The gig work adventure of Britton Beatrous, MD, began with what he thought might be an attempt at humor.
Dr. Beatrous had just finished residency and started his private practice in the New Orleans region, and his schedule had not become full. The idea of doing an out-of-the-area locum tenens job—a temporary medical position—came from his father, who had done some of this work in the early and latter parts of his career.
So he contacted a recruiter for locum tenens companies and soon got a call that, at first, threw him for a loop.
“She called me back the next day and said, ‘I have the perfect job for you,’” Dr. Beatrous said. “‘It’s in January—and it’s in Fargo, North Dakota.’ I thought she was joking.”
It turned out that the 600-bed Sanford Health Fargo system has a reputation for being a good place to work in a locum tenens position, and Dr. Beatrous said he has had a positive experience, despite a workload that is a bit like residency. Since his first frigid, week-long trip that January, he has been back twice more, and when he returns to New Orleans, his two half-full weekly schedules have been consolidated into one full-week schedule.
“I don’t think it has slowed down my practice, but it has helped me be more efficient when I do come back and have a more full schedule,” he said.
Dr. Beatrous’ experience in gig work illustrates the many-sided phenomenon of medical gig work. It frequently involves venturing to a far-off, perhaps sleepier, place, where the quality of life you will have is not always clear beforehand. The work is often tough, with more medical minutiae to tend to. And it often involves time away from family. But it allows for the experience of a new culture and scenery, boosts income, and often sharpens skills that doctors might not be able to hone as readily in their usual practice back home.
Stats on Gig Work
Gig work has generally been on the rise, fueled largely by a shortage of otolaryngologists, ENT physicians’ desire to limit demanding call work that can lead to burnout, and the need to fill the gaps while healthcare systems conduct time-consuming searches for staff vacancies.
In its 2024 report on the locum tenens industry, CHG Healthcare—the parent corporation of locum tenens companies CompHealth, Weatherby Healthcare, Global Medical Staffing, and RNnetwork—reported that 7% of physicians were working locum tenens in some capacity in 2023 (CHG Healthcare. chghealthcare.com/chg-state-of-locum-tenens-report). That amounts to 51,873 doctors, down from the peak of 68,295 physicians in locums positions in 2019, but the trend has been up each year since 2020 when 37,548 were reported to be working locums. And the 2023 figure is almost double the number from 2015 when 26,325 were working locum tenens, the Latin phrase for “hold the place of.”
No specific numbers that show how many otolaryngologists do locums work are available, but the greatest demand for locum tenens work in 2023 was reported to be in primary care, sub-specialties, and surgical specialties, followed by cardiology/pulmonology and oncology.
According to the report, 44% of physicians said their overall impression of locum tenens work was somewhat positive, while 37% said it was very positive, and 43% said they were extremely or very likely to continue working locums.
The top reason physicians reported for starting to work locums was financial, with 46% saying it was intended to supplement their income. But many report other motivations as well, with 27% saying they wanted to control their schedule, 20% saying they wanted to work while going through a personal life transition, and 13% each saying their motivation was to see the country or the world or to expand their experience through new cases, according to the CHG report.
Most healthcare organizations—88%—reported that they were concerned with the cost of locums physicians; 75% said they were concerned with the physicians’ lack of familiarity with the practice setting, and 67% were concerned with the quality of patient care. But the time to fill a surgeon job is 277 days on average, 240 days for a specialty care physician vacancy, and 180 days for a primary care physician. And the income lost if a hospital doesn’t hire a locums replacement is typically greater than the cost of a locums physician, the report said.
“The flexibility of locums in filling coverage gaps or quickly adjusting staffing levels to meet patient demand will continue to make it the go-to option for healthcare organizations,” according to the report.
Why Consider Gig Work?
Mark Royer, MD, MBA, and Allison Royer, MD, who founded the locums company ENT Surgery Solutions in 2013, said they developed a passion for locums when they saw the value in having coverage when they needed to be out of town and when their daughters were born. They say the trend for ENT physicians doing locums has been on the rise, with their clientele doubling each year since 2017; about 50 physicians now work with them in locums positions on a rotating basis. Mark, who is the medical director for the company, said it has led to better access in underserved areas, a better quality of life, and better care for patients.
[Locums] gives them a lot more flexibility to really have the career and the work-life balance they’re looking for…as the need for it has grown, the possibilities are pretty much endless.” — Mark Royer, MD, MBA
“They’re not needing to be distracted or literally taken away from clinic while they are seeing patients because they’re on call,” he said. “It has allowed these docs to have a higher quality of life [and] to decrease their feelings of burnout.”
Using locums to cover call, he said, means physicians are less likely to be doing clinic while fatigued after handling a 2 a.m. emergency department call, or irritating patients because they get called away halfway through a clinic visit because they have to do a consult. This, he said, leads to physicians who are “just happier and more refreshed and feel good about their situation.”
One physician he works with lives in Italy, returns to the U.S. once a month to do a 10-day stretch of locums work, and then goes right back to his home overseas, he said. Doctors in the military do locums to stay sharp on trauma cases so they are ready when they are called into a battle zone.
“It gives them a lot more flexibility to really have the career and the life and work-life balance that they’re looking for that just really wasn’t available even 10 years ago,” Dr. Royer said. “It’s wild. As locums has grown and as the need for it has grown, the possibilities are pretty much endless.”
Jamie Litvack, MD, MS, who has a private ENT practice in the Seattle area, has worked a locums position at the Alaska Native Medical Center in Anchorage several times, and found the work very rewarding, she said.
There’s something very meaningful [in] taking care of a community that is typically underserved.” — Jamie Litvack, MD, MS
“There’s something very meaningful if you’re taking care of a community that is typically underserved or is different than the one that you’re working with,” Dr. Litvack said. “It makes you think harder about the way you practice, it sharpens your skills, and it’s neat to be able to provide services for people that need those services.”
The Alaskan native population has a higher prevalence of chronic ear disease, which makes it a different sort of clinical challenge and makes the work inherently interesting, she said.
“I get opportunities all over the country—there’s more work than there are otolaryngologists,” she said. “For me, I love to travel. For me, a lot of it is about the community … I think a lot of people will choose places that they’re curious about.”
Taking herself out of her routine makes her a better doctor, she said.
“The mentally interesting part is the ‘how,’” she said. “How do you practice when the resources are different, when the access is different, when the time to care is different, when there is one person on call versus a call group of five, seven, 10, 15 people? All of those things are just different.”
She said doing locums work is a great way to fend off burnout.
“You have autonomy, you have freedom, you have a lot more control over your schedule,” she said.
Ilaaf Darrat, MD, a pediatric otolaryngologist at Henry Ford Health who normally works in the Detroit area, regularly did locums work at a center more than an hour from home, farther west in Michigan. She and other physicians doing locums filled in while vacancies were being filled, a process that took six years, she said.
As a single mother, she would work during weekends when she was not with her children. It was not part of her contract, and “they paid us accordingly for that”—about a week’s pay for a weekend of work, she said.
In the locums work, she would see mostly adult patients, allowing her to work on case types she didn’t routinely see.
“The patients were so grateful to have seen you there,” she said. “I definitely sensed that.” But the job involved handling more details than she normally would in her regular work, she said. “If there is a nosebleed, I actually have to stop it,” she said. “I usually see the patient after everything is taken care of by the residents.”
But she said it has been a worthwhile experience financially and professionally.
“It keeps your skills sharp,” she said.
Do Due Diligence
Despite its numerous benefits, doctors considering these positions need to exercise due diligence before taking a position, those who’ve done locums say.
Dr. Royer said it is important to find out beforehand who will be handling post-op issues, how malpractice coverage is handled, how many patients a physician is expected to see per day, what support staff is available, and whether they have done ENT work before.
“In some states, they don’t even need to have an anesthesiologist on the premises or supervising” the certified registered nurse–anesthetist during induction and awakening, he said. “So what that means is ultimately the anesthesia responsibility falls on the operating surgeons. Some docs may feel more comfortable with that than others, but that’s always important to know.”
Dr. Litvack emphasized that regardless of the type of practice—private, employed, or locums—“We are physicians first. The grounding professional principles of ‘do no harm’ and ‘patient first’ always apply.
“As physicians, we prioritize patient care above all else. In a locums position, we have the opportunity to contribute to the quality of care by advocating for what we believe is best for our patients,” she said. “If we encounter a situation where a service isn’t meeting those standards, we always maintain the influence to work with hospital or practice leadership, a locums employer, and other stakeholders to ensure the highest level of care.”
It seems that once you put your name on a list of interested physicians, you are then open to a regular flow of messages, doctors say.
“I have recruiters texting me or calling me multiple times a day for locums work,” Dr. Darrat said. “Every day, I’m not kidding you. I don’t know what listserv I’m on, but I get a text or an email or a call every day.”
Dr. Royer said his company tries to minimize the paperwork burden on doctors doing locum jobs.
But Dr. Beatrous said there is still a fair amount of legwork. “The truth of the matter is, there are quite a few hoops you have to jump through,” he said.
He also said that physicians will sometimes be asked to commit to a set of locum stints—such as six trips over 12 months—but he recommended being careful about such arrangements.
“I would be hesitant to sign up for something like that because it could have easily been not what they said,” he said.
Still—especially after a subsequent trip to Fargo when his family accompanied him, and another one in nice summer weather suitable for golf and pickle ball—he said locum tenens positions are worth considering for many.
“Every situation is different,” he said. “I think it’s a good gig for someone fresh out who’s not super busy and wants to make a little extra cash and start paying off loans. It’s a great gig if you’re in that situation and you’re single. Personally, I would do it again, and I have recommended it to others.”
Thomas R. Collins is a freelance medical writer based in Florida.