What Is Locum Tenens? The Complete Guide to Temporary Physician Staffing in 2026

What Does "Locum Tenens" Mean?

Locum tenens (pronounced *LOH-kum TEN-enz*) is a Latin phrase meaning "to hold the place of." In healthcare, it refers to physicians, surgeons, and advanced practice providers who fill temporary positions at hospitals, clinics, and health systems.

Think of it as the physician equivalent of a consultant or contractor: you work where you're needed, for as long as you're needed, then move on.

But that clinical definition barely scratches the surface. Locum tenens has evolved from a niche coverage solution into a $5.4 billion industry that reshapes how medicine is practiced, staffed, and compensated across the United States.

Here's what nobody tells you about it.

How Big Is the Locum Tenens Industry?

The numbers are staggering — and growing:

*Sources: Staffing Industry Analysts (SIA) Healthcare Staffing Report 2024, AMN Healthcare Survey of Facility Staffing 2024, Medscape Physician Compensation Report 2024*

Locum tenens is the fastest-growing segment of healthcare staffing, outpacing travel nursing in growth rate since 2023. The reason is simple: the physician shortage is structural, not cyclical.

The AAMC projects a shortfall of 37,800 to 124,000 physicians by 2034. An aging population (65+ growing 30% faster than working-age adults), 150+ rural hospital closures since 2010, and a physician burnout rate of 53% are all accelerating demand for flexible coverage.

Locum tenens isn't a temporary fix. It's becoming permanent infrastructure.

How Does Locum Tenens Work?

The process has five steps. Here's what actually happens — not the sanitized version from staffing agency marketing pages.

Step 1: A Facility Has a Gap

A hospital needs coverage. Maybe their only urologist is on maternity leave. Maybe three emergency physicians quit in the same quarter. Maybe they're launching a new GI service line and need an experienced gastroenterologist while they recruit permanently.

The most common reasons facilities use locums:

*Source: AMN Healthcare 2024 Survey of Facility Staffing*

Step 2: They Contact a Staffing Agency (or Use a VMS)

The facility either calls a locum tenens staffing agency directly or posts the assignment on a Vendor Management System (VMS) like LocumSmart, where multiple agencies can bid.

The job posting — called an Assignment Request (AR) — includes the specialty, schedule, clinical requirements, credentialing timeline, and sometimes a rate cap.

Step 3: The Agency Matches a Physician

The staffing agency searches its network for physicians who:

• Hold an active license in the required state (or are eligible through the Interstate Medical Licensure Compact, which covers 42 states)
• Are board certified in the requested specialty
• Have availability matching the schedule
• Have a clean malpractice and background history

The agency presents the physician's CV to the facility for approval.

Step 4: Credentialing and Privileging

This is the part that surprises most physicians. Before you can start working, you must be:

1. Credentialed by the staffing agency (internal verification of your licenses, board certifications, training, malpractice history, references, and background checks)
2. Privileged by the hospital (the facility's medical staff office grants you temporary or locum tenens privileges to practice there)

Typical timelines:

The credentialing timeline is the #1 bottleneck in locum tenens. Some agencies have streamlined this to 21 days — but the industry average is still 60–90 days. Ask your agency what their actual timeline is, not what their website claims. For a complete walkthrough, see our Credentialing 101 guide.

Step 5: You Work the Assignment

You show up, do your job, and leave. The agency handles:

• Malpractice insurance (occurrence-based with tail coverage, typically)
• Travel arrangements (flights, rental car, or mileage)
• Housing (hotel, furnished apartment, or stipend)
• Payroll (you're typically paid as a 1099 independent contractor)

You submit timesheets. The agency bills the facility. You get paid.

That's the clean version. The messy version — how agencies mark up your rate, what contract clauses to watch for, and how to negotiate — is covered in our pricing transparency guide and contract negotiation article.

Who Works Locum Tenens?

The stereotype of a locum physician as someone between jobs or semi-retired is outdated. The 2026 locum workforce looks like this:

*Source: CompHealth 2025 State of Locum Tenens Report*

74% of locum physicians in Barton Associates' network have 15+ years of experience. This isn't a market for new graduates finding their footing — it's a market for experienced physicians who've decided the traditional employment model doesn't work for them anymore.

By Career Stage

By Work Pattern

• 34% work locums full-time exclusively — this is their career, not a side gig
• 66% do locums part-time alongside a permanent position or during career transitions
• Average locum physician works 24–36 weeks per year
• Most common assignment length: 13 weeks (one quarter)

Which Specialties Use Locums Most?

1. Psychiatry — chronic national shortage, telepsych has expanded reach
2. Anesthesiology / CRNAs — high-acuity demand, call coverage gaps
3. Emergency Medicine — shift-based model is a natural fit
4. Radiology — teleradiology has made this partially location-independent
5. Primary Care / Family Medicine — rural and FQHC-driven demand
6. Hospitalist Medicine — fastest-growing locum segment
7. Surgical subspecialties — orthopedics, CV surgery, general surgery

The most common reasons physicians choose locum tenens:

1. Better schedule control (86% cite this as primary reason)
2. Higher compensation (78%)
3. Burnout recovery (80% of those who switched cited burnout as a factor)
4. Geographic flexibility (61%)
5. Clinical variety (54%)

How Much Do Locum Tenens Physicians Make?

This is the question every physician actually wants answered — and the one every other "what is locum tenens" article avoids.

Here are real numbers:

2026 Locum Tenens Pay Rates by Specialty

*These are pay rates to the physician — not bill rates. For the full breakdown of how bill rates, markups, and your actual take-home connect, see our locum tenens salary guide and pricing article.*

Key context:

• Rates vary by geography, urgency, and whether it's a rural or urban assignment
• Call-only assignments and weekend coverage often pay premium rates
• "All-inclusive" rates bundle travel, housing, and malpractice into one number
• Some agencies quote bill rates (what the hospital pays) as if they're your pay rate — they're not

For specialty-specific deep dives, see:

• Anesthesiology locum rates in 2026
• Cardiac anesthesia locum tenens
• CRNA locum salary guide

Locum Tenens Pay: The Agency Margin Factor

Here's what most locum guides don't tell you: the agency you choose matters as much as the specialty you practice.

When a hospital posts a locum need, they set a bill rate — what they pay the agency per hour. The agency takes its margin and pays you the rest. Large national agencies take 30–50% of the bill rate. Smaller agencies operating at 15–22% margins pass significantly more through to you.

Same hospital. Same work. Very different paycheck:

That's a $195K difference on the exact same assignment. Ask your agency what their margin is. If they won't tell you, that tells you something.

The Agency Margin Factor

Here's what most locum guides don't tell you: the agency you choose matters as much as the specialty you practice.

When a hospital posts a locum need, they set a bill rate — what they pay the agency per hour. The agency takes its margin and pays you the rest. Large national agencies take 30–50% of the bill rate. Smaller agencies operating at 15–22% margins pass significantly more through to you.

Same hospital. Same work. Very different paycheck:

That's a $195K difference on the exact same assignment. Ask your agency what their margin is. If they won't tell you, that tells you something.

The 1099 Independent Contractor Structure

As a locum tenens physician, you are an independent contractor, not an employee. You receive a 1099-NEC, not a W-2. No taxes are withheld from your paychecks.

This has significant implications — both positive and negative.

What You Gain

• Higher hourly rates — 30–50% above permanent positions
• Business deductions — travel, housing, meals, licensing, CME, equipment, health insurance premiums
• Solo 401(k) access — contribute up to $70,000/year (vs. $23,500 in employer plans)
• Schedule control — you choose which assignments to accept
• S-Corp election — can save $15K–$25K/year in self-employment taxes above $300K income

What You Manage Yourself

• Quarterly estimated taxes — due April 15, June 15, September 15, January 15
• Self-employment tax — 15.3% on top of income tax (covers both employee and employer FICA)
• Health insurance — you purchase your own (100% deductible as self-employed)
• Retirement contributions — you fund your own Solo 401(k) or SEP-IRA

The math usually works in your favor. A locum hospitalist earning $410K gross with $50K in deductions and a maxed Solo 401(k) often pays a lower effective tax rate than a W-2 hospitalist earning $295K. For the full breakdown, see our complete locum tenens tax guide and our 1099 independent contractor guide.

What Are the Real Pros and Cons of Locum Tenens?

Every staffing agency website lists the benefits. Almost none mention the trade-offs. Here's the honest version.

The Advantages

1. Higher Compensation

Locum physicians typically earn 30–50% more per hour than their permanently employed counterparts. A hospitalist making $280K/year employed might earn $350K–$450K working locums — while working fewer weeks. For the full salary comparison, see our locum tenens salary guide.

2. Complete Schedule Control

You choose when, where, and how much you work. Take December off. Work 7-on/7-off. Stack three months of work and travel for three months. No PTO requests, no committee meetings, no "mandatory" hospital events.

3. Zero Administrative Burden

No billing headaches, no staff management, no EMR committee. You show up, practice medicine, and leave. The agency handles malpractice, travel, housing, and credentialing.

4. Geographic Freedom

Work in Maui for a month, then Manhattan, then Montana. Or stay local and pick up shifts at nearby facilities. Locum tenens for rural hospitals is especially in demand — and often pays premium rates.

5. Burnout Recovery

53% of physicians report burnout (Medscape 2024). Locums removes the politics, the after-hours emails, and the obligation to be available 365 days a year. You practice medicine on your terms.

6. Try Before You Commit

Thinking about relocating? Take a 13-week locum assignment there first. Considering a new practice setting? Test it without a 3-year contract. Many permanent positions start as locum-to-perm arrangements.

The Trade-Offs (What Nobody Tells You)

1. No Employer Benefits

No health insurance, no retirement match, no disability insurance, no paid time off. You're a 1099 independent contractor. You fund your own benefits. The higher hourly rate is meant to compensate for this — but you have to actually set it up yourself. Our tax guide covers the financial planning.

2. Income Isn't Guaranteed

Assignments can be cancelled. Credentialing can stall. Gaps between assignments mean $0 income. Full-time locum physicians need a financial buffer — ideally 3–6 months of expenses saved.

3. Self-Employment Tax

As a 1099 contractor, you owe 15.3% self-employment tax (Social Security + Medicare) on top of income tax. That's the employer's half AND the employee's half. You can reduce this with S-Corp election and smart deductions, but it's a real cost that salaried physicians don't see.

4. Quarterly Tax Payments

No employer is withholding taxes for you. You must make estimated quarterly payments to the IRS (and often to multiple state tax authorities if you work across state lines). Miss a payment and you'll owe penalties.

5. Credentialing Fatigue

Every new hospital means a new credentialing packet: references, background checks, drug screens, vaccination records, privilege applications. The paperwork adds up, especially if you're working multiple short-term assignments.

6. Social Isolation

You're always the new person. You won't have the same depth of relationships as a permanent physician. Some locum docs thrive on this — others find it lonely after a while.

7. Continuity of Care Limitations

You're covering, not building a panel. If long-term patient relationships are what drives you, locums may feel unfulfilling for certain specialties (primary care, oncology).

Locum Tenens vs. Permanent Employment: Side-by-Side Comparison

The math that matters: A hospitalist earning $300K salary with benefits works ~48 weeks/year. A locum hospitalist earning $200/hr works 36 weeks at 50 hrs/week = $360K gross — with 12 weeks off. After self-employment tax and self-funded benefits, take-home is roughly comparable. The difference is in the 12 extra weeks of freedom.

For surgical and procedural specialties, the gap is wider. A locum anesthesiologist earning $400/hr for 36 weeks grosses $720K — significantly more than the $450K median employed salary.

How Much Do Hospitals Actually Pay for Locum Tenens?

This is the part staffing agencies don't want you to see.

When a hospital hires a locum physician, they pay a bill rate to the staffing agency. The agency keeps a percentage — the markup — and pays the physician the rest.

The Bill Rate Breakdown

Here's what happens to every dollar a hospital pays:

Example: A hospital pays $600/hr for an anesthesiologist.

• At a traditional agency (45% markup): the physician receives $330/hr
• At a low-margin agency (18% markup): the physician receives $430/hr

That's a $100/hr difference — or $200,000/year working full-time — determined entirely by which agency you work with.

This is why understanding how locums pricing works is the single most valuable thing a locum physician can do. And it's why choosing the right agency matters more than almost any other career decision.

The Tax Reality of Locum Tenens (What to Expect)

Most locum physicians are classified as 1099 independent contractors. This fundamentally changes your tax situation compared to W-2 employment.

The Key Differences

The #1 Rule

Set aside 30% of every check for taxes. Open a separate savings account. Transfer 30% of every payment the day it hits. This covers federal income tax, self-employment tax, and state taxes.

The most common financial mistake new locum physicians make is spending their gross pay as if it's net pay. It's not. Uncle Sam is coming for 25–35% of it.

For the complete breakdown — quarterly payment calendar, every deductible expense, S-Corp math, multi-state filing, and a full tax return walkthrough — read our locum tenens tax guide.

How Locum Tenens Agencies Work

There are 200–300+ locum tenens agencies in the United States. They range from massive publicly traded companies (AMN Healthcare, Cross Country, Envision) to small specialty-focused boutiques. Understanding how they make money helps you choose the right one.

The Agency Business Model

Agencies earn revenue by charging hospitals a bill rate — typically 30–50% above what they pay the physician. On a $500/hr bill rate:

• Large agency (40% margin): physician earns $300/hr
• Mid-size agency (25% margin): physician earns $375/hr
• Lean agency (18% margin): physician earns $410/hr

The agency uses its margin to cover malpractice insurance, travel and housing costs, payroll processing, credentialing staff, and profit.

What a Good Agency Provides

• Credentialing support — handles the entire process, not just submits paperwork
• Malpractice insurance — occurrence-based, $1M/$3M, at no cost to you
• Travel and housing — arranged and paid, not just reimbursed after the fact
• Licensing support — covers fees and manages applications for new state licenses
• Tax professional connections — some agencies connect physicians with CPAs who specialize in 1099 income
• Transparent billing — will tell you the hospital's bill rate if you ask

Red Flags in an Agency

• Won't disclose their margin or the hospital's bill rate
• Claims-made malpractice instead of occurrence-based
• Credentialing takes 60+ days as a standard
• Vague about what's included in the compensation package
• Pressures you to accept assignments quickly without time to review contracts

For a complete guide to evaluating agencies, see our locum tenens agency guide. For how pricing and markups work in detail, see our locum tenens pricing guide.

Locum Tenens for Hospitals: Why Facilities Use It

From the hospital side, locum tenens is a calculated financial decision. The alternative to paying a locum physician's premium rate is often far more expensive.

What an unfilled physician shift actually costs:

A locum physician at $400/hr for a 10-hour shift costs $4,000. The vacancy costs $8,500–$22,000. The math is obvious.

For rural and critical access hospitals, the stakes are even higher — an unfilled ED can trigger patient diversions that shift $500K–$2M annually to competing facilities. For the full analysis, see our guide on the true cost of unfilled physician shifts and our rural hospital staffing guide.

How to Get Started with Locum Tenens

If you're considering your first assignment, here's the practical roadmap:

1. Get Your Documents Ready

Before you contact a single agency, gather:

• Updated CV (locum-formatted — procedures, case logs, and licenses prominently listed)
• All active state medical licenses
• Board certification documentation
• DEA certificates
• Malpractice history (request your NPDB self-query)
• Professional references (3 recent, with current contact info)
• Immunization records and TB test results
• BLS/ACLS/ATLS certifications (current)

2. Choose Your Agency Carefully

Not all agencies are created equal. The agency you choose determines your pay rate, your assignment options, and the quality of your experience.

Questions to ask every agency:

• What is your typical markup percentage?
• Will you show me the bill rate, or just the pay rate?
• What does your credentialing timeline actually look like?
• Do you have a non-compete clause?
• What happens if an assignment is cancelled?
• Do you provide occurrence-based malpractice with tail coverage?

3. Negotiate Your Contract

Never accept the first offer. Locum tenens contracts are negotiable — rates, travel stipends, housing arrangements, cancellation terms, and call expectations are all on the table.

Critical contract clauses to understand:

• Tail coverage — who pays if a malpractice claim is filed after your assignment ends?
• Non-compete clauses — can you work at that hospital through another agency (or directly) later?
• Cancellation policy — what happens if the facility cancels your assignment 2 weeks before the start date?
• Conversion fees — if the facility wants to hire you permanently, how much does the agency charge them?

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

4. Plan Your Finances

Set up:

• A separate business bank account
• A tax savings account (auto-transfer 30% of each payment)
• Quarterly estimated tax payments (IRS Form 1040-ES)
• Health insurance (marketplace or private)
• Disability insurance (own-occupation policy)
• Retirement account (Solo 401k is usually optimal for high earners)

Consider forming an LLC or S-Corp if you'll earn over $200K — the tax savings can be significant. For the full financial planning guide, see our locum tenens tax guide.

5. Start with One Assignment

Don't quit your job and go full-time locums overnight. Take one assignment — a weekend moonlighting gig, a 2-week vacation coverage, or a 13-week trial. See if the lifestyle fits. Then scale up.

For Hospitals: Why Locum Tenens Is a Strategic Investment, Not a Cost

If you're a hospital administrator, CMO, or medical staff director reading this, here's the perspective most articles miss.

The Cost of a Physician Vacancy

An unfilled physician position costs a hospital $150,000–$250,000+ per month in lost revenue, depending on specialty. For a high-revenue specialty like cardiology or orthopedics, it can exceed $500,000/month.

The math is simple: a locum physician at $4,000/day ($80K/month all-in) generating $200K+/month in patient revenue is a net positive — even at premium rates.

When Locum Tenens Makes Sense

• Permanent recruitment taking too long — the average physician recruitment cycle is 6–12 months. Locums bridges the gap.
• Testing a new service line — want to add GI or orthopedics? A locum physician lets you prove demand before committing to a permanent hire.
• Seasonal volume fluctuations — snowbird states, college towns, and resort communities all have predictable demand spikes.
• Emergency coverage — when a physician leaves unexpectedly, locums can be in place within 14–21 days.
• <a href="/blog/locum-tenens-rural-critical-access-hospitals">Rural and critical access hospitals</a> — for facilities that can't attract permanent specialists, rotating locum coverage may be the most viable long-term staffing model.

How to Reduce Your Locum Tenens Costs

1. Understand the markup. Ask your agency to disclose the bill rate breakdown. Traditional markups of 40–50% are common — but not necessary. Low-margin agencies operate at 15–22% and pass the savings to both you and the physician. See our locum tenens pricing guide for the full breakdown.

1. Use a VMS. Vendor Management Systems create competitive bidding among agencies, which drives rates down.

1. Plan ahead. Emergency coverage costs 20–30% more than planned coverage. If you know a physician is leaving in 6 months, start the locum search now.

1. Consider locum-to-perm. Many placements convert to permanent hires. Negotiate the conversion fee upfront — it's typically $25K–$75K but can often be reduced or credited against the locum spend.

The Physician Shortage: Why Locum Tenens Is Growing

The structural forces driving locum tenens growth aren't going away. Understanding them helps you see why this market will only get stronger over the next decade.

The AAMC physician shortage projection:

*Source: AAMC 2024 Physician Workforce Projections*

What's driving the shortage:

• Aging population — the 65+ population is growing 30% faster than working-age adults, driving disproportionate healthcare demand
• Physician aging — 40%+ of currently active physicians are over 55 and approaching retirement
• Rural hospital closures — 150+ rural hospitals have closed since 2010, concentrating demand in fewer facilities
• Burnout and early retirement — 53% of physicians report burnout; many are leaving clinical practice earlier than planned
• Training pipeline constraints — residency slots are federally capped and haven't kept pace with demand growth

The result: hospitals that can't recruit permanent physicians turn to locum tenens. And as the shortage deepens, that demand grows. Physicians who understand this market have significant leverage — more assignments available than physicians to fill them, rate negotiation power, and long-term career viability.

Locum Tenens Myths vs. Reality

The Future of Locum Tenens

Three forces are reshaping the industry:

1. The Physician Shortage Is Accelerating

The AAMC's projected shortfall of 37,800–124,000 physicians by 2034 isn't theoretical — it's already being felt. Rural communities, safety-net hospitals, and underserved specialties are hit hardest. Locum tenens fills the gap.

2. Technology Is Removing Friction

Telehealth credentialing, interstate compact licensing (IMLC now covers 42 states), AI-powered matching, and digital credentialing platforms are compressing the 60–90 day startup timeline. Agencies that leverage technology can credential and place physicians in as few as 21 days.

3. Physician Preferences Are Shifting

The post-COVID physician workforce is fundamentally different. Flexibility isn't a perk — it's a requirement. Younger physicians who saw colleagues burn out during the pandemic are choosing portfolio careers: part-time locums, part-time telehealth, part-time clinical research. The traditional model of one job, one location, one employer for 30 years is fading.

Locum tenens isn't a trend. It's the future of physician staffing.

Frequently Asked Questions

What is locum tenens in simple terms?

Locum tenens is temporary physician staffing. A doctor works at a hospital or clinic on a short-term basis — anywhere from a few days to a year or more — to cover for absent physicians, fill vacancies, or meet increased patient demand. The physician is typically placed by a staffing agency and works as an independent contractor.

How is "locum tenens" pronounced?

LOH-kum TEN-enz. It's Latin for "to hold the place of." You'll also hear it shortened to "locums" (LOH-kumz) in casual conversation. Both the singular ("a locum tenens physician") and plural ("locum tenens physicians") use the same phrase.

How much do locum tenens doctors make?

Pay varies widely by specialty, location, and urgency. Ranges in 2026: Primary Care $130–$200/hr, Emergency Medicine $250–$350/hr, Anesthesiology $250–$450/hr, Cardiovascular Surgery $400–$550/hr. Locum physicians typically earn 30–50% more per hour than permanently employed physicians in the same specialty. For the complete salary breakdown by specialty, see our 2026 Locum Tenens Salary Guide.

Do locum tenens physicians pay their own taxes?

Yes. Most locum physicians are 1099 independent contractors, which means no taxes are withheld from your pay. You're responsible for federal income tax, self-employment tax (15.3%), and state income taxes — potentially in multiple states. You must make quarterly estimated payments to the IRS. Our locum tenens tax guide walks through every detail.

What's the difference between locum tenens and permanent employment?

Locum tenens offers higher hourly pay, complete schedule control, geographic flexibility, and zero administrative duties — but no employer-provided benefits, less job security, and more paperwork. Permanent employment offers stability, benefits, career advancement, and long-term patient relationships — but less flexibility and typically lower hourly compensation. Many physicians do both at different career stages.

How does locum tenens work?

A facility identifies a coverage gap, contacts a staffing agency, the agency matches a qualified physician, credentialing is completed (typically 21–90 days), and the physician begins the assignment. The agency handles malpractice insurance, travel, housing, and licensing. The physician is paid weekly as a 1099 independent contractor.

Is locum tenens worth it?

For most physicians who try it, yes. The combination of higher pay, schedule control, zero administrative burden, covered malpractice, and paid travel/housing produces better financial and lifestyle outcomes than permanent employment for the majority of physicians who make the switch. The trade-offs — managing your own taxes and benefits, income variability, no long-term patient relationships — are real but manageable.

Do locum tenens physicians get benefits?

No employer-sponsored benefits — no health insurance, 401(k) match, or PTO. However, the higher hourly pay, covered malpractice ($15K–$40K value), travel/housing ($25K–$50K value), and tax deductions typically more than compensate. Locum physicians purchase their own health insurance (100% deductible) and contribute to Solo 401(k) plans with limits up to $70,000/year.

How long does locum tenens credentialing take?

The industry average is 60–90 days. Agencies with strong facility relationships can complete credentialing in 21 days. For urgent coverage needs, facilities can grant emergency temporary privileges in 24–72 hours while full credentialing runs in parallel. For the complete credentialing walkthrough, see our Credentialing 101 guide.

What specialties do locum tenens?

Almost every specialty has a locum tenens market. The highest demand and highest pay are in diagnostic radiology, gastroenterology, anesthesiology, emergency medicine, and psychiatry. Hospitalist and primary care locums are the highest-volume markets by number of assignments.

Can you do locum tenens while working a permanent job?

Yes. Many physicians supplement their permanent income with locum work on days off. The shift-based structure of emergency medicine, hospitalist medicine, and anesthesia makes this particularly practical. Confirm your permanent employer's contract doesn't restrict outside work before accepting locum assignments.

How do I find locum tenens jobs?

Through a staffing agency. Agencies maintain relationships with hospitals and match physicians to assignments. You can work with multiple agencies simultaneously — there's no exclusivity requirement. When evaluating agencies, ask about their margin (lower is better for you), credentialing timeline, malpractice coverage type, and whether they'll disclose the hospital's bill rate.

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

The industry average is 60–90 days, which includes agency credentialing (7–14 days), hospital privileging (30–60 days), and state licensure if needed (4–12 weeks). Some agencies can compress this to 14–21 days with streamlined processes and pre-credentialing. The Interstate Medical Licensure Compact (IMLC) significantly speeds up multi-state licensing.

Do I need to be board certified to do locum tenens?

Most hospital-based assignments require board certification (or board eligibility within a specific timeframe, typically 5 years of training completion). Some outpatient, urgent care, and rural assignments accept board-eligible physicians. Fellowship training may be required or preferred for subspecialty positions.

Who provides malpractice insurance for locum tenens?

The staffing agency typically provides malpractice insurance as part of the assignment. The key question is whether it's occurrence-based (covers incidents during the policy period regardless of when the claim is filed) or claims-made (only covers claims filed while the policy is active). Occurrence-based with tail coverage is the gold standard — always confirm this before accepting an assignment. For more on malpractice in contracts, see our contract negotiation guide.

Can I do locum tenens while keeping my permanent job?

Yes. 66% of locum physicians work part-time alongside a permanent position. Check your employment contract for non-compete clauses or moonlighting restrictions first. Many physicians start with weekend or vacation coverage assignments before transitioning to full-time locums.

What specialties are in highest demand for locum tenens?

As of 2026, the highest-demand specialties are: Psychiatry (#1 by volume), Anesthesiology/CRNAs, Emergency Medicine, Radiology, Primary Care/Family Medicine, Hospitalist Medicine, and Surgical subspecialties (orthopedics, general surgery, CV surgery). Demand is driven by specialty-specific shortages, retirement patterns, and the growth of telehealth.

How do locum tenens agencies make money?

Agencies charge the hospital a bill rate and pay the physician a lower pay rate. The difference — the markup — covers the agency's operating costs and profit margin. Traditional agencies mark up 40–50%. This means if a hospital pays $600/hr for an anesthesiologist, the physician might receive only $330–$360/hr. Understanding agency markups is the most important financial decision a locum physician can make.

Is locum tenens worth it?

It depends on what you value. If you prioritize schedule control, geographic freedom, higher hourly pay, and practicing medicine without administrative burden — locum tenens can be transformative. If you prioritize job security, employer benefits, long-term patient relationships, and career advancement within one organization — permanent employment may be a better fit. The honest answer is that most physicians benefit from trying locums at least once. 52% already have.

The Bottom Line

Locum tenens is a $5.4 billion industry that 96% of U.S. hospitals depend on — and it's growing at 7–9% annually because the physician shortage is structural, not cyclical.

For physicians, it offers a genuine alternative to the traditional employment model: higher pay, complete schedule control, zero administrative burden, and covered malpractice and travel. The trade-offs are real — you manage your own taxes and benefits, income can be variable, and there's no long-term patient continuity. But for the 52% of physicians who've tried it, and the 38% who've made it their primary income source, the math and the lifestyle work.

The physicians who get the most out of locum tenens are the ones who approach it intentionally: choosing low-margin agencies, targeting high-demand specialties and regions, structuring their taxes intelligently, and negotiating from real market data.

Ready to explore what locum tenens looks like for your specialty?

Use our free tax calculator to model your take-home by specialty, state, and working weeks. For current pay rates by specialty, see our 2026 Locum Tenens Salary Guide. For the full benefits breakdown, see our locum tenens benefits guide. For how the 1099 tax structure works, see our independent contractor guide. For contract red flags before signing, see our contract negotiation guide.

*Statistics sourced from AAMC 2024 Physician Workforce Projections, Staffing Industry Analysts Healthcare Staffing Report 2024, AMN Healthcare Survey of Facility Staffing 2024, CompHealth 2025 State of Locum Tenens Report, Barton Associates Locum Tenens Workforce Survey, and Medscape Physician Compensation Report 2024. All rates are 2026 market data.*