As I sit on the balcony of the apartment I’ve rented for the next three months in Jerusalem overlooking the ancient streets below, I can’t help but feel grateful for the abundance of free time my career choice has offered. I’m not referring to a career in medicine generally but, rather, to my specific path as a locum tenens physician (locums, for short). Before I started working as a locums, I was filled with many misconceptions about it, misconceptions I believe are held by a great many of my colleagues. In fact, now that I know so much more I’m convinced that, for a great many physicians, locums work would not only be a viable career option — but a superior one.
I started my career as a psychiatrist in administrative and academic medicine. I treated patients in a continuing day treatment program setting as well as in my own private practice, taught and supervised medical students and residents, and did some administrative work and research. All of this was satisfying, though there wasn’t one specific type of work that “called” to me more than any other. And though psychiatry is my profession, I also enjoy dedicating time to multiple hobbies and international travel. Though employed physicians are typically afforded much more vacation time (typically 4–6 weeks) than the average person, I desired more still, to travel and to indulge my pastimes. By some stroke of luck, on my last day at one employed job (and on the verge of starting another), I ran into a colleague with whom I had previously rarely interacted. He spoke to me of his time as a locums psychiatrist, of the money he made and the leisure time the work afforded him. I decided to look into it and found a suitable position, which I took instead of the employed position I’d been planning on starting. Five years and several assignments later, I’m still working as a locums psychiatrist.
Locums work provides physicians with the opportunity to take control of their schedule. Personally, I’ve negotiated jobs where I’ve worked seven days on/seven days off or worked four 10-hour days with a three-day weekend every week. One gets to choose positions with responsibilities best suited to their practice interests. You also have the opportunity, if so desired, to take jobs all across the country (or, indeed, in many other countries), usually with travel and housing costs covered. This makes it an excellent way to explore new areas. Best of all, you get to decide exactly how much vacation you wish to take and when, balancing income and free time however you like.
In many specialties, locums also have the chance to make much more than their employed peers (even after taking employment benefits and self-employment taxes into account), particularly after they learn the game a little and, thus, have a better idea of how to negotiate each assignment. Additionally, locums are self-employed, independent contractors, which comes with tax deduction and retirement options that simply can’t be matched by an employed physician position. While some of these advantages also apply to private practice, it’s rare such a physician has enough coverage that he or she has the freedom to take as much vacation as a locums. Locums work also avoids many of the traditional hassles of private practice, including the purchasing and upkeep of equipment, hiring and managing employees, and spending capital on other overhead expenses, all while providing a more-predictable income stream.
In speaking with many other physicians on this topic, there seems to be a rather widespread and regrettable misconception that locums are those only unable to get “real” jobs. This is a shame, not only for the not-so-subtle denigration of locums but also because nothing could be further from the truth. The vast majority do it for the lifestyle or as a way to continue practicing part time when they are in the latter stage of their career. Unfortunately, while people hold contrary notions it prevents them from exploring the opportunities this career option offers.
There are three other common misconceptions I often hear surrounding locums work. First, there is a belief you won’t be “hirable” for an employed position should you desire one in the future. This is complete myth. Most places using locums do so because there is an unfilled opening. If you do good work, you’ll often be offered that very position! Second, people seem to worry there won’t be a steady stream of assignments. This, too, is myth. Rarely does a day go by when I don’t get a dozen emails or phone calls offering me positions; this isn’t because I am special in any way but, rather, because there is so much demand for locums. Finally, people often think each assignment is very short in length and may imagine themselves having to move every few weeks. On the contrary, almost all positions last a few months, many last more than a year, and sometimes they can last several years.
All this isn’t to say there aren’t some good reasons to not consider this path. If your primary goal is to work your way up the ladder as a physician-administrator or an academician, then locums work is likely not the best route to go. If your dream is to own and build your own practice, then locums work probably isn’t the right choice for you. If you intensely dislike learning new hospital or EMR systems, and the thought of doing so every six months or so gives you agita, then this line of work is likely not for you. Finally (and provisionally), if you’re bound to a specific location because of family or some other reason, this career path may not be ideal. (I say “provisionally,” because if you live in or near a major urban area, there will very likely be enough opportunities in the area for you to “rotate” through while remaining at your home base.) For the remainder of physicians: I’d encourage you to throw off your preconceptions, keep an open mind, and give locums work a shot.
Jeffrey A. Vernon, DO is a New York City-based locum tenens psychiatrist with an interest in treatment-resistant mental illness. He has published research on schizophrenia and is a 2017–2018 Doximity Fellow. He can be reached for questions about locum tenens work at firstname.lastname@example.org.