The White Coat Investor blog recently published an article about locum tenens work in human medicine, and it made me realize there are some notable differences from veterinary locum work. Many people may not know about locum opportunities, and it’s a benefit of academia I’ve mentioned before. For those who are interested in academia, or even those in private practice who want to spend time teaching, this is an introduction to veterinary locum tenens.
Locum tenens literally means “place holding” and is a short-term work commitment. Many locums are short- 2-4 weeks- while others are long enough to cover maternity leave- 6-9 months. Let’s break down how to find locum jobs, what the process is like, and advantages and disadvantages.
Finding Locum Jobs
Most locum jobs will be found in academia, although private practices will also sometimes employ locums, particularly when they’re also searching for a full-time and hard-to-get specialist. Finding locum positions depends on the discipline. In anesthesia, an email gets sent out to ACVA-L, to which most anesthesiologists are subscribed. Other disciplines without a universal listserv may use more specialized listservs (e.g. Society of Veterinary Soft Tissue Surgery), post on Linkedin, post on social media, or put the listing up on the specialty’s job board website.
Personal connections are also a valuable source for locums. About half of the time I do a locum, it’s because I get an email from someone I know who needs a locum for a specific time frame. Many institutions which have an open position posted for a new faculty member will be amenable to locums- you just have to email the contact listed on the full-time position posting or reach out to the department head and ask if they are interested in you providing locum coverage. Some universities may list locum positions on their employment site, although this is uncommon. As far as I know, there are no third-party companies facilitating locums like there are in human medicine.
Locums Process
At least in anesthesia, once an email goes out to ACVA-L, you only have maybe a day or two to reply before the locum position has been booked up, in my experience. So you have to be ready to jump on an opportunity that comes up. Usually, institutions are looking for a locum for specific dates. If it lines up with your availability (you’re off clinics and don’t have major teaching/research responsibilities), you email the contact person and indicate your willingness to help. Sometimes, the details of the locum will be provided up front (e.g. pay, what expenses the institution pays vs. what you pay), but many times you have to ask in the email. Most locums pay between $5-10k/week, and some of them cover your expenses (travel, lodging) while others do not.
Here’s a really important note: some employers will pay you as a W-2 and some will pay you as a 1099. If you have to pay for your own expenses, and they pay you as a W-2, you CANNOT write off those expenses on your taxes! I have no idea how institutions justify paying you as a W-2 employee (since you’re obviously a casual contractor, which is what 1099 is designed for), but I paid about $1k more in taxes one year than I had to because of that classification. Ask before you agree: does the institution pay for your expenses and, if not, are you paid as W-2 or 1099? At this point in my career, I’ve stopped taking any job which pays me as a W-2 and doesn’t take care of expenses.
Once you have agreed to do the job, some places will send you a contract. They will walk you through the licensing process. Getting a license in another state can be a significant pain. You have to get a letter from EVERY state you’ve EVER had a license in to indicate you didn’t do anything bad in that jurisdiction. The AAVSB can facilitate this- for a fee, of course. I’ve found it easiest to just pay the AAVSB fee rather than go through the hassle, but if you only have one or two state licenses, it may not be too bad for you to DIY.
If the institution is going to take care of your expenses, they may book lodging for you or you may book it and get reimbursed. Sometimes, they have a lodging budget so you could book a nicer place and just pay for the difference yourself. Usually, you will book your own flights. If you have to pay for a license, you’ll usually get reimbursed. If there are visa issues (e.g. locum in Canada), the institution’s lawyers will generate the paperwork and get everything set for you. You may have to pay the fees at the time of the visa (obtained when clearing customs), but they will reimburse you.
If the institution doesn’t take care of your expenses, you have to pay for it all out of pocket and, hopefully, they give you a higher pay to compensate for everything. I usually budget $1500/week for expenses, although this is highly location- and individual-dependent. If you don’t mind AirBnBing a room in someone’s house, your expenses will be much lower compared to staying in a hotel.
When you show up on Monday before 8am, you should have a contact person to call who will escort you where you need to go. Most locums start at 8am on Monday with orientation and paperwork and pharmacy access, then you start clinic responsibilities some time mid-morning. If you’ve locumed there before, they may skip those steps and you can go right to the clinic area and get started.
Some locums require you to do primary emergency duty, some require you to be back-up to their residents/staff, and some have no emergency requirements. Most will require 7-days-a-week coverage of clinic responsibilities, just like your “usual” job. That is, if you have patients to discharge on Sat or Sun, you have to take care of them. Some will require you to be on call until 8am the Monday after your week, making it impossible to do a locum week and then do a clinic week back home. You may be able to finagle things- such as starting the locum on Sat or Sun before your official start date so you can leave on the Sun at the end of the time- if you have worked there before and know the people.
Some locums will give you the specialized communication devices the hospital uses (e.g. Vocera) or a dedicated cell phone for use during your time there. They’ll provide you with access cards and maybe a name tag. Some will provide scrubs, but I always bring my own anyway because they usually don’t have many sets in my size. Otherwise, you should bring your own lab coat, stethoscope, and similar paraphernalia you use in your regular day-to-day clinic work. Don’t forget to return everything they gave you before you leave on the last day!
You will have set up direct deposit with the institution at some point. When the pay period after your locum rolls around, presto, the money gets deposited into your account. If it was a W-2 locum, they will have taken out taxes. If it was a 1099 locum, you’ll have to pay taxes when you file next year, assuming you have a regular full-time W-2 job. If all you do is 1099 jobs, you’ll need to file estimated quarterly taxes.
Advantages
- No committee work, politics, classroom teaching, equipment issues, or anything else not related to clinical teaching and patient care. If all you want to do is be on clinic duty, teach house officers and students, and then leave the job without worrying about everything else normally associated with academia, locum jobs are perfect.
- Good pay rate. If you do 50 weeks of locum work a year, you could earn in the $250k-$500k range. On a practical level, that’s unlikely given the sporadic nature of locum offerings and coordinating the schedule.
- Working vacation. Whenever I do a locum, my wife comes along for at least part of the time, and we have a nice little trip. We obviously can’t go on a hike 4 hours away from the hospital, or take a river cruise, but we can have a grand fun time nonetheless. We love doing locums in Saskatoon– it’s now one of our favorite places to visit in the summer!
- Different types of practice. I learned to place coccygeal arterial catheters when I spent time at CSU. I learned how to do TAP blocks at UMN. Remifentanil is cheaper than fentanyl in Canada, so I use it for large dogs when I’m there and get more experience with it. It’s fun to see how everyone practices differently and try out some drugs and approaches you don’t regularly have access to.
- Appreciative admin and coworkers. Usually, you are solving a problem when you do a locum job that everyone appreciates. Without you, the full-time people would have had to work more, or a service would have to close, or students wouldn’t get to be on the rotation. My experience is that people are happy to see you.
Disadvantages
- No benefits. You don’t get a laptop or an office or healthcare or any of a myriad of other benefits associated with full time academic employment. If you have a regular job, this isn’t a problem. But, if you’re only doing locums, you have to consider those other expenses in your budget.
- Away from home. If you have pets at home, they will need to be cared for. If you have children and you can’t bring them with you, or any other responsibility that requires you to be home, it’s hard to do locums. If everyone comes with you, it can be a grand adventure.
- Questionable continuity of care. You may pick up patients you don’t know about and you may work on patients which you then have to transfer. I think this is pretty similar to most academic jobs where people rotate being on and off clinics but, at home, you can at least chat with the other specialists since they’re around.
- Minimal acclaim. You won’t earn any teaching awards, or “clinician of the year” awards, or getting approval from your department chair, or similar external validation. You do the job, you get paid. That’s it.
One of the many benefits of an academic position is that we get consulting time when we can pursue locum opportunities without having to take annual leave. At one institution, I had 20 days a year I could do consulting. At another, I had one week a semester. This is time you can spend generating extra revenue on top of your already perfectly sufficient academic salary. You can supercharge your savings, or progress to financial independence, doing locum work. It’s also a nice potential bridge to early retirement. I could do 3-4 months of locum work a year to pay for all our expenses, and delay having to dip into my retirement savings. Even doing 1-2 months would be a significant benefit in terms of income in a partial retirement. If you haven’t tried it, I definitely recommend it!