Nurse practitioners and physician assistants who work in urgent care have two ways to do it: a full-time role with one employer, or locum work, where you pick up shifts at one or more clinics. The clinical day is the same in both. The schedule, the pay structure and the amount of non-clinical work are different, and those differences are why some urgent care NPs and PAs choose locum work.
This post goes through what locum work changes for an NP or PA, what it costs, and who it suits.
What a full-time urgent care role involves for NPs and PAs
A full-time urgent care role comes with a set schedule, usually a fixed number of shifts per pay period with a weekend and holiday rotation. Time off goes through a request. When a colleague calls out or volume rises, the permanent staff are the first people asked to cover.
It also comes with work outside the exam room: staff meetings, annual reviews, mandatory trainings and whatever projects the clinic group is running that year. In exchange you get a predictable paycheck, employer-sponsored benefits, paid time off and colleagues you work with every week.
Whether that exchange is a good one depends on what you value. Locum work reverses most of it.
Why locum work suits NPs and PAs in urgent care
Urgent care is a practical setting for NP and PA locum work for a few reasons.
The work is by the shift. An urgent care clinic opens and closes on a schedule. There's no overnight call and no patient panel to hand off, so a single shift is a complete unit of work. That makes it possible to work one Saturday at a clinic without a longer commitment.
There's no hospital privileging step. A clinic still verifies your credentials, but there's no hospital privileging committee in the timeline.
The setting is familiar from clinic to clinic. An NP or PA with urgent care experience walks into a new clinic knowing what an urgent care day looks like. The EMR, the layout and the staff are new, and those are learned in a shift or two.
One thing does vary and needs checking before any shift in a new state: how NP and PA practice is regulated there. Collaboration and supervision requirements are set by state law, and they differ. Ask the clinic how it meets them for locum NPs and PAs.
Schedule control for locum NPs and PAs
The main reason to choose locum work is control over your time. A locum NP or PA decides which shifts to take, so a lighter month during a family change or a block of time off doesn't need anyone's approval.
Locum work also removes the non-clinical obligations. You aren't on committees and you don't attend the staff meeting, because your commitment to the clinic is the shifts you accepted.
The same freedom means nobody is filling your calendar for you. Income follows bookings, and a slow month is yours to absorb. Our post on managing multiple locum assignments without burnout covers how to keep a self-set schedule from turning into no days off.
How locum pay compares with a full-time NP or PA role
A locum hourly rate and a full-time salary can't be compared directly, because the salary comes with paid time off and benefits and the hourly rate usually doesn't. The comparison takes three steps:
- Divide the salary by 2,080 hours (40 hours for 52 weeks) to get its hourly equivalent.
- Count the hours you'd work as a locum NP or PA, leaving out every week of vacation, holiday and sick time, since none of it is paid.
- Add the dollar value of the employer's benefits (health insurance, retirement match, CME allowance, disability coverage) to the salary, and divide that total by your locum hours.
The result is the hourly rate at which locum work pays the same as the full-time role. Our guide to how locum tenens pay works runs through the arithmetic with a worked example. It's written for physicians, and the method is the same for NPs and PAs.
Taxes are part of the comparison. How locum income is taxed depends on how the work is classified, which varies by arrangement. When it's self-employment income, you owe a 15.3% self-employment tax that covers both the employee and employer halves of Social Security and Medicare, and you pay through estimated tax payments during the year. That's a general description, not tax advice, and an accountant can apply it to your numbers.
Licensing for locum NPs and PAs
Working locum shifts in more than one state means holding a license in each, and for NPs and PAs there's currently no shortcut.
Nurse practitioners. The Nurse Licensure Compact covers RN and LPN/VN licenses only. A multistate RN license doesn't authorize NP practice in another state. A separate APRN Compact has been written, but it takes effect only after seven states enact it, and it isn't in effect. An NP needs each state's advanced practice license.
Physician assistants. The PA Licensure Compact has been enacted in enough states to form its commission, but compact privileges aren't available yet. When they are, a PA will apply for a separate privilege in each member state. For now, a PA needs each state's license.
DEA registration. NPs and PAs who prescribe controlled substances need a separate DEA registration in each state where they do so.
In practice this makes locum work simplest in the state where you're already licensed. A second state is worth adding when there are enough shifts within reach to justify the fee and the wait. The licensing guide has more.
What NPs and PAs give up by choosing locum work
A full-time role provides things that locum work doesn't.
Benefits. Health insurance, retirement contributions and paid time off are generally yours to fund in locum work.
Predictable income. A salary arrives whether the clinic is busy or slow. Locum income depends on the shifts available and the ones you book.
Mentorship and a team. A full-time NP or PA has colleagues who know their work and a supervising or collaborating physician they see regularly. A locum clinician is often new to the room. Early in a career, that support is worth more than flexibility.
Advancement. Lead clinician and clinical director roles go to permanent staff.
Less paperwork of your own. An employer handles credentialing once and tracks your renewals. Doing locum work through several agencies means keeping a credential file current for each.
Who locum work fits
Locum work in urgent care fits NPs and PAs who:
- Have enough urgent care experience to be effective in a new clinic on the first shift
- Keep their own licenses, certifications and paperwork in order without reminders
- Can absorb a month with fewer shifts
- Want control over when and how much they work more than they want employer benefits
It fits less well for new graduates, for anyone who needs the same paycheck every two weeks, and for clinicians who want a path into clinic leadership.
The two aren't exclusive. You can keep a full-time or part-time role and add locum shifts, which is also the lowest-risk way to find out whether you'd want more. Check your employment agreement for limits on outside work first. Our guide to moving from permanent to locum work and back covers that approach, and Locum Tenens 101 covers credentialing and malpractice.
Rediworks is a self-service marketplace for urgent care shifts. NPs and PAs build a credential wallet once and reuse it at every Rediworks facility, and each listing shows the rate, location, shift length and facility before you apply. Sign up to see shifts.