When I first met James, I was a physician just out of training. James had arrived as a locum tenens physician at my permanent job. He was energetic, enthusiastic, and seemed incredibly refreshed. As he explained to me what he did, I went from disbelief to awe. This finally morphed into suppressed anger.

I felt my life was in disarray: constant weekends, never getting the holidays I wanted, and the schedule flipping: harsh night to day conversions and vice-versa. I lived in a constant state of exhaustion, trapped in a position I had imagined would be my only future. I wanted to plant roots and become involved in administration. I was under the impression the pay would justify it. Unfortunately, the “RVU multiplier” model was not panning out according to what I had been promised–more like taking a dart, hurling it at a board, and that would be my monthly paycheck.

My hatred of my job eventually congealed into an admiration of what might be. James spoke of a different mode of practicing emergency medicine. I had heard of doing “locums work” in residency but had immediately tuned out. It sounded unstable, hard, and certainly did not coincide with my vision of the future.

James made his own schedule, chose where he worked, didn’t have to deal with schedule flipping, and was paid by the hour for all of the time he worked, including overtime. He was told how much he would be paid, and actually got that amount–shocking! Further, he was traveling and meeting new people and seeing different ER environments and various practice settings. Most importantly, he was practicing medicine on his terms and doing right by his patients, even if that often-meant shunning metrics or patient satisfaction scores.

After much struggle, I finally left my first job, realizing it was not the type of physician I intended to become. I took several months off and was questioning if I wished to quit clinical medicine entirely. I felt like a factory worker, under constant control by an administration that generally had no clinical background. And as I advocated for my patients–pushing the hospitalist to admit a critical patient, insisting cardiology take a STEMI to the cath lab–I knew I was upsetting people, and my job was not secure. But wasn’t advocating for my patients my job?

That vision James had painted kept nagging me, and so I finally opted to dive into locums, not having any conception of what that actually entailed. But what did I have to lose? Like many ebbs and flows in my life, I acted first and asked questions later.

My first locums post was on a border town in Texas. Border town medicine was near and dear to my heart, and treating the underserved in this part of my state became a passion of mine. I also was seeing a remote part of my state I never knew existed. I met staff and patients who changed the way I practice. And it was all because I left my comfort zone.

Unfortunately, in due time, the ER I was assisting became fully staffed. I went from having a surge of energy and excitement about my job to no work at all. I asked myself how I could make this last, and more importantly if I could really make this into a bona-fide, full-time career.

The answer was simple: I needed to get credentialed at multiple locations and expand where I was willing to work. Initially, I began in Texas. Then, through the guidance of an experienced locum tenens agency, I expanded to New Mexico, and from there, beyond, to four more states.

I formed my own locums consortium, staying PRN (pro re nata, a medical term for short-term, contract employment) at all facilities but making myself available everywhere. In my practice “portfolio,” I was, and today still do, contracting with several organizations and staffing models. I also utilize locums agencies simply because they are in-tune with unique needs that may arise across the country and often can plug you in directly. For example, an agency placed me in a longer-term assignment in New Orleans. I had the opportunity to live in and experience a city in a way I never thought imaginable.

There are risks of working this way. By maintaining PRN status at all my hospitals, no work is ever guaranteed. And, ironically, working for myself, I find that I commit to far more work than I probably would if I were a permanent employee. But the pure joy of this model is being your own boss, taking vacations when you please, deciding how much you wish to earn each year, and realizing if things change at the hospital–a new CMO, new staffing group, or new leadership that does not align with your values–you can simply and quietly exit. And above all, being a mercenary of sorts, I bring a quality standard to each hospital.

Like a carefully planned game of chess, I have become much more strategic about what clients I choose to serve. I make sure I understand the location and needs of the facility before I agree to work. The jolts in my yearly schedule when no work is available have become less and less, and when they do arise, I simply look at them as a forced vacation.

I have been a full-time locums physician now for several years and have found working locums allows me to combine my passion for academics and global health work into my regular private practice as I am able to mold my schedule around these two important aspects of my life. I have been blessed to enjoy all the benefits of having a Sep-IRA and the multitude of tax write-offs the model entails. Living as a constant traveler, most of my personal vacations and out-of-country excursions are all free, simply due to the massive amounts of travel points I accumulate.

It’s strange as I reflect on what my career has become and think of my father: a gastroenterologist, he was also a “rural” physician of sorts. After his fellowship, he moved to the Appalachian Mountains of Virginia to serve a small, coal-mining community. He became a de facto ER physician and, in a town scant of specialists, he really did it all. Each time I serve hospitals in similar locales, I feel closer to understanding that passion that drove him and get a better feeling for what medicine used to be.

The freedom that James unveiled to me in that first encounter with locums years ago has allowed me to branch out to practice to the same environments my father served.  But what I love most about locums is the ability to tell my patients that I work for no one except for them: I flew here to bring my skill set to serve their community. That alone constantly drives me forward.