Becoming a locum tenens physician requires the same medical training as any other practicing doctor, plus a few extra steps around licensing, credentialing, and setting yourself up as an independent contractor. The Latin phrase means “to hold the place of,” and the work involves filling temporary staffing gaps at hospitals, clinics, and other facilities across the country. If you already have your medical degree and residency behind you, the path to your first assignment is shorter than you might expect.
Education and Training You Need First
There are no shortcuts here. You need a medical degree from an accredited school (MD or DO), completion of an ACGME- or AOA-accredited residency program, and board certification in your specialty. These are the same requirements as permanent physician positions. Most facilities and staffing agencies expect board certification to be current, not just completed at some point in the past.
While physician assistants and nurse practitioners can sometimes find locum work right out of graduate school, physicians are generally expected to have finished residency and passed their board exams before taking locum assignments. Many positions also prefer at least two years of post-residency clinical experience, though this varies by specialty and how urgently the facility needs coverage.
Getting Licensed in Multiple States
Locum tenens work often means practicing in states where you don’t currently hold a license. Each state has its own medical board, and applying individually to several states is time-consuming and expensive. The Interstate Medical Licensure Compact (IMLC) solves much of this problem.
The Compact is a voluntary, expedited pathway that lets you apply for licenses in multiple member states through a single process. As of early 2026, 43 states and 2 U.S. territories participate. Alaska and Massachusetts have legislation under consideration, and Michigan is working to rejoin. To use the Compact, you designate one member state as your State of Principal License (SPL), which must be where you live, where at least 25% of your practice takes place, where your employer is located, or the state you use for federal tax purposes.
Eligibility requirements are strict. You need a clean disciplinary record, no criminal history, no controlled substance actions against your license, and you must have passed each component of the USMLE or COMLEX-USA in no more than three attempts per component. The application fee is $700 (non-refundable), and you pay each state’s individual license fee on top of that. If your record is clean and your credentials are straightforward, this is the fastest route to practicing across state lines.
Working With a Staffing Agency
Most locum tenens physicians work through a staffing agency rather than finding assignments independently. Agencies handle a significant amount of the logistical and administrative burden that would otherwise fall on you. They match you with a recruiter who learns your preferences for location, schedule, and practice setting, then connects you with facilities that fit.
Beyond job matching, agencies typically coordinate travel and housing, assist with licensing and credentialing paperwork, negotiate your pay rate with the facility, and provide malpractice insurance. In most cases, malpractice coverage is included as part of the agency arrangement, which removes one of the bigger financial and administrative headaches of independent practice. You’ll negotiate an hourly or daily rate before accepting any assignment, and the agency pays you directly rather than the facility.
The tradeoff is that agencies take a cut of the billing rate the facility pays. Working independently (contracting directly with facilities) lets you keep more per hour but requires you to handle your own credentialing, licensing, travel, malpractice insurance, and contract negotiations. Most physicians, especially those starting out in locum work, find the agency route far more practical.
What to Expect With Housing and Travel
Staffing agencies generally cover your travel and housing costs, though what that looks like depends on the assignment. For short stints under a month, expect an extended-stay hotel. Longer assignments typically come with a fully furnished apartment. In rural areas where apartments are scarce, you might be placed in a private rental home. If the assignment is close enough to drive, you may be reimbursed for mileage instead of receiving airfare. For distant assignments, the agency books flights and arranges a rental car.
It’s worth communicating your preferences clearly upfront. Agencies aim for safe, convenient accommodations, but “convenient” means different things to different people. If you need a kitchen, a pet-friendly space, or proximity to a gym, say so before the booking is made.
Compensation and How It Compares
Locum tenens physicians typically earn more per hour than their permanently employed counterparts. On average, full-time locum physicians make over $32 more per hour than permanent staff in the same roles. That premium reflects the lack of traditional benefits (employer-sponsored health insurance, retirement contributions, paid time off) and the flexibility you’re offering the facility.
Your actual rate depends on your specialty, the location, the urgency of the facility’s need, and your experience level. Rural and underserved areas often pay more because demand is higher and candidates are fewer. You negotiate your rate before accepting an assignment, so you always know what you’re earning upfront.
Taxes as an Independent Contractor
This is the part that catches many new locum physicians off guard. Unlike salaried positions where taxes are automatically withheld, locum tenens physicians are typically classified as independent contractors. You receive a 1099-NEC instead of a W-2, and nothing is withheld from your pay for federal income tax, Social Security, or Medicare.
That means you’re responsible for making quarterly estimated tax payments to the IRS using Form 1040-ES. These are due April 15, June 15, September 15, and January 15. Miss these deadlines and you’ll face penalties. On top of federal and state income taxes, you pay self-employment tax at 15.3% on your net earnings, which covers both the employee and employer portions of Social Security and Medicare.
The upside is that you can deduct a wide range of business expenses that permanent employees cannot. Common deductions for locum physicians include:
- Travel costs: Flights, rental cars, lodging, baggage fees, and mileage (the IRS standard rate for 2026 is 70 cents per mile) when not reimbursed by your agency
- Meals: Food costs while traveling for assignments
- Professional development: CME courses, conference travel, licensing fees, DEA registration, board certification costs, and professional dues
- Equipment and supplies: Your phone, medical equipment, and work-related technology
- Health insurance premiums: Deductible as a business expense when you pay for your own coverage
- Malpractice insurance: Deductible if you pay for it yourself rather than having it covered by an agency
- Home office: A portion of rent, mortgage interest, utilities, and internet if you use part of your home regularly and exclusively for administrative work
Working with a tax professional who understands 1099 income and self-employment tax is well worth the expense, particularly in your first year of locum work when the shift from W-2 employment can lead to costly mistakes.
Credentialing Before Your First Assignment
Every facility where you work will need to credential you independently, even if you’re fully licensed in that state. Credentialing verifies your education, training, board certification, malpractice history, and work history. Your agency handles much of this process, but you’ll need to keep an up-to-date CV, copies of your transcripts and exam scores, your medical school diploma, postgraduate certificates, and any other relevant documentation ready to submit promptly.
Credentialing can take weeks, sometimes longer, depending on the facility. The single biggest thing you can do to speed up your start date is respond quickly to document requests and keep your files organized. Some physicians maintain a digital credentialing folder that they can share at a moment’s notice, which makes the gap between accepting an assignment and actually starting as short as possible.
Benefits and Insurance You Arrange Yourself
As an independent contractor, you don’t receive employer-sponsored benefits. Health insurance, retirement savings, disability coverage, and life insurance are all your responsibility to arrange and fund. Health insurance premiums are deductible as a business expense, which helps offset the cost, but you still need to actively select and maintain a plan.
For retirement, options like a solo 401(k) or SEP IRA let self-employed physicians contribute significantly more than a traditional IRA. Since you’re earning well and paying self-employment tax, maximizing these contributions can meaningfully reduce your tax burden while building long-term savings.