For most of the last decade, telehealth and locum tenens existed as parallel solutions to the same problem: patients in underserved areas couldn't reliably access specialty care. Telehealth removed the need for physical presence. Locum tenens filled gaps when a local specialist wasn't available. The two models operated largely in separate lanes.
That separation has collapsed. The most effective staffing strategies in 2025 don't treat telehealth and locum tenens as alternatives — they integrate them into a single hybrid model designed for the actual shape of modern care delivery. Facilities that have adopted this approach are seeing measurable improvements in specialty access, cost control, and provider retention. Those still treating them as separate levers are leaving significant operational value on the table.
The Structural Problem Both Models Were Trying to Solve
The United States faces a structural mismatch between where specialty physicians practice and where patients actually need care. Urban academic medical centers and large health systems absorb a disproportionate share of the specialist workforce. Rural and semi-rural communities — often home to older, sicker, and lower-income populations — are left with inconsistent access, long wait times, and care gaps that result in preventable hospitalizations and worse outcomes.
Locum tenens addressed this by moving physicians to where patients were. A psychiatrist from Chicago could spend two weeks per month in rural Montana, providing coverage that a standalone critical access hospital could never sustain with a permanent hire. The model worked, but it had friction: credentialing across multiple states, travel logistics, housing costs, and the cognitive load of practicing in constantly rotating environments.
Telehealth addressed this by removing geography from the equation entirely. A cardiologist licensed in multiple states could conduct follow-up visits, interpret diagnostics, and manage chronic conditions without getting on a plane. The model also worked — but it had limits. Certain specialties, procedures, and patient populations still require in-person presence, and the pure telehealth model left those gaps unaddressed.
Hybrid staffing models combine the reach of telehealth with the physical availability of locum coverage, deploying each where it does the most work.
What a Hybrid Model Actually Looks Like in Practice
The mechanics vary by specialty and facility type, but the core structure is consistent: a specialist operates as a locum provider for periodic on-site visits while extending their coverage footprint via telehealth during the intervals between those visits.
Consider a behavioral health example — a population where the access gap is arguably the most severe. A psychiatrist working under a hybrid arrangement might be on-site at a rural hospital or federally qualified health center for five days per month. During those on-site days, they conduct new patient evaluations, manage complex cases, and do the relationship-building work that in-person clinical interactions enable. During the remaining three-plus weeks, they remain the psychiatrist of record for that facility's patient panel, conducting medication management appointments, responding to clinical questions from nursing staff, and providing urgent consultations via video. The facility gets something closer to a continuous specialist relationship rather than a disjointed series of locum visits.
This model is particularly effective in psychiatry because of what's at stake when coverage disappears between assignments. A patient mid-treatment who loses access to their prescribing physician — even for two weeks — faces real clinical risk. Hybrid arrangements dramatically reduce those continuity gaps.
The same logic applies in other specialties. Cardiology hybrid programs allow a locum cardiologist to be on-site for procedures and acute cases while managing a follow-up panel via telehealth. Endocrinology programs can address diabetes management at scale across a large geographic area with a small on-site presence supplemented by robust virtual visits. Neurology coverage for stroke protocols — where time-to-treatment is the most important variable — can be structured so that a remote specialist is always accessible via telemedicine while periodic on-site coverage handles elective consults.
The Credential and Licensure Infrastructure Behind Hybrid Staffing
One of the meaningful barriers to hybrid adoption has been the credentialing complexity it introduces. A physician practicing in a telehealth capacity across multiple states must be licensed in each state where the patient is located — not where the physician sits. This creates a multistate licensing burden that can be substantial.
The Interstate Medical Licensure Compact (IMLC) has materially reduced this friction for physicians in participating states. As of 2025, 40 states plus Washington D.C. and Guam participate in the Compact, allowing physicians who meet eligibility criteria to obtain multiple state licenses through a single application process. For locum physicians building hybrid practice arrangements, IMLC participation has become nearly table-stakes — it's the infrastructure that makes geographic flexibility operationally viable rather than administratively punishing.
Facility credentialing processes have also evolved. Health systems that have built serious hybrid staffing programs now maintain credentialing frameworks that can accommodate providers in dual on-site and telehealth roles, including expedited credentialing pathways for locum physicians who have already been vetted by their staffing partner. The facilities that are slowest to adopt hybrid models are often the ones with credentialing offices that weren't built for this kind of provider relationship and haven't invested in modernizing.
This is one area where technology platforms — including AI-powered credentialing tools — are beginning to make a measurable difference. The manual credentialing bottlenecks that delay locum placements by weeks are exactly the kind of friction that erodes the viability of hybrid arrangements, where timeliness of onboarding is essential to maintaining continuity.
Why Hybrid Models Are Winning on Cost
The financial logic of hybrid staffing is straightforward once you model it against the alternatives. Traditional locum coverage has significant cost structure beyond the physician's rate: travel, housing, malpractice, and the administrative overhead of managing frequent handoffs between providers. These costs are real but often underweighted by facilities because they're distributed across departments rather than showing up as a single line item.
Telehealth-only models carry their own cost implications. While they reduce travel spend, they don't address the in-person care gaps that continue to drive expensive emergency utilization. Patients who can't get an in-person specialist consult when they need one often end up in the emergency department — a far more expensive setting for a problem that could have been managed earlier.
Hybrid models create a cost structure that better matches clinical utility. The on-site locum presence handles what genuinely requires physical presence. Telehealth coverage handles everything it can — and the combination reduces the volume of care that falls through the gaps entirely. Facilities with well-designed hybrid programs have reported reductions in specialist-related ED utilization as a direct outcome of improved access continuity.
For clinicians, the financial picture is also compelling. A physician practicing in a hybrid arrangement can generate a substantial portion of their revenue through telehealth visits during periods when they're not on-site — effectively monetizing clinical time that would otherwise be unproductive. Locum physicians who have built multistate licensure portfolios and hybrid practice arrangements report meaningfully higher annual earnings than those in traditional locum-only models.
The Specialties Driving Hybrid Adoption
Not every specialty lends itself equally to hybrid staffing. The model works best where a meaningful portion of care can be conducted via video without compromising clinical quality — and where the access gap is severe enough to justify the operational investment in building a hybrid program.
Psychiatry and behavioral health remain the leading edge of hybrid adoption for the reasons described above: severe access shortage, a high proportion of care that can be effectively delivered via telehealth, and significant clinical risk when coverage lapses.
Neurology has emerged as another strong hybrid specialty. Stroke telestroke protocols have been telehealth-native for years; extending that into a broader hybrid coverage model for non-acute neurology is a natural progression for facilities in markets without local neurology capacity.
Endocrinology is increasingly hybrid by default. Diabetes management — the dominant use case — involves frequent touchpoints that are well-suited to video, with periodic in-person visits for physical examination and device management. The growing prevalence of continuous glucose monitoring and remote physiologic monitoring has further shifted the visit-type mix toward telehealth-compatible encounters.
Dermatology has long had a teledermatology component, and hybrid arrangements are becoming more common for facilities in underserved markets that need a locum dermatologist for procedures while managing the referral and follow-up volume via telehealth.
The specialty shortage data from 2026 reinforces why these specialties are leading adoption: the supply constraints are sharpest precisely where hybrid models offer the most leverage.
What Rural and Critical Access Hospitals Need to Know
For rural and critical access hospitals, hybrid staffing models aren't just a nice-to-have — they're increasingly the only viable path to specialty access. The math of full-time specialty recruitment in rural markets simply doesn't work for most specialties. The patient volume isn't sufficient to support a full-time specialist position financially, and the lifestyle proposition isn't competitive enough to recruit one away from urban alternatives.
Hybrid models solve both problems. The locum physician's income is blended across multiple facilities and modalities, making the math work even at patient volumes that wouldn't support a permanent hire. The telehealth component means the physician isn't fully isolated in a rural environment — they maintain a distributed practice with meaningful income continuity between on-site visits.
The facilities that have made this work are the ones that have been intentional about building it as a program rather than defaulting to it out of necessity. They've invested in the telehealth infrastructure — reliable broadband, appropriate video visit technology, workflows that support remote prescription management and documentation — before the locum arrangement goes live. They've built facility relationships with locum physicians that extend beyond individual assignments, creating the kind of continuity that makes a hybrid model function as a real care team rather than a series of disconnected engagements.
Rural hospital administrators who want to understand the full range of what's driving these dynamics — and the strategies that work — should read the deeper breakdown on rural hospital staffing approaches.
How Clinicians Should Think About Hybrid Practice
For locum tenens physicians and advanced practice providers considering hybrid arrangements, the opportunity is real — but so is the planning required.
The first step is licensure. Building a multistate license portfolio through the IMLC takes time but is the prerequisite for practicing telehealth across state lines legally and compliantly. Physicians who haven't invested in multistate licensure are limited in how far they can extend a hybrid practice geographically.
The second is technology. Effective telehealth practice requires more than a video call platform. Clinicians practicing in hybrid arrangements need workflows for asynchronous communication, remote monitoring data review, and documentation that satisfies regulatory requirements in multiple state jurisdictions. These are learnable, but they take deliberate setup.
The third — and most important — is relationship-building with facilities. The hybrid model works because it creates continuity; continuity happens when the facility sees the clinician as a long-term partner rather than a rotating coverage placeholder. Locum physicians who approach hybrid arrangements with a relationship orientation — communicating proactively with facility staff during telehealth intervals, investing in understanding the patient population, maintaining clinical handoff discipline — are the ones who turn single assignments into multi-year arrangements with stable income.
The earnings potential of a well-structured hybrid practice is substantial. Physicians who combine on-site locum rates with telehealth visit revenue across multiple facilities can build income profiles that compare favorably to permanent positions while retaining the schedule flexibility that makes locum work attractive. The physician pay guide covers the compensation mechanics in more detail for clinicians building out the financial model.
The Regulatory Landscape in 2025
Federal telehealth policy has been in flux since the COVID-19 public health emergency expired, and the hybrid staffing model is directly affected by where that policy lands.
The most consequential active issue is the status of DEA prescribing rules for controlled substances via telemedicine. During the public health emergency, prescribers could initiate controlled substance treatment via telehealth without an in-person examination. The extension of that flexibility has been subject to ongoing regulatory review, with the current framework preserving the in-person exemption through at least mid-2025 but with significant uncertainty beyond that.
For hybrid models in psychiatry and pain management — specialties with high volumes of controlled substance prescribing — this matters enormously. Facilities and clinicians building hybrid arrangements in these specialties should be tracking the DEA's special registration framework for telemedicine prescribing, which is expected to create a permanent regulatory structure for telehealth-based controlled substance prescribing but with requirements that differ from the public health emergency flexibilities.
Beyond DEA prescribing, state-level telehealth parity laws continue to evolve. As of 2025, the majority of states require commercial insurers to reimburse telehealth visits at parity with in-person visits, but the details vary — some states apply parity only to certain visit types, others have restrictions on audio-only visits or asynchronous modalities. Facilities building hybrid programs need to model their telehealth reimbursement assumptions carefully against the parity rules in the states where they operate.
Looking Forward
The trajectory of hybrid staffing is clear. As telehealth infrastructure matures, as multistate licensure becomes more accessible, and as facility credentialing processes catch up to the reality of distributed clinical work, the hybrid model will become the default for specialty coverage in underserved markets — not an innovation, but standard practice.
What's less clear is the pace. Facilities with legacy credentialing processes, siloed telehealth and locum contracting, and clinical workflows that weren't built for remote care will lag. Those that invest early in the infrastructure — technology, relationships, and credentialing capability — will have a structural advantage in attracting the specialist coverage that increasingly defines the quality of care their communities can access.
For clinicians, the window to build a differentiated hybrid practice is open. The physicians who are establishing multistate licensure portfolios, building long-term facility relationships, and developing telehealth practice competence now will be well-positioned as demand for hybrid-capable locum providers continues to outpace supply.
The combination of telehealth reach and locum flexibility isn't a workaround. It's the architecture of specialty care delivery for the next decade.
Rediworks helps facilities and clinicians build the kind of long-term, flexible staffing relationships that make hybrid models work. If you're exploring what hybrid coverage could look like for your specialty or your facility, learn more about how we approach staffing.