The History Of Locum Tenens Physicians
/The History of Locum Tenens
The Latin translation for Locum Tenens is “to hold in place of” or “one holding a place”, and although I wish I could tell you a unique story of medieval doctors traveling around Europe in a 1972 VW minibus, it didn’t play out that way. The oldest logical origin of locum tenens work dates back hundreds of years, evolving into the business it is today and picking up the name along the way. In today’s post, we dissect the origins and history of locum tenens, starting way back in the 1800s and detailing the evolution and historical moments that shaped what locums is today. We will finish up with the current state of locums in 2018. Now gather round young kids and let grandpa tell you a story….
The earliest origins of modern locum tenens can be traced back to the mid 1850s, when California had just become a state and The New York Times was recently founded. At the time, frontiersmen had moved west in droves in search of gold and land in the rapidly growing number of new states. With expansion came new problems and a major source of concern was a lack of medical care in these newly founded towns and farms. The earliest ancestors of modern locum tenens can be traced to this period of American history, as records indicate both nurses and doctors would travel west for periods of time to provide medical care, albeit with limited resources. Although these physicians lacked a structured system of work, it would not take long for demand to be met with policy with the start of the Civil War in 1861. During the Civil War, doctors and nurses were assigned temporary positions by the government and would return to their pre-war practices, compensated for their time.
From 1900-1930, several medical advances brought a growth in locum tenens work. The newly developed mobile X-ray machine was used in limited capacity until the start of World War 1, when it was used with mobile technicians and radiologists in the treatment of wounded soldiers. At the conclusion of the war, a demand for physicians to treat returning soldiers provided the impetus for the opening of the first veterans emergency hospital in Virginia. Several years later President Hover would sign into law the creation of the Veteran Administration, providing the backbone for modern governmental locums as physicians often traveled between VA hospitals as they still can do today.
For almost 50 years, non-governmental physicians practiced locum tenens type work, but it did not take on a formal structured system until another demand surfaced. At this time, from 1968-1979, the modern era of locum tenens developed. In 1968, a group of American doctors would travel to Biafra Nigeria to aid in much needed medical care following a brutal civil war. Only 3 years later, the group would formalize itself under the name Doctors Without Borders. At the same time, in 1970, a need for rural physicians to receive continuing medical education training was proving to be an issue in Utah. Secondary to limited resources, doctors could not leave their towns for much needed education. To help with the growing problems of education and rural physician burnout (sound familiar!) an organization known as Health Systems Research Institute (HSRI), began offering a program at the University of Utah. Rural physicians were able to come for education and training largely because the program provided temporary physicians to cover their practices. This represented the first modern utilization of locum tenens physicians. As the program’s success grew, so did its demand, with similar programs starting in Alaska and California’s Yellowstone National Park. In 1979, the first true locum tenens staffing agency was founded when Dr. Alan Kronhaus and Dr. Therus Kolff, both prior travel doctors with HSRI started KRON Medical and Comprehensive Health Systems. I wondered why these two original founders wanted to do locum tenens, and the answer was easy to find. Dr. Kronhaus just wanted to ski. He took advantage of the opportunity HSRI provided and would take locum assignments all summer outside of Utah and save his money. He would return to Utah and take the winters off while pursuing his passion for big mountain skiing. Dr. Kolff’s story was slightly different, his entry into the locum tenens world started with a demand for visiting physicians in Yellowstone National Park to care for visitors and park rangers. These two had similar goals for life balance, to get off the hamster wheel and practice medicine on their own terms in a location they found inspiring. Together, they would set in motion the modern system of locum tenens.
From 1979 to 2001, the number of locum tenens agencies grew rapidly in response to demand for physicians by hospitals and practices. The original two staffing agencies saw competition in the form of specialty specific and expanded allied health locum tenens companies. In 2001, the National Association of Locum Tenens Organizations (NALTO) was founded with a commitment to ethics and to maintain the highest standard in the industry. NALTO provides guidelines of practices that protect both the agency and the physician. Such things as maintaining signed contracts, ownership and use of CV, resolution of disputes, and practice standards have allowed for transparency in the market. In 2018, NALTO has a total of 81 members, with a large majority being relatively young companies born out of a 20% growth in locum tenens demand in the past 5-10 years.
With the growth of physician’s locum tenens opportunities, many of the original and largest staffing agencies have grown in size and scope of services. Currently the 5 largest staffing agencies provide not only physician jobs, but service the nursing and allied health fields. The largest remains CHG Healthcare Services, the current name for the parent company of that small staffing agency in Yellowstone almost 40 years ago. Since 1979, it has grown to incorporate numerous smaller locum tenens agencies and recently expanded into international placements. In 2015 CHG represented 29% of the total locum tenens positons available with a revenue of 1.1 billion dollars. Not bad for a ski bum and a rural doctor in our national park!
Locum Tenens started over 150 years ago, with several adventurous doctors serving the frontier of a growing American landscape. In a way we have come a long way, both as a medical profession and a country, but the common reasons for interest in locum tenens work have not changed. Despite exponential growth over the past 10-20 years, the advent of technology and much needed regulation, the strong allure of locum tenens work remains. Within us all is a personal interest in adventure, a commitment to serving those in need and an earnest belief that doctors can still practice in an environment and a manner they believe in.
~The Locums Life~
FAQ: The History of Locum Tenens Work for Physicians
1) What does “locum tenens” mean, literally?
Locum tenens is Latin for “holding the place.” In modern healthcare, locum tenens physicians are doctors who temporarily fill staffing gaps—covering shifts, blocks, or contracts when a hospital, clinic, or practice needs short-term clinical coverage. The phrase matters for SEO because many people search “what does locum tenens mean” when first exploring locums work.
2) How old is the concept of locum tenens work?
The concept is older than modern medicine. The idea of a trained professional temporarily covering for another is centuries old in clergy, law, and government roles. In medicine, locum-style coverage emerged as communities needed temporary clinicians during:
illness or retirement of local physicians
rural shortages
war mobilization
seasonal population changes
Modern locum tenens physician staffing is a structured industry version of that long-standing concept.
3) When did locum tenens become a formal part of medical practice?
The modern locum tenens physician industry took shape primarily in the late 20th century, as healthcare systems grew more complex and staffing needs became more volatile. As hospitals expanded service lines, call coverage requirements, and regulatory demands, “temporary physician staffing” became a predictable, recurring need rather than an occasional emergency fix.
4) Why did locum tenens work grow so much in the United States?
Locum tenens growth is tied to several forces:
physician shortages in many specialties and rural areas
increasing complexity of scheduling, coverage, and call
hospital consolidation and expansion
burnout and early retirement trends
greater demand for flexible staffing models
the rise of staffing agencies able to recruit and credential physicians quickly
In short: the system needed a pressure valve—and locum tenens became one of the most important ones.
5) Was locum tenens originally meant to be a career path?
Historically, locum tenens was often a temporary bridge:
covering for a physician on leave
filling in until a permanent hire was found
supporting underserved communities
providing short-term seasonal coverage
Over time, many physicians discovered that locum tenens could also be a long-term lifestyle and career strategy—especially for doctors prioritizing autonomy, travel, or financial acceleration.
6) How did the first locum tenens staffing agencies start?
Staffing agencies emerged to solve a specific problem: hospitals needed a reliable way to find credentialed physicians quickly, and physicians needed an organized way to find temporary work without negotiating each detail alone. Early agencies acted as matchmakers and logistics managers—handling credentialing, travel, housing, and contracts. As demand grew, agencies evolved into large businesses that built national networks of clinicians and client facilities.
7) How did credentialing requirements shape the locum tenens industry?
Credentialing became a major driver of agency value. Hospitals require verification of training, licensure, malpractice history, references, and often background checks and immunization records. Because credentialing can be slow and repetitive, agencies that developed efficient credentialing workflows gained a competitive advantage.
This is one reason modern locum tenens work is often easier through an established agency than independently—agencies know how to move paperwork faster.
8) What role did rural medicine play in the history of locum tenens?
Rural and underserved communities have always been a major part of locums demand. When a rural hospital loses a physician, the impact can be immediate and severe. Locum tenens physicians often serve as the bridge that keeps services alive:
ER coverage
obstetrics coverage
anesthesia coverage
hospitalist coverage
specialty clinics
Historically, rural staffing needs helped normalize locum tenens as a legitimate and essential part of healthcare delivery.
9) How did hospital consolidation affect locum tenens growth?
As hospitals consolidated into larger systems, staffing models changed:
centralized scheduling
increased reliance on standardized coverage requirements
multi-site service lines
greater emphasis on productivity and revenue protection
When coverage gaps occur in a consolidated system, the financial and operational impact is large. Locum tenens became a tool to protect continuity of care and keep services running during recruitment, turnover, or growth phases.
10) How did physician burnout contribute to the rise of locum tenens?
Burnout didn’t create locum tenens, but it accelerated demand. As more physicians reduced hours, left employed roles, or retired early, hospitals faced more gaps. Meanwhile, some physicians turned to locums for relief from:
administrative burdens
productivity pressure
rigid schedules
hospital politics
This created a feedback loop: burnout increased staffing gaps, and locums filled them.
11) How did the rise of hospitalists change locum tenens?
The hospitalist model created new, shift-based staffing patterns, which naturally fit temporary coverage. Hospital medicine also expanded rapidly, increasing demand for:
night coverage
weekend coverage
seasonal surge staffing
Locum tenens agencies became a key solution for hospitalist staffing gaps, and the industry expanded with it.
12) How did specialty shortages shape locums work?
Specialty shortages made locums not just common but essential. Certain specialties became highly dependent on temporary staffing solutions due to:
limited supply
high call burden
recruitment challenges
geographic maldistribution
This is why locum tenens compensation varies widely by specialty and urgency—market forces drive rates.
13) How did temporary staffing shift from “emergency fill-in” to “strategic staffing”?
Over time, hospitals started using locum tenens strategically, not only in emergencies. Common strategic uses include:
keeping service lines open during recruitment
preventing revenue loss from cancelled clinics or OR blocks
covering maternity leave or medical leave
supporting expansion (launching new programs)
handling seasonal patient surges
Locums became a planning tool, not just a patch.
14) Did locum tenens become more common because younger physicians wanted flexibility?
Partially. Over the past few decades, more physicians have valued:
autonomy
schedule control
ability to live in one place while working in another
the option to travel
reduced administrative obligations
While older physicians also do locums, the cultural shift toward flexibility made locums more appealing—and increased the physician supply willing to do it.
15) How has compensation evolved in locum tenens historically?
Early locums arrangements were sometimes informal and inconsistent. As agencies professionalized, compensation became more standardized and market-driven, often structured as:
hourly rates
daily rates
call stipends
overtime premiums
Rates have historically increased in areas of high demand, urgent staffing needs, and for hard-to-recruit specialties.
16) How did malpractice and liability concerns affect locums evolution?
As healthcare became more regulated and liability concerns grew, facilities demanded clearer malpractice arrangements. Agencies began bundling malpractice coverage into their offerings and standardizing policy structures. This reduced friction and made it easier for physicians to accept temporary assignments.
17) How did technology change locum tenens work?
Technology dramatically improved:
recruiter matching and job search
credentialing workflows
digital signatures and contract turnaround
timesheets and payroll
telemedicine locums expansion (in certain fields)
These shifts made locum tenens faster and more scalable than it was decades ago.
18) What is the role of locum tenens during public health crises?
During crises (natural disasters, outbreaks, staffing emergencies), locum tenens can function as surge staffing. Facilities may rely on temporary clinicians when:
local staff are overwhelmed
physicians are ill or quarantined
patient volume spikes suddenly
services must remain open
This role reinforced locums as part of the healthcare “resilience” infrastructure.
19) Is locum tenens work the same globally?
No. Many countries use temporary staffing models, but:
regulations differ
licensing systems differ
healthcare funding and employment structures differ
agency roles vary
The U.S. locum tenens model is particularly robust due to private staffing markets, multi-payer complexity, and a large national network of facilities.
20) What misconceptions exist about the history of locum tenens?
Common misconceptions:
“Locums is new” → the concept is old; the industry is modern
“Locums is only for rural areas” → locums exists everywhere, including major cities
“Locums is only for new grads” → many experienced physicians do locums
“Locums is only emergency fill-in” → it’s also strategic staffing
Locums is a longstanding tool that evolved into a major workforce component.
21) When did locum tenens become a mainstream career option?
As agencies scaled, credentialing became streamlined, and demand increased across specialties, locums became more visible and normalized. Many physicians now plan for locums intentionally:
between jobs
after residency/fellowship
pre-retirement
as a long-term independent career
It shifted from “temporary gig” to “career design option.”
22) How has locum tenens influenced physician negotiating power?
Locums created a visible market price for physician labor. When physicians can compare:
hourly rates
call pay
travel/housing benefits
It becomes easier to understand fair value. The existence of a locums market has, in some cases, strengthened physicians’ leverage—even in employed roles—because it offers an alternative pathway.
23) What is the future trajectory of locum tenens based on its history?
History suggests locums will remain important due to:
ongoing physician shortages in many areas
aging physician workforce
demand fluctuations and seasonal surges
burnout and flexible work preferences
hospital financial pressure to keep services staffed
The exact shape will change, but the core function—temporary physician coverage—will likely remain central.
24) What does the history of locum tenens teach physicians considering it today?
Three lessons:
Locums is not a fringe practice—it’s built into modern healthcare staffing.
Agencies exist because credentialing and logistics are complex; use them strategically.
Locums works best when physicians treat it like a professional system: contracts, insurance, taxes, boundaries.
“The history of locum tenens physicians shows that temporary medical staffing is not a new trend—it is an evolution of a centuries-old concept of ‘holding the place’ for communities in need. As healthcare systems expanded, credentialing requirements increased, and physician shortages and burnout intensified, locum tenens work grew from an informal fill-in role to a strategic staffing model used nationwide. Understanding how locum tenens evolved helps physicians recognize why it remains a powerful option for flexibility, income, and autonomy today.”