Permanent vs. Locum Tenens – Which is Right For You? Part 1

When applying for a job as a physician, you have many options to consider. One of the first issues to decide on is: in what type of medical setting would you like to practice? Would you be more suited for a traditional, permanent position or a locum tenens position?

A permanent position is what most likely comes to mind first for most physicians - either employed full time in a hospital owned network or as an employee or partner in a private group practice. You would usually receive a yearly or multi-year contract clearly describing your income, benefits, and job responsibilities.

In contrast, locum tenens positions offer some enticing alternatives to permanent positions. Latin for “to hold in place of,” locum tenens jobs were initially introduced in the 1970s to help patients in underserved geographic areas have access to qualified physicians. Most commonly, you would be hired to fill in for another physician who may be out on maternity leave, sick leave, or on vacation. Other situations requiring locum tenens services include a physician retiring and needing to be replaced or increased patient load at a medical facility. The locum tenens contract usually spans 2 weeks to 2 months, on average. This type of arrangement is attractive to some physicians because it offers the flexibility to determine and set your own work schedule, travel to another location, and typically pays at a higher rate than permanent positions, about $30 per hour more on average (with some strings attached; stay tuned for part 2 of this article!).

So why would you sign on for a permanent position instead, you ask?  Your employment contract guarantees you a steady and predictable paycheck. You will have your responsibilities made clear and will know your expected work hours and reimbursement. You will likely have a benefits package, including medical and dental insurance, malpractice coverage, incentive bonus, paid time off, sick days, continuing medical education stipend, and license fee reimbursement. Your social security and taxes will automatically be taken out of your paycheck. In contrast, locum tenens physicians are essentially independent contractors who need to set up their own work schedules and will receive a paycheck based only on hours worked, with no taxes taken out, and no benefits package. The locum tenens doctor is responsible to take care of all these issues on his own. However, there are a number of locum tenens staffing agencies that will help guide you through this process and help you find work opportunities.

The permanent medical position is usually the most feasible and traditional way to practice medicine for many people, especially for recently graduated physicians who have young children at home. The reassurance of a steady income and lack of long-distance travel requirements are more conducive to family life. A permanent position allows you develop a patient base and build patient relationships over many years. For many physicians, this is an integral aspect of practicing medicine and brings great personal satisfaction. Working in the same environment on a regular basis also makes you more comfortable with the electronic medical records system (if that is even possible!), administration, staff, and general culture of the institution.

Over time, however, you may feel that your work scope is limited, with less freedom to control your schedule, too much administrative oversight, and less opportunity to negotiate your income...in short, you might suffer from physician burnout. The idea of being a “free agent” and working when, where, and for how long you want can look very appealing. Add in the paid travel arrangements and lodging, and the locum tenens position may be just what the doctor ordered.

The feeling of burnout and desire to practice medicine in a different setting are just some examples of motivating factors in pursuing a locum tenens opportunity. Some people are just inherently more adventurous, want to travel widely and be paid to do so, want to practice medicine in a variety of locales with different types of patient populations, and not have long term commitments to any particular institution.  For all these situations and more, locum tenens may be something for you to consider.

There are over 50,000 physicians working locum tenens positions annually, and that number is expected to continue to rise. There are many factors that play a role in the growth of the locum tenens industry. Important ones include the United States physician shortage and the global coronavirus pandemic, which continue to challenge the entire healthcare system.

Part 2 of this article series will look more closely at the locum tenens industry and provide further information to help you determine if it is something that would work for you.