There is a tax embedded in every locum shift an urgent care facility fills through a traditional staffing agency. It runs 25–40% on top of whatever the provider earns. It doesn't appear as a line item. It's built into the all-in rate — the number the agency quotes as the cost of the shift.
Most urgent care operators pay this tax on every single locum engagement, quarter after quarter, without a clear accounting of what it costs them annually. A facility running 300 locum physician shifts per year at $210/hour for 10-hour shifts, sourced entirely through agency, is spending roughly $630,000 on agency markup alone — not on clinical coverage, but on the intermediary layer between the facility and the providers it needs (CHG Healthcare, "2025 State of Locum Tenens Report").
The float pool strategy is the operational response to this structural problem. An internal locum network — built and managed by the urgent care operator as a complement to other staffing channels — can shift a significant portion of reactive last-minute fills to planned, relationship-managed coverage. Facilities that build this infrastructure systematically can realistically move 35–45% of their previously unplanned fills to internal network coverage at planned rates, which is the basis of what operators describe when they say they've improved their internal fill rate by 40%.
This isn't a novel idea. Henry Ford Health built an internal resource pool called the Best Choice program and now avoids nearly $10 million in labor-related costs annually through it (HWL Works, 2024). The challenge for urgent care operators — particularly multi-site groups and single-location facilities without large operations teams — is building that infrastructure at their scale, without a health system's credentialing apparatus and HR infrastructure.
Here's what it actually takes.
What a Float Pool Is (and Isn't) in Urgent Care
The term "float pool" originates in hospital staffing, where it describes a group of staff nurses who rotate across departments based on census and need. In urgent care, the concept applies differently — not to permanent employees rotating across internal departments, but to a curated group of pre-credentialed locum and per-diem providers who are directly contracted with the facility and available for coverage through direct platform engagement rather than ad hoc sourcing.
An urgent care float pool is, in practice, your own mini-staffing function. Instead of outsourcing the identification, vetting, and booking of temporary providers to an agency, you build and manage that capability internally.
The distinction matters more than the terminology. What makes a float pool different from an informal list of physicians who've covered shifts before is:
- Systematic pre-credentialing. Every provider in the pool is fully credentialed at your facility before they're needed. Not credentialed-in-process. Credentialed.
- Active relationship management. The pool is maintained with regular communication, proactive scheduling outreach, and direct compensation — not surfaced only when a gap appears.
- Defined coverage rules. Float pool providers have clear expectations about availability windows, response times, and scheduling priority — explicit agreements rather than assumed availability.
- Transparent financial relationships. Float pool providers are paid at market rates with full transparency — through a platform that makes rate structures visible to both parties rather than embedded in opaque all-in billing.
Without all four of these elements, what you have is a contact list. Contact lists don't fill shifts reliably when you need them. Float pools do.
The Economics: Where the 40% Number Comes From
Float pool performance is measured in terms of shift displacement: what percentage of your coverage gaps are being filled from your internal pre-credentialed pool versus reactive channels. "Shifting 40% of fills to the internal network" means 40% of previously last-minute fills are now covered by pool providers at planned rates. The 40% target is not a cost-reduction target; it's a fill-pattern target. The cost savings follow from the shift in fill pattern.
Here's the arithmetic that makes it compelling:
For a mid-sized urgent care operation filling 400 locum physician shifts per year through agency at an average bill rate of $260/hour (10-hour shifts), annual agency expenditure is approximately $1,040,000. Of that, roughly 25–30% — $260,000–$312,000 — represents agency markup above what the provider receives (Weatherby Healthcare, 2024; industry standard markup range).
If you shift 40% of those fills — 160 shifts — to platform-managed internal network fills at the provider's market rate of $200/hour, your per-shift cost drops from $260 to $200. On those 160 shifts, savings total $96,000 annually. That's real money, and it doesn't require restructuring your entire staffing approach — it requires building enough proactive internal capacity to handle a defined portion of your coverage at planned rates.
The 40% displacement target is meaningful because it's achievable without heroic effort. You don't need to build a float pool of 50 providers to displace 40% of agency fills. For a single-site urgent care running one to two locum shifts per day, a pre-credentialed pool of eight to twelve providers with active availability offers realistic same-week fill capacity for the majority of predictable gaps.
The Case for Proactive Float Pool Infrastructure
Before building the infrastructure, it helps to be precise about what problem you're actually solving beyond cost reduction.
Reactive staffing optimizes for the fill, not your cost structure. When you call with a gap at the last minute, the fill happens at whatever the market will bear on short notice. The incentive structure around urgency-driven placement is not aligned with your goal of minimizing cost while maintaining clinical quality.
Relationship-less coverage doesn't compound. A physician who covers twelve shifts at your facility without a direct relationship remains a transactional fill, not a facility asset. That physician may return or may not. The compounding value of a familiar, experienced provider who has internalized your workflows and team culture only accumulates when you own and manage the relationship — not when it passes through an intermediary who holds the physician connection.
Single-channel scheduling concentrates risk. When your only backup for a no-show or coverage gap is a reactive call to a single channel, you're one failed response away from an unfilled shift. The operational and financial consequences of an unfilled urgent care shift are well-documented — 2–4x the face value of the missed shift when downstream effects are counted. An internal float pool with pre-credentialed providers and direct notification gives you a faster, more reliable backstop.
The post-pandemic market has made last-minute fills more expensive, not less. According to CHG Healthcare's 2025 State of Locum Tenens Report, locum tenens usage jumped 25% higher than anticipated in 2024 — demand for the same supply means rates stay elevated for last-minute fills. Hospitals' contract labor expenses increased 258% between 2019 and 2022 as the market tightened (American Hospital Association, 2023). Building proactive internal capacity now, while the economics are compelling, positions you ahead of further tightening.
Infrastructure Requirements: Building the Pool
An internal locum float pool is not a complicated project. It has four components: provider recruitment, credentialing, scheduling infrastructure, and compensation management. The challenge is not complexity — it's that all four must be built before the pool provides value, which creates a horizon problem for operators accustomed to reactive gap-filling.
Provider Recruitment for Float Pool Roles
Recruiting for a float pool is different from recruiting for a scheduled locum assignment. You are not looking for a provider who wants a two-week engagement. You are looking for providers who want an ongoing, part-time, flexible relationship with a specific facility.
The ideal float pool candidate:
- Is already established in locum work and comfortable with variable scheduling
- Values facility familiarity and prefers repeat relationships over constant new assignments
- Is geographically local or regional (which reduces travel costs and response time)
- Has availability windows that overlap with your typical coverage gaps (often weekends, evenings, and short-notice fills)
This profile is more common than operators assume. Many experienced locums who have been doing locum work for several years actively prefer a small number of facility relationships where they're known, over constant new-facility placements. The dynamics of provider retention in urgent care apply to float pool recruitment: the providers who are best suited to this model are looking for what you're offering. The question is whether you're offering it clearly.
Recruitment channels that work well for float pool staffing:
- Direct outreach to physicians who have covered shifts at your facility through agency — these providers already know your environment
- Referrals from your permanent staff and medical director
- Locum-focused platforms that enable direct-engagement contracting rather than agency placement
- Regional physician Facebook groups and LinkedIn, particularly for NP and PA recruitment
Credentialing: The Non-Negotiable Front-Load
Credentialing is the operational bottleneck that determines whether your float pool actually functions when you need it. Providers who are not fully credentialed at your facility cannot legally see patients there — and credentialing in a traditional workflow takes 30–90 days.
The required posture is: credential first, fill gaps second. Every provider you identify as a float pool candidate must complete credentialing before you need them. Not when the gap appears. Before.
This is a real investment. For a float pool target of ten physicians, you are running ten credentialing processes — each requiring licensure verification, background check, DEA and DEA registration confirmation, CME review, and facility privileging. If your credentialing team is at capacity, this either requires additional resourcing or a platform that centralizes and accelerates the verification process.
Modern staffing platforms address this by creating portable credential verification — a physician's credentials are verified at the platform level and accepted by participating facilities without restarting from scratch. For operators building a float pool, platform-supported credentialing dramatically reduces the time and cost of pre-credentialing a bench of providers who may cover shifts infrequently.
The target credential velocity for a functional float pool: complete initial credentialing for at least two to three new providers per month during the build phase, and maintain active credentialing for every provider in the pool with no lapsed credentials.
Scheduling Infrastructure: One System, All Providers
The single most common failure mode for internal float pool programs is maintaining them in the wrong tool. A spreadsheet of credentialed provider contacts, even a well-maintained one, cannot do what a float pool requires:
- Surface available providers in real time when a gap appears
- Track which providers are already scheduled (to avoid double-booking)
- Manage credentialing status and renewal dates automatically
- Notify multiple providers simultaneously when a fill is needed
- Track shift history and provider utilization across the pool
The multi-site urgent care scheduling challenges that make spreadsheets insufficient at scale apply to float pool management as well. A float pool that lives in a spreadsheet will be maintained well right after it's built and progressively less well as the novelty fades and the coordinator has other priorities. The infrastructure needs to work with minimal manual maintenance.
Purpose-built scheduling platforms for urgent care — whether general-purpose healthcare workforce tools or urgent-care-specific platforms — provide the data layer that a spreadsheet cannot. The return on that infrastructure is measured in shifts filled from the internal pool that would otherwise have been agency-filled.
Direct Compensation: Rates, Timing, and Clarity
Float pool providers who are paid correctly become loyal. Those who are not become unreliable and eventually unavailable.
"Paid correctly" means three things in the float pool context:
At market rate, directly. The market rate for a float pool physician is the same as the market rate for any locum physician — whatever the current benchmark is for your geography, specialty, and shift type. The savings from your float pool come from eliminating agency markup, not from paying providers below market. Providers who feel they're being paid below market because the facility "saved" on the agency fee will disengage.
On a defined payment schedule. One consistent complaint from locum physicians working directly with facilities rather than through agencies is payment uncertainty — when will the invoice be paid, by whom, and how. Set a clear payment cycle (weekly, biweekly) and adhere to it without exception. Administrative predictability is a retention lever that costs nothing to implement and matters more than operators realize.
With explicit rate structures for different shift types. Standard weekday shifts, weekend and evening shifts, same-day fill requests, and holiday coverage should have published rate differentials — not negotiated case by case. A clearly communicated rate card that float pool members can count on is more attractive than a vague "competitive rates" promise. Benchmark details can be found in the 2025 urgent care locum compensation overview for reference.
How Many Providers Do You Need?
Float pool sizing depends on your shift volume and your agency displacement target, but the practical math is simpler than it looks.
A single-site urgent care filling two locum shifts per day (a weekend-heavy coverage pattern) needs reliable availability from the pool for roughly 20–25 locum shifts per month. To fill 40% of those from the float pool rather than agency — 8–10 shifts per month — you need a pool of pre-credentialed providers with enough depth that on any given weekend, at least one is available.
Provider availability in a float pool is not 100% predictable. Float pool members have their own schedules — vacations, personal commitments, other engagements. A reasonable planning assumption is that any individual float pool provider will accept a given fill request 30–50% of the time when offered, depending on lead time and shift timing. With a pool of 8–10 providers, a single shift request sent to all available pool members will generate at least one confirmed response in the majority of cases.
As a rough sizing guide:
- Single-site operation targeting 40% internal fill: 8–12 credentialed physicians and APPs
- Two-to-three-site group targeting 40% internal fill: 15–25 credentialed providers across credential types
- Four-plus-site network: 30+ providers with cross-site credentialing and a dedicated coordination function
These numbers scale with shift volume and complexity. The floor for any meaningful float pool is approximately eight providers — below that, availability reliability becomes too low to depend on.
The Build Sequence: Realistic Milestones
Operators who try to build a float pool in response to a coverage crisis fail. The build requires lead time, and it requires treating the float pool as a strategic infrastructure project rather than a staffing workaround.
A realistic 12-month build sequence for a single-site urgent care operation:
Months 1–2 (Foundation): Audit existing relationships. Identify physicians who have worked at your facility through agency in the past 18 months and are geographically local. Contact them directly and gauge interest in a direct-engagement relationship. Target: three to five expressions of interest.
Months 2–4 (Credentialing sprint): Run credentialing for the three to five interested providers simultaneously. Set up direct contracting with a standard locum physician agreement covering rate structure, scheduling expectations, and payment terms. Target: two to three fully credentialed float pool members.
Months 3–6 (Pool expansion): Begin actively recruiting additional float pool members through referrals and platforms. Continue running credentialing as new candidates complete intake. Target: six to eight credentialed pool members.
Months 4–6 (First internal fills): Begin routing predictable, advance-notice gaps to the float pool before going to agency. Track fill rate, response time, and shift quality. Target: 15–20% of locum shifts filled internally.
Months 6–12 (Optimization): Expand the pool to target depth. Refine the scheduling workflow. Identify which providers are most reliable and increase shift allocation to them. Begin routing same-week gaps to the pool as a first response, before agency. Target: 35–45% of locum shifts filled internally.
The twelve-month timeline is conservative — operators who prioritize the build and have experienced operations resources can move faster. The important discipline is not skipping the credentialing front-load. A float pool of interested-but-not-yet-credentialed providers is not a float pool.
What This Looks Like on a Budget Line
Modeling the economics for a concrete example makes the build case clearer.
Baseline: A two-site urgent care group filling 500 locum physician shifts per year through agency. Average bill rate: $240/hour (10-hour shifts). Total agency spend: $1,200,000/year. Implied agency markup (30%): $360,000 of that total goes to agency margin.
After Float Pool Build (Year 2 and Beyond):
- Internal pool fills 200 of 500 shifts (40% displacement)
- Internal fill cost: 200 shifts × $185/hour × 10 hours = $370,000
- Remaining agency fills: 300 shifts × $240/hour × 10 hours = $720,000
- Total locum cost: $1,090,000
- Annual savings vs. baseline: $110,000
Additional recurring savings:
- Reduced no-show crisis costs from a deeper pre-credentialed bench
- Lower onboarding overhead from familiar repeat providers
- Higher throughput from providers who know your systems and workflows
The $110,000 hard-dollar savings is on the conservative end — it assumes the pool fills only the lower-acuity, advance-scheduled shifts at the low end of the rate range. If you also displace same-week urgent fills that would otherwise carry short-notice premiums, the savings increase. The direct and downstream costs of coverage gaps are the other lever — a float pool that fills gaps before they become crises avoids a category of cost that rarely appears in the staffing budget but consistently affects the P&L.
Maintaining the Pool Over Time
Float pools decay without active maintenance. Providers lose interest, credentialing lapses, shift allocation patterns drift toward agency defaults, and the pool becomes a nominal asset rather than a functional one.
The maintenance requirements are modest but non-negotiable:
Quarterly scheduling outreach. Float pool members should hear from you on a regular cadence — not just when you have an urgent need. Advance scheduling communication builds the relationship and ensures pool members are blocking time for your facility rather than taking competing engagements.
Annual credentialing renewals. Track credential expiration dates and start renewal processes 90 days before expiration. A single credentialing lapse that prevents a provider from covering a shift, discovered when you need them, erodes confidence in the pool.
Pool depth monitoring. Track your fill rate from the internal pool monthly. If it's declining, investigate why — are providers taking fewer shifts because of competing options, or is your scheduling infrastructure routing gaps to agency before the pool is offered?
Proactive pool expansion. Attrition in a float pool is normal. Providers move, change practice models, accept permanent positions. Build regular pool recruitment into your staffing calendar rather than treating it as a crisis response when the pool shrinks.
The operations overhead for maintaining a functional float pool — at a single site — is estimated at three to five hours per week for a dedicated scheduling coordinator. That's modest relative to the management overhead of chronic agency-dependent staffing, which tends to consume scheduling coordinator capacity in reactive crisis management rather than proactive relationship building.
The Compound Return
The financial case for a float pool is clear in year two. The strategic case compounds over time in ways that don't appear in the initial ROI model.
A float pool provider who has covered 40 shifts at your facility over two years is not the same asset as a provider who has covered three. They know your EMR configuration, your triage protocols, your front desk team, your lab capabilities, and your preferred order sets. They hit the ground running on shift one with zero ramp-up overhead. Their throughput is the same as your permanent staff, not the learning-curve throughput of a first-shift newcomer.
According to CHG Healthcare's 2025 State of Locum Tenens Report, 80% of healthcare facilities expect to maintain or increase their locum usage through 2025 — which means the agency market for urgent care coverage is getting tighter, not looser. Operators who have built internal float pool infrastructure are increasingly positioned to fill coverage needs that competitors cannot, at costs competitors cannot match, with providers who deliver operational continuity that pure-agency operators never achieve.
The operators building this infrastructure today are not doing it because it's easy. They're doing it because reactive, last-minute staffing — at premium rates, in a market that's tightening on the supply side — gets more expensive every year. Building proactive infrastructure is how operators get ahead of that curve.
Rediworks is building the platform infrastructure for urgent care float pool programs — transparent direct-engagement contracting, portable credential verification, and real-time shift matching with full market-rate transparency. If you operate urgent care sites in Colorado and want early access to modern staffing infrastructure, join the waitlist and a member of our team will be in touch.
Sources
- CHG Healthcare. (2025). 2025 State of Locum Tenens Report. Retrieved from chghealthcare.com
- CHG Healthcare. (2024). 2024 State of Locum Tenens Report. chghealthcare.com
- HWL Works. (2024). Physician and Provider Float Pool Strategy in Healthcare Systems. blog.hwlworks.com
- American Hospital Association. (2023). Fact Sheet: Strengthening the Health Care Workforce. aha.org
- Weatherby Healthcare. (2024). The Cost of Hiring Locum Tenens for Your Practice or Facility. weatherbyhealthcare.com
- MGMA. (2024). MGMA Stat: Physician Burnout Still a Major Factor Even as Unexpected Turnover Eases. mgma.com
- Becker's Hospital Review. Building a Flexible Healthcare Workforce: Tech-Powered Internal Agency and Float Pools for Cost Savings and Efficiency. beckershospitalreview.com