soon to be new grad, interested in locums position

[thyroxine2468]

new pgy3 at well known midwest program
ideal situation would be: living on west coast and doing locums full time.

I don't mind travel for work, I don't have any strong personal ties to a region.

the biggest draw for me is location independence, scheduling freedom, increased pay.

what is the best avenue for locums for a new grad?

an attending that I work with did locums with a CMG when fresh out and he said it was tough, but the pay made it worthwhile. only reason he quit was for wife & kids. i've been told that it might be easier to start off with a CMG and then branch out after making your own contacts, have some experience.

not sure where to start.

thanks.

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[wook]

I have done locums part-time and the pay was better than I was making at my full-time job. The sites I worked at were excellent as well! Not everyone I know who has done locums has had as pleasant of an experience at their sites.

I did stop doing locums. The reason being that is if you are called into court about a criminal case to testify about a patient you saw (who is a suspect or victim), you are not compensated. The locums companies that I worked with would not pay, and the hospital where the care was rendered also would not cover my time, travel, or lodging.

Just an additional factor as you consider this.


Thanks.


Wook

 

[turkeyjerky]

I considered doing locums right out of residency and am glad I didn't. I did eventually do locums for about a year and a half and while I enjoyed the flexibility and control over my schedule, the travel and instability did take a toll.

However, I would highly recommend against it right now. The job market is going to tighten significantly in the next 2 years and you might end up on the outside looking in. Also, the pay differential is really not what you'd expect. At the very least, get a 50% FTE job locally and travel on the side. Also, take advice from your attendings w/ a grain of salt--they're probably suckers.

 

[bky3c]

What turkeyjerkey said. I did locums part time for many years, then full time for many years, then half time for a year. The schedule control is great, the hotel/airline points/miles are great, the paid-for state licenses and DEAs (and help with the paperwork!) are great, and I got to see many beautiful parts of the country that I might not have seen otherwise, with insider advice on what to see/do from coworkers. I was also generally very much appreciated by the other physicians and the nurses at the desperate EDs I worked in. (But it is true that not all of them are bad. Some were very nice.)

However... I got a glimpse of what turkeyjerky is talking about when the bottom fell out of the FSEDs in Texas a few years ago. That bled over into hospital-based ED jobs, so there were no decent locums jobs to be found in Texas for a while after that. I would have been screwed if I hadn't had licenses in other states. Then things started to get thin elsewhere, so I couldn't get quite as many shifts as I wanted each month, and that's why I ended up taking a permanent part-time job in my own state. If the job market goes downhill in the entire country all at once, you could be left with no way to pay your bills.

Also, flying sucks right now. The airlines are a mess, and I wouldn't want to count on my flight arriving on time or having to leave a day or two early to make sure I'd get to work on time.

As far as residency attendings go... I'm sure there are some great ones, in terms of real-world knowledge... but mine all let me take an absolutely atrocious, low-paying full-time job right out of residency. They saw my contract and everything. I'm still glad I did it, because it ended up being a huge learning experience for me, and I got to live in a very cool place, but I wouldn't recommend it. So yes, take what your attendings say with a grain of salt. If possible, talk to a couple of community docs about whatever plans you're considering.

If you're asking for recommendations on specific companies to work for... I worked for several, and they were all about the same. Just remember that no matter how friendly they might be, the recruiter is not your friend. They're usually making commission on you. Ask to talk with another doc who has worked for their company, and if you can, another doc who has worked at the site you're considering working at. Sometimes you can establish a rapport with your recruiter, and over time they will be more real with you, but it takes time. You will also get to know other locums docs and find that you've worked at the same places in the past, they've worked someplace you're considering, etc. EM is a small world.

All that said, my last job was a half-time one in an ED 2 hours (driving) from where I lived. The pay was slightly less than my locums pay, but I could be home within 2 hours of my last shift (I stayed in a hotel -- which I paid for myself -- for each stretch of shifts). Financially, it wasn't as good as locums, but it was guaranteed hours every month. Another doc at that site flew in from REALLY far away and worked nights, because that was "daytime" for him at home. He'd do 10-14 shifts in a row and then go home. So you could just get a permanent (non-locums), full time job and fly in once or twice a month, or drive for 3-4 shifts in a row. That would give you more stability than locums, although obviously you'd be sticking to just one place.

I don't know if CMGs still have "firefighters" or "special ops" or whatever ego-inflation-attempt name they're giving them these days, but even though it always sounded awful to me... I worked with some docs who did it, and they seemed happy. It's similar to locums except that the CMG owns you and tells you where to work, and I think the pay tends to be better than a normal full-time CMG job.

 

[EctopicFetus]

I have done locums part-time and the pay was better than I was making at my full-time job. The sites I worked at were excellent as well! Not everyone I know who has done locums has had as pleasant of an experience at their sites.

I did stop doing locums. The reason being that is if you are called into court about a criminal case to testify about a patient you saw (who is a suspect or victim), you are not compensated. The locums companies that I worked with would not pay, and the hospital where the care was rendered also would not cover my time, travel, or lodging.

Just an additional factor as you consider this.


Thanks.


Wook

Is this common. I’ve been doing this about 15 years and have never done anything more than a few minutes in the phone with a prosecutor. I think thats happened to me 2 times.

 

[EctopicFetus]

What turkeyjerkey said. I did locums part time for many years, then full time for many years, then half time for a year. The schedule control is great, the hotel/airline points/miles are great, the paid-for state licenses and DEAs (and help with the paperwork!) are great, and I got to see many beautiful parts of the country that I might not have seen otherwise, with insider advice on what to see/do from coworkers. I was also generally very much appreciated by the other physicians and the nurses at the desperate EDs I worked in. (But it is true that not all of them are bad. Some were very nice.)

However... I got a glimpse of what turkeyjerky is talking about when the bottom fell out of the FSEDs in Texas a few years ago. That bled over into hospital-based ED jobs, so there were no decent locums jobs to be found in Texas for a while after that. I would have been screwed if I hadn't had licenses in other states. Then things started to get thin elsewhere, so I couldn't get quite as many shifts as I wanted each month, and that's why I ended up taking a permanent part-time job in my own state. If the job market goes downhill in the entire country all at once, you could be left with no way to pay your bills.

Also, flying sucks right now. The airlines are a mess, and I wouldn't want to count on my flight arriving on time or having to leave a day or two early to make sure I'd get to work on time.

As far as residency attendings go... I'm sure there are some great ones, in terms of real-world knowledge... but mine all let me take an absolutely atrocious, low-paying full-time job right out of residency. They saw my contract and everything. I'm still glad I did it, because it ended up being a huge learning experience for me, and I got to live in a very cool place, but I wouldn't recommend it. So yes, take what your attendings say with a grain of salt. If possible, talk to a couple of community docs about whatever plans you're considering.

If you're asking for recommendations on specific companies to work for... I worked for several, and they were all about the same. Just remember that no matter how friendly they might be, the recruiter is not your friend. They're usually making commission on you. Ask to talk with another doc who has worked for their company, and if you can, another doc who has worked at the site you're considering working at. Sometimes you can establish a rapport with your recruiter, and over time they will be more real with you, but it takes time. You will also get to know other locums docs and find that you've worked at the same places in the past, they've worked someplace you're considering, etc. EM is a small world.

All that said, my last job was a half-time one in an ED 2 hours (driving) from where I lived. The pay was slightly less than my locums pay, but I could be home within 2 hours of my last shift (I stayed in a hotel -- which I paid for myself -- for each stretch of shifts). Financially, it wasn't as good as locums, but it was guaranteed hours every month. Another doc at that site flew in from REALLY far away and worked nights, because that was "daytime" for him at home. He'd do 10-14 shifts in a row and then go home. So you could just get a permanent (non-locums), full time job and fly in once or twice a month, or drive for 3-4 shifts in a row. That would give you more stability than locums, although obviously you'd be sticking to just one place.

I don't know if CMGs still have "firefighters" or "special ops" or whatever ego-inflation-attempt name they're giving them these days, but even though it always sounded awful to me... I worked with some docs who did it, and they seemed happy. It's similar to locums except that the CMG owns you and tells you where to work, and I think the pay tends to be better than a normal full-time CMG job.

Exactly what I came here to say. USACS team and envision have these firefighters. Aka internal locums. Pay is lower than other locums as you agree to a rate up front. These guys got smart and realized they could do it themselves. That being said many are still short. Key point is we are moving rapidly to 10k too many docs in 2030. So while we focus on the year 2030 we have to realize this means practically the market will be close to near collapse by 2025/2026. I say this because many of the assumptions of the in the acep and other study don’t fully account for non EM docs and MLPs.
as it stands now it is hard to find a job in a city. Period. Any city. Most of the jobs are 1-2 hours outside of big cities. In this backdrop we are still cranking out too many residents. New programs are opening.
so docs will be pushed further and further into the jobs no one wants. Generally lower volume and pay.
if you do locums when that dries up either in hours or pay what will you do next? You aren’t just going to walk into a decent job. Something to consider. I bring this up to my residents when they consider finding a job for the short term before they make their long term play. I would advise all to find a job they want for the long haul and secure it now.
as mentioned if you want to try locums secure a 0.5 FTE position now and do locums for the other 0.5. You may be able to do it within 3-4 hours of your main job.
m y advice is if you want to do locums do 0.5 fte elsewhere so you have a floor. Be great at that job cause at some point you may see them squeeze you down to 0.25 or less and ideally if they like you before they did that they would tell you to either go FT or push you down. Ideally you want them to let you know this is coming before you realize this happened when they publish a schedule.

 

[Groove]

Some good advice in here. I think in this case the only positive to doing locums would be to give you experience in a variety of different ED environments if you weren't quite sure what type of shop you wanted to work. Also, some people want to travel and see other locations to get a better idea as to where they want to settle down. In those scenarios, there's nothing wrong with doing locums for a bit. You could do Weatherby or sign up as a strike/firefighter team for a regional/national CMG. Just look up the major CMGs that are in the state(s) you are interested in and call them up.

That being said, we're quickly reaching a point where beggars can't be choosers. The only hope for us by 2030 is if more hospitals keep adopting ABEM requirements for their EDs which will push out the FM/IM guys and make a little more room for our ranks, delaying critical mass for a few more years.

Personally though, I'd recommend against locums for many of the reasons that have already been mentioned. I got so tired of learning new EMRs, new hospitals, new consultants. I got sick of airports, hotels, rental cars. Watching movies on my iPad in the hotel room by myself... It gets really old, really quick. Sometimes you just want to be in your own bed at the end of the day. The rates can be deceiving as they don't account for travel time. As I said in another thread, locums is really only great when you're running away from something...usually a bad home situation or impending divorce, etc.. I suppose it could offer freedom to live in any location but I would always be paranoid that the locums opportunities would dry up like they did during the FSED implosion. I'd much rather have a local gig to where I live and alternate potential gigs within 1 hour driving distance.

If you take a local FTE position or half position, I wouldn't recommend locums. As soon as you get hired, they are going to find someone else to fill the remaining shifts that you can't work. It becomes very hard later on giving up your locums and being able to acquire FT hours. That's why I always negotiate 140 hours in my contracts at a minimum. Good luck.

 

[wook]

Is this common. I’ve been doing this about 15 years and have never done anything more than a few minutes in the phone with a prosecutor. I think thats happened to me 2 times.

Great question!

I do not think its common, but it does happen. In my case, I had been doing it for 3-5 years before the two cases arose. Given that witness can be sequestered, I did not want to take a chance. I know if one case homicide case where witnesses were sequestered for weeks, and I cannot afford to go without pay for that amount of time. I know of a recent case where the ED doc had to testify for several hours (not a locums occurrence, so I suspect his employer paid him to attend). Again, not common, but does occur. If considering working locums, you may want to factor this into your decision making process.

 

[BoardingDoc]

I have done locums part-time and the pay was better than I was making at my full-time job. The sites I worked at were excellent as well! Not everyone I know who has done locums has had as pleasant of an experience at their sites.

I did stop doing locums. The reason being that is if you are called into court about a criminal case to testify about a patient you saw (who is a suspect or victim), you are not compensated. The locums companies that I worked with would not pay, and the hospital where the care was rendered also would not cover my time, travel, or lodging.

Just an additional factor as you consider this.


Thanks.


Wook

Is this something which happens to you with some frequency? I have never had this happen in my 5 years as an attending and I don't personally know any doctors where they were called to testify either.

Edit: saw your response above as I hadn't read the whole thread yet. Seems like a pretty small risk. I'm not advocating for locums, but it seems like you could be sequestered at a local job just as easily and there's no guarantee that the local CMG will pay you for that time either.

 

[wook]

Is this something which happens to you with some frequency? I have never had this happen in my 5 years as an attending and I don't personally know any doctors where they were called to testify either.

Interestingly, this has not happened to me at my full-time job (been an attending for over 10 years). This has only happened to me with the locums work I've done. One of the cases was probably because it was at a small shop and there was not an available sexual assault nurse examiner resource available, so I had to do the exam.

So, I would expect this to be an uncommon occurrence, but depending on the hospital, there may increased likelihood if there are less resources (i.e. having to do your own sexual assault exam).

 

[BoardingDoc]

Interestingly, this has not happened to me at my full-time job (been an attending for over 10 years). This has only happened to me with the locums work I've done. One of the cases was probably because it was at a small shop and there was not an available sexual assault nurse examiner resource available, so I had to do the exam.

So, I would expect this to be an uncommon occurrence, but depending on the hospital, there may increased likelihood if there are less resources (i.e. having to do your own sexual assault exam).

Side question: does anyone know of medicolegal requirement for a SANE exam to be performed? It seems like that particular component is a criminal law thing and not a medical need thing. I ask because I had a patient not long ago who came in requesting an exam with a very vague story, she heard that I was the only doc on (male) and that we didn't have a SANE RN available. She asked where else she could go and I looked up local hospitals that listed having SANE RNs on staff and she left to go self present there.

 

[GonnaBeADoc2222]

I was on the strike team / alpha force / rogue squadron for a CMG for 3 years immediately post residency. I'll echo the above pro's about (potentially) increased pay, schedule flexibility, and perk of credit card points as above. Below are some pro's/con's specific to my personal time on the job:

Pro:

a) I was at one site for approximately 2 years, which is definitely not the norm for most people. It was a **** show ER, but I developed relationships / friendships with other travelers and FT docs there which I still maintain 3 years later.

b) I was at another site for 2 months that was a 30 min drive from my home. So I was essentially locums, but sleeping in my bed and seeing my family!

c) I never had to fly anywhere. Again, your mileage may vary. I would NOT want to be subject to today's airline fiasco.

d) Because my (now ex) wife at the time was doing a fellowship in a city with very below national market EM rates and terrible medmal environment, I was able to make more money and work less hours.

e) I was on my wife's health insurance, so being an independent contractor was not a concern for me.

Con:

a) Some of these ERs have very strange and insular cultures and may not be used to having travelers. If you piss off the wrong people (as I did a few times hehe), it can go poorly for you.

b) I cannot emphasize how much traveling sucks after awhile, even though I did not have to fly. I was incredibly homesick and isolated at times.

c) This thankfully did not happen to me, as I quit the job a few months before COVID started, but the CMG will assuredly cut your hours and your pay if volume drops. Some of my friends got royally screwed (even the FT ones).

Overall, I'm glad I did my time with the travel group because of my specific circumstance. However, I don't think I would recommend it now, given the instability of the EM market. If I had not been tied down by my (now ex) wife, I definitely would have either looked for an ER where my family lives, or bit the bullet of lower pay in exchange for an awesome location.

 

[turkeyjerky]

Side question: does anyone know of medicolegal requirement for a SANE exam to be performed? It seems like that particular component is a criminal law thing and not a medical need thing. I ask because I had a patient not long ago who came in requesting an exam with a very vague story, she heard that I was the only doc on (male) and that we didn't have a SANE RN available. She asked where else she could go and I looked up local hospitals that listed having SANE RNs on staff and she left to go self present there.

I'm pretty sure that there's a legal requirement to perform a forensic examination, or facilitate transfer to another site if that's the hospitals' protocol. I don't believe there's any requirement that said exam be performed by a SANE.

No idea if a sexual assault is considered an unstable medical condition under emtala, and thus subject to its transfer requirements. I would think not, but clearly some of the CMS auditors can get a little crazy.

 

[PianoMedic]

Side question: does anyone know of medicolegal requirement for a SANE exam to be performed? It seems like that particular component is a criminal law thing and not a medical need thing. I ask because I had a patient not long ago who came in requesting an exam with a very vague story, she heard that I was the only doc on (male) and that we didn't have a SANE RN available. She asked where else she could go and I looked up local hospitals that listed having SANE RNs on staff and she left to go self present there.

Incredibly state specific. My state just passed a new law in the past several years that we now have to provide a SANE exam within a certain amount of time after patient arrival to the ED or facilitate transfer to a site with a SANE. It goes into effect in about 6 months and is going to be a cluster.

As to being called as a witness:
I can’t say much about it, but I’m just now one year out and have a case pending to testify. One of the NPs at the same site has three cases she is supposed to testify for and she started after I did. This can be incredibly site dependent. Definitely look into the local crime rate for various crimes you could see in the ED that are likely to go to court (violent crimes with a weapon and sexual assault come to mind mainly) to determine your possible exposure to having to testify. Haven’t done locums, but this would be a factor if I did. My testimony is unpaid, won’t have to be sequestered. Have another doc in my group who is waiting to testify (for a different site) as the case has been continued several times.

 

[Groove]

I took care of a 2yo pediatric pt while doing locums in a state and it turned into an abuse case. Very bad head trauma, huge SDH and the case is a long story but she miraculously survived. The mother's boyfriend was charged with abuse. I was living in another state and they called me to show up in person to testify. It was incredibly frustrating because I was finishing residency at the time and had to get my shifts covered and they would end up cancelling it a week or even a few days before... They did this 2-3 times and I asked them for a phone/video deposition because I couldn't get my shifts covered and get travel arrangements quickly enough on short notice. Then the guy pled guilty and I didn't have to go anymore.

 

[lp430]

I was in your shoes a few years ago. I am now several years out of residency and have almost exclusively travelled out of state to work. The big downsides and why I am leaving full-time travel work are:
1. As others have said in this thread, traveling gets old. I have all the airport perks (clear, pre-check, free upgrades, airline clubs etc) and that only makes it less painful, not enjoyable.
2. Pay is not that great anymore. When I was in residency, people were talking about jobs for $300+/hr. When I started, I could easily find jobs $240-250/hr. Now, the offers I get are more like $200-210. Sure, you may be able to find the occasional high paying job, but who knows how long you'll even work there? There is very little security.
3. Not being able to come home after a every shift. I am someone who enjoys working out/reading etc and am ok doing solo activities. Eventually, you get tired of frequently telling your friends, significant other etc that you're out of town again and cannot spend time with them. I am really starting to value community more and that's hard to have when you're always leaving.

I hear you with the scheduling freedom and location independence. They were big draws for me too when I started, but ultimately not enough to keep me doing travel work. Most of the docs I meet doing long-term locums have adult children, ex-spouses and tend to be later career. Only noting a correlation here and certainly not universal.
If anything, consider part-time locums as it still gives additional flexibility but more of a life. Hope this helps some.

 

[wook]

....they would end up cancelling it a week or even a few days before... They did this 2-3 times and I asked them for a phone/video deposition because I couldn't get my shifts covered and get travel arrangements quickly enough on short notice. Then the guy pled guilty and I didn't have to go anymore.

This happens a lot in criminal cases. Often by the the defense attorney....claiming that they need to time to get a piece of evidence or a witness. It drains the witnesses, including police.

 

[RuralEDDoc]

Another thought is support from other physicians on shift. Right out of residency, you haven’t had to troubleshoot a thousand difficult situations and impossible patient scenarios. Most of medicine is not actually medicine. Will the hospital or other physicians help you through this as a locums? Maybe. Maybe not. Might not be a great gig as a first job post residency.
There’s another recent thread about predatory scheduling of new graduates. You’re walking right into this potential as a new grad if you choose locums.

 

[turkeyjerky]

I think you guys are making too much fuss about being called to testify in criminal cases. I got called one time w/ minimal notice to a jurisdiction an hour and a half away from me--I just told that it wasn't gonna happen. They said ok, came back a few times w/ alternates and eventually offered a phone call which was subsequently canceled.

Our testimony just isn't that necessary for most of these cases. Every answer is gonna be, "Don't know", "Don't remember", "Check the medical record--which I don't have". "Yup, that's what it says".

I highly doubt many judges are gonna hold a physician in contempt of court for failing to respond to a last minute subpoena

 

[RustedFox]

I think you guys are making too much fuss about being called to testify in criminal cases. I got called one time w/ minimal notice to a jurisdiction an hour and a half away from me--I just told that it wasn't gonna happen. They said ok, came back a few times w/ alternates and eventually offered a phone call which was subsequently canceled.

Our testimony just isn't that necessary for most of these cases. Every answer is gonna be, "Don't know", "Don't remember", "Check the medical record--which I don't have". "Yup, that's what it says".

I highly doubt many judges are gonna hold a physician in contempt of court for failing to respond to a last minute subpoena

This is my experience too.
"I remember nothing. You can read the chart as well as I can. Kthxbye."

 

[BoardingDoc]

This is my experience too.
"I remember nothing. You can read the chart as well as I can. Kthxbye."

From what I've heard from friends that do expert witness trial stuff, lawyers will sometimes subpoena docs with the goal of getting expert opinion testimony out of them without paying for it.

I would also respond that I would have little to add to the case beyond what was already written in my chart. If they wanted to pay me for my expert witness opinion, I would be happy to offer that as well.

 

[Groove]

I think you guys are making too much fuss about being called to testify in criminal cases. I got called one time w/ minimal notice to a jurisdiction an hour and a half away from me--I just told that it wasn't gonna happen. They said ok, came back a few times w/ alternates and eventually offered a phone call which was subsequently canceled.

Our testimony just isn't that necessary for most of these cases. Every answer is gonna be, "Don't know", "Don't remember", "Check the medical record--which I don't have". "Yup, that's what it says".

I highly doubt many judges are gonna hold a physician in contempt of court for failing to respond to a last minute subpoena

This is probably what I would do now but at the time I was a PGY 4 with a couple years locums during residency under my belt and didn't know any better. It was only when I exasperated over the phone to the DA investigator after the last cancel that I realized it's not such a big deal if you simply tell them you can't make it. They offered to do a phone deposition and I was like "Why didn't you guys offer that to begin with?!"

Edit: Actually, I just looked back at my old emails and I think what gives these things teeth is that I had been formally subpoena'd by the court to appear. You're probably right that the judge would not find you in contempt but that's always a risk you take and the judge might find you in contempt prematurely without having all the details of why you couldn't appear. They didn't release me from the subpoena apparently until he pled guilty.

 

[DO3]

Here’s my advice. Find a good, full-time gig. Work the least amount of shifts that the full-time gig will let you and still be considered full-time. And then work extra Locums shifts on top of that if you want. Good, full-time spots are going to be harder and harder to find in the years to come. They’re already pretty hard to find now. You don’t want to miss the window if you find a good job. At my job (considered a good job) we had no full time hires for 2-3 years until this year. Locums will always be there to a certain extent…although the pickings have become pretty thin the last couple year…the good jobs don’t come around often.

 

[thyroxine2468]

I considered doing locums right out of residency and am glad I didn't. I did eventually do locums for about a year and a half and while I enjoyed the flexibility and control over my schedule, the travel and instability did take a toll.

However, I would highly recommend against it right now. The job market is going to tighten significantly in the next 2 years and you might end up on the outside looking in. Also, the pay differential is really not what you'd expect. At the very least, get a 50% FTE job locally and travel on the side. Also, take advice from your attendings w/ a grain of salt--they're probably suckers.

why are you glad you didn't?

 

[alpinism]

Completely agree with all the other comments.

Good locums opportunities are few and far between at the moment and will likely be all gone within a few years.

If you really want to live out west and travel for work your best option would be to find a solid part time job located in one of the higher paying regions of the country and do a block of shifts there once a month. You can still find plenty of places in the less desirable parts of the country willing to pay 250+ hour for shifts. If you sign up for as little as 5 shifts its easy to make 150,000+ guaranteed salary. Afterwards you can still begin picking up high paying locums shifts but if you can't find shifts or if the shifts get cancelled you still have a reliable source of income.

 

[Tenk]

Traveling for work gets old fast. It’s just unpaid time. If you’re flying in and out, you need to factor in the days you spend flying on your hourly wage. Suddenly it becomes far less attractive unless you’re making $350/hr+.

 

[turkeyjerky]

why are you glad you didn't?

Primarily because I think it would've been hard to make connections develop my career if I had been full time locums. There's definitely some intangible value to your development in being a dedicated member of hospital staff rather than a fill-in guy nobody knows (although this is less so w/ many of the CMG gigs out there). If the **** ever hits the fan (which is more likely early in your career) it's preferable to have colleagues who'll back you up rather than cut you loose.

A secondary reason, that unfortunately won't be the case for you, is that my gig was pretty understaffed and I had the opportunity to pick of a ****-ton of extra shifts at 1.5-2x pay. So despite living in a relatively low-paying city I made some pretty good money my first few years out.

 

[Mbekweni]

Also if you can find a good job with a SDG you can get in now before the competition for slots becomes brutal. Then after a few years make partner and get profit sharing and likely end up making far more than you would with locums WITH added job stability and working close to home. Maybe I just got lucky, but if you are looking at such terrible options close to home I would think hard about moving for a good job if possible before locums.