The Pros and Cons of Locum Tenens

The Pros and Cons of Locum Tenens

Let’s be honest, we have all contemplated locum tenens work. There isn’t a doctor I have interacted with who hasn’t had a moment of reflection, the age-old question, “Is the Grass Greener?”  Maybe you are in residency, and a couple months working on Hawaiian island or remote Alaska seems like an adventure you can wrap your head around. A reasonable transition until you settle into family life and join a practice. Perhaps you are 5-10 years into practice, and certain aspects of your work aren’t exactly as you planned. Could you do it better on your own? Or maybe you are at the tail end of your career, kids already out of the house and you are looking for a bit of a change, a step down before retirement, focusing on the aspects of practice you think are getting lost amongst paperwork, prior auths, and meetings. Wherever you are in your career, today we break down the big points of locums work. The items that must be addressed before making a decision if locum tenens is right for you. So let’s get started with the broad strokes and we will break each of these down in future posts.

FREEDOM

FREEDOM!! Scream it like William Wallace did in Braveheart. It feels that good. Freedom to define where and how you practice. Freedom to choose how much you work, how much call you take and where you decide to practice. Let’s not forget, you are the one who spent 10 years in medical school and residency. Shouldn’t you be the one to decide how the next step in your journey looks? We think so, its why we do locum tenen’s work. We think everyone should spend winters in Aspen and summers in Hawaii. However, all freedom comes with a price, and the price can depend on several factors.  While there are always certain specialties with opportunities in highly desired areas, others are often limited in where you can go. It is important to know whether your specialty has availability. Anesthesia, emergency medicine and hospitalist positions are easy to find, but want to do pediatric allergy, it’s a little bit more difficult.

Ok, so let’s say you happen to be a hospitalist, and the opportunities are more plentiful. The stars don’t always align. Just being in a highly desired specialty in the locums world won’t ensure you land the position in the exact location you want. You will need to be a little flexible and strategic. Yes, there are hospitals in San Francisco and New York looking for doctors to fill in, but there is no guarantee that location will always be available. Once you decide that your field will allow you to pursue locums, and most will, you need to get a feel for exactly where the positons typically are and if that will fulfill your goals.

Finally, the freedom to define exactly the way you want the practice medicine. Yes, you can find positions that limit the aspects of practice you want to avoid. No call- easy to find. Shift work and clock out, many hospitals want you now. Emergency coverage only- the list is long. However, hospitals aren’t looking to pay you to golf or ski. Most have requirements that need to be fulfilled. Although you can do it your way, locums isn’t a paid vacation.

PAY

This is by far the biggest question I get when interactive with doctors contemplating locum tenens work. I get it, we all dream about setting up shop in some amazing location, but are they really going pay me to do it and how does the typical locums pay system work? 

Take a deep breath here, locums work is designed to pay you for your work at a rate set ahead of time. How does it work? The rate and details of the contract is negotiated with the hospital or practice ahead of time by the locums staffing agency who is handling the position. Typically, the contract will pay a daily rate for a defined amount of work. In addition, any extra work (call or after hours) will be rewarded with an hourly rate for any additional work. Let me give you an example. Hospital “A” needs a Cardiologist to cover its health system while they recruit someone new after the old doctor left or retired.  They contract with a locums company to find someone fast. The hospital agrees to pay $1200 for an 8 hour day of hospital consults and/or clinic coverage. They also will pay $150 dollars an hour for any direct patient care beyond the 8 hours of work if you agree to take call coverage at night and on weekends.  Cover for 2 weeks and not get a single call, you walk away with $16,800. Add in 3-4 calls in the 2 week period, each taking 2 hours, and you add in an additional $1200 for you extra work. At the end of the 2 weeks, the Cardiologist walks away with $18,000. Be aware, you will not have access to the billable charges, these will go to the hospital.

That’s a simple breakdown, but it holds true for the vast majority of positions. The benefit of being a locum tenens doctor is you are in demand. The rates aren’t set in stone and are usually negotiable. I have found hospitals and practices willing to pay more for immediate needs and longer contracts. The details of how much you are paid will depend on the demand for your specialty, the location, and the work volume expected of you.

How does the payment get to you? The hospital pays the locums staffing agency. That agency takes a small cut to cover the licensing, credentialing and privileging, as well as pay their employees. Most locums staffing agencies have a quick and easy system of logging your hours and typically have a 2 week pay cycle.  Every 2 weeks you log your hours worked and they simple cut you a check. Its relatively easy.

DURATION

Your time is your most valuable commodity, if you are considering locums you probably already understand this point. The duration of each position will vary, but there are some industry norms and typical groups of doctors who take advantage of locums work. The length of the assignment will depend on the reason why your service is needed. Many doctors use locums to make some extra income, taking 1-2 week positions on vacation time. These opportunities are plentiful and are used by thousands of doctors every month. Typical this is covering for the doctor in that community who is on vacation or dealing with a short term leave of absence. Longer assignments can be secondary to a medical or maternity leave of the current doctor, and can last anywhere from 1-3 months. However, the most common long term positions are used by hospitals to fill a need while searching for a permanent practitioner. This can lead to both opportunity and frustration. Most doctors complete there 6 to 12 month term without issue. However, some contracts give the hospital the ability to cancel your contract early if they find a permanent doctor to fill your temporary spot. While infrequent, this hiccup can be both frustrating to your quality of life and your wallet! On the other side of the coin, there always exists the possibility that you love the job and want to stay forever. You will have to finish your locums agreement before this can be discussed but many doctors use locums to transition into a permanent position, a bit of a test drive before buying the car!

Locums offers many doctors the opportunity to practice where they want, for the pay they think they deserve and to leave when they are ready to move on. Read on to learn more if  locum tenens is right for you!

Locum Tenens for Physicians: Pros, Cons, and What to Know (2500-Word SEO FAQ)

1) What is locum tenens work for physicians?

Locum tenens is temporary physician coverage—filling staffing gaps at hospitals, clinics, and health systems. A locum tenens physician may cover shifts, blocks of time (like one to four weeks), or longer assignments lasting months. Many doctors use locums to gain scheduling flexibility, boost income, explore new practice environments, or step away from administrative burdens common in employed roles.

2) What does “locum tenens” mean?

“Locum tenens” is Latin for “holding the place of.” In healthcare staffing, it means a physician temporarily filling in for another clinician or covering a vacancy. In everyday terms: you’re the coverage solution when a site needs a doctor now.

3) Is locum tenens the same as per diem work?

Not exactly. Both can be flexible, but:

• Locum tenens often involves a defined assignment (sometimes including travel, housing, and multi-week coverage) and is frequently arranged through a staffing agency or a locums group.

• Per diem is often local and shift-based—sometimes through a facility’s internal pool or a local group—without the broader travel/credentialing package often associated with locums.

4) How does locum tenens differ from being a 1099 physician?

Many locum tenens roles pay physicians as 1099 independent contractors, but some are W-2. The difference matters:

• 1099: you handle tax withholding, retirement contributions, bookkeeping, and often arrange your own benefits.

• W-2: taxes are withheld; paperwork can be simpler; some benefits may be offered (varies).
  This is both a pro (control and deductions) and a con (more admin responsibility).

5) What are the biggest pros of locum tenens for physicians?

Commonly cited advantages include:

• Flexibility and autonomy (choose your schedule and location)

• Potentially higher pay (especially for high-demand specialties/regions)

• Reduced politics and meetings (less institutional admin)

• Defined start and end dates (easier to protect time off)

• Practice variety (explore different care settings and systems)

• A bridge between jobs (income and continuity without long-term commitment)

6) What are the biggest cons of locum tenens for physicians?

The tradeoffs physicians mention most often:

• Credentialing and licensing hassles (time-consuming paperwork)

• Onboarding friction (new workflows, new EHRs repeatedly)

• Variable support and staffing (you may walk into a struggling system)

• Travel fatigue (especially for weekly commuters)

• Less continuity with patients and teams

• Benefits gaps if you’re 1099 (health insurance, retirement, disability)

• Income variability (assignments can pause or cancel)

7) Is locum tenens worth it financially?

It can be—especially if you’re in a high-demand specialty or willing to cover call-heavy or rural assignments. However, the true financial picture includes:

• Taxes (1099 physicians must plan aggressively)

• Benefits costs (insurance, retirement, disability)

• Travel time and “hidden hours” (airports, onboarding, chart catch-up)

• Downtime between contracts
  Locums can be lucrative, but it’s best evaluated on true hourly rate after all costs.

8) Do locum tenens physicians get paid more than employed physicians?

Sometimes yes, sometimes no—depends on specialty, region, assignment urgency, and call burden. Locums rates often look higher because they compensate for lack of benefits and job security. A fair comparison is:
Locums total compensation minus benefits costs vs employed salary plus benefits—and include the value of flexibility.

9) How do physicians get paid in locum tenens assignments?

Common pay structures:

• Hourly rate

• Shift rate (per 8/10/12-hour shift)

• Daily rate

• Call compensation (pager call, call-back rates, guaranteed minimums)
  Your contract should clearly define how time is tracked, what counts as billable hours, and how call-back is paid.

10) Do locum tenens physicians get benefits?

It varies. Many 1099 locum tenens physicians do not receive traditional benefits through the facility. Some staffing firms offer limited benefit options or W-2 arrangements. Most locums doctors plan their own:

• Health insurance

• Disability insurance

• Retirement plan (Solo 401(k), SEP IRA, etc.)
  This is a con for simplicity, but a pro for control and customization.

11) Who pays for travel and housing for locum tenens physicians?

Often the locums agency or facility arranges and covers travel and lodging, but it depends on the contract. Clarify:

• Are flights reimbursed or booked directly?

• Is a rental car included?

• Is housing a hotel or furnished apartment?

• Are there limits on travel class, mileage, or upgrades?
  Travel coverage is a major pro—unless it’s vague or capped.

12) What are the lifestyle pros of locum tenens work?

Lifestyle benefits can be substantial:

• Build a schedule around family, health, or training

• Take longer blocks of time off

• Avoid long-term committee and leadership burdens

• Travel to new places (if you enjoy that)

• Reduce “always on” inbox culture—sometimes
  For many physicians, the biggest pro is time autonomy.

13) What are the lifestyle cons of locum tenens work?

The most common downsides:

• Being away from home (strain on relationships)

• Disrupted routines (sleep, nutrition, workouts)

• Social isolation in new places

• Constant adaptation to new systems

• Charting spillover time in unfamiliar workflows
  If you thrive on stability and deep team connections, locums can feel draining.

14) Is locum tenens good for physician burnout?

It can be a strong tool for reducing burnout—especially if your burnout is driven by admin overload, rigid scheduling, and institutional politics. But locums can also introduce its own stress: travel, onboarding, unfamiliar EHRs, and variable staffing. Many physicians find locums helps when they choose assignments with clear expectations and build real recovery time between blocks.

15) What are the best locum tenens jobs for work-life balance?

Generally, roles with:

• Predictable hours

• Minimal call

• Stable staffing and support

• Clear workflow expectations

• Reasonable patient volume and documentation norms
  High-pay emergency coverage can be tempting—but may come with high burnout risk if staffing is poor.

16) What specialties are best suited for locum tenens?

Many specialties do well, especially:

• Emergency medicine

• Hospital medicine

• Anesthesiology

• Psychiatry

• Primary care in underserved areas

• Surgical subspecialties in regions with coverage gaps
  The “best” specialty depends on your tolerance for variability, call, and travel.

17) What are the biggest operational pros of locum tenens?

Operational advantages include:

• You can avoid long-term politics and administrative roles

• You may have a narrower scope: “show up, take care of patients, go home”

• Defined coverage expectations (when done well)

• The ability to walk away from dysfunctional settings after the assignment ends
  This can feel like a relief compared to endless institutional obligations.

18) What are the biggest operational cons of locum tenens?

Operational disadvantages often include:

• Repeated credentialing and compliance modules

• New EHR learning curves

• Unclear local norms (consult patterns, admission criteria, OR scheduling flow)

• Inconsistent staff support (nursing, MA coverage, APP help)
  These are manageable—but they add friction.

19) How hard is credentialing for locum tenens physicians?

Credentialing can be one of the biggest cons. It typically requires:

• Licenses and DEA

• Work history and references

• Immunizations, background checks

• Privileging paperwork
  Some agencies help a lot; some systems move slowly. The easiest way to reduce pain is to maintain a “credentialing packet” that’s always up to date.

20) How long does it take to start a locum tenens assignment?

It depends on state licensing and facility credentialing. If you’re already licensed in that state and the site is efficient, it can be relatively quick. If you need a new license and the hospital credentialing committee meets infrequently, it can take longer. This variability is a real con—especially if you need predictable income.

21) What are the pros and cons of working with a locum tenens agency?

Pros

• They find jobs, negotiate logistics, and coordinate travel

• They often handle credentialing support

• Access to more assignments across regions
  Cons

• Less direct control; you’re a layer removed from the facility

• Differences in transparency and responsiveness across recruiters

• Rates and terms may vary by agency relationships
  A good recruiter is a major pro; a disorganized one can make locums painful.

22) Should physicians use multiple locum tenens agencies?

It can be beneficial. Pros:

• More job options

• Better leverage on rates and schedules
  Cons:

• More paperwork streams

• More communication overhead
  A balanced approach: keep 1–3 strong recruiter relationships rather than spreading yourself thin.

23) What should be in a locum tenens contract?

Key items to protect you:

• Exact dates, hours, shift definitions

• Call expectations and call-back pay

• Rate details (hourly/shift), overtime, holiday pay

• Cancellation policy and guaranteed minimums

• Malpractice coverage type (occurrence vs claims-made; tail coverage)

• Travel/housing terms

• Scope of work: clinic, inpatient, procedures, rounding, OR, consults
  Contracts are where pros become real—or where cons hide.

24) What malpractice coverage do locum tenens physicians get?

Many locum tenens arrangements include malpractice coverage, but details matter:

• Occurrence coverage is generally simpler

• Claims-made may require tail coverage after the assignment
  Ask explicitly what’s provided and whether tail coverage is included. Misunderstanding this is a classic locums pitfall.

25) What are the pros and cons of locum tenens call coverage?

Pros

• Higher pay and strong demand

• More schedule blocks available
  Cons

• Higher fatigue and burnout risk

• More unpredictability and emergencies

• Potential for inadequate backup coverage
  Call can be worth it when staffing is solid and expectations are clear. It’s a con when the system is chronically understaffed.

26) Do locum tenens physicians have less administrative burden?

Often yes—less committee work, fewer meetings, fewer leadership obligations. However, you may still face:

• Documentation pressure

• Compliance training

• EHR message expectations depending on the site
  So it’s typically reduced, but not always eliminated.

27) What are the pros and cons of practicing in different hospitals as a locums physician?

Pros

• Rapid learning and broadened clinical exposure

• New perspectives on workflow and patient care

• Ability to compare systems and choose future employers wisely
  Cons

• Repeated onboarding and EHR learning

• Less influence over processes

• Potential for inconsistency in quality and support
  This is great for adaptability; hard for those who prefer consistency.

28) How does locum tenens affect patient continuity and satisfaction?

Continuity can be a con, especially in outpatient settings. However, many locums roles focus on coverage needs where continuity is already disrupted (vacations, staffing gaps). Physicians can improve continuity by:

• Clear handoffs

• Strong documentation

• Coordination with permanent staff
  It’s a tradeoff: flexibility vs long-term relationships.

29) Can locum tenens help physicians explore a new location before relocating?

Yes—this is a major pro. Locums can function like a “working interview”:

• Test a region, hospital culture, and clinical workflow

• Evaluate schools and lifestyle for family

• Potentially transition into a permanent role
  Many physicians use locums strategically to avoid committing blindly.

30) Can locum tenens help physicians negotiate better permanent jobs?

Often yes. Pros include:

• You’re not desperate; you have income options

• You can compare multiple systems

• You can identify what you truly want (schedule, call, support)
  This leverage can lead to better long-term decisions and less burnout.

31) What are the pros and cons of locum tenens for new attending physicians?

Pros

• Rapid skill growth and exposure to different practice models

• Potentially higher early earnings

• Flexibility to choose geography
  Cons

• Less mentorship and stability

• Higher cognitive load from constant change

• Harder to build a long-term professional network
  Early-career physicians can do well in locums with intentional mentorship and cautious assignment selection.

32) What are the pros and cons of locum tenens for mid-career physicians?

Pros

• Escape from administrative overload

• More autonomy and freedom

• Opportunity to reset or retool career direction
  Cons

• Family logistics and travel strain

• Harder to maintain leadership trajectory if you want it

• More responsibility for financial planning if 1099
  For many mid-career physicians, locums is a powerful burnout countermeasure.

33) What are the pros and cons of locum tenens for late-career physicians?

Pros

• “Semi-retirement” schedule

• Choose lower-intensity assignments

• Continue practicing without full-time demands
  Cons

• Credentialing can feel more annoying than ever

• Travel may be less appealing

• Maintaining certifications/licensing may be burdensome
  Late-career locums can be ideal if you prioritize control and reduce travel.

34) What about stability and job security in locum tenens work?

Job security is a con compared to employment. Assignments can end early due to volume changes, staffing hires, or budget cuts. The pro is flexibility: you’re not locked into one system. Best practice is to maintain a pipeline—always know your next likely option.

35) How do physicians manage income variability in locum tenens?

Practical tips:

• Keep a cash buffer (often 3–6 months)

• Track monthly averages and plan for gaps

• Avoid lifestyle inflation tied to peak locums months

• Consider a “base schedule” with optional extra shifts
  Income variability is manageable—but ignoring it increases stress.

36) What are the tax pros and cons of being a locum tenens physician?

Pros (1099)

• Potential business deductions (as allowed)

• More control over retirement contributions (Solo 401(k), SEP IRA)
  Cons

• You must plan quarterly taxes

• More bookkeeping and complexity
  Taxes can be a pro if you’re organized—or a con if you’re not.

37) Does locum tenens limit career advancement or leadership opportunities?

It can. Locums physicians may have fewer chances for leadership roles, research, or long-term program building at a single institution. If leadership and institutional influence are important to you, a hybrid approach can work: part-time employed leadership + selective locums.

38) Can locum tenens physicians build a long-term “home base”?

Yes. Many physicians do repeat assignments at the same facility, creating familiarity and community without full employment. This can reduce the biggest cons (onboarding and isolation) while keeping the primary pro (flexibility).

39) What are the pros and cons of local locum tenens vs travel locums?

Local locums pros

• Less travel fatigue

• Easier routine, family stability

• Often better for burnout prevention
  Local locums cons

• Fewer options depending on market

• Rates may be lower than urgent travel roles

Travel locums pros

• More job availability

• Travel/housing often covered

• Can be financially strong
  Travel locums cons

• Routine disruption, fatigue, loneliness risk

40) How do I choose the right locum tenens assignment?

Use a simple filter:

• Does it match my schedule needs?

• Are the hours and call clear?

• Is staffing adequate?

• Is the workflow reasonable?

• Is the pay fair after considering travel and charting time?
  A good locums job feels “defined.” A bad one feels vague.

41) What are red flags in locum tenens jobs?

Watch for:

• Vague descriptions (“help where needed”)

• Unclear call expectations

• High turnover of nurses/APPs

• “You’ll cover until we hire someone” with no timeline

• No onboarding or EHR training plan

• Recruiter avoids specifics about volume or staffing
  Red flags turn locums cons into a daily grind.

42) What are green flags in a good locum tenens site?

Green flags include:

• Clear schedule, predictable workload

• Organized credentialing and onboarding

• Stable support staff

• Reasonable patient volume and documentation norms

• A named clinical lead and escalation pathway

• Repeat locums physicians who return (a strong sign)

43) Does locum tenens improve clinical skills?

It can. Pros:

• Exposure to different approaches and patient populations

• High-volume experience in some settings
  Cons:

• Lack of continuity may limit long-term outcome feedback

• Inconsistent resources can impact your usual practice style
  For many physicians, the variety is professionally energizing.

44) Will I lose continuity with colleagues and professional community?

Sometimes. That’s a con, especially if you value stable teams. But you can build community by:

• Doing repeat assignments

• Joining specialty societies and online physician communities

• Maintaining a home-base clinical role part-time
  Community matters for wellbeing; plan for it intentionally.

45) How can I make locum tenens work sustainable long-term?

Sustainability comes from boundaries:

• Cap your call frequency

• Schedule recovery time as non-negotiable

• Choose stable sites and repeat them

• Keep your credentialing packet organized

• Build financial systems that reduce stress
  The goal is to preserve the main pro—flexibility—without letting the cons pile up.

46) What is the best “first locum tenens job” for a physician?

A good first assignment is typically:

• Short (2–6 weeks or a defined block)

• Predictable schedule

• Minimal call

• Strong onboarding support
  Starting with a high-chaos “urgent coverage” job can sour the experience quickly.

47) Can locum tenens be a stepping stone back to a permanent job?

Absolutely. Many physicians use locums to:

• Recover from a bad job fit

• Explore different systems

• Identify what they want in a permanent role

• Convert a successful locums assignment into a full-time offer
  This is one of the most strategic pros of locums.

48) How do I weigh the pros and cons of locum tenens objectively?

Try a simple scoring approach:

• Flexibility (schedule control)

• Pay (true hourly after costs)

• Stress (call, volume, staffing)

• Admin load (inbox, meetings)

• Travel burden (frequency and distance)

• Support (nursing, APP, consult access)
  If an assignment scores high on pay but low on support and predictability, it may not be worth it for long-term wellbeing.

49) What’s the bottom line: what are the main pros and cons of locum tenens for physicians?

Pros: flexibility, autonomy, potentially strong pay, reduced long-term admin, variety, and an escape hatch from toxic systems.
Cons: credentialing burden, variable support, onboarding friction, travel fatigue, benefits complexity, and less continuity.

50) Is locum tenens right for me?

Locum tenens is often a great fit if you want control over your time, you’re adaptable, and you’re willing to trade some stability for flexibility. It’s less ideal if you need deep continuity, dislike constant change, or want a traditional leadership track inside one organization. Many physicians find the best solution is a hybrid: a stable home base with selective locums blocks that preserve freedom without constant disruption.