Locum Tenens for Emergency Medicine Doctors
/Locum Tenens for Emergency Medicine Doctors: The Complete Guide to Your First Assignment (and Beyond)
Locum tenens medicine can be an incredible career lever for emergency medicine (EM) physicians—whether you’re using it to regain control of your schedule, earn more per hour, explore different practice environments, bridge a job transition, avoid burnout, or sample new cities before committing. It can also be frustrating if you walk in unprepared: credentialing delays, unclear coverage expectations, documentation landmines, surprise productivity pressures, and contracts that subtly shift risk onto you.
This guide is written specifically for emergency medicine doctors who want a clear, practical roadmap. You’ll learn:
What locum tenens is (and how EM locums differs from other specialties)
How EM locum pay is structured (and what actually moves the needle)
Exactly how to get your first locum tenens emergency medicine assignment
What to look for (and what to avoid) in ED coverage agreements
Common pitfalls—and how to protect your license, sanity, and income
A step-by-step checklist to go from “interested” to “paid and renewed”
What Is Locum Tenens (in Emergency Medicine)?
Locum tenens is Latin for “to hold the place.” In modern healthcare, it refers to physicians who provide temporary clinical coverage—typically through a staffing agency or directly with a hospital/ED group.
In emergency medicine, locum tenens usually means you are covering ED shifts for:
A hospital needing short-term coverage (vacancies, leaves, seasonal surges)
A contract management group (CMG) with staffing gaps
A democratic group needing temporary help during transitions
Rural critical access hospitals needing consistent coverage
New ED programs ramping up staffing
Unlike many outpatient locums roles, EM locum work is shift-based. That’s a major advantage: you trade time for money in discrete blocks, with fewer longitudinal obligations (no patient panel, fewer admin meetings, less committee work).
What EM Locums Looks Like Day-to-Day
Most EM locum roles fall into these buckets:
Standard ED physician coverage
Typical mix of acuity, depending on site
8, 10, or 12-hour shifts common
Rural / critical access ED
Lower volume, broader scope, more autonomy
Higher variability in acuity; limited subspecialty backup
Sometimes includes observation, inpatient holds, or limited admissions
High-acuity / trauma center coverage
Higher volume, more consultants, stricter metrics
Often requires recent trauma experience and specific certifications
Fast track / urgent care-style ED coverage
Lower acuity, metrics-heavy, high throughput expectations
Nocturnist-focused coverage
Often higher hourly rates, more autonomy, fewer resources depending on site
Why Emergency Medicine Doctors Choose Locum Tenens
Emergency medicine is uniquely positioned for locums because shift work is already the norm. Doctors choose EM locum tenens for several practical reasons:
1) Flexibility and Schedule Control
You decide:
When you work
How many shifts you take
Whether you stack shifts for longer stretches off
This is ideal for:
Parents who need predictable off-blocks
Physicians transitioning between jobs
Doctors building side businesses or other income streams
Physicians who want to travel without “vacation approval” politics
2) Higher Effective Hourly Pay (Often)
Locums can pay more per hour than a W-2 role—especially in underserved areas or nights/weekends. But the true comparison depends on:
Whether travel/housing is covered
Your tax strategy and benefits costs
Whether you’re giving up retirement matching, health insurance, CME, etc.
3) Geographic Freedom
Want to test a region before relocating? Locums lets you “try before you buy.”
4) Escape From Politics and Admin Overload
Many EM physicians feel squeezed by:
Throughput metrics
RVU pressure
Staffing ratios
Boarding and crowding with no institutional support
Locums can’t fix systemic ED issues, but it can reduce long-term entanglement with one institution.
5) Variety and Skill Expansion
Different EDs force you to adapt. Some physicians love the “new environment” energy—others find it stressful. Know yourself.
How Locum Tenens Works: The EM Staffing Ecosystem
The Three Common Structures
Agency-based locums (most common)
A staffing company finds you an assignment
They coordinate licensing, credentialing, travel, and contracts
They bill the hospital and pay you
Direct contracting (less common, higher control)
You contract directly with a hospital or group
More negotiation power and sometimes higher rates
More responsibility on you for logistics
Internal float pool / per diem
Some systems hire “internal locums” (PRN, per diem)
Often W-2, fewer tax advantages, but easier credentialing
Credentialing Is the Gating Factor
In EM locums, your ability to start quickly depends on:
State medical license status
DEA registration
Board certification and documentation
Clean credentialing packet
Facility privileges timeline (often 4–12+ weeks)
If you want a smooth locums career, you treat credentialing like a system, not a one-off headache.
Emergency Medicine Locum Tenens Pay: What You Need to Know
Locum tenens compensation can look high on paper and mediocre in real life if you don’t account for hidden costs. Here’s how to evaluate it properly.
Typical Pay Formats
Hourly rate (most common in EM)
You’re paid a flat hourly amount for time worked
Sometimes with minimum shift guarantees
Shift rate
You’re paid a fixed amount per shift (e.g., $2,400 per 12-hour shift)
Blended models
Lower base + productivity bonus
Rare in locums but exists
Call pay / backup pay
In smaller facilities, you might be paid to be “on-call” or “available”
Clarify whether you must be on site, response times, and what triggers callback
What Moves the Rate Up
Rural / underserved geography
Nights (especially true nights), weekends, holidays
Short notice coverage
Higher acuity sites requiring recent trauma experience
Facilities with boarding problems and staffing shortages
Sites needing procedural breadth (intubations, central lines, etc.)
Fast credentialing / already licensed in-state
What Can Quietly Reduce Your Earnings
Unpaid orientation time
Mandatory EMR training that’s unpaid or underpaid
Long credentialing delays causing you to miss shifts
Travel days that aren’t reimbursed or compensated
Housing that’s provided but impractical (distance, safety, quality)
Malpractice with weak tail coverage details (rare but important)
The Real Metric: Effective Hourly Rate
Calculate what you actually net per hour including:
Travel time
Unpaid onboarding
Housing costs if not covered
Licensing/DEA expenses if not reimbursed
Lost income due to delays
A “high rate” assignment can become average once you include friction.
W-2 vs 1099 in EM Locum Tenens (And Why It Matters)
Most locum tenens EM physicians are 1099 independent contractors. Some agencies offer W-2 options.
Why 1099 Can Be Powerful
You can deduct legitimate business expenses:
licensing fees
travel not reimbursed
CME
scrubs, equipment
part of phone/internet
You may be eligible to open:
Solo 401(k)
SEP IRA
Defined benefit plan (high earners, advanced strategy)
You gain more control over tax planning
But 1099 Comes With Responsibility
You handle:
quarterly estimated taxes
retirement planning
health insurance if you don’t have it through a spouse
bookkeeping
business compliance and liability considerations
Rule of thumb: If you’re doing locums as a side gig while staying W-2 elsewhere, 1099 can be straightforward. If locums becomes your primary income, you need a more intentional setup.
Step-by-Step: How to Get Your First Emergency Medicine Locum Tenens Assignment
This is the part most doctors want: “What exactly do I do next?”
Step 1: Decide Your Locums Goal and Constraints
Before you talk to recruiters, get clear on:
Minimum acceptable hourly rate
Preferred shift types (days, evenings, nights)
Shift length (8/10/12)
Number of shifts per month
Maximum travel distance
Rural tolerance and resource comfort level
Trauma level comfort
Whether you’re okay with solo coverage
Write these down. Recruiters respond better when you have boundaries.
Step 2: Get Your Paperwork Organized (Your “Locums Packet”)
This is your fastest path to getting credentialed.
Prepare:
Current CV (with month/year for each position)
Board certification documentation
Medical school diploma
Residency certificate
State medical license(s)
DEA certificate
ACLS / BLS / PALS / ATLS (as applicable)
NPI number
Immunization records (MMR, varicella, hep B, TB testing, etc.)
Driver’s license + passport (some facilities require)
Malpractice history / claims history
References (often 2–3)
Work history explanations for gaps
Pitfall: Most delays happen because of missing documents or mismatched dates on CV vs credentialing forms. Fix that early.
Step 3: Choose Your Recruiting Strategy (One Recruiter vs Many)
You can work with:
one agency and one recruiter (simpler)
multiple agencies (more opportunities, more noise)
Best approach for first-timers: start with 1–2 recruiters you trust, then expand if needed. Too many recruiters can lead to duplicate submissions to the same job (a credentialing headache and sometimes a disqualifier).
Step 4: Ask the Right Questions About the ED
Before you accept anything, gather data. You’re not being “difficult”—you’re being safe.
Ask:
Annual ED volume
Acuity mix and admit rate
Trauma designation and role expectations
Typical physician coverage model (single coverage? double? triple?)
APP coverage and scope
Consultant availability (24/7? on call? delays?)
Boarding environment (average boarding time, admitted holds)
Transfer process and receiving facilities
Procedural expectations (intubations, central lines, sedation, ultrasound)
Peds volume and required comfort
EMR system and documentation expectations
Metrics pressure (door-to-doc, LWBS, RVU expectations)
Orientation time and whether it’s paid
Red flags for first assignment:
Solo coverage with high volume
No backup and poor transfer pathways
Unclear scope (e.g., “You may cover inpatient holds too”)
Significant peds volume without support (if you’re not comfortable)
Step 5: Get Submitted and Interviewed
Many locum EM assignments involve a short interview:
medical director or site lead
sometimes HR or credentialing rep
You want to confirm:
shift schedule availability
start date realism (credentialing timeline)
culture: “How do you support docs when volume surges?”
documentation expectations
Step 6: Review the Contract Like a Risk Manager
Locums contracts are often templated. Still, you need to understand key terms.
Look for:
rate and pay schedule
cancellation policy (how much notice? any guarantee?)
shift minimum guarantees
orientation pay
travel and lodging details
malpractice coverage type (occurrence vs claims-made) and tail
assignment scope and responsibilities
termination clause
indemnification language (avoid one-sided clauses)
non-compete language (some facilities try this—be careful)
Pitfall: “We can’t change the contract” is often not true. Even if the core agreement is fixed, agencies can adjust pay terms, travel, and cancellation protection in writing.
Step 7: Credentialing and Privileging (The Slow Part)
Credentialing often takes 4–12 weeks, sometimes longer.
How to speed it up:
respond to credentialing requests same day
provide accurate references and contact info
keep your CV consistent (no unexplained gaps)
proactively request primary source verification status updates
Step 8: Licensure Strategy (Don’t Let It Bottleneck You)
For emergency medicine locum tenens, state licensure is frequently the #1 limiter.
Options:
Start in states where you already hold a license
Target states with faster licensing timelines
Consider multi-state planning if you expect to do regular locums
If you plan to do locums long term, treat licenses as assets.
Step 9: Travel and Logistics
Confirm:
flight booking process (agency-booked vs reimbursement)
hotel vs furnished housing
rental car policy
per diem policies if any
what happens if you’re delayed (weather, cancellations)
Ask for everything in writing. “We usually do…” is not a policy.
Step 10: First Shift Success Strategy
Your first shift at a new ED is about rapid orientation and risk reduction.
Do this:
arrive early
ask for a quick ED layout tour
learn consult process and who to call for escalation
find where critical equipment is stored
understand how admissions happen
confirm sedation and airway workflow
clarify radiology turnaround expectations
What to Look For in a Great EM Locums Assignment
1) Safe Coverage and Backup
For early locums:
double coverage or at least easy backup is ideal
avoid “you’re the only doc” unless volume is truly low and you’re comfortable
2) Clear Scope of Practice
Make sure you understand:
peds expectations
trauma role
whether you will cover observation, inpatient holds, or urgent care overflow
whether you supervise APPs and what the liability looks like
3) Reasonable Documentation Burden
Ask:
typical charts per hour expected
required templates or macros
whether scribes exist
how they handle critical care billing and procedure documentation
4) Supportive Culture
Green flags:
clear escalation pathways
nursing stability
consultants who answer calls
medical director available and engaged
5) Smooth Logistics
If an agency is disorganized before you start, it won’t magically get better once you’re onsite.
Common Pitfalls (and How to Avoid Them)
Pitfall 1: Credentialing Delays That Cost You Money
Fix: Maintain a ready-to-go locums packet. Respond fast. Track every deadline.
Pitfall 2: Misaligned Expectations About Acuity or Volume
Fix: Ask for objective data: annual volume, admit rate, LWBS, and staffing model.
Pitfall 3: Getting Trapped in Bad Shifts
Some assignments “offer flexibility” but mainly need:
nights
weekends
holidays
Fix: Get your minimum schedule terms in writing.
Pitfall 4: Documentation and Billing Landmines
EMR quirks, coding expectations, and facility compliance culture vary widely.
Fix: Ask how they handle:
critical care documentation
procedure notes
time-based billing
split/shared documentation with APPs (if applicable)
Pitfall 5: Poor Malpractice Clarity
Most agencies provide malpractice, but you still need to confirm the structure.
Fix: Ask directly:
Is it occurrence or claims-made?
Who is the carrier?
Who pays for tail if needed?
Pitfall 6: Burnout-by-Travel
Locums can create a “work hard, travel hard” cycle.
Fix: Build recovery days into your blocks. Don’t stack 12-hour nights with long travel days unless you’re sure you tolerate it.
Pitfall 7: Recruiter Pressure
Some recruiters push you toward what they need staffed, not what you need.
Fix: Treat your criteria as non-negotiable. If they don’t respect it, switch recruiters.
Your First Assignment: A Practical Checklist (Emergency Medicine)
Use this as a quick pre-flight list:
Before You Commit
Confirm rate (hourly or per shift) and pay schedule
Confirm shift lengths, day/night mix, and minimum shifts
Confirm ED volume, staffing model, APP coverage
Clarify trauma role, peds expectations, airway/procedures
Clarify boarding and admission workflow
Confirm EMR type and orientation/training (paid?)
Confirm travel, housing, rental car details
Confirm malpractice type and tail details
Review cancellation policy and guarantees
During Credentialing
Submit complete packet
Provide accurate references
Respond quickly to follow-ups
Track license/DEA and facility deadlines
Ask for estimated privilege date (and confirm in writing)
Before Your First Shift
Arrive early
Learn ED layout and equipment
Get charge nurse + RT workflow
Know how to reach consultants and escalation chain
Confirm sedation protocol, airway backup, transfer process
Set realistic charting workflow
How to Build a Sustainable EM Locum Tenens Career (Not Just a One-Off)
Once you’ve completed your first assignment, you can turn locums into a stable system.
1) Build a “Core Site” Strategy
The best locum physicians often settle into:
1–2 primary sites where they are known and rebooked
plus occasional premium short-notice shifts elsewhere
This reduces onboarding friction and increases leverage.
2) Keep Licenses and Credentials “Evergreen”
Maintain:
clean, updated CV
logged procedures if relevant
updated immunizations
updated certificates
an organized digital folder system
3) Track Your Own Metrics
Even if the facility doesn’t:
shifts worked
effective hourly after travel
cancellation losses
charting time burden
best/worst sites
Your data becomes negotiation power.
4) Be Intentional About Taxes and Retirement
If locums income becomes meaningful, consider:
a proper bookkeeping process
quarterly estimates
retirement plan choices appropriate for your income level
Final Thoughts: The “Right Way” to Start EM Locums
Your first emergency medicine locum tenens assignment sets the tone. Choose a site that’s safe, supportive, and realistic for your comfort level—especially around coverage, acuity, and consultant availability. Build a clean credentialing system early. And don’t let a recruiter’s urgency override your standards.
If you want, tell me:
what states you’re willing to work in,
whether you prefer days/nights,
your ideal shifts per month,
and your comfort with rural/solo coverage,
…and I’ll give you a “first assignment target profile” (the exact type of ED you should look for first, what rate range to demand, and which red flags should be non-negotiable).
Locum Tenens Emergency Medicine FAQ
1) What does “locum tenens” mean in emergency medicine?
Locum tenens literally means “to hold the place.” In emergency medicine, it usually refers to an EM physician working temporary ED shifts for a hospital, emergency department group, or contract management group (CMG) to fill staffing gaps. Unlike many other specialties, EM locums is typically shift-based, so your work is defined in blocks (8/10/12-hour shifts) rather than ongoing clinic panels or long-term rounding responsibilities.
2) Is locum tenens a good fit for emergency medicine doctors?
For many emergency medicine physicians, yes—because EM is already structured around shifts, and locums often offers:
Greater control over your schedule
Potentially higher hourly rates (especially for nights/weekends/rural)
Geographic flexibility
Less exposure to internal politics and committees
That said, it’s not ideal for everyone. If you dislike walking into new systems, adapting to different nursing cultures, or learning new EMRs, locums can feel draining. The best fit is an EM physician who values autonomy, can ramp up quickly in unfamiliar environments, and wants more control over time and income.
3) How does emergency medicine locum tenens pay work?
Most EM locum tenens roles pay in one of these formats:
Hourly rate (most common)
Flat shift rate (e.g., $2,400 per 12-hour shift)
Hourly + incentives (less common)
Some assignments also include:
Paid orientation (sometimes)
Travel reimbursement or agency-booked travel
Hotel or furnished housing
Rental car or mileage
The number that matters most is your effective hourly rate, after subtracting any unpaid onboarding time, travel friction, licensing costs, and un-reimbursed expenses.
4) What is a “good” hourly rate for EM locums?
Rates vary widely by region, facility type, urgency, and shift timing (nights/weekends pay more). A “good” rate is one that makes sense after considering:
Is travel covered?
Are you paid for orientation and EMR training?
Are shifts guaranteed?
How intense is the ED (volume/acuity/boarding)?
What is the medicolegal risk environment?
Rather than obsessing over one number, compare offers by calculating:
(Total compensation – your costs – unpaid time) / total hours worked.
If an assignment is high-friction (bad boarding, chaotic nursing, no consultant backup), you should demand a premium—or pass.
5) Do EM locums jobs pay more for nights, weekends, and holidays?
Usually, yes. Emergency departments often struggle to staff:
True overnight shifts
Weekend blocks
Holiday coverage
Short-notice cancellations
If you can tolerate nights or you’re willing to do “undesirable” blocks, your negotiating leverage increases. The key is to decide what your “pain premium” is—how much extra you require to do nights or travel farther.
6) What’s the difference between locum tenens and per diem?
Locum tenens typically implies a temporary assignment arranged through an agency or direct contract, often 1099, and sometimes involving travel.
Per diem/PRN is usually local, often through a hospital or group, sometimes W-2, and often easier to maintain once credentialed.
Many EM physicians do both: per diem locally for convenience and locums for premium blocks elsewhere.
7) Will I be a 1099 contractor or a W-2 employee?
Most EM locum tenens work is 1099. Some agencies offer W-2 options, but 1099 is common because you’re functioning as an independent contractor.
1099 pros:
Potential deductions (legitimate business expenses)
Ability to set up self-employed retirement plans (e.g., Solo 401k)
More control over tax planning
1099 cons:
You handle quarterly taxes
You fund your own benefits (health insurance, disability, retirement)
You need a system for bookkeeping
If you’re doing locums on the side while keeping a main W-2 job, the complexity is manageable. If locums becomes your primary income, you’ll want a tighter tax and retirement strategy.
8) Do I need to form an LLC for locum tenens work?
Not always. Many EM physicians do locums as a 1099 contractor in their own name without an LLC.
An LLC can be useful for:
Separating business finances
Branding and professionalism (optional)
Streamlining bookkeeping
Certain tax strategies (depending on income and structure)
But an LLC does not replace malpractice insurance, nor does it automatically protect you from professional liability claims (that’s what malpractice coverage is for). If you’re earning substantial 1099 income, an LLC can be reasonable—just don’t assume it’s required or magically protective.
9) How do I find EM locum tenens jobs?
Common pathways:
Locum tenens agencies (the most common)
Direct contracting with hospitals/groups (less common but more control)
Networking with EM directors and groups
Online job boards (useful, but can be noisy)
For your first assignment, agencies often make the process easier because they coordinate licensing, credentialing, travel, and paperwork.
10) Should I work with one recruiter or multiple recruiters?
Both approaches work.
One recruiter can reduce confusion and duplicate submissions.
Multiple recruiters increases opportunity flow and competitive offers.
For a first-time locums EM doctor, a good strategy is:
Start with 1–2 recruiters you trust
Expand later if you want more options
Important: Avoid having multiple recruiters submit you to the same job, which can create conflicts and slow everything down.
11) How long does it take to start my first EM locums assignment?
Usually 4–12+ weeks, depending on:
State licensure status
Facility credentialing speed
Medical staff office efficiency
Your responsiveness and document readiness
If you already have a license in the state and your paperwork is organized, you can sometimes start faster. If you need a new state license and the facility is slow, it can drag out.
12) What documents do I need for emergency medicine locums credentialing?
Most facilities will request:
Updated CV with month/year accuracy
Medical license(s)
DEA certificate
Board certification status documents
BLS/ACLS (often PALS; sometimes ATLS depending on trauma role)
Immunization records and TB testing
References (often 2–3)
Malpractice claims history (if any)
IDs (driver’s license, passport)
Education and training certificates
Pro tip: Keep a single digital folder with your full packet, plus a running “credentialing tracker” spreadsheet listing what you submitted and when.
13) What are the biggest credentialing delays for EM locums?
Common delays include:
Incomplete immunization records
References not responding
CV dates not matching applications
Past privileges needing verification
Unexplained employment gaps
Multiple state licenses with inconsistent status updates
Credentialing is a process you can “systematize.” The fastest locums physicians treat their packet like a professional asset.
14) Do I need PALS and ATLS for EM locums?
It depends on the site.
Many EDs require ACLS and BLS minimum
Many require PALS, especially if there is meaningful pediatrics volume
ATLS may be required if you’re expected to manage trauma in a designated trauma center (varies by site and group norms)
If you’re missing a certificate, it doesn’t always disqualify you—but it can limit your options or reduce your negotiating power.
15) How do I choose a safe first emergency medicine locums assignment?
For a first assignment, “safe” usually means:
Not solo physician coverage (or truly low volume if solo)
Clear transfer pathways and consultant availability
Reasonable acuity for your comfort level
Adequate nursing and respiratory therapy support
A medical director who is reachable and supportive
If you’re transitioning from a resource-rich academic center, jumping into solo rural coverage can be a shock. You can do rural later—start where you can succeed.
16) What questions should I ask before accepting an EM locums job?
Ask for objective details:
ED environment
Annual ED volume
Admit rate
Acuity mix (ESI distribution if available)
Peds volume
Trauma designation and your role
Boarding statistics (average admitted holds, longest holds)
Staffing model
Physician coverage model (single/double/triple)
APP coverage and expectations
Who does procedures and sedation?
Backup availability
Operations
EMR type and training requirements
Consult process and response times
Transfer process and typical receiving facilities
Radiology turnaround times
Contract logistics
Rate and pay schedule
Cancellation policy and guarantees
Travel/housing/rental car policies
Malpractice coverage type (occurrence vs claims-made)
17) What are red flags in an emergency medicine locums assignment?
Red flags include:
Vague answers about volume, acuity, or coverage model
“You’re the only doctor most nights, but it’s fine” without data
High boarding with no support and relentless throughput metrics
Poor consultant availability or frequent transfer barriers
Unpaid EMR training that takes hours
Shifts frequently cancelled without pay protection
Disorganized communication from the agency/facility
Pressure to start “immediately” when credentialing isn’t realistic
If something feels off before you begin, it often feels worse on shift.
18) What’s the difference between critical access/rural ED locums and large hospital ED locums?
Rural/critical access ED:
Often lower volume but broader scope
Limited specialty backup
More autonomy and procedural responsibility
Transfer logistics matter a lot
Larger hospital/trauma center ED:
Higher volume and more defined workflows
More consultants and internal resources
More metrics pressure and operational complexity
Often more documentation and performance oversight
Your choice should reflect your comfort with autonomy vs resource depth.
19) Will the locums agency pay for travel and housing?
Often, yes—but not always, and not all policies are equal.
Clarify:
Does the agency book travel directly, or do you get reimbursed?
Is lodging a hotel or furnished housing?
How far is lodging from the ED?
Is a rental car provided?
Are travel days compensated?
Get everything confirmed in writing, even if it’s “standard.”
20) Do I get paid for orientation and EMR training?
Sometimes, but not reliably. EMR onboarding can be anywhere from 1–6+ hours and sometimes includes remote modules.
Ask:
Is training paid?
At what rate?
Is it required before your first shift?
Can you do it onsite on the clock?
Unpaid training is a quiet way assignments steal your time.
21) What should I look for in the contract?
Key items:
Pay rate, pay schedule, and overtime rules (if any)
Cancellation policy (how much notice is required and what you’re paid)
Shift guarantees or minimums
Travel and lodging terms
Malpractice type and tail coverage details
Scope of duties (procedures, APP supervision, trauma coverage)
Termination clause (and whether it’s one-sided)
Indemnification language (watch for unfair risk transfer)
Non-compete clauses (be cautious)
If you don’t understand a clause, ask for clarification in writing.
22) How does malpractice coverage work for EM locums?
Most agencies provide malpractice insurance, but you should confirm:
Occurrence vs claims-made
Carrier name (if provided)
Limits (common are 1M/3M, but varies)
Who pays for tail if claims-made is used (often the agency, but verify)
Whether you’re covered for work outside the assignment (usually not)
This is not the place to be casual. You’re protecting your license and future.
23) Can I negotiate my locum tenens EM rate?
Often, yes. Negotiation depends on:
How hard the site is to staff
How urgent the need is
Your flexibility (nights/weekends)
Your credentials (trauma, ultrasound, procedural comfort)
Whether you are already licensed in-state
Your past locums performance (later this becomes huge)
Even if the base rate is fixed, you can sometimes negotiate:
travel upgrades
paid orientation
shift guarantees
higher rates for nights or weekends
block scheduling preference
24) What are common reasons EM physicians get burned in locums?
Common “burn” scenarios:
Credentialing takes months and shifts evaporate
Facility cancels shifts with minimal notice
“Low volume” was inaccurate and you’re solo with chaos
Boarding dominates the ED, and the job becomes unmanageable
Documentation expectations are extreme and unpaid time balloons
You’re expected to supervise APPs with unclear boundaries
The antidote is asking better questions and getting terms in writing.
25) What’s the best way to avoid being overwhelmed on your first shift?
Success strategies:
Arrive early to orient yourself
Learn where airway and procedural equipment lives
Clarify consult process and escalation chain
Identify RT workflows for intubation and BiPAP
Understand how admissions and transfers work
Set charting habits early (don’t let charts pile up)
Also: don’t be afraid to ask nurses what the “local way” is. ED staff usually appreciate humility and clear communication.
26) How do I handle unfamiliar EMRs as a locums doctor?
You won’t master every EMR. Your goal is functional competence:
Learn how to order common ED labs/imaging fast
Learn discharge workflow and prescriptions
Learn procedure documentation templates
Learn critical care time documentation process (if applicable)
Learn how to find old notes, labs, and imaging
Ask for quick-reference guides if available. Some EDs have cheat sheets.
27) Do locum tenens EM doctors get to pick their schedule?
Usually you can influence it, but it depends on the site’s needs.
You can often request:
Block scheduling (e.g., 7 on / 7 off)
Clusters of shifts to reduce travel
No nights (but rate may drop)
All nights (rate may rise)
The earlier you set expectations, the better. If you agree to “whatever you need,” you’ll usually get the hardest-to-fill shifts.
28) Can I do locums while holding a full-time job?
Yes—many EM physicians do locums as a side gig. Key considerations:
Non-compete or moonlighting restrictions in your contract (check!)
Fatigue and recovery time
Malpractice coverage separation between jobs
Tax planning (quarterly estimates)
Protecting your primary job performance
If you’re moonlighting, start small—one block per month—until you understand the travel and recovery burden.
29) How do taxes work for EM locum tenens?
For 1099 income:
You’ll likely need to pay quarterly estimated taxes
You should track expenses and keep receipts
A dedicated business bank account helps
You may consider retirement contributions through self-employed plans (depending on your setup)
Many locums physicians under-withhold in their first year and get surprised by tax bills. Plan early.
30) Should I get disability insurance as a locums EM doctor?
If locums becomes a meaningful portion of your income, you should think seriously about disability coverage. Emergency medicine is physically and cognitively demanding, and income interruption can be financially painful.
If you already have a strong policy through a main employer, review whether it covers you adequately if you move more income to 1099 work.
31) Can I transition from full-time EM to full-time locums?
Yes, but do it strategically:
Build 1–2 stable sites where you’re consistently booked
Maintain multiple state licenses if needed
Build a financial buffer (credentialing delays happen)
Create a tax and benefits plan (insurance, retirement, disability)
The doctors who thrive full-time in locums treat it like a business.
32) How do I know if a locums EM site will rebook me?
Rebooking depends on:
You being reliable (on time, responsive, low drama)
Chart completion (don’t leave a mess)
Clinical competence and collegiality
Site culture and staffing needs
If a site likes you, your life becomes easier: less credentialing churn, better shifts, and sometimes higher rates over time.
33) What should I do if the ED is unsafe or the assignment is misrepresented?
If you arrive and the job is not what you were told:
Document concerns objectively (volume, staffing, lack of backup)
Communicate promptly with the medical director and agency
Avoid confrontations during patient care—focus on safety
If needed, escalate to agency leadership
Consider ending the assignment if safety is compromised
You are responsible for patient care and your license. If something is truly unsafe, do not let “contract guilt” trap you.
34) Can I be cancelled and not paid?
Yes—depending on the cancellation policy. That’s why it matters.
Ask:
How much notice is required to cancel you?
Do you get a guaranteed minimum if cancelled late?
Does travel reimbursement still apply if they cancel after booking?
Try to negotiate cancellation protections, especially if you’re traveling.
35) What’s the biggest mistake first-time EM locums doctors make?
The biggest mistake is choosing an assignment based on rate alone and not vetting:
coverage model
acuity
consultant support
boarding realities
documentation load
travel logistics
cancellation terms
A slightly lower rate at a well-run ED often produces higher effective pay and a better life.
36) What’s the best “first assignment” profile for most EM doctors?
A great starter locums site usually has:
double physician coverage (or very low volume if solo)
predictable workflows and strong nursing
reasonable consult access
clear transfer pathways
moderate acuity
manageable boarding
Once you have one successful assignment, your options widen.
37) Should I aim for rural ED locums as my first job?
Only if you’re truly comfortable with:
limited backup
broad scope
high autonomy
transfer logistics
occasional high-acuity surprises
Rural ED locums can be rewarding and sometimes pays more, but it’s not always the best first step if you’re used to heavy consultant support.
38) How do I evaluate ED volume and staffing quickly?
Ask:
Annual ED volume and typical daily census
Patients per hour per physician
Coverage grid by time of day
APP roles and supervision expectations
LWBS rate (often reflects throughput stress)
Admit rate and boarding patterns
If they can’t answer basic operational questions, that’s a warning sign.
39) How do I protect my license as a locums EM physician?
Key habits:
Don’t work outside your competence (especially with limited resources)
Clarify scope and consult availability
Document critical decisions clearly
Follow local policies where reasonable (especially sedation, transfers)
Avoid cutting corners in high-risk areas (sepsis, chest pain, neuro deficits)
Don’t let pressure force unsafe throughput
Locums doesn’t change your standard of care obligations. If anything, unfamiliar environments mean you must be extra deliberate.
40) Can locums help with burnout in emergency medicine?
It can—if you use it to build control and recovery time. But it can also worsen burnout if you:
travel constantly without rest
take only high-intensity sites for the money
work too many nights
accept chaotic EDs with poor support
The best “anti-burnout” locums plan is sustainable blocks, recovery days, and at least one stable rebooking site.
41) What’s a smart way to start locums if I’m nervous?
A low-risk pathway:
Pick a state where you’re already licensed
Choose a site with double coverage
Take a small block (4–6 shifts)
Evaluate travel burden and charting time
Scale up only after you’ve proven the model works for you
Start “boringly.” Boring is good when you’re learning.
42) How do I become the kind of locums doctor everyone wants to rebook?
Simple, underrated moves:
Be early, prepared, and calm
Treat nurses and staff with respect
Ask how the site works instead of assuming
Keep charts clean and complete
Don’t create drama
Be flexible when reasonable (without being exploited)
Medical directors rebook physicians who make their department run smoother.
43) What should I do next if I want to pursue EM locum tenens?
Here’s a practical next-step sequence:
Update your CV with month/year accuracy
Gather your credentialing packet in one folder
Choose 1–2 recruiters/agencies and communicate your criteria
Target a safe “starter” site
Get submitted and start credentialing
Build a repeatable system so your next assignments get easier