Physician Assistant Locum Tenens: The No-BS Guide

By Cory Kleinschmidt

2026-07-23

Physician assistants work locum tenens on temporary contracts, usually as 1099 contractors, covering staffing gaps across emergency medicine, surgery, orthopedics, urgent care and more. Pay is strong and demand is climbing.

What varies most is the supervision or collaboration rule in the state where you take the opportunity. That’s the piece worth getting right, so we start there after the money. This guide brings together the numbers, named sources, and state-specific considerations that can shape a locum PA opportunity.

The Model, Minus the Sales Pitch

Locum tenens is temporary contract work. A practice or hospital is short a clinician, you cover the gap for a defined stretch, and you move on when it ends. Opportunities run from a few days of coverage to multi-month blocks filling a leave or a vacancy. Some PAs do it full time. Plenty do it alongside a permanent job.

The detail that changes everything is the tax status. Most locum PAs are independent contractors on a 1099, not W-2 employees. That’s why the pay looks bigger, why the taxes work differently, and why malpractice becomes a question you have to ask out loud. More on each below.

The Pay, and What Locum Tenens Adds to It

Start with the anchor. The median annual wage for physician assistants was $135,880 in May 2025, per the U.S. Bureau of Labor Statistics (Occupational Outlook Handbook). That’s the median for employed physician assistants; BLS wage data don’t include self-employed PAs.

Locum work generally pays a premium per hour, because the rate carries none of the benefits an employer folds into a salary. Published staffing figures put locum PA rates in the range of roughly $70 to $130 an hour, with the top tied to surgical coverage, ICU support and rural shortage opportunities (Barton Associates, 2026). Read that as one agency’s self-reported market data, not a guarantee.

So a high hourly rate isn’t the same as a high salary. No health plan, no PTO, no retirement match, and self-employment tax on every dollar. The specifics by specialty and state live in our rates guide.

Supervision and Collaboration: It’s a State-by-State Map

A PA’s practice conditions are set by state law, and those laws are moving. This is the part that trips people up, so read it before you sign anything. The trend is toward what the profession calls Optimal Team Practice, adopted by AAPA’s House of Delegates in 2017, which aims to let PAs practice to the full extent of their training without a mandated relationship to one specific physician (PA practice modernization).

Ten states have gone furthest so far. Delaware, Iowa, Maine, Montana, New Hampshire, North Dakota, South Dakota, Utah, Virginia and Wyoming have eliminated the legal requirement for a specific relationship between a PA and a physician or any other clinician (AAPA). Everywhere else, some form of collaboration or supervision agreement still applies, and the details differ by state. Ratios, chart-review rules, prescriptive authority: all of it varies.

Why PA Demand Keeps Growing

The demand under these opportunities is not a blip. The Bureau of Labor Statistics projects physician assistant employment to grow 21 percent from 2025 to 2035, much faster than the average for all occupations, with about 11,500 openings a year over the decade (Occupational Outlook Handbook).

PAs are versatile, and that’s the point. The same license moves across emergency medicine, surgical and orthopedic support, dermatology, urgent care and hospital medicine, which is exactly the flexibility a short-staffed facility needs. When a department can’t fill a role fast enough, a locum PA keeps it running. That’s why the opportunities keep coming.

What It Takes to Land an Opportunity

The baseline is a master’s degree from an ARC-PA accredited program, national certification and an active state license. Certification runs through the National Commission on Certification of Physician Assistants, which grants the PA-C credential after the PANCE exam (NCCPA). You’ll also see the title ‘physician associate,’ adopted by AAPA in 2021; whether that title is legally recognized for clinical or licensure purposes varies by state.

The credential is rarely the bottleneck. State licensure and facility credentialing are, and they run on their own timelines. Start those early. It’s the difference between a start date next month and one next quarter.

The 1099 Realities: Taxes, Malpractice and Who Pays for Tail

Going 1099 is where locum PAs earn more and, sometimes, get surprised. You owe self-employment tax. You may need to pay estimated taxes quarterly instead of having them withheld. And you need to know whose malpractice policy covers you on each opportunity, and whether anyone is buying tail when it ends. Set up right, none of this is hard. Ignored, all of it is expensive.

Because these questions are identical for PAs, nurse practitioners, CRNAs and physicians, we cover them once, in depth:

• Locum 1099 taxes: deductions, entity choice and what changes when you leave a W-2.
• Quarterly estimated taxes: how much to set aside and when it’s due.
• Malpractice and tail coverage: occurrence vs. claims-made, and who pays for tail.
• Reviewing a locum contract, clause by clause.

On the tax pages, we anchor hard numbers and deadlines to the IRS, then bring in our tax partner The Doctor’s CPA, founded by Prithi Daswani, CPA (meet the team), to serve 1099 locum clinicians, alongside other independent sources. It’s a partnership, and we say so.

What you were allowed to do on your last opportunity isn’t automatically what you’re allowed to do on the next one.

The Honest Ledger

Locum tenens is worth it for a PA who wants higher pay by the hour, control over the schedule and variety in the work, and who’s willing to run the business side. It’s the wrong fit if you want a steady salary, employer benefits and a single credentialing process you never revisit.

Most PAs try it somewhere in the middle, often alongside a permanent role rather than instead of one. What we do is show you PA locum job across competing agencies in one neutral place, with the numbers and the state rules attached. Whether it fits your life is your call.

Related Guides

• Go deeper: Locum tenens pay rates, what the numbers really look like.
• Shared for every locum clinician: 1099 taxes · Quarterly estimated taxes · Malpractice and tail · Contract review · Travel and housing
• Other clinician guides: Locum tenens for nurse practitioners · Locum tenens for CRNAs

Up: The No-BS Guide to locum tenens.