10 Questions to Ask Before Your First Locums Assignment

Your first locum tenens assignment is a big step. You're trading the predictability of a permanent position for higher pay, more flexibility, and the chance to work in different settings. But before you sign anything, you need answers to some critical questions.

The physicians who have the best experience with locum work aren't necessarily the ones with the most experience. They're the ones who approach it intentionally.

1. What's the Hourly Rate — and Is It Negotiable?

This is the obvious one, but most first-time locum physicians don't realize how much room there is to negotiate. The first rate you're offered is rarely the best. Your willingness to take on call or rural assignments gives you real leverage. Use it.

What to ask:

• "What's the hourly rate for this assignment?"
• "Is there room to negotiate based on my experience and the assignment location?"
• "Are there shift differentials for nights, weekends, or holidays?"

What you're listening for: A clear answer on the base rate, and openness to negotiation. If the recruiter immediately says "that's the best we can do," they're either lying or working for an agency with no flexibility. Either way, it's a red flag.

For a full breakdown, see our guide on <a href="/blog/negotiate-locums-contract">How to Negotiate Your Locum Tenens Contract</a>.

2. Are There Guaranteed Hours?

Some assignments guarantee a minimum number of hours per week regardless of patient volume. Others don't. If you're taking an assignment at a facility with unpredictable volume, guaranteed hours protect your income.

What to ask:

• "Does this assignment include guaranteed hours?"
• "If patient volume is low, am I still paid for the full shift?"

What you're listening for: A clear yes or no. If the answer is no, ask about the facility's typical patient volume and whether low-volume weeks are common. A $250/hour assignment with no guaranteed hours at a low-volume facility might end up paying less than a $220/hour assignment with 40 guaranteed hours.

3. What's Covered: Malpractice, Travel, and Housing?

Reputable locum tenens agencies cover three things at no cost to you: malpractice insurance, travel expenses, and housing. If an agency is asking you to cover your own malpractice, walk away.

What to ask:

• "Does the agency provide malpractice insurance? What are the limits?"
• "Is travel covered — flights, rental cars, mileage?"
• "Is housing provided, or do I get a stipend to find my own?"

What you're listening for:

• Malpractice: $1M/$3M coverage is standard. Make sure you understand whether it's occurrence-based or claims-made, and who pays for tail coverage if it's claims-made.
• Travel: The agency should cover flights, rental cars, and mileage. Some agencies book travel directly; others reimburse you. Direct booking is usually easier.
• Housing: Most agencies provide furnished housing near the facility. Some give you a stipend and let you find your own place. Either works, but make sure the stipend is realistic for the area.

4. What's the Credentialing Timeline?

<a href="/blog/credentialing-101">Credentialing</a> is the process of verifying your qualifications with the facility before you can start seeing patients. The industry average is 60 to 90 days. That's a long time to wait before you start earning.

What to ask:

• "What's your average credentialing timeline for this facility?"
• "Do you have an established relationship with this facility that speeds up the process?"
• "Does the facility offer provisional privileges?"

What you're listening for: Anything under 30 days is excellent. 30 to 45 days is good. 60 to 90 days means you're waiting a long time before you start earning. If the agency doesn't have a clear answer, that's a red flag — it means they don't have established relationships with the facility.

At <a href="/why-locumsone">Locums One</a>, our average credentialing time is 21 days. That's not an accident — it's the result of deep facility relationships and dedicated credentialing staff who manage the process proactively.

5. What's the Cancellation Policy?

Facilities cancel assignments. It happens. You need to know what happens when they do — specifically, whether there's a "kill fee" that compensates you for lost income.

What to ask:

• "What happens if the facility cancels the assignment?"
• "Is there a kill fee or guaranteed payment if they cancel with short notice?"
• "What happens if I need to cancel?"

What you're listening for: A clear cancellation policy in writing. Some contracts include a kill fee — typically one to two weeks of guaranteed pay — if the facility cancels within a certain window (usually 30 days of the start date). If there's no kill fee, you're taking on all the risk.

Also ask what happens if you need to cancel. Life happens. Make sure you understand the consequences before you commit.

6. What's the Patient Volume and Acuity?

This is especially important for emergency medicine and hospitalist assignments. A high-volume urban ED is a very different experience from a low-volume rural critical access hospital.

What to ask:

• "What's the typical patient volume per shift?"
• "What's the acuity level — are we talking minor complaints or high-acuity trauma?"
• "What subspecialty backup is available?"

What you're listening for: An honest assessment that matches your comfort level. If you're an EM physician who thrives in high-volume environments, a 15-patient-per-shift rural ED might bore you. If you prefer a broader scope with more autonomy, a 60-patient-per-shift urban trauma center might burn you out.

For more on this, see our comparison of <a href="/blog/rural-vs-urban-locums">Rural vs Urban Locum Assignments</a>.

7. What EMR System Do They Use?

This seems minor, but it's not. If you're walking into a facility using an EMR you've never seen before, you're going to spend the first few shifts fighting the system instead of focusing on patient care.

What to ask:

• "What EMR system does the facility use?"
• "Will I get training or access to the system before my first shift?"

What you're listening for: Ideally, it's an EMR you've used before — Epic, Cerner, Meditech, Allscripts. If it's something unfamiliar, ask whether the facility provides training or access to a demo environment before you start. Some do, most don't.

8. Is There a Non-Compete Clause?

Some locum tenens contracts include non-compete or non-solicitation clauses that prevent you from working directly with the facility — or through a different agency — for one to two years after your assignment ends.

What to ask:

• "Does the contract include a non-compete or non-solicitation clause?"
• "If I want to return to this facility for another assignment, am I required to work through your agency?"

What you're listening for: Ideally, no non-compete. If there is one, negotiate it down or get it removed entirely. A two-year non-compete can cost you significant income if you want to convert to a permanent position at the facility or return as a locum through a different agency.

9. What Support Staff Will I Have?

The quality of your support staff — nurses, techs, scribes, ancillary services — has a huge impact on your day-to-day experience.

What to ask:

• "What's the nurse-to-patient ratio?"
• "Will I have a scribe or dedicated support staff?"
• "What ancillary services are available — lab, imaging, pharmacy?"

What you're listening for: A realistic picture of what you're walking into. Urban academic centers usually have strong support staff. Rural critical access hospitals often don't. Neither is better or worse — they're just different. Make sure you know what you're signing up for.

10. Can I Talk to a Physician Who's Worked There?

This is the single best way to know what you're actually getting into. A five-minute conversation with a physician who's worked at the facility will tell you more than any recruiter can.

What to ask:

• "Can you connect me with a physician who's worked at this facility recently?"
• "What did they say about the experience?"

What you're listening for: A willingness to connect you with a reference. If the agency hesitates or says they can't do that, it's a red flag. Good agencies are proud of their placements and happy to connect you with physicians who've worked there.

The Bottom Line

Your first locum tenens assignment sets the tone for everything that follows. The physicians who have the best experience are the ones who ask the right questions upfront — about rate, guaranteed hours, malpractice coverage, credentialing timelines, cancellation policies, and what the day-to-day work actually looks like.

Don't be afraid to ask tough questions. Don't accept vague answers. And don't sign anything until you've read the contract carefully and understand every term.

At <a href="/why-locumsone">Locums One</a>, we believe transparency is the foundation of a good working relationship. <a href="/contact">Talk to our team</a> about current assignments and what you can expect — we'll give you straight answers to every question on this list.