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The Real Cost of Locum Tenens

If you commit to a locum tenens gig for 6-12 months then you might have your traveling and housing costs covered. But if you are planning on working for a few months, the cost of locum tenens work can be ridiculous. Maybe even not worth it.

I am in my second day working at a Community Health Center in South Central Los Angeles. I already regret the decision because everything is difficult. From traveling here to learning the system to getting the patients what they need.

I am locked into this gig for the next 6 weeks – 45 days. The income from this gig will be in the $20k range, while the cost of this locum tenens gig will be nearly $15k.

I should mention, getting this gig took a lot of effort. For me to pass credentialing despite my medical license troubles wasn’t easy. For this reason, my experience with locums might be very different for someone else who accepts a shorter locums position.

1. Relocation

I grew up in West LA, so I know the LA area pretty well. In fact, I used to volunteer at this exact CHC back in college, so I’m familiar with South Central LA.

Because of my medical board stuff, I already had to come to the US. But I had to pay for the tickets to go from Portland to LA. Because of the timing, this ended up being damn pricey.

The logistics of figuring out this temporary relocation was insanely difficult. Seriously, that part alone made this entire experience an emotional wash.

2. Housing

It was impossible finding short-term housing in a safe neighborhood in LA, even on AirBnb. By the time I would research a place no Airbnb, someone would book it out from under me.

The only places which nobody was snagging up were $5,000/mo studios. And they were still a 1-hr commute away from South Central LA.

I ended up finding am 85 sqft apartment in Little Tokyo for $1,500/month. I only get a room with a bed and a sink. The bathroom and kitchen are shared.

And it’s LA so there it’s an orchestra of sirens going by my window. Not to mention the smog. Or the smokers outside of my window. Or the midnight arguments.

3. Transportation

I was told by everyone not to walk around the clinic neighborhood. And not to walk outside of my apartment in Little Tokyo, either. Supposedly it’s best to take Uber or rent a car.

Renting a car wasn’t a great option. The problem is that parking is a nightmare around me, assuming my car isn’t stolen. And I have very little desire to drive in LA traffic.

It would cost at least $2,500 to rent a car in LA for the 45 days that I’m here. That’s the cheapest price I could find with adequate insurance coverage.

Uber is fine but it will cost me $20-30 each way and that’s with a 45 min – 1 hour commute. It’s not a long distance, it’s just trafficy as shit. Apparently I’ll be murdered if I bike these 7 miles, shot if I take the bus, and car-jacked if I drive it.

4. Food

My jail-cell apartment has enough space for me to store some snacks which I’ll probably share with the rats. But I’m not about to pull a Little House on the Prairie and hot-stove it in my room.

So I’ve been eating out so far. Japanese food is pretty good, no complaints. Aged fish and white rice and pink rice balls with sweet bean paste is … delicious.

Of course, I have to brave the streets in order to get food or pay $20 to get food delivered.

I suppose I’ll look to see if I can have groceries delivered. I have a small fridge which apparently has a 700 hp engine the way it sounds all night.

5. Exercise

My rock climbing gym costs $30 for a single day pass. $30 … for a day … for one day. Digest that for a minute.

Yes, I could do push ups on top of the bed bugs in my room. Or I could do ab crunches on my scabies infested mattress. But I think I’ll leave that level of spartan exercise for when I end up in jail someday.

Unfortunately, when you have a 1-hr commute there isn’t much time to exercise. So that’s another cost of locum tenens work. Not to mention being sedentary in the clinic and riding Uber.

6. The Stress

I have spent so many hours online finding a place to live and figuring out how to commute and where to eat. I’m emotionally and physically exhausted.

After work I want to come home, watch Netflix, and binge on nasty ass food. That’s what stress does to you.

The rest of the time I walk around the streets with my shaved head wondering if I’m gonna get shanked by someone. Fortunately, I’m skinny as fuck and resemble an AIDS patient more than a gangster. Though I’m not sure how clinically discerning the South Central gangsters are.

My first day back in clinic, I literally shit my pants. Not metaphorically. I’m talking the real deal incontinence. My stomach was destroyed from shitty airport food and food on the go. And apparently my rectum couldn’t tell the difference between a fart and a shit and it took it out on my boxers. RIP self-respect.

7. Losing Stuff

I lost my headphones at one hotel. I had my electric toothbrush stolen at another hotel.

I busted my laptop during my trip and had to buy a replacement. I didn’t have a lot of options and chose an expensive but POS Chromebook.

The Real Cost of Locum Tenens

So it’s everything, the time lost, the stress, the negative effects on health, the financial costs. In my head I will barely break even after taxes.

My income from the clinic is $800/day working 5 days a week. For 6 weeks that’s about $24,000.

I’ll be deducting all of my expenses, sure. I figure somewhere around $8,000. And then I’ll be paying federal income taxes and Cali state income taxes on what’s left over.

All this for 1.5 months of work. I don’t see the value in it. I don’t even see the value in practicing medicine anymore. But we’ll see. Maybe by the end of this experience I’ll be a reborn clinician.

I am definitely spinning this to as positive of an experience in my head as possible. But all I want to do is run the fuck out of this shithole and go back to beautiful Spain.

16 replies on “The Real Cost of Locum Tenens”

Seems like you planned poorly and should’ve figured out this before accepting the job. Better preparation next gig will certainly be in order. Good warning for others.

Hey, funny as hell! loved reading about your experience and all the detailed info. Certainly, I related to a lot of the issues, specially the stress that comes with “higher” paying jobs and the stress of living and driving in LA. However, I have a feeling that the experience maybe worth it at the end. If nothing else, you’ll know for sure that this type of gig is not what you want to do. Thanks for sharing. lMAO.
would love to read about your daily experiences at the clinic. I think we all need to get in touch with realities of life in South Central LA. A life that a lot of us privileged ppl are out of touch with. Perhaps that is your calling for this job. To help educate us about realities of life when one is poor.

Please write more about this locum experience! This job sounds like It will be a riot to read about. I guess you had to go commando at the clinic for the rest of the day after the soiled boxers incident.

I was standing at a computer desk when it happened and had no way of assessing the fecal volume. So, with cheeks pressed together I shuffled to the bathroom and inspected the damage. To my surprise, the boxers didn’t look too bad. However, my cheeks got the majority of the insult and that took some work to fix. Not to mention trying to get back to seeing patients.

I did locums for years. Every gig paid for housing, plane tickets, car, and medmal. As you point out, it’s not worth it otherwise. That’s why the locums companies talk up the fact that they pay for these things.

Locums should pay for housing, medmal, travel etc. Rarely do they give a per diem. Should also pay more than comparably with a regular gig in the same specialty. The tax deductions are insane, too, especially the per diem and the ability to sock away way more money in a solo 401k.

If you aren’t interested in practicing clinical medicine, why are you doing this? I agree there’s no point. You say you don’t need the money, don’t want to practice clinical medicine, and that you were happier in Spain. So the answer seems clear, no?

Locum pays well and covers a lot when you are a normal candidate for locums work. Because of my medical license issues this was a gig of desperation because the medical boards are after me to inactivate my medical license. I don’t do enough clinical work to keep my medical license, according to them. Whether for pride or convenience, I’m not ready to have my medical license taken away from me as it happened with Oregon – I’d like to exit medicine on my own terms.
Medicine is a fabulous fall-back career for me and I have a lot of other career aspirations. Having some medical income to rely on is ideal. I have enough investments to be able to live off of them but mobilizing investment income is an involved process. As long as I can cover my living expenses with income from work, I would rather do that.
I love clinical medicine but on my own terms. Titrating metformin for patients who can’t even afford their meds or who won’t take it even if they can afford it isn’t clinical medicine.
I think these are fairly normal career fluctuations for anyone looking for an encore career or trying to exit something lucrative. The answer might seem clear to everyone, which is the same sentiment echoed by friends and family. But I think once you’re the one making the decisions it’s always a bit more involved.
For now, I feel comfortable both complaining about the work and enjoying the shit out of it. I had some great cases yesterday, worked with a solid MA, practiced my Spanish with some patients, and managed to find some edible food in this hood. Not bad, gonna try to beat that today.

So, this isn’t the “real cost of locum tenens”- it’s the real cost of keeping your license. That’s totally different.

OMG! So funny — with a bit of truth to it. Keep up the quality writing! Really enjoying it. BTW, after reading this and several of your other recent pieces I immediately subscribed.

I totally relate to what you are saying about trying to leave a lucrative career. I’ve been trying to exit my more lucrative specialty for years now (EM) to do something less stressful, but the ED keeps pulling me back in. I’m lucky to have many opportunities and different directions I can go. I’m sure to others, it seems obvious which way I should go, but there are so many factors involved…

One thing I’ve learned is to appreciate that my instinct is to naturally gravitate to what society considers normal and what is most lucrative. That herd mentality is bred into me – and I’m happy about that. But when I’m trying to change something in my life then that same protective mentality fucks me up. I see an easy income and I jump on it and get caught up with it. I come up with all sorts of reasons why it’s a good idea to continue with it …. suddenly a few months have gone by and I’m totally pulled away from my real goals and aspirations.

Especially when the going gets tough with alternative career options, that’s when I gravitate back towards what’s safe and secure – naturally. For example, I should be spending on things which help advance my real career aspirations: I should be looking for more healthcare consulting clients, I should be building out my own telemedicine platform further, I should be learning my data science shit … instead, I’m here in LA trying to save my medical license … or at least that’s what I’m telling myself … I think the real reason I’m in LA is because this was easy money.

As you said, it’s a lucrative specialty but it’s stressful. To everyone else things seem clear because they only see what they they are able to see … for you and I (any many others in our shoes) we aren’t dealing with facts … there is no solid pathway or precedence for what we doing, we have to to make it up as we go along and get over our own insecurities ….

I realize that those in my life who have their opinions about what I should do mean well … but I can’t share all of my thoughts with them because I haven’t even formulated all the thoughts yet … and they can’t live my life for me … and at some point I’ll have to either rip the bandaid off or just accept how things are and develop a better relationship with the medical career that I’m fortunate to have….

You know, this one doc reached out to me a while back and she got fucked over by the Arizona medical board real bad…. the standard stuff they do to female providers … anyway, she ended up getting a gig in the IHS area and she loved the work …. look, troubled doctors are always gonna be trouble … I’m sure she had some fault and blame in her situation just like I have my own faults …. so I get the perspective of that article but yea, it’s interesting, something I will check out in the future I suppose …. I’ll try to research it and write about it … I can interview her and see what her work is like, in fact

I would be very interested in others’ experiences in IHS. I’ve always thought of doing it. I’ve heard it can be rewarding.

Dr. Mo,

I am sure not being board certified by the ABMS makes finding locums gigs more difficult, let alone getting licensed in another state anew. That being said, if you could, I’d recommend looking into some rural locations for locums, the pace is often slower and the work more interesting (see a broader range of problems and complaints). Other question, a lot of places with highly seasonal volumes (ski towns, tourist towns, the RV parking lot seasonal communities of the SW) are often looking for locums coverage on regular basis. You could easily set up a a recurring gig (1-3 months/year) if you got past all the red tape of your medical board stuff to keep your license active and retreat to Spain otherwise.

That’s an interesting idea. That seasonality might be exactly what I need. That way I can continue to live in Spain and fly out just for work at a specific location where they can use the help. Not having the ABMS is tough and the medical board stuff on top if that – that makes credentialing tough. Maybe with my current work experience at this FQHC, I might have a better chance. If you have a good staffing agency you’d recommend, email me or post the name here if you’re comfortable doing so.

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