3 Downsides of Locum Tenens Medicine You Should Know

by The Darwinian Doctor

In this post, I’ll reflect on my experience working as a locum tenens physician and talk about 3 big downsides I’ve noticed along the way.

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Over the last six months, I went from a big city employed physician to a traveling doctor for hire.  As I settle into my third month of locum tenens work, I want to take a moment to reflect and share my experience.  While many aspects about locum tenens work met my expectations, a few things have definitely surprised me. 

Read more: My Hiatus from Medicine: 3 Eye-Opening Revelations

How I got here

When I was an employed urologic surgeon in Southern California, I often dreamt of the freedom of locum tenens.  More often than not, this would be when I was sitting in my office at 6pm, tiredly working on my inbox.  The inbox would be filled with dozens of results and messages that had piled up during the day.  As I paused to sip my fifth cup of coffee of the day, I’d take a second and dream of a future where I didn’t have the responsibility of continuity of care.  

Even though I enjoy treating patients over time and watching them improve, the price of these relationships is high.  As the physician of record, you become sea level.  All the results, messages, and complaints of your patients eventually trickle down and flood your inbox.  

Read about how AI can rescue doctors from patient messages: 7 Ways Artificial Intelligence (AI) will Revolutionize Healthcare

So when my family decided to move from SoCal to Memphis for my wife’s career, I carefully considered the different practice options.  While I interviewed with private practices in town and liked them, we quite didn’t see eye to eye on schedule or pay.  So I decided to try locum tenens as a way to efficiently earn income as a physician while still having time to indulge my extracurricular pursuits like real estate and writing.

More money, more free time?

It’s true – the income potential in locum tenens is good.  Especially if you are skilled, personable, and have an open mind to geography, locums work can deliver a full doctor paycheck in about half the time.  

This is my own experience, of course, so the income potential I’m sure varies by specialty. It probably helps to be in a specialty like urology that is experiencing a severe nationwide shortage.  Anecdotally, I now know of multiple towns just a bit off the beaten track that have seen half their urology workforce retire or move away within the last few years.

Currently I’m working 14 days a month for a hospital outside of Cleveland, Ohio.  I get satisfaction from knowing that I’m able to give their local urologists a much needed hand when I’m on assignment.

While my income doesn’t include benefits, I’m making about as much as I made as a full time urologist in Southern California.  

And since I’m just covering call, there’s no flood of results and messages to worry about when I’m off duty.  When I go home, I can truly disengage my doctor brain and put my full energy into my real estate and blogging businesses.

Read more about how I grew our real estate empire: Anno Darwinii Real Estate Empire Archives

The downsides

But after a couple months of work, I can also speak to some of the downsides of locum tenens.  Let’s talk about three of them today: 

  • Job security
  • Family
  • Solitude

Job security

One of the first downsides of locum tenens is related to job security. I’ve realized that there’s no such thing as a secure locum tenens job. 

But first, let’s talk about why people like locum tenens work. One of the major reasons is freedom. It’s true that you have more autonomy as a locum tenens physician.  That’s one of the major reasons why I like it so much.  

I can review my calendar and tell the hospital which weeks I’d like to work and which weeks I’d like to be off.  And if I decide that a particular assignment isn’t for me, I can cancel my contract with 30 days notice.  

But the same qualities that are appealing about locums (money and autonomy) are what makes hospitals eager to replace you.  It would be vastly better for a hospital to have their own permanent employee as opposed to a locum tenens physician.  An employee is bound by a hospital contract and is more predictable.  It is also much easier to influence the behavior of an employee as opposed to an independent contractor.

Also, the freedom goes both ways.  A hospital can terminate a locum tenens contract from their end with very little notice.  If they find a good candidate for permanent employment, they’ll pull the plug on your locums contract just like that.  

My solution for this uncertainty is to diversify my assignments.  Starting in July, I plan to alternate assignments to hedge my bets.  I’m also going to save cash in a rainy day fund to smooth any periods of reduced cash flow from the possible loss of a gig.  


The second downside I’ve noticed from locum tenens medicine is its effect on family.

As a father to two boys and a husband to an amazing woman, I am keenly aware that being a traveling doctor is taking a toll on my family.  Each day I spend away from my kids is one less day for me to watch them grow and be a part of their lives.  It’s also one less day that I can support my wife in person.  Although we get a ton of help from my parents, who moved to Memphis with us, it’s still a lot of work to single parent two rambunctious young boys.

When I was young, my father traveled for work so much that I recall years when he seemed more like an occasional visitor than a father.  While I don’t see this happening to me, this possibility nags at the back of my mind.  

Read more: A Darwinian Doctor origin story: the meatball sub

The counterpoint to this is that when I’m home, I’m fully home.  I’ve had the flexibility to go to my sons’ school events during the day and see them for both breakfast and dinner.  These are things I didn’t get to do as a full time urologist in California.  

Today after I landed back in Memphis, I took my sons out bike riding. My five year old is newly off from training wheels and is making excellent progress on his bike riding. Tomorrow, I’ll have breakfast with them before they head off to school.


Lastly, the final downside of locum tenens work is solitude. It’s lonely!

It’s harder to grow social bonds when the very nature of your work is based on impermanence.  As opposed to a true hospital employee, my colleagues at the hospital know that I’m just helping out temporarily.  This keeps interactions at a superficial and solely professional level. 

After my hospital rounds and surgeries are done for the day, I head back to the hotel.  I spend all of my hours outside of work alone.  There’s little incentive for me to get involved socially in the community when I know that the assignment might come to an end with little notice.  

At least I’ve used my solitude to be productive.  I’ve worked hard during my off hours on my real estate business and my fitness.  I also see my family via Facetime virtually every day and participate in a number of virtual business or mastermind meetings every week.  

But I still feel the lack of community while I’m on assignment.  


At the end of the day, I feel that locum tenens work is fulfilling all of the goals I had hoped for.  I am making about a full time urology salary working two weeks a month.  I have the opportunity to utilize my hard earned skills while helping a hospital that is in dire need of urology coverage.

The free time has allowed me to nurture my passions outside of medicine and step more fully into my role as CEO of my real estate business.  This was very difficult to do when I worked 60 hours a week as a full time urologist in SoCal.  

But I’m honest enough to say that locum tenens medicine has downsides, namely in the areas of job security, family, and solitude.  

So it’s a good solution for right now.  Perhaps it’s a good solution for the long term as well.  I enjoy knowing that no matter the situation, I’ll have the freedom and autonomy to make the best choice that meets my life goals and journey.

– The Darwinian Doctor 

Are you interested in locum tenens work? Or have you tried locum tenens and also experienced downsides? Let me know in the comments below what else you want to know about locum tenens or real estate and subscribe for more!

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1 year ago

Thank you for the info.
I have also thought of doing locums as a supplement to my current salary. I am also a urologist like you. I live in AZ where the outlying smaller towns and communities already suffer with very little specialty support. How do you care for these patients knowing you will not be there long term? I could only see myself doing cases that are more acute or require shorter follow up. I would consider doing stones, torsions, hydroceles, bladder biopsy, etc. How do you manage what cases to do and what to send out? I would not want to get involved in cancer cases and then have to leave before pathology is back or in case there is a surgical complication.
Thanks in advance for any advice you have

Connie Braun MD
Connie Braun MD
8 months ago

I. am in the. fortune builders. but. want. to get. more. active in real estate. I live in. florida now. but I am from Michigan .
Lots of. real estate. here. especiallly. apts.. non stop. building

1 year ago

i did locums twice, for a year after my training &again mid practice in a transition in which 6 months turned into 6 years. Ditto to above. But there are ways around this. When you’re single Family &job security not so much an issue, and when younger finding friends was easier. In mid career we homeschooled so the kids came along till they got older. Then it was more of an issue. You can pick and choose your best jobs. Never worked a Christmas, Thanksgiving or birthday. Ultimately the separation from family got me to when kids older & they didn’t come along, so I found a job in town. It’s a pretty good gig, especially early in career& if single. My situation lent itself well to Locums, but later family separation made me work at home. If my wife liked travel more I would consider again.

House of Doctors
1 year ago

Thank you for this info. This is really helpful. Thanks again!

Connie Braun MD
Connie Braun MD
8 months ago

Yes. I. do. think locums. are. more money but. also. you need to be. always. looking for another job . Its. best. to be. certified in several states. I have. quit a good permanent. job. and only to have. a locums. job. pulled out from. under me. or. taken away. at. last. minute. Especially. during COVID. You. get. blamed. for. problems. that occur to. that. are. not really. yours. On. your free. time. its. lots of. paper for the. next. job. The. money is. good. but you. may have. a month or two. lag. Yes. I am in the. Fortune. Builders. group but. plan to get. my real estate. license. and flip homes and get. some. rentals.

Dr. J
Dr. J
4 months ago

Thanks for sharing, Daniel. I’ve done typical locums work in the past and found the same upsides and downsides as yourself. I’m a general surgeon and after nearly 9 yrs working full-time at a VA I started working as an independent contractor 14 days on and 14 days off in rural NM, which requires me to travel from my home in NE Indiana. Similar downsides to typical locums except I’m hard to replace as the only person doing upper and lower endoscopy within an hour or two in any direction and I am very productive. I’m lucky that my wife is pretty self-contained and good at holding down the fort and that we live in super safe part of town and we don’t have children I’d miss out on raising. 15 months into this gig, being gone and 1,100 miles away from home does bother me. There’s no place like home (and your own bed).

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