Exploring Locum Tenens Opportunities in Medicine-Psychiatry: A Guide

Locum tenens work is no longer just for late-career physicians or those “in between” jobs. For residents and early attendings in medicine-psychiatry combined training (med psych residency), it can be a powerful tool to explore practice settings, build financial stability, and maintain flexibility in a niche but growing field.

This guide walks you through locum tenens opportunities in Medicine-Psychiatry—what they look like, where to find them, and how to decide if they fit your career and your residency-to-attending transition plan.

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Understanding Medicine-Psychiatry and Why Locums Fit So Well

Med-psych physicians are trained at the intersection of internal medicine and psychiatry, with competencies in:

• Complex medical patients with comorbid severe mental illness
• Inpatient consult-liaison services
• Integrated primary care and behavioral health
• Addiction and psychosomatic medicine
• Population health approaches for high-utilizer, high-need patients

Because of this dual skill set, med-psych physicians bring rare value to healthcare systems—and rare value is exactly what drives demand in locum work.

Why healthcare organizations seek med-psych locums

Hospitals and clinics increasingly struggle with:

• High psychiatric comorbidity on medical floors
• Boarding psychiatric patients in EDs
• Limited access to psychiatrists for medically complex patients
• Fragmentation between medical and behavioral health services

A medicine-psychiatry locum can instantly expand capacity by:

• Covering both internal medicine and psychiatry call
• Running integrated clinics (e.g., for SMI with metabolic syndrome)
• Supporting med-psych inpatient units or consult services
• Bridging staffing gaps during faculty or staff transitions

For you, that translates into unique leverage in negotiating:

• Higher rates than “single-specialty” colleagues in similar settings
• Better control over scope of practice (med only, psych only, or true combined)
• More choice of assignments aligned with your interests

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Types of Locum Tenens Roles for Medicine-Psychiatry Physicians

Locum tenens opportunities for med-psych physicians tend to fall into several patterns. Understanding them helps you decide what fits your training, comfort level, and long-term goals.

1. Pure Psychiatry Locums (Leveraging Your Dual Training)

Most locum tenens opportunities in this niche are advertised as psychiatry roles—even if your combined background is exactly why you’re hired.

Common psychiatry-focused locum settings:

• Inpatient psychiatry units (community or academic)
• Consult-liaison psychiatry services
• Emergency psychiatry and PES/CRU coverage
• Outpatient psychiatry clinics (SMI, mood/anxiety, geri-psych, etc.)
• Telepsychiatry (for rural clinics, crisis services, or follow-up visits)

How your med-psych background adds value:

• You handle medically complex patients more confidently (e.g., CHF + schizophrenia)
• You communicate efficiently with hospitalists and internists
• You’re comfortable with medical workup of psychiatric presentations

These roles are often a good starting point because:

• Credentialing is straightforward (psychiatry privileges)
• Workflows are familiar from residency rotations
• You build strong outpatient or inpatient psych experience if that’s your primary interest

2. Pure Medicine Locums with “Behavioral Plus”

Another major category is hospitalist or outpatient internal medicine jobs that tacitly rely on your psychiatric expertise.

Settings include:

• Hospitalist services with high psychiatric comorbidity
• Medical wards needing leadership in managing agitation/delirium
• Primary care clinics with embedded behavioral health needs
• Addiction medicine or complex care clinics

Typical expectations:

• You are boarded/board-eligible in internal medicine (or about to be)
• You function as a standard hospitalist or outpatient internist
• Informally, you’re consulted constantly for “behavioral questions,” med management of psychotropic polypharmacy, and complex capacity assessments

These positions can be satisfying if you:

• Enjoy the internal medicine workflow
• Want to keep your medical skills current
• Are comfortable setting boundaries when psychiatric consults start to consume your day

3. True Combined Medicine-Psychiatry Locums

These are less common but increasingly emerging, especially around:

• Med-psych inpatient units (co-managed medical and psychiatric care)
• Integrated clinics (HIV + psych, SMI metabolic clinics, VA integrated care)
• Academic roles needing med-psych faculty for hybrid services

In true combined locum roles, you might:

• Admit patients with both acute medical and acute psychiatric needs to the same service
• Manage both insulin and antipsychotics, both delirium and sepsis
• Work with interdisciplinary teams (nursing, social work, OT/PT, pharmacy) trained to handle complex dual diagnoses

Because the candidate pool is small, these medicine psychiatry combined roles can be highly negotiable in:

• Schedule
• Compensation
• Scope of practice
• Academic/teaching components

But they may also:

• Require longer commitments (e.g., 6–12 months)
• Be concentrated at specific med-psych programs or VAs

4. Hybrid Academic and Locum Arrangements

For residents transitioning into faculty roles, an appealing approach is a hybrid model:

• 0.5–0.8 FTE academic appointment
• 0.2–0.5 FTE locum work (often over weekends or compact blocks)

Benefits:

• Stable base salary and mentorship
• Protected time for research/education
• Extra locum income to pay down loans or build savings
• Flexibility to explore various systems before locking into a long-term job

This is particularly common at institutions that are:

• Understaffed in both medicine and psychiatry
• Building or expanding integrated care lines
• Supportive of faculty doing outside work with appropriate approvals

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When Locum Tenens Makes Sense in Your Med-Psych Career Path

Locum tenens isn’t “all or nothing.” It can play different roles at different phases of training and practice.

During Residency and Immediately Post-Residency

Many med-psych residents start thinking about locum work in PGY-4 or PGY-5, especially with:

• Rising educational debt
• Curiosity about geographic or practice variation
• Uncertainty about committing to a long-term position

Key timing considerations:

• Most agencies and hospitals require board eligibility or at least completion of core training years for independent practice
• Moonlighting within your own institution is often the first step before external locum tenens roles
• External locums during residency must comply with duty-hour, GME, and malpractice regulations

Strategic uses in this phase:

• Use short-term travel physician jobs to explore cities or regions where you might apply for permanent positions
• Test whether you prefer inpatient vs outpatient, academic vs community
• Build a financial cushion before graduation

Early-Career Attendings (Years 1–5)

For early attendings, locum tenens can be:

• A bridge between fellowship and a permanent job
• A trial period in different practice settings before deciding on a home institution
• A primary career model—especially for those who want travel and flexibility

Advantages at this stage:

• You can be paid competitively relative to your years of experience because of your rare combined training
• You can avoid early “golden handcuffs” that make future transitions harder
• You can selectively choose assignments that strengthen your CV for future med-psych leadership roles

Challenges:

• Lack of long-term mentorship from a single system
• Need to self-direct CME, board maintenance, and career development
• Potential for burnout if you accept high-intensity assignments back-to-back

Mid- and Late-Career Physicians

By mid-career, some med-psych physicians pivot into locum tenens for:

• More control over schedule (e.g., blocks of time off for family or projects)
• Geographic flexibility (e.g., to live in one state and work periodically in others)
• Transitioning away from administrative roles or heavy leadership burdens

Some late-career physicians use locums to:

• Gradually taper clinical hours
• Focus on specific kinds of work they enjoy (e.g., strictly consult-liaison or integrated outpatient)
• Give back to underserved or rural communities without relocating permanently

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Practical Steps to Getting Started as a Med-Psych Locum Tenens Physician

Transitioning from resident or faculty to a locum tenens physician in medicine-psychiatry involves several deliberate steps.

1. Clarify Your Scope: Medicine, Psychiatry, or Both?

Before talking with recruiters or employers, be explicit with yourself about:

• Are you seeking psychiatry-only roles?
• Medicine-only?
• Or truly combined positions where both skill sets are active?

Consider:

• Your board status (boarded/BE in IM, psych, or both)
• What you enjoy most day-to-day
• How recent and robust your experience is in each area

Write a 3–4 sentence “scope statement” (for yourself and recruiters), such as:

“I am a board-eligible med-psych graduate interested in inpatient psychiatry and consult-liaison roles, with the ability to comanage medical issues for complex psychiatric inpatients and provide cross-coverage on internal medicine when needed.”

This clarity pays dividends in matching you with the right opportunities.

2. Decide How You Want to Work: Agency vs Direct Contracting

Most physicians begin locum work through staffing agencies, but med-psych specialists sometimes benefit from direct conversations with interested institutions.

Agency-mediated locums:

Pros:

• Easier onboarding—agency handles search, credentialing, logistics
• Broader nationwide access to assignments
• Negotiation assistance for rates, housing, and travel

Cons:

• Agency takes a margin from your bill rate
• Some assignments may not fully utilize your combined skill set

Direct contracting with hospitals or groups:

Pros:

• Potentially higher direct pay
• More control over contract terms and role design
• Easier to create a truly medicine psychiatry combined role around local needs

Cons:

• You handle negotiation, legal review, and sometimes travel logistics
• Limited geographic breadth unless you network aggressively

Many med-psych physicians use a hybrid approach: start with agencies to learn the landscape, then pursue direct arrangements with systems that clearly see your unique value.

3. Understand Licensure, Credentials, and Malpractice

Core administrative considerations:

• State licensure: For travel physician jobs, a multi-state strategy (and, if applicable, interstate medical licensure compact) can widen your options.
• Board certification/eligibility: Clarify how your dual training appears on CVs and credentialing forms.
• DEA and state-specific prescribing requirements: Especially if working in addiction, pain, or telepsychiatry.
• Malpractice coverage:
  • Who provides it? (Agency, hospital, or self-insured?)
  • Occurrence vs claims-made policy
  • Tail coverage if needed

For med-psych roles, ensure that your malpractice descriptions explicitly include both medicine and psychiatry if you’ll be practicing both.

4. Evaluate Locum Offers with a Med-Psych Lens

When evaluating offers, ask targeted questions:

Scope and setting:

• Is the role psychiatry-only, medicine-only, or combined?
• Who admits the patient—medicine, psychiatry, or a med-psych team?
• What percentage of patients have serious medical comorbidity vs primarily psychiatric needs?

Workload:

• Typical census (inpatient) or visits per day (outpatient)
• Night call structure and backup
• Expectations for cross-coverage between medicine and psychiatry services

Support and resources:

• Availability of other psychiatrists, hospitalists, and subspecialists
• Nursing experience with dual-diagnosis/medically complex psych patients
• Access to integrated behavioral health or social work support

Safety and boundaries:

• How are violent or highly agitated patients handled?
• Clear policies for involuntary holds, restraints, and capacity determinations
• Limits on prescriptive authority (e.g., clonazepam or stimulants in specific systems)

Contract terms:

• Rate (hourly or per diem) and overtime structure
• Travel and housing benefits
• Cancellation and termination clauses
• Non-compete or no-poach language that could affect future opportunities

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Financial, Lifestyle, and Career Implications of Med-Psych Locums

Locum tenens offers a distinctive blend of financial upside and lifestyle control, with career trade-offs to consider carefully.

Financial Considerations

Typical pay patterns:

• Locums psychiatry rates often exceed standard salaried positions, especially for inpatient and high-demand regions.
• Internal medicine hospitalist locums can be highly competitive, particularly with nights or ICU coverage.
• As a dual-trained physician, you may command premium rates if the role explicitly uses both skill sets (consult-liaison med-psych units, high-acuity integrated services).

Key strategies:

• Compare locum rates to total compensation for permanent roles (including benefits, retirement, loan repayment).
• Track effective hourly rates including charting and after-hours responsibilities.
• If doing substantial locum work, meet with a tax professional about:
  • Entity structure (e.g., LLC vs S-corp, if beneficial in your region)
  • Quarterly estimated taxes
  • Deductible expenses (travel, licensing, CME, home office for telepsychiatry)

Lifestyle and Flexibility

Locums can be tailored to different life stages:

• High intensity, high earning: Back-to-back inpatient assignments, frequent call, maximizing savings or loan repayment.
• Balanced and flexible: 1–2 weeks per month on assignment, remainder at home, with time for family, projects, or academic work.
• Geography-focused: Sequential assignments in one region to explore living there without a permanent commitment.

Med-psych-specific advantages:

• You can shift between medicine-focused and psych-focused locum periods depending on personal energy, interests, and market demand.
• Your dual skill set may allow shorter or more targeted blocks to be highly impactful for systems, giving you bargaining power for schedule customization.

Career Growth and CV Building

Done thoughtfully, locum work can support long-term career goals:

• Exposure to different care models (FQHCs, VAs, academic centers, private systems)
• Diverse clinical experience that strengthens your med-psych credibility
• References from multiple settings and mentors

Ways to avoid downsides:

• Keep a structured CV that clearly organizes locum assignments by type, dates, and scope (medicine, psychiatry, combined).
• Maintain continuity with at least one institution if possible, even in a locum capacity, to avoid the perception of constant job-hopping.
• Seek chances to contribute beyond clinical work (teaching residents, protocol development, quality improvement) and document these contributions.

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Special Considerations for Med-Psych Physicians Considering Locum Work

Your combined training creates some additional nuances.

Preventing Deskilling in Either Discipline

If you lean heavily into psychiatry locums, your internal medicine skills can atrophy—and vice versa.

Practical solutions:

• Alternate assignment types: e.g., 3–6 months heavy psych, then a hospitalist block.
• Engage in CME across both specialties consistently.
• Periodically take on consult-liaison or integrated roles to exercise both sides of your training.

Advocating for True Combined Work Where You Want It

Many hiring managers and locum coordinators have never worked with a medicine-psychiatry physician before. You may need to teach them what you can do:

• Share a short, plain-language description of med-psych training.
• Provide examples of previous combined roles:
  • Managed SMI patients with active CHF/COPD on integrated units
  • Ran metabolic syndrome clinics for antipsychotic-treated patients
  • Created delirium prevention protocols for psychiatric inpatients with complex medical comorbidities
• Propose pilots: short locum stints that demonstrate the value of med-psych coverage to both medicine and psychiatry services.

Protecting Your Boundaries and Well-being

Because you have both skill sets, institutions may be tempted to “stretch” your role:

• Covering both medicine and psychiatry simultaneously without adequate support
• Informal curbside consults that become de facto cross-coverage
• High-risk medicolegal situations (e.g., sole attending responsible for both ICU-level care and involuntary psychiatric holds)

You can set boundaries by:

• Clarifying role limits in writing before starting
• Requesting explicit backup structures for high-risk areas
• Saying no to unsafe coverage expectations, especially early in your locum relationship with a site

Thinking Long-Term: How Locums Shape Your Future in Med-Psych

Locum tenens can be:

• A short-term tactic (income, exploration)
• A medium-term lifestyle choice
• Or a long-term career model

For medicine-psychiatry physicians, it can also become a strategic tool to:

• Identify systems that genuinely value integrated care before committing permanently
• Build experience that positions you for:
  • Med-psych unit directorship
  • Integrated care program leadership
  • Academic roles in consult-liaison or combined residency programs

Think consciously about:

• What you want your 5–10-year med-psych career narrative to be
• How each locum assignment contributes to that story

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FAQs: Locum Tenens in Medicine-Psychiatry

1. Can I do locum tenens work right after completing a med-psych residency?

Yes, many new graduates start locum assignments immediately after residency. Most organizations require you to be:

• Board-eligible (or already board-certified) in at least one discipline (IM or psychiatry)
• Fully licensed in the state of practice
• Clear on malpractice coverage arrangements

Starting with shorter roles or within familiar systems (e.g., your training institution’s affiliates) can ease the transition from resident to attending.

2. Will locum work hurt my chances of landing a permanent med-psych faculty or hospital role later?

Not inherently. In fact, thoughtfully chosen locum experiences can:

• Demonstrate adaptability and exposure to diverse systems
• Strengthen your clinical depth in complex populations
• Provide strong references from multiple settings

What can raise questions is frequent, unexplained short stints. Keep your CV organized, clarify the nature of each assignment, and be ready to explain how your locum work has been intentional and growth-oriented.

3. Are there many true “medicine psychiatry combined” locum jobs, or will I mostly be doing one specialty?

Currently, most locum listings fall into psychiatry-only or medicine-only categories, with combined roles less common but growing. That said:

• Institutions often informally use your med-psych expertise even in single-specialty assignments.
• You can sometimes shape a role into a more integrated one by clearly explaining your training and proposing a combined model (e.g., helping start a med-psych unit or integrated clinic).
• VA systems, academic centers with med-psych tracks, and large hospital systems are more likely to create formal combined positions.

4. How does locum tenens compare financially to a permanent med-psych job?

In many markets, locum tenens compensation:

• Is higher on a per-hour or per-shift basis than permanent roles
• Often lacks employer-paid benefits like retirement matches, paid leave, or health insurance
• Involves variable income depending on your schedule and assignments

Over a year, some full-time locum physicians earn significantly more than counterparts in permanent roles, especially if they take high-intensity or rural assignments. But you must account for:

• Self-funded benefits and insurance
• Time off between assignments
• Travel and housing considerations

For a medicine psychiatry combined physician, your rare skill set can enhance negotiating power both for locum and permanent positions. A financial advisor familiar with physician careers can help you model scenarios and long-term implications.

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Locum tenens can be a powerful way for medicine-psychiatry physicians to align their skills, values, and lifestyle. By understanding the landscape, clarifying your preferred scope of practice, and advocating for integrated roles that match your training, you can turn locum work into a strategic asset—not just a stopgap—on your med-psych career path.