1. You’re deeply in debt and need to make some fast cash.
2. You need a break from training between residency and fellowship.
3. You’re waiting for your partner to graduate so you can couples match.
4. You’re ready to experience real autonomy as a physician.
5. You love to travel.
You’re deeply in debt and need to make some money without long-term commitment. While you might not make more money than you would if you were to take a permanent position, locum tenens can be a good opportunity to make some quick cash without signing your life away. Many employers want to hire physicians who will sign two-year contracts, which can feel stifling when you’re still (sort of) young and not ready to settle down. Whether you need to make a quick buck between residency and fellowship, you want a trial run in a new geographic location, or you have a year to kill before continuing your long-term plans, a temporary job may offer the flexibility and experience you’re looking for.
If you’re just finishing residency, then you’ve spent the last decade working your way up a steep hierarchy. From shadowing as a pre-med to supervising junior residents, you’ve gradually taken on more and more responsibility. But academic medical centers are run by teams with layers of doctors, nurses and pharmacists that help protect patients from any single inexperienced individual; while that might be the best way to promote a safe environment for healing and learning, it does limit your autonomy. Outside the safety net of tertiary medical centers is an enormous web of community and critical-access hospitals. If you want to be only doctor on call in a tiny hospital with an open ICU, you can do that. If you aren’t comfortable with certain procedures and wouldn’t mind a little back up, you can find that too.
You love to travel! Locums work is everywhere. If you want to get off the beaten track, you will find more jobs for physicians in out-of-the-way places. You can look at it a few ways. If you want to dive deep into a totally different environment, you will find higher paying locums work in more remote locations. Hanging out in a sleepy town isn’t for everyone, but many jobs will come with travel benefits. For example, I spent last fall working as a hospitalist in Alaska. Because of the challenges of recruiting to such a faraway place, my contract included travel benefits back and forth every week. I don’t have a permanent home, so I spent my off weeks exploring different national parks. In addition to covering my flights, I had a free hotel and rental car to use when I was working. And since I was camping on my off weeks, I saved a lot of money. Not every job will pay for such extensive travel, and many will only pay to fly you in at the beginning and out at the end. That’s the situation I’m in now working as a hospitalist in Guam. Fortunately, I’m a short flight from endless destinations in Asia to spend my off weeks. All of these intricacies are negotiable, so don’t be afraid to ask for what you want.
Every job is different, but my experiences so far have drawn a very stark contrast to life as a resident. Tell me if this sounds familiar: wake up at 6 a.m., rush to work, wait in line for signout, listen to mostly meaningless overnight events, pre-round, round, social work round, write notes, work on signout and then wait in line again to give anticipatory guidance that night float with largely disregard. And mixed in, you draw blood on a few patients who refused labs and collect blood cultures and a blood gas on someone with a fever. (Note: this last part is possibly limited to programs with only the most broken health care economies, i.e. New York City.) Then you go home, eat, sleep, wake up and do it again. Every day. For three years. Now imagine, if you can: you stroll into work at whatever time you want. You round on your patients, write notes and leave. The rest of the day you give verbal orders over the phone while you hang out at the beach. It’s not always literally that good, but sometimes it is literally that good. Not to mention you do it for a week at a time and then have the entire next week off, while making five times as much money.
Now, all of that is great, but of course locum tenens is not perfect. It’s cheaper for hospitals to hire permanent employees, so why hire someone temporarily? Because they’re understaffed and in a pinch. Before signing on, make sure you know what workload you can expect and what contingencies are in place if the job is different from what you agree to. You may also find that the breadth of practice is not what you’re used to in some ways. Once you get outside of academic medicine, the complexity and medical curiosity of your cases will be less. For me, the increased autonomy I described above helped blunt the blow of not having as many fascinomas. There are times when there is no one from neurology, infectious diseases, gastroenterology and cardiology that I can consult, which has helped me grow my bread-and-butter practice. Finally, educate yourself about the financial realities of your new type of employment. Most locums work is independent contracting, which means you’ll be on the hook for twice the Social Security and Medicare tax, and you may be able to take advantage of certain business tax breaks you’ve never used as an individual. On the whole, locum tenens has helped me meet multiple professional goals even though it’s not the kind of work I plan to do for my whole career.