Locum Tenens Salary in 2026: What Physicians Actually Earn by Specialty

Most locum tenens salary articles recycle the same vague ranges from 2023. This one uses current 2026 data pulled from AMN Healthcare postings, SIA market reports, and our own placement data to show what physicians are actually earning right now — by specialty, by region, and after the agency takes its cut.

Locum Tenens Pay Rates by Specialty (March 2026)

These are hourly pay rates — what hits your bank account, not the bill rate the hospital pays. Ranges reflect the spread across facilities: the low end is a standard weekday assignment at a well-staffed hospital, the high end is nights, weekends, rural, or high-acuity settings.

*Most locum physicians work 40–46 weeks per year, not 52. These annualized figures show the hourly math at scale — not a guarantee. Adjust for your actual working weeks.*

How to Read These Ranges

The range between the low and high end of any specialty isn't random. It maps to five consistent factors:

1. Setting type. Critical access hospitals and rural facilities pay 15–25% more than urban academic centers. The scarcity premium is real.

2. Shift type. 24-hour call, nights, weekends, and holidays add 10–25% on top of base day rates. Anesthesiologists covering rural call can earn $7,000–$11,000 for a single 24-hour shift.

3. Subspecialty depth. Cardiac anesthesia, interventional GI, neuroradiology, and interventional radiology command significant premiums over general practitioners in the same base specialty.

4. Assignment length. Short-term and per diem assignments (2–4 weeks) pay more per hour than 3–6 month extended contracts. You pay for flexibility.

5. Your agency's margin. This is the biggest variable most physicians ignore entirely. More on this below.

What's Behind These Numbers: Specialty Breakdown

Diagnostic Radiology ($320–$520/hr)

The clear leader, and the gap is widening. On-site diagnostic rads at hospitals — especially mammography, nuclear radiology, and body imaging — are consistently pulling $420–$520/hr. Teleradiology reads (reading from home) start lower at roughly $39–$42 per read, which works out to less per hour but offers lifestyle flexibility.

The wide range reflects the subspecialty spread: a general diagnostic radiologist doing teleradiology from home earns $320–$380/hr. A fellowship-trained neuroradiologist or nuclear medicine physician doing on-site work at a high-acuity center hits $480–$520/hr. Most radiologists fall in the $380–$450/hr range.

The radiology shortage is real. Residency slots haven't kept pace with imaging volume growth, and the physicians who are willing to do locums have enormous leverage right now. Teleradiology has also made radiology the most geographically flexible specialty in medicine — a radiologist in Denver can cover a rural hospital in Wyoming without leaving their home office.

Gastroenterology ($385–$450/hr)

GI has quietly climbed into the top tier. Endoscopy demand is relentless — screening colonoscopies alone drive massive volume — and the pool of GI physicians willing to do locum work is small. Hospitals that lose a GI doc can't afford to wait 6 months for a permanent hire, so they pay locum rates that reflect the urgency.

Advanced endoscopists with fellowship training in ERCP, EUS, or bariatric endoscopy command rates at the top of the range — $430–$450/hr for procedural work — because there are simply very few of them available. For facilities, the math is obvious: a week of endoscopy suite capacity generates $57,000+ in procedural revenue. A locum GI physician paid at $430/hr for a 40-hour week costs $17,200. That's a 3:1 ROI before downstream revenue.

Anesthesiology ($350–$450/hr)

The most consistent high-earner in locums. General anesthesiology sits at $350–$400/hr with minimal negotiation required. Cardiac anesthesia pushes the ceiling to $415–$450/hr. If you have cardiac fellowship training and multi-state licensure, you're in the strongest negotiating position of any locum specialty.

24-hour call shifts for anesthesia earn $6,000–$9,000/day — the highest single-shift earnings in locum tenens. In physician supervision states, MD/DO anesthesiologists are essential for OR coverage, and rates hold at the top of the range.

For the full breakdown, see our Anesthesiology Locum Rates guide.

Emergency Medicine ($295–$320/hr)

EM rates have normalized after the COVID-era spike. The $350+ rates of 2021–2022 are mostly gone, but $295–$320/hr is still strong money — and the volume of available assignments is massive. Rural EDs and critical access hospitals still pay at the top of that range. If you're willing to cover nights and weekends in a smaller facility, you'll consistently earn at or above $320/hr.

The EM locum market is one of the most liquid in medicine — high assignment volume, fast credentialing at facilities that know how to work with locum physicians, and genuine flexibility in shift structure. Block scheduling (7–14 consecutive days) remains the dominant model.

For the full EM breakdown, see our EM Locum Tenens guide.

Cardiology ($295–$375/hr)

Wide range depending on subspecialty. Non-invasive cardiology sits at the lower end ($295–$315/hr), while interventional and electrophysiology push toward $350–$375/hr. The daily rate equivalent runs $2,100–$3,000/day depending on facility type and procedure volume. Interventional cardiologists willing to cover rural programs with limited cath lab backup command consistent premiums.

Hospitalist ($195–$215/hr)

The workhorse of locum tenens. Hospitalist rates won't top the charts, but the sheer volume of assignments available is unmatched. You can work as much or as little as you want, in virtually any state. Nocturnist roles (overnight hospitalist coverage) pay 10–15% above standard day rates. For a physician who wants maximum schedule control and minimal credentialing friction, hospitalist locum work is the most accessible on-ramp in the entire specialty list.

Primary Care: Family Medicine ($155–$165/hr) and Internal Medicine ($150–$165/hr)

These rates might look modest next to the procedural specialties, but context matters. A permanent family medicine physician earns $230K–$260K managing a full patient panel with admin burden, RVU pressure, and no schedule flexibility. A locum FM doc at $160/hr working 44 weeks clears $281K — with zero overhead, no call, and a month of vacation built in. Plus malpractice, travel, and housing are covered.

The real comparison isn't hourly rate to hourly rate — it's effective compensation and quality of life. At that math, primary care locum work looks substantially better than the raw hourly number suggests.

Psychiatry ($215–$290/hr)

Psychiatry demand is surging, driven by the behavioral health crisis and facility expansion across the country. The range is wide because telepsychiatry assignments pay less ($215–$240/hr) while inpatient psych at state hospitals and crisis facilities pushes $260–$290/hr. If you're willing to do inpatient and you have multi-state licenses, you'll stay booked. The scarcity of psychiatrists willing to do inpatient work — particularly in underserved and rural facilities — means rates at the top end face little downward pressure.

OB/GYN ($195–$275/hr)

OB rates vary significantly based on whether the assignment includes surgical call. Standard OB hospitalist (laborist) roles sit at $195–$215/hr. Full-scope OB/GYN covering C-sections, hysterectomies, and call pushes to $250–$275/hr. California facilities consistently pay the top of the range.

General Surgery ($295–$335/hr)

Solid rates for general surgery, with trauma and vascular subspecialties pushing above $335/hr. Daily rates of $2,100–$2,600/day are standard, with trauma call earning $2,400–$3,400/day at larger facilities. VA hospitals tend to pay slightly below market.

Urology ($325–$350/hr)

Strong and stable. Most urology locum positions post at $2,400–$2,600/day. The specialty doesn't have the flashy highs of radiology or GI, but the demand is consistent and the rates don't fluctuate much.

What Actually Determines Your Locum Tenens Salary

The table above gives you the range. Here's what determines where you land within it.

Location Is the Biggest Lever

A hospitalist gig in downtown Chicago and a hospitalist gig in rural Kansas might be the same clinical work, but the Kansas assignment pays 20–30% more. Rural hospitals with thin coverage can't afford gaps.

Highest-paying regions in 2026:

States with large physician populations — California, New York, Massachusetts — pay less on average because there's more supply. You can still find premium assignments there, especially upstate NY or inland CA, just not as easily.

Best net pay (no state income tax): Florida and Texas. A $400/hr assignment in Texas often nets more after taxes than $440/hr in California.

Shift Type and Schedule

If you're willing to cover overnights or take holiday call, you can push any specialty's rate 15–25% above the standard range.

Assignment Length

Short-term assignments (1–2 weeks) pay higher hourly rates — the facility is typically desperate and credentialing effort is the same whether you stay two weeks or two months. Longer contracts (3–6 months) come with slightly lower rates but less downtime between gigs. Over a full year, the physician who stays continuously booked often earns more than the one chasing the highest hourly rate with gaps in between.

Credentialing Speed

This doesn't show up in any rate table, but it's real money. The industry average for credentialing is 60–90 days. Every week you're waiting on paperwork is a week you're not earning.

If your agency credentials you in 21 days instead of 75, that's 7–8 extra weeks of work per year. At $300/hr, that's over $80,000 in additional annual income just from starting sooner.

Agency Margins: The Part Nobody Talks About

When a hospital posts a locum need, they set a bill rate — what they pay the agency per hour for your time. The agency takes its margin, covers malpractice and overhead, and pays you the rest. The size of that margin is the single biggest variable in your take-home pay that you have direct control over.

How the same bill rate turns into very different paychecks:

That's a $193K difference on the exact same assignment, same hospital, same clinical work. The only variable is who's in the middle.

Large agencies have massive overhead — sales teams, corporate offices, marketing budgets, shareholders. That overhead comes out of your rate. Smaller agencies operating at 15–22% margins can pass significantly more of the bill rate through to you.

Ask your agency what their margin is. If they won't tell you, that tells you something.

At Locums One, we operate at 15–22% margin and are transparent about it — we'll tell you the hospital's bill rate if you ask.

How Locum Tenens Pay Actually Works

If you're new to locums, here's the mechanical breakdown.

You're a 1099 independent contractor. The agency is not your employer — they're a client who engages your services at an agreed hourly rate. They don't withhold taxes, don't pay employer FICA, and don't provide benefits. They do pay your full hourly rate directly to you (or your business entity, if you've set one up).

What's typically included on top of your hourly rate:

• Malpractice insurance — $1M/$3M occurrence-based, paid by the agency
• Travel — flights or mileage reimbursement to and from each assignment
• Housing — furnished accommodation at or near the facility
• Rental car — when the location requires it

These don't show up in your hourly rate but they're real compensation. At $200/night for a 4-week assignment, that's $5,600 in housing alone. Across 8–10 assignments per year, you're looking at $25,000–$50,000 in additional value beyond your hourly earnings.

Quarterly taxes are your responsibility. The IRS expects estimated tax payments four times per year. Miss them and you'll owe penalties. Set aside 28–35% of gross income into a separate account and make quarterly payments in April, June, September, and January.

Your effective tax rate is lower than it looks. As a 1099 physician, you can deduct licensing fees, CME, professional dues, unreimbursed travel, home office, and retirement contributions. A Solo 401(k) allows contributions up to $70,000 per year — a $70,000 deduction from taxable income at 37% bracket is $25,900 back in your pocket.

Use our free tax calculator to model your quarterly payments, deductions, and take-home based on specialty, state, and working weeks.

What Your Agency Covers (at No Cost to You)

When you see the rates in the table above, that's your cash hourly rate. Malpractice, travel, and housing are on top of that — adding $20K–$40K in value per assignment that you'd otherwise pay out of pocket.

Taxes: 1099 Independent Contractor

Almost all locum tenens physicians work as 1099 independent contractors. That means:

• No taxes withheld — you pay quarterly estimated taxes (federal + state)
• Self-employment tax — 15.3% on top of income tax (Social Security + Medicare)
• But significant deductions — travel, meals, home office, CME, licensing fees, professional dues, equipment, health insurance premiums

The deductions are substantial. A locum physician with good tax planning typically has an effective tax rate 5–10% lower than a W-2 physician at the same income level, even after self-employment tax. Above roughly $300K in net income, an S-Corp election can save $15K–$25K/year in self-employment taxes.

One thing most agencies won't mention: find a tax professional who specializes in locum tenens or 1099 physician income. Generic CPAs miss deductions that are specific to this work structure. Some agencies connect you with one for free — it's worth asking.

How Your Locum Rate Compares to Permanent Employment

The comparison most frequently cited is this: locum tenens physicians earn 30–50% more than their permanently employed peers in the same specialty. Let's put numbers to that claim.

*Full-time equivalent assumes 46 working weeks, 40 hours/week. Most locum physicians work fewer weeks. The hourly advantage is real even at reduced hours.*

The permanent physician comparison also understates the locum advantage because it ignores the tax benefits of 1099 work, which can add $30,000–$70,000+ per year in effective savings through deductions and retirement contributions.

Tax Considerations: What You Actually Keep

Locum physicians work as 1099 independent contractors. The agency pays your full hourly rate, and you handle your own taxes. Here's what that means:

Set aside 28–35% of gross income. The exact amount depends on your state tax situation, filing status, and deductions. When in doubt, set aside more.

Track every deductible expense. Travel, housing when not provided by agency, licensing fees, CME courses, medical equipment, professional dues, home office — all deductible. At locum income levels, deductions can easily total $20,000–$40,000+ per year.

Solo 401(k) contribution. As a self-employed physician, you can contribute up to $70,000 per year to a Solo 401(k). That's a $70,000 deduction from taxable income — saving $25,900 in federal taxes at the 37% bracket.

S-Corp election above $300K net income. The S-Corp structure can save $15,000–$25,000 per year in self-employment taxes at this income level. Setup costs $2,000–$4,000 but pays for itself in the first month.

File in every state where you worked. You need a nonresident return in every state where you earned income. States with no income tax (Texas, Florida, Nevada, Washington, WY, TN) effectively give you a 5–10% hourly raise.

Model your specific numbers — specialty, state, deductions, retirement — with our free locum tax calculator.

How to Maximize Your Locum Tenens Income

1. Negotiate every offer. The first number is not the final number. Your specialty, availability, multi-state licenses, and willingness to cover call or weekends give you leverage. Use it.

2. Stack licenses strategically. Physicians with 10+ active state licenses have dramatically more options and can cherry-pick the highest-paying assignments. Every additional license is another market you can access.

3. Go rural. Rural and critical access assignments pay 15–25% above urban rates for the same clinical work, the variety is broader, and credentialing is often faster because they need you yesterday.

4. Minimize gaps between assignments. The highest-earning locum physicians aren't always getting the highest hourly rates — they're the ones booked 44–48 weeks per year with no dead time. Work with an agency that has enough facility relationships to keep your calendar full.

5. Get credentialed before you need it. Don't wait for an assignment to start paperwork. Get your documents organized, references lined up, and licenses current. When the right gig comes, you want to say yes and start in weeks, not months.

6. Understand your agency's margin. This is the single most actionable thing on this list. A 10–15% difference in agency margin translates to $50K–$150K/year in your pocket. Ask the question.

Planning your first assignment? See our complete locum tenens packing guide for what to bring.

Frequently Asked Questions

How much do locum tenens physicians make per hour?

It depends on specialty. Primary care (family medicine, internal medicine) earns $150–$165/hr. Mid-range specialties like emergency medicine, neurology, and psychiatry earn $215–$320/hr. High-end specialties — diagnostic radiology, gastroenterology, anesthesiology — earn $320–$520/hr. These are 2026 figures based on current AMN Healthcare postings and market data.

Do locum tenens doctors make more than permanent physicians?

On an hourly basis, yes — typically 30–50% more. A permanent hospitalist earning $280K/year works about 48 weeks. A locum hospitalist at $205/hr working 44 weeks earns $361K, and malpractice, travel, and housing are covered on top of that. The trade-off is no employer-sponsored benefits (health insurance, 401k match, PTO), but most locum physicians find the math works strongly in their favor.

What is the highest-paying locum tenens specialty?

Diagnostic radiology leads at $320–$520/hr, followed by gastroenterology ($385–$450/hr) and anesthesiology ($350–$450/hr). Cardiac anesthesiology and interventional radiology can push even higher in specific markets.

Are locum tenens rates going up or down in 2026?

Rates have stabilized after the post-COVID correction, but they remain well above pre-2020 levels. Specialties with persistent shortages — radiology, GI, anesthesiology, psychiatry — continue to see gradual rate increases. Emergency medicine rates came down from 2021–2022 peaks but are holding steady in the $295–$320/hr range.

How do locum tenens taxes work?

Most locum physicians are 1099 independent contractors. You pay quarterly estimated taxes (federal + state) and self-employment tax (15.3%). The upside: you can deduct travel, housing, meals, CME, licensing fees, professional dues, and more. With proper tax planning — especially S-Corp election above $300K — many locum physicians pay a lower effective tax rate than their W-2 peers at the same income. Find a tax professional who specializes in physician 1099 income.

What does "all-in pay" mean for locum tenens?

All-in pay means your hourly rate is one number with nothing separate for malpractice, travel, or housing. Some agencies quote a lower hourly rate but then cover travel and housing on top — which can make the total package comparable or even better. Always compare total compensation, not just the hourly number on the contract.

How long does it take to start a locum tenens assignment?

The industry average for credentialing is 60–90 days, which is the biggest bottleneck. Some agencies complete the process in as few as 21 days. Once credentialed, you can often start within a week. Getting your documents organized in advance — CV, references, license verifications, immunization records — speeds up the process significantly.

How much can a locum physician make in a year?

It depends on specialty, hours worked, and agency margin. A radiologist working 40 weeks/year earns $512K–$832K. An anesthesiologist earns $560K–$720K. A hospitalist earns $312K–$344K. These are pre-tax figures; after deductions and retirement contributions, effective tax rates are typically lower than permanent W-2 positions at similar income levels.

Do rural assignments actually pay more?

Yes — consistently 15–25% more than urban assignments in the same specialty. The scarcity premium is real. A critical access hospital in rural Iowa pays more for a hospitalist than a large urban academic center in Chicago.

What's the difference between pay rate and bill rate?

The bill rate is what the hospital pays the agency. The pay rate is what you receive after the agency's margin. On a $500/hr bill rate with a 35% agency margin, you receive $325/hr. On the same bill rate with an 18% margin, you receive $410/hr. Always ask about the bill rate.

Is locum tenens worth it for primary care physicians?

Yes, but the math looks different. At $150–$165/hr, FM and IM locum physicians earn 30–40% more than the permanent median — with no call obligations, no practice overhead, and complete schedule control. The dollar premium per hour is smaller, but the lifestyle advantage is significant.

Which locum tenens companies have the lowest markup?

Locums One operates at 15–22% margins, compared to 30–50% at most national staffing agencies. On a $500/hr bill rate, that difference means up to $110/hr more in the physician's pocket — or roughly $250,000 more per year working full-time locums.

How transparent is Locums One about pricing?

Locums One publishes its margin structure (15–22%) and will share the hospital's bill rate with any physician who asks. There are no hidden fees, no bundled overhead surprises, and no bait-and-switch on agreed rates. Our contract negotiation guide covers what to look for in any agency's pricing structure.

The Bottom Line

Locum tenens compensation in 2026 represents a genuine premium over permanent employment across every specialty that employs it. The size of that premium depends on specialty, setting, geography, shift type — and critically, the agency you choose to work with.

The physicians earning the most aren't necessarily in the highest-paying specialty. They're the ones who understand the full compensation picture: choosing low-margin agencies, targeting high-demand regions, structuring their taxes intelligently, and negotiating from real market data.

At Locums One, we operate at 15–22% margins — we're transparent about it, and we'll tell you the hospital's bill rate if you ask. Our average credentialing time is 21 days, and we cover $1M/$3M occurrence-based malpractice on every assignment.

For specialty-specific rate deep dives, see our Anesthesiology Rates guide or our CRNA Salary guide. For a full breakdown of how agency markups affect your pay, see our guide on how locum tenens pricing works. For the full financial and lifestyle case for locum work, see our locum tenens benefits guide. For 1099 tax structuring and deductions, see our independent contractor guide. For what hospitals pay when shifts go unfilled, see our guide on the true cost of unfilled shifts. For tax modeling, use our free tax calculator.