I’ll never forget the moment when I knew I was going to have to make a big transition. After more than a decade of navigating what had become an ongoing tension between work and life, I remember running the numbers one evening and realizing something had to give. My overhead and schedule pressures became impossible to ignore.
As a private-practice otolaryngologist, I lived and worked in the same community where my children went to school, yet I still missed most of the ordinary family moments that I wanted to be present for. My wife and I both work full time and have school-age children with demanding schedules of their own. I was spending too much time increasing my work volume to meet overhead costs, and I was convinced that my professional life and my family life were out of balance.
However, I struggled with the idea of what this pivot would entail for me, a physician in the middle of my career. How would my future change if I left private practice? I felt there must be a better alternative to more traditional practice models of medicine.
The growing pressures on mid-career physicians
Mid-career physicians offer the health care system a great balance between recent training and substantial experience, yet many are leaving traditional practice because those models have become unsustainable. They also experience higher rates of burnout. It was reported that physicians between the ages of 40 and 54 experience a higher rate of burnout than older or younger doctors. Common reasons cited include the burden of administrative tasks and long work hours as key drivers of burnout. Many physicians say they would take a pay cut for better work-life balance.
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Historically, mid-career is a professionally intense time for physicians. Many of us are mentoring and training younger colleagues or taking on leadership responsibilities for our organizations. Declining reimbursements and rising overhead continue to squeeze private practices, creating financial stress. Those of us in this age group (ages 45-54) are also parents, often smack in the middle of raising young children, and a tension can develop between balancing responsibilities at work and at home. I’d be remiss if I didn’t acknowledge that these challenges are worse for women physicians. Research shows that many of these challenges are exacerbated for women physicians, who struggle with the increased burden of childcare responsibilities as well as a lack of female role models and mentors in leadership positions.
When I contemplated the imbalance of my home and career life several years ago, I started having conversations with colleagues, and I learned that many of them suggested locum tenens as a possible solution to my dilemma. Like many physicians, I assumed that locums was for younger physicians getting their footing or more senior doctors hedging toward retirement. Turns out, this assumption was far from accurate.
Disputing the myths surrounding locums and family life
One of the greater myths surrounding locum tenens work is that it’s not conducive to family life. However, data show that physicians with children participate in locums at rates nearly identical to nonparents. For instance, one study found nearly half (46 percent) of physicians who have locums experience also have children and that physicians without children are not overrepresented in the locums cohort. This same study shows that the proportion of physicians without children in the locums cohort (54 percent) is essentially the same as the proportion of physicians with no locums experience and no children in traditional modes of practice (53 percent).
Prior to locums, I worked close to where my children attended school, yet it didn’t help me be more present. I was rarely, if ever, able to chaperone school field trips, volunteer in their classrooms, or split household responsibilities in the way that I wanted to. This created frustration and stress between my partner and me at times, which was an added impetus to explore a different career model.
Since making a transition to locums employment, I can honestly say that I have been pleased with the decision from a professional standpoint. Simultaneously, I’ve been fortunate to enjoy more quality time and meaningful interactions with my children and my spouse than was possible previously. I’ve enjoyed much more control over my schedule, with one example being the ability to enjoy three-plus weeks in New Zealand with my family, joining my wife on a work research trip. This experience was exceptional for our family and one that I would have never conceived of happening had I still been in a small group practice.
Of course, like anything, there are many providers that locum tenens would not be a fit for. Travel can sometimes be challenging, and you have to be adaptable to new environments and different workplace cultures. For me, these small challenges were a great tradeoff because they freed me up to not only practice at the top of my license but also to lean into the parts of my life outside of medicine that were equally, if not more, important to me. The growing desire for flexibility in medicine is increasingly important to all physicians, not just for those with children or in the middle of their careers.
Continuity of care isn’t lost in locums
In addition to the myth that locums isn’t right for physicians with families, there is a misperception by some that locums physicians can’t provide continuity of care. However, long-term locums assignments increasingly allow for sustained patient relationships more than one would think. For instance, there is a health care facility where I have continued to practice for nearly three years, returning monthly, seeing patients repeatedly, and where I am able to manage longitudinal surveillance cases. Continuity does not require being physically present five days a week year-round.
Locums can also provide continuity of care for rural and underserved communities who otherwise would have access to no specialists at all. There are patients who wait months to see providers or have to travel incredibly long distances for care. As a locums, you’re not simply filling shifts; you’re helping sustain access to specialty care in communities that might otherwise go without.
Improving health care’s workforce from outside the box
Mid-career physicians remain one of health care’s most valuable resources. We’re highly experienced and deeply committed to our patients, whether I’m seeing those patients every month or for two weeks and not again.
The skills and scope of practice for locums physicians, in my experience, don’t diminish simply because we’re not practicing in one setting consistently. If anything, the fact that a locums physician is recruited to fill a need indicates that a given assignment will entail equal volume and complexity of practice vis-à-vis a more traditional model of work.
My experience, while resolved by a pivot to locums, is in fact a reflection of a much broader systemic issue. I wish health care leaders recognized that traditional practice models that continue to prioritize financial pressure as much as clinical outcomes are increasingly pushing providers away. The many mid-career doctors suffering from burnout, financial pressure, and family responsibilities deserve more options that deliver sustainability, flexibility, meaningful patient care, and the ability to remain fully engaged both professionally and personally.
Ben Feldman is an otolaryngologist.
