Exploring Locum Tenens Opportunities in Orthopedic Surgery: A Guide

Understanding Locum Tenens in Orthopedic Surgery

Locum tenens roles have become a powerful career tool for orthopedic surgeons at every stage of training and practice. Whether you are a senior resident exploring travel physician jobs before committing to a long-term position, or an established attending looking to supplement income and maintain operative volume, locum work can offer flexibility and opportunity that traditional roles may not.

In orthopedic surgery, locum tenens physicians temporarily fill staffing gaps at hospitals, surgery centers, and clinics—sometimes for a weekend, sometimes for months at a time. Demand is strong across subspecialties: general orthopedics, trauma, joints, spine, sports, hand, and pediatric orthopedics.

For residency applicants and recent graduates focused on the orthopedic surgery residency and the ortho match, it’s useful to understand this pathway early. Locum tenens can shape your long-term career strategy, financial planning, and work–life balance.

What “Locum Tenens” Really Means

The term “locum tenens” is Latin for “to hold the place of.” In practice, that means:

• A hospital, private group, or academic department has coverage needs (vacation, maternity leave, retirement, backlog, or unfilled positions).
• A locum tenens orthopedic surgeon contracts (usually through a staffing agency, sometimes directly) to provide clinical services for a defined period.
• The facility pays a daily, hourly, or per-shift rate; the surgeon is typically an independent contractor rather than an employee.

Orthopedic locum assignments range from:

• Short-term: Weekend trauma call coverage, 1–2 week blocks.
• Medium-term: 3–6 month assignments to bridge recruitment.
• Long-term: Ongoing coverage with recurring blocks or “locums-to-perm” roles where you can test-drive a job before signing a full-time contract.

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Why Locum Tenens Appeals to Orthopedic Surgeons

Orthopedic surgeons are uniquely positioned to benefit from locum tenens opportunities. The combination of procedural skill, high demand, and variable local staffing makes ortho one of the most sought-after specialties in the locum market.

1. Financial Advantages

Locum tenens roles often pay competitively—sometimes more than employed positions on a per-day basis—especially for urgent needs or high-call environments.

Typical financial benefits include:

• Premium rates for scarcity
  Level I/II trauma centers, rural hospitals, and underserved areas may pay significantly higher rates to secure coverage.
• Extra income on top of a full-time job
  Some orthopedic surgeons pick up locum weekend call or short blocks to pay down loans or increase savings.
• Negotiable terms
  As an independent contractor, you can negotiate:
  • Daily or hourly rate
  • Call pay (in-house vs. beeper)
  • Extra compensation for high case volume or complex cases

Example:
A general orthopedic surgeon with trauma skills might work 7–10 locum days per month at a rural hospital, earning per-day rates plus call stipends that rival or exceed full-time compensation, while keeping part-time clinic time at home.

2. Flexibility and Control Over Your Schedule

Locum work can support a variety of life and career goals:

• Control over when and where you work
  Choose assignments around family needs, academic interests, or time off for travel.
• Protected time between assignments
  You decide when to accept or decline new contracts—great for preventing burnout.
• Transition tool
  Ideal between fellowship and your first permanent job, during relocation, or after leaving a long-term position without rushing into the next.

3. Clinical Variety and Skill Maintenance

Orthopedic locum tenens physicians often see a broad range of pathology:

• Rural settings may require broad general orthopedics: fractures, basic sports, joints, and trauma.
• Regional or tertiary centers may focus on high-acuity trauma or subspecialty elective work.

Benefits include:

• Exposure to different practice patterns and systems
• Maintaining or expanding procedural skills, especially if your home practice is narrowly focused
• Understanding regional differences in injury patterns and healthcare resources

This can be particularly valuable early in your career—after orthopedic surgery residency or fellowship—when you’re cementing surgical judgment and preferences.

4. Geographic Exploration and Lifestyle

Locum tenens aligns well with travel physician jobs:

• Test-drive living in different parts of the country before committing to a permanent role.
• Experience different hospital cultures: academic centers, community hospitals, critical access sites.
• Pair assignments with personal interests—mountain town skiing, coastal communities, or proximity to family.

For residents entering the ortho match, awareness of this pathway can relieve pressure: you are not locked forever into your first attending job or geography.

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When Locum Tenens Makes Sense in an Orthopedic Career

Locum tenens can fit at multiple career stages. Understanding timing helps you plan strategically, especially as you move through orthopedic surgery residency and beyond.

During and Immediately After Training

Although residents cannot work independently as locum tenens physicians until fully licensed and board-eligible, planning can start early:

• PGY-3 to PGY-5 (Senior Residents)
  • Learn about credentialing, licensure, and malpractice basics.
  • Network with attendings who do locum work.
  • Rotate at different practice sites to see how systems vary.
• Fellowship Year
  • Consider where you may want to work short-term post-fellowship.
  • Familiarize yourself with agencies and state licensure timelines.

Early attending phase (Years 1–5):

Locum work is most common here when:

• You want to bridge fellowship and first permanent job.
• You are still deciding between community, academic, or hybrid practice.
• You seek extra operative exposure to build volume and confidence.
• You want financial flexibility (loans, home purchase, family needs).

Mid-Career Orthopedic Surgeons

For mid-career surgeons, locum tenens can:

• Provide relief from burnout: stepping away from partnership politics, admin roles, or RVU pressure.
• Allow part-time or seasonal work (e.g., 7-on/7-off call coverage).
• Facilitate relocation while maintaining income during job searching.
• Offer test runs at new practice environments before signing a contract.

Late Career and Pre-Retirement

Senior orthopedic surgeons may use locum tenens to:

• Gradually reduce workload while remaining clinically active.
• Maintain procedural skills and income with selective, flexible assignments.
• Share decades of expertise in resource-limited or rural settings where mentorship is highly valued.

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Types of Orthopedic Locum Tenens Assignments

Orthopedic surgery is not monolithic; different locum setups will better fit your skill set, comfort level, and goals.

1. General Orthopedics vs. Subspecialty-Focused

General Orthopedic Locums

• Common in rural and community hospitals.
• Expect:
  • Fracture management (upper and lower extremity)
  • Basic sports (meniscal tears, simple shoulder pathology)
  • Bread-and-butter hand and foot/ankle
  • Non-complex joint replacements depending on site

Subspecialty-Focused Locums

• More common in larger centers or regions with known shortages.
• Examples:
  • Trauma: Level I/II trauma centers needing acute fracture and polytrauma management.
  • Joints: High-volume centers needing extra arthroplasty coverage.
  • Spine: Filling gaps for spine call and elective cases.
  • Sports/Hand/Peds: Often elective-block intensive, with carefully arranged clinic and OR schedules.

Identify and present your skill set clearly when speaking to recruiters—knowing your comfort scope is critical for patient safety and satisfaction.

2. Call-Heavy vs. Elective-Focused Assignments

Not all locum tenens roles look the same day-to-day.

Call-Heavy Assignments

• Typical in small or mid-sized hospitals, especially in underserved regions.
• Features:
  • 24-hour call coverage, possibly in 7–14 day stretches.
  • High fracture volume, on-the-fly decision-making.
  • Less clinic, more emergent and urgent cases.
• Best suited for:
  • Surgeons comfortable with broad trauma.
  • Those seeking high-intensity, short-duration work blocks.

Elective-Focused Assignments

• More common in large group practices or subspecialty centers.
• Features:
  • Scheduled clinic days and block OR time.
  • Planned arthroplasty, sports, or other elective cases.
  • Limited or no overnight ED call.
• Best suited for:
  • Surgeons with strong elective subspecialty practices.
  • Those prioritizing predictable daytime schedules.

Often, real-world assignments blend both: daytime elective work plus some level of call.

3. Short-Term vs. Long-Term Locum Contracts

Short-Term (Days to Weeks)

• Weekend call coverage.
• Vacation or parental leave backup.
• Good for:
  • Surgeons keeping a primary full-time job.
  • Trying locum work on a small scale first.

Medium-Term (1–6 Months)

• Bridge staffing gaps during recruitment.
• Offers more integration: established clinic templates, consistent OR days.
• Great for:
  • Early attendings exploring new regions.
  • Surgeons between jobs needing sustained income.

Long-Term / Locums-to-Perm

• Ongoing coverage where both sides are exploring a permanent fit.
• A low-risk way to:
  • Evaluate hospital culture, referral patterns, and volume.
  • Assess real compensation and work-life balance before signing.

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How to Get Started in Orthopedic Locum Tenens

If you are considering locum work—now or after residency—there are several practical steps to take.

1. Clarify Your Clinical Scope and Comfort Zone

Before any contract discussion:

• List:
  • Procedures you perform independently and frequently.
  • Procedures you can do but prefer not to be primary for.
  • Procedures you will not do in a locum context (e.g., complex revisions, pelvic/acetabular trauma, certain spine pathologies if out of your usual practice).
• Be transparent with:
  • Recruiters
  • Medical staff offices
  • Department chairs or service line leaders

Overpromising and underdelivering can harm both patient care and your reputation.

2. Licensing, Credentialing, and Malpractice

State Licensure

• Each state has its own medical board and timeline; some are fast (weeks), others slow (months).
• For travel physician jobs, consider:
  • Obtaining multiple state licenses in regions where you’d like to work.
  • Using services that manage licensure paperwork (some agencies cover this).

Hospital Credentialing and Privileging

• Expect to provide:
  • CV with gap explanations
  • Training documentation (medical school, orthopedic surgery residency, fellowship)
  • Case logs for procedures you will perform
  • References from program directors or colleagues
  • Board eligibility/certification documentation (ABOS or equivalent)
• Timeline:
  • 60–120 days is common; plan ahead and keep documentation organized.

Malpractice Coverage

Typical models:

• Most locum tenens agencies provide claims-made coverage for your assignments.
• Confirm:
  • Policy limits (often $1M / $3M or state-specific).
  • Whether tail coverage is included or needed.
  • Coverage for telehealth or remote consults, if applicable.

If contracting directly with a hospital or group, malpractice may be separate and negotiable.

3. Working with Locum Tenens Agencies

Most orthopedic locum tenens physicians partner with agencies that:

• Match your skills and preferences to open jobs.
• Assist with licensure, credentialing, travel arrangements, and scheduling.
• Negotiate rates on your behalf.

When evaluating agencies:

• Ask:
  • How many orthopedic surgery jobs they currently staff.
  • What types of hospitals they work with (trauma level, academic vs. community).
  • Whether they have in-house credentialing teams.
• Compare:
  • Pay rates.
  • Travel and housing policies.
  • Malpractice terms.
• Watch for:
  • Restrictive non-compete clauses that limit future work in certain regions.
  • Lack of clarity around cancellation terms or schedule changes.

You can (and often should) work with more than one agency, as long as you’re transparent about which facility each is submitting you to, to avoid duplicate submissions.

4. Evaluating an Orthopedic Locum Assignment

Before you agree to an assignment, ask detailed, orthopedic-specific questions:

About the Hospital and Practice Setting

• What is the trauma level and annual ED volume?
• Are you the only orthopedist on call? Is backup available?
• What subspecialists are on site (vascular, plastics, neurosurgery, etc.)?
• What is the anesthesia coverage like (24/7 availability, block times)?

About Clinical Expectations

• Typical daily workload:
  • Average consults per 24-hour call.
  • Typical number and type of cases per day.
• Cases you are expected to handle vs. transfer:
  • Complex pelvic/acetabular fractures.
  • Major spine trauma.
  • Severe open fractures requiring microvascular reconstruction.
• Clinic structure:
  • New vs. follow-up patient ratio.
  • Support staff (PAs, NPs, MAs, scribes).

About Logistics and Support

• OR resources:
  • Available implant vendors and systems.
  • Imaging (fluoro, CT, MRI) and after-hours access.
• Call logistics:
  • In-house vs. home call.
  • Average response time expectations.
• Documentation:
  • EMR system (Epic, Cerner, etc.).
  • Templates available for operative notes and consults.

About Contract Terms

• Rate (daily, hourly, or per-24-hour call).
• Call pay structure, if separate.
• Guaranteed minimum hours or days.
• Cancellation policy (what happens if the hospital cancels late?).
• Payment timeline (how soon you’re paid after submitting timesheets).

Put everything in writing—verbal assurances should match the contract.

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Practical Tips for Success as an Orthopedic Locum Tenens Physician

Locum tenens work demands strong clinical skills and adaptability. These strategies can help you thrive.

1. Build a Portable Professional Toolkit

Have a “locum-ready” package of:

• Updated CV with clear chronology.
• Case logs highlighting your key procedures.
• Digital copies of:
  • Medical license(s)
  • DEA registration
  • Board certificate/eligibility letter
  • ACLS/BLS/ATLS (if required)
• Reference list (program director, department chair, senior colleagues).

Keep these organized and easily shareable with credentialing teams.

2. Prepare for New Systems Quickly

You’ll frequently adapt to new:

• EMR systems
• OR workflows
• Clinic layouts
• Nursing and ancillary staff cultures

To ramp up efficiently:

• Ask for EMR training sessions (even brief) before or upon arrival.
• Request sample order sets and note templates from local surgeons.
• Spend your first half-day walking through:
  • OR storage and equipment.
  • Clinic infrastructure and imaging process.
  • ED triage and consult workflows.

Taking the initiative early smooths the rest of the assignment.

3. Communicate Clearly With Local Teams

Professional communication is crucial when you are “the new person”:

• Introduce yourself to:
  • ED staff and nurses.
  • OR nurses, techs, and anesthesia.
  • Radiology and physical therapy teams.
• Clarify:
  • How you prefer to be contacted (pager, phone, secure text).
  • Your expectations for fracture reductions, splinting, and pre-op workups.
• Be transparent about your practice style; document thoroughly, especially in complex trauma.

Done well, you’ll rapidly become trusted, which makes locum work much more pleasant and efficient.

4. Maintain Quality and Continuity of Care

Continuity is a common concern with locum tenens, especially in surgery.

Mitigate risks by:

• Documenting clear operative notes and post-op plans.
• Leaving structured sign-outs for local surgeons or the next locum.
• Using standardized post-op orders and protocols when possible.
• Communicating with outpatient PT/OT teams for complex cases.

Ask about local follow-up systems: who will see the patients you operate on if you leave? Align your treatment choices with what local surgeons can reasonably manage long term.

5. Protect Your Well-Being and Boundaries

Orthopedic locum tenens roles can be intense, particularly call-heavy assignments.

Protect yourself by:

• Understanding realistic call expectations and saying no to unsafe workloads.
• Prioritizing rest between call shifts.
• Scheduling time off between locum blocks to avoid burnout.
• Setting financial and professional goals: know when “enough” is enough.

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FAQ: Orthopedic Locum Tenens for Residency Applicants and Early-Career Surgeons

1. Can I do locum tenens work right after orthopedic surgery residency or fellowship?
Yes, many newly trained, board-eligible orthopedic surgeons start with locum tenens work. You’ll need an unrestricted medical license, DEA registration, and hospital privileges. Some facilities prefer or require board certification, but many accept board-eligible candidates, especially in high-demand areas. Strong case logs and references from training are essential.

2. Is locum tenens experience viewed negatively when applying for permanent orthopedic jobs?
In most cases, no. Many employers respect locum experience, especially when it shows adaptability and high case volumes. To keep your CV attractive:

• Avoid very short, repeated assignments without clear reason.
• Be ready to explain what you gained from each post.
• Show continuity (e.g., repeated contracts at the same site, or progression to a permanent role).

3. How does compensation for locum tenens compare to a permanent orthopedic job?
Per-day or per-call rates are often higher in locum roles, particularly in high-need regions. However:

• You may not receive benefits (health insurance, retirement matching, paid vacation).
• Income can be less predictable if you take time off between assignments. Many orthopedic surgeons use locum work strategically—either as their primary income with intentional breaks, or as a supplement to a core permanent job.

4. Should I think about locum tenens while I’m still in the ortho match and residency application phase?
Yes—at least conceptually. While your primary focus now is the orthopedic surgery residency and matching well, understanding that locum tenens physician roles exist can:

• Reduce anxiety about your long-term options.
• Help you frame questions during residency interviews about case volume and autonomy (which affect later marketability for locums).
• Inform how you build your skills during training—broad general competency and trauma versatility are particularly valuable in locum settings.

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Locum tenens opportunities in orthopedic surgery offer a flexible, financially strong, and professionally rich pathway—whether as a full-time career model, a bridge between jobs, or a supplement to permanent practice. By understanding the structure, demands, and strategies for success in locum work, you can integrate it thoughtfully into your overall orthopedic career plan.