Why I Chose Locum Tenens, and Why I Rejected the Word First

The question I keep getting

Physicians ask me some version of the same question. Why would a cardiothoracic surgeon with an academic career choose locum tenens work? Underneath it sits an assumption worth saying out loud: that locums is what you do when you have run out of better options.

I believed a version of that myself. I want to explain what changed, because the honest answer is more useful than the polite one.

Sixteen years building something

I trained at the University of Missouri in Kansas City in a six-year medical program, then spent a long stretch of my career in academic medicine at Emory University in Atlanta. In 2003 and 2004 I was appointed to build a heart surgery program from scratch at WellStar Kennestone Hospital in Marietta, Georgia, in collaboration with Emory. Starting a program from nothing was the most exciting professional work I had done.

It also exposed me to the business of healthcare, and I was not ready for it. I sat in meetings with chief executives, operating officers, and finance officers, and there were stretches where I genuinely did not know what they were talking about. Google arrived not long after, and I earned what I have always called a Google PhD across a number of functional areas. That gap is what made me curious about how healthcare actually works as a business.

I served as medical director of that cardiac program for 16 years. It was successful, and under the leadership that followed me it has continued to grow. I left in 2019 to do something entrepreneurial, and I still needed income while I built it. So I started taking locum assignments.

“Oh, you’re the new locums”

My first assignment was at a hospital in Macon, Georgia. I walked into the ICU, and one of the nurses looked up and said, “Oh, you’re the new locums.”

I corrected her. I said, “No, I am a cardiothoracic surgeon.”

I am not proud of that. I had spent my career behind what you might call the pearly gates, at a major academic center and a large urban tertiary care hospital, and I had absorbed the stigma completely. The idea was that a physician does locums because there is nothing better available. It took me a short while to hear how silly my own correction sounded.

I was there to play a role. I was there to be a physician, the same as every other doctor on that medical staff. The nurse was not diminishing me. She was describing an arrangement. The status I thought I was defending was institutional identity, not clinical work, and the two are not the same thing.

What actually changed

Once I got past the label, the substance of the work was better than what I left.

I set my own schedule. I am on call because I chose those dates, not because someone else built a call schedule around a group’s needs. When my family has something planned, I do not schedule work into it. That sounds small until you have spent two decades on the other arrangement.

I also stopped chasing RVUs. I will say plainly what I believe: relative value unit compensation is one of the biggest problems in how medicine is practiced in this country right now. If a physician is paid on an RVU model, it influences clinical decision-making. Physicians can argue with me about that, but I think they will mostly be arguing with themselves.

I have gone back to employed roles twice since, deliberately. I helped start a program at Reston Hospital Center in Virginia and stayed until it had a solid foundation. Earlier, during the uncertain stretch of the pandemic from late 2020 into 2021, I returned to the faculty at the University of Kansas. Independent work did not close those doors. It let me choose when to walk through them.

What locums asks of you in return

This is the part physicians considering it should hear clearly, because it is not free.

You have to get used to travel, and you have to get used to operating in environments that are not yours. Heart surgeons in particular arrive with a long list of expectations and requirements. You have to learn to drive a Ford down the street rather than a Mercedes every time you operate, and to do excellent work anyway.

You also have to be honest enough to say when something is not safe. I have walked into a program and had to tell them they should seriously reconsider whether they ought to be doing heart surgery at all, because too many necessary pieces were missing. That conversation is part of the job. If you are not willing to have it, this work is not for you.

The reframe

I knew my value and my worth, and I have always been willing to take a risk. What I did not have, at the start, was an accurate picture of the model I was stepping into.

Locum tenens is not a lesser tier of medicine. It is a different operating arrangement, with real trade-offs and real control. The stigma attached to it says more about how we are taught to locate our professional identity inside an institution than it says about the clinical work itself.

That is why I do this, and it is why we built PRIME to do it differently.