Locum tenens physicians consistently earn more than those in permanent positions — often by 30% to 50% on an hourly basis. But actual earnings vary significantly based on your specialty, where you work, and how your assignments are structured.
This guide breaks down current locum tenens salary data for 2026, including hourly pay rates by specialty, the highest-paying states, and the factors that actually move the needle on your income.
QUICK SUMMARY — 7 THINGS EVERY LOCUM PHYSICIAN NEEDS TO KNOW
Locum rates run 30–50% higher than permanent salaries — hourly, not annually
Radiology and IR top the market at $330–$475/hr — anesthesiology and GI follow at $300–$407/hr
Midwest pays the most — Indiana, Iowa, Nebraska consistently offer the highest rates
Rural hospitals pay 15–25% more — critical access hospitals pay premium rates
Credentialing speed affects your income — 60–90 days is standard, 21 days is possible
1099 deductions save $20K–$40K/year — travel, housing, licensing, CME all deductible
Negotiate every offer — the first rate is rarely the best offer
Locum Tenens Pay Rates by Specialty (2026)
Hourly rates for locum tenens physicians have continued to rise in 2026 due to ongoing physician shortages and high demand across nearly every specialty. Here are the latest figures based on staffing agency data and market rates:
| Specialty | Hourly Pay Rate | Annualized Estimate* |
|---|---|---|
| Anesthesiology | $300 - $407 | $624,000 - $846,560 |
| Cardiology | $250 - $400 | $520,000 - $832,000 |
| Emergency Medicine | $200 - $300 | $416,000 - $624,000 |
| Gastroenterology | $355 - $407 | $738,400 - $846,560 |
| Family Medicine | $120 - $145 | $249,600 - $301,600 |
| Hospitalist | $195 - $250 | $405,600 - $520,000 |
| Internal Medicine | $120 - $145 | $249,600 - $301,600 |
| Interventional Radiology | $350 - $450 | $728,000 - $936,000 |
| Diagnostic Radiology | $330 - $475 | $686,400 - $988,000 |
| Neurology | $200 - $275 | $416,000 - $572,000 |
| OB/GYN | $150 - $225 | $312,000 - $468,000 |
| Orthopedic Surgery | $225 - $275 | $468,000 - $572,000 |
| Pediatrics | $105 - $130 | $218,400 - $270,400 |
| Psychiatry | $185 - $300 | $384,800 - $624,000 |
| Urology | $220 - $275 | $457,600 - $572,000 |
| CRNA (Nurse Anesthetist) | $200 - $325 | $416,000 - $676,000 |
| Nurse Practitioner | $70 - $158 | $145,600 - $328,640 |
| Physician Assistant | $70 - $116 | $145,600 - $241,280 |
*Scroll horizontally to view all columns on mobile devices
*Annualized estimates assume 40 hours/week, 52 weeks/year. Most locum tenens physicians work fewer weeks, so actual annual income will vary based on the number of assignments you take.
The highest-paying locum tenens specialties continue to be diagnostic radiology, interventional radiology, anesthesiology, and gastroenterology — all exceed $300 per hour at healthcare facilities nationwide. Hospitalists also earn competitive rates between $195 and $250 per hour, significantly higher than permanent salaries.
What Factors Affect Your Locum Tenens Salary?
Not every assignment at the same hourly rate is the same. Several factors can influence what you actually take home:
Location and Facility Type
<a href="/blog/rural-vs-urban-locums">Rural hospitals and critical access facilities</a> often pay higher locum tenens rates because they struggle to attract permanent physicians. Urban academic centers, while prestigious, usually offer lower pay for locum roles.
Specialty Demand
Specialties with severe physician shortages tend to command higher pay rates. <a href="/blog/emergency-medicine-locums">Emergency medicine</a>, anesthesiology, and psychiatry have consistently high demand, which keeps locum tenens salaries elevated. Family medicine and internal medicine physicians see steady demand, but at lower hourly rates.
Shift Structure and Call Coverage
Weekend, holiday, and overnight shifts often offer higher pay. Assignments that include call coverage, especially in surgical specialties, typically pay more than standard weekday clinic hours.
Assignment Length
Shorter assignments (one to two weeks) usually pay higher hourly rates for locum tenens work. Longer contracts (three to six months) may provide slightly lower rates but offer more guaranteed hours and less downtime between jobs.
Credentialing Speed
Here's something most salary guides don't discuss: how quickly you get <a href="/blog/credentialing-101">credentialed</a> affects your income. The average time for locum tenens credentialing is 60 to 90 days. Each week you're waiting for paperwork means a week without earnings. Agencies that can credential faster — some do it in as little as 21 days — help you start earning sooner.
Highest-Paying States for Locum Tenens Physicians
Geographic demand plays a significant role in locum tenens compensation. States with significant physician shortages or large rural populations generally offer higher pay rates for locum tenens assignments:
- Midwest (Indiana, Iowa, Nebraska, Kansas) — Consistently the highest-paying region, accounting for roughly a third of available assignments in most specialties
- Southeast (Arkansas, Tennessee, Mississippi, Alabama) — Strong demand fueled by healthcare gaps in rural areas
- Southwest (New Mexico, Arizona, West Texas) — Growing need, especially for emergency and family medicine
- West (Montana, Wyoming, Alaska) — Remote facilities offer higher rates to attract coverage
States with large physician populations — like California, New York, and Massachusetts — tend to have lower locum tenens rates due to greater provider supply. However, major metro areas still have pockets of high demand.
How Locum Tenens Pay Works: What the Agency Covers
Understanding how staffing agencies structure locum tenens compensation is crucial when evaluating any offer. Most reputable locum tenens agencies provide:
- Malpractice insurance — Usually $1M/$3M occurrence-based or claims-made coverage while you're on assignment
- Travel and housing — Flights, rental cars, and furnished housing close to the facility
- Licensing and credentialing — The agency takes care of paperwork and often covers state licensing fees
These covered expenses can add $15,000 to $30,000 in value per assignment beyond your hourly pay.
What You Pay as an Independent Contractor
Most locum tenens physicians work as independent contractors, meaning the agency does not withhold taxes. You are responsible for:
- Federal and state income taxes (quarterly estimated payments)
- Self-employment tax (Social Security and Medicare)
- Health insurance, retirement contributions, and disability coverage
However, independent contractors can deduct many work-related expenses — travel, meals, home office, continuing education, and professional dues — which often offsets the higher <a href="/blog/locum-tenens-tax-guide">tax burden</a>.
Some agencies offer an Employer of Record (EOR) model as an alternative. With an EOR arrangement, the agency handles payroll, tax withholding, workers' compensation, and compliance, giving you W-2 simplicity while maintaining the flexibility of locum tenens work.
How to Maximize Your Locum Tenens Income
Based on what the highest-earning locum tenens physicians do differently:
- <a href="/blog/negotiate-locums-contract">Negotiate every offer</a>. The first rate usually isn't the best. Your specialty, experience, and willingness to take on call or rural assignments give you leverage.
- Minimize gaps between assignments. Work with an agency that has enough facility relationships to keep you booked back-to-back if you want a constant income.
- Target high-demand regions. The Midwest and Southeast often pay more for the same specialties.
- Get credentialed fast. The sooner you clear privileging, the sooner you start earning. Ask your agency about their average credentialing timeline before signing.
- Negotiate the full package. Rate is one lever. Guaranteed hours, travel, housing, and cancellation terms all have real dollar value. Negotiate the full package.
The Bottom Line on Locum Tenens Salary in 2026
Locum tenens physicians earn competitive — and often significantly higher — pay rates than permanent positions. Diagnostic radiologists and interventional radiologists lead the market with rates between $330 and $475 per hour, followed by anesthesiologists and gastroenterologists at $300 to $407. Even hospitalists earn between $195 and $250 per hour, while primary care specialties see solid rates of $120 to $145.
The physicians who earn the most from locum tenens work are those who choose high-demand locations, negotiate their rates, and work with agencies that credential quickly and cover the full cost of malpractice, travel, and housing.
Whether you're exploring locum tenens assignments for the first time or looking to improve your current locum tenens salary, the market in 2026 strongly favors providers. <a href="/why-locumsone">Learn more about how Locums One supports physicians</a> with transparent pricing and faster credentialing.