My Income as a Locum Tenens Physician

Today, I share the specific details on my income as a locum tenens physician working seven days a month.

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Introduction

I made a TikTok video a couple of weeks ago about how much I make as a locum tenens physician (see below).

I said that this year, working seven days of locum tenens a month, I should make about 2/3^rd of what I made as a full time employed urologist in Southern California. 

That’s specific enough for practicing urologists, but most of my viewers on TikTok aren’t urologists.  Some of them were unhappy with this answer and demanded specifics!

Ever since I created this blog to track my journey to financial freedom, I’ve promised transparency, especially about money.  That led to this post on how much money my family spent when we lived in Los Angeles, which has become cornerstone content on my blog.    

So today, I decided to stay true to that philosophy and break down the specifics of my income as a locum tenens urologist. 

Here’s that TikTok video for those who’d like to see it (make sure to follow before TikTok gets outlawed!):

The bottom line

I used to make around $600,000 a year working as a full-time, employed urologic surgeon in Southern California. 

This year, working 7 days a month as a locum tenens urologist, I expect to make about $400,000.

(These numbers are pre-tax.)

But first, a little background about how this all came to pass…

Setting the scene

In 2022, I quit my full-time job as an employed urologic surgeon in Southern California.  There was a lot of reasons why I made this decision, and if you’re interested, you can check out these other posts that go into the backstory:

• My Why: Family, Friends, and Freedom
• My 15 Year Plan to Financial Independence, MoFIRE Style
• Your Mom is a Badass | Letters to my Sons

Basically, I loved many things about my job, but I was also seriously burnt out.  I also was juggling my real estate business and running the Darwinian Doctor on top of my full time job as a surgeon.  I had a game plan to achieve financial freedom within 15 years, but increasingly felt my path to that future was going to take some detours.

So when my wife got an incredible career opportunity in Memphis, we decided to go for it. 

We both quit our jobs and moved across the country with our kids and my parents. 

A tough transition

I’m not going to sugar coat it – the last couple of years have been a hard adjustment.  It turns out that there are big cultural differences between Los Angeles and Memphis.  There were typical foreseeable challenges, like getting our kids started in a new school in the middle of the school year.  Another predictable problem was finding a housing solution that would fit my family as well as my parents. 

There were also less obvious challenges, like re-creating social bonds in your 40s as transplants to a tight-knit city like Memphis. 

I also faced a big decision regarding my medical career:  I wanted a flexible option to practice medicine that allowed me sufficient time to run what would eventually become Cereus Real Estate, manage my own real estate portfolio, and continue to grow the Darwinian Doctor platform. 

After a few months of negotiations with the various private practices in town, I concluded that what I required didn’t really exist in Memphis.  So, I contacted a few locum tenens agencies and within about 8 weeks I was flying around the country as a traveling physician.

Locum tenens job #1

The first job I took as a locum tenens was in Mississippi on the Gulf of Mexico.  It was a small community hospital who needed just a few hours of inpatient work per day, plus evening coverage for overnight call. 

As is typical for most locum tenens gigs, I’d fly there in advance and stay in a nearby hotel for the 10 days of my assignment.  The hospital would cover my transportation, lodging, a rental car, and my malpractice insurance.    

My duties included covering the inpatients and the consult service, as well as taking care of emergencies like renal colic, testicular torsion, penile fracture, urinary retention, gross hematuria, and intraoperative ureteral injury.

Here was my compensation:

• $1800/four-hour day
• $200/hour overtime

I’d characterize the assignment as mild to moderate in terms of difficulty, with a manageable rate of ER consults and emergencies. 

I averaged about 4-8 hours of “overtime” a day.  After 10 days of work, I was compensated about $28,000. I completed just one shift before deciding that I’d be better off in a different setting.

Locum tenens job #2

My second locum tenens job was assisting with a great private practice in Mississippi.  I would help them for a few days at a time for a flat $2500/day.  While on duty, I saw patients in clinic, operated on scheduled cases, and covered call.  This meant that I saw the consults in the ER and helped other services in the hospital that required urology consults. 

While the compensation was lower than my first locum tenens gig, I saw this more as an opportunity to explore a partnership with the private practice. It was drivable from my home in Memphis, so if things worked out well, it could be a more convenient option for the long term. 

Since I usually did 3-day assignments with this group, I’d make $7500 for the 3 days of work.

I paid for my own malpractice insurance and covered my own transportation costs.  They covered my lodging costs. 

After a few months of working with the group, it became clear that between this position and job #3 below, I was working too many days away from home. My family was suffering from my absence, and I also foresaw increased demands from the upcoming launch of Cereus Real Estate. 

Read more: 3 Downsides of Locum Tenens Medicine You Should Know

So I parted ways from this opportunity on what I hope were good terms. 

That leaves us with the third locum tenens gig, which I continue to work today. 

Locum tenens job #3

When I discussed my goals with the physician recruiting agency, one of the major goals I mentioned was time efficiency. 

Between my real estate investments and the Darwinian Doctor, I knew that I had a discrete amount of time that I could comfortably spend on medicine.  Therefore, I wanted to maximize my income for the time I’d be away from my family on a locum tenens job. 

With this in mind, one recruiting agency found me a position in Ohio.  They warned me that it would be a busy job, but the pay was higher than the other jobs I had before. 

My starting rate at the Ohio position was:

• $2400/eight-hour day
• $250/hour overtime

It turns out that they were quite right about the job.  The hospital I cover is a referral center for the surrounding region and the ER has tremendous volume.  This leads to a corresponding demand for emergency consults from everything from septic kidney stones to priapism and gross hematuria.  (So much gross hematuria.)

The first seven days of coverage I complete at this hospital yielded compensation of about $20,000. 

After a couple of weeks, it was clear that they weren’t kidding about the pace. There were multiple days where I got destroyed by the volume of consults and urgent/emergent surgery during the night. I was on call 24/7, so there wasn’t really any ability to recover if I had a bad night. Due to the pace, I requested an increase in my pay rate.

That was granted by the recruiting company and afterwards, this was my pay rate:

• $3000/eight hour day
• $250/hour overtime

After a few months, I was accustomed to the pace and was getting along very well with the local urologists and staff.  I was also providing a high level of service.  I try to achieve excellence in everything I do. Therefore, the hospital approached me about buying out my locum tenens contract and hiring me directly.

After some consideration, I agreed, but requested a pay increase for the inevitable paperwork and time investment required to switch employers.  We negotiated a little bit before settling on this pay rate:

• $4250/eight hour day
• $300/hour overtime

Despite the higher rate and the buyout, the local hospital was still coming out ahead because they were no longer paying significant overhead costs to the locum tenens agency. 

I still travel to Ohio each month to work this assignment.  On average, I work about a 10-12 hour day, leading to a 7-day paycheck of around $34,000.  As I mentioned, I work one shift a month, so this should yield an annual income of about $400,000.

Employees cost more than their paycheck

I want to point out one very important point in regards to income. If you’re employed, your annual income only reflects part of your whole compensation package.  As an employee, a lot of your pay never hits your bank account.  It comes in the form of benefits like a 401k match, pension, health insurance coverage, life insurance, etc.  While these figures vary wildly by employer, you can roughly calculate that your benefits are costing your employer an additional 20-40% on top of your base pay. 

So if we think about my $600,000 of income as an employed urologist back in Southern California, that might be more equivalent to a total compensation package of $750,000 – $850,000!

The same thing is true for locum tenens work, but to a much lesser extent. 

As a locum tenens, I’m reimbursed for whatever I spend on transportation and lodging.  For me, this means that they’ll pay for my rental car, airline ticket, and my hotel room.  This typically comes to about $2000 for every seven day stretch of work. 

They also cover my malpractice insurance.  I can’t really project what that costs them, since this cost might vary wildly based on the specialty and bargaining by the provider.  When I’ve purchased malpractice coverage for myself for my work in Mississippi, it cost about $7000 annually, which I think would be considered pretty affordable. 

Expressed as a percentage of my annual earnings,  extra costs to my locum tenens employer are probably only an additional 10% on top of my income (if that).

This is one reason why hospitals can pay more to locum tenens per hour than their regular employees — they have little to no benefits.

Conclusion

As a locum tenens urologic surgeon working seven days a month, my annual income will be about $400,000 this year. 

I’m very grateful for this income, because it allows me virtually unlimited runway as I continue to build my real estate investments and Cereus Real Estate.

It took trying a few different opportunities and strong negotiation to yield this pay rate, but I don’t think this is unachievable for other specialists.  I have spoken to a few other specialists who are compensated at a similar rate for their locum tenens gigs.  Also, I’ve spoken to another hospital who agreed to match my rate to help cover their urology needs. 

Although I’m happy and grateful to have my current assignment, I understand that at any moment, the hospital might come up with a different solution to cover their needs.  Job security is not assured in the world of locum tenens.

In the end, it all comes down to supply and demand.  With the physician shortage and burnout epidemic (which is especially bad in my specialty), I foresee the demand for physicians’ expertise only growing over the next decade. 

Locum tenens is a good solution for burnout, and it also helps distribute medical care to underserved areas of the country. If you’re considering it, I hope you now have some better insight about what’s possible in terms of your income.

Daniel Shin, MD

The Darwinian Doctor

What do you think about my income as a locum tenens? Is it higher or lower than you expected? Let me know in the comments below!

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