Considering Locum Tenens? Freedom, Good Pay, and Some Risks

Neil Chesanow


March 08, 2017

In This Article

Working With a Locum Firm

Once you've decided to do locum work, your next step will be to connect with a locum firm. It's wise to go in with your eyes open when dealing with these firms.

There are over 100 locum firms, about 75 of which are members of the National Association of Locum Tenens Organizations (NALTO), a trade group.[13] NALTO members must adhere to a code of ethics and standards of practice, although not being a NALTO member does not mean that a locum firm lacks professionalism.

"Rule number 1 is to remember that the locum company works for the practice to meet the practice's needs, not yours," cautions family physician William T. Cushing, MD, JD, MBA, who has had extensive experience as a locum tenens.[14] "The locum company is the practice's agent (after all, the practice is the one footing the bill), so it is simple to see where the company's loyalty lies. Do not expect them to protect you. Instead, you will have to protect your own interests."

"It's like selling real estate," Dr Crawford explains. "If I'm a real estate agent, I want to invest the least amount of money in advertising and turn over the property as quickly as possible. The more properties I can turn, the better. It's the same thing with a lot of locum firms. You sign your name as a doctor, and they get half the payment from a client. You show up for the first day of work, and they get the second half. A lot of these people are on commission. All they care about is that the hole is filled. The rest is up to the physician to figure out, and that's where we often get ourselves into trouble."

You want a recruiter with whom you can have a good relationship—someone whom you can trust to be responsive if the locum work arrangements turn out to be different from what you were led to believe, or if an unexpected problem arises.

Dr Cushing tells of one locum doctor who showed up at a clinic for assignment and was promptly accosted by the practice administrator, who demanded that he immediately write opioid prescriptions for all of the patients in a stack of over 100 charts.[15] Dr Cushing himself did a locum stint at a clinic in Alaska, where he was not allowed to venture more than a 10-minute walk from the clinic in case there was an emergency in which he was needed, making him a virtual prisoner.

"The single best thing that prospective locums can do to prepare themselves for an assignment is to ask their recruiter and the hiring manager at their potential worksite the right questions," Indresano says. "Clinicians should ask about patient volume, orientation length and format, required procedures, and the population they will be serving. Doing so helps ensure that locums know what to expect before they arrive at the facility. The interview process allows locum practitioners to talk to a representative at the facility or in the health system to ensure the assignment will be a good fit for all parties involved."

What about licensure? Is there any reciprocity between states? "Unfortunately, there is no reciprocity for locum doctors concerning state licenses," Indresano says. "In most circumstances, providers must be licensed by the state in which they plan to practice, with a specific application and timeline that varies by state. Like many applications, there's a deluge of paperwork and ancillary materials—background check, malpractice history, educational background, et cetera—that must be furnished along with the application."

A few locum firms offer licensing and credentialing support at no charge to the doctors they place, Indresano explains—something to consider when deciding on a firm to represent you. You provide the requisite documents that must accompany the licensing application, and the firm does the rest. Some firms even pay the licensing fees for the locums they represent. However, once a license is obtained in this way, you can only practice in that state through the locum firm.


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