Exploring Locum Tenens in Radiation Oncology: A Comprehensive Guide

Locum tenens work is no longer just for late‑career physicians looking to wind down. In radiation oncology, it has become a strategic option for graduates, mid‑career attendings, and even academic faculty. Whether you’re exploring flexible work after the radiation oncology residency, trying to bridge a rad onc match gap year, or rethinking your long‑term career structure, understanding locum tenens opportunities can dramatically expand your options.

This guide walks through how locums work specifically in radiation oncology, who it’s right for, how to get started, and what to watch out for—so you can make informed decisions about your career.

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Understanding Locum Tenens in Radiation Oncology

Locum tenens—Latin for “to hold the place of”—refers to temporary physician staffing. As a locum tenens physician, you contract (usually through an agency) to provide short‑term coverage at hospitals, cancer centers, or clinics that have a temporary staffing need.

Why Locums Are Common in Radiation Oncology

Radiation oncology has several features that make it well‑suited to locum coverage:

• Steady, ongoing patient volumes
  Cancer centers need continuous coverage for on‑treatment visits (OTVs), new consults, and planning. Even a short staffing gap can disrupt care and hurt quality metrics.

• Difficulty recruiting in certain markets
  Rural centers, small community hospitals, and some private practices struggle to recruit full‑time radiation oncologists. Locum work fills the gap.

• Subspecialty needs
  Programs may need temporary help with specific disease sites (e.g., CNS, pediatrics, brachytherapy) or new technology (SBRT, SRS, proton therapy).

• Coverage for life events and transitions
  Maternity/paternity leave, medical leave, sudden resignations, or expansion projects often trigger short‑ or medium‑term locums needs.

Common Settings for Rad Onc Locum Work

You’ll see locum jobs posted across:

• Community cancer centers
  Bread‑and‑butter disease sites, 3D/IMRT/VMAT, conventional fractionation, and SBRT. Often solo or 1–2 physician practices.

• Academic‑affiliated community sites
  Hybrid settings where you may see trial patients, participate in tumor boards, but focus mainly on clinical volume.

• Academic centers
  Less common for pure locums, but can occur for sabbaticals, coverage of disease‑site specialists, or satellite locations.

• Private practice groups
  Cover a partner’s leave or backfill while a group recruits a permanent physician.

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Why Radiation Oncologists Choose Locum Tenens

Locum work isn’t just a stopgap; for many in radiation oncology it’s an intentional career strategy. The motivations differ by career stage.

For Residents and New Graduates

If you’re finishing radiation oncology residency or are between a fellowship and permanent job, locums can provide:

• Bridge income before a permanent role
  Perfect if you matched late, are delayed in onboarding, or have a gap between visa changes.

• Try‑before‑you‑buy exposure
  Experience different practice models—hospital‑employed, academic satellite, private practice—before committing long‑term.

• Geographic exploration
  Work in multiple regions to assess where you want to settle permanently.

• CV building and clinical maturity
  Independent practice, managing solo clinics, and handling common operational challenges can strengthen your profile.

• Plan B after a tough rad onc match
  Rare but relevant: if your rad onc match outcome was not what you wanted (e.g., you matched preliminary year only or needed reapplication), locum work in related roles (e.g., general oncology support, research with clinic time, or international stints) can keep you clinically active while you plan your next step. Direct rad onc locums usually requires board eligibility/certification, so this is more realistic after a completed residency.

For Mid‑Career Physicians

For established attendings, locum tenens offers:

• Higher earning potential and debt reduction
  Daily rates and overtime can be competitive, especially in hard‑to‑staff regions. Some physicians use 2–3 years of high‑intensity locums to pay off loans.

• Schedule autonomy
  Build your own calendar: work 2–3 weeks per month, take extended time off, or stack assignments seasonally.

• Escape from burnout and bureaucracy
  Step away from perpetual committee meetings, EMR build projects, and administrative creep. Focus on patient care without long‑term politics.

• Career pivot flexibility
  Use locums while transitioning between jobs, exploring a move to a new state, or pursuing part‑time academic/industry work.

• Test‑drive different practice models
  See what life is really like in rural versus urban, private versus academic, small versus large systems.

For Late‑Career and Semi‑Retired Oncologists

Locums can be an elegant glide path to retirement:

• Gradual scale‑down
  Move from full‑time to 6–8 weeks of work per year, or take on periodic coverage for former colleagues.

• Maintain skills and licensure
  Stay clinically active, maintain credentialing, and keep intellectual engagement without full‑time workload.

• Location flexibility
  Combine work with living near family, wintering in warmer climates, or international travel.

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How Locum Tenens Works in Practice for Radiation Oncology

Understanding the nuts and bolts is critical before you commit.

How You’re Employed and Paid

Most radiation oncology locum assignments are arranged through locum tenens agencies. Models include:

• 1099 independent contractor
  Most common. You are paid directly by the agency, no taxes withheld. Offers maximum flexibility but requires self‑managed taxes, retirement, and benefits.

• W‑2 employee of the agency or group
  Less common. You may receive some benefits, but often with more restrictions and lower after‑tax flexibility.

• Direct contract with a hospital or group
  Rare in the first assignment, but possible if you establish relationships and negotiate directly.

Compensation structures:

• Daily or hourly rate
  Example: flat rate for Monday–Friday coverage; increased rates for call, weekends, or overtime.

• Per‑week guarantee
  A set minimum even if census is low, which is common in rad onc locums due to patient volume variability.

• Travel and housing
  Usually covered separately: flights, rental car, lodging (hotel or corporate housing), and sometimes a daily per diem for meals.

Typical Assignment Length and Schedule

Radiation oncology locums are often longer than in some other specialties because continuity matters:

• Short‑term: 1–2 weeks (e.g., urgent coverage for unexpected leave)
• Medium‑term: 1–3 months (common for planned maternity leave or recruitment gaps)
• Long‑term: 6–12+ months (for difficult‑to‑recruit sites or long‑term vacancies)

Schedules may include:

• Standard clinic hours: 8–5, Monday–Friday
• Rotating call: Phone call only, or phone plus emergency on‑site consults
• No in‑house nights: Most rad onc locums do not involve overnight in‑house call.

Clinical Scope and Responsibilities

Your day‑to‑day work typically includes:

• On‑treatment visits (OTVs) and toxicity management
• New patient consults and follow‑ups
• Simulation and contouring
• Plan review and approval
• Chart rounds and quality checks
• Tumor boards and multidisciplinary conferences (varies by site)

Before starting, clarify:

• Disease site distribution (breast/prostate/lung vs complex CNS/heme/peds)
• Whether you’re expected to cover SRS/SBRT, brachytherapy, or specialized techniques
• Whether there’s dosimetrist and physicist support on site or remote
• Whether you are the only radiation oncologist on site (solo practice)
• Average daily patient load and new consult volume

Technology and Workflow Considerations

Radiation oncology workflows are technology‑heavy. Ask specifically:

• Which treatment planning systems (TPS) are used? (e.g., Eclipse, RayStation, Monaco)
• Which EMR and oncology modules are used? (e.g., ARIA, MOSAIQ, Epic, Cerner)
• What machines are on site? (Varian, Elekta, TrueBeam, CyberKnife, Tomotherapy, proton)
• How are contours performed? Physician only vs team‑based; any AI‑assisted contouring?
• Are there existing templates, order sets, and pathways you’re expected to use?

If you haven’t used a particular TPS or EMR, that’s not a dealbreaker, but onboarding time and support become crucial.

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Pros and Cons of Locum Tenens in Radiation Oncology

Locum work offers real advantages, but it’s not ideal for everyone.

Key Advantages

1. Financial Upside

   • Competitive day rates, especially in underserved or rural areas.
   • Paid travel and housing reduce your personal expenses.
   • Ability to “stack” work (e.g., work 3 intense months, then take 1 month off).

2. Professional Variety and Growth

   • Exposure to multiple practice styles and patient populations.
   • Experience with different technologies and workflows (Varian vs Elekta, ARIA vs MOSAIQ).
   • Valuable insight into what you want—and don’t want—in a permanent job.

3. Lifestyle Flexibility

   • Control over when and where you work.
   • Potential to cluster shifts and enjoy mini‑sabbaticals.
   • Opportunity to test living in a new region without long‑term commitment.

4. Reduced Administrative Burden

   • Typically fewer committees and long‑term projects.
   • Less internal politics—your role is to keep the clinic running and patients safe.

5. Impact on Underserved Communities

   • Many assignments are in areas with poor access to oncology care; your presence can significantly impact timely treatment.

Key Challenges and Risks

1. Fragmented Continuity of Care

   • You may not see the long‑term outcomes of your treatments.
   • Hand‑offs to the permanent team must be meticulous to avoid missed follow‑ups.

2. Variable Work Environments

   • Quality of support staff, leadership, and infrastructure can vary widely.
   • You may encounter suboptimal workflows and must decide what you can and cannot safely tolerate.

3. Credentialing and Licensing Burden

   • Multiple state licenses and hospital privileges require time and documentation.
   • Delays in licensing can jeopardize start dates.

4. Financial and Benefits Tradeoffs

   • As a 1099 contractor, you must manage:
     • Quarterly estimated taxes
     • Retirement savings (solo 401(k), SEP‑IRA)
     • Health, disability, and malpractice gap coverage if not provided
   • Periods without work mean no income.

5. Family and Relationship Logistics

   • Extended time away from home can strain relationships.
   • Frequent travel may feel exhausting over time.

6. Career Narrative and Networking

   • Longer‑term locums can confuse future employers if not framed well.
   • You must be proactive about networking and maintaining references.

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Getting Started: A Step‑by‑Step Guide for Radiation Oncologists

If locum work appeals to you, approach it systematically.

1. Clarify Your Goals

Be specific about what you want locums to achieve:

• Financial goal (e.g., pay off $150k loans in 3 years)
• Lifestyle goal (e.g., 6 months of work per year, 3 months on/3 months off)
• Experience goal (e.g., explore Midwest and West Coast community practices)
• Long‑term plan (e.g., ultimately secure a full‑time job in a particular region)

Your goals should shape every decision—what assignments you accept, how often you work, and which agencies you work with.

2. Assess Your Readiness

Ask yourself:

• Am I clinically comfortable managing bread‑and‑butter cases independently?
• Do I have recent letters of recommendation and clean references?
• Are there any licensing, malpractice, or disciplinary issues that could slow credentialing?
• Can I tolerate uncertainty in schedule and location for at least the first 6–12 months?

For new grads, consider 1–2 years of stable practice before going fully locums—unless financial or personal circumstances push you toward immediate flexibility.

3. Get Your Licensing and Credentials in Order

Locum agencies will help, but you should:

• Maintain an up‑to‑date CV, including exact dates, positions, and responsibilities.
• Keep digital copies of:
  • Medical school and residency/fellowship certificates
  • Board certification documents
  • State licenses and DEA certificates
  • Immunization records and TB tests
  • Procedure logs (if relevant, e.g., brachytherapy, SRS volume)
• Consider obtaining additional state licenses where locums volume is high (Midwest, South, Mountain West). Some states offer expedited licensing or participate in the Interstate Medical Licensure Compact.

4. Vet and Choose Locum Agencies

Not all agencies are equal, and not all have strong radiation oncology residency or rad onc expertise.

When interviewing agencies, ask:

• How many radiation oncology jobs do you handle annually?
• Do you have dedicated oncology recruiters?
• In which regions do you have the most active client relationships?
• What’s your average time from signed contract to start date?
• Do you provide malpractice coverage (claims‑made or occurrence) and tail coverage?
• What support do you provide for travel, housing, and credentialing?

Work with 2–3 reputable agencies, not 10. Too many agencies lead to confusion, duplicate submissions, and reputation issues with hospitals.

5. Evaluate Specific Assignments Carefully

For each potential assignment, dig into:

Clinical details

• Daily census: on‑treatment and total patients
• New consult volume per week
• Disease site complexity
• Expectations for SRS/SBRT, brachytherapy, pediatrics
• Average time allocated for new consults and follow‑ups

Operational structure

• Number of attendings on site (are you solo?)
• Dosimetry and physics support (in‑house vs remote)
• Availability of therapists and nurses with rad onc experience
• Existing protocols and pathways (are they up‑to‑date, evidence‑based?)

Technology and systems

• EMR, OIS, TPS, and machine types
• Availability of prior templates and plan libraries
• Onboarding/training time before independent coverage

Logistics and compensation

• Daily/weekly rate and overtime structure
• Call requirements
• Guaranteed minimums (e.g., number of shifts per month)
• Travel, lodging, and per diem policies
• Cancellation terms (what happens if the site cancels last minute?)

Red flags include:

• Pressure to start before credentialing is complete
• Vague responses about support staff or technology
• Unwillingness to let you speak to another physician who has worked there
• Very low pay paired with heavy volume and solo coverage

6. Protect Yourself Legally and Financially

• Tax planning:
  • Work with a CPA familiar with locum tenens and 1099 income.
  • Track all business expenses (travel, licensing, CME, home office) carefully.
• Business structure:
  • Many locum physicians create an LLC or S‑Corp for tax and liability reasons—get professional advice before doing this.
• Insurance:
  • Confirm malpractice details and tail coverage explicitly in writing.
  • Maintain your own disability and life insurance independent of any assignment.
  • Secure health insurance that isn’t tied to a specific employer.

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Integrating Locums into a Long‑Term Rad Onc Career

Locum work doesn’t have to be “all or nothing.” Many radiation oncologists blend locums with other roles.

Blended Career Models

1. Academic + Locums

   • Full‑time or part‑time academic appointment
   • Short locums stints during academic breaks or sabbaticals
   • Requires careful management of conflict‑of‑interest and moonlighting policies.

2. Permanent Community Job + Occasional Locums

   • Take locums assignments during vacation weeks or between job transitions
   • Clarify non‑compete clauses and employer policies about outside work.

3. Locums + Industry/Research Work

   • Combine periodic clinical locums with consulting, pharma, device, or AI startup work.
   • Maintain board certification and clinical credibility while exploring other interests.

4. Locums as a Long‑Term Primary Career

   • Build a stable rhythm of recurrent assignments with a few trusted sites.
   • Develop deep but time‑bound relationships with certain programs and communities.

Locums and “Travel Physician Jobs” Mindset

If you’re attracted to travel physician jobs, radiation oncology locums can satisfy that wanderlust with professional guardrails. You’ll experience:

• Different hospital cultures and regional CP guidelines
• Varying patient populations and referral patterns
• The practical side of healthcare access in rural/underserved communities

Think of locums as a structured travel job with meaningful patient impact, rather than simply a tourism vehicle.

Transitioning from Locums to a Permanent Role

Many physicians eventually decide to settle down. Locums can actually strengthen your candidacy:

• You’ve seen multiple systems and can bring best‑practice ideas.
• You’ve proven adaptability to different EMRs, technologies, and workflows.
• You may already have a “favorite” site that wants to convert you to permanent staff.

To position yourself well:

• Keep meticulous records of each assignment: responsibilities, technologies used, volumes, and achievements.
• Ask for written references or testimonials from medical directors and colleagues.
• Be prepared to explain your locums period as a deliberate choice, not just a fallback.

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Frequently Asked Questions (FAQ)

1. Can I do locum tenens work immediately after finishing radiation oncology residency?

Yes, but with caveats. Many sites prefer board‑certified or at least board‑eligible physicians with some independent experience. If you feel clinically strong and have good mentors to call on informally, you can start locums right after residency. However, spending a year or two in a stable, well‑staffed environment can build your confidence and make solo locums assignments more comfortable.

2. How does locum work affect my board certification and CME requirements?

Locum tenens doesn’t change your board requirements. You still need to:

• Maintain state licensure and controlled substance registrations where required.
• Complete MOC (maintenance of certification) activities and exams per your board’s schedule.
• Meet CME requirements for each state license.

Locums can actually help you gather diverse clinical experiences to discuss in MOC activities, but you must track CME independently.

3. Are there locum opportunities for subspecialized radiation oncologists (e.g., peds, proton, brachy)?

Yes, though they are more limited and sometimes clustered in academic or high‑volume centers. Niche skills—like HDR brachytherapy, proton therapy, or pediatric rad onc—can command higher rates but may require you to travel to specific regions. When you register with agencies, highlight these skills clearly and provide procedure logs if requested.

4. How is locum tenens different from being a per diem or PRN physician locally?

Per diem/PRN roles are typically with a single institution or system near where you live, often as a W‑2 employee with a fixed pay scale. Locum work usually involves traveling to different institutions, working as an independent contractor with negotiated rates, and having your travel and lodging covered. Both offer flexibility, but locums generally provide more variety and higher financial upside, with more logistical complexity.

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Locum tenens in radiation oncology offers a powerful combination of flexibility, professional growth, and financial opportunity. Whether you’re just emerging from the rad onc match, looking to redesign your mid‑career path, or easing toward retirement, understanding how to use locums thoughtfully can turn uncertainty into strategic choice. By evaluating assignments carefully, protecting yourself legally and financially, and aligning your locum work with your long‑term goals, you can build a career that serves both your patients and your life outside the clinic.