Locum Tenens in Preliminary Medicine: A Comprehensive Guide for Residents

Understanding Locum Tenens in the Context of a Preliminary Medicine Year

For residents completing or planning a preliminary medicine year, the idea of locum tenens work can be both exciting and confusing. You may have heard about travel physician jobs, high pay, and flexible schedules, but you may also be wondering whether prelim IM training is enough to qualify, what kinds of assignments exist, and how this fits with your long-term residency and fellowship goals.

Locum tenens (Latin for “to hold the place of”) refers to temporary physician staffing—filling in for permanent clinicians who are on leave, covering staffing gaps, or helping hospitals meet surge demand. While traditionally associated with fully trained internists, hospitalists, and subspecialists, there is a growing—but nuanced—set of opportunities for physicians who have completed or are in the middle of a preliminary medicine year.

This guide breaks down:

• What locum tenens looks like for prelim-trained physicians
• When during your career it’s realistic and appropriate
• How to evaluate offers, avoid pitfalls, and stay aligned with your training goals
• Practical steps to plan a locum strategy that makes sense for you

Throughout, we’ll use “preliminary medicine year” and “prelim IM” to reference the same training context: a one-year internal medicine position, often prior to advanced training in neurology, anesthesiology, radiology, PM&R, dermatology, or another specialty.

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1. Can You Do Locum Tenens with Only a Preliminary Medicine Year?

The starting point is eligibility. Most locum tenens postings you see online assume:

• Completed residency in internal medicine (or family medicine/hospitalist track)
• Board eligibility or certification
• Independent practice capability with minimal supervision

This immediately raises two questions for prelim residents:

1. Can I do locum work during my preliminary medicine year?
2. Can I do locum tenens after finishing prelim IM but before an advanced residency?

During Your Preliminary Medicine Year

In almost all cases, you cannot work as an independent locum tenens physician during your prelim year. Reasons include:

• You are still a trainee requiring supervision
• You almost certainly lack an unrestricted medical license in multiple states
• Malpractice coverage is structured through your residency program, not for independent practice
• Hospital privileging systems require attending-level credentials and references

However, there are a few realistic opportunities adjacent to classic “locum tenens”:

• Moonlighting within your training institution

  • Some PGY-2+ residents (and occasionally late PGY-1s) can pick up extra shifts as supervised moonlighters, often in cross-cover or night float roles. This is not true locum tenens but can feel similar (extra income, shift-based work).
  • Most prelim IM residents are not eligible early in the year and may only be eligible later, depending on institutional policies and performance.

• Per diem/PRN work after hours (rare at PGY-1 level)

  • A few states and health systems allow senior residents to work extra shifts as per diem clinicians under structured supervision. Again, this is not classic locums, and you must strictly adhere to ACGME duty hour rules and program policies.

Key takeaway: During your preliminary medicine year, focus on training quality and future specialty match. Treat “locum curiosity” as planning research, not an immediate work option.

After Completing a Preliminary Medicine Year

This is where the possibilities open slightly, but with significant caveats.

To work as an independent locum tenens physician in internal medicine or hospital medicine, most agencies and facilities expect:

• Completion of a full categorical IM residency (three years)
• Or completion of another primary specialty with comparable scope
• Board-eligible or board-certified status
• Independent licensure and credentialing

If you have only a preliminary medicine year and do not progress to an advanced residency, your options include:

1. Non-physician roles (e.g., research, administrative, quality improvement)

   • Not locum tenens, but occasional short-term contracts exist.

2. Telemedicine or urgent care roles where supervision is built-in

   • These are rare and usually still require completion of residency or board eligibility.

3. Limited, niche hospital or clinic roles in underserved areas

   • A small number of employers may consider a physician with 1–2 years of GME and strong references, especially if local regulations allow it.
   • Pay is often lower, malpractice expectations are complex, and supervision structures can be unclear.
   • Many locum agencies will not place you in these roles because of risk and credentialing barriers.

Practical reality: For most physicians, the best locum tenens opportunities as a “travel physician” come after you complete full residency training, not after only a prelim year. However, your preliminary medicine experience is extremely valuable in setting you up for those future roles.

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2. How Your Preliminary Medicine Year Sets You Up for Future Locum Work

Even if locum tenens isn’t an immediate option, your prelim IM training year can be one of the strongest foundations for later locum work in hospital medicine, internal medicine, or subspecialties. Understanding this can help you intentionally shape your experiences.

Skills that Translate Directly to Locum Tenens

Locum tenens physicians—especially in internal medicine—are valued for their ability to:

• Quickly adapt to new hospitals, EMRs, and workflows
• Manage high-acuity, undifferentiated adult patients
• Work nights, weekends, and understaffed periods
• Communicate clearly with new teams and consultants
• Provide safe, evidence-based care despite limited familiarity with the local system

A strong preliminary medicine year naturally develops these skills if you prioritize:

• Robust inpatient exposure: ward, ICU step-down, night float, cross-cover
• Procedural competence where allowed: paracentesis, thoracentesis, central line (if in scope)
• Rapid clinical reasoning for common presentations: chest pain, shortness of breath, sepsis, altered mental status, DKA, GI bleed
• Interdisciplinary communication: nurses, case managers, social workers, consultants

Every time you rotate to a new service or site, you are essentially “test-driving” the adaptability muscle that future travel physician jobs require.

Building a Locum-Oriented CV During Prelim IM

If you think you might want to do locum tenens after full residency, use your prelim year strategically:

1. Request strong inpatient rotations

   • Volunteer for ward-heavy blocks rather than primarily outpatient, when you have a choice.
   • Extra exposure to admissions and cross-cover will mirror future hospitalist locum work.

2. Work on efficiency and documentation

   • Locum tenens physicians are often evaluated on throughput and clear, billable documentation.
   • Ask attendings for specific feedback on your notes and discharge summaries.

3. Seek out leadership experiences

   • Serve as a liaison for workflow improvements or QI projects.
   • This strengthens future applications for leadership-heavy locum roles (e.g., small community hospitals that rely heavily on locums for clinical leadership).

4. Prioritize relationships with mentors who understand locums

   • Attendings who have done locum work can provide useful insights, references, and realistic expectations.

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3. Locum Tenens After Residency: Pathways for Those with a Prelim Background

Most prelim IM residents go on to an advanced residency (e.g., anesthesiology, neurology, radiology). Many of these specialties have robust locum markets, and your prelim year gives you a competitive edge.

Common Locum Tenens Pathways After Completing Full Training

1. Hospitalist/Internal Medicine (if you later complete categorical IM or a hospitalist fellowship)

   • This is the classic pathway for travel physician jobs.
   • Prelim IM residents who switch into a categorical track often find that their intense PGY-1 year set them up very well for hospitalist locums.

2. Specialty-Based Locum Tenens

   • Anesthesiology, Neurology, Radiology, PM&R, Dermatology, Emergency Medicine, etc.
   • Your prelim year acts as a major differentiator—comfort with medical comorbidities, inpatient dynamics, and complex admissions.

3. Hybrid Roles

   • Some physicians combine a part-time permanent position with several months per year of locum tenens work.
   • This model can be appealing if you want stability plus flexibility—and your prelim IM year’s breadth of exposure helps you adapt to different practice environments.

How Prelim IM Experience Strengthens You in Any Locum Specialty

Even if you never practice as a general internist, the prelim year provides:

• Clinical credibility: Ability to recognize unstable patients and medical emergencies
• Systems literacy: Familiarity with hospital hierarchies, transfer processes, and discharge planning
• Interdisciplinary collaboration: Essential across all specialties when you arrive as a short-term physician
• Resilience to change: You’ve already adapted quickly during intern year—an experience that mirrors constant onboarding in locum roles

Example:
A neurology attending working as a locum tenens physician at different stroke centers may need to manage complex patient comorbidities, coordinate with hospitalists, and interpret labs and vital sign trends fluently. A robust preliminary medicine year makes this transition much smoother.

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4. Practical Steps to Prepare for a Future in Locum Tenens

Even if locum tenens opportunities won’t be fully accessible until you complete a full residency, you can start preparing strategically during or right after your preliminary medicine year.

Step 1: Clarify Your Long-Term Trajectory

Before planning your locum future, answer:

• Am I committed to my advanced specialty (e.g., anesthesia, neuro, radiology)?
• Am I open to switching to categorical internal medicine or another specialty if my interests change?
• Do I see myself wanting travel physician jobs for lifestyle, family, or financial reasons?

Being intentional helps you choose:

• The right advanced specialty
• Programs that are locum-friendly (location, reputation, procedural exposure)
• Training that will produce a broad, independent skill set

Step 2: Learn the Basics of Licensure and Credentialing

Independent locum tenens work depends heavily on:

• State medical licenses
• DEA registration
• Hospital privileges
• Malpractice insurance

Even as a prelim resident, it’s helpful to:

• Attend workshops or webinars on post-residency practice and locums
• Ask graduated residents how they navigated multi-state licensure for locum work
• Understand that credentialing can take 60–120+ days per facility, which is crucial if you plan to bridge gaps between contracts or between training and practice

Step 3: Build a Financial and Lifestyle Strategy

Locum tenens can be financially attractive, but also variable:

• Higher hourly/day rates
• No guarantee of continuous assignments
• Travel and housing logistics (often partially or fully covered)
• Taxes can be more complex (1099 income, quarterly estimated taxes in many cases)

During your prelim IM year, focus on:

• Foundational financial literacy: emergency fund, basic budgeting, loan repayment understanding
• Talking to recent grads who have worked as a locum tenens physician about real-world income and expenses
• Deciding whether flexibility and travel appeal to you or whether you prefer a more anchored post-residency life

Step 4: Network With Locum-Experienced Physicians

Seek opportunities to talk with:

• Attendings or hospitalists who have done locum work
• Senior residents taking gap years with locums between residency and fellowship
• Alumni from your program working as locums in various specialties

Ask them about:

• Best and worst aspects of locum life
• Interactions with staffing agencies
• Ideal timing (e.g., right after residency vs later in your career)
• How their prelim or intern year experiences helped or didn’t help

You will quickly realize that while advertisements focus on income and travel, successful locum physicians emphasize:

• Flexibility
• Ability to tolerate uncertainty
• Strong baseline clinical competence (which your prelim year is building now)

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5. Common Mistakes and Pitfalls for Prelim Residents Thinking About Locums

Because locum tenens is marketed aggressively, it’s easy as a prelim resident to develop unrealistic timelines or expectations. Being aware of common pitfalls can protect your training and career.

Mistake 1: Treating Locums as a Backup to Incomplete Training

Some prelim residents consider leaving the training pathway early and jumping straight into locums. In most cases, this is risky:

• Employers and agencies may be wary of placing someone without completed residency.
• You may be limited to lower-paying, less structured roles, sometimes in challenging practice environments.
• Malpractice risk and clinical safety concerns are real without full training.

Advice:
Unless there are severe extenuating circumstances, aim to complete a full residency before planning a major locum career. Talk openly with mentors and program leadership if you’re struggling with your current path.

Mistake 2: Overestimating Immediate Post-Prelim Marketability

Your prelim IM year is valuable, but it does not automatically translate into:

• Hospitalist-level responsibility as an attending
• High-paying travel physician jobs
• Freedom to practice independently in multiple states

The typical path:

1. Preliminary year (PGY-1)
2. Advanced or categorical residency completion
3. First attending job (permanent or locums)

Recognize that locum tenens is mainly a post-residency opportunity.

Mistake 3: Ignoring Visa and Immigration Constraints

For international medical graduates (IMGs) on visas:

• J-1 and H-1B restrictions significantly limit independent locum activity during and right after training.
• Some locum models are incompatible with visa regulations requiring employment by a sponsoring institution.

If you’re on a visa:

• Discuss with a qualified immigration attorney before planning a locum-focused future.
• Consider how a preliminary medicine year feeds into waiver jobs, permanent roles, and later locum flexibility once fully independent.

Mistake 4: Neglecting Reputation and References

Your performance during the prelim IM year shapes:

• Letters of recommendation for advanced specialties
• References hospitals and agencies will later call when you apply for locum privileges

Even if you are “just passing through” on your way to another specialty, treat each interaction as part of a long professional record. Locum roles are highly dependent on:

• Verified competence
• Professionalism
• Reliability

A weak or problematic intern year can follow you into future credentialing.

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6. Actionable Roadmap: From Prelim IM to Locum Tenens Physician

To make this concrete, here’s a stepwise roadmap tailored to someone in or planning a preliminary medicine year but interested in future locums.

During MS4 / Before Starting Prelim

• Clarify why you chose a preliminary medicine year and how it relates to your advanced specialty.
• Research which specialties have strong locum tenens markets (anesthesiology, EM, radiology, neurology, hospital medicine, etc.).
• Select a prelim program with:
  • Strong inpatient and ICU exposure
  • Good reputation and mentorship
  • A track record of matching residents into advanced specialties

During Prelim IM Year

Clinical Focus:

• Aim for excellence on inpatient services: show reliability, good judgment, and teachability.
• Seek opportunities to manage admissions and cross-cover; these mirror future locum hospitalist work.
• Ask attendings about their experiences with locum work or moonlighting.

Career Planning:

• Confirm your advanced residency path (and apply or reapply as needed).
• Attend any career development sessions about post-residency practice models.
• Start learning the difference between W-2 employment and 1099 contract work (very relevant to locums).

During Advanced Residency or Categorical IM

• In PGY-2/3, consider small steps:

  • Internal moonlighting within your institution once allowed (always respecting duty hours).
  • Short-term elective rotations at different sites to build adaptability.

• Learn from faculty who have been locum tenens physicians, especially in your chosen specialty.

• Near the end of residency:

  • Decide whether to start your career with a permanent job, full-time locums, or a hybrid.
  • If leaning toward locums:
    • Start state license applications early
    • Research 2–3 reputable locum agencies and compare offerings
    • Gather strong references from your IM and specialty mentors

Early Attending Years

• Begin with 1–2 well-structured locum assignments, ideally at reputable hospitals with orientation and clear expectations.

• Use your preliminary medicine year skills:

  • Adapt quickly
  • Communicate clearly with nursing and consultants
  • Manage high-acuity patients confidently in your scope

• Evaluate whether the locum lifestyle suits you:

  • Travel, schedule variability, time away from family
  • Financial trade-offs vs permanent employment

From here, you can adjust—more locum work, a permanent home base, or a mix of both.

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FAQs: Locum Tenens and the Preliminary Medicine Year

1. Can I work as a locum tenens physician right after completing my preliminary medicine year?
In most situations, no. Standard locum tenens roles require completion of a full residency and board eligibility or certification. A single prelim year may qualify you for some niche or supervised roles, but these are not typical locum tenens positions and can be professionally risky. The safest and most flexible locum options come after you complete full residency training.

2. Is there any benefit to my preliminary medicine year if I plan to do locums in another specialty (like anesthesia or neuro)?
Absolutely. A strong prelim IM year gives you broad exposure to inpatient medicine, acute care, comorbidities, and hospital systems. This foundation makes you more adaptable and clinically confident when you later work as a locum tenens physician in anesthesiology, neurology, radiology, or other specialties, particularly in complex inpatient settings.

3. How does locum tenens differ from moonlighting during residency?
Moonlighting during residency is extra clinical work (often within your institution) done while you are still a trainee, under specific rules and supervision, and subject to ACGME duty hours. Locum tenens is independent, attending-level practice where you hold the primary responsibility for patient care. Locum jobs usually involve separate contracts, higher pay, different malpractice coverage, and multi-state licensure. Most prelim IM residents are not eligible for true locum roles but may do limited moonlighting later in training if allowed.

4. Are locum tenens roles mainly hospitalist positions, or do other specialties have opportunities as well?
While many high-demand locum roles are in hospital medicine and internal medicine, there are robust locum work markets in emergency medicine, anesthesiology, radiology, neurology, psychiatry, and several surgical subspecialties. The common thread is independent practice after full residency, not the preliminary medicine year alone. Your prelim IM experience enhances your competitiveness and adaptability regardless of which specialty you ultimately pursue.

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By viewing your preliminary medicine year as a strategic foundation rather than a final destination, you can position yourself for a flexible, well-informed future in medicine—one where locum tenens opportunities, if you choose them, serve your career and life goals rather than define them prematurely.