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

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published July 1, 2022

Key Takeaways

  • Over 70% of healthcare facility managers reported seeking locum tenens physicians in 2019—a sharp increase from 47% in 2016 and 39% in 2012.

  • A perk of locum tenens work is the exposure you get to new experiences in different environments including community, hospital, and other practice settings.

  • The major challenges associated with a locum tenens career include the tax burden of being your own boss and an employee, as well as the many “first days” you must endure to adjust to new environments.

Taking on the role of a locum tenens physician is considered an honorable tradition in medicine: When a doctor cannot fulfill their duties, another steps in as a professional courtesy.[]

And ever since the 1970s, when institutions started embracing locum tenens arrangements to solve medical staffing issues and government grants supported the practice in underserved areas, this staffing method has continued to grow. Today it's a multi-billion-dollar industry.

Doctors who pursue locum tenens careers have the flexibility to design their own schedules in locations of their choice—but with that freedom comes different financial and professional responsibilities.

What’s to love about locum tenens?

There are a number of reasons why locum tenens choose this path: greater assignment flexibility, being one’s own boss, and traveling the world are just a few.[] To get a closer look at some of those reasons, MDLinx spoke to Andrew Wilner, MD, FACP, FAAN.

Wilner is author of The Locum Life: A Physician’s Guide to Locum Tenens, host of the podcast “The Art of Medicine with Dr. Andrew Wilner,” and producer of the Youtube series,“Underwater with Dr. Andrew Wilner.” He spoke to the freedom that scheduling his own time gave him to pursue several of his other interests.

"Working locum tenens freed up my schedule, which enabled me to advance my writing career. "

Andrew Wilner, MD, FACP, FAAN

“The flexibility of the locum tenens schedule also allowed me to become the medical director of a medical mission group, Lingkod Timog, which provides medical care in the Philippines,” he added. “I also had time to obtain my PADI divemaster certification and develop my YouTube channel.”

On top of having the option to pursue another career path outside of doctorhood, Wilner mentioned that locum tenens work allows physicians to avoid the local politics associated with any one workplace.

“During your assignment, you can cheerfully ignore potential hospital mergers, staffing issues, and administrative inadequacies,” he said. “You can (and should) focus only on what most doctors do best: patient care.”

Other physicians may find great satisfaction in filling in for colleagues taking much-needed breaks, according to an article published by the Canadian Family Physician.[]

The article’s author, Taylor Lougheed, MD, MSc(HQ), CCFP(EM), is one of those physicians. He’s happy to support colleagues during their continued education, maternity leave, and vacation time. Doing so is central to the sustainability of the job.

“In fact, the lack of locum coverage has historically been identified as a challenge in these settings, and might contribute to burnout and retention issues,” he wrote.

Challenges (and solutions) that come with the turf

While locum tenens certainly have more flexibility in where they practice and for how long, their path isn’t free of its own unique hurdles and responsibilities.

There are few major challenges to consider. The first is the responsibility that comes with being your own boss. It’s a double-edged sword. 

“From a business perspective, a locum tenens physician is both a business owner and an employee,” Wilner said. As such, locum tenens doctors need to budget accordingly. 

“Quarterly estimated taxes must be paid to the Internal Revenue Service, expenses tallied to avail of business tax deductions, and money set aside for optional (but very desirable) 401K investment plans,” Wilner explained. Hiring the help of a CPA experienced with locum tenens physicians could be a good move. 

In addition to the increased budgeting requirements associated with self-employment, Wilner mentioned the challenge of always being the new hire. You must learn and adapt to new environments quickly. This may require you to act “as a guest in someone else’s house.”

“I put 100% effort into my clinical responsibilities and resisted the impulse to suggest improvements that did not seem obvious to the staff,” Wilner recalled.

Another consideration is the uncertainty involved in the job, said Wilner in his MDLinx interview.

Locum tenens jobs can be canceled unexpectedly, which can hurt your finances and schedule if you don’t have a backup plan—and a healthy savings account.

Outside of self-employment considerations, adaptability, and some uncertainty attached to this track, Wilner recommended budgeting time to attain proper licensure and credentials. Once you parse through these hurdles, this path may be what you need to achieve your goals.

On balance, though, locum tenens work has a lot to offer, and Wilner recommends trying it for anyone thinking of leaving the field entirely.

"Any physician considering leaving medicine due to administrative hassles should definitely consider locum tenens before hanging up his or her stethoscope! "

Andrew Wilner, MD, FACP, FAAN

What this means for you

The shortage of physicians and increasing physician turnover rates are behind the growing need for locum tenens doctors. As a locum tenens, you can practice in new places for varying stretches of time, while being able to pursue other passions and careers. You also can set aside workplace politics and totally focus on patients. As a self-employed physician, you have to be your own tax accountant and retirement planner, and adjust to constant change. But these challenges could be worth it.

Read Next: Real Talk: When you're thinking of quitting medicine
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