F3 doctors have loads of job options, but locum work remains one of the most popular out there. Not only does it offer flexibility and autonomy in your schedule, but the pay is significantly higher compared to most other junior doctor roles. 

In this article, we compare two different types of locum work: long term locuming vs ad hoc locuming. In particular, we highlight the key pros and cons of each option so that you can choose the role that suits you best. 

If you are looking for quick answers to your locum-related questions, why don’t you check out our Locum Academy. Or for more in-depth articles about locuming visit our Locum Doctor Hub. 

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❓  What is ad hoc locuming?

Ad hoc locuming is when you pick up locum shifts across departments as and when they come up. Rota coordinators frequently book ad hoc locum doctors to cover annual leave, sickness, study leave, or other absences of regular medical staff. They may offer enhanced rates for hard-to-fill or last-minute shifts. 

Picking up shifts in this way, generally means you need to work across multiple teams and departments if you want to work full-time, as it is unusual for there to be regular shifts available in one department only. You will likely not have consistency between multiple shifts and even if you do manage to book several shifts in one department, there is always the possibility that you will be moved last minute to maintain continuity for the regular staff on the team. 

❓  What is long term locuming?

Long term locuming is when you agree with a rota-coordinator in advance to accept a vacant rota line in a particular department. This usually happens when the Trust has a training vacancy that they have not been able to fill with a Trust grade doctor. In this case, you get the benefit of locum pay AND the security of regular work with one particular department or team. 

❓  Which pays better?

Generally, Trusts will have standard locum rates for shifts and whether you are an ad hoc locum or a long term locum your hourly rate will be the same. However, sometimes you can get higher rates (enhanced rates) for anti-social hours so if you are doing more of these out of hours shifts you may be able to earn more. 

Sometimes, rota-coordintors may offer enhanced rates for ad hoc locum shifts that are hard to fill even within normal day time hours, but this normally means you have to be available with very little warning i.e. same day or next day, or work unpopular shifts (i.e. during doctor or nurse strikes, or on holidays like Christmas or new year).

Working as an ad hoc locum may give you greater flexibility to accept higher-rate shifts when they crop up, as you won’t be able to do this as a long term locum (because you may already be tied into a lower paid shift). 

❓  Which job is harder work?

One of the most difficult aspects of ad hoc locum life can be the constant need to adapt to different teams, departments, and specialties. Never feeling truly settled in a role can be exhausting, and holding information for a number of different specialties in your head is hard work. Moving across teams can also mean that you need to get to know a whole new patient list each day, which is something that typically gets easier for regular teams as they get to know their patients a bit better day in and day out. 

Long term locum doctors may not have the issue of moving between specialties and departments, but as they get to know their team they may find themselves being given additional responsibilities or being asked to act up without the legal, or psychological support that trainees get. It can be hard to assert your boundaries as a locum, and know when to say ‘no’ to a request beyond your level of competence. 

❓  Which has better learning opportunities?

It depends on what you’re looking for. A long term locum position gives you the opportunity to get to know a department and team, and to establish relationships with your colleagues. This might make it easier to get case-based discussions and mini-cex’s signed off as your registrars and consultants may be more willing to spend time of these with you. You may also find it easier to get references from your higher-ups if you want senior support for future job or specialty applications. 

Alternatively, ad hoc locum shifts make it easier to explore a number of specialties in a short period of time. If you want to learn quickly and through a variety of cases (perhaps you’re studying for an exam and need to see lots of different types of patients) with several different consultants, then this may be easier in an ad hoc locum environment. Working across multiple departments may give you better networking opportunities and provide you more face-time with a larger number of consultants and specialists. 

❓  Which one is easier for annual leave?

You don’t really get ‘annual leave’ as a locum doctor because you are not on an employment contract. For locums, if you want time off it is as simple as not booking yourself to work. 

As a long term locum, this may mean telling your rota coordinator that you will not be able to take previously agreed shifts. You should aim to give the rota coordinators as much warning as possible so they can find a replacement for the shifts. Some rota-coordinators may penalise you for cancelling shifts too often, or too last minute and offer work opportunities to other doctors before going to you. 

Some long term locum doctors may feel peer-pressured or guilted into thinking they are letting down your team if they choose to take holiday when other team members are also on leave. Ad hoc locum doctors don’t really encounter this type of pressure. 

❓  Which job is more secure?

Some doctors would say that having multiple shifts booked a long time in advance feels more secure, whereas others feel that having the confidence to work across multiple departments gives them more opportunities for work and therefore is more secure. 

Both are true, as is the fact that neither job is truly secure as locum shifts can be cancelled by the rota coordinator at any time (for example if they are able to hire a trust grade to fill a rota line at a lower rate), and availability of work may ebb and flow over the year (often tying in with school and bank holidays). In the end, you have to choose the type of work that feels most comfortable and secure to you. 

📋  In summary

There are a number of differences between working as an ad hoc locum vs a long term locum, and there are certainly pros and cons to each. Depending on what you are looking for in terms of pay, workload, networking, educational opportunities, and job security, you may find that one type of locuming suits you much better than the other.

This article is part of a wider series of comprehensive guides and information to help doctors ensure their F3 year is a success. We cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience.

Click here to visit our F3 Resource Hub to explore the full list of guides and articles.

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