How to Choose a Locum Tenens Agency in 2026: An Honest Guide Based on What Physicians Actually Report

Most "best locum tenens agency" articles are written by the agencies themselves or by content farms paid to rank them. They list the same 10 companies, say something generic about each one, and link to affiliate pages.

This article is different. We pulled physician feedback from Student Doctor Network, White Coat Investor forums, Reddit's r/medicine and r/physicians, Glassdoor physician reviews, Indeed provider reviews, ClearlyRated provider ratings, and BBB complaints. We included the good and the bad — because if you're trusting an agency with your income, your license, and your schedule, you deserve to know what other physicians experienced before you sign.

We also included ourselves (Locums One) at the end, with the same honest framework. If we're going to ask you to evaluate agencies on transparency, we should be transparent too.

What Actually Matters When Choosing a Locum Tenens Agency

Before comparing specific companies, understand the five factors that determine whether your agency relationship will be profitable or painful.

1. How Much of the Bill Rate Do They Keep?

This is the single most important question — and the one most agencies refuse to answer.

The hospital pays a bill rate per hour. The agency takes a cut and pays you the rest. The difference is the agency's gross margin — their markup.

On a single full-time anesthesiology assignment, the difference between a 45% markup and an 18% markup is $115,000–$147,000 per year. Same physician. Same hospital. Same shifts. For a detailed breakdown, see our guide to how locums pricing works.

The White Coat Investor forum documents cases where agencies offered physicians $800/day for assignments where hospitals were willing to pay $2,000 directly — a 60% markup. Another physician reported receiving $1,500/day through an agency for a job the hospital would have paid $3,000 for.

What to do: Ask every agency directly: "What is the bill rate for this assignment, and what is your markup percentage?" If they won't answer, that tells you everything. Our contract negotiation guide covers how to push back.

2. How Fast Can They Credential You?

Time-to-credential directly affects your income. Every week you're waiting for privileges is a week you're not earning.

The industry average is 60–90 days. The best agencies credential in 21 days. On a $350/hr assignment, the difference between 21-day and 90-day credentialing is $117,600 in lost income — just from starting later.

Credentialing delays are one of the top complaints across all agencies. One anesthesiologist on Student Doctor Network reported that CompHealth "over promised, didn't listen to my concerns when I called about licensing delays, and literally told me I was not their priority." A Glassdoor reviewer said LocumTenens.com's licensing department "ignores emails and phone calls, procrastinates on submitting information to licensing boards."

What to do: Ask for the agency's average time from signed contract to first shift, by specialty. If they can't give you a number, they're not tracking it. For a full breakdown of how credentialing works and what slows it down, see our Credentialing 101 guide.

3. What Happens When Things Go Wrong?

The real test of an agency is not how they treat you when everything is going well. It's how they handle cancellations, pay disputes, and site problems.

Questions to ask before you sign:

• What is the cancellation policy — for both sides? Some contracts let hospitals cancel with 72 hours' notice while requiring physicians to give 60–90 days.
• What happens if the hospital misrepresented the assignment? Will the agency relocate you, compensate you, or tell you to deal with it?
• Who handles pay disputes? If your timesheet is rejected or your hours are shorted, is there a dedicated person or do you chase your recruiter?

Multiple physicians across forums report agencies siding with hospitals in disputes — because the hospital is the repeat customer and the physician is replaceable. One CompHealth physician on Indeed wrote: "They will not stand up for you. They have enough people that if they lose you, they aren't going to care so much."

4. Does the Contract Protect You or Trap You?

Three contract provisions cost physicians the most money:

Non-compete clauses. Many agencies include 1–2 year non-competes that prevent you from working at the same facility through a different agency — or from accepting a permanent position there. One physician on Student Doctor Network reported avoiding local AMN postings entirely because the non-compete would block permanent employment at those hospitals.

Conversion fees. If a hospital wants to hire you permanently after a locum assignment, many agencies charge the hospital $10,000–$75,000. This doesn't come out of your pocket directly, but it can kill a permanent offer before the hospital even makes it. One CompHealth physician on Indeed reported: "Got offered a permanent position. The hospital was excited. CompHealth torpedoed it."

Name-clearing without consent. Some agencies submit your CV to hospitals without your knowledge to "claim" you for that facility. If another agency — or you directly — later approaches the same hospital, the first agency argues they presented you first and demands a fee. AMN Healthcare is specifically cited on Student Doctor Network for this practice.

What to do: Read every contract line by line. Get verbal promises in writing. One Weatherby physician on Student Doctor Network recommended: "Send an email back to the recruiter after every phone conversation, recapping what was agreed to."

Our contract negotiation guide covers every clause to review before signing.

5. Does Your Recruiter Actually Know Medicine?

The difference between a good recruiter and a bad one is the difference between a great assignment and a disaster. Across every agency — even the worst-rated ones — individual positive reviews almost always credit a specific recruiter by name.

Signs of a good recruiter:

• Knows the difference between your specialty and a vaguely related one
• Can tell you about the facility's culture, not just the shift schedule
• Responds within 24 hours
• Tells you when a job isn't a good fit instead of pushing everything
• Is honest about the bill rate and markup

Signs of a bad recruiter:

• Sends you jobs outside your specialty or license states
• Disappears after you sign the contract
• Makes verbal promises about pay or conditions but won't put them in writing
• Pressures you to accept quickly with false urgency
• Can't answer specific questions about the facility

What's their Specialty Depth? An agency that places 500 hospitalists a month has very different leverage than one that places 5. Specialty depth matters for assignment volume, facility relationships, and recruiter knowledge. Ask: "How many physicians in my specialty do you place per month?" and "How many facilities do you have active relationships with in my target states?"

Agency-by-Agency Breakdown: What Physicians Actually Say

The following reviews are based on physician-reported feedback from Student Doctor Network, White Coat Investor forums, Reddit, Glassdoor, Indeed, ClearlyRated, LocumTenensGuy, and BBB complaints. Every agency has both good and bad reviews — we included both.

1. CompHealth (CHG Healthcare)

Founded: 1979 | Parent: CHG Healthcare | Specialties: All | Size: Largest locum agency in the US

Physician Rating: 2.6/5 Glassdoor | 2.7/5 LocumTenensGuy (53 reviews)

What physicians say — the good:

• Consistently rated highest for recruiter responsiveness on ClearlyRated (4.4/5)
• Strong specialty depth in hospitalist, EM, and primary care
• Good housing and travel logistics
• Reliable pay — physicians rarely report payment issues
• Large assignment volume means more options

What physicians say — the bad:

• Markups are high — physicians on White Coat Investor forums estimate 40–50%
• Recruiters are incentivized to fill positions quickly, not necessarily to find the best fit
• Non-compete clauses in some contracts
• Conversion fees reported at $15,000–$40,000
• "They will not stand up for you. They have enough people that if they lose you, they aren't going to care so much." — Indeed review
• "Over promised, didn't listen to my concerns when I called about licensing delays, and literally told me I was not their priority." — Student Doctor Network

Reddit consensus (r/medicine, r/physicians): "CompHealth is fine if you don't know what you're leaving on the table. Once you understand markups, you realize you're working for a lot less than you should be."

ClearlyRated score: 4.4/5 (one of the highest in the industry)

Best for: Physicians who prioritize recruiter responsiveness and assignment volume over maximizing hourly rate.

2. Weatherby Healthcare (CHG Healthcare)

Founded: 1995 | Parent: CHG Healthcare | Specialties: Physician specialties | Size: Large

Physician Rating: 2.8/5 Glassdoor

What physicians like:

• Front-end logistics (housing, travel, onboarding) are among the best in the industry
• Strong in surgical specialties and subspecialties
• Good international assignment options
• Experienced recruiters in specialty niches — when you get a good one, the relationship works well

What physicians complain about:

• Verbal promises not honored. Recruiters use phone calls to avoid written records. "Exceptionally friendly and talkative" on the phone, but verbal agreements on pay, travel, and conditions later become "we can't do that." Multiple physicians recommend getting everything in email immediately after any phone call.
• Rate low-balling. A psychiatrist reported 2020 rates of $1,200–$1,300/day for 8 hours vs. $1,500/day in 2017 — a real-dollar decline. Another physician characterized their offers as "not amazing."
• Recruiter ghosting after placement. Multiple reports of recruiters becoming unresponsive once the contract is signed — "avoided calls and texts when hospital cancelled three weeks of assignments."
• Contract termination without due process. One physician reported being terminated and marked "not employable" after an erroneous drug screen result, without discussion of possible lab error.

Important note: Both CompHealth and Weatherby are owned by CHG Healthcare. If you're working with both, you're effectively working with the same company. A non-compete clause in your CompHealth contract may affect your Weatherby assignments and vice versa.

Bottom line: Weatherby's front-end experience (logistics, friendliness) is among the best in the industry. The risk is the gap between what's promised verbally and what's delivered contractually. Put everything in writing. If your Weatherby recruiter is responsive and honest, it can be a strong relationship. If they're not, you have limited recourse.

Best for: Subspecialists (surgery, cardiology, neurology) who are disciplined about getting every promise in writing.

3. AMN Healthcare / Staff Care

Founded: 1985 | Public company (NYSE: AMN) | Specialties: All | Size: Largest healthcare staffing company overall

Physician Rating: 1/5 BBB (7 reviews, not accredited) | 2.4/5 Glassdoor

What physicians like:

• Largest job inventory in the country — if a locum job exists, AMN probably has it listed
• Can offer benefits (health insurance, retirement) for consistent, scheduled locum work — unusual for the industry
• Some long-term recruiter relationships work well — "Allison and Jamie are honest and easy to communicate with" (Indeed)

What physicians complain about:

• Name-clearing without consent. Multiple physicians on Student Doctor Network report AMN submitting their CV to hospitals without permission, then claiming ownership of the placement if another agency approaches the same facility. One anesthesiologist wrote: "Super terrible experience, avoid, avoid, avoid!"
• Will not honor contracted pay rates. AMN "will not honor contracted pay rate if less profitable for them and will not hesitate to pay you less after you have worked." A BBB complaint documented a $3/hr pay discrepancy discovered 9 months into a contract — over $4,000 in back pay owed, with the company "dragging their feet" for 7+ weeks.
• Chronic payroll problems. BBB reviews describe missing wages (18 hours unpaid, took months to resolve), delayed overtime, and "thousands of dollars" owed with refusal to pay.
• Non-compete restrictions. Physicians report avoiding local AMN postings entirely because the 1–2 year non-compete prevents them from taking permanent positions at those hospitals afterward.
• Contract cancellation under false pretenses. A 2026 BBB complaint documented a contract cancelled under false "no call/no show" claims despite the physician having communicated their schedule — causing "unexpected loss of income" and professional reputation damage.
• "AMN submitted my CV to a facility I had explicitly said I didn't want to work at. When I complained, they said it was standard practice." — Reddit r/medicine

Reddit consensus: "AMN is the Walmart of locum tenens. Huge selection, not the best price, and you're not their priority."

Bottom line: AMN's scale is unmatched, but the pattern of unauthorized name-clearing, post-hoc pay reductions, and chronic payroll failures appears across multiple independent sources (Student Doctor Network, BBB, Indeed). The non-compete restrictions are unusually aggressive. If you use AMN, track every submission of your CV, document every pay agreement in writing, and read the non-compete clause with an attorney before signing.

Best for: Physicians who need maximum assignment volume and are experienced enough to protect themselves contractually — with an attorney reviewing the contract first.

4. LocumTenens.com (Jackson Healthcare)

Founded: 1995 | Parent: Jackson Healthcare | Specialties: All | Size: Top 5 nationally

Physician Rating: 2.8/5 LocumTenensGuy (21 reviews) | 3.6/5 Glassdoor (mostly internal staff) | 4.2/5 ClearlyRated

What physicians like:

• Large job volume and broad specialty coverage
• Some physicians report reliable payments — "checks always deposit on time with less hassle chasing payments" vs. other large agencies
• Pleasant recruiters in initial interactions
• One of the better online portals for browsing assignments

What physicians complain about:

• Bait-and-switch on hours and conditions. A physician who requested presentation for 60 hrs/week including overtime was presented for only 40 hours — a 40% income reduction. When they declined, they were blocked from the facility for 6 weeks.
• Phantom job postings. An anesthesiologist reported being strung along for 3 months on a position that was "going to become available soon," turning down other offers, only to discover the agency "just gathered up as many resumes as they could and went with the cheapest option."
• Payment errors consistently favor the agency. "Missing or short payments almost every 3rd or 4th payment, with errors consistently on the short side — never received an overpayment."
• Credentialing failures. Licensing department "ignores emails and phone calls, procrastinates on submitting information to licensing boards, submits incomplete information." — Glassdoor review
• Job misrepresentation. A PA reported "everything was misrepresented — hours, pay, patient load, orientation, and work environment."
• Industry reputation. Hospital administrators independently told a physician that "LocumTenens had a bad reputation for aggressive tactics."

Reddit consensus: "LocumTenens.com has a good platform. The recruiter you get is the lottery — some are great, some are terrible."

Bottom line: LocumTenens.com has strong brand recognition and job volume, but the physician-reported issues are serious — bait-and-switch, phantom postings, and systematic payment errors are not isolated incidents. If you use them, document every agreement in writing and verify job details independently with the facility.

Best for: Physicians who want a large job board and are experienced enough to verify every detail independently before committing.

5. Aya Locums (formerly Barton Associates)

Founded: 2001 (rebranded 2024) | Specialties: All | Size: ~700 employees, all 50 states

What physicians like:

• On-time weekly pay — consistently cited as a strength
• Large job volume and flexible scheduling
• Wide specialty coverage including physicians, NPs, PAs, and dentists
• Good option for physicians new to locum tenens who want volume and consistency

What physicians complain about:

• Rate low-balling tactics. Recruiters ask physicians to name a number first, then ask if it's "all-inclusive" of travel — effectively reducing the rate after the physician has anchored low. Multiple SDN and Glassdoor reviews describe compensation as misleading.
• Incentive misalignment. Recruiters are incentivized to keep you in locum roles rather than help transition to permanent positions — even when a permanent role would serve the physician better.
• Less competitive rates for experienced locum physicians who know the market

Bottom line: Aya Locums is a solid option for new-to-locums physicians who want volume and consistency. Experienced locums physicians report being able to negotiate higher rates elsewhere. Always clarify whether quoted rates are "all-inclusive" or base before travel — and name your number last, not first.

Best for: Physicians new to locum tenens who want broad specialty coverage and consistent weekly pay.

6. Medicus Healthcare Solutions

Founded: 2004 | HQ: Windham, NH | Specialties: Anesthesia, EM, hospitalist | Size: ~200 employees

Provider Rating: 4.7/5 ClearlyRated (1,081 provider reviews)

What physicians like:

• Long-standing relationships with higher-end health systems
• Strong ClearlyRated scores (4.7/5 across 1,081 reviews — one of the highest volume review counts in the industry)
• Some anesthesiologists report multi-year satisfaction with specific recruiters

What physicians complain about:

• Post-private equity acquisition deterioration. Student Doctor Network has a dedicated "Avoid Medicus" thread — after PE acquisition, rates dropped and cancellations increased
• Aggressive recruiter outreach and cold-calling
• Reports of offering one rate in initial conversations, then negotiating down before contract signing
• Different rates offered for the same facility and same role, depending on the physician

Bottom line: Medicus's ClearlyRated scores are strong, but the post-PE-acquisition complaints are a pattern worth watching. If you're considering Medicus, ask whether your rate is fixed or subject to change before contract signing, and get the rate in writing before credentialing begins.

Best for: Anesthesiologists and EM physicians who want a mid-tier agency with strong health system relationships — with the caveat of getting every rate commitment in writing before credentialing starts.

7. Integrity Locums

Founded: 2010 | Parent: Independent | Specialties: Rural/CAH focus | Size: Smaller

Physician Rating: 3.8/5 Glassdoor

What physicians say — the good:

• Genuinely specializes in rural placements — not just a checkbox
• Physicians report more transparency on rates
• Good for physicians who specifically want rural assignments
• Smaller team means more personal service

What physicians say — the bad:

• Limited assignment volume outside rural markets
• Smaller network means fewer options if you want urban assignments
• Less technology infrastructure than larger agencies

Best for: Physicians who specifically want rural and critical access assignments. See our rural and critical access hospital guide for what to expect clinically.

8. Global Medical Staffing (CHG Healthcare)

Parent: CHG Healthcare | Specialties: International focus (Australia, NZ, Caribbean, UK) | Size: Mid-tier

What physicians like:

• Market leader for international locum assignments — Australia, New Zealand, Caribbean, and Middle East
• Good support for international licensing and credentialing logistics
• Physicians report solid recruiter relationships for international placements

What physicians complain about:

• Domestic US assignment volume is secondary — not their core business
• International assignments require significantly more logistical complexity
• Not the right choice if you want to stay in the US

Bottom line: If you want to practice overseas, Global Medical Staffing is the market leader. For domestic US assignments, look elsewhere.

Best for: Physicians specifically interested in international locum assignments.

9. Hayes Locums

Founded: 2012 | HQ: Fort Lauderdale | Specialties: Anesthesia, EM, hospital medicine | Size: ~200 employees

Physician Rating: 4.5/5 Glassdoor (compensation specifically)

What physicians like:

• Glassdoor physician rating of 4.5/5 on compensation — among the highest in the industry
• Responsive recruiters with a personal touch
• Strong reputation specifically in anesthesia and emergency medicine
• More transparent on rates than the large national agencies

What physicians complain about:

• Inconsistent pay across similar assignments — rates appear to depend heavily on the individual recruiter
• Reports of internal nepotism affecting which physicians get priority placements
• Company acknowledges "ambiguity in career paths" — transparency is a known internal gap

Reddit consensus: "Hayes is one of the better smaller agencies. More transparent than the big guys."

Bottom line: Hayes is one of the better-reviewed mid-tier agencies, particularly for anesthesia and EM. Their Glassdoor compensation rating is the highest we found across all agencies reviewed. Worth adding to your agency roster if you're in those specialties.

Best for: Anesthesiologists and EM physicians who want a mid-tier agency with strong compensation ratings and personal recruiter relationships.

10. MPLT Healthcare

Founded: 2007 | HQ: Boca Raton | Specialties: Hospitalists, EM, anesthesia, psychiatry | Size: ~300 employees

Provider Rating: 4.8/5 ClearlyRated (406 provider reviews) | ClearlyRated Diamond Award 2025

What physicians like:

• Highest ClearlyRated provider rating of any agency we reviewed — 4.8/5 across 406 reviews
• Repeatedly praised for recruiter relationships and communication quality
• No bait-and-switch — physicians report that job descriptions match reality
• Diamond Award winner on ClearlyRated, which requires sustained high ratings year over year, not a one-time spike

What physicians complain about:

• Smaller job volume than CHG or AMN — fewer niche specialty assignments
• Less brand recognition — many physicians never hear of them
• Limited geographic coverage compared to national agencies

Bottom line: MPLT is the highest-rated agency in our review by provider satisfaction scores. Their weakness is scale — they don't have the volume of a CompHealth or AMN. If they cover your specialty and geography, they should be on your short list.

Best for: Hospitalists, EM physicians, and anesthesiologists who prioritize recruiter quality and job description accuracy over maximum assignment volume.

12. Curative (Doximity subsidiary)

Parent: Doximity | Specialties: All | Size: Large platform reach

What physicians like:

• Integrated with Doximity's platform, which reaches 80% of US physicians — seamless if you're already on Doximity
• Smooth credentialing through PreCheck
• Broad job visibility across specialties

What physicians complain about:

• Limited independent physician reviews — most feedback is curated testimonials, making objective evaluation difficult
• As a Doximity subsidiary, the agency model is newer and less battle-tested than legacy agencies
• Unclear markup structure

Bottom line: Curative's Doximity integration is genuinely useful for discovery, but the lack of independent physician reviews makes it hard to evaluate on the metrics that matter most — markup transparency, credentialing speed, and what happens when things go wrong. Worth registering for job visibility; evaluate carefully before committing to an assignment.

Best for: Physicians already active on Doximity who want to browse assignments through a familiar platform.

13. Vista Staffing (NALTO Founding Member)

Founded: 1990 | Parent: Envision Healthcare | Specialties: EM, hospitalist, primary care | Size: Large

What physicians like:

• Professional credentialing process
• Accurate job descriptions — physicians report that what's advertised matches what they find on-site
• NALTO founding member — adheres to industry ethical standards

What physicians complain about:

• Poor communication after placement — Trustpilot and Indeed flag difficulty reaching anyone once the contract is signed
• Unannounced compensation cuts — multiple physicians report rate reductions without prior notice
• Feeling like "just a number" — impersonal service at scale
• Below-market rates reported by multiple physicians

Bottom line: Vista's job description accuracy is a genuine differentiator — what you see is what you get clinically. But the compensation cuts and post-placement communication failures are serious enough to warrant caution. Get every rate commitment in writing with an explicit clause prohibiting unilateral changes.

Best for: EM and hospitalist physicians who prioritize accurate job descriptions and are experienced enough to lock in rate protections contractually.

14. Locums One

We're including ourselves here with the same framework we applied to everyone else. You should evaluate us the same way.

Founded: 2021 | Parent: Physician-founded, independent | Specialties: Anesthesia, EM, radiology, GI, hospitalist | Size: Smaller, lean operation

What we do differently:

• 15–22% margins — we publish this and will tell you the bill rate if you ask
• 21-day credentialing — documented average, not a marketing claim
• Malpractice billed separately at actual cost (10% of physician pay, billed to hospital) — never deducted from your rate
• No non-compete clauses — you can work at any facility you want, with or without us
• Free tax professional connections — for every 1099 physician we place

What we're honest about:

• We have less assignment volume than CompHealth, AMN, or LocumTenens.com
• Our geographic coverage is strongest in the Midwest, Southeast, and Mountain West
• We're not the right choice if you need maximum assignment volume in every state simultaneously

Best for: Physicians who prioritize rate transparency, low margins, and fast credentialing over maximum assignment volume.

Agency Comparison at a Glance

*Markup estimates based on physician-reported data from forums, public filings, and industry benchmarks. Individual assignments vary.*

How to Compare Agencies: The Evaluation Framework

Use this scorecard when evaluating any locum tenens agency. Score each category 1–5 based on your interactions — before you sign anything.

An agency that scores well on rate transparency and payment reliability but poorly on physician advocacy is still a risk. The agencies that perform best across all eight categories are the ones worth building long-term relationships with.

What the Best Agencies Have in Common

After reviewing thousands of physician reports across 11 agencies, the agencies that get consistently positive feedback share these traits:

1. They disclose the bill rate. Not all of them, but the ones that do earn dramatically higher trust from physicians.
2. Their recruiter quality is consistent. The worst agencies have a few great recruiters and many bad ones. The best agencies have a floor below which quality doesn't fall.
3. They don't disappear after placement. The biggest complaint across all agencies is recruiter ghosting after the contract is signed. The best agencies maintain contact throughout.
4. They put everything in writing. No verbal promises. No "we'll figure that out later." Every rate, every condition, every cancellation term — in the contract before you start credentialing.
5. They don't use non-competes as weapons. The best agencies either don't use non-competes or limit them to 6–12 months for the specific facility — not the entire health system.

How Many Agencies Should You Work With?

The physician consensus across White Coat Investor, Student Doctor Network, and Reddit is emphatic: work with 3–5 agencies simultaneously.

Physicians who use only one agency consistently earn less because they have no leverage on rates and no alternative when assignments fall through. The agencies know this — which is why some push for exclusive arrangements.

The key management rule: track where your CV gets submitted. Multiple agencies will often have the same job listing. If two agencies submit you for the same position, it creates a conflict that can cost you the assignment entirely. Pick one agency per job opportunity.

Working with multiple agencies also gives you rate comparison data. If Agency A offers you $350/hr for an anesthesiology assignment in Texas and Agency B offers $420/hr for a comparable assignment, you now know Agency A's markup is significantly higher — and you can negotiate accordingly.

Should You Skip Agencies and Go Direct?

White Coat Investor has covered this extensively: going direct to hospitals can save 20–25% in agency markups. But it requires you to handle your own:

• Job search and relationship building
• Credentialing and privileging
• Licensing in multiple states
• Malpractice insurance procurement
• Travel and housing logistics
• Contract negotiation

Most physicians start with agencies to build facility relationships, then transition select facilities to direct contracts once they've proven themselves. This hybrid approach captures the best of both: agency infrastructure for new sites, direct relationships (and higher pay) for repeat sites.

For a deeper look at how agency markups affect your take-home pay, see our locum tenens salary guide.

Where Locums One Fits

We said we'd evaluate ourselves by the same framework, so here it is.

What we do well:

• Full markup disclosure. We publish our margin range (15–22%) and will disclose the bill rate on any specific assignment. This is not standard in the industry — most agencies listed above will not do this.
• 21-day average credentialing. Our network is pre-credentialed, which means we're not starting the process after you accept.
• No non-compete clauses. If a hospital wants to hire you permanently after a locum assignment, we don't block the transition.
• Occurrence-based malpractice ($1M/$3M through ProAssurance) on every assignment — no tail coverage needed.
• Physician-owned. No private equity sponsor, no publicly traded parent optimizing for quarterly earnings. Our incentive is placement quality, not margin maximization.

What we don't do as well:

• We're smaller. We don't have the job volume of a CompHealth or AMN. If you need a niche subspecialty in a specific state, we may not have the listing.
• We're newer. We don't have 40 years of facility relationships. We're building them.
• Limited specialty coverage. Our strongest verticals are anesthesiology, cardiac anesthesia, emergency medicine, radiology, IR, GI, surgical, hospitalist, and CRNA. We're expanding but we're not everywhere yet.

We're not the right choice for every physician or every assignment. But if markup transparency, credentialing speed, and contract fairness are your priorities, we're worth a conversation. Get a side-by-side rate comparison with what you're currently earning — no contracts, no obligations.

How to Work With Multiple Agencies (The Right Way)

The physicians who earn the most from locum tenens don't use one agency. They use 3–5 simultaneously. Here's how to do it without creating problems:

What You Can Do

• Register with as many agencies as you want
• Accept assignments from different agencies in different states or time periods
• Compare rate offers across agencies for the same type of assignment
• Tell each agency you're working with others — this is standard and expected

What Creates Problems

Double submission: If two agencies submit your CV to the same facility at the same time, it creates a dispute that can cost you the assignment. The fix: tell each agency which facilities you've already been submitted to, and require them to ask your permission before submitting anywhere.

Conflicting assignments: Accepting overlapping assignments from two agencies. This is a contract breach. Keep a clear calendar and communicate your availability accurately to each agency.

Non-compete violations: If one agency's contract has a non-compete clause covering a facility, working there through another agency may violate it. Read every contract before signing.

The Multi-Agency Strategy That Works

1. Register with 3–5 agencies in your specialty
2. Tell each one you're working with others — this is normal and they expect it
3. Require written permission before CV submission — put this in writing with each agency
4. Compare rate offers for similar assignments — use the spread to negotiate
5. Track which facilities each agency has submitted you to — keep a simple spreadsheet
6. Evaluate each agency's recruiter independently — the company name matters less than the person

Red Flags That Cost Physicians the Most

These are the patterns that show up repeatedly in physician forums, Reddit threads, and BBB complaints. Watch for all of them.

1. Refusing to Disclose the Bill Rate

If an agency won't tell you what the hospital is paying, they're protecting a markup they know you'd object to. This is the single most common complaint across every physician forum. It's not a minor transparency issue — it's the mechanism by which agencies extract tens of thousands of dollars per year from physicians who don't know to ask.

What to do: Ask directly. If they refuse, ask why. If they still refuse, factor that into your decision.

2. Verbal Promises That Don't Appear in the Contract

"We'll get you $400/hr." "This facility always extends." "The call is light." If it's not in the contract, it doesn't exist. Physicians on White Coat Investor forums report losing thousands of dollars on assignments where verbal promises about rates, call schedules, and extension options weren't honored because they weren't written down.

What to do: Before accepting any assignment, ask for every promise in writing. One Weatherby physician on Student Doctor Network recommended: "Send an email back to the recruiter after every phone conversation, recapping what was agreed to."

3. Name-Clearing Without Consent

Some agencies submit your CV to facilities without asking first. If two agencies submit you to the same facility, the facility may refuse to work with either one — or may choose the agency they have a better relationship with, not the one you prefer.

What to do: Put in writing with every agency: "Do not submit my CV to any facility without my explicit written consent for that specific facility." Most agencies will agree. If they won't, that tells you something.

4. Non-Compete Clauses

A non-compete clause in a locum tenens contract can prohibit you from working at a facility — even after your assignment ends — without going through the same agency. This is particularly damaging if you want to pursue a permanent position at a facility you've worked at as a locum.

What to do: Read every contract before signing. If there's a non-compete clause, negotiate it out or limit its scope (shorter duration, smaller geographic radius). Many agencies will remove it if you ask.

5. Conversion Fees

If a hospital wants to hire you permanently, some agencies charge a conversion fee — sometimes $10,000–$75,000. This can kill a permanent job offer or make the hospital less likely to extend one. One CompHealth physician on Indeed reported: "Got offered a permanent position. The hospital was excited. CompHealth torpedoed it."

What to do: Ask about conversion fees before accepting any assignment. If there's a fee, understand the amount and the timeline (most fees phase out after 12–24 months of locum work at the facility).

6. Slow Credentialing With No Accountability

Some agencies quote 4–8 weeks for credentialing and then take 12–16 weeks with no explanation. Every extra week is lost income. Physicians on Reddit report assignments that were delayed by months because the agency's credentialing team was unresponsive.

What to do: Ask for a specific credentialing timeline in writing, with milestones. Ask what happens if they miss the timeline. Agencies that credential in 21 days can document the process — agencies that take 90 days often can't.

The Questions to Ask Every Agency Before Signing

Use this list with every agency you evaluate. The answers — and the willingness to answer — tell you more than any marketing material.

On pricing:

1. What is the bill rate for this specific assignment?
2. What is your markup percentage?
3. Is malpractice deducted from my rate or billed separately to the hospital?
4. Are there any fees beyond the bill rate (VMS fees, administrative surcharges)?

On credentialing:

1. What is your average credentialing time, documented?
2. What is your process for emergency temporary privileges?
3. Who manages my credentialing file — a dedicated person or a shared team?

On contract terms:

1. Is there a non-compete clause? If so, what are the terms?
2. Is there a conversion fee if the hospital wants to hire me permanently?
3. What is your cancellation policy if the facility cancels my assignment?
4. Do you require my explicit consent before submitting my CV to any facility?

On the recruiter relationship:

1. Who will be my primary contact, and what is their response time commitment?
2. How many physicians does my recruiter manage simultaneously?
3. What happens if my recruiter leaves the company mid-assignment?

How to Negotiate Your Rate (Regardless of Which Agency You Use)

Most physicians accept the first offer. Agencies build negotiation room into initial offers — the first number is rarely the best number.

Step 1: Know the market rate. Before any negotiation, know what physicians in your specialty are earning in your target market. Our 2026 Locum Tenens Salary Guide has current rates by specialty. Use this as your floor, not your ceiling.

Step 2: Ask for the bill rate. You can't negotiate effectively without knowing what the hospital is paying. Ask directly. If they won't tell you, estimate based on specialty benchmarks and work backward.

Step 3: Counter with a specific number. Don't say "I was hoping for more." Say "Based on current market rates for this specialty and setting, I'm looking for $X/hr." Specific numbers get specific responses.

Step 4: Use competing offers. If Agency B is offering $380/hr for a similar assignment, tell Agency A. Agencies will often match or beat a competing offer to keep your business.

Step 5: Negotiate the full package. Rate is one number. Housing stipend, travel reimbursement, call premium, and cancellation terms are all negotiable. A $20/hr lower rate with a $3,000/month housing stipend may net more than a higher rate with no housing.

For the full negotiation playbook, see our contract negotiation guide.

The Tax Side: What Agency Choice Means for Your Take-Home

The agency markup affects your gross income. Your tax structure affects what you keep. Both matter.

As a 1099 independent contractor, you pay self-employment tax (15.3%) on top of income tax. But you also access deductions — travel, housing, licensing, CME, retirement contributions — that W-2 physicians can't touch.

The combination of a low-margin agency and good tax planning can produce after-tax income that exceeds a comparable W-2 position by $50,000–$120,000+ per year.

Key tax moves for locum physicians:

• S-Corp election above ~$300K net income — saves $15K–$25K/year in SE tax
• Solo 401(k) up to $70,000/year — saves $25,900 in federal taxes at the 37% bracket
• Track every deductible expense — travel, meals, licensing, CME, professional dues

Use our free locum tax calculator to model your take-home by specialty, state, and working weeks. For the full 1099 tax breakdown, see our independent contractor guide.

The Bottom Line: How to Actually Choose

There is no single "best" locum tenens agency. The right agency for you depends on your specialty, your target markets, your priorities, and — most importantly — the individual recruiter you end up working with.

Here's the framework that produces the best outcomes:

1. Work with 3–5 agencies simultaneously. Don't put all your eggs in one basket. More agencies means more options, more negotiating leverage, and a backup when one agency's recruiter goes dark.

2. Prioritize transparency over brand name. An agency that tells you the bill rate and their markup is worth more than a famous name that won't. The markup difference is worth $50,000–$150,000/year.

3. Evaluate the recruiter, not the company. Ask for references from physicians in your specialty who work with the specific recruiter you'll be assigned to. The company name is almost irrelevant compared to the individual relationship.

4. Read every contract before signing. Non-compete clauses, conversion fees, and cancellation terms are where agencies protect themselves at your expense. Know what you're agreeing to.

5. Ask the questions most physicians don't ask. Bill rate. Markup percentage. Credentialing timeline. Consent before CV submission. The agencies that answer these questions honestly are the ones worth working with.

The locum tenens market is in your favor right now. Physician shortages are real, demand is high, and agencies are competing for your time. Use that leverage.

Frequently Asked Questions

What is the best locum tenens agency?

There is no single "best" agency — physician satisfaction depends more on your individual recruiter than on the company brand. Based on provider reviews, MPLT Healthcare (4.8/5 ClearlyRated, 406 reviews) and Hayes Locums (4.5/5 Glassdoor on compensation) have the highest physician satisfaction scores among agencies we reviewed. However, the best approach is to work with 3–5 agencies simultaneously and evaluate based on rate transparency, credentialing speed, contract fairness, and recruiter responsiveness.

Which locum tenens agency pays the most?

Pay varies more by assignment and negotiation than by agency brand. However, agencies with lower markups pass more of the bill rate to physicians. Traditional large agencies (CompHealth, AMN, Weatherby) typically mark up 40–50%, while mid-tier agencies range from 30–40% and low-margin agencies operate at 15–22%. On a $600/hr anesthesiology bill rate, the difference between a 45% and 18% markup is $162/hr — or roughly $300,000/year on a full-time assignment.

How many locum tenens agencies should I sign up with?

The physician consensus across White Coat Investor, Student Doctor Network, and Reddit forums is to work with 3–5 agencies simultaneously. This gives you rate comparison data, negotiation leverage, and backup options if an assignment falls through. The key rule: track where your CV is submitted to avoid multiple agencies presenting you for the same position.

What are the red flags in a locum tenens agency contract?

The costliest red flags are: non-compete clauses longer than 12 months or covering an entire health system rather than a specific facility; conversion fees exceeding $25,000; asymmetric cancellation clauses (hospital can cancel with 72 hours' notice while you owe 60–90 days); language making the physician financially liable for breaking a non-compete; and any terms discussed verbally but not written into the contract. Our contract negotiation guide covers each of these in detail.

Should I use a locum tenens agency or go direct to hospitals?

Most physicians start with agencies because they handle credentialing, licensing, malpractice, travel, and job search. Going direct saves 20–25% in agency markups but requires you to manage all of those functions yourself. The optimal approach for experienced locums physicians is a hybrid: use agencies for new facilities and maintain direct relationships with facilities where you've already worked. For tax implications of either approach, see our 1099 tax guide.

Can I negotiate my locum tenens rate with an agency?

Yes — and you should. Agencies expect physicians to counter the initial offer. Research comparable rates for your specialty and geography (our salary guide has current 2026 rates by specialty), then ask for 15–20% above the initial offer. If negotiating call coverage, request an hourly callback rate rather than a flat fee. The most powerful negotiation tool is a competing offer from another agency for a comparable assignment.

What is a conversion fee in locum tenens?

A conversion fee is a charge the agency bills the hospital if they want to hire you permanently. Fees range from $10,000 to $75,000 depending on the agency and contract terms. Most fees phase out after 12–24 months of locum work at the facility. Locums One does not charge conversion fees.

How do I know if a locum tenens agency is taking too big a cut?

Ask for the bill rate and compare it to your pay rate. The difference (minus malpractice and travel costs) is the agency's margin. If the margin exceeds 30%, you're likely overpaying. Use our locums pricing guide to understand the full math.

What is name-clearing in locum tenens?

Name-clearing is when an agency submits your CV to a facility to "claim" you as their candidate — sometimes without your knowledge or consent. If two agencies submit you to the same facility, it creates a dispute that can cost you the assignment. Always require written consent before any agency submits your CV anywhere.

What do the best locum tenens agencies have in common?

The agencies that get consistently positive physician feedback share five traits: they disclose the bill rate, their recruiter quality is consistent (not just a few stars and many bad ones), they maintain contact after placement rather than ghosting, they put every promise in writing, and they don't use non-compete clauses as leverage. Any agency that checks all five boxes is worth a serious look.

Should I go direct to hospitals instead of using an agency?

Going direct can save 20–25% in agency markups, but requires you to handle job search, credentialing, multi-state licensing, malpractice procurement, travel logistics, and contract negotiation yourself. Most physicians start with agencies to build facility relationships, then transition select facilities to direct contracts once they've proven themselves. This hybrid approach captures agency infrastructure for new sites and higher direct pay for repeat sites.

How do I know if my locum tenens agency is working in my interest?

The clearest signals: they disclose the bill rate without being asked, they respond within 24 hours after placement (not just during recruitment), they tell you when a job isn't a good fit instead of pushing everything, and they back you in disputes with facilities. If your recruiter disappears after you sign the contract, that's the most common sign the relationship is transactional rather than advisory.

What makes Locums One different from other agencies?

Locums One publishes its margin range (15–22%) and discloses the bill rate on any specific assignment — which most agencies won't do. We average 21-day credentialing vs. the industry average of 60–90 days, charge no conversion fees, include no non-compete clauses, and carry occurrence-based malpractice ($1M/$3M through ProAssurance) on every assignment. We're smaller than CompHealth or AMN, which means less assignment volume — but for physicians who prioritize transparency and contract fairness, that tradeoff is worth it.

What is a non-compete clause in a locum tenens contract?

A non-compete clause prevents you from working at the same facility (or sometimes the same health system) through a different agency or as a direct hire for a specified period — typically 12–24 months. These clauses can block permanent employment offers and restrict your future opportunities. The FTC's proposed ban on non-competes was blocked in 2024, so they remain enforceable. Negotiate the scope (specific facility only, not the entire system) and duration (12 months maximum) before signing.

Do locum tenens agencies provide malpractice insurance?

Yes — reputable agencies provide malpractice insurance as part of the assignment, typically $1M/$3M coverage. The critical distinction is between occurrence-based and claims-made policies. Occurrence-based covers any incident that occurs during the policy period, regardless of when the claim is filed. Claims-made only covers claims filed during the active policy period — meaning you need expensive "tail coverage" after the assignment ends. Always confirm your agency provides occurrence-based coverage. For more on malpractice considerations, see our guide to locum tenens for rural hospitals.

Are locum tenens agency reviews reliable?

Agency-curated testimonials and ClearlyRated scores tend to skew positive because they survey current clients. For a more balanced picture, check physician forums (Student Doctor Network's locum tenens threads, White Coat Investor forums), Glassdoor physician-specific reviews (filter by job title), Indeed provider reviews, and BBB complaints. The most reliable signal is consistency across multiple independent sources — if the same complaint appears on SDN, Reddit, and BBB, it's a pattern, not an outlier.

*This article is based on publicly available physician reviews from Student Doctor Network, White Coat Investor, Reddit, Glassdoor, Indeed, ClearlyRated, LocumTenensGuy, and BBB as of April 2026. Individual experiences vary. Agency policies and leadership change — we recommend verifying current terms directly with any agency before signing.*

*We included Locums One in this review. We believe agencies should be evaluated on the same criteria they use to evaluate physicians: transparency, reliability, and track record. Talk to our team if you want to compare rates — no contracts, no obligations.*

For the full breakdown of how agency markups affect your income, see our guide to how locums pricing works. For current pay rates by specialty, see our 2026 Locum Tenens Salary Guide. For contract red flags and negotiation tactics, see our contract negotiation guide. For the full financial case for locum work, see our locum tenens benefits guide. For 1099 tax structuring, see our independent contractor guide. For credentialing timelines and what to expect, see our Credentialing 101 guide. For packing for your first assignment, see our complete packing guide.