Locum tenens work has many advantages, such as flexibility, both in terms of time commitment and the possibility of practicing in different geographic areas. However, there are some disadvantages with inconsistent pay models, expectations of the employer that may not align with yours, and other areas of a contract that may not be clear. Although contract negotiation is always important when getting a job, these aspects make contract negotiation key for locum tenens physicians. These negotiations may take place directly with a medical practice but also may be with a hospital/healthcare facility or a staffing agency.
Key Contract Terms to Negotiate
Compensation and Payment Structure
One of the key items that needs to be negotiated is whether you are being paid hourly, daily, or by the shift. Some l ocum tenens physicians may earn 30 to 50 percent more than full-time doctors. If the pay is daily, make sure you know how many hours that entails. Also, ask about the exact hours—is it daytime, overnight, or on-call? If you’re expected to complete your charting after your shift, inquire about being paid for that time as well. There also may be overtime pay and/or incentive (productivity) bonuses. Getting all the details nailed down regarding compensation is crucial before signing a contract.
Scheduling and Workload
Schedule flexibility is one of the main advantages of being a locum. That’s why you’ll want to know what your guaranteed minimum hours or shifts are, in addition to the specifics about being on call and how many patients you’re expected to see. Having these aspects in your contract can help assure that you won’t suddenly be asked to work more hours, and you’ll make the money you need. T
Travel and Housing Arrangements
One of the things many physicians like about being a locum is the ability to see new places and live in different environments. With that comes the cost of travel and lodging, so you’ll need to know who is paying for the expenses of housing and transportation, depending on if you’re moving to a new area temporarily or commuting.
Malpractice Insurance and Liability Protection
As with all physician jobs, malpractice insurance is a necessity and a huge expense. With a locum tenens position, sometimes there’s a question of who is going to pay for it. If you’re working through an agency, malpractice insurance may be provided, but you need to make sure it covers you for the standard $1 million/$3 million terms. If you’re not working with an agency, you’ll likely need to obtain this insurance yourself, and then consider negotiating for the practice or hospital to reimburse you while you’re working there.
There are different types of malpractice insurance . Occurrence policies cover anything that happens while you’re employed, whether the claim is filed while you are still there or any time later. Claims-made policies only cover you if the claim is made while the policy is active (while you are still employed). If the policy is claims-make, tail coverage becomes a necessity and can be very expensive, so make sure to negotiate for employer-paid tail coverage.
Contract Length and Termination Clauses
What happens if you want to (or need to) leave or the practice or facility terminates your contract early? To protect yourself in these situations, it’s important to negotiate a fair termination clause with a time frame and compensation explicitly stated. This may include who covers the cost of housing and travel expenses. The notice period for locum tenens is generally shorter (thirty days) than the typical ninety-day notice given for regular employment.
Credentialing and Licensing Fees
Credentialing and licensing fees are expenses you can negotiate. The agency or healthcare organization can pay for or reimburse you. If you’ll be working in that state again, you may need to pay up front, but negotiate for the employer to reimburse you at least partially. If there’s a cost for hospital credentialing, the employer can pay up front or reimburse you (or make sure the agency is paying). You also need to make sure you have enough time to obtain necessary licenses before your contract starts.
How to Negotiate a Better Locum Tenens Contract
When negotiating your locum tenens contract, you should first know what the market rates are for your specialty. You can check the Health eCareers locum tenens listings to see current offerings. You can also check out the general physician salary listing for the United States by specialty (not specific to locum tenens).
Next, if you’re going through a locum tenens staffing agency, you should know how they work and what kind of fees they charge. By knowing that in advance, you may be able to negotiate. Other places to research available jobs include job fairs and online job boards . If you get multiple offers, you may be able to use those to leverage better offers; this can even apply to using multiple agencies.
One of the most important aspects of negotiating is to always get everything in writing, especially any changes you’ve renegotiated. If it’s not in writing in the contract, it’s as if it doesn’t exist and isn’t enforceable.
Common Mistakes to Avoid
A few mistakes to avoid when negotiating are as follows:
- Not doing your research: It’s important to research market trends for the jobs to which you’re applying. Without doing that, you may be underestimating your expertise and your value to the agency or healthcare facility and might not get paid what you deserve.
- Not considering more than just salary: Although the salary number is important, don’t forget to look at the whole package , including the benefits, working hours, cancellation clauses, time off, and who is paying for credentialing and licensing.
- Not being prepared: Make sure you prepare for negotiating by knowing what you want ahead of time. Failure to do this will almost certainly affect your ability to negotiate the best contract.
Case Study: A Locum Physician’s Successful Contract Negotiation
An otolaryngologist who had just completed their residency moved to Japan to join their spouse, a military physician, who had already been overseas for the previous six months. They had one 3-year-old child at the time. After briefly looking into volunteer opportunities at the military hospital, they decided to look into locum tenens work. The physician’s goals were to earn some income, maintain their recently acquired skill set, and figure out what type of position would be a good fit long term.
After interviewing for three positions, they decided to accept a position at a hospital that was hiring a short-term otolaryngologist to fill in for one of their two otolaryngologists, who was out on medical leave. Agreeing to commit to two months, the time period during which their husband would be deployed, they were able to negotiate a slightly higher rate than originally offered to help cover child care costs. They were also able to arrange an apartment rather than a hotel room and negotiated a 4-wheel drive rental vehicle for the winter weather.
Upon arriving at the hospital, they were provided with two full days of orientation and EHR training and then worked in the operating room for a day with the staff otolaryngologist to serve as a form of proctoring. Following that, they enjoyed a busy, productive two months of locum work. When the hospital needed help again the following summer, the doctor happily agreed to come back for a second assignment. Overall, they had great exposure to what a hospital-employed practice looks like, met many wonderful people, and kept their surgical skills and clinical acumen sharp.
If you’re interested in exploring locum tenens physician jobs, make sure you’re prepared for your contract negotiation by doing your research and knowing what you want before you start negotiations. You can also find jobs on the Health eCareers job board .
