The most common question physicians ask before going locum is simple: how much will I actually make?
The answer is more nuanced than the headline numbers suggest. Locum tenens compensation ranges from $120/hour for family medicine clinic work to north of $400/hour for locum anesthesiologists in high-demand markets. Where you land in that range depends on specialty, geography, scheduling structure, and — more than most physicians realize — how well you understand the market before you negotiate.
Here's what the data actually shows, and what it takes to maximize your earnings.
What Locum Physicians Earn by Specialty
Compensation is typically quoted as an hourly rate for clinical time, not a salary. That distinction matters — locum physicians often earn more per hour than permanently employed peers, but without employer-paid benefits, retirement matching, or predictable income between assignments.
Emergency Medicine and Urgent Care EM locums earn $200–$300/hour in 2025, with variation driven by shift type (day vs. overnight), facility acuity, and whether solo coverage is required. Urgent care-specific shifts, which typically carry lower acuity than true ED work, sit at the lower end of that range — but volume is high and assignments are plentiful. Demand for urgent care locums remains acute: 42% of urgent care physician searches went unfilled at end of 2024.
Family Medicine and Primary Care The most accessible entry point for new locums. Rates run $120–$145/hour for outpatient clinic work, with most contracts running two to six months. These roles are available in volume and provide a lower-friction first assignment — particularly useful if you're testing locum work before committing fully.
Anesthesiology Among the highest-paid locum specialties: $300–$400/hour is realistic for experienced anesthesiologists, up from $275–$325 in 2024. Demand consistently outpaces supply in this space.
Psychiatry and Neurology Telepsychiatry has broadened access to these roles dramatically. Psychiatry locums typically earn $150–$250/hour; neurology runs $200–$275/hour. Both specialties face substantial shortages that translate directly into negotiating leverage.
Hospitalist A strong entry point for physicians coming out of residency. Hospitalist locums working 15 shifts/month in favorable markets regularly earn $350,000 or more annually — with some exceeding $400,000 without additional shifts.
What Actually Moves Your Rate
Specialty is the largest determinant of your baseline. But within a specialty, these factors have the biggest effect on where your offer lands:
Geography and setting. Rural and underserved placements routinely pay 15–30% premiums over suburban or urban assignments covering equivalent acuity. Solo coverage requirements (no backup on-call) add additional premium.
Shift timing. Nights, weekends, and holidays carry differentials that compound quickly. A physician optimizing for nights-and-weekends in a high-demand specialty can meaningfully outperform a comparable physician working standard hours.
Assignment length. Short-term gap coverage (under two weeks) typically commands higher hourly rates than multi-month contracts, because facilities pay a liquidity premium for fast availability. If you can commit to longer assignments, you trade rate for stability and reduced administrative overhead.
Credentialing completeness. A physician with current DEA registration, an active state license in the target state, and clean malpractice history is worth more to a facility than one with gaps — because they can start sooner. The more portable and current your credentials, the stronger your negotiating position.
Experience. Most platforms and facilities recognize a premium for physicians with 5+ years post-training. Additional certifications (critical care, point-of-care ultrasound, telemedicine proficiency) add further leverage in competitive markets.
The Independent Contractor Reality
Most locum arrangements are structured as 1099 independent contractor engagements, not W-2 employment. This has real implications for how you plan your finances.
There's no employer withholding. Set aside 35–40% of gross income for state and federal taxes — more in high-tax states — and make quarterly estimated payments to avoid penalties.
The upside is substantial deductibility. As a self-employed physician, you can deduct:
- Malpractice insurance premiums (often paid by the facility, but when paid personally, fully deductible)
- Continuing medical education — conferences, courses, board review, all 100% deductible
- Travel, lodging, and meals when working away from your tax home
- Professional licenses, DEA registration, and credentialing fees
- Home office, if you manage assignments and administrative work from home
- Health insurance premiums (when not eligible for a spouse's employer plan)
The most significant financial advantage is retirement savings capacity. As a self-employed contractor, you can contribute up to $66,000 annually to a Solo 401(k) or SEP IRA — versus the $22,500 employee limit in a W-2 position. That gap, compounded over a decade, is a significant wealth-building advantage that rarely gets discussed in locum compensation conversations.
How Locum Pay Compares to Permanent Employment
The comparison is more complex than it appears. Permanent positions include benefits (health insurance, malpractice tail coverage, retirement matching, CME allowances) that typically add $30,000–$60,000 in effective compensation above the base salary. Locum hourly rates are gross — you're self-funding all of those.
That said, locum physicians who actively manage their practice often out-earn permanently employed peers by $50,000–$150,000 annually — particularly in high-demand specialties and when optimized for high-rate markets.
The physicians who earn the most in locum work are not necessarily the ones working the most hours. They're the ones who:
- Understand current market rates and negotiate accordingly
- Keep credentials current and portable across multiple states
- Maintain relationships with facilities where they've performed well
- Structure their finances to capture the tax and retirement advantages of independent contractor status
Why Urgent Care Is a Particularly Strong Locum Market
For physicians who can work urgently care acuity — broad presenting complaint mix, procedural capability, fast-paced patient flow — the urgent care locum market has durable demand characteristics.
Patient volumes in urgent care have grown consistently as more patients use urgent care as their primary access point. The physician shortage projected to reach 86,000 by 2036 is acutely felt in this setting, where permanent hiring pipelines are slow and volume is unpredictable.
Locum physicians who build reputations at specific urgent care facilities often become the go-to first call when coverage gaps open — which means better scheduling control, fewer agency intermediaries, and more favorable terms over time.
Getting Started
If you're considering locum work for the first time, the practical steps are:
- Ensure your credentials are current — active state license in target states, DEA registration, malpractice coverage.
- Understand your tax home — critical for determining which travel expenses are deductible.
- Research market rates in your specialty before accepting your first offer — the first offer is rarely the best one.
- Work with a healthcare CPA in your first year — the tax structure is different enough from W-2 employment that professional guidance typically pays for itself many times over.
Rediworks is building a platform that removes friction from both sides of this equation — for physicians managing credentials and assignments across facilities, and for urgent care centers that need reliable coverage with full market-rate transparency and AI-enabled matching. If you're a physician interested in locum work in Colorado, join the waitlist to get early access.
Pay rate data in this post reflects 2025 market figures compiled from industry sources including Locums.com, CompHealth, and Locumpedia. Individual rates vary by market, assignment type, and negotiation.