3 locums tenens physicians share the best—and worst—parts of contract work

By Kristen Fuller, MD | Fact-checked by Barbara Bekiesz
Published June 8, 2023

Key Takeaways

  • Locum tenens work is an arrangement whereby a physician is employed as a contractor, using a third-party placement service, to fill much-needed spots in hospitals and medical practices.

  • Locum tenens work can be an attractive alternative to being employed by a hospital or a practice, though this type of work has positives and negatives.

  • Positives include the ability to travel and work in new places, with flexible work hours and potentially higher pay. Some negatives include difficult contract negotiations and having to purchase your own medical insurance. 

“Locum tenens” in Latin means “to hold the place of.” This term is used to describe healthcare workers, including physicians, who work temporarily on assignment in a specific hospital or practice. These workplaces can be located in a physician's hometown, out of state, or in a foreign country.

The workplaces contracting locum tenens are usually in more remote areas, however, where there is an insufficient number of local physicians to accommodate the patient load.

These contracts can vary from a few weeks to several months, and even a year. 

Working as a locum tenens

Individuals often explore this option as a way to travel and see new places, or to see how different practices and hospitals are run. Some people are attracted by the potential to have more flexibility in their work-life balance, as locum tenens are not employed by a hospital or practice, but work as contractors through a third-party company. 

The hospital or medical practice pays a sum that includes the physician's compensation and a service fee to the third-party company. The third-party company then pays the physician his or her compensation and keeps their cut, meaning the hospital is often not fully aware of how much the physician is paid for the contracted work. Generally, the third-party company keeps a file of physicians who do contract work and are appropriately licensed by state.

As with every type of physician employment, there are pros and cons. 

Real-life perspectives of locum tenens physicians 

Writing in Family Practice Management, William Cushing, MD, JD, MBA, explains that one of the primary challenges in securing a locum tenens position is reading, understanding, and negotiating the contract.[] You need to protect yourself against unfair work hours or practices, he says, and ensure appropriate payment for your services; you also need to have malpractice coverage and reimbursement for extraordinary expenses, like those related to travel and lodging.

"I have had a couple of poor experiences and many positive ones, working as a locum tenens."

William Cushing, MD, writing for Family Practice Management

In one instance, Dr. Cushing felt completely overworked and unsupported by the administration. Other physicians in the same practice were quitting and going on vacation, leaving him with an overwhelming patient load. “Thankfully,” he says, “I had a 1-week termination clause in my agreement, so I gave my notice and left.” 

His other poor experience was due to lack of payment. He signed a contract to work in a small town in Alaska, but it took 2 years to get paid, and he eventually had to sue the third-party locum tenens company for payment. 

From that experience, he strongly advises physicians to always have a termination clause in their contract, and to receive direct payment from the hospital or clinic every week.

This way, the practice knows exactly how much you are getting paid and how big of a cut the third-party company receives as part of this deal. 

Johnny Shen, MD, practices family medicine in Denver. In an interview with MDLinx, he asserts that one of the biggest perks to pursuing locum tenens positions is that you get to be your own boss, in the sense that you choose how much you work and get paid, and also that you can use it as an opportunity to travel and work in different locations. 

“I was overworked and burned out in residency,” he says, “and becoming an attending for a hospital was not much different, as I had no control over how many hours I worked.”

"So I started to pursue locum tenens because I wanted to choose when I worked, and how much I got paid."

Johnny Shen, MD

“I feel like I am in control of my career, and I can dictate where I want to travel and get paid for these expenses and accommodations, in addition to looking for contracts elsewhere that pay more. It is truly similar to being an entrepreneur,” Dr. Shen says. 

Adebayo Fasanya, MD, a pulmonologist in Arkansas, also stressed the importance of contract negotiations in an interview with MDLinx.

“One of the greatest challenges I find working as a locum tenens is that you have to carry your health insurance, as a hospital does not employ you. Additionally, you must be very diligent about negotiating your contract regarding work hours, malpractice insurance, pay rate, and termination, and you ‘pay’ the locum tenens staffing agency as an intermediary.”

He advises that, instead of figuring out how much the staffing agency is making, “dictate how much you want to be paid, regardless of the cut the staffing agency is receiving. This can best be done by telling the practice your hourly rate and ensuring that you are paid this directly by the practice weekly.” 

An internal medicine physician in Brooklyn, Maryland, Craig Holt, MD, spoke to MDLinx about many positive outcomes from his locum tenens experiences.

An internal medicine physician in Brooklyn, Maryland, Craig Holt, MD, spoke to MDLinx about many positive outcomes from his locum tenens experiences.

“Locum tenens has given me the flexibility of working the hours I choose so I can also spend time with my family. Additionally, I have used locum tenens contracts to travel and work in new places that I most likely otherwise [would] not experience.”

"Practicing medicine in different locations, such as rural towns, allows me to work with unique patient populations, making me a more well-rounded physician."

Craig Holt, MD

Remarking on the 6 months he spent in the US Virgin Islands, Dr. Holt noted it “allowed me to not only live and experience a beautiful place with my family but also to learn about the local patient culture and treating tourists in a concierge-medicine setting.” 

Tips for landing a successful locum tenens position

Both Dr. Cushing and the author of an article published by Wolters Kluwer [] offer some practical advice on how to enter into the world of locum tenens. 

  • Don’t let your locum tenens staffing agency dictate your salary rate. Ask for pay that you believe you deserve and stick to it.

  • Ask for payment regularly, such as weekly or biweekly; this is an important protection to avoid potentially not getting paid. If at all possible, ask the hospital or medical practice to pay you directly instead of giving the entire middleman fee plus your compensation to the locum tenens staffing agency, from which you then have to collect payment. This way, the hospital or medical practice knows how much you are paid. 

  • Make sure your contract covers malpractice insurance (it usually does).

  • Negotiate a termination clause, so that, in case your situation is not ideal or not what you expected, you can give notice and leave. A 1- or 2-week termination clause is appropriate. 

  • Be prepared to shop around for your medical insurance, and set aside a budget for this, as it could be costly, especially if you have dependents. 

  • Consider setting up a retirement plan, and consult with a tax accountant about potentially becoming incorporated, as you are now a contractor and not an employee. 

  • Choose your locum tenens agency wisely—not all are created equal. Ask them questions, seek advice from other physicians who work as locum tenens, and make sure you feel comfortable with your chosen staffing agency. Remember this is your journey and your choice, so you have the upper hand. 

What this means for you 

Locum tenens can be a wonderful employment opportunity if you are looking to travel, work flexible hours, and potentially make more money. However, it can be extremely difficult negotiating contracts, finding the right medical insurance, and negotiating the salary you want after the staffing agency—the intermediary—gets their cut. 

Read Next: Lessons learned from a locum tenens doc who's been there
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