No two clinicians have the same reasons for pursuing locum work; some want to use their flexibility to start a business, write a book or climb Mt Kilimanjaro, while others want to save money for a house or a wedding, or spend more time with their family and friends. This heterogeneity is something that gives my work here great meaning, and helping people find their own path through life has become something of a calling for the Go Locum team in general.
But despite the thousands of different life stories we hear on a regular basis, we've found that it's the same few potholes that catch new locums by surprise as they navigate a new way of living and working. These "traps for young players" can turn the locum dream into a locum nightmare if we aren't careful. This article is intended to be something of a "Locum 101" course for people new to the industry, to help them avoid unnecessary flat tyres and chipped windscreens. It's informed by our years of experience in helping people transition to locum work and we encourage anyone who's locuming for the first time to read it in full.
Lesson 1: You can say no
People who work in the hospital system will be very familiar with the idea of direct or indirect pressure from administration to change their shift pattern to help meet operational demands. Because of this we have sometimes seen new locums who "feel bad" saying no to the shifts we've offered them, or feel as if they need to provide an excuse for why they can't work a given run. One of the big advantages of locum work is that you have far greater choice in when you work and the types of work you accept. This of course comes at the cost of the guarantee of shifts and income that comes with a permanent contract, however for many people this exchange is clearly worth it.
Along the same lines, you don't need to provide an excuse or reason why you need time off either — simply saying "no" is enough. You aren't letting us down personally or professionally by doing so. You're in charge.
At the same time, we may occasionally ask why you have declined an offer, as that can help us inform future offers to you. For example, if you're unavailable on a given weekend, we can withhold future offers that clash with those dates — but know that providing that information is voluntary at all times.
Lesson 2: The industry is unstructured
We're frequently asked questions like "When will summer jobs for Timbuktu Hospital be released?" or "What date will I hear back about my pending job application?" And the truth is that most of the time we don't know, and our answers to this question are an educated guess. In the permanent employment world, you may be used to annual recruitment campaigns that have fixed start and end dates, including multiple rounds of offers and so on. No such structure exists in the locum space, which can be a tough adjustment for those among us who really like to have a clear plan ahead of time.
This can even create problems for the Go Locum team — I can recall at least one occasion when most of the team were out of the office and a hospital sent us a request for 24 medical registrars at 11:10am on a random Tuesday morning with no warning, prompting us all to scurry to get online to make sure our locums had a chance to throw their hat in the ring.
Locum jobs generally pop up between 6 months and 1 hour before their planned start date. I appreciate that's a big range, but it's the reality of the industry. For the most part, medical administrations tend to think "one roster ahead", which tends to be between 2 and 4 months into the future, and that's a good yardstick for how far in advance most locum work is planned in general. Of course, exceptions may apply depending on the circumstances.
Lesson 3: The industry is fast-paced
In annual recruitment campaigns for permanent roles, you typically have a week or more to mull over an offer before you decide what you'd like to do with it. It's also not unusual to hold multiple offers simultaneously while you consider your options.
Unfortunately in locum land, however, due to the urgent nature of many roles on offer, employers will typically want you to confirm your acceptance within 1–2 business days of receiving an offer. In extreme cases, they will continue to actively advertise the role while waiting to hear back from you. This is to give them sufficient time to find and credential an alternative candidate in the event that you decline the offer, to avoid clinical service interruptions. This may mean that an offer made to you might be withdrawn faster than you're used to, which can be a jarring experience at first, but we find that the vast majority of people eventually adjust to the change of pace without longstanding issues.
Lesson 4: Not all jobs are created equal
If you've worked under a hospital award before, you'd likely be familiar with standardised tables of wage rates for all clinical staff. First-year RNs get X dollars per hour, while second year registrars get Y dollars, and consultants get a few dollars more. And we all get a little extra on Saturdays, and a bigger bonus on Sundays. This standardisation means that people get used to the idea that people working in the same role alongside them should be paid the same rate. However in the locum industry, while many award terms still apply, this assumption breaks down in some ways.
Locum rates are calculated through a combination of supply and demand, urgency, employer reputation, negotiation and several other factors, all of which are subject to change. This can work in your favour when you're offered an inflated rate to fill an urgent vacancy, however it can also work against you when someone else in the same role gets a better rate because they picked it up with less notice. It may also mean that the next time you return to the same role, your pay is different to what it was last time.
While we will always represent you firmly in pay negotiations with potential employers, it is important to acknowledge that just because the pay rate was X dollars per hour at one point in time, does not necessarily mean that will always be the case. We have had the odd occasion when someone has become upset when they discover pay disparities like this, but unfortunately it is an unavoidable part of the industry.
In practice most locum clinicians are more likely to benefit from this ambiguity than be harmed by it.
Lesson 5: Health services rely heavily on locum professionalism
As a general rule, locum jobs are skewed towards outer metropolitan and regional areas. This is because health services in these areas have a smaller pool of local staff to pull from to help smooth over changes in their staffing needs. Therefore they are also far more vulnerable to last minute cancellations.
They really need you to turn up when you've committed to doing so, or patient care may be materially affected.
Once in a while we do come across locums who mistake the "ability to say no" (as mentioned in lesson 1) with "the ability to drop out of existing commitments at any time", and this is a misunderstanding of how the industry works.
While we do recognise that life events do happen, our general expectation is that absenteeism, especially at last minute, is reserved for rare and exceptional circumstances. In severe and enduring cases of unreliability, we have had to terminate working relationships due to the risk to patient care being consistently unacceptably high. With that said, the vast majority of locums manage this without a worry.
Lesson 6: Your relationships will matter
The clinical world is surprisingly small, and once you start doing the rounds as a locum, you'll typically start to encounter the same people in different situations. Therefore your conduct on any given day will follow you across locations in the form of your professional reputation, and in locum land this translates directly into how likely you are to be offered subsequent locum or permanent roles in the same network.
Out of thousands of clinical placements we've had probably about 5 instances where a hospital or network has told us that they don't want a clinician back ever again in any form. The top three reasons for this, in order of frequency, are:
- Being unreliable
- Issues relating to interpersonal communication
- Mismatched role and skill level
The other perspective to this is that locums in good standing benefit enormously from a positive reputation. Almost all of the hospitals I've worked at have either a spreadsheet or group chat of "preferred locums" who have proven themselves to be trustworthy, who get first pick of any vacancies before their peers do, and you can leverage this over time into a lucrative pool of work opportunities.
Lesson 7: Higher hourly pay, but that's not the whole story
Hourly rates for locum work start at around 1.5x the base rates and increase to as much as 4x depending on the situation. This of course sounds fantastic in isolation, however there are a few important things to consider alongside this when planning your finances.
Firstly, we know from experience that despite the higher hourly rates, some locums may not end up earning dramatically more than previously on an annualised basis. This is typically due to working fewer hours than they have previously, which is one of the most appealing factors of locum work in general.
Secondly, to access pay at the top end of that range, you typically have to be prepared to do things other people aren't prepared to do:
- change plans and travel long distances at short notice
- work at the top of your scope of practice with high levels of autonomy and responsibility
- work a high proportion of nights and weekends
As a general rule we find that most locums (quite reasonably) aren't prepared to do all of those things for extended periods, meaning that their average hourly rate will likely fall somewhere in the middle of the above range rather than right at the top — and this is by design.
Thirdly, rates between different states and employers may not be directly comparable, for a few reasons. Some networks will include superannuation in their advertised rates, while others will not. Some others may pay more on a per-hour or per-day basis, but not include travel and accommodation allowances, whereas others are the other way around.
All of this should be taken into account when comparing two different offers — a process we're very happy to be involved in on a case by case basis.
Lesson 8: Your newfound freedom might take some getting used to
The first time I woke up on a Monday morning without a permanent hospital job to go to, I can remember feeling quite unsettled. The combination of both excitement and uncertainty for the next phase of my working life was palpable, and this was a new feeling that took some getting used to. The world was my oyster, but my life had also lost a lot of structure that had become familiar and safe.
I've since had several conversations with other people who felt the same way when they started locuming. It's not unusual to take a few weeks to unwind and settle into a new pace of life, with less rigidity and more spontaneous opportunity before you. To the people feeling that way:
- Rest assured that feeling will pass for you as it has for hundreds of others.
- Channel that energy into planning something focused on you, your dreams, or your family and friends. This serves as a great early reminder of why you're doing what you're doing.
- Feel free to get in touch. We're always happy to carve out a path forward that suits you best.
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Locum doctor, founder of Go Locum and labradoodle enthusiast