A locum doctor is a physician who fills temporary positions at hospitals, clinics, or practices rather than holding a permanent staff role. The term comes from the Latin phrase “locum tenens,” meaning “to hold the place of.” About 52,000 physicians work locum assignments in the United States each year, representing roughly 8% of all practicing doctors.
How Locum Work Differs From Permanent Practice
A permanently employed physician works for one employer on an ongoing basis with a set schedule, benefits package, and salary. A locum doctor, by contrast, takes short-term assignments that can last anywhere from a single weekend to several months. They might cover for a doctor on maternity leave, fill a gap while a practice recruits a permanent hire, or staff a rural clinic that can’t attract a full-time physician.
Locum doctors are typically independent contractors rather than employees. This means they receive a 1099 tax form instead of a W-2, handle their own tax withholdings, and are responsible for self-employment taxes. Most work through staffing agencies that match them with facilities, negotiate pay rates, and handle the logistical details of each assignment.
The model first emerged in the 1970s as a way to address physician burnout in rural Utah, and it has since expanded into a major segment of healthcare staffing nationwide.
Why Hospitals and Clinics Hire Locum Doctors
Healthcare facilities turn to locum physicians for several reasons. The most straightforward is coverage gaps: when a staff doctor takes leave, retires, or resigns unexpectedly, patient appointments and hospital shifts still need to be filled. Recruiting a permanent replacement can take months, and a locum keeps the practice running in the interim.
Rural and underserved areas rely on locums more heavily because they struggle to recruit permanent physicians. A small-town hospital that loses its only cardiologist can’t wait six months for a replacement, so a locum bridges the gap. Locum staffing also helps facilities manage seasonal surges in patient volume or test whether they need to add a permanent position in a particular specialty.
Which Specialties Use Locums Most
Some medical specialties depend on temporary physicians far more than others. Urgent care leads the pack, with 41.5% of urgent care facilities using locum doctors. Hospital medicine follows at 30.1%, and emergency medicine at 24.4%. These specialties share a common thread: shift-based work that’s relatively easy to hand off between providers, since patients are typically seen once rather than followed over time.
Specialties like primary care and psychiatry also have significant locum demand, largely driven by nationwide shortages of permanent providers in those fields.
What Locum Doctors Earn
Higher compensation is one of the biggest draws of locum work. Locum physicians typically earn about 30% more than their permanently employed counterparts, though the premium varies by specialty and location. Some facilities also provide travel stipends, housing allowances, student loan repayment assistance, or malpractice insurance coverage on top of the hourly or daily rate.
To give a sense of the range: emergency medicine locums earn between $160 and $245 per hour, hospitalists between $140 and $180, and psychiatrists between $145 and $180. At the higher end, anesthesiologists command $285 to $350 per hour, while cardiologists and trauma surgeons can earn up to $2,500 per day. Internal medicine and pediatrics sit at the lower end, with rates of $90 to $130 and $100 to $150 per hour respectively.
These numbers look impressive, but they come with trade-offs. Independent contractors don’t receive employer-sponsored health insurance, retirement contributions, or paid time off. They also pay the full self-employment tax, which covers both the employee and employer portions of Social Security and Medicare. After accounting for those costs, the effective premium over permanent employment narrows, though most locums still come out ahead financially.
Why Doctors Choose Locum Work
Money matters, but it’s not the top reason physicians go locum. In surveys of locum doctors, 97% rated freedom and flexibility as the most rewarding or moderately rewarding aspect of the work. When asked what drove their decision, 86% cited wanting a better schedule, 80% wanted to reduce or address burnout, 75% were frustrated with falling compensation in permanent roles, and 71% were dissatisfied with being an employee.
For early-career physicians, locum work serves as a way to explore different practice settings before committing to one. You can try working in a large hospital system, a small group practice, and a rural clinic all within a single year. One physician recruiting executive described it as the ability to “date before you marry,” testing out different clinical environments, geographic areas, and work cultures without a long-term contract.
Physicians nearing retirement also find locum work appealing. It lets them scale back their hours gradually rather than going from full-time practice to nothing overnight.
Getting Credentialed and Licensed
One of the biggest hurdles in locum work is the paperwork. Every state requires its own medical license, so a doctor who wants to take assignments in multiple states may need to apply for several licenses, each with its own processing time, fees, and requirements. Most state boards require a completed application, proof of medical education and training, board certification verification, professional references, and background checks including fingerprinting in some states. Processing times range from a few weeks to several months depending on the state.
Beyond state licensure, each facility where a locum works must credential them individually. This involves verifying training, prior employment, malpractice claims history, immunization records, and current licenses. The credentialing process typically takes 60 to 90 days, though some facilities take up to 120 days. Staffing agencies usually manage much of this paperwork, but the timeline means locum doctors need to plan well ahead of their desired start dates.
Malpractice Insurance for Locums
Malpractice coverage is a critical detail for any locum doctor. Many staffing agencies and hiring facilities provide malpractice insurance as part of the assignment, which is one of the practical benefits of working through an agency rather than independently.
The type of policy matters. “Occurrence” policies cover any incident that happened during the policy period, regardless of when the claim is filed. “Claims-made” policies only cover you if the same insurer is in place both when the incident occurred and when the lawsuit is filed. Since locum doctors move between assignments and insurers frequently, claims-made policies create a gap: if you leave an assignment and the policy ends, you’re unprotected against late-filed claims from that period. Closing that gap requires purchasing “tail insurance,” an additional policy that extends coverage after the original one expires. If your agency or facility provides occurrence-based coverage, this isn’t an issue.
The Trade-Offs for Patient Care
Locum doctors fill a real need, but the model has limitations. The most significant is continuity of care. A locum physician stepping into an unfamiliar clinic doesn’t know the patients, their histories, or the subtle context that a regular doctor picks up over years of visits. Locum doctors themselves cite the inability to provide continuity as one of the main drawbacks of the work, along with limited ability to change clinic protocols or workflows that they see as problematic.
There’s also a learning curve with each new assignment. Every facility has different electronic health record systems, different support staff, and different referral networks. Locum physicians report that constantly adapting to new environments is one of the more challenging aspects of the lifestyle, both in finding each new opportunity and in getting up to speed once they arrive.
For patients, seeing a locum doctor is generally no different from seeing any other qualified physician. These are fully licensed, credentialed doctors practicing within their specialty. The main difference is that you may not see the same doctor at your next visit, which can matter more in ongoing care situations like managing a chronic illness than in one-time encounters like an urgent care visit or emergency room trip.