Most clinicians first hear about locum tenens from a colleague who tried it between jobs and never looked back. Or from a program director who mentioned it in passing. Or from a recruiter who called at exactly the right moment — during burnout, a contract dispute, or a life transition that demanded more flexibility than a permanent position could offer.
Whatever brought you here, the appeal is real: locum tenens gives clinicians geographic freedom, scheduling control, and hourly rates that often exceed what a comparable permanent role would pay. But the logistics — licensing, credentialing, taxes, finding reputable placements — can feel opaque to anyone who hasn't done it before.
This guide covers the fundamentals so you can make an informed decision.
What "Locum Tenens" Actually Means
The phrase is Latin for "to hold the place." Clinicians practicing locum tenens step in temporarily at healthcare facilities to cover staffing gaps — a physician on leave, a volume surge during flu season, a gap during a permanent search. Assignments range from a single weekend shift to a six-month contract.
It's not a career category for underperformers. The clinicians sought for locum work are typically experienced practitioners with clean credential histories, strong clinical skills, and the adaptability to function effectively across different EMR systems, patient populations, and facility cultures.
Who does locum work?
Locum tenens is practiced across virtually every clinical specialty and credential type:
- Physicians (MDs and DOs) — from family medicine to subspecialists like anesthesiology and psychiatry
- Advanced Practice Providers (APPs) — nurse practitioners (NPs), physician assistants (PAs), certified registered nurse anesthetists (CRNAs)
- Allied health professionals — in some contexts, though the term is most commonly applied to physicians and APPs
Why Clinicians Choose Locum Work
The motivations vary significantly by career stage.
Early-career clinicians often use locum work to build clinical experience across different settings, explore geographic markets before committing to a permanent position, or manage student debt more aggressively than a starting salary would allow.
Mid-career clinicians frequently transition into locum work to regain scheduling control after years of rigid productivity expectations. Being able to work three weeks on, one week off — or cluster assignments around life events — is a concrete, significant benefit that permanent employment rarely offers.
Late-career clinicians use locum work to scale down gradually without stopping entirely. A physician who wants to reduce to 20 clinical hours per week on their own timeline often finds locum work more accommodating than negotiating part-time status with an existing employer.
Clinicians leaving employment — whether voluntarily after burnout or due to practice dissolution — frequently use locum work to maintain income while evaluating their next permanent move without urgency.
The Financial Picture
Compensation in locum tenens is typically structured as an hourly rate for clinical time, not a salary. In 2025–2026, rates broadly fall within these ranges by credential type and specialty:
| Specialty / Credential | Typical Rate Range |
|---|---|
| Family Medicine MD/DO | $120–$145/hour |
| Hospitalist MD/DO | $150–$225/hour |
| Emergency Medicine MD/DO | $200–$300/hour |
| Anesthesiology MD/DO | $300–$400/hour |
| Psychiatry MD/DO | $150–$250/hour |
| Nurse Practitioner (NP) | $70–$110/hour |
| Physician Assistant (PA) | $65–$100/hour |
| CRNA | $150–$220/hour |
Rates vary meaningfully by geography (rural placements pay 15–30% premiums), shift timing (nights and weekends carry differentials), and assignment type (short-gap coverage typically commands higher rates than multi-month contracts).
The 1099 Reality
Most locum arrangements are structured as 1099 independent contractor engagements. This means:
No employer withholding. Estimate 35–40% of gross income for combined federal and state tax liability, depending on your state. Quarterly estimated payments are required — missing them triggers underpayment penalties.
Significant deductibility. As a self-employed clinician, legitimate deductions include:
- Malpractice insurance premiums (when not covered by the facility)
- Continuing medical or nursing education — conferences, courses, certifications
- Travel, lodging, and meals when working away from your tax home
- Professional licenses, DEA registration, credentialing fees
- Health insurance premiums (when not covered through a spouse's employer plan)
Expanded retirement savings. This is the most underappreciated financial benefit. As a self-employed contractor, you can contribute up to $66,000 annually to a Solo 401(k) or SEP IRA — roughly three times the employee contribution limit. Over a decade, that difference compounds meaningfully.
Working with a healthcare-focused CPA in your first year of locum work typically pays for itself many times over. The tax structure is different enough from W-2 employment that professional guidance avoids costly mistakes.
Benefits You're Responsible For
Permanent employment packages typically include $30,000–$60,000 in effective additional compensation: health insurance, malpractice tail coverage, retirement matching, CME allowances, and disability insurance. In locum arrangements, you fund all of these.
This doesn't make locum work financially inferior — high hourly rates frequently more than offset the benefits gap — but it requires that you price these costs into your decision before comparing offers.
Licensing and Credentialing
This is where most first-time locum clinicians encounter friction.
State Licenses
Locum work typically means working in multiple states. Each state requires a separate active license from the relevant medical or nursing board. Maintaining licenses in multiple states is the norm for active locum practitioners — and it adds administrative overhead.
The Interstate Compact: The Medical Licensure Compact (IMLC) allows physicians licensed in one member state to obtain expedited licensure in other member states. As of 2025, over 40 states participate. This significantly reduces time-to-license in new states for eligible physicians.
Nurse practitioners should check whether their state participates in the Nurse Licensure Compact (NLC), which allows multistate practice under a single license. PAs should look at the PA Licensure Compact (PALC).
Plan for 60–90 day lead time. Even with compact arrangements, obtaining a new state license typically takes two to three months. Initiating licensing in target states before you need the work — not after — is the single most important logistical move you can make early in your locum practice.
DEA Registration
If your practice includes prescribing controlled substances, your DEA registration must be active and registered in each state where you practice (or you must have a SUPREME registration for multi-state coverage). DEA registration takes 4–6 weeks for new applications.
Hospital Credentialing
Facility credentialing — verification of your license, training history, malpractice history, board status, and references — typically takes 30–90 days depending on the facility and the completeness of your documentation. Hospitals and health systems tend to run slower than urgent care centers.
What to have ready:
- Copy of current state license(s) and DEA certificate
- Medical school diploma and residency completion documentation
- Board certification certificates
- Malpractice insurance documentation (or evidence of facility coverage)
- Work history for the past 10 years with explanation of gaps
- Three to five professional references from clinical supervisors
- A current CV formatted to include all training and employment
Malpractice Coverage
Locum assignments are typically covered by the facility's malpractice policy during active shifts. Confirm this explicitly with each placement. If you practice independently between assignments, you'll need your own coverage.
Occurrence vs. claims-made: Most facility policies are occurrence-based (covers incidents that happened during the coverage period regardless of when the claim is filed). Claims-made policies require tail coverage if you stop paying premiums. Understanding which type covers you — and whether a tail is required — is essential when evaluating malpractice arrangements.
Finding Assignments
Staffing Agencies
Traditional staffing agencies maintain physician and APP rosters and match clinicians to open shifts at client facilities. They handle credentialing coordination, logistics, and payments. The trade-off is the agency markup — typically 25–40% of the facility's cost — which may or may not compress your rate relative to a direct arrangement.
The quality of agencies varies substantially. Before committing to one:
- Ask how they handle disputes with facilities
- Confirm their malpractice arrangement and whether you're covered during travel
- Ask specifically how they handle your licensing costs in new states
- Understand whether they offer housing assistance for out-of-state assignments
Direct Placement and New Platforms
Newer platforms — including Rediworks — are replacing the traditional agency model with transparent, AI-enabled matching that connects clinicians and facilities with full rate visibility, portable credentialing, and streamlined scheduling coordination. For urgent care specifically, where shifts are frequent and scheduling windows are often short, platform-based matching reduces time-to-fill significantly while providing the market-rate transparency that traditional agency relationships rarely offer.
Building a Network
The locum clinicians who sustain the best practices over time build genuine relationships with medical directors and facility administrators at the facilities where they perform well — and they manage those relationships through platforms that give both parties scheduling transparency, portable credentials, and consistent payment infrastructure. When a coverage gap opens, they get the first call because the platform surfaces them as a preferred, pre-credentialed provider.
This doesn't happen on the first assignment. It happens after the third or fourth shift at the same facility, when the medical director notices that you show up on time, integrate quickly, and don't generate complaints. Consistency and reliability are the primary currency — and the right platform preserves that track record and surfaces it when the next gap opens.
Making the First Assignment Work
The logistical success of a locum assignment depends almost entirely on what you do before day one.
Confirm the scope in writing. Before you arrive, you should have a signed contract that specifies the clinical scope (what you're expected to do), the shift schedule, the rate and payment terms, and the malpractice coverage arrangement. Do not start work without this documentation.
Learn the EMR before your first shift. Most facilities use Epic, Cerner, Athena, or a regional system. Basic familiarization before arrival — even an hour of self-guided training — dramatically reduces friction on day one.
Understand the patient population. A rural critical access hospital and a suburban urgent care center serving a tech-heavy population are clinically distinct environments with different presenting complaints, risk profiles, and patient expectations. Ask the medical director in advance.
Confirm escalation paths. Who do you call if you need a specialist consult? What's the relationship with the closest hospital for transfers? Where do critical lab values get routed? Knowing this before you need it matters.
Operate like a guest who plans to be invited back. The locum clinicians who build sustainable practices are the ones who leave every facility better than they found it — detailed handoffs, clean documentation, good relationships with the nursing staff. Your reputation travels faster than your CV.
Common Questions
Can I do locum work while maintaining a permanent position?
Yes, and many clinicians start this way. Working one weekend per month at a locum facility while maintaining a primary position is a common entry point that lets you evaluate locum work without committing fully. Confirm that your primary employer agreement doesn't prohibit outside clinical work — some contracts include geographic non-competes or exclusivity clauses that would limit this.
What if I've never done locum work before — will facilities hire me?
Experience matters, but it's not the only factor. Facilities need coverage, and a well-credentialed clinician who's a few years post-training is often a viable candidate even without prior locum experience. Some agencies specifically market to new locum practitioners and manage the logistics more heavily as a result.
How long does it take to start earning money?
The administrative runway — licensing, credentialing, DEA registration — typically takes 60–90 days from when you begin the process. If you start the paperwork before you need the income, the timeline is manageable. Starting the process after you've already left a permanent position creates avoidable financial pressure.
Is locum tenens stable enough to be my only income?
It can be, but stability requires active management. Experienced locum clinicians maintain relationships with three to five facilities and stay in contact with multiple placement sources. Relying on a single facility or agency creates concentration risk. The most durable locum practices look more like a small professional services business than a single employment relationship.
What happens if an assignment doesn't work out?
Assignments end early. Sometimes the facility's needs change. Sometimes the clinical environment isn't what was described. Most agencies have assignment cancellation policies in their contracts — understand yours before signing. Short-gap assignments (under two weeks) have less lead time for cancellations, so the exposure on either side is limited. Longer contracts typically require more notice from both parties.
Is Locum Tenens Right for You?
Locum tenens works well for clinicians who are clinically confident, logistically organized, and comfortable with variability. It works less well for clinicians who want deeply consistent relationships with a patient panel, who are uncomfortable with administrative uncertainty, or who need the predictability of a biweekly paycheck.
The financial upside is real. The flexibility is real. So is the administrative overhead — licensing fees, tax complexity, benefits funding, and the work of building and maintaining a practice that isn't handed to you by an employer.
Most clinicians who try locum work with realistic expectations find that it offers something permanent employment rarely does: autonomy. Not just over scheduling, but over the terms of their practice. That's a significant thing, and it's worth understanding clearly before you decide.
Rediworks is building a platform designed specifically for urgent care clinicians — streamlined credentialing, transparent market-rate pricing, and AI-enabled matching that connects physicians with facilities that fit their skills, schedule, and geography. If you're a clinician interested in locum opportunities in Colorado and beyond, join the waitlist to get early access.
Rate ranges reflect 2025–2026 market data. Individual compensation varies by specialty, geography, assignment type, and negotiation. This post is educational and does not constitute legal, tax, or financial advice — consult qualified professionals for advice specific to your situation.