Locum Tenens

How do you choose a locum tenens assignment?

physician happy from choosing a locum tenens assignment

Nicholas Kusnezov, MD, shares his tips on what to look for when choosing a locum tenens assignment.

Having been actively engaged in locums now for a number of years, I have developed a good working idea of what I look for when choosing a locum tenens assignment.

When I was fresh out of residency, I would pick up whatever assignment I could find. Now, I am approached with so many offers a day for new assignments that I only end up picking up about 1-2%. 

In my mind, there are a number of important considerations when choosing a locum tenens assignment. These generally fall into the categories of job composition, call coverage, anticipated time commitment, case mix, patient volume, geographic location and accessibility, and of course the structure and amount of compensation. 

What is the job composition?

You will be presented with a variety of different job compositions, ranging from simply call coverage up to full-time practice including clinic and OR.

In my experience, most assignments are seeking purely call coverage. Now, that being said, you are often in a position to negotiate the composition of your coverage. This could include asking for more or less call and even call simultaneous with clinic or operative days.

As a locum surgeon, I would encourage you to ask for a post-operative clinic, as there is great value not only to honing your own practice but to maximizing patient care by closing the loop with follow-up.

What is the time commitment?

The requested time commitment may range from a single block of time (for example, when a local provider is planning on going on vacation and the facility is seeking temporary coverage) to ongoing and nearly full-time coverage with the prospect of transitioning to a permanent position.

For me, with a full-time primary practice, I select largely for jobs seeking periodic weekend trauma call coverage. This way the time commitment is manageable and not excessive.

Physician choosing a locum tenens assignment

What is the case mix and patient volume?

Case mix and patient volume are dually important considerations, both of which may often be overlooked when choosing a locum tenens assignment. Neither may be advertised at the time that you are presented with the job opportunity, so I would strongly recommend inquiring into both.

The locum company may not know the answer immediately, but your representative will be able to ascertain both of these either from the institution directly or based on the logs of previous locum providers who have covered there.

Both of these factors may also be the difference between a satisfying and an unsatisfying assignment. For instance, if you show up to a Level 2 Trauma Center expecting to be very busy and only get a few consults for low-acuity injuries, you may be disappointed. Conversely if you were looking for a lower-key assignment but are absolutely destroyed on call with high-acuity and complicated consults, this may in turn be overwhelming.

Where is the job located?

Geographic location and accessibility are key and are often independent of one another. You may be presented with a job in an attractive location but one which may be unknowingly difficult to access.

I would recommend doing your research on accessibility prior to accepting a new assignment. Some locations are desirable, but the nearest airport may be many hours away. Moreover, accessibility may be seasonal. Locations in the Midwest and Northeast may be difficult if not sometimes impossible to access in winter weather. 

How much pay should you expect?

After weighing these variables, you can decide on what your desired compensation should be. For instance, a high-volume and high-acuity trauma center warrants much higher compensation than a low-acuity, primarily clinical assignment. Similarly, a more remote location which may be difficult to access warrants much higher compensation than a similar facility which is located closer to you or to a large airport.

You are a trained professional and you are in demand; make sure you know what your time is worth.

Weighing the factors

Weighing the above factors is a matter of individual preference. For me, location is important up to a certain extent. I would accept a lower rate of compensation and would be much more flexible on composition with a facility that is very close to where I live and practice. Once a commute is required, I much more strongly consider the facility, job composition, and compensation structure. Beyond that, when offered multiple jobs with similar structure, I would opt for the one with the nicer and more accessible location.

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Article updated June 3, 2022

About the author

Dr. Nicholas Kusnezov

Nicholas Kusnezov, MD, is a premier, nationally recognized, board-certified, and fellowship-trained orthopaedic surgeon currently practicing in Southern California. He specializes in total joint replacement with extensive experience in managing complex sports and traumatic injuries. In addition to a highly decorated career in the U.S military, Dr. Kusnezov is the recipient of numerous national meritorious awards and is actively engaged in graduate medical education and clinical research, having co-authored over 100 peer-reviewed publications to date. Click the YouTube logo next to Dr. Kusnezov's name for interviews expanding on the topics of his blogs.