Nationwide, thousands of locum tenens surgeons deliver surgical care to communities on a temporary basis. As this segment of the surgical workforce grows, surgeons and healthcare organizations are weighing its role in expanding access to care, its implications for surgical quality, and the practical considerations of locum tenens practice.
Yesterday, locum tenens surgeons, academic surgery leaders, and policy specialists convened to discuss these issues in the Panel Session “Locum Tenens as a Growing Practice Niche: Solution or Signal?” (PS323).
Thomas C. Tsai, MD, FACS, a minimally invasive surgeon at Harvard Medical School in Boston, Massachusetts, and the ACS Medical Director for Health Policy Research, opened the session by describing the workforce gaps that locum tenens surgeons can help address. Using the new ACS Surgical Workforce Mapping Tool, he showed that 40% of US counties, home to 15 million people, have no general surgeons.
Dr. Tsai also highlighted the “evolving definition” of locum tenens surgeons.
Although once considered temporary stand-in roles for regular clinicians that largely appealed to surgeons nearing retirement, locum tenens opportunities are increasingly “a new workforce strategy that meets the needs of our communities and contributes to successful careers for surgeons,” Dr. Tsai said.
Dr. Tsai noted that one in three eligible physicians has worked as locum tenens, and 52,000 physicians participate each year. Among these physicians, 81% are in early or mid-career rather than semi-retired. He also reported that 90% of healthcare organizations had contracted with a locum tenens clinician in the past year. Although locum tenens clinicians practice in rural and underserved communities, their use is not limited to those areas.
“Even in Boston, where I work, hospitals employ locum tenens clinicians for coverage,” Dr. Tsai said.
Locum Tenens Practice Expands Across the Surgical Workforce
Dana A. Telem, MD, MPH, FACS, Lazar J. Greenfield Professor of Surgery and Chief of General Surgery at the University of Michigan in Ann Arbor, shared additional data while noting limitations in the available evidence. “Most of the data we have is reliant on billing codes,” she said, adding that resulting statistics represent “under-captures by a factor of at least four.”
Despite these limitations, Dr. Telem said available data show no difference in surgical quality associated with locum tenens practice. “There’s a bias that there’s something wrong with hospitals that use locums,” Dr. Telem said. “The truth is, there’s not. There’s no difference on a population level in hospitals who employ locums versus don’t employ locums.”
She said data similarly show no difference in outcomes for emergency or elective procedures performed by individual locum tenens surgeons. As a result, Dr. Telem said, “We should support people who are interested in this career path.”
Flexibility Comes with Practical Challenges
Miechia Esco, MD, PhD, MBA, RPVI, FACS, a vascular surgeon and chief medical resource advisor at Locumtenens.com, offered the perspective of a surgeon working exclusively in locum tenens roles.
Describing her goal as "to serve the underserved in the vascular desert," she noted that her career path had involved becoming licensed in 15 states and two US territories and working in more than two dozen healthcare systems. In a single year, that meant accumulating 251,000 air miles and 283 nights in hotels. Her 268 on-call days all included responsibility for 100% of vascular surgery coverage.
She described the experiences as rewarding, saying, "The reward has been immense. I’ve been able to provide care to those who otherwise would not have had timely care or even care at all."
Nonetheless, she said, "Locums is not for the faint of heart," requiring careful attention to the business model, formation of a limited liability company, and, in her case, a master of business administration degree. "It’s really important to consider what you want for your life."
Shannon Foster, MD, FACS, an acute care surgeon and facilitator from Reading, Pennsylvania, reinforced Dr. Esco’s comments. She said locum tenens practice offers the autonomy to choose specific work environments, but may offer little or no support for malpractice coverage or retirement benefits.
Additionally, locum tenens surgeons may have limited ability to shape the specifics of clinical practice: "This is what we need, and this is what you will do for us here."
Some communities may not have the preferred infrastructure or teams to support the surgeon. Even when such personnel or resources are available, locum tenens surgeons may lack the administrative input that employed surgeons have.
As a result, Dr. Foster said, accountability and transparency are of heightened importance. "Those are practical decision-making strategies," Dr. Foster explained. "Put yourself in an environment where you have the tools and opportunities to succeed."
Health Systems Consider Different Staffing Models
Christopher D. Carey, MD, FACS, of INTEGRIS General Surgery in Oklahoma City, Oklahoma, said locum tenens surgeons may come to hospitals via placement agencies, through direct contracting, or through a healthcare system’s internal locum tenens pool. Of these, the internal model can offer an alternative to the agency model, which involves payments "the hospital may find prohibitive," Dr. Carey said.
His own experience has included working with surgeons to meet population needs "in some areas that are hard to recruit to," helping support rural surgeons, keep surgical care closer to patients’ homes, and reduce costs.
The panel reserved considerable time for discussion with an audience of current and former locum tenens surgeons and surgeon leaders. Presenters also highlighted forthcoming resources from an ACS workgroup on locum tenens surgeons, including a toolkit and checklist planned for release in late 2026.
