Advice for being a locum tenens healthcare provider?
May 28, 2015 4:29 PM   Subscribe

I'm an NP interested in doing locum tenens work. I am looking for more information on how this works, and any experience or advice you'd like to share. Details below the fold.

I am an NP who has been working for about six months. I have a few years of experience as an RN in my field, so I feel more competent than the average new grad. I've been at my current, full-time, salaried job since graduation and I'm not in love with it for a few reasons: poor management, poor communication with/support from tertiary facilities, low pay, high cost of living, commute, and limitations on practice.

I'm looking at taking a locums position in another state that would remedy some of the frustrations I have with my current job, especially the practice limitations, commute, and cost of living. I'll be moving to another country at the end of the year, and the LT position fits my time scale and will give me a better chance to be licensed in the country I'm moving to.

However, I don't exactly know how the locums process works. I've been in touch with a recruiter who has requested my hourly independent contractor rate, and I have no idea what to say, as the job would be a few days in clinic and a few days of call. How can I determine a good salary to set for myself? What are the advantages or disadvantages of being an independent contractor? Taxes or liabilities or other things to consider? I know they will pay my malpractice, and won't cover my health insurance, but are there other things to watch for? Should I accept housing from the company, or seek it on my own? The assignment is in a rural area with a low cost of living, though I have a partner and several pets I'd take with me. I've contacted my professional organization and haven't found much helpful information there, and very limited information on and similar sites. Hoping there's some wisdom here!
posted by robertthebruce to Work & Money (2 answers total) 3 users marked this as a favorite
Best answer: Locum tenens can be very hard, but very rewarding work. I've physician colleagues who've pursued the locum tenens route and work with some from time to time (albeit in different specialties).

Every such position I've encountered is as a 1099/independent contractor, which I've worked as myself in the past. Familiarize yourself with the differences between being an independent contractor and being and employee. This not only has important tax implications, but also will inform you of what your rights are as a 1099 worker, namely the control you have over how you do your work. As someone who's going through this process for the first time, I would run every contract by an attorney as well as an accountant.

If you've no idea what your hourly rate should be, your best bet would be to try to get in touch with another NP who's working locums. There may be professional publications or websites that will have listings explicitly stating how much they'll be paying. I would also try going through several recruiters and approaching things a bit differently: instead of being asked how much you want to be paid, ask how much they'll be paying you, as well as what additional benefits there are for any particular assignment (sign-on bonus, moving expenses, housing, etc.).

It's their job to get you matched up to a practice or facility that needs you. LT positions pay more because there's a void and a need to fill that void, sometimes desperately.

Some pros of being locum tenens:
- you're an independent contractor. You dictate how you work (though it's often the case that you'll be told how to work and what your responsibilities will be. Here there's often a big blurry line between being 1099 vs an employee, which is why it's important to have any contract reviewed carefully.)
- you will often be able to fully dictate your schedule; you provide your availability
- there are some tax benefits of being a 1099, including deductions for work expenses, as well as as SEP IRA for retirement
- travel and housing can be negotiable: I've known MDs who've lived 3-4 hours away by car, and were flown in to work for however many days, lodged in a hotel, and flown back by the locums company
- you get to travel and work where you want, and gain experience with different healthcare systems and patient populations
- you might fit in so well and the people you work with might like you so much that they'll make a reasonable offer to hire you as an employee (if this happens, review your contract carefully, again, as the pay may be significantly less, or just a bit less, but offset by other benefits).

Some cons:
- many times, you're going to be treated poorly. You're not one of the "regulars," you're a body that's there to fill a need. While you may say you're available to work for 5 days, then off for 5 days, you might get the worst times of day to work, or have to work holidays. Your contract may specify that you'll need to work a minimum number of hours or days per month, and even though you may state that you're not available to work those days, you may find yourself being cornered into doing so (again, that line between 1099/employee is very vague)
- you may have no real long-term stability. If you've signed a contract for X number of months, with renewal, you may find yourself of being let go at any point in time
- you will receive NO benefits: no retirement matching/401(k)/403(b), no CME expense reimbursement, no PTO, no health or dental insurance. However, it is often the case that you'll receive malpractice and tail coverage
- you may find that the position had been oversold: that the people you work with suck, that the city/town/village/hamlet you live in sucks, that the job itself sucks. Remember: there may be a very good reason why they're recruiting hard for a locum tenens!
- you are responsible for managing and paying your own taxes quarterly. This isn't too difficult to learn, but it's disheartening to have a certain percentage of your paycheck deferred to another account specifically for paying taxes, seeing a large amount of money in said account, and seeing it go to zero every quarter
- as an independent contractor, you will be at a nominally higher risk of audit, based on how you manage your business expenses and deductions.

If your recruiter is unable to provide you with a information regarding average pay, find another recruiter. Find another recruiter or two, anyway. You're in control: shop for the job you'd like, and shop carefully. Consider large, national staffing companies that place locum tenens. Realize that in such a case, the clinic/healthcare system/hospital will be paying the company, who will then be paying you, and that such contracts often cost-plus contracts and are lucrative for the company and costly for the people you'll be working with.

Disclaimer: I'm not an attorney, accountant, recruiter or work for a staffing agency. I am no longer an independent contractor. My experience and that of my colleagues may be grossly different than yours or of PAs or NPs, and may also be completely wrong.
posted by herrdoktor at 9:43 PM on May 28, 2015 [2 favorites]

Response by poster: A bit late on the reply, but thanks so much for the thorough response. You greatly helped me with my decision.
posted by robertthebruce at 1:42 PM on July 18, 2015

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