The traditional path for physicians was clear: finish training, find a permanent position, stay for decades. But increasingly, physicians are exploring alternatives—and locum tenens work has exploded in popularity.
Is locum life right for you? Let's break down the real differences.
What Is Locum Tenens?
"Locum tenens" is Latin for "to hold the place of." In practice, it means working temporary assignments—typically 1 week to 6 months—filling in for physicians on leave, covering vacancies, or helping with overflow.
Locum physicians are typically:
- Paid hourly or daily rates
- Independent contractors (1099)
- Responsible for their own benefits
- Free to accept or decline assignments
The Financial Reality
Locum Tenens Compensation
Locum rates vary widely by specialty and location:
| Specialty | Daily Rate Range | Annual Equivalent* | |-----------|------------------|-------------------| | Primary Care | $800-$1,500 | $200K-$375K | | Hospitalist | $1,200-$2,000 | $300K-$500K | | Emergency Medicine | $1,500-$2,500 | $375K-$625K | | Psychiatry | $1,500-$3,000 | $375K-$750K | | Anesthesiology | $2,000-$3,500 | $500K-$875K |
*Assuming 250 working days per year
Looks great, right? But remember:
The Hidden Costs of Locum Work
- Self-employment taxes - You pay both employer and employee portions of FICA (15.3% up to limits)
- Health insurance - $500-$2,000+/month for family coverage
- Retirement contributions - No employer match; must fund entirely yourself
- Disability insurance - $300-$800/month for own-occupation coverage
- Malpractice - Usually provided by agency, but verify
- Unpaid time off - Vacation = lost income
- Licensing - Multiple state licenses needed ($500-$2,000 each)
- Credentialing gaps - Time between assignments is unpaid
When you factor in these costs, the "premium" for locum work often shrinks to 10-20% above comparable permanent positions—not the 50-100% it appears at first glance.
Permanent Position Compensation
Permanent positions typically offer:
- Base salary (predictable)
- Benefits (health, dental, vision)
- Retirement with employer match (often 3-6%)
- CME allowance
- Paid time off (4-6 weeks)
- Malpractice coverage
- Disability coverage (sometimes)
- Signing bonus
- Loan repayment (sometimes)
The total compensation value of benefits is typically $50,000-$100,000+ annually.
Lifestyle Comparison
Locum Tenens: The Pros
Flexibility & Control
- Choose when and where you work
- Take extended breaks between assignments
- No office politics or administrative burden
- Easy to explore different practice settings
Variety
- Experience different EHR systems, patient populations
- Work in diverse geographic locations
- Try before you buy when considering a move
Escape Valve
- Leave a bad situation immediately
- No long-term commitment to a failing organization
- Test semi-retirement or reduced schedule
Locum Tenens: The Cons
Instability
- Income fluctuates
- Assignments can be cancelled
- Credentialing delays cause income gaps
- Economic downturns hit locums first
Isolation
- No colleagues to build relationships with
- No mentorship or professional development
- Miss out on organizational leadership
- Can feel like a "hired gun"
Administrative Burden
- Manage your own taxes (quarterly payments)
- Track expenses meticulously
- Handle your own benefits
- Deal with multiple state licenses
Permanent Positions: The Pros
Stability & Security
- Predictable income
- Job security (usually)
- Clear career trajectory
- Organizational support
Benefits
- Employer-subsidized health insurance
- Retirement matching
- Paid time off
- Malpractice coverage
Community
- Build long-term patient relationships
- Develop collegial relationships
- Leadership opportunities
- Professional development support
Permanent Positions: The Cons
Less Flexibility
- Fixed schedule
- Limited vacation
- Geographic commitment
- Harder to leave bad situations
Politics & Administration
- Meetings, committees, paperwork
- May be pressured to see more patients
- Less autonomy in practice decisions
- Corporate medicine frustrations
Who Should Consider Locum Tenens?
Locum work often fits best for:
- New graduates exploring options before committing
- Mid-career physicians burnt out and needing a change
- Pre-retirees transitioning to reduced schedule
- Physicians with working spouses who have benefits covered
- Adventure seekers who want to travel and experience variety
- Those escaping bad situations who need immediate exit
Who Should Choose Permanent Positions?
Permanent positions often fit best for:
- Physicians building a practice (surgeons needing referral networks)
- Those seeking leadership (department chief, medical director)
- Academic physicians pursuing research and teaching
- Physicians with families valuing stability and community
- Those who dislike administrative tasks of self-employment
- Physicians seeking loan repayment programs
The Hybrid Approach
Many physicians find a middle ground:
- Permanent + Moonlighting - Stable base with extra locum shifts
- Part-time permanent + Part-time locum - Best of both worlds
- Locum to perm - Try a position before committing
- Seasonal locum - Work locum during peak demand periods
Making the Decision
Ask yourself:
- How important is income predictability?
- Do I have a spouse with benefits coverage?
- Am I comfortable with self-employment admin?
- Do I value flexibility over stability?
- Where am I in my career arc?
- What are my family obligations?
There's no universally right answer. Both paths can lead to fulfilling careers and financial success.
Exploring your options? Browse permanent physician positions or search for locum opportunities on Doctor CareerHub.