Locum tenens is a staffing arrangement where physicians take temporary assignments at healthcare facilities instead of holding permanent positions. A staffing agency sits in the middle, connecting doctors with hospitals or clinics that need coverage. The agency handles most of the logistics, from credentialing to travel, while the physician works as an independent contractor. Nearly 90% of hospitals and medical groups use locum tenens hiring, most often to fill gaps while searching for permanent staff.
The Basic Setup
Three parties are involved in every locum tenens arrangement: the physician, the staffing agency, and the healthcare facility. The facility tells the agency what kind of provider it needs, including specialty, schedule, and expected procedures. The agency then matches that request with physicians in its network who have the right qualifications and availability.
Once a match looks promising, the facility screens the candidate, usually starting with a phone call to confirm qualifications, scope of the assignment, and whether the physician is a good cultural fit for the team. If both sides agree, two documents formalize the deal. A master agreement sets the overall business terms between the facility and the agency. A confirmation letter spells out the specifics of that particular assignment: work dates, location, and compensation. Every new assignment gets its own confirmation letter, even if the physician has worked with the same facility before.
What the Agency Actually Does
The staffing agency is more than a matchmaker. Before a physician’s name ever reaches a facility, the agency pre-screens their credentials, verifying licenses, board certifications, work history, and malpractice records. Many of these documents overlap with what the hospital needs for its own credentialing process, so the agency often serves as a go-between, collecting paperwork from the physician and passing it along to the facility’s medical staff office.
The agency also arranges travel and housing. When you accept an assignment, the agency typically covers round-trip airfare (or mileage reimbursement if you drive), a rental car or other ground transportation, and private, furnished housing for the duration of the assignment. These aren’t reimbursements you chase down later. They’re arranged before you arrive. For physicians, this is one of the biggest practical perks: you can take a job across the country without coordinating a temporary move on your own.
Credentialing and Licensing Timelines
Credentialing is usually the bottleneck. Standard hospital credentialing cycles take 30 to 90 days, which covers background checks, license verification, and granting clinical privileges. Many facilities can speed this up through expedited or temporary privileges, especially for board-certified physicians with clean records. In urgent situations where the physician already holds an in-state license and has no credentialing flags, coverage can sometimes begin within a few weeks. When new state licensure and full credentialing are both required, the timeline can stretch to several months.
State licensing is its own step. Physicians need a valid medical license in whatever state they’re practicing in, and historically that meant applying separately to each state board. The Interstate Medical Licensure Compact has simplified this considerably. It offers an expedited pathway for physicians who want to practice across state lines, and 43 states plus two U.S. territories currently participate. If you plan to work locum tenens in multiple states, the Compact can save significant time compared to filing individual applications.
Pay Structure and Tax Status
Locum tenens physicians are typically classified as independent contractors, not employees of the facility or the agency. You receive a 1099 instead of a W-2, which means no taxes are withheld from your pay. You’re responsible for estimated quarterly tax payments and self-employment tax.
Pay rates vary widely by specialty and are quoted hourly or as a daily rate. Some representative hourly ranges: anesthesiology runs $300 to $425, emergency medicine $250 to $300, family medicine $120 to $135, hospitalist work $170 to $190, and general surgery or OB-GYN $150 to $200. These figures typically exceed what the same physician would earn per hour in a permanent salaried role, partly because the rate compensates for the lack of employer-provided benefits.
The independent contractor status does come with tax advantages. You can deduct business expenses including health and dental insurance premiums, mileage, meals during assignments, and equipment you use for work like laptops, tablets, and cellphones. Some physicians set up a business entity to manage these deductions more efficiently.
Why Facilities Use Locum Tenens
The most common reason is simple: a facility has a gap in patient care and no permanent physician to fill it. That gap could come from a doctor leaving, a retirement, a maternity leave, or a growing patient volume that outpaces recruiting. Rural and underserved areas lean on locum tenens heavily because permanent recruitment in those regions can take a year or longer. Having a temporary physician keeps revenue flowing and prevents patients from being diverted to other facilities.
Facilities also use locum tenens strategically during permanent searches. Hiring a full-time physician is a months-long process involving interviews, contract negotiations, relocation, and credentialing. A locum provider bridges that gap so patient panels don’t sit unmanaged and referral networks don’t dry up.
Why Physicians Choose It
A 2024 survey of nearly 600 physicians and other healthcare professionals who had recently worked locum tenens found that work conditions and burnout were the most commonly cited reasons for choosing temporary work over (or in addition to) a permanent role. The flexibility to set your own schedule, avoid administrative politics, and take breaks between assignments appeals to physicians at every career stage, from those fresh out of residency exploring different practice settings to semi-retired doctors who want to stay clinically active without full-time obligations.
When surveyed about how they pick specific assignments, location was the top factor at 89%, followed by pay rate at 67%, length of assignment at 60%, and patient load at 38%. Some physicians use locum work to travel, spending a few months in a mountain town or coastal city before moving on. Others use it to supplement income from a part-time permanent position.
What a Typical Assignment Looks Like
Assignments range from a single weekend to six months or longer. A common scenario is a two-to-three month placement at a community hospital that lost a provider. You fly in (or drive, if you prefer), move into the furnished housing the agency arranged, and start seeing patients on the agreed schedule. The facility provides the support staff, the EMR system, and the clinical infrastructure. You provide the medical expertise.
Day to day, the work is clinically identical to a permanent position. You see patients, write notes, perform procedures within your credentialed scope, and coordinate with the existing care team. The main differences are administrative: you’re not sitting in committee meetings, navigating internal politics, or managing a panel long-term. When the assignment ends, you either extend if both sides agree or move on to the next opportunity. The agency typically has new options lined up before your current assignment wraps, so gaps between assignments are as long or short as you want them to be.
What You Give Up
The tradeoffs are real. As an independent contractor, you don’t receive employer-sponsored health insurance, retirement contributions, paid time off, or disability coverage. You fund all of that yourself. The higher hourly rate is designed to offset these costs, but it requires more financial planning than a salaried position where benefits are automatic.
There’s also less continuity. You won’t follow patients over years, build long-term relationships with a care team, or have a say in how a practice evolves. Some physicians find this liberating. Others miss the sense of belonging. The learning curve at each new facility, including different EMR systems, workflows, and team dynamics, can also be draining if you’re switching settings frequently.