Troubles with Locum Work

I’ve been a full-time travelling locum CRNA for over 2 years. It’s no secret that locum work pays well.

Some do it for the schedule flexibility. Anything from desired work hours to days off.. Another group is seeing the country on someone else’s dime. All valid reasons. 

Social media portrays locum work and 1099 contracting as a glorious endeavor — true, but not without caveats. There are notable downsides. 

The first to be cut

Pigs get fat and hogs get slaughtered. In every profession the locums and travelers are the highest paid and therefore the first to go. If you can withstand potential irregularities in work, this is manageable. There is an art to maintaining credentialing at multiple locations within a small geographic area.

It’s still not fun to be cut 35 days before starting a contract. Not close enough to be paid for canceled dates. Too short of a window to be credentialed at a new job. 

Make your own schedule

It’s true that you can make your own schedule and take vacation time when you want. This includes certain shifts, holidays, or consecutive weeks off. 

Just like locums are the first to be cut, they’re the last to be signed. They’re generally a last resort to fill staffing vacancies. I have spoken to multiple facilities that don’t schedule locums than a month or two in advance. 

Facilities with chronic needs are much more flexible. I have now signed a couple contracts four or five months prior to the scheduled start date.  

Scheduling in advance takes me out of the locum job pool and theoretically secures work – A relief. This being said, most contracts may be terminated with a 30-day notice. So… a false sense of security.

I  have only encountered one instance having a hard time filling weeks. My availability simply did not align with the needs of the three hospitals I was credentialed at. Struggling to fill 3 of 156 weeks, not bad.

Sometimes the facilities or geographical area you want to be don't have work for you. This is where creating your own schedule becomes problematic. 

No work, no pay

Most locums I know take fewer weeks off than the standard 6-8 weeks at most full-time jobs — Guilty. This isn’t like spreading a salary over 52 weeks. It's a mindset change. Every week or weekend I’m not working is a missed paycheck. It was my goal in 2026 to be paid every hour of the year knowing it wouldn’t happen, but goal setting.

Negotiations

Prepare for frequent contract and salary negotiations. I use compensation as exclusion criteria. Next, I look at contract specifics. If a contract doesn’t meet my hard stops, it’s a no-go. I have preferences that I will let slide, but there must be something favorable to offset the downside risk.

I don’t mind negotiating because I can say “no.”

“Anchor high and let it fly!”

-L. Murren

Unless someone else said that first, then they can have credit.

 For every point of compensation negotiation , I negotiate 5 points of verbiage. A combination of addendums and amendments to protect me as the independent contractor. Hospital lawyers write the contracts to protect hospitals. Agency lawyers write the contracts to protect the agencies. It’s important to ensure protections for you as a contractor because other parties don’t willingly take downside risk. 

Unfamiliarity

Flashback to your time as an SRNA going through rotations. It’s the same anesthesia with a new workflow, new surgeons, new staff, and a new facility. There’s something about not having the comfort of what you have become accustomed to. 

I have my own system that I take from place to place. Emergency drugs and equipment are always in the same spot regardless of where they are kept after hours. 

Benefits

If you have a spouse who is offered health insurance, one problem averted. The TFC family has health insurance through our LLC. It isn’t enough to get just any marketplace insurance because we travel nationally.  

To stay in-network in the Midwest, Southwest, and South, we have Blue Cross coverage. This is a headache to setup and even more unpleasant when you see the bill.  

Now replace the remaining benefits to fit your situation. This includes insurances and retirement. Definitely some perks, but not as easy as checking a box on every October. 

Recruiters

Many of the Midwest hospitals funnel CRNAs through recruiters. Like any profession, there are good and bad recruiters. We have all heard the horror stories. I don’t mind that agencies take a fee to provide a service, but I mind when the communication pipeline is poor.  

There is an awkward dynamic of obscurity between the hospital, the agency, and me. I'd prefer to contract directly, but in the Midwest, that results in a lower rate. I encountered this at more than a few hospitals. $200 per hour direct or $250 through an agency -- Plus the 25% agency fee. Don’t get me started on forced recruiter use. 

Travel

Openings commonly have a 50-mile requirement. They want local CRNAs to sign full time or PRN. Probably not a bad move because geographical location is a strong pull. No one willing takes the job 100 miles from home when the same job is down the block.

I heard this was a really big deal for travel nurses following COVID. She said it took about 12-18 months, but they finally had their RN staffing (and budget) back in line after implementing a minimum milage policy.

I know there are ways around this, but that’s another story.

Traveling for work sucks. Maybe it's a 1 hour drive each way. This makes a 10-hour day out of an 8-hour shift. This is wearing and dilutes earnings.  

Maybe you fly in, fly out. Now you are gone for days or weeks at a time.  

Option 3 is to travel full time. This is what we do. Pack everything into a toppered pickup. Basically pack everything you own like a college student moving into the dorms. Except we were doing this on a weekly basis with a family. Better now with longer contracts. But…looking for longer contracts limits my job options.  

It's a clown circus moving with a wife, kids, and a dog. Basically anesthesia nomads.  

Housing

Get used to hotels, hospital housing, and furnished rentals. An RV is tough anywhere it gets cold and they shut off the water. And I have a 20-minute callback most places, so out-of-town camping is tough.  

If the agency knows you are in an RV, they will try to cut your lodging reimbursement. Hospitals will do the same with housing. If they have a crappy 1BR apartment or attached call room, they will present that as the only option. Negotiate well friends. 

Why are locum jobs available?

Great jobs in great places with a great culture don’t need locums. Locums are a last resort to fill spots. Have low expectations going in and you will be fine.  

Look at how long other locums have stayed. If they burn out after a month or two, expect the same. Perm staff knows you are making the big bucks, so they may spread some toxic culture your way. This propagates the cycle. 

Others are happy to see you because management isn’t up their backside about covering open call.

I mitigate bad vibes with assignment selection and offering maximal services. I offer a full scope of practice, call, and weekends. Relieve the full-time folks because they are experiencing the stressors that led to the locum role becoming available.  

In 15 minutes you can show me the OR, OB, and ED. Where are the drugs and ultrasound? Let’s check my badge and EMAR credentials before you go. Give me the beeper and enjoy your night off.

If you are considering locum work…

Do it. 100% full send. If you have been a CRNA long enough to feel comfortable in your practice and have been considering locum work, do it.  

The learning curve of dealing with the drawbacks is steep. Sign a couple contracts and you will be a pro. The market is dynamic and currently friendly towards locums in many areas of the country. I’d love to see you disqualified from the AANA compensation survey because you make over $600,000.

My list of pros would be shorter, but far more potent. Nomad life for the foreseeable future. 

Free course available. Thanks for reading!