Some articles about working as a locum tenens physician immediately after residency create a rather rosy picture. In one Doximity post, Dr. Ali Chaudhary described being “unappreciated, under-valued, and burdened by administrative BS” after getting his first full-time job post-residency – while also working weekends, holidays, and nights to pay student loan debt and taxes. He eventually transitioned from working occasional locum tenens shifts to pay off student loans into working full time locum tenens, calling the decision a “no-brainer.”
Dr. Chaudhary’s post was written in 2018 and his decision was based on the assumptions that “there is extremely high demand” for physician services and that “essentially, a good physician will never be out of a job.” As the COVID epidemic has shown, these generalizations aren’t necessarily true. Post-COVID, most hospitals have eliminated locum tenens positions and many hospitals are cutting pay or reducing hours for their employed physicians.

Challenges of Working Locum Tenens During or Immediately After Residency

This previous post discusses many of the general pros and cons to working locum tenens assignments.  Some locum tenens advantages include paid travel, higher pay, more control over your schedule, and an improved work/life balance. Some disadvantages of locum tenens jobs include lack of job security, lack of benefits, potential staff resentment, and sometimes getting stuck working with less than reputable staffing companies.

Taking a locum tenens position during or immediately after a residency program may present some additional challenges.

Practicing medicine in residency training provides some security. Residents have attendings to answer questions about difficult cases and if there is a question about a case, residents can to “curbside consult” other specialties for their input. Locum tenens assignments may not have the same luxuries. Rural hospitals may have few readily-available specialists. Free-standing emergency departments may have no readily-available specialists. How will patients who need specialty consults be managed? Necessary obstetric care, trauma care, or critical care services may require patient transport to another facility in less than optimal circumstances. Working locums in a high-acuity tertiary care facility may require acceptance and stabilization of multiple critically ill transfers from outlying hospitals under completely different patient management protocols. Adapting to new practice patterns in such facilities may force residents to practice outside of their comfort zones. Add a new practice environment to the other challenges of locum tenens work and residents may have some difficulty adapting to a locums lifestyle.

While locum positions may provide extra income to supplement a residency paycheck, working solely in locum tenens positions after residency may result in little or no paycheck during an adverse job market. Post-graduate expenses will increase with student loan repayments. Don’t get caught in a situation where no locum tenens jobs are available and you have no other source of income.

Advantages of Working Locum Tenens During or Immediately After Residency

There are many benefits of locum tenens opportunities for residents and recent grads. While adapting to new practice patterns may present some difficulties, being able to adapt to a wide variety of practice patterns is a valuable job skill. Consider that most residents work at only one or two facilities during their residency. In those same hospitals, they use the same EMR, consult the same specialists, and use the same treatment protocols. Working in a variety of practice settings will help expand a resident’s breadth of practice and will help residents become efficient using different EMRs and interacting with different specialists who have different personalities.

Working locum tenens during residency also gives residents the opportunity to improve medical skills while still being able to obtain additional training through the residency program. For example, it might impress a department chair during an interview if you state that you’re experienced with direct laryngoscopy, GlideScopes, and Storz endoscopes and can help the department develop protocols or a learning curriculum for using each method. It would be equally impressive to tell an employer for a prospective full-time position that you’re comfortable using three major EMR systems and that you already have your own dotphrase templates so you won’t need training when you start.

Locum tenens positions will help residents build their resume. Having several positive letters of recommendation from department directors at facilities where you worked as a locum tenens physician might be an advantage on job applications over an applicant with a single recommendation letter from a residency or fellowship director. Hospitals or groups where you have had locum tenens experiences may also choose to offer you a permanent position when you graduate.

Working in locums assignments during or immediately after residency will introduce physicians to the financial side of their medical practice. Since locum tenens physicians are independent contractors, they will need to learn about the income tax implications of independent contractor practice and the importance of documentation and billing.

One other point to consider is that for physicians whose significant other is still in training, temporary locum tenens positions allow a physician to earn supplemental income in different practice environments without making a long-term contractual commitment until after their significant other graduates.

Deciding Whether A Locums Life is Right for a Resident

If you residency allows moonlighting (many do), the best way to see if you’d enjoy a locum tenens lifestyle is to just do it. Get permission from your residency director. Discuss your goals with someone you trust in the locum tenens industry. Do you want to travel? Want to work in a rural setting? Looking for proximity to a ski resort? Search job boards or have a recruiter perform a job search for you. Working locum tenens is a great way to practice skills you’ve learned during residency and to find the practice environment that best meets your goals.

While the locums lifestyle may not be an option for everyone, working a few locum shifts during or immediately after residency may help you decide if the locums life is an option for you.