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Should Physicians Finishing Residency or Fellowship Training Go Straight to Locums Jobs?

2 days ago
8 min read

Many physicians these days are craving flexibility and the freedom to work on their terms. Additionally, locum tenens can mean more money per hour worked, which can be very helpful when you’re trying to pay down student loans, particularly if you don’t have anything tying you to one place yet. Because of this, many trainees nearing graduation ask about whether it’s a good idea to consider doing locums right after they finish residency or fellowship. Depending on the physician, it could be a great option - but the fact is that many (if not most) seasoned physicians in our online communities for doctors recommend against it. Below, we cover the pros and cons of exploring this career option straight after training.


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Downsides of doing locums right after finishing residency or fellowship training


Why might doing locums right after finishing residency or fellowship be attractive?


As we alluded to above, there are several reasons why physicians graduating from training may want to explore locum tenens as a career option immediately after finishing residency or fellowship. 


Reasons to consider this career option that we often see in our communities include:


  • You aren’t sure what job environment you want to work in permanently and you want to explore options (rural, academic, community hospitals, large private medical centers, etc)

  • You have a significant other who has job considerations that make it difficult for you to take a permanent job in the short term, so you want to do locums in the interim

  • You want the flexibility of locums for a number of reasons (examples: ability to help take care of patients, know that you want to start trying for a family soon and don’t want to commit to a permanent position in the short term, want to explore other career options aside from clinical work in the time off, etc)

  • You’re in a specialty with substantial demand and well paying options with locums and you want to make as much money as possible

  • You want to explore new locations before life gets more complicated with settling down and/or having children


In these situations, it’s likely worth giving locums serious consideration, but it’s also important to understand the downsides of doing locums right after graduating.


When it might make sense to do locums right after residency or fellowship training


What are the downsides of doing locum tenens straight from residency or fellowship training before having a ‘traditional’ physician job first?


When these questions come up on our communities, the more seasoned members of our communities are quick to point out hesitation based on their own experiences being new attendings.



Learning to be and getting comfortable as an attending requires an adjustment period


While you may feel at the top of your game when you finish your training, many doctors realize that once there’s no one working above them, decisions that you were once confident about just feel different when you’re the final say. Additionally, it takes some time to get used to patient flow, schedules, and the business of medicine. You’ll also want to develop your own practice style that doesn’t involve the preferences of your previous attendings. A permanent job may give you the stability that you need while you figure out these pieces, without the hassles of learning new hospital systems and referring physicians and medical teams every week.



You need to develop your own consistent practice patterns


Similarly, going from environment to environment can be not just physically and mentally disorienting, but also may require you to change practice patterns routinely. Each environment has different realities, admission criteria, preferences on drugs and formularies, order sets, consultation patterns, discharge practices, documentation requirements, protocols, and procedural norms. You’ll likely spend a lot of cognitive energy adjusting to these rather than refining your own practice patterns - and it could be confusing to you to the point where you have challenges feeling confident in your decision making. The imposter syndrome in those early attending years can be real, so be mindful of the effects that doing locums, where you’re expected to come in as an expert and help, could have on that.



You won’t have the benefit of having co-attendings that are understanding of your role as a new attending physician


In a permanent job, your colleagues will view you as somebody who will be a long standing partner to practice medicine alongside of. They’re much more likely to take you under their wings and mentor you, answer your questions, cut you some slack when things don’t go right, and back you up or help out if you’re uncomfortable with something. 


In locum tenens, depending on the locums environment, you could be the only doctor on the floor when a key decision needs to be made that you’re not sure how to handle. The hospital is contracting you to fill a need, and they need to be able to depend on you for that role. They’re less likely to want to see their role as supporting you in your career growth.



You may find that a locums job requires locums physicians for a reason; they may not be they best place to work as a new attending


While there are very legitimate reasons why great places to work need locums physicians, some hospitals need locums because they have a hard time retaining physicians or with persistent vacancies. Again, this could be due to a number of reasons that are not red flags - location in a rural area, patient populations that more more challenging, etc. However, some of these positions may also have administrative teams and support staff that are difficult to work with, undesirable scheduling requirements, unreasonable expectations from physicians include very high patient loads or requests to do non-physician work because of short staffing on the nursing or clinical support side, etc.


Again, while these are not insurmountable challenges, and locums physicians deal with these daily across the country, it may not be ideal at a time that you’re just getting used to attending life. 



There may be longstanding professional consequences from working at the wrong first job


Piggybacking off of the point above, as a new graduate without experience working elsewhere, you may be poorly positioned to recognize when a request is unreasonable or unsafe, and put yourself into a bad situation that leads to burnout, malpractice risk, or other patient safety issues. 


Especially in high acuity situations, not having the benefit of professional connections you can call on can be devastating. Imagine being in a new system and not knowing how to contact a surgeon or intensivist efficiently when something goes wrong with a patient on the floor. While you may be clinically capable of handling a case, that’s not the same as being able to do it within the system you’re practicing in and having all the tools readily at your fingertips.


Some of these things could result in issues with oral boards during a case collection period, reporting to the National Practitioner Data Bank (NPDB), or other issues.



You may not get meaningful feedback


During training, you get a lot of feedback, but in attending life, people will be hesitant to give you feedback when they don’t know you or how you’ll take it. They may also not have a vested interest in improving your practice patterns, and instead just suggest to the leadership that they not bring you back again for another locums assignment. But in that process, you’ve lost the ability to benefit from constructive feedback that could help you be a better clinician.



You may lose valuable skillsets


Depending on the hierarchy at the hospital, as well as what services in house teams want to provide (either because they feel most comfortable, or because they’re the most lucrative), you may not be offered the opportunity to do certain procedures or participate in the care of certain types of patients. This could atrophy valuable skills that you spent years learning in training. You’re being called in to fill a very specific niche, but you may want to keep all of your skills active, and generally the best way to do that is to have a more well-rounded practice.



You may stunt your professional growth


Many physicians coming out of training aren’t familiar with all the job opportunities and areas of professional growth available to them. When you’re siloed in the world of locums, you may lose the opportunity to find out about these opportunities.


New attending physicians often have mentorship and others advocating for and advising them in their early careers. These relationships can lead to leadership opportunities, committee positions, teaching opportunities, research collaborations, referrals, partnership opportunities, and other opportunities to be engaged within the physician community.


Locums can be very professionally isolating, and you’ll have to decide if you want to take that step so early in your career. Just make sure that in optimizing for flexibility or money, you’re not sacrificing career development at an early stage in your career.



You may stunt your personal growth, even if you make substantial progress towards your financial growth and goals


Most physicians finishing training have spent many years away from friends and family, missing family events, moving around the country for college, med school, residency, and fellowship, etc. This can make it very difficult to set down roots. One of the things that many physicians look forward to the most about finishing their training is finally having the opportunity to settle down in one place, actually put some holes in the walls to hang up artwork without having to worry about patching them in a few months for the next move, and to build a community around themselves and their families. 


Signing up for locums life, for many doctors, means traveling constantly, or potentially continuing to work nights and weekends and holidays, as these are the shifts that both pay the most, as well as are in highest demand from hospital systems with their employed doctors looking to take time off. 



If you’re trying to date and find your significant other, start a family, or just get deeply entrenched in your community, locums life could interfere with your plans.



Conclusion


Though going into locums may certainly be the right decision for many doctors coming out of training, physicians in our online communities often contend that your first year out is more about learning how to be an attending than about making the most amount of money possible per hour. There is stability and community that can help with that transition in more traditional physician jobs, which may give you a better foundation to eventually transition into locums life.



Related resources for physicians considering locums


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