American College of Physicians: Internal Medicine — Doctors for Adults ®

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Physician trades solo practice for locum tenens lifestyle

Despite missing long-term connections to patients, hassle-free schedule is a perfect fit for this internist

From the July-August ACP Observer, copyright 2006 by the American College of Physicians.

By Janet Colwell

In 1995, internist James M. Williams, MD, was fed up with managed care and the competition among doctors that had gone from friendly to fierce. After 20 years of practice, the solo practitioner in Tampa, Fla., considered retiring—but instead chose another option: locum tenens.

Today, that career path is still a perfect fit, despite time away from family and the loss of long-term connections to patients, said Dr. Williams, now age 63.

“The way I practiced medicine was being more and more interfered with by HMOs and other insurers trying to make things go in their own direction,” said Dr. Williams, who takes on several temporary assignments a year, commuting to U.S. sites from his home in Chapala, Mexico. Locum tenens, he said, was an opportunity to drop what he didn’t like about medical practice without dropping out altogether.

A growing number of physicians may share that opinion. The Irving, Texas-based Staff Care, which places locum tenens physicians, has estimated that annual spending on temporary services nationwide doubled to almost $3 billion between 2001 and 2005.

According to a Staff Care survey, most locum tenens physicians—like Dr. Williams—are experienced and do not want to be tied down to permanent jobs.

However, about 15% are looking for permanent placements and just over 30% moonlight from their permanent practice for the extra income, survey results showed. But the key draw is the ability to get a break from what Dr. Williams called "the administrative headaches" and to shift the focus back to patient care.

Setting his own rules

In the mid-1990s, Dr. Williams and his wife were tossing around the idea of retiring. Instead, he signed up with two locum tenens firms and got his first three-week assignment about six months later.

"It started slowly but since that second job it has been pretty steady," said Dr. Williams, who is currently on assignment at Fort McPherson’s Lawrence Joel Army Health Clinic, a large outpatient facility in Atlanta. Now he knows he can take several weeks or even months off to recharge and even turn down work if he wants to.

Other benefits include:

  • Length of assignment. While his current assignment—his longest to date—has lasted more than a year, most assignments generally last from two to four months.
  • Where he fits in. He has filled in for vacationing solo practitioners and worked at both hospitals and large group practices. One of his favorite assignments was with a 50-physician family practice group in Kentucky where he returned several times—and eventually helped them set up their own in-house locum service. "I actually worked myself out of a job."
  • Income and living expenses. Dr. Williams said his annual income is a little less than when he was in full-time practice but that the overall package is better. Employers typically pay for his living expenses, including an apartment and rental car, during long-term assignments.
  • Malpractice. Most locum tenens staffing firms absorb the cost of malpractice insurance, he said.

The personal cost

Although the lifestyle suits Dr. Williams overall, he also pointed out its shortcomings.

“If I miss anything about being in a regular practice," he said, "it’s the long-term follow-up and getting to know patients very well." There also can be frustrations with the positions themselves, such as having no control over established work processes or working with inefficient technology.

And the constant travel and separation from family can take a toll on a physician’s personal life. “Sometimes I live out of a suitcase and I often miss my wife,” Dr. Williams said.

During long-term assignments, he may come home during breaks in his schedule or his wife may visit for several weeks at a time. Time off between jobs also helps mitigate separations but, he conceded, this aspect could be a deal breaker for some.

Still, when employers occasionally ask him to stay on permanently, he's never been tempted. “I’m not working all the time, I get to work in different areas, I meet new groups of people,” he explained. "And I don’t develop the long-term problems that come when you stay in one place."


Have an idea for a future "ChartNotes"profile to highlight an unusual medical practice or insight? Send your ideas to Janet Colwell at jcolwell@acpoline.org.

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