Locum coverage is a variable labor cost. You pay for it only in the hours you schedule it. A permanent clinician is a fixed cost, paid whether or not patients walk in during those hours.
A budget that records all locum spend as an overage can't separate a peak-week shift you planned months ago from an emergency booking. This guide is for the owner or finance lead of an urgent care. It covers how to build a locum budget line, how to compare the cost of each kind of hour, and what to review each month.
What goes in an urgent care locum budget line
Locum hours come from three sources, and each is predictable to a different degree. Budget them separately.
- Planned leave. Approved vacations and parental leave are on the calendar. The budget is the hours to cover times the rate you expect to pay.
- Peak hours above your permanent team. Last year's visit data shows which weeks and which hours of the day ran above what your permanent staff could cover. Urgent care hybrid staffing shows how to size those hours.
- Unplanned gaps. Call-outs and sudden departures can't be scheduled. Count how many you had last year, by role, and set aside a contingency for a similar number.
With three lines, a variance tells you something. Spending above plan on unplanned gaps points to a different fix than spending above plan on peak hours.
Compare all-in hourly costs for locum and permanent staff
A locum rate and a permanent wage aren't the same kind of number. To compare them, build the full cost of each hour.
A locum hour includes:
- The hourly rate, with any agency or platform fee
- Premium multiples for holiday, overtime or short-notice hours
- Travel or lodging passed through to you, if any
- Your staff's time to arrange the shift and orient a new clinician
A permanent hour includes:
- Wages or salary
- Payroll taxes and benefits
- Paid time off, which is paid hours with nobody on the floor
- Malpractice coverage and any licensing or education allowances you pay
- Recruiting cost, spread over the time the clinician stays
Divide the permanent total by the hours the clinician actually works on the floor, not the hours you pay for. That figure is the one to set beside the locum hour.
A locum hour can cost more than a permanent hour and still be the cheaper choice. The permanent hour is bought in a block that covers the whole year, including the slow weeks. Which one costs less for a given block of hours depends on how many weeks a year you need that block, and the hybrid staffing guide linked above gives the breakeven calculation.
Budget the cost of an uncovered urgent care shift
Every block of hours has three options: staff it permanently, cover it with a locum, or leave it short. The third option has a cost too. It shows up as visits you didn't see and overtime for the clinicians who stayed late.
What an unfilled urgent care shift costs has a worksheet for that figure. Run it for one of your peak blocks and one of your slow blocks. The peak-block result is the most you can sensibly pay to cover that block.
Track overtime beside locum spend
Locum spend and overtime are two ways of paying for the same gap. If you cut the locum line and overtime hours rise in the same months, the cost has moved to another line. It hasn't gone away.
Put both on one report, by month and by role. Whether overtime pay applies to a given clinician depends on their role and how they're employed, so ask your payroll provider or employment counsel which of your staff it covers.
The locum budget numbers to review each month
| Number | What a change tells you |
|---|---|
| Locum hours, split into planned leave, peak and unplanned | A rising unplanned share means gaps are being found late |
| All-in cost per filled shift, by source | A rise without a rate change points to premiums or pass-through costs |
| Share of locum shifts booked with less notice than your own threshold | Short-notice bookings can carry a premium and reach fewer clinicians |
| Overtime hours for permanent staff, by role | Gaps are being covered internally, at a premium |
| Shifts that ran short or went unfilled | Coverage you budgeted for didn't happen |
Set the notice threshold yourself. A week is a reasonable place to start, and your own booking records will show whether it's the right one.
Check locum invoices against what you approved
Check four things on each invoice:
- Hours invoiced match the hours your clinic approved.
- The rate matches the rate agreed for that shift.
- Any premium was applied to hours that qualify under your agreement.
- Any pass-through cost was one you approved.
Ask for the total cost of a shift in writing before you book it. What to read in a staffing agency contract covers the terms that change that total.
When a locum budget line should stay small
If your volume is nearly flat across the year, you need the same hours almost every week, and permanent staff cover them at a lower cost. The same is true of a small clinic where one provider handles demand in nearly every open hour. In both cases the locum line covers leave and call-outs only.
This guide explains how these costs are generally built. It isn't accounting or employment advice, and your accountant is the person to confirm how your clinic should record them.
Rediworks is a self-service marketplace for urgent care locum shifts. You post the clinician type, dates and shift details yourself, and the rate is on the listing before a clinician applies. Sign up to post shifts.