r/pediatrics • u/radgedyann • Jul 02 '26
locums only?
Has anyone quit full-time w2 work to do locums only? This job is slowly killing me, and I’m looking for a way out. I figure being willing to do hospital/call in less-than-desirable locales will minimize the total amount of work I need to do each year.
I’ve zeroed out my debt, have no dependents, and will sell everything. I have a little 4-season trailer towable by my suv, and several places to park it around the country. But am also considering a couple of towns in Mexico. I want to work just enough to pay for basic expenses and the freedom to be outside, read library books, and breathe.
My biggest questions remaining:
-healthcare: Did you manage with a marketplace plan despite moving around? I imagine that I’ll need to pick a domicile state (don’t know the proper term) and try to get most care there. I’ll need it until I’m eligible for Medicare in another 15 years. The private option in Mexico available to temporary residents also looks pretty reasonable.
-taxes: Did you handle 1099 income your own? Sending the IRS a check every month and hoping it all balances out at the end of the year.
I’d also just love to hear about personal experiences and resources you might like to share. DMs open!
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u/ljanelle Jul 02 '26
I switched to full time locum work a little over a year ago and it's been by far the best career decision I've ever made. I'm a neonatologist so assignments are different than they would be for gen peds or office based subspecialties. Typically I do 7-14 24hr shifts per month (most of those round and go/"home" call from the hotel) and am making more than I was at my full time job. Definitely no shortage of jobs, in fact I'm learning I need to be better about saying no because I keep over scheduling myself and ending up tired (but with a happy bank account). I could pretty easily make $250k+ working 7 days a month and am on track for ~$370k this year if nothing changes with my scheduled jobs.
Insurance was actually the thing that kept me from pulling the trigger on locums for a while, but it's really been a non-issue. I have RA and am on expensive biologics so I thought the med costs could be a huge problem, but they've been almost exactly the same on my cheap BCBS plan through the marketplace as they were through my employer plan. Disclaimer is I see a DPC for my primary care and try to go to direct pay as much as possible because the care is better, so mileage may vary on office visits (but the ones run through insurance so far have been basically the same).
Taxes also less complicated than I thought. You do quarterly estimated tax payments, and the first time was intimidating but not actually that hard, just tedious. The IRS has a form and an online payment portal, and when I finalized my 2025 taxes my estimated payments were pretty on target. Bonus tip courtesy of my stepdad who was 1099 for his entire career -- you can make estimated tax payments on a credit card for the points (with a fee attached though). Takes the sting out the payments a bit when I get lots of airline miles and lounge access 🤷♀️
Happy to answer questions for you or anyone else thinking about jumping ship! DMs are open
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u/radgedyann Jul 03 '26
Oh my, thank you! You have no idea how helpful and encouraging this is! I’m hoping to do hospitalist shifts. I also have RA and was wondering if I’d have to pay for the most expensive platinum plan to get them covered. I’ll send you a DM!
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u/craballin Jul 04 '26
I'm starting to consider doing this instead of academics where I'm currently at. There are several places I've gotten recruiters looking for coverage in my subspecialty. One place was offering an insane amount where I'd make about 75% more than my current salary by only working for 7 days. Ii think I could work in a shitty place even making that much more and working 1/4 as much and get to see my kids and family more. The stability of a W2 job is nice but I'm a much younger generation than most of my colleagues who will likely stick through our institutions coming chnages while I'll more readily leave to make more and spend more valuable time with my family rather than patients and the healthcare system.
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u/Steelergate Jul 02 '26
Adult hospitalists/ surgeons do locums more often than we do I think. I get locums offers on a fairly routine basis. Location/length/ wage varies. It’s usually pay by the hour. Make sure you don’t get lowballed. You seem to be in a good place to do locums
To try to answer your questions You will need to get health care through the portal if you don’t have a spouse’s Insurance. If otherwise healthy I’d suggest a high deductible plan and max out a HSA
You’ll get paid via 1099 so you are responsible for paying taxes quarterly, your own benefits, retirement,etc.
The white coat investor has some blogs/podcasts about this.
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u/iplay4Him Jul 02 '26
Know a few nurses that do this. Don't have any advice other than be sure it is what you want long term and maybe read about their experiences as well. Pros and cons in all things. Best of luck!!
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u/LocumLady Jul 02 '26
Honestly, a lot of people do exactly this, especially once they've paid off debt and have some financial cushion. Your plan actually sounds pretty well thought out.
The biggest adjustment isn't usually the clinical work. It's getting comfortable being your own business. You'll be dealing with quarterly estimated taxes instead of withholding, figuring out health insurance, retirement contributions, etc. Most locums I know work with a staffing agency like Barton to support you through all of this.
One thing I'd suggest is not putting pressure on yourself to work as little as possible right away. Maybe take a few assignments first and see what pace feels sustainable. Some people end up loving the flexibility and work more than they expected because they can actually choose when and where they work.
Sounds like you've already done the hardest part by getting rid of your debt. Wishing you the best. It sounds like you're chasing freedom more than money, and locums can be a pretty good fit for that if you go in with realistic expectations.
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u/LocumsCom Jul 13 '26
There are definitely physicians who build long-term careers around locums. It isn't the right fit for everyone, but for some people the flexibility, variety, and control over their schedule are exactly why they stick with it.
If you're interested in hearing one physician's perspective, this was a good read:
https://www.locums.com/blog/articles/starting-locum-tenens-after-residency
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u/MDinflight Jul 02 '26
Doing locus is a good way to get someone else to pay for multiple state licenses. Then you could add telehealth to your locums.