Should I Take a Locums Hematology Oncology Job?

As a new graduating fellow, please do not.  I know it sounds very tempting.  The pay is beyond excellent.  No strings attached.  You get to travel, all expenses paid.  But it is a very shortsighted decision.  And I begrudgingly answer no.  Let me dive into some of the details…


I would like to begin by saying that it truly is a shame that there are such excellent job opportunities available for hematology oncology positions that go unfilled.  Many of these jobs are in the more rural parts of coastal states and generally scattered across the Midwest and the South.  Many are usually 1 to 3 hours away from the larger or midsized cities. Sometimes further. Many of them are part of a larger hospital networks rather than small solo practices.  Many of those patients, are in dire need of well-trained hematologist and oncologist, they also need clinicians who will be there long-term.

I will cover 3 main reasons why a new graduating hematology oncology fellow should not take a locum’s job.

First, unfortunately, a new graduate working as a locum’s physician will raise eyebrows to future employers.  This is particularly true, for employers in the more cosmopolitan cities.  There are reasons for this, but do not try to change any employers’ perception, because you simply cannot.  Unless you are trying to join a large rapidly expanding group or network that has a significant supply and demand issue with hiring medical oncologist, a small or medium sized group, that is trying to bring on another member of the team, will tend to be more selective with a new higher.  Locum’s physicians tend to be seen as uncommitted.  Especially, if they are a new graduate.  Most hematology oncology fellows who are graduating, are in their early 30s, and are likely either married with at least 1 child, or extremely near to that.  It would be unusual, for a spouse to want to jump on board with the temporary locums gig for a few months, and then pack up and leave for another locum’s gig. 

Second, what is the endpoint?  While getting to travel for a few months to  years, with all your housing and transportation expenses covered, as you grow your savings account, sounds exciting, but what is the endpoint? Perhaps you do this for 2 to 3 years.  And then what?  There are certainly a lot of luxuries associated with a “no strings attached” commitment to a job.  Less meetings you have to attend.  Less long-term planning.  You simply clock in and clock out.  More established groups in high-demand areas will want to onboard physicians with long-term plans and commitment. The new doctor is expected to be integrated into more administrative decision-making roles.  This may not be palatable for somebody who had the luxury of simply picking another job in a few months and walking away.

Third, you will not build a long-term connection with any of your patients.  Part of the maturation process of becoming a seasoned physician, in particular an oncologist, is really long-term longitudinal care.  As a fellow, the longest you probably had was about 3 years, from your continuity clinic, perhaps at a veterans Hospital or County clinic.  When you join the private world, you will meet patients who have been with their oncologist for 20 years.  By no means am I saying force yourself to stay with the same group for 20 years, but you do have a different perspective on patient care when you have taken care of the same patient for years on end. 

In conclusion, who has not flirted with the idea of a locum’s job? You probably get at least an email or a phone call weekly. The hematology oncology fellow near the end of his third year of fellowship, has spent 10 years in essentially a military type structure, with little to no true autonomy.  The thought of being let loose and free, with no long-term commitments, is so tantalizing.  Considering many of the noncoastal states, have little to no income tax, and the locum’s pay can approach a $500,000- $600,000 a year salary, you would be almost financially disincentivized to do anything else.  Putting all this together, I would argue that if you want to take the risk of being less competitive as a future employee, with the added benefit of all expenses be traveling, and excellent income, and a chance to at least provide excellent (transient) care to patients in need, then by all means move forward.

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