How Locum Pay Is Calculated
By Cory Kleinschmidt
Locum hourly rates are best estimated by taking a specialty’s total W-2 cash compensation, adding the employer’s benefit load and dividing by that specialty’s actual annual clinical hours. The honest catch: published clinical-hours data exists for only a handful of specialties, which is why credible rate figures are scarcer than the internet suggests.
Most locum pay content quotes a number and hopes you don’t ask where it came from. We show the arithmetic instead, because the method is sound and honest sourcing is the whole point.
How Is a Locum Hourly Rate Actually Calculated?
The cleanest method is cost parity: what would it cost an employer to buy the same clinical time on a W-2 basis? Take annual total cash compensation, add the employer’s benefit load and divide by annual clinical hours.
We publish a second method as a cross-check, cash-to-cash: annual cash compensation divided by annual clinical hours, multiplied by a locum premium. When two methods built on different evidence land within a few percent of each other, that agreement is the argument that the approach is sound.
One rule that matters: never apply both the employer benefit load and the locum premium in the same calculation. They measure the same economic quantity from two directions, so stacking them overstates the rate.
Why Are Trustworthy Locum Rate Numbers So Hard to Find?
Because the denominator is usually missing. Salary data is well sourced across many specialties. Annual clinical hours, the load-bearing input, aren’t: FTE definitions vary by organization, and only some surveys report clinical hours at all.
The 2,080-hour convention people reach for has no physician-specific basis. It’s payroll arithmetic (40 hours times 52 weeks). And MGMA, the survey most people assume settles the question, measures a full-time provider against the practice’s own normal workweek, whether that’s 37.5, 40, 50 hours, or something else. So for most specialties the intellectually honest page shows observed rates with their sourcing caveats, or states plainly that no published clinical-hours figure exists. Saying “we don’t know” is better journalism than a confident fabricated number. It’s the differentiator.
Does the Method Work? The Emergency Medicine Check
Yes, where the sourcing exists. Emergency medicine is the test case because one survey publishes both compensation and annual clinical hours for the same physicians. Using ACEP’s 2025 median total compensation and its median annual ED hours, the cost-parity method produces roughly $275 to $298 per hour, inside the observed locum EM range of $250 to $300.
| Method | Computed EM rate | Observed locum EM | Verdict |
|---|---|---|---|
| Benefit load then premium (stacked) | $316 to $372/hr | $250 to $300/hr | Fails: double-counts |
| Cost parity (load only) | $275 to $298/hr | $250 to $300/hr | Agrees |
| Cash-to-cash times premium | $264 to $286/hr | $250 to $300/hr | Agrees |
The validation underneath it: dividing that same compensation by those same hours reproduces ACEP’s independently reported median hourly base pay to within about 3%. That’s a real, non-trivial check, and it’s exactly the pairing of sources that doesn’t exist for most other specialties. Anesthesiology rates can be derived the same way, because AMGA publishes annual hours for the specialty. Hospital medicine comes close. Full-time adult hospitalists average 11.3-hour shifts (Today’s Hospitalist, 2023), but we haven’t found a current published count of annual shifts, so we don’t compute a hospitalist rate. The rest we won’t fake.
What About the Most-Quoted Locum Pay Number?
You’ve probably seen the claim that full-time locums earn “over $32 more per hour” than permanently employed physicians. It’s the industry’s most-repeated premium figure. We won’t lead with it, because it’s unsourced. The number does appear in Weatherby’s 2026 Locum Tenens Physician Report, but the report attaches no disclosed source or methodology to it. It’s also widely mis-attributed to CHG’s State of Locum Tenens report, whose published editions contain no such comparison. A figure with no shown method, pinned to the wrong source, isn’t one we’ll build a rate page on.
How This Differs for NPs, PAs and CRNAs
The methodology is identical for every profession; the inputs differ. This page is the cross-profession methodology hub, so each profession’s rate cut lives inside its own pillar rather than as a competing pay page.
CRNAs have the strongest tie to the rate-transparency work and among the highest locum rates of the APP professions, so the CRNA cut leads. See the CRNA guide.
NPs and PAs slot in as their pay data firms up. See the nurse practitioner and physician assistant guides.
Physicians anchor the specialty examples: emergency medicine and anesthesiology, where hours data exists.
Key Takeaways
- Cost parity is the method: total cash compensation plus the employer benefit load, divided by annual clinical hours. Cash-to-cash (times a locum premium) is the cross-check.
- Never stack the benefit load and the locum premium. They’re the same quantity from two directions.
- The hours denominator is the problem. Published annual clinical hours exist for only a few specialties, so most single hourly numbers are someone’s arithmetic, not data.
- Emergency medicine validates the method to within about 3%. Anesthesiology derives with visible arithmetic; hospital medicine is one sourced input short; the rest we won’t fake.
- The “$32 more per hour” premium is unsourced and mis-attributed, so we don’t lead with it.
Frequently Asked Questions
How are locum tenens rates calculated?
Total cash compensation plus the employer benefit load, divided by annual clinical hours (cost parity), cross-checked against a cash-to-cash method. Never stack the benefit load and the locum premium.
Why do published locum rates vary so much?
Because most rest on an unstated hours assumption. Without a sourced annual-clinical-hours figure for the specialty, any single hourly number is someone’s arithmetic, not data.
Is the “$32 more per hour” locum premium real?
It appears in one 2026 agency report but carries no disclosed source or methodology. It’s also often mis-attributed to a different report that doesn’t contain it. We treat it as unsourced.
Which specialties have reliable computed rates?
The few where a survey pairs compensation with clinical hours: emergency medicine most cleanly, then anesthesiology. Hospital medicine has published shift lengths but no current annual shift count, so we don’t compute it yet.
Rate figures are estimates built from cited sources with a stated method; they aren’t guarantees of what any opportunity pays.