Have stethoscope, will travel

Is locum tenens work right for you?

More physicians are choosing contract work, and many relish the flexibility it gives them to pursue other passions. Here’s a closer look.


After finishing medical school and his family medicine residency, Colin Zhu, DO, realized that the logical next step in his career—signing an employment contract or setting up his own practice—was not for him.

“My mentors loved what they did, but I saw a lot of them start to get jaded,” says Dr. Zhu. “It’s challenging and stressful to sustain a private practice.”

Instead, Dr. Zhu decided to freelance, or, in his words, try “dating” different jobs.

The practice he’s referring to is known as locum tenens, which is Latin for “to hold a place” and refers to working shorter, contract gigs in lieu of taking a full-time job.

Locum tenens assignments are typically obtained through a health care recruitment firm and can last anywhere from a few days to several weeks. In some cases, such as with government contracts, they may last for months or years and lead to permanent job opportunities. In the past decade, they’ve become an increasingly popular alternative to a traditional career path.

The pros

Benefits of locum tenens positions include schedule flexibility, the ability to earn extra income and the opportunity to gain clinical experience. Locum tenens work can also help physicians determine whether a particular location, community or job is a good fit.

Most locums tenens assignments include hourly pay, transportation and housing expenses as well as medical malpractice insurance, which can include tail coverage for claims brought after a policy is terminated. The pay is generous, especially when the paid-for housing and transportation are taken into account. It varies by specialty and facility, but outpatient primary care physicians, who are among the most in-demand locum tenens physicians, typically make $100 to $125 an hour, says Steve Belcher, president of Catapult Healthcare, a health care staffing agency based in Texas.

In the past two years, Dr. Zhu’s assignments have taken him from Nevada, where he worked with a Native American population at a tribal-run outpatient clinic, to a Veterans Affairs system in Louisiana and a county medicine department in California that runs its own homeless shelter. A fourth gig found him at a community health clinic in Seattle with a very diverse refugee population.

“There were refugees from Nepal, Somalia, Ethiopia, Afghanistan—people from all over the world,” says Dr. Zhu. “It’s been a really fun, educational journey.”

The cons

Locums work is not for everyone. Contract jobs do not offer stability. Nor do they offer typical employer benefits, such as health insurance, a retirement plan or disability insurance.

Another drawback is continuity of care—for the hospital or clinic as well as for the physician and patients. “I develop such great relationships with patients and staff,” says Dr. Zhu, “that the hardest part is saying goodbye.”

The rise of ‘locum tenens’

In 2016, there were 48,000 physicians working in locum tenens positions, according to Staff Care, a health care staffing firm. That figure is up from 44,000 in 2014 and 26,000 in 2002.

Several factors, including more millennials in the workforce, are contributing to the upswing, Belcher says.

“Millennials want flexibility,” he says. “They’re on board with the gig economy, which I think is going to be the new normal.”

Indeed, Dr. Zhu, who is 33, takes advantage of the flexibility of his locums work to pursue his passions, which include triathalons, scuba diving, cooking and traveling. When he’s on assignment, he’s typically working a standard 8 a.m.-to-5 p.m. day, which leaves him with plenty of free time.

Beyond millennials, half of locums are in mid-career, says Belcher. These doctors have seen the stigma of locums work fade and are taking their entrepreneurial spirit on the road. “These are folks who sold their practices and just want to take care of patients,” he says.

The stigma Belcher refers to is an outdated perception that freelance practitioners could not otherwise get a job, but that has changed radically in recent years.

“The stigma has been debunked,” says Dr. Zhu. “Most clients that want locums prefer that they’re board-certified, and that has really raised the standard.”

The shortage of doctors, particularly in rural, underserved medical areas, is also driving demand for locums physicians. One of Catapult’s clients is a physician who knows he wants to practice in a rural setting, says Belcher, but he’s trying to figure out where. He’s currently working and living in rural Kentucky, but soon will move on to a six-month stint in another medically underserved area.

For those interested in exploring locums possibilities, Belcher suggests asking a lot of questions. “Find a recruiter who genuinely invests in finding out about your career goals and wants to know you personally,” he says, “and isn’t just looking to fill a post.”

Those who choose locums, like Dr. Zhu, often do it for the flexibility and freedom to balance the work they love with the life they want to lead. Dr. Zhu’s passion for travel has taken him to 25 countries spanning 6 continents. Meanwhile, he has created his own wellness brand—The Chef Doc—with a website, YouTube channel and Facebook page. Through the online platform, he shares information about healthy cooking, lifestyle medicine and opportunities to book him as a wellness speaker or coach.

“I’ve always been one to carve my own path,” says Dr. Zhu, “and it’s been an awesome journey.”


  1. Kate Wilson

    After retiring from the military, I looked at locuming globally. Currently finishing my second year in New Zealand.
    Highly recommend it!
    Kate Wilson, DO

  2. Chi

    Do you purchase your own tail malpractice coverage if the Locums agency doesn’t or were you able to negotiate it prior to accepting a position? Didn’t know much about malpractice before I started, the first company I worked informed me not worry that I would be covered after the assignment but discovered it was a claims policy.

    1. Colin Zhu, DO

      I would not take an assignment if it does not cover a head and tail malpractice coverage. So, no I never had to purchase my own coverage for an assignment in general.

  3. Toni Liu

    Hi Dr. Zhu, as a locums, what do you do about medical insurance, or do you try to go outside the US for medical care? I’m just concerned about emergencies such as appendicitis or a DVT that cannot wait until I’m somewhere more affordable to treat.

    Thanks so much!

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