What’s Negotiable in a Derm Locums Contract?

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.

1. The Clock: Start, End, and Admin Time

Be specific about your clinic start and end times. If you're on a short assignment, you might just power through the after-hours admin time. This is what I did for my weeklong stints. But for longer assignments where you’ll have a heavy inbox burden (path, labs, and patient messages), consider negotiating paid admin time.

2. Patient Mix and Clinic Schedule

You can negotiate:

• Time per patient: Are you comfortable with 10 minutes, or do you need 15?

• Blocks: Ensure you have a hard lunch break and "catch-up" blocks built-in if needed.

• Scope of practice: Be explicit. For example, if you don't do peds under age 10, cosmetics, or complex excisions, put it in the contract. Checking the schedule before you start is the best way to avoid surprises on day one.

3. Pay Structure: Hourly vs. Productivity

Most derm locums gigs pay a flat hourly rate. While some offer RVU or collections-based pay, I prefer the hourly model. Productivity-based pay punishes you for no-shows, a low-paying payor mix, and poor revenue cycle management—all things you can’t control and likely won’t know the full details about before you start the gig. If you're uprooting your life to keep a clinic running, you should be paid for your time. The onus should be on the clinic to fill the seats and collect the revenue, not on you to hope they do.

4. Travel and Licensing

If you’re traveling, you should expect flights, car rental, and lodging to be covered. You can also negotiate to have the agency or clinic cover state medical license fees and the DEA registration for that specific state.

5. Malpractice and the "Tail"

You'll either carry your own policy or use the one provided by the assignment.

• Occurrence-based policy: This is the gold standard. It covers you indefinitely for any incident that happened during the assignment, regardless of when the claim is filed. No "tail" is needed.

• Claims-made policy: If the assignment provides this, you must clarify who is paying for the "tail" coverage when you leave. Never leave this to chance.

Remember, this is not an exhaustive list. Everything is negotiable. Make sure you do your due diligence before you sign any contract.