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A framework for building a sustainable, professionally rewarding locum practice from the ground up The first year of locum practice is the one that sets the pattern. The decisions you make - about which settings to work in, how to manage your schedule, how to handle the administrative side, and how to build the professional relationships that make locum work sustainable - compound over time. Getting the structure right early matters more than it might appear.
The research on locum physician motivations identifies a wide range of reasons physicians choose locum work: financial strategy during debt repayment, career exploration before permanent commitment, clinical breadth maintenance, work-life balance, geographic variety, or deliberate phasing toward retirement.1 Knowing which of these applies to you shapes every subsequent decision.
A physician using locum work to explore permanent practice options should be deliberately choosing placements in settings they might want to stay in, building relationships with clinic directors and teams, and treating each placement as a trial run. A physician using locum work to maintain procedural skills while working primarily in another context should be choosing placements that provide those specific opportunities. A physician in early career managing debt should be factoring compensation, including the cost and friction of each placement, into their decisions with more weight.
The mistake that makes first years difficult is treating all placements as equivalent when they are not. Specificity about what you are trying to get from locum work allows you to make better decisions, manage your time more effectively, and avoid the accumulation of placements that are financially fine but professionally uninspiring.
The administrative infrastructure of locum practice - licensing, billing, medicolegal coverage, professional incorporation if applicable, tax structure - is not glamorous, and the temptation is to sort it out as you go. The consequence of not having it sorted before you need it is either delayed placements or poorly structured agreements that create problems later.
Ensure your provincial licence is current and that you understand the requirements for practising in provinces other than your home province if interprovincial placements are part of your plan. Each provincial college has its own registration pathway for locum physicians; some offer expedited processes for short-duration placements. The time and cost involved in obtaining out-of-province registration is a real factor in the economics of interprovincial locum work and should be factored into your decisions before you commit to a placement.
CMPA membership is the standard medicolegal coverage for most Canadian physicians, including locums. Ensure your category of membership is appropriate for the clinical activities you will be performing - scope matters for coverage determination. If your locum practice will include activities significantly different from your primary practice, verify your coverage explicitly.
Billing arrangements vary by placement and province. Some locum arrangements are fee-splitting arrangements with the hosting physician, others involve billing directly as a locum. Understand the arrangement before you accept the placement, and ensure that the contract specifies it clearly. If you are new to billing in a particular province's fee schedule, invest time in understanding the codes relevant to your scope before your first shift.
Whether to incorporate is a financial planning question that depends on your income level, personal circumstances, and the province in which you practise. The decision is consequential enough to be worth a conversation with an accountant who works with physicians - ideally before your first year of significant locum income. The administrative costs of incorporation need to be weighed against the tax advantages, and those advantages vary substantially by income level and family situation.
The research on locum experience consistently identifies professional isolation as the dominant deterrent to ongoing locum work.2 Most of that isolation is not inherent to the arrangement, it is a consequence of poor onboarding on both sides. A physician who arrives knowing where to go, who to call, how the system works, and who the complex patients are is a physician who can practise effectively from day one. That physician is also far more likely to be invited back.
Before your first shift: obtain and review the site layout and access information, read the patient charts for anyone flagged as complex or high-risk, introduce yourself to the nursing and administrative staff, confirm your system access, and know your escalation pathway for both clinical and operational concerns. None of this takes more than a few hours and all of it meaningfully changes the quality of the placement.
The career architecture of locum practice is more flexible than permanent practice, which is both its advantage and its management challenge. Without the structure that a permanent position provides, the pattern of your practice emerges from a series of individual decisions that can drift toward whatever is easiest rather than whatever is most professionally rewarding.
At the end of your first year, it is worth asking: Do the placements I have taken reflect what I said I wanted when I started? Have I been building relationships with clinics and teams that might develop into something ongoing? Have I maintained the clinical breadth I wanted to maintain? Is the income-to-effort ratio sustainable, and if not, what would need to change?
The physicians who find locum practice professionally sustaining over time tend to be those who treat it as a career with deliberate architecture rather than a series of individual gigs. That architecture does not emerge by accident.
The first year of locum practice is formative in ways that are easy to underestimate. The administrative foundation, the habits of evaluating and preparing for placements, the relationships built and the settings chosen - these compound. Approaching the year with explicit intentions and reviewing them at the end is a more useful structure than treating it as a period to get through before settling into a pattern.