I remember a time when many physicians, especially residents in various specialties, would moonlight in small emergency departments. They viewed it as a convenient way to supplement their low salaries. Some of them were excellent doctors. Sadly, quite a few were not qualified and caused more harm than good. I did the same thing, although I was a second- and third-year emergency medicine resident at the time. Indeed, the money came in handy, and so did the experience of working alone. I learned efficiency and independence. I also took care of a patient with cyanide poisoning who survived. How cool is that? Later, I remember hearing some physicians in our specialty rail against “backpack doctors” who came in with their packs, saw patients for a day, then left with no connection. They were viewed as mercenaries. As I said, some moonlighters weren’t very good, and I agree that it is useful for physicians to connect to both a hospital and the community in which they practice. However, times have changed. And those who hold onto the traditional view of emergency medicine practice need to come to terms with those changes. The problem is there aren’t enough physicians to go around. There are plenty of hospitals and patients, but staffing those facilities and treating those patients with good physicians is becoming more and more difficult. Likewise, many of the facilities in greatest need are those that are “off the beaten path”. I have seen firsthand the difficulties associated with recruiting physicians to rural or semi-rural areas. It’s tough. Young physicians with families often want to go to larger urban areas to start their lives. Those same physicians also want to work in large hospitals with the sort of specialty backup they remember from their training programs. It’s all about comfort I suppose. Given the lack of physicians, combined with the vast need for those physicians, locum tenens medicine is an important part of providing healthcare to the nation. Physicians, educators, and administrators who are uncertain about locums should remember that for many patients around the country, locum doctors may be the only chance they have for surviving a terrible injury or illness. When well-qualified physicians practice emergency medicine outside their comfort level, they bring a level of quality, professionalism, and expertise that may be in short supply in smaller or more remote hospitals. Is locum tenens lucrative? It certainly can be. And the schedule options are attractive. Physicians doing locums (especially those who do it fulltime) can elect to work large blocks or take large blocks of time off. Furthermore, it demonstrates what all of us have been saying for a long time. Qualified emergency physicians are extremely valuable; after all, as we know from economics in general, scarcity creates value. Locums medicine fills an enormous gap in healthcare by providing doctors where there aren’t doctors; or aren’t nearly enough. To those concerned about the lack of connection to a community or hospital, I say that we practice in an era in which physicians and groups are routinely dismissed from hospitals which feel no “connection” to them. If we want to encourage connection, it has to go both ways. And until our government and healthcare educators decide to fund and educate a lot more physicians to work in the country’s emergency departments, locums may be the best hope for securing the sanity and professional futures of physicians as well as the health and safety of the patients living in the places no one else is practicing. So here’s to you locum tenens providers and locums companies! You’re changing the face of medicine for the better and providing life-saving healthcare to untold numbers of patients. I don’t think that’s mercenary. I think it’s good business coupled with compassion, and I’m proud to be part of it.