During my third year of residency, I remember getting calls from the recruiters trying to solicit me for locum tenens work. Sometimes I would get paged from an out-of-state number and learn it was yet another staffing company’s cold call.

Opportunities to work locum tenens seem to be endless. If you consider full-time locum work, you can create a more flexible schedule and make more money. In fact, it can become a career in itself, which happened to me.

Before signing an agreement with the first locum firm you’ve been called by, consider three following issues and solutions in order to make the most of locum tenens work.

Problem #1: Most locum tenens gigs are short term.

Solution: Consider per-diem employment instead of locum tenens if you want to find a long-term flexible job without needing to travel away from home.

What is per diem? A per diem contract is signed directly between the physician and the hospital without any middleman involved (e.g. locum firm).

You don’t have any set schedule and you work as long as there are open shifts.

Hospitals like it because they use your services without paying agency fees, which are sometimes 50% of your hourly pay. Therefore, you can form long-term relationships and potentially work there for years.

Another perk is that the hourly pay tends to be higher than your employed position, so you can have a great income.

One common issue with per diem and locum work is that you don’t get any health insurance benefits. Having said that, you will make a higher income compared to the full-time employment and thus have the ability to pay for your own insurance along with other benefits.

If you are interested in trying to work in a per diem capacity, you need to start contacting the hospitals of your interest directly.

You can also do some online search looking for keywords like “per diem” + your specialty or “prn” + your specialty.

Keep in mind that all of the hospitals will have ups and downs in terms of demand for per diem physicians. In order to always have enough work, make sure to sign the contracts with as many local facilities as you can.

If you are interested in a hospitalist per-diem work, you can check out this article that describes an exact step-by-step process that I have used.

Problem #2: Highest paying gigs may not be in the same location as your residency or fellowship.

Solution: Look beyond your current location.

For example, the Northeast may have the highest number of residency and fellowship programs in the country, but it’s also the lowest paid region as far as the locum rates.

Do not be fixated on only one state or city and don’t be afraid to extend your search to other geographic areas. You may be surprised how big of a difference it can make to getting what you want.

For example, the pay rate in the South and Southwest may be up to 30% higher than in the Northeast.

If you plan to become a hospitalist, you can find comprehensive information about the pay rate in different regions here.

Problem #3: Attending salary is high but so are the taxes!

Solution: Be aware of the state income taxes and consider consulting with an accountant.

After transitioning from a resident to an attending role, I was surprised by how much of my income disappeared when doing taxes. If you pay 30% annual tax, it means that you work four months a year for free!

Be aware so you are not blinded by hefty locum pay rates. Before agreeing to locum work in a particular state, be sure check the state income tax rates.

To get a rough idea you can glance at this map or use this calculator for more accurate estimates.

Consider consulting with a knowledgeable accountant to learn about the ways to minimize your general tax burden as well.

This information should help you to jump start you locum career. If you have any other questions, drop me a line and I’ll be happy to share my knowledge.