My first year as a locum tenens physician

Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that having the skills of a physician would be able to allow me to travel and interact with places and people in a meaningful way, have adventures, roll up my sleeves, get my feet wet, that sort of thing. It turns out that this is true. Doctors with certain skills, especially internal medicine and hospital medicine, are wanted all over the country, especially in small towns and rural hospitals, and locums are hired often to avoid catastrophe while a hiring a permanent physician.

I have worked in California, Washington, Oregon, Idaho and Alaska in the last year and it has been really interesting and mostly gratifying. I have met new colleagues, made friends for life, seen lots of patients with mysterious and interesting problems and fascinating life stories and felt like I was useful and appreciated. I have also felt frantic and overextended, gotten lost, slept and ate less than was ideal.

There are many locum tenens agencies in the US that find jobs for physicians like me. They take care of helping facilities make sure that I am a legitimate doctor, not a serial killer or child molester, facilitate licensing in new states and make and pay for the arrangements that include travel, lodging and advocacy with the various organizations which hire me. For this they get about the same amount of money per hour that I do, so the client pays about double the amount that I am compensated to have me work. This is a LOT of money. It is a painful amount of money for the hospital to pay, so they really only use locum tenens doctors if they are desperate. Which means that, no matter how much they may like me at a given facility, they will rejoice when they can replace me with someone permanent. This means that I go to places, get to know people and systems, get good at them, am appreciated, then leave and never come back. They have the right to cancel my work within 30 days if they find someone cheaper to do it, and this has happened a couple of times. It is disconcerting, because it is often not possible to find new desirable work to replace what was planned with such short notice.

Becoming a locum tenens physician is easy: one simply contacts an agency online and then begins to fill out application forms and send countless documents to various places. It is time consuming but simple. Then a locums recruiter will call and begin to offer all sorts of jobs. If a job is interesting, the recruiter will send curriculum vitae information to the client and if the client is interested, phone interviews follow and if what they want is what the physician wants to provide, credentialing and scheduling follow.

I have found that different locums companies have different job opportunities and that I like some recruiters more than others. I have worked with Staff Care, CompHealth and Weatherby and have found them all to be honest and mostly easy to work with. The recruiter, though, makes money when I work, so they are all pretty proprietary about my time. In order to have a job when I want and where I want, I need to apply for more than one job at a time. If more than one comes through, I either have to work more than I want to or disappoint someone which makes me feel like a flake.

Full time work that pays much more than I made as a full time primary care doctor is 7 days a week, every other week, about 12 hours a day. This allows me to have real time off, which is great. Still, I spend lots of time on travel and lots of time away from my home, friends, family and dog. If I decide to do something creative in my off week, like attend a meeting or go on a trip, then I am away from home for 3 weeks in a row, which I virtually never did for the 20 years preceding starting locums. This is a little bit disruptive to anything that I have established at home, plus my dog gets really depressed.

Locum tenens work is a truly great option. It allows me to know that I will be able to stay busy in my field and make enough money to support my family and to have breathing space to do other important things. It is also not something that I will want to do as a primary occupation for very long.

Janice Boughton is a physician who blogs at Why is American health care so expensive?

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