larger culture, and what you offer to the role. Conversely, as an employee, you get the opportunity to try out a group before committing. I was grateful to have many doors open for me and I received several job offers during my time as a locums. The experience I had with each group helped me make an informed decision of what opportunity to pursue.
100% IR While every position will be different, I was able to specifically look for locum positions that allowed me to do almost 100% IR, even though I was not necessarily filling in for role that had been 100% IR. I negotiated this focus with each practice but that approach may not always be possible because most IR locum jobs expect some DR coverage as well. Certain practice settings (e.g., academic centers, OBLs and dialysis centers) are set up as 100% IR positions to begin with and therefore do not expect a locum to perform any DR responsibilities. Regardless of the extent of IR vs. DR responsibilities, locum positions allow you to focus entirely on your clinical tasks without becoming mired within local group/hospital politics or interspecialty turf wars. For many IRs who face these burdens in their full-time positions, the lack of politics can be a welcome respite.
Compensation As a locum tenens provider, I was compensated by the day with additional hourly overtime coverage, as well as separate call coverage compensations. All these rates are negotiable. When taken together, the work results in an hourly compensation rate that is higher than most salaried IR positions. During my locums work, I contracted mostly through locums recruiting agencies, which ensured coverage of all my travel, hotel and car expenses; if contracting directly with a group you can still try to negotiate coverage of these expenses. However, keep in mind that, except for malpractice insurance, most locums positions do not provide benefits (medical, dental, life insurance, retirement, etc.), and one will have to file self-employment tax.
Work–life balance As a locums provider, you are free from the extracurricular responsibilities that usually come with full-time
As a locums provider, you are free from the extracurricular responsibilities that usually come with full-time work. There are no expectations for you to attend tumor boards or multidisciplinary conferences or do quality improvement projects. But that also means you likely won’t have a clinic or partake in research.
work. There are no expectations for you to attend tumor boards or multidisciplinary conferences or do quality improvement projects. But that also means you likely won’t have a clinic or partake in research.
Challenges Limited cases Although you will be exposed to different types of IR procedures depending on the practice and its coverage needs, as locum tenens you will largely be doing the bread-and- butter and urgent/emergent IR cases. The more interesting elective work will often be reserved for the full-time physicians at the practice who may have seen the patient already in their clinic and/or been referred to directly.
Unfamiliar territory Coming into new practices means you are constantly “the new kid on the block.” You are always starting from scratch to build new relationships with colleagues and staff and are always navigating unfamiliar waters. Moving to new practices also means having to learn new EMR systems, adapting to new policies, working with unfamiliar inventory and equipment, and collaborating with unknown referring providers. With the right mindset this type of environment can be very effective in cultivating skills
such as team building, flexibility and resourcefulness, but it can also be challenging to navigate ever- changing surroundings.
Constant travel and Lack of stability While this work is a great way to see the world, the endless travel can become exhausting. Because each position will need coverage for variable lengths of time, you may no longer be needed just as you grow comfortable in a position. Constantly being on planes and living in hotels can cause a sense of loneliness and impermanence. Some people will live for the excitement, but others, like me, will eventually tire of it and crave the stability of growing roots.
Lack of longitudinal care One of the biggest challenges of locum work is that even if you can negotiate a 100% IR position, you will likely not be able to practice longitudinal/clinical care. As mentioned above, locum position durations are highly variable, making it almost impossible to consistently follow up on patients. Furthermore, your primary role as a locums provider in most practices is to simply ensure that the daily and on-call procedures are covered. There is no expectation, let alone infrastructure, for an IR locums longitudinal clinic.
Despite this accepted paradigm, new and creative setups where clinical/ longitudinal care can be delivered while in a locums capacity (e.g., through telehealth visits) are currently being trialed by some intrepid IR locums providers. This will likely reinvent the traditional approach to the IR locums and possibly even establish a new practice model.
Licensing/credentialing Prior to starting a locums job, you must have an active medical license in that specific state as well as be credentialed at the particular hospital you will cover. The process to obtain a new state medical license and complete hospital credentialing can take several months or longer. When one locum position ends and another is set to begin, the licensing/credentialing process can cause major delays in starting a new position. Furthermore, you will likely find yourself
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