What Locum Tenens Is, and What It Isn't

By Cory Kleinschmidt

2026-07-20

Locum tenens is temporary physician work. A hospital or practice needs coverage, a physician fills the gap for a defined period then moves on when the coverage ends. The term is Latin for “holding the place,” which is exactly the job. You hold a clinical post until it’s permanently filled, or for as long as the facility needs the extra hands.

It isn’t a lesser tier of medicine. The clinical work is identical to what you’d do as a staff physician: the same patients, the same charts, the same standard of care. What changes is the employment structure. You’re an independent contractor, not an employee. That single difference drives most of what follows in this guide.

The model is not new either. It traces to 1979, when a University of Utah program began arranging coverage so rural doctors could leave their practices for training without abandoning their patients (CompHealth company history). More than 40 years on, it’s a mainstream way to practice.

How Locum Tenens Works

Three parties make a locum opportunity work: the physician, the facility that needs coverage and, in most cases, a staffing agency in the middle.

Facilities end up short-staffed for ordinary reasons. A physician goes on leave, a permanent hire takes months to fill, a rural site can’t recruit or patient volume spikes with the season. Rather than leave a service uncovered or turn patients away, the facility brings in a locum to keep the doors open.

The agency is the matchmaker and the back office. It presents your CV to facilities, negotiates the rate and terms, helps with state licensing and arranges travel and housing. It also carries the malpractice coverage for the placement. You’re paid an hourly or daily rate as a 1099 independent contractor. Here’s the part that surprises new locums: the agency is paid by the facility, never by you.

That fee comes out of the facility’s bill rate, the amount it agrees to pay for the coverage. Your pay and the agency’s margin both sit inside that number, which is why what you’re offered varies from one placement to the next. The full mechanics live in the pay chapter.

One reality to plan around: before your first shift, you have to be credentialed at the facility. That can take anywhere from a few weeks to a few months. It’s the single most common reason a start date slips. The licensing and credentialing playbook is in the starting chapter.

Opportunities run from a few days of shift coverage to several months. Many run long enough to renew. Physicians string them together into a full schedule, use them to fill the gap between permanent jobs or add a few shifts on top of a staff role.

Why the Model Exists at This Scale

“The country is short of physicians, and care can’t wait for a permanent hire. The AAMC projects a shortage of up to 86,000 physicians by 2036 (2024 projection). When a department is short a body, locum tenens is how the facility keeps services running in the meantime.

The gap is widest where recruiting is hardest. Rural areas have long had fewer physicians per capita, about 68 primary care physicians per 100,000 people versus 84 in cities, per the AAFP (2013). Locums coverage is often the only way a small or remote site keeps a service line open at all.

The result is steady demand. About 57,000 physicians (8%) were working locum tenens as of 2024. Roughly a third have done it at some point in their careers, per CHG State of Locum Tenens (2025). CHG puts the US locum market at about $9.4 billion.

Shortages concentrate in certain specialties and regions, which is where locum demand runs hottest. The next chapter maps who works locums and where the need is greatest.

Why Physicians Choose It (the Upside)

Money leads. In CHG’s 2025 survey, 47% of locum physicians said they work locums to supplement their income and 30% called the salary itself appealing. Schedule control came a close second at 29%, per CHG State of Locum Tenens (2025). So the honest headline is money first, freedom right behind it.

• Contractor-rate pay. Locum work pays an hourly or daily 1099 rate. Physicians who do it full time often out-earn a comparable staff salary. The mechanics and ranges live in the pay chapter.
• Schedule control. You decide when and where you work and how much. Block off a month, take a season or work straight through. It’s the top lifestyle reason physicians give (CHG 2025).
• Faster debt payoff. New physicians finish training owing a median of about $205,000, per AAMC (Class of 2024). Higher locum rates, aimed at the loans before a mortgage and kids arrive, can retire that balance years faster.
• Try before you buy. Work a site for a few weeks before you sign a permanent contract there. You see the call schedule, the staff and the systems from the inside first.
• Less administrative drag. Fewer committee meetings and less institutional politics, more time on patients. You’re there to practice, not to sit on the budget task force.
• Variety and reach. Different settings, different teams and the option to work across the country. It’s a fast way to broaden your clinical range and find the kind of practice you actually want.

What It Isn’t (the Honest Tradeoffs)

Locum tenens is neither a benefits package nor a steady salary. We’d rather you weigh the tradeoffs now than find them mid-placement.

• No employer benefits. You fund your own health, disability and retirement coverage. There’s no group plan, no employer match and no paid time off. The higher rate is meant to cover the difference, but you have to actually set the money aside.
• No PSLF. As a 1099 contractor you don’t qualify for Public Service Loan Forgiveness, which counts only full-time work for a qualifying employer. If you’re chasing forgiveness, locums time doesn’t count toward it.
• Uneven income. Gaps between placements and slow credentialing can interrupt your pay. The work is steady in aggregate, not week to week, so a cash cushion matters more than it does on a salary.
• Agency economics. The agency’s fee comes out of the facility’s bill rate, which shapes what you’re offered. It’s not money out of your pocket, but it’s why two placements for the same work can pay differently.
• Less institutional voice. As a temporary physician you have limited say in how a department runs. You’re not there long enough to build staff standing, so your input may carry less weight than a permanent colleague’s.
• Life on the road. Travel and time away from family come with the work. How much depends on how far you travel and how long you stay, covered in the travel chapter.

The clinical work is identical to staff work. The only thing that changes is who signs your check.

Locum Tenens vs Permanent Employment

The two trade the same things in opposite directions. A staff job buys stability and benefits with less control. Locums buys control and often higher pay with less security. Neither is better in the abstract. It depends on what you need right now.

So Is It a Step Down?

No. For most physicians who choose it, locum tenens is a deliberate strategy, not a last resort. It trades benefits and stability for pay, schedule control and freedom. Whether that trade fits you depends on your stage, your finances and your life, which is what the rest of this guide is built to help you decide, plainly and without the sales pitch.

Go Deeper

• Who Works Locum Tenens (and whether it fits you)
• Locum tenens pay rates, what the numbers look like
• How to vet an agency before you sign

Up: The No-BS Guide to locum tenens.