As a newly qualified optometrist, you might be wondering, “Should I locum, or should I accept an employed role?” This decision can greatly influence your early career, so it’s important to consider your options carefully.

There are many aspects to consider – far beyond the “I want to locum because they get paid loads!”

We’ll explore the differences between these paths, touching on flexibility, income potential, job rights, and legal matters like IR35 in the UK. By understanding these aspects, you’ll be better placed to choose the route that suits you best.

Please note: Whilst this guide covers some of the considerations that you must think about when asking yourself “should I locum?”, it by no means constitutes legal advice, nor covers every point of consideration. It is intended to act as a prompt for thinking about your career, whilst highlighting areas for further research, should you feel locuming may be right for you. Please research further before you decide!

Flexibility: Employed vs Locum Roles

Choosing between an employed role and becoming a locum can be a tough decision. Flexibility is often a big draw for those asking themselves, “Should I locum?” As a locum optometrist, you set your own schedule. You can work when it suits you, fitting around other commitments. This freedom can be appealing, especially if you value control over your time.

However, with flexibility comes uncertainty. No work is guaranteed when you might need it most. This could lead to unexpected gaps in your income. While you decide your hours and set your rates, clients might not always need your services at the times you prefer and the rates that you charge. This mismatch can make it harder to secure consistent work.

On the flip side, an employed role offers stability. You have set working hours and a regular paycheck. For someone just starting out, this reliability can be reassuring. You won’t have to worry about finding the next job or filling your schedule.

Whilst flexibility is one of the major drawing points when asking yourself “Should I locum?“, another big draw is the potential income. We will take a look at this now.

Should I Locum for the Income Potential?

Earnings are a big factor when deciding between an employed role and working as a locum. As a locum optometrist, you might see higher daily rates, often ranging from £275 to £450. This can be tempting, especially when you consider setting your own rates based on factors like location, working hours, and test times.

But it’s important to look beyond the headline figures. The money you earn as a locum hasn’t had any deductions. You’ll need to set aside funds for tax, national insurance contributions, student loan repayments, and other expenses. Paying the tax bill in January and July can be a shock if you’re not prepared. There’s also the cost of hiring an accountant to handle your tax return.

In an employed position, your employer takes care of these deductions. Taxes are taken out of your pay as you earn, which can make budgeting easier. You might also receive additional benefits like healthcare, discounts, or pension contributions. These perks add value to your overall package and can make up for a lower base salary. I was certainly grateful to be employed during my burnout in 2021-22; where I was able to receive counselling to help me back on my feet through the healthcare package provided by my employer. This alone would have set me back several hundred pounds.

It’s worth considering that, as a locum, you won’t have an employer contributing to your pension. Setting up and maintaining your own pension scheme requires effort and planning. Without the benefits that come with employment, the higher daily rates might not stretch as far as you’d expect.

Employee Rights

Choosing between an employed role and a locum position involves considering several aspects, one of which is employee rights. When debating “Should I locum?” you need to remember that locums don’t enjoy benefits like sick pay, holiday pay, or maternity leave. This means if you fall ill, go on holiday or decide to take a break, your income stops. The lack of these safety nets can put extra pressure on your finances. To mitigate this, it’s advisable to take out insurance to cover any unforeseen circumstances that may prevent you from working.

An employed role, on the other hand, comes with these rights and more. Your employer is responsible for providing benefits like healthcare, pension contributions, and various other perks. This security can make a significant difference, especially when you’re just starting out in your career.

As described above, as a locum, you’ll need to handle your pension. Setting up and maintaining your own pension scheme requires effort and financial planning. The additional expenses for insurance and managing your finances can eat into your overall income, eroding away the benefit that the higher locum rates may offer.

There’s also less job security in locum work. I’ve experienced cancellations at the last minute, where the clinic no longer needed cover because a staff member returned early. As an employee, you’d still get paid for that day, but as a locum, it’s a lost opportunity and income. This unpredictability can be frustrating and financially challenging if it happens often.

Such a case happened to me in Winter 2017-18 when the Beast from the East storm meant all my clinics ended up cancelled for 3 weeks. If you are debating “Should I locum?”, could you manage no income for 3 weeks?

High Expectations

You may have high expectations of income and flexibility when you are debating “Should I locum?”, but you aren’t the only party in the contract that will want high expectations. Many practices want to get the most out of their locums to justify the fees.

This often means you’ll have a full clinic, while resident optometrists may have lighter schedules. As a locum, you might face shorter testing times, fewer breaks and the challenge of adapting to new patient management systems, record cards, and unfamiliar equipment, sight charts and referral protocols. They will also want you to be commercially aware to convert sight tests into sales to offset your locum fee.

I locummed for an optical for a few years – but it was only when they made the move from paper diaries to electronic, I realised that my testing times were shorter, I had fewer breaks and had higher targets set of me. It was a real eye-opener how the locum is often made to justify their fee. This must be considered when debating “Should I locum?”.

These demands can be tough for newly qualified optometrists who need to focus on practicing safely. The pressure to keep up with a busy clinic while figuring out the workflow can be overwhelming. It can affect the quality of care and your confidence in your abilities.

Another challenge is the potential for “ghost clinics.” This is when you end up seeing more patients than your diary indicates. Practices might overbook your schedule, expecting you to manage without additional support. This can lead to long hours and increased stress, making it hard to maintain a high standard of care.

Experience

When optometrists are debating if they are experienced enough to locum, the variety of work environments can seem appealing. Working in a different practice and location each day provides a wealth of experience. I’ve personally found this beneficial, as I’ve encountered diverse patient records, varied working techniques, and numerous types of equipment.

The variety of practices can enhance your skills, as you adapt to different settings and learn new methods. This exposure can be particularly valuable early in your career, helping you to build a broad understanding of optometry.

However, there’s a downside to this. As a locum, your tasks might be limited to standard eye examinations or basic contact lens work. This can restrict your experience with specialist clinics; such as myopia management or refractive surgery clinics. These limitations can affect the development of specialised skills and may hinder your ability to fully engage in aspects of patient care.

I am keen to do more regarding myopia management, but the majority of practices I locum in do not have the ideal set up to measure axial length, nor the range of options beyond myopia control spectacle lenses. The lack of continuity with patients also would mean I wouldn’t be able to see patients through their treatment plans; thus missing out on experiencing the complete process. A residency would remedy that.

Employed roles, in contrast, often provide opportunities for comprehensive training and involvement in a wider range of optometric services. Being a regular presence as part of a stable team allows you to develop deeper expertise in specific areas, which can be crucial for career advancement – especially as the profession progresses at an alarming rate.

Teamwork Considerations

When asking, “Should I locum?” consider teamwork. Locums often move between practices, limiting social interactions and leading to a lonely work existence. In contrast, being an employed staff member allows you to strengthen professional relationships and make work more sociable.

I remember doing a block booking from November to January to cover maternity leave at a practice. I built a great rapport with the team, but felt terrible seeing photos of their Christmas party on social media the next day, knowing I wasn’t invited because I was a locum. While I accepted this as part of being a locum, moments like these can impact morale and a sense of belonging. Keep this in mind if you decide to locum!

Some teams will be more enjoyable to work with than others. The benefit of being a locum is that if you find it challenging to fit into a particular team, your time with them is temporary. You can choose not to work with that practice again, giving you flexibility in your work environment.

However, this transient nature also means missing out on staff events such as training sessions, huddles, parties, or nights out. Even if you build good working relationships, you might feel like an outsider. Being an external contractor rather than an employee naturally sets you apart from the rest of the team.

An employed role provides more stability in your working relationships. Regular colleagues help build camaraderie and a supportive work environment. This stability can be particularly valuable for newly qualified optometrists who benefit from mentorship and consistent teamwork.

Risks

Locum work comes with significant risks compared to employed roles. One major concern is patient care. With transient encounters, ensuring patients receive proper follow-up care can be challenging. As a locum, you might not be there to address patient queries after your contract ends. This can lead to complaints if patients feel their care was insufficient. In an employed role, you can provide consistent follow-up, ensuring patients receive the best care.

Another risk is dealing with tax issues. When considering “Should I locum?”, think about your business type and ensure you act like a contractor. Claiming expenses appropriately is crucial to avoid trouble with the taxman. The IR35 regulations in the UK can complicate matters, determining if you’re genuinely self-employed or a hidden employee. It’s essential to understand these rules to avoid unexpected tax liabilities.

Locum work also involves compliance with legal aspects, taxes, non-disclosure agreements, and business secrets. The administrative burden can be overwhelming, especially for newly qualified optometrists. The risk extends beyond the testing room, encompassing all aspects of running a business. If this feels too daunting, employment might be a safer choice.

I’ve faced situations where the complexity of tax regulations and administrative tasks felt overwhelming. Ensuring compliance with all requirements while managing patient care was a significant challenge. This aspect of locum work can be stressful and time-consuming, highlighting the importance of understanding the risks involved. Be sure to consider this when considering “Should I locum?”

Continuing Professional Development

It is also important to think about continuing education and training. As optometrists, we’re responsible for our professional development, ensuring we accumulate the appropriate CPD points to meet GOC requirements. Many employers offer training events and conferences to their staff, opportunities that might not always be extended to locums.

The NHS provides each ophthalmic performer with a CPD grant, but this can only be claimed via an NHS contractor. Some contractors might be hesitant to claim this grant for self-employed optometrists, or they may charge a fee for doing so. This additional hurdle can make accessing regular training more challenging for locums. The Association of Optometrists offers a great guide to this for its members – so be sure to read it!

In contrast, being an employed optometrist often means having easier access to training opportunities. Employers may organise and fund these events, ensuring that you stay updated with the latest developments in the field. This ongoing support can make an employed role more attractive, especially for newly qualified optometrists who need consistent training to build their skills.

I’ve found that being part of an employed team provides more structured opportunities for professional growth. Regular training sessions, workshops, and conferences become part of your routine, helping you stay current and competent in your practice. This support system can be invaluable as you navigate your career.

That said, there are many different ways that you can obtain CPD points – many events and conferences offer it, you can find some online at providers such as Eyecare or through journal subscriptions from the AOP or College of Optometrists – so don’t feel you need to be part of a practice to get CPD!

“Should I Locum?” A Summary

Deciding between an employed role and locum work as an optometrist is a significant choice that depends on various factors. When you ask, “Should I locum?”, consider the pros and cons carefully. Locum work offers flexibility and potentially higher daily rates, but it also comes with uncertainties like inconsistent income, lack of employee rights, and higher administrative responsibilities.

On the other hand, an employed role provides stability, consistent income, and access to benefits such as sick pay, holiday pay, and pension contributions. You also have the advantage of being part of a team, enjoying a supportive work environment, and receiving regular training opportunities.

For newly qualified optometrists, the predictability and support offered by an employed role can be invaluable. It allows you to focus on developing your skills, building professional relationships, and ensuring patient care without the added stress of managing the administrative aspects of locum work.

In summary, while locum work may seem attractive with its flexibility and higher rates, the stability and support of an employed role might be the better option for those starting their careers. Consider all these factors when deciding if you should locum, and choose the path that aligns best with your personal and professional goals.

When contemplating “Should I locum?”, weigh your options carefully to ensure you make the best decision for your future.

If you found this article useful, please consider sharing with colleagues and peers – especially those who are considering the life of a locum, or students that believe locuming is the way forward – without understanding the risks it poses (or the benefits of being employed bring!).

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Common Questions I’ve Encountered from Optometrists Asking “Should I Locum?”