Locum Tenens: Complete Physician Guide to Pay, Agencies & How to Start (2026)

What Is Locum Tenens?

Locum tenens (Latin for "one who holds the place") refers to physicians who work on temporary assignments at hospitals, clinics, and practices rather than in permanent employed positions. The market is substantial — roughly 50,000 US physicians work locums at least part-time, and the US locum tenens staffing market exceeds $4 billion annually.

Physicians choose locums for different reasons: maximizing income during peak earning years, geographic flexibility, avoiding administrative burdens of permanent employment, testing a new specialty or geography before committing, or supplementing income alongside a part-time permanent position.

Locum Tenens Daily Rates (2026)

Locum pay is typically quoted as a daily rate (8-hour day) or hourly rate. Rates vary dramatically by specialty, geography, assignment type, and urgency. General benchmarks:

• Family Medicine / Internal Medicine: $1,200–$2,200/day
• Emergency Medicine: $1,800–$3,200/day (hourly: $225–$400/hour)
• Hospitalist: $1,400–$2,400/day
• Psychiatry: $1,600–$2,800/day (telehealth assignments often on the lower end)
• Anesthesiology: $2,000–$3,600/day
• Radiology: $1,800–$3,000/day (teleradiology often structured differently)
• Orthopedic Surgery: $2,200–$4,000/day
• OB/GYN: $2,000–$3,400/day
• Cardiology: $2,200–$3,600/day

In addition to daily rates, agencies typically cover round-trip travel, lodging (hotel or furnished apartment), and malpractice coverage (occurrence or claims-made with tail).

How Locum Tenens Agencies Work

Staffing agencies connect physicians with facilities. The agency handles credentialing, contract negotiation, logistics (travel, housing), and malpractice coordination. In exchange, the agency adds a margin above the facility's pay rate — typically 15–40% of the total bill rate.

Physicians work with multiple agencies simultaneously to maximize assignment options. Key agencies in the locum market:

• CompHealth (AMN Healthcare) — largest locum tenens firm; broad specialty coverage; known for strong credential support
• Weatherby Healthcare (AMN) — hospital-focused; strong in procedural specialties and surgical locums
• Medicus Healthcare Solutions — independent; strong relationships with rural and critical access hospitals
• LocumLife / Barton Associates — strong in NP/PA and physician locums for outpatient/clinic settings
• Global Medical Staffing — US and international locum assignments
• Ava Health Partners — physician recruiting with locum and direct-hire options in FL, LA, TX, and the Southeast

Malpractice Insurance for Locum Physicians

Most agencies provide malpractice coverage while you're on assignment. Verify:

• Coverage type: occurrence (covers incidents that occurred during coverage, even after policy ends) vs claims-made (only covers claims filed while the policy is active). Occurrence is preferable; if claims-made, confirm the agency provides a tail.
• Coverage limits: $1M/$3M is standard; surgical specialties often require $2M/$6M or higher
• Gaps between assignments: if you take time off, you may not be covered during the gap — confirm with the agency

Tax Setup for Locum Physicians

Most locum physicians operate as independent contractors (1099). Tax setup recommendations:

• Form a PLLC or S-Corp — allows you to take a portion of income as a salary (subject to payroll taxes) and the remainder as a distribution (not subject to self-employment tax). The S-Corp election can save $10,000–$30,000+ annually in SE tax at high income levels.
• Quarterly estimated taxes — required when you don't have withholding. Missing them triggers underpayment penalties.
• Deductible expenses — CME, professional dues, medical license fees, home office (if used exclusively for work), travel not reimbursed by agency
• SEP-IRA or Solo 401(k) — as a self-employed physician, you can contribute up to $69,000/year to a SEP-IRA or similar plan, dramatically reducing taxable income

Work with a CPA who specializes in physician finances — the tax strategy differences between a W-2 employee and a 1099 independent contractor locum physician can mean $50,000+ in annual tax differences.

How to Get Started in Locum Tenens

1. Contact 2–3 agencies — register with multiple agencies simultaneously; compare assignment availability and rates
2. Get your credentials packet ready — DEA registration, state medical license(s), board certification, CV, references, CME transcripts; agencies need all of this to credential you at facilities
3. Confirm your malpractice status — understand your current coverage and what tail requirements your current employer has if you're transitioning from employed to locum
4. Apply for state licenses strategically — the IMLC (Interstate Medical Licensure Compact) allows expedited licensing in 40+ member states; applied physicians get licenses in 2–3 months vs 6–12 months traditional pathway
5. Start with a short assignment — 1–2 weeks before committing to a longer contract lets you evaluate the facility, patient population, and workflow fit