COMMENTARY

Locum Tenens: The Upsides of Being a 'Freelance Physician'

Andrew N. Wilner, MD

Disclosures

March 20, 2019

Editor's note: The following is an excerpt from Dr Andrew Wilner's book, The Locum Life: A Physician's Guide to Locum Tenens.[1]

Locum Tenens

One filling an office for a time or temporarily taking the place of another; used especially of a doctor or clergyperson

Dream Job

Imagine a dream job where you could work when you want, where you want, how you want, ignore local politics, enjoy generous compensation, and bask in appreciation from patients, peers, and even administrators. That's a quick summary of The Locum Life!

Locum tenens physicians serve as "placeholders," taking the place of physicians on maternity, paternity, or sick leave, or away at medical conferences or vacation. Expanding medical clinics and hospitals also hire locum tenens physicians to fill in while they recruit for permanent staff.

Physicians may work locum tenens as a one-time experience, at different stages of their career, or as a full-time employment strategy. Assignments can be domestic or international and last as little as a day or longer than a year.

Locum tenens physicians allocate time to their families and hobbies as they see fit, rather than squeeze their lives into the rigid schedule of a conventional job. It's all about flexibility.

An Expanding Industry

If you have been thinking about temporary work, you are not alone. In a recent survey, 11.5% of physicians indicated that they would work locum tenens in the next 1-3 years, an increase from 9.1% in 2014.[2] To address physician interest, articles about locum tenens have appeared in Family Practice Management, KevinMD.com, MD Magazine, Medpagetoday.com, Medscape.com, Medical Economics, and the New England Journal of Medicine Career Center. Locum tenens radio programs regularly play on ReachMD.com. There are even locum tenens blogs. A blog post on locum tenens published on Medscape garnered more than 4000 views.

Locum tenens is a growing, multibillion-dollar industry. A 2017 survey of temporary physician staffing trends revealed that demand for locum tenens physicians has never been greater.[3] In 2016, approximately 50,000 US physicians worked locum tenens.

Three quarters of all hospitals rely on locum tenens physicians to stay fully staffed. Needs are greatest for anesthesiology, family practice, general surgery, internal medicine, and psychiatry, but locum tenens opportunities exist for every specialty.

Physician as Free Agent

The growing physician shortage, estimated at 121,000 by 2030 by the Association of American Medical Colleges, is an important factor fueling locum tenens growth. Another driver is the fact that more than 50% of physicians now work as employees for medical groups or hospitals. These physicians have far more professional mobility than traditional private-practice owners, who suffer constraints of office mortgages and monthly overhead. Because modern practices grow primarily via inclusion in insurance networks, physicians no longer have to invest as much energy to garner referrals. Consequently, physicians are no longer bound as tightly to their communities and can work as "free agents" in the national and even global marketplace. Like a freelance journalist, a locum tenens physician plies his or her trade for different employers.

Why Me?

Locum tenens may not be for you. Many physicians receive adequate professional and financial satisfaction from conventional full-time employment and have no desire to supplement or replace it. Besides, how many doctors dreamed of becoming a "placeholder" when they grew up?

However, for physicians looking for additional income, or those who want to try out different practice styles or geographic locations, locum tenens merits a closer look. About half of locum tenens physicians hold permanent positions but boost their income with occasional locum assignments. In a recent survey, locum tenens physicians ranked "freedom and flexibility" as the number-one advantage of locums, followed by "pay rate," "no politics," and "travel."[3]

One locum tenens physician wrote, "The 4 Lessons of Locums. 1) Locums makes you MONEY...FAST! 2) Locums lets you explore other jobs and network to find other positions, 3) As Locums, you are paid for what you work, and 4) Locums lets YOU decide what working conditions you're willing to accept and for what price."[4] Sound good?

Too Young or Too Old?

Think you're too young? Some physicians choose locums as their first job out of residency. Too old? Not likely. Three quarters of locum tenens physicians (including the author) reside on the far side of 50. Locum tenens is appropriate for young physicians who have just completed training, mid-career physicians seeking new experiences, and late-career physicians searching for part-time work in lieu of retirement. Dual physician couples and others with demanding schedules may benefit from part-time locums. Locum tenens provides an attractive alternative for physicians at all career stages who value increased flexibility and improved work-life balance.

Travel

A long locum tenens tradition speaks to balancing travel and work. Alan Kronhaus, MD, the founder of Kron Medical, one of the first locum tenens companies, worked 6 months a year in Nevada. He spent the remaining 6 months enjoying the Colorado ski slopes, unfettered by clinical responsibilities.

Locum tenens physicians can literally travel the world while earning a paycheck. Although frequent travel may be more suitable to young, single physicians, locums assignments may also be attractive to men and women with children. International opportunities for US physicians extend to the US Virgin Islands as well as other locations, such as Australia, Bermuda, Canada, the Caribbean, China, Malaysia, New Zealand, and others. Compensation in foreign countries might be lower than US rates, but the travel and cultural experiences that families share come free!

An Army of One

All of this freedom comes at a price. The independence and flexibility of locum tenens work imposes its own set of responsibilities, including learning the fundamentals of running a business. For example, usually locum tenens physicians work as self-employed "independent contractors." Income is tallied on IRS 1099-MISC forms. Alternatively, locum tenens physicians may be traditional employees, with income reported on a W-2 form. I've had it both ways.

It's up to you to understand the difference between an IRS 1099-MISC and W-2 and manage your finances accordingly. As a self-employed individual, you will be responsible for paying quarterly tax estimates, obtaining health insurance, contributing to a retirement plan, tallying deductible business expenses, and most important, creating your own work schedule. Many locum tenens physicians gladly accept these new responsibilities in return for the flexibility and control they gain over their professional and personal lives.

Recommendations

Locum tenens is not for everyone. However, approximately 50,000 physicians have discovered that a flexible schedule enhances their lives. If you are curious about locum tenens and not completely satisfied with your current employment, read the rest of this book. By the time you finish, you should have a good idea about whether locum tenens is for you.

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