Locum Tenens 101: What You Need to Know

Locum tenens, derived from the Latin phrase “to hold the place of,” usually refers to doctors who contract with a company to provide medical services for a limited period of time. Since its beginnings in the 1970s, the locum tenens industry has grown to over 25 companies and $2 billion annually.¹  But how do you know if locum tenens work is right for you? In this article, we will provide a primer on what you need to know about locum tenens work, exploring both what you should expect from locum tenens work and what pitfalls you should try to avoid.

Locum tenens is defined as “one filling an office for a time or temporarily taking the place of another,” and most often describes a physician who is contracted to work on a temporary basis.²  Health organizations may employ locum tenens physicians to fill positions that have recently been vacated or to cover physicians away from work for various reasons such as taking vacation or an extended leave. While some similarities exist between locum tenens and per diem (literally meaning “by the day”), locum tenens typically implies that a physician holds a temporary position for a longer period of time based on a contract with a staffing agency.

Recently, an increasing number of physicians have participated in work via the locum tenens industry. For example, the number of locum tenens assignments has blossomed from approximately 26,000 in 2002 to 48,000 in 2016, a 184 percent increase.¹  This rapid growth suggests that more medical professionals see temporary placements as a viable career option and that employers place increasing value on the contribution of locum tenens physicians within the health care landscape.

Locum tenens work presents a number of benefits to physicians, both from a professional and personal standpoint. However, some of these “perks” may also present challenges:

• ■ Freedom/Financial: Locum tenens work inherently provides freedom and flexibility to physicians through the ability to choose when they do their assignments and, to an extent, the hours they work. Locums physicians may choose positions with no call, less call than a permanent position, or taking call that may have a large financial benefit. At the same time, freedom can come at a cost of variable or uncertain income. Many jobs have short time frames to give notice for cancellation. Often, the provider is only compensated if a cancellation occurs within 24 hours of an assignment. This may make it difficult to plan ahead or have a back-up plan. If your assignment is filling a vacancy and the site hires someone, your assignment may end abruptly.
• ■ Benefits: Locum tenens typically offers competitive compensation, particularly for locations that find staffing challenging. As independent contractors, many in locum tenens use 1099 forms and have the option to own their own business and hand pick benefits (i.e., health, life or disability insurance; retirement accounts). Often, locum providers must provide their own benefits. Agencies typically provide malpractice insurance, but may take a cut of your pay. Some agencies will provide services that help you set up a Simplified Employee Pension (SEP) IRA or give you discounts on disability and life insurance; however, you will have to obtain health insurance independently, which can be challenging. If you work as a solo provider outside of an agency, you will need to have a personal malpractice insurance policy that must comply with the contract at each work site.
• ■ Adaptability: Locum tenens increases exposure to different health systems and practices, which makes physicians adaptable. Locum physicians learn how to work and troubleshoot all kinds of things in a new practice (i.e., different anesthesia machines and variable availability of airway equipment). Some choose to do locum tenens to have exposure to cases that they may not have in their current practice. Each site will have different equipment and resources. Small surgery centers may have older equipment and often lack anesthesia technician support. There may not be an ultrasound for nerve blocks. Small surgery centers and office-based practices have more limited offerings of medications (i.e., no sugammadex). Prior to starting a locum tenens position, make sure that you know where the code cart, difficult airway equipment and malignant hyperthermia medications are located. Inquire if the location has a bougie and, if not, consider purchasing your own.
• ■ Travel: Locum tenens have an opportunity to travel to places they haven’t before and can use their evenings and weekends to explore a different part of the country. Occasionally, locum positions will be in an exotic travel location or big city that you want to visit. More often, they are located in smaller towns or rural areas that have difficulty recruiting providers. Life on the road in hotels and temporary housing can bring its own set of challenges. While working alone or being the temporary person can avoid office politics, it can be lonely as well.

Once a physician has weighed the pros and cons, two main routes exist for those looking to pursue a locum tenens assignment. One option is word of mouth, as people you already work with may know someone who contracts with surgery centers locally in need of help. For those looking more broadly, the alternative is to search online, where many locum tenens agencies will help you find jobs that are a good fit (Table 1, page 39). Often these agencies can expedite credentialing for time-sensitive listings. Regardless of which option is the best fit, physicians should consider exploring a number of important questions prior to signing up for locum tenens work (Box 1). Good luck with your adventures as a locum tenens physician anesthesiologist!