Family Medicine’s “Other” Way to Be Self-Employed

Think about the many different ways you can work as a family medicine clinician. You can work for a hospital or a hospital-owned group practice. You can work as a staff doctor at a privately owned group practice. You can even employ yourself by opening a solo practice. Unfortunately, the luster of solo practice has worn off over the years.

Older doctors who have toiled in solo practice for years are closing up or selling them to hospital-owned groups. New doctors are avoiding private practice, preferring the stability of employment instead. The result is fewer private practices today. According to data from the American Medical Association, the percentage of doctors operating solo practices fell from just over 18% in 2012 to under 15% in 2018.

If you are a family medicine practitioner wary of self-employment as a solo practice owner, there is another way: find a job as a locum tenens clinician. Locum tenens family medicine is growing in leaps and bounds thanks to the ongoing physician shortage.

Self-Employed Contractors

Perhaps you are among those doctors who never realized that locums are self-employed contractors. They are. They do not work for their staffing agencies as employees on the payroll. They are not employees of the facilities they work for, either. They work for themselves. They work on a contract basis for facilities looking to bring them on-board temporarily.

As self-employed contractors, locums are free to control nearly every aspect of their work – within reason. They are obviously compelled to adhere to the policies of whatever facility they are working at. They are still required to comply with the law. But other than those two things, they are free to do as they please.

A locum tenens doctor can determine how frequently he wants to work. He can take a six-month contract that carries into the summer and then choose to spend the winter relaxing in his favorite warm weather locale. He can work three months on, three months off, etc. He can work year-round but only take weekend assignments that pay premium rates.

Locums can also determine where they work. They can choose the facilities and the geographic locations. They can combine work with travel, both domestically and abroad. It is really an amazing thing.

Legal and Financial Obligations

Locum tenens work is absolutely an option for being self-employed without opening a solo practice. But it is not all sunshine and roses. There are some legal and financial obligations that come with the territory. For example, locums are sometimes responsible for their own malpractice insurance. Depending on whether they get work through a staffing agency, they might also have to pay for their own housing and travel.

Next up are tax obligations. Because locums are self-employed, their pay is not subject to income tax and FICA withholding. It is not subject to state withholding either. That means the locum must pay self-employment tax and file quarterly estimated tax returns to keep Uncle Sam happy.

All of this entails a bit of accounting. So unless a doctor has a good handle on basic accounting procedures, he or she is better off hiring an accountant to handle things for him/her. That is yet another expense.

It is possible to practice family medicine in the self-employment environment without opening a private practice. You do it by becoming a locum tenens provider. For some doctors, locum tenens is a steppingstone to a more desirable position. For others, it is a career. If you are a young doctor still trying to figure out what you want to do, locum tenens is at least an option.