A Geographical Breakdown of Locum Tenens Opportunities
When I first considered locum tenens there were three items that were important to me. They were the location of the position, the details of the position (hours, call, clinic set up, etc.) and the pay structure. They all worked together, meaning one item could directly impact the other two. Ideally, all three would be maximized, with each opportunity being a defined shift in a great area for good pay. I imagined finishing my shift around 4pm, heading right to the beach and knowing I was being nicely compensated for the high-quality care I provided that day, and, oh yeah, I had my nights and weekends free!
In reality, these ideal positions are available, depending on how you define what it takes for you to be happy. For me, life is about balance, I am willing to make sacrifices to ensure that I distribute my energy where I want to. Each specialty will define what the nature of the position entails. With a good degree of certainty, if you are an ER doctor, you are going to be required to cover a defined amount of shifts in a given week or month. Pediatrician? Plan on covering the clinic from 8am to 5pm Monday to Friday. When it comes to pay, there are industry averages for what each specialty makes. These can vary a great degree depending on demand and location, but in general, they fall within fairly predictable amounts. Assuming the specialty drives the nature of the job and the amount payed, the real question in play related to where I could practice. Are all the jobs in rural Arkansas (no offense to the razorbacks out there) or is there the ability to practice in desirable locations for long stretches or in consecutive order? Today’s post digs deep into the geographic variation of the locum tenens jobs available both in the United States and Internationally.
For ease of review, I broke down the specialties in medicine into four categories.
Very High Demand
Primary Care (Family Medicine, Pediatrics and Internal Medicine)
Obstetrics and Gynecology
Physical Medicine and Rehabilitation
These four categories allowed me to make reasonable determinations about geographic availability of all specialties. Are there outlier specialties? Of course, but within each quartile, there were similar statistics when it came to the number of jobs in highly desirable geographic areas, the diversity of locations, and total number of jobs available. For each category, I broke down the available opportunities within one of the specialties in the group as an example for the others. Information about locations and number of jobs was obtained by a thorough search of the internet for available positions posted within 30 days of my research. Full disclosure, there was considerable overlap in information on several sites and determining what job was unique and the date of each posting was not always possible. I researched each opportunity in an attempt to reduce duplicated and outdated job postings in my data.
Very High Demand
At first glance, those physicians practicing in the very high demand specialties are presented with a large amount of opportunities. Of all hospitals and medical practices looking for locum tenens positions in 2016, almost 50% were in the very high demand specialties of primary care, hospital medicine, emergency medicine and anesthesiology. With family practice, pediatrics and Internal Medicine coming in at number one, Emergency Medicine second, followed by Hospital Medicine and Anesthesiology. It should be noted that of the available jobs, Anesthesia saw the largest decline in the past 5-10 years while both Emergency Medicine and Hospitalist positions experiencing a near doubling in demand.
I used Emergency Medicine as my example for the Very High Demand group. At the time of my research, I was able to find approximately 250-300 unique locum tenens jobs for an ER doctor to evaluate. Considering the American Academy of Emergency Physicians lists the total number of practicing ER doctors at around 40,000, if in a given year 8% are doing locums, that would mean 3200 a year or 266 per month. Looks like the data checks out for total available jobs. Breaking these down by state, I found the following:
Looking at the geographic availability, there is at least 1 job in every state, including Hawaii and Alaska. At the low end of the availability, only 2 (4%) states, Delaware and North Dakota, are limited to a single position within the 30-day stretch I evaluated. 6 (12%) states had only 2 jobs open, 32 (64%) states had between 3-9 positions available, and 8 (16%) had 10 or more positions. The states with the most opportunities were Texas (13) and New York (15). Taken together, an emergency medicine physician looking to utilize locum tenens would be able to work in any state, and in most states, choose from several positions. Not bad! The next question is obvious, where in these states are the jobs. Let’s break down New York as our example.
In breaking down the 15 jobs available in New York state within the 30-day window I used, I was able to determine the regional location in 13 of 15 (86%) positions. Of the 13 positions, 6 (46%) were in New York City, including all 5 boroughs. Two of the other positions were found to be in western NY, Syracuse and suburban Rochester. Two were in upstate NY, both in the Albany area and the remaining 3 were in suburban New York City, but not in the main boroughs. Looking at a map, it does appear that locum tenens would allow you to choose the area of New York state you preferred as well as give you the diversity of selections you would hope for in New York City.
Although the drop off from physicians practicing in the “very high” demand to “high” demand specialties is considerable, there are ample positions available and considerable variability in the locations. The large number of different specialties within this group equates to almost 30% of the total available positions, with Cardiology, Orthopedic Surgery, Neurology and Urology making up the largest of this group. Just as we did for Emergency Medicine, lets break down Urology for geographic availability.
According to the American Urological Association website, there are currently around 11,000 urologists actively practicing in the USA. The states with the largest population of doctors are New York, Florida, California and Texas. Interestingly, Urology represents a specialty most in need of doctors, with over 64% of counties in the USA not having a practicing doctor. When evaluating the current locum tenens opportunities, I was able to find around 60 total jobs during a 30-day block. The state breakdown was as follows.
Although there were 62 total Urology jobs, 13 (26%) states did not have a single position available and 34 (68%) of states had between 1 and 3 positons open. The three states with the most opportunities were California, New York and Florida, all with 4 total positions. What we see is that there are definitely positions available and in some of the most sought-after states to live, but the variability of choices in each state decreases for this grouping of specialities.
When looking at a specific state, lets use California as our example. There were four total positions in California in the 30-day time frame I used to calculate my statistics. Luckily, these 4 jobs would provide a urologist with some variability in geographic location, albeit small. Two of the positions were in southern California, one directly inside and one just outside of Los Angeles. This would provide the ability to be in southern California and chose either the benefits of being in a major city versus the benefits of being in a suburban environment. Of the two remaining jobs, one was along the coast in central to northern California and one was north of San Francisco by about an hour. The glaring omission here is the ability for a practicing urologist to easily find a job directly in San Francisco, an often sought after area in the locum tenens world. All in all, for a relatively small specialty like Urology, there are a good amount of positions available, but nowhere near as plentiful as our colleagues in the ER.
Oncology and Radiology are pulling the most weight in the moderate demand group of specialties for locum tenens. However, the group made up an average of 15% of the total available positions with each specialty seeing a fair amount of opportunity in both number and geographic variability. The drop off here is not major, with a total of 30 Oncology jobs available, but it does begin to dramatically limit the locations available to practice.
Only 18 (36%) of states had available Oncology locum tenens positions at the time of my research. Of these 18, 15 (88%) had a single position with California representing the anomaly with 3 total jobs. Of these 3, all were outside a major city and all were in northern California. With the moderate demand group of specialties, we begin to see serious limitations in the geographic variability of positions, however, a creative physician could capitalize on the 30 total jobs in 18 states.
Less than 5% of the locum tenens positions fall to the low demand group of medical specialties. Unfortunately for this grouping, there are variabilities that decrease both the demand and interest in locum tenens work. The drop off is palpable and severe. An Allergist looking to use locum tenens would have to choose from only 4 total jobs in 4 states. If you are from Minnesota and looking to go back for a short rotation, you may be in luck, otherwise, it is going to take some creativity to make a long-term career out of locum tenens work.
We hope this post helps shine some light on what is really out there for physicians looking to start a career in locum tenens right out of residency or even transition out of practice. There are clearly huge opportunities if your specialty is in the high demand groups, with jobs in several different cities in almost all states. If you happen to fall into a lower demand group, the benefits of locum tenens work may still be there and utilizing some strategic planning may get you on the path to your goals!
~The Locums Life~