical start

Even small rate increases add up significantly over multiple shifts.

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Succeeding as a Locum Tenens Internal Medicine Physician

Once you secure assignments, the focus shifts to thriving clinically and professionally.

1. Master Rapid Adaptation

You’ll repeatedly walk into new systems. Develop a personal checklist for your first-day orientation:

• EMR basics (orders, notes, messaging, results review)
• Code blue protocol and rapid response contact methods
• How to reach consultants and primary teams
• Order sets for common diagnoses
• Signout and handoff processes
• How to contact radiology, pharmacy, case management

Take notes you can reference quickly. Be transparent about your newness; most teams appreciate locums who ask sensible questions early to avoid errors later.

2. Prioritize Patient Safety and Communication

In temporary roles, clarity matters even more:

• Communicate clearly in notes about follow-up plans and contingencies.
• Use read-back and closed-loop communication with nursing and consultants.
• For outpatients, ensure robust handoffs to permanent PCPs, including pending lab/imaging results.

You are an ambassador for locum physicians in general: professionalism and reliability help reduce stigma and build trust for future locum colleagues.

3. Build a Portable Professional Identity

Even as a locum tenens physician:

• Maintain an updated CV and procedure log.
• Keep a list of EMRs and hospital systems you’ve worked in—this is valuable if you later apply for permanent internal medicine positions.
• Collect written feedback or references from clinical leaders when possible.

If you decide later to pursue a permanent job or academic role, your locum experience can be framed as:

• Evidence of adaptability and broad clinical exposure
• Intentional exploration of practice settings
• Commitment to underserved or high-need areas

4. Protect Your Well-Being and Boundaries

Locum schedules can be intense, especially if you’re motivated to maximize income.

To sustain yourself:

• Build rest and recovery time between intense blocks.
• Set limits on maximum consecutive shifts or nights.
• Maintain routines (exercise, nutrition, sleep) even while traveling.
• Recognize early signs of burnout and adjust your schedule accordingly.

Remember: part of the appeal of locum tenens is control over your work life. Use that control intentionally.

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Strategic Use of Locum Tenens Across Your IM Career

Locum tenens isn’t an all-or-nothing commitment. Many internal medicine physicians weave locum work in and out of their careers.

During or Right After Residency

• Bridge to Fellowship: A one-year gap between IM residency and fellowship can be filled with locum hospitalist work, bolstering finances while maintaining clinical skills.
• Exploration Phase: Use locums in different regions (urban vs. rural, academic vs. community) to clarify what long-term role fits you best.

While Working Full-Time

• Work occasional locum weekends or short blocks to:
  • Supplement income
  • Maintain exposure to different practice environments
  • Test potential future employers before fully committing

Be transparent with your primary employer and ensure contracts allow external work.

Later Career or Semi-Retirement

• Gradually reduce permanent commitments while accepting targeted locum assignments:
  • Seasonal work (e.g., winters only)
  • Limited months per year
  • Less administrative burden, more pure clinical practice

This can be a dignified way to transition out of full-time internal medicine while preserving clinical impact and income.

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FAQs About Locum Tenens in Internal Medicine

1. Can I do locum tenens work immediately after internal medicine residency?

Yes. Many graduating residents go directly into locum tenens work as hospitalists or outpatient internists. You’ll need:

• An unrestricted state license (or multiple licenses)
• Board eligibility or certification in internal medicine
• Clean professional record for credentialing
• Willingness to adapt quickly to new systems

Starting your planning in your PGY-2 or early PGY-3 year ensures enough time for licensing and credentialing before graduation.

2. How does locum work affect future fellowship or permanent job applications?

Locum tenens experience is generally viewed neutrally to positively, especially when framed intentionally. To optimize perception:

• Maintain strong clinical references from supervising physicians or medical directors.
• Document your case mix, procedural skills, and systems exposure.
• Be ready to articulate why you chose locum work and what you learned from it (e.g., exposure to diverse populations, practice-style exploration).

Programs and employers typically value maturity, adaptability, and clear professional reasoning over a rigid, linear path.

3. Do locum tenens internal medicine physicians receive benefits?

Typically, no—or only limited benefits. Most are independent contractors (1099) and must:

• Purchase their own health insurance and disability coverage
• Set up individual retirement accounts (e.g., Solo 401(k), SEP IRA)
• Budget for taxes (often with the help of a tax professional)

A minority of agencies or large staffing companies offer benefit options, often contingent on maintaining a certain volume of work with them. Always compare these against what you could arrange independently.

4. Is locum tenens a viable long-term career in internal medicine?

Yes. Many internal medicine physicians build full, satisfying careers through locum tenens. Long-term viability depends on:

• Your tolerance for travel and change
• Ability to manage finances and benefits as an independent contractor
• Maintaining licenses and board certification
• Proactively guarding against burnout

Some internists blend longer-term recurring assignments at the same sites with occasional new locations, balancing continuity with variety.

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Locum tenens opportunities within internal medicine offer remarkable flexibility, earning potential, and professional growth. Whether you use locum work briefly after the IM match or build a full career as a travel physician, understanding the landscape—its benefits, risks, and logistics—allows you to design a career that truly aligns with your goals, values, and life outside of medicine.