I'll say up front that I haven't built my own locums career around this. I practice where it makes sense for my life, not where a spreadsheet tells me to. But readers ask about it, and the underlying mechanics are worth understanding even if you only ever use one piece of them. Locums happens to be one of the few ways to practice dermatology that makes real geographic arbitrage possible.

I'll start this post with the disclaimer that at every locums assignment I've taken, I've negotiated for the practice to cover my malpractice insurance, so I've never bought my own policy. That happens to be the path I'd guide most people toward, for reasons I'll get to. But some locums derms, especially those direct contracting with smaller practices, end up needing to buy their own. Since I haven't walked that road myself, I researched it a bit for your benefit.

When you cover a colleague's clinic, you inherit their patients and their treatment plans for a temporary period (days, weeks, or months depending on your assignment length). I think how you handle medical management for their patients should come down to two general principles: change as little as you reasonably need to, and document whatever you do carefully.

When you leave a W2 for 1099 locums work, one thing quietly disappears: the invisible machinery that was pulling taxes out of every paycheck. As an employee, you never had to think about it. Payroll withheld federal, state, Social Security, and Medicare before the money hit your account. As an independent contractor, that machinery is gone, and you are now the payroll department.

At some point over the course of your 1099 work, someone will tell you that you're leaving money on the table by not setting up an S-corp. It could be a colleague, a guy at a conference, or even a CPA. It gets repeated like dogma. For some locums derms an S-corp is a clear benefit. For others, the overhead eats the savings and you've bought yourself a pile of paperwork and administrative headaches for a few hundred dollars. It all comes down to the numbers.

The most common question I get, after "agency or direct?", is some version of "What should I charge?" Nobody wants to answer it in public, and understandably so. Recruiters won't, because a vague number protects their margin. Other locum docs might tell you privately, but there is so much variability from place to place that it can be hard to gauge what’s actually applicable to your situation.

Eating healthy is a challenge, even if you’ve got a well-established day-to-day routine. When that routine evaporates with locum work, the challenge is amplified.

Living the locums life involves a lot of planning to minimize unnecessary or undesired gaps in working. One of the more common questions I get asked is when to start hunting for opportunities.

"What agency should I work with? What recruiter do you recommend?" These are questions I’ve been asked by other BCDs looking to do locums. Many dermatologists start their locum search by reaching out to a staffing agency. Recruiters are the standard entry point for these positions. But I don’t feel this should be the default route for a BCD considering locum work.

A reader recently reached out with a concern that I hear from time to time from other dermatologists: will a stint in locums look like a red flag on a CV when it’s finally time to land a permanent role?

When you’re a locum, you don't have the luxury of growing with your staff over several years. Everyone around you, including your MAs, will be new faces. There might be some initial awkwardness, and that’s okay.

You’ve found your first locums derm gig and agreed to the basic terms with the clinic. Now the contract is sitting in your inbox. What do you do from here?

As a locums dermatologist, you’ll eventually hear about the Q6 modifier. It’s a billing shorthand used for Medicare patients that allows a clinic to bill for your services under a permanent doctor’s NPI.

Credentialing and tax prep are easily some of the most tedious parts of working locums. Between the constant requests for paperwork and the need to track every single travel expense, it's easy to get buried in files. If you're mucking through a messy "Downloads" folder every time someone requests a document, you're wasting your time.

If you’re looking to pick up assignments in multiple states quickly, you need to know about the Interstate Medical Licensure Compact (IMLC). I’ve personally never used it because only one of the three states where I practice participates, but it's useful to know about for any locums derm.

Whether you’re going through an agency or contracting directly with a derm clinic, remember: everything is negotiable. If it’s not in writing, it doesn’t exist. Here is a baseline of what you should consider.

When you work at the same practice for years, you develop deep roots. At my last job, I knew the staff’s kids’ names and which administrators to avoid. I also knew exactly where the bathrooms were. Moving into locums means giving that up. Suddenly, you’re "The Outsider" over and over again.

This post is geared towards locums derms who have decided to set up their business as a sole proprietorship. Getting the foundation right early on saves you from a massive headache during tax season.

Tracking mileage is boring to do and boring to write about. But you can save money by doing so.

If your locums roadmap involves a lot of flying, TSA PreCheck is worth your while. You’ll save time and skip the hassle of taking off your shoes or pulling out your laptop at security. The more interesting part is how you should go about getting it.