In his own words
A choice, not a compulsion
I chose this. I had built programs and served as a medical director. Then I went and did that same work independently, at hospitals that had no one.
The myth
The biggest myth about doing this work is that something must have gone wrong. That your career stalled, that you could not get a job, that something went awry.
That was not my experience at all. It may be the experience for some physicians, and I am not going to speak for them. But I chose this.
What I actually did next
At the time I left what I call institutionalized medicine, I had built programs and I had been a medical director. When I left, the irony is that I went back to doing much the same work, in an independent contract role, at several hospitals that had nobody. I went in and filled the gap.
From a career perspective that was deeply satisfying. It was the same expertise, applied where it was genuinely needed. Taking this pathway was a choice, not a compulsion driven by some other reason.
I had the bad impression too
I want to be fair about this, because I was not above the assumption. Six or seven years ago, before I got into any of it, I had a poor impression of locum tenens work myself. I thought roughly what many physicians reading this still think.
So I understand where the question comes from. I just no longer think it survives contact with the actual work.
And it is not all upside
To be completely transparent, there are still real issues with it.
I have now done surgery in about 15 different hospitals. That in itself can be a challenge, because you do not have all the bells and whistles you may be used to. When you were employed, you had a degree of choice about your instrumentation and about the people around you. Independently, you often do not.
This work requires a particular mindset. You have to be willing to be a little fearless, and you have to be courageous about walking into unfamiliar rooms and performing at the same standard.
What you are still accountable for
Independence is not the absence of accountability. It changes who holds you to it.
You are still a physician. You are still professionally responsible and still accountable, to yourself first, and then to a medical staff system and to institutions that set the standards. You maintain your licenses and you answer to every licensing board, and to the DEA for your certificates.
You also take on the business side. Taxes, accounting, and the administrative work of running yourself as a practice all become yours. Physicians considering this should price that in honestly rather than discover it later.
The question underneath all of it
For those of us who keep asking the real questions as our careers go on, it comes down to a few: What do we want our practice to look like? What do we want our career to look like? How much flexibility do we actually want?
And the one I said in my last video and will say again: when am I going to stop chasing RVUs to feed my family? I think it is one of the most pervasive problems in healthcare right now.
When surgeons ask me what this is like, I tell them the grass is not automatically greener. But there is something real to be said for the independence and the flexibility to practice on your own terms. At this point in my career, that is what it is about for me.
Who keeps asking me this
One group I meet more often than any other along this pathway, because we do handoffs together, is other cardiac surgeons approaching the end of their careers. They are trying to work out how to transition out.
They are being pulled back in. They do not want to return to what I call the six in the morning to ten at night grind. But they still want to stay active, and they still have expertise worth deploying.
There are a lot of programs around the country that need exactly that help. If that describes where you are, reach out. I would like to hear what you think.
Questions from the field
Frequently asked questions
Is locum tenens bad for your career?
In my experience, no. I had built programs and served as a medical director before I left employed medicine, and I went on to do that same work independently at hospitals that needed it. The assumption that locums signals a career problem does not match what I have seen, though every physician should evaluate it against their own goals.
What are the real downsides of locum tenens work?
You often lose the equipment, instrumentation, and familiar team you had as an employed physician. You work in unfamiliar environments, which requires adaptability and a degree of professional courage. You also take on the administrative and business side yourself.
What is an independent physician still responsible for?
Everything clinical, plus the business. You remain professionally accountable to yourself, to the medical staff systems and institutions that set standards, to your licensing boards, and to the DEA for your certificates. You also handle taxes, accounting, and the administration of your own practice.
Is locum tenens a good option for a late-career surgeon?
It is one of the most common reasons surgeons approach me. Physicians who want to step away from a demanding employed schedule, but who still want to stay clinically active and use their expertise, often find that independent assignments let them stay in the work on terms they choose.