Physician Job Security: Time to Check Your Contract?

Andrew N. Wilner, MD


November 11, 2016

Merriam-Webster defines locum tenens as one filling an office for a time or temporarily taking the place of another—used especially of a doctor or clergyman.


For the past 6 years or so, I've been employed as a locum tenens neurologist. I've practiced as a neurohospitalist in a 300-bed community hospital and two large teaching hospitals. I've worked in a busy private-practice outpatient clinic and in a tertiary referral clinic. My practice has included teleneurology consultations as well.


Each experience has been different and has come with its own challenges, but it's all been instructive and rewarding. I even liked one hospital so much that I wanted to stay! But locum tenens work provides unequaled flexibility that allows time for writing and other creative endeavors. In addition, I have acted as medical director of Lingkod Timog, a nonprofit medical mission group operating in the Philippines. Of course, being a locum tenens is not for the faint of heart. In order to obtain these assignments, I've filled out countless forms and painfully obtained multiple state licenses.

Job Security?

Of course, one often-mentioned downside of locum tenens work is the lack of job security. Sometimes I miss the days in private practice when I was a partner and scheduled 3 months out.

I held an employed position years ago that came with a 5-year contract. It stipulated that termination could only occur with "cause." "Cause" included:

  • License is revoked, suspended, or limited;

  • Loss of DEA license;

  • Termination or suspension of staff privileges;

  • Felony conviction;

  • Abuse of controlled substances;

  • Use of illegal drugs;

  • Failure to maintain board certification;

  • Material breach of contract; or

  • Physician dies.

Barring any of these unfortunate circumstances, particularly the last one, the 5-year contract was secure.

Termination 'Without Cause'

While language regarding termination "with cause" continues, a less desirable feature has sneaked into physician contracts: termination "without cause."[1] In the case of multiyear contracts, inclusion of termination "without cause" language creates a gaping loophole regarding job security.

Here is an example: "Notwithstanding any of the provisions of this Agreement, this Agreement shall be terminated upon ninety (90) days prior written notice by either Employee or Employer."[2]

Consequently, it doesn't matter how long the contract is—1 year, 2 years, or even perpetual with an "evergreen" automatic renewal. If it includes termination "without cause," as in the example above, the contract is guaranteed for only 90 days.

In addition, long-term employment is no longer expected in employment contracts. The venerable Cleveland Clinic, for example, holds its physicians to 1-year contracts.

Thought you had a "permanent job"? Now might be a good time to check your own employment contract. You might be surprised at what you find.

So much for job security!


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