Locums doctors are the Cinderellas of the medical profession; rarely liked, badly treated, unrepresented, but always needed. Locums are in demand in both hospital and general practice and in this article we shall explore the pros and cons of locum work.

The definition of a locum doctor

The commonly used term “locum” is an abbreviation of the the Latin term “locum tenens” which means “place holder”. And that is precisely what a locum doctor is. The locum physician temporarily holds the position vacated by another physician in a hospital department, clinic or medical practice due to vacation, illness, sabbatical or other reason.

Locum doctors have the advantage of mobility, flexibility and the valuable opportunity to experience medical practice in a varied range of settings and healthcare management styles. This creates a breadth of vision. However the work is seasonal, often unreliable and unaccredited for postgraduate training. It also lacks the benefits and guarantees to be found in a standard employment contract.

The two main practice settings for locums are in hospital secondary and tertiary care services and in general practice and we shall review the prospects for both.

Hospital doctor locum jobs

Locums have become increasingly important for hospitals struggling to maintain consistent clinical services, but constrained by the new working arrangements and frequent shortages of junior doctors. Shortages of consultant doctors in some specialties (particularly psychiatry) and a demand for study leave and sabbatical cover has driven many hospitals to seek locum consultants for short and sometimes lengthy assignments.

It is relatively easy to find locum work through an agency and the locum doctor will be paid at a significantly higher hourly rate than the incumbent doctor. The terms and conditions of service, including additional duty hours and notional half days may be different. These should, therefore, be checked prospectively.

The style of work is as variable as the locum wishes, with no previous experience or training required for many junior doctor locums. In some cases hospitals employ “floating” locums who work in various departments. This can relieve an urgent staffing problem for a hospital and for the junior doctor, provide a broad view of current specialties in a short period of time. The flexibility of choice is always the locum's.

There are, however, disadvantages to being a locum. Personnel departments have been known to cancel appointments at the last minute, causing inconvenience and no compensation. If the post is confirmed, the locum may find that the responsibility is beyond the job description and the limits of his or her professional ability.

The incumbent staff often seem hostile to locums and resentful that the locum receives a higher pay rate for the same job. Locums are often stigmatised as second class doctors, seemingly having a lack of responsibility. The irony is that locums often have more experience of different ways of managing conditions than incumbent doctors.

There is also the problem of specialist training recognition. There are two types of locum posts. There is the service appointment which has no training element and cannot be used as training for a specialist registrar grade programme. And there is the training appointment. This offers training experience that may, if prospectively approved, count for specialist registrar training by the relevant college or faculty. A successful long term locum appointment can also provide useful contacts and references for the locum if he or she decides to progress in that speciality.

General practice locum jobs

The potential for locum work in general practice is enormous and attractive to different groups of doctors. Locums can work in diverse settings and experience a wide range of medical practice in inner city practices, suburban modern multi partner medical centres, urgent care centres, hospital emergency departments and in rural practice with access to the local cottage hospital.

The work can include single surgery or clinic sessions, regular retainer sessions, day time and evening visiting, telemedicine sessions, as well shift work in urgent care and emergency departments.

Longer locum appointments, for example, to cover maternity leave or sabbaticals, allow the locum to practise a special interest and assist in the surgery's clinics of antenatal and postnatal care, child health surveillance, and minor surgery.

The major bonus to the locum is to see how each practice differs in clinical and practice management. This is important as general practice registrars are closeted in the best 10% of all practices in Britain. As a locum they get a chance to see what the other 90% of practices are like, together with other aspects of general practice, including fundholding, commissioning, dispensing, and computing.

A locum will be appreciated by the staff for easing their workload and may be recommended to other practices. Some patients see locums as a nuisance and complain, “You are not my real doctor.” These patients will book to see “their” doctor when he or she has returned. However patients often like to try out the locum as a listening post or as a “free” second opinion. Other patients will try to wheedle a prescription or sick note out of the locum when they believe “their” own doctor will refuse, while others do not care whom they see, as long as it is today. The locum GP may be privy to previously untold secrets, be used to get around the regular service, or be asked to provide an immediate and necessary service.

The abundance of options provides locums with the chance of a potential principal post, an assistant's post with the clinical commitment and lower level of management responsibility or a retainer post with increasing flexible working arrangements and more time to spend with their family. They can branch out and do things that are not normally part of general practice, but require medical training. These could include private and occupational health work as well as clinical assistant posts.

The disadvantages of locum work include missing continuity of care, no maternity benefit, no annual leave pay, or sick pay, no college recognition, no postgraduate education allowance, and limited professional camaraderie.

Income sources for locum doctors

In general, general practice locums are financially better off than their hospital colleagues. Hospital locums are salaried, and so are paid net of income tax and national insurance. They are entitled to offset few expenses against their salaries, so there is little scope for reducing income tax and national insurance contributions.

General practice locums may also be employed through agencies with similar financial constraints as for hospital locums, but employment is more often obtained direct from general practices, in which case remuneration is received gross.

Apart from the better rates that can usually be negotiated, this allows locums to claim a wide range of expenses for income tax purposes. Legitimate expenses include running a car, telephone charges, printing, stationery, and accountancy fees. Accounts must be submitted annually to the Inland Revenue with whom the various expenses can be agreed. Normally once a basis is set up and agreed the same principle can be applied annually. General practice locums will need to set up their own personal pension arrangements whereas hospital locums will have this built into their salaries.

Whichever way the locum works, there are seasonal variations and an income cannot be guaranteed.

Quality of locum doctors

Locums have a reputation of being “suboptimal” in their work and there have been threats to introduce logbooks or a central register to prove their competence. This is because of the notoriety of a few locums, but it is unjustified to generalise all locum doctors because of one or two. There is, however, no perfect system that can be applied to the locum workforce that should not be equally applied to the incumbent staff.

General Practitioner and District Medical Officer Locums in Australia

Doctors who are registered to practise and have the right to work in Australia have many well paid options for locum work in urban clinics and rural medical practice. The role of District Medical Officer (DMO) is for general practitioners with at least 8 years postgraduate experience and preferably some training in rural medicine, a growing speciality in its own right in Australia and New Zealand.

DMOs work in rural hospitals and medical centres with up to 30 in patient beds and enjoy a high degree of independent practice with responsibility for the management of acute emergencies, urgent care, in patient admissions, obstetric care, anaesthesia and air retrievals to regional hospitals for patients who need specialist care.

DMOs usually have some specialist training and further qualifications in emergency medicine, anaesthetics or obstetrics. The work is challenging but interesting and rewarding financially as well as professionally, attracting high daily rates.

Locum Doctor Jobs in the Middle East Gulf States

Locum positions are occasionally available for consultant physicians and surgeons in the hospitals of the United Arab Emirates (UAE), Qatar and Saudi Arabia for assignments of several weeks to months duration.

Employers cover international travel expenses and provide accommodation and sometimes a car for local transport but rates of pay (usually quoted as monthly rates) are often lower than rates for full time salaried employees in the same position. The advantage of these posts is the opportunity to experience living and working conditions in the Middle East before making a commitment to a full time lengthy contract with an employer. Clinical practice and hospital management styles vary considerably in this region of the world and a brief locum assignment can prove to be definitive in making a sound career choice.

Conclusion

Locums are in great demand. The work is varied. The pay is good, although it is not guaranteed. The general terms and conditions can often be poor, without any national representation for support. There are, however, obvious differences between hospital and general practice locums. General practice locums have a distinct advantage over their hospital colleagues, with better appreciation from colleagues, and advantages of self employment. Furthermore, working has no effect on postgraduate training. The locums are already fully trained.

Locum work is flexible and interesting. It gives the doctor the chance to see many aspects of medicine without the requirement of a long term commitment early in a career. With the ever increasing demands for a better quality of life, part time work in an unstructured or semi structured form is possible.

Interest in working as a locum doctor?

If the prospect of working as a locum doctor appeals to you, please register your curriculum vitae (CV) and interest with us. You can browse currently advertised jobs and apply for them on line or contact us to discuss.