Unlocking Locum Tenens Opportunities in Preliminary Surgery Residency

Preliminary surgery residents and recent graduates often feel boxed into a narrow set of next steps: scramble for a categorical spot, pivot specialties, or leave clinical medicine. Locum tenens work is an often-overlooked fourth path that can provide income, flexibility, and experience while you figure out long‑term plans. This guide explains how preliminary surgery training fits into the locum landscape, what roles are realistic, and how to position yourself for success.

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Understanding the Preliminary Surgery Year and Its Impact on Locums

A preliminary surgery year (PGY‑1 or PGY‑2 without a guaranteed categorical slot) is different from categorical general surgery training in ways that matter for future practice and locum work.

What a preliminary surgery year usually includes

Most prelim surgery residents gain:

• 12 months of ACGME‑accredited surgical training
• Rotations on:
  • General surgery (inpatient, night float, emergency surgery)
  • Surgical subspecialties (e.g., vascular, trauma, acute care, colorectal, transplant)
  • ICU or SICU
  • Sometimes off‑service rotations (anesthesia, emergency medicine)
• Experience with:
  • Pre‑op and post‑op assessment and orders
  • Surgical consults and initial management
  • Assisting in the OR
  • Basic bedside procedures (lines, chest tubes, wound management, etc.)

However, most prelims do not complete enough years to be board‑eligible in general surgery. Many do only one year; some complete two, occasionally more, depending on individual paths.

Why board eligibility matters for locum tenens

Most traditional locum tenens physician roles in surgery expect:

• Board certification or at least board eligibility in general surgery (ABS)
• Independent operative experience and comfort managing call alone
• Ability to carry malpractice coverage at attending level

With a single prelim surgery residency year, you will generally:

• Not be board‑eligible in general surgery
• Have limited independent OR experience
• Need supervision (legally and safely) for major cases

This doesn’t mean you have no options. It means your locum opportunities will be more limited and targeted—often in supervised environments, transitional roles, or non‑traditional clinical paths.

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Where Preliminary Surgery Training Fits in the Locum Ecosystem

To plan a strategy, it helps to understand the major buckets of locum work and which are realistically accessible with prelim‑only training.

1. Classic locum tenens attending surgeon roles

These are the positions most people think of:

• A general surgeon flying to rural hospitals to cover call
• A trauma surgeon filling a gap at a Level II trauma center
• A bariatric surgeon covering maternity leave for a partner

Requirements (typical):

• Completed ACGME general surgery residency (5+ years)
• Board certified or board eligible
• Independent operative logs demonstrating breadth and volume
• Prior attending experience preferred

Reality check for prelims:
With only a preliminary surgery year, you will not be competitive (or usually eligible) for these positions as a surgeon. Credentialing committees and malpractice carriers will not view you as qualified to function as an independent attending surgeon.

However, this is not the end of the story—only a boundary around pure “attending surgeon” locum roles.

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2. Locum tenens opportunities better suited to prelims

Instead of aiming for traditional attending surgeon posts, prelims can look for adjacent locum roles where surgical experience is an asset but full surgical board certification is not required.

Common pathways:

A. Hospitalist or inpatient medicine roles (with surgical flavor)

Some hospitals—especially smaller ones—hire PGY‑1–3 physicians into:

• “Nocturnist” house officer / in‑house physician roles
• Surgical co‑management services (post‑op medical management)
• Observation unit or step‑down unit oversight
• General hospitalist positions, sometimes under supervision

Your surgical year gives you:

• Strong familiarity with inpatient workflows
• Comfort with acute issues, rapid responses, and procedures
• Systems knowledge (order sets, EMR, consult culture)

To move into hospitalist‑type travel physician jobs, you will need:

• Strong medicine references (ideally from IM or hospitalist attendings)
• Proof of competency managing common medical problems
• Openness to additional training (short courses, ACLS, bedside ultrasound, etc.)

Most locum tenens physician agencies that staff hospitalists are used to internal medicine or family medicine trainees. You will need to be transparent about your surgery-focused background and frame it as a strength plus a learning curve you’re actively closing.

B. ICU, step‑down, and night coverage roles

Some hospitals hire non‑board‑certified physicians for:

• Night coverage (“moonlighter” or locum PGY‑2/PGY‑3) in ICUs
• Step‑down unit coverage
• House officer roles (responding to codes, rapid responses, admissions)

Your prelim surgery year likely included:

• ICU rotations
• Ventilator management exposure
• Sepsis and shock recognition
• Common ICU procedures (lines, arterial sticks, sometimes chest tubes)

These are valuable for ICU‑adjacent locum jobs, especially in:

• Community hospitals with staffing gaps
• Hospitals that use intensivists during the day and non‑intensivists at night
• Systems that have robust NP/PA teams with a physician backup model

These roles sit at the boundary between “locum attending” and “moonlighter” and are often recruited locally or regionally. They may not appear on big locum agency job boards but are powerful stepping‑stones for a prelim‑trained doctor.

C. ED fast‑track, observation, and urgent care

A surgical prelim year can be particularly useful for:

• Minor procedures (lacerations, I&Ds, foreign body removal)
• Trauma assessments and initial stabilization
• Surgical consult triage

Community hospitals and urgent care groups occasionally hire:

• PGY‑1–3 physicians (including prelims)
• To staff low‑acuity urgent care clinics
• Or ED fast‑track for minor complaints
• Under supervision or with limited scope

This is more common in:

• Rural areas
• High‑volume urgent care chains
• Systems that accept non‑EM‑trained physicians with enough ED experience

In these roles, your surgical comfort with procedures can make you attractive, especially if you market yourself specifically for procedural urgent care work.

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D. Telemedicine‑adjacent and hybrid roles

While less common, some locum work blends:

• In‑person inpatient coverage
• Tele‑consults (e.g., triage, follow‑up)
• Procedure‑focused clinics

Your prelim experience is especially helpful if:

• You’ve managed post‑op complications
• You’re comfortable with risk stratification and “sick vs. not sick” assessments
• You’re interested in blending travel with remote work

You may not start with pure telemedicine as a prelim (licensing and supervision issues), but a hybrid path can evolve as you build experience.

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Practical Steps to Enter Locum Tenens after a Preliminary Surgery Year

Locum tenens is, at its core, about matching skill sets to immediate clinical needs with clear risk boundaries. As a prelim‑trained doctor, you’ll need a deliberate strategy.

1. Clarify your long‑term goal

Before pursuing locums aggressively, be clear on your target:

• Do you still want a categorical surgery position?
• Are you pivoting to another specialty (e.g., anesthesia, EM, radiology, IM)?
• Are you considering a permanent non‑surgical clinical career (hospitalist, ICU, urgent care)?
• Are you unsure and want time plus income to figure it out?

Your answer will shape:

• Which locum roles are worth pursuing
• How much you invest in credentialing and licensing
• What kind of schedule and geographic flexibility you need

If you’re aggressively chasing a categorical surgical spot, heavy locum travel may pull you away from networking and in‑house opportunities. In that case, local moonlighting‑style locum shifts might be better than long‑distance assignments.

2. Optimize your prelim year for locum‑friendly skills

If you’re currently in your preliminary surgery residency, you can still shape your trajectory:

Prioritize rotations and experiences that build portable skills:

• ICU blocks (document procedures and responsibilities clearly)
• Night float / cross‑cover roles (evidence of independent decision‑making)
• ED consult rotations (triage, trauma activations, acute care)
• Any opportunity to manage common medical issues (CHF, COPD, sepsis, diabetes)

Ask your PD or faculty:

• “Can I take an additional ICU or ED month?”
• “Can you document my independent call responsibilities in my evaluations?”
• “Could I cross‑cover for medicine teams on nights or weekends to broaden my experience?”

These details matter later when a hospital considers hiring you for locum work without board eligibility.

3. Collect strong, targeted letters and documentation

For locums, credentialing committees want to know:

• Can this doctor safely do what we’re hiring them to do?
• Is there a clear description of their training and responsibilities?
• Did supervisors trust them with increasing independence?

You will need:

• At least 2–3 strong letters from attending physicians
  • Ideally from ICU, hospital medicine, ED, or trauma
  • Specifically commenting on your ability to manage acute issues
• A detailed procedure log (intubations, lines, chest tubes, central lines, etc.)
• Clear confirmation of completion of your preliminary surgery year
• Performance evaluations that highlight reliability and judgment

Ask letter writers to emphasize:

• Clinical judgment and triage ability
• Teamwork and communication
• Comfort with procedures and acutely ill patients
• Readiness for roles like night coverage, house officer, or co‑management

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4. Work with the right locum tenens agencies—and screen them too

Not all locum agencies are equal, and many are not used to placing prelim‑only candidates.

When contacting agencies:

1. Be transparent:

   • “I completed a preliminary surgery year but am not board‑eligible in general surgery.”
   • “My strengths are ICU, ED triage, and inpatient management; I’m looking for supervised or mid‑level attending roles.”

2. Ask targeted questions:

   • “Do you work with hospitals that hire non‑board‑eligible physicians for house officer or hospitalist roles?”
   • “Have you placed PGY‑2/3 or prelim doctors before?”
   • “What types of malpractice arrangements do you have for non‑board‑certified clinicians?”

3. Look for:

   • Agencies with a strong hospitalist and ICU footprint
   • Recruiters who understand the nuance of graduate medical education
   • Willingness to approach hospitals with creative proposals (e.g., hybrid NP/PA + you on nights)

You may need to contact several agencies before finding one that actively advocates for someone with your profile.

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5. Start local and build a track record

For many prelim‑trained physicians, the first “locum” steps are often local or regional:

• Per‑diem or part‑time shifts at your training hospital (as a moonlighter after hours)
• Coverage shifts at affiliated community hospitals
• Short‑term contracts with nearby facilities, sometimes arranged directly rather than via an agency

Advantages of starting locally:

• Credentialing is easier when people know you
• Malpractice can sometimes be extended from your current institution
• You receive informal mentorship and supervision while transitioning into more independent roles
• You avoid the chaos of juggling travel, housing, and new EMRs while still learning

Once you have:

• 6–12 months of experience in a semi‑independent role
• Strong references as a “locum‑style” clinician
• Comfort with documentation, EMR, and billing as an attending‑equivalent

…you’re in a better position to expand into true travel physician jobs further from home.

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Benefits and Risks of Locum Work for Preliminary Surgery Physicians

Like any major career move, becoming a locum has trade‑offs. Understanding them is crucial so you don’t get stuck in a pattern that limits your future options.

Key benefits

1. Income while you regroup

   • Locum shifts can be significantly better paid than resident salary.
   • You can service loans, build savings, or support a geographic move while exploring options.

2. Flexibility in schedule and geography

   • Take blocks of time off for interviews, second looks, or studying for another specialty’s boards (if applicable).
   • Sample different practice environments—rural vs urban, academic vs community.

3. Broadened skill set

   • Working outside pure surgery (e.g., hospitalist, ICU) expands competence and options.
   • You gain a richer understanding of medicine around surgery, which is invaluable if you later return to a surgical or acute care specialty.

4. Networking and career pivots

   • Many permanent jobs arise from temporary locum assignments.
   • A hospital where you do locums might later sponsor you for additional training, fellowship, or a hybrid role.

Major risks and downsides

1. Credentialing limitations

   • Without board eligibility, some hospitals and malpractice carriers will simply say no.
   • The roles you can get may have narrow scope or less prestige.

2. Potential “pigeonholing”

   • If you stay too long in loosely defined roles (e.g., generic “hospital physician” without a clear specialty), it can be harder to re‑enter structured residency.
   • Future program directors may question your long‑term commitment to training.

3. Variability in supervision and support

   • Not all hospitals are used to having PGY‑level physicians as locum clinicians.
   • You must be vigilant about scope: do not let a desperate hospital push you into functioning as an independent general surgeon if you are not trained or credentialed for it.

4. Licensing and administrative overhead

   • Multiple state licenses, DEA registration, and credentialing processes take time and money.
   • For someone still deciding on a long‑term specialty, this investment needs careful consideration.

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Actionable Roadmaps: Example Scenarios for Prelim Surgery Trainees

To make this concrete, here are realistic paths for different prelim backgrounds.

Scenario 1: PGY‑1 prelim who does not secure a categorical spot

• You finish June 30, PGY‑1 only.
• You are not eligible for most independent locums, but you can:

Steps:

1. Immediately discuss with your program leadership:

   • Ask about local moonlighting or transitional roles within the same system.
   • Explore possibilities as a junior hospitalist/house officer with supervision.

2. Target ICU or night coverage roles:

   • Build on your strengths from ICU or night float rotations.
   • Seek PGY‑2‑level positions at other programs (including non‑surgical specialties).

3. Use locum tenens selectively:

   • Work with agencies that place PGY‑level physicians in house officer roles.
   • Keep these assignments regional and short term while searching for new residency positions.

Scenario 2: PGY‑2 prelim with significant ICU and ED exposure

• Two years of surgery with heavy ICU and ED time.
• You’ve managed vents, lines, shock, and trauma activations.

Potential route:

• Start as a locum ICU night coverage physician in community hospitals under an intensivist’s daytime guidance.
• Supplement with urgent care shifts emphasizing procedural skills.
• Over 12–18 months, gather strong references and then decide whether to:
  • Apply for critical care fellowships (some will consider non‑traditional applicants), or
  • Transition into a more permanent hospitalist/ICU hybrid position.

Scenario 3: Prelim resident pivoting to Emergency Medicine or Anesthesia

• You know you want EM or anesthesia but missed the match.
• Locums can bridge the gap year.

Approach:

• Focus on locum roles that mirror your target specialty:
  • ED fast‑track, observation units, urgent cares if you’re heading toward EM.
  • ICU or pre‑op assessments if you’re leaning toward anesthesia.
• Use the year to:
  • Gain targeted experience
  • Gather specialty‑relevant letters
  • Prepare a compelling narrative for your next residency application

In all scenarios, the common thread is intentional use of locum work as a bridge, not an accidental long‑term holding pattern.

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FAQs: Preliminary Surgery and Locum Tenens

1. Can I work as an independent locum general surgeon with only a preliminary surgery year?
No. One or two preliminary years do not make you board‑eligible, nor do they provide the operative experience required to practice independently as a general surgeon. Credentialing committees and malpractice carriers will generally not approve you to function as an attending general surgeon based solely on preliminary training.

2. Are there locum tenens roles specifically marketed for prelim surgery residents?
Directly advertised “prelim‑only” locum jobs are rare. However, there are many functionally compatible roles—house officer, hospitalist‑adjacent, ICU night coverage, ED fast‑track, and urgent care—that may be open to someone with strong preliminary surgery experience, especially in rural or underserved areas. You often have to work with a flexible recruiter and negotiate scope and supervision clearly.

3. How does locum work affect my chances of getting a categorical surgery position later?
It can help or hurt, depending on how you use it:

• Helps if you:

  • Maintain close ties with academic surgeons
  • Continue to demonstrate clinical growth and responsibility
  • Use locums sparingly as a bridge while actively reapplying

• Hurts if you:

  • Drift into loosely supervised roles that look unfocused or unsafe
  • Move far away from surgical practice for multiple years without a coherent narrative
  • Fail to secure strong surgical references during or after your locum period

Programs will look for a clear story: why you left, what you did, and how those experiences make you a stronger candidate now.

4. What should I prioritize in my prelim year if I already know I’m interested in locum work?
Focus on high‑value, portable skills and documentation:

• Seek additional ICU and ED or trauma rotations.
• Volunteer for night float or cross‑cover, with explicit evaluation notes on your independent responsibilities.
• Build a detailed procedure log.
• Cultivate attendings who can later write letters describing your readiness for roles like hospitalist, house officer, or ICU night coverage.
• Complete and document certifications (ACLS, ATLS, PALS, basic ultrasound courses), which are commonly required in locum settings.

By approaching your preliminary surgery year and subsequent locum tenens opportunities strategically, you can convert what often feels like an uncertain detour into a structured, flexible, and financially sustainable path that keeps multiple career doors open.