In the past, there was a stigma that locum tenens was for physicians who couldn’t get a “real job.” Doctors who did this temporary work may have been viewed as not being on top of their game, or they were retiring and on their way out.
Not so anymore. According to the National Association of Locum Tenens Organizations (NALTO), every year about 52,000 locum tenens providers take care of more than 7.5 million Americans.
With existing and predicted physician shortages, locum tenens has become important to mitigate burnout among doctors working in short-staffed medical institutions, as well as to cover all the patients who need to see a doctor but wouldn’t otherwise have access. And the work can be of great benefit to locum tenens physicians themselves.
“Locum tenens is a great option if you want to travel or work part time,” said otolaryngologist LaKeisha Henry, MD, who did locum tenens work when she was in the military and now does comprehensive otolaryngology in private practice with ENT Consultants of Nevada in Henderson. “I have friends who have pursued regular locum tenens work post-military service for years as a way to have variety in their practice, avoid burnout, and be able to work in different locations and systems.”
In addition to flexible schedules that can accommodate parenting and travel, locum tenens offers occasional slow-but-well-paid shifts in the emergency room (ER), as well as experience treating patients in underserved areas and in a wide range of cases. And when locum tenens physicians go home at the end of a shift, they don’t take work home with them in the form of filling out electronic medical records.
Benefits of Locum Tenens
Fresh out of residency about a decade ago, Mark C. Royer, MD, and Allison K. Royer, MD, married otolaryngologists living in Indiana, took jobs at a 300-bed community hospital an hour outside of Indianapolis. “It was great. We loved it,” said Mark. “The only problem was that we were the only otolaryngologists in the group, so when we were preparing to deliver our daughter, there would be nobody to cover the ER.”
That’s when locums came to their notice. The hospital they worked for made good use of locum tenens otolaryngologists as the Royers had two of their daughters.
“We got to know the physicians who worked locums and their stories,” Mark said. Around this same time, he was pursuing an MBA and thinking about doctors working too hard, doctors in private practice losing partners to big healthcare corporations, and billion-dollar companies taking a big cut of those hard-working doctors’ pay.
“We had a gut feeling that the need for locum tenens was going to be great as more doctors became employed and their quality of life became a bigger issue,” he said. “I had the MBA, so I knew the whole point of business is to figure out how to create value. I knew there had to be a way to pay doctors more and charge the hospital less.”
The Royers did just that in 2013 by forming an otolaryngology staffing agency, ENT Surgery Solutions, LLC, (www.ENTlocums.com). Allison is founder and CEO; Mark is the medical director. Today, they are the largest provider of otolaryngology surgeons around the country for short-term and ongoing staffing needs at healthcare centers, and a member of NALTO. Their administrative team features practicing otolaryngologists in directorship roles who understand the challenges of the specialty. The Royers also continue to practice as comprehensive otolaryngologists in southern Indiana.
A lot of the locum tenens things I’ve been doing are at critical access locations that wouldn’t otherwise have any sort of head and neck presence, and it’s rewarding to be able to deliver care in places that have less access. —Paul A. Tennant, MD
Paul A. Tennant, MD, an otolaryngologist fellowship trained in head and neck cancer surgery and based in Louisville, Ky., has been doing locum tenens work through the Royers’ agency for much of the past year. When he was recruited by a private hospital system in Louisville, he had to honor the one-year noncompete agreement he had signed with the University of Louisville, where he had done his residency and worked as a faculty physician for seven and a half years. Married, with six young sons, Dr. Tennant did need to work, but was prohibited from working within 100 miles of the city until that noncompete expired.
“I got into locum tenens reluctantly,” he said. “I wasn’t enamored with the idea of leaving home and my family.” Dr. Tennant still doesn’t love it sometimes and says he didn’t have the best attitude about it at first. But he has found locum tenens options that allow him to be in town often, and he finds it fulfilling to provide care to patients in rural parts of western Kentucky and southern Indiana, given that Louisville and Lexington are the only metropolitan centers in Kentucky that provide tertiary or quaternary care.
He hustled this past year to piece together enough work and has privileges at 10 or more different facilities. He has also formed relationships with many other physicians as a result, learned several healthcare facilities’ systems, and can interact within these systems effectively.
“A lot of the locum tenens things I’ve been doing are at critical access locations that wouldn’t otherwise have any sort of head and neck presence, and it’s rewarding to be able to deliver care in places that have less access,” he said. While Dr. Tennant starts his new job this November, he said he would consider taking the occasional call in some of the locations in which he has practiced, doing weekend work or vacation coverage.
Currently, Dr. Tennant is working in Ohio County, Ky., the largest county in the state by land size, but the smallest by population. The otolaryngologist who worked there was nearing retirement age and left during the pandemic; Dr. Tennant filled his position in a locum tenens capacity.
I have friends who have pursued regular locum tenens work post-military service for years as a way to have variety in their practice, avoid burnout, and be able to work in different locations and systems. —LaKeisha Henry, MD
As a provider who offers subspecialty service in head and neck cancer in outlying areas, Dr. Tennant said he now has a better understanding of barriers to access in rural environments. He has had the opportunity to think about how to streamline care for a patient with tongue cancer in an outlying area, and has thought about options like telehealth, virtual tumor boards, and better communication with centralized locations.
“Being able to deliver as much care remotely as possible while continuing to offer quality is something that I’m very interested in and would love to explore in the job that I’m going to be starting,” he said. “Being able to do a large surgical intervention at a tertiary or quaternary center in the big city is one thing, but if a patient elsewhere needs adjuvant treatment or continued cancer surveillance, it would be great to grow networks of providers that collaborate seamlessly so that patients can get what they need locally.”
Increasing Demand
Mark said that after the initial COVID- 19 shutdown in 2020, his agency saw a 100% increase in the demand for locum tenens otolaryngologists. “From a call coverage standpoint, people really started reevaluating what was important to them. The reality ofbeing an older physician, or one with other risk factors, and sticking scopes in noses all day with a life-threatening virus out there and no vaccine for it just didn’t make sense.” He added that, as older physicians left practices and younger partners picked up the slack, these younger partners had also just spent two months at home with their families, considering their own mortality and what they valued in life; some realized they didn’t want to be on call every night.
When the Royers started their locum tenens agency, Mark said, it was very common for independent practices of four or five physicians to sell their practices to a local hospital and then become employed by that hospital. The way those hospitals measure productivity is in work relative value units (wRVUs). “ Then, two or three years into their contract, the hospital would tell the physicians they weren’t meeting their wRVU targets, and their contracts would be adjusted with a new salary that was usually less than the initial guarantee,” he said. “They’re working more because there are fewer of them, and they have to be on call every other night or weekend, but they’re actually taking a pay cut.”
Also according to Mark, when doctors would press their administrators about taking on more work that wasn’t being reflected in their compensation, those administrators would cite federal fair market value laws, Stark anti-kickback laws, and an assortment of rules and regulations that essentially meant a ceiling on compensation.
Dr. Tennant has enjoyed the quality of his life this past year, particularly the autonomy of being able to create his own schedule. He has worked with several locum tenens companies providing contracted services, mixing and matching different types of work and seeing how different health systems operate. “I’m not good at not being busy,” he said, adding that this type of variety has been fun. “I don’t have a health policy background, but I have an undergraduate political science degree, and being in multiple healthcare systems has really grown my perspective. In academics, when you’re in one place it can be really insulated.”
The pay for locum tenens work is competitive, particularly in otolaryngology, where there tends to be a paucity of specialists in rural areas. But unlike travel nurses, who reportedly make a great deal more than their colleagues who work for one institution, the pay difference isn’t that stark. According to Dr. Tennant, locum tenens tends to pay more for time than for productivity.
“It’s been an interesting way of valuing my time, because I’ve always felt like my time wasn’t valued to the degree that it ought to be,” he said. “With head and neck oncology, you’re doing 12- to 15-hour surgeries and often not eating dinner with your family and not seeing your kids before they go to bed. I never felt like the compensation accounted for that.”
Renée Bacher is a freelance medical writer based in Louisiana.
Locum tenens: A Military Doctor’s Experience
Scott McCusker, MD, a comprehensive otolaryngologist with Mercy Medical Group in Sacramento, Calif., strongly recommends that all military otolaryngologists do locum tenens work. “It really is a win-win situation,” he said. “It isn’t that hard, it broadens your clinical skills, and it pays really well for the amount of effort involved.”
Dr. McCusker, who focuses on facial plastic surgery and sleep apnea surgery in his current practice, attended the United States Air Force Academy for college, went to medical school on a military scholarship, did an internship at Northwestern, and then went back to the military for his residency. He finished in 2011 and served for the next nine years as an attending otolaryngologist in the Air Force before separating from the military in 2020.
His main motivation for doing locum tenens work was financial. “The military doesn’t pay its physicians very well and California is an expensive place to live, especially with two young kids,” he said. But he also liked being able to experience different practice environments and see different places, which helped him to decide what he wanted to look for in a subsequent career after the Air Force. “Sometimes my wife and kids would join me for at least part of the trip, which was a fun little adventure,” he said.
The downsides included the challenge of finding the right balance among the primary practice, locum tenens time, and time off. “Sometimes there’s a lot of need all at once,” he said, “but there’s also dry periods, and it isn’t something you can necessarily depend on even once you get established.”
Dr. McCusker stopped doing locum tenens when he left the military because his current practice doesn’t allow it; even if it did, he doesn’t need to supplement his income. But one of the advantages as a military physician, he said, was that he could use the skills stateside that are important to be proficient in downrange, which is something many military doctors struggle with.