Locum tenens physician pay is an hourly rate, and an hourly rate can't be compared with a salary until you know what each one includes. A locum rate usually has to fund the things an employer pays for on top of salary: time off, health insurance, retirement contributions, and in some arrangements the employer's share of payroll tax. What a locum physician earns is the rate, times the hours actually worked, minus those costs.
This guide covers how urgent care locum pay is quoted, what moves the rate, and how to run the comparison with your own numbers. It doesn't publish a rate table. For wage data on employed physicians, the Bureau of Labor Statistics publishes annual wage estimates by occupation, state and metro area, and that's the baseline to compare any locum rate against.
How locum tenens physician pay is quoted
Urgent care locum work is paid by the hour for a scheduled shift. The rate on its own tells you less than the terms around it, so read a locum physician pay offer for four things:
- Which hours are paid. A shift scheduled for ten hours may be paid as scheduled or as worked. If the clinic closes its doors at 8 p.m. and you finish charts at 8:45, ask whether those 45 minutes are paid.
- What happens when the shift changes. A shift can be cut short on a slow day or canceled outright. Whether you're paid for the scheduled hours depends on the cancellation terms, not on the rate.
- Whether differentials exist. Some clinics pay more for evenings, weekends and holidays, and some pay one flat rate. Neither is standard.
- How malpractice coverage is handled. Coverage may be provided by the agency or the facility, or it may be yours to carry. Where it's provided, its cost is usually reflected in the rate you're offered.
An hourly rate that looks lower can pay more over a month once unpaid charting time and canceled shifts are counted. Our guide to locum tenens contract terms goes through the cancellation and malpractice clauses in detail.
What moves a locum physician's pay rate in urgent care
Urgent care sets its own conditions on locum physician pay, and they differ from hospital locum work. There's no call schedule and no overnight coverage at a clinic that closes in the evening, so the variation comes from other places.
Shift timing. Evenings, weekends and holidays are harder for a clinic to cover with permanent staff, and a clinic that needs those shifts filled has a reason to pay more for them.
Local supply. The same shift pays differently in a market with many licensed physicians available and in one with few. Location affects the rate through how hard the shift is to fill, not through cost of living.
Notice. A shift posted for tomorrow is worth more to the clinic than one posted for next month. If your schedule lets you pick up short-notice shifts, that flexibility has a price.
What the shift involves. Being the only clinician on site, covering a clinic with higher daily volume, or working a longer shift are all different jobs from a double-covered weekday. Ask what the staffing looks like before you compare two rates.
Whether you can start. A physician already licensed in the state, with a current DEA registration for that state and a complete credential file, can work a shift next week. A physician who needs a new state license can't, and the shift will be gone by the time it arrives.
Comparing a locum physician rate with a salary
The comparison takes three steps. The figures below are round numbers chosen to show the arithmetic. They aren't market rates.
Step one: convert the salary to an hourly figure. A full-time year is 2,080 hours (40 hours for 52 weeks). A $200,000 salary divided by 2,080 hours is about $96 an hour.
Step two: count the hours you'd actually work as a locum. A salaried physician is paid through vacation, holidays and sick days. A locum physician isn't. If you plan to work 36 clinical hours a week for 46 weeks, that's 1,656 paid hours. At $96 an hour, 1,656 hours pays about $159,000, which is roughly $41,000 less than the salary. To match $200,000 on 1,656 hours, the rate has to be about $121 an hour.
Step three: add what the employer was paying on top of salary. Health insurance, retirement matching, disability coverage and a CME allowance are part of an employed physician's compensation even though they aren't in the salary figure. Take the dollar value of each from your own offer letter or benefits statement, add them to the salary, and divide by your planned locum hours. The result is the hourly rate at which locum work pays the same as the job.
That break-even rate is the number to hold a locum offer against. A locum rate above it pays more than the permanent job for the same clinical hours, and a rate below it pays less, however large the hourly figure looks beside the salary.
Taxes change what a locum physician keeps
How locum income is taxed depends on how the work is classified, and that varies by arrangement. Some locum work is paid as wages with tax withheld. Some is paid as self-employment income, reported on a Form 1099, with nothing withheld. Find out which applies before you compare rates, because the difference comes out of your take-home pay.
When income is self-employment income, two things change. The first is a 15.3% self-employment tax, made up of 12.4% for Social Security and 2.9% for Medicare. An employee pays half of those taxes through withholding and the employer pays the other half, so a self-employed physician is covering both. The Social Security part applies only up to an annual earnings cap, and the employer-equivalent half is deductible when you figure adjusted gross income.
The second is timing. With no withholding, tax is paid during the year through estimated tax payments across four payment periods, and underpaying can bring a penalty. Self-employed physicians can also deduct ordinary business expenses and use retirement plans designed for the self-employed, and the limits on both change from year to year.
This section explains how the rules generally work. It isn't tax advice, and state rules differ, so take your own numbers to an accountant who works with self-employed clinicians. Our guide to locum taxes covers the mechanics in more depth.
How to maximize locum tenens physician pay
Higher locum physician pay comes from a short list of things within your control.
- Keep your credential file current. An expired certification or a lapsed registration takes you out of consideration for a shift you'd otherwise get. The paperwork has no hourly rate, but it decides which shifts you can accept.
- Hold a license where the shifts are. Physicians in member states can use the Interstate Medical Licensure Compact to apply for licenses in several states through one application. Each state still issues its own license.
- Take the shifts that are harder to fill. Weekends, evenings, holidays and short-notice openings are where a clinic has the most reason to pay more.
- Price your unpaid time. Driving, charting after close and credentialing paperwork are all hours. Divide a shift's pay by every hour it costs you, and a nearby clinic at a lower rate can come out ahead.
- Go back to clinics that work for you. A physician who knows the EMR and the staff is more useful on a second shift than a first. Building a long-term relationship with a facility is how occasional shifts turn into a steady schedule.
See the rate before you commit
Every comparison in this guide depends on knowing the rate early. When a rate is quoted by a recruiter instead of posted, ask for it, and for the shift details, before you put time into an application.
Rediworks is a self-service marketplace for urgent care shifts. The rate, location, shift length and facility are shown on every listing before you apply. Sign up to see shifts.