I worked in the same emergency department for six years. I knew the nurses by first name, knew which attending covered which overnight, knew where the difficult IV sticks were kept and who to call when the charge phone went quiet for too long. That familiarity was comfortable. It was also, I eventually realized, exactly what was keeping me from admitting that the structure around the job had stopped working for me.
The schedule was not mine. My PTO was a managed resource. The administrative obligations — committee work, quality improvement documentation, mandatory training modules — consumed roughly a day a week that I would have rather spent either with patients or not in the building at all. I liked medicine. I was wearing out under everything surrounding it.
I took my first locum assignment almost reluctantly, filling a gap during a six-week leave of absence I had negotiated to deal with some family circumstances. I expected it to feel like a temporary detour. It did not. It felt, for the first time in years, like I was practicing medicine on my own terms.
What the First Year Actually Looked Like
I won't pretend the transition was frictionless. The first few months involved a real learning curve — multi-state licensing, assembling credentialing packets for each new facility, figuring out the tax and retirement implications of independent contractor status. Nobody handed me a playbook. I made mistakes I would not make now.
But the clinical work itself was immediately better. Not because the patients were different — urgent care and emergency medicine present similarly across markets — but because I walked into each shift knowing I had chosen to be there. That distinction is difficult to explain to someone who has not experienced it, but it is real. The relationship between choice and engagement is not subtle.
By month four, I had worked in three states. By month eight, I had a reasonable sense of which markets paid what, which facility types suited my practice style, and how to structure my availability so that I was working intensively enough to feel productive but not so continuously that I was recreating the burnout conditions I had left.
The schedule control people talk about when they describe locum work is not theoretical. I took three weeks off in October because I wanted to. No approval required, no PTO balance to manage, no friction. I worked more heavily in January because I had a financial goal that month. The relationship between my decisions and my professional life became direct in a way it had never been inside a permanent position.
What I Needed From a Platform
Here is what I learned about the locum market that nobody told me upfront: the traditional agency model is not built for clinicians. It is built for the transaction. The agency earns a margin — a significant one — on the spread between what a facility pays and what you receive, and the information flow is calibrated to protect that margin, not to inform your decisions.
I spent most of my first year working through a traditional agency arrangement. I was told what I would be paid. I did not know if the rate was competitive. I did not know what the facility was paying on the other side. When credentialing issues came up — and they do, especially when you're managing documentation across multiple facilities — I often found out about them from a facility coordinator rather than from anyone at the agency proactively watching my file.
When I moved to Rediworks, the operational experience changed substantially. I could see posted rates before I applied. I could filter shifts by rate, location, and specialty without going through a coordinator. My credentialing documentation was in one place, expiration tracking was automatic, and when I took a new assignment the package moved to the facility without me reassembling it from scratch.
The difference sounds administrative, and it is — but administrative friction is what erodes the autonomy that makes locum work worth doing. When the overhead of managing your own career becomes significant enough, the freedom starts to feel theoretical. If you're curious about how the platform approaches this, the post on the Rediworks clinician experience covers it in more depth than I will here.
What I Would Tell Someone Considering the Switch
If you're reading this because you're thinking about leaving a permanent position, a few things I wish someone had told me:
The autonomy is real, but it requires infrastructure. You need to understand multi-state licensing, credentialing logistics, and independent contractor tax obligations before your first engagement, not after. There are resources — the locum tenens 101 guide is a reasonable starting point — but do the homework before you sign your first contract.
The financial picture is probably better than you think. The conventional wisdom that permanent employment is the financially conservative choice has not been accurate for several years in most emergency medicine and urgent care markets. The physician pay guide breaks down the math in detail, including the tax-advantaged retirement vehicles available to independent contractors that most employed physicians cannot access.
The emotional adjustment takes time. I did not immediately feel comfortable with the absence of institutional belonging. It took a year before I stopped feeling like I was doing something temporary. I am now two and a half years in, and I have no plans to return to a permanent position. That shift in how I think about the work was gradual — give it time.
Why I Stayed
Locum medicine is not for everyone. If your professional identity is significantly rooted in longitudinal patient relationships, the episodic nature of the work is a real cost. If you need the structure of an institution to stay clinically engaged, you may find the independence isolating rather than freeing.
For me, the tradeoff is clearly worth it. I am practicing better medicine — more present in each shift, more engaged with each patient encounter — because I am not carrying the weight of institutional obligations that had nothing to do with clinical care. The flexibility that looked, from inside a permanent position, like a benefit has turned out to be the core of a sustainable way to practice.
The work is the same. The structure around it is entirely different. For physicians whose burnout — or whose restlessness, or whose ambition — is rooted in that structure, the locum path is worth taking seriously.
Rediworks connects urgent care physicians with facilities across Colorado — with transparent rates, centralized credentialing, and no agency markup. If you're exploring locum work, join the waitlist to see what's available in your market.