In early 2025, locum tenens leaders described a market settling into a more normalized rhythm after several surge years.
Growth was still expected, but at a more measured pace, supported by persistent provider shortages and broader acceptance of locums as part of long-term workforce planning.
Staffing Industry Analysts currently projects 4% growth for the locum tenens staffing market this year. That points to a stable, resilient segment rather than a breakout year.
For our 2026 Locum Tenens Industry Outlook story, we spoke with eight industry leaders about their observations on demand, provider behavior, client expectations, and operating conditions. Participants include leaders from national firms, mid-sized agencies, and organizations with a strong presence in rural coverage.
- Melissa Byington, Co-Founder and Board Member, Era Locums
- Drew Cihlar, Senior VP, Hayes Locums
- Tim Hand, CEO of Interim Physicians
- April Hansen, CEO of Barton Associates
- Ryan Hickey, VP of Engage Locums
- Natasha Lee, CEO of Floyd Lee Locums
- Tom McLain, CIO of Medicus Healthcare Solutions
- Ethan McWilliams, President, Locum Tenens of Elite365; President, Wilderness Medical Staffing; and Vice President, NALTO
We asked each leader to respond to current growth forecasts and describe what’s changing and what remains the same across the locum tenens space. Their responses indicate ongoing demand, higher expectations, and a locums market that continues to evolve.
What Market Growth Looks Like This Year
If you feel like you’ve seen this before, you’re not alone.
Most leaders we spoke with agree SIA’s 4% forecast for 2026 feels about right. They’re not expecting a surge year, but steady expansion supported by persistent coverage gaps and stable demand across specialties. Most indicate mid single-digit growth, with higher projections appearing more often at the firm level than across the industry overall.
So, 2026 is largely viewed as a continuation rather than a reset.
April Hansen, CEO of Barton Associates, believes the estimate is directionally correct.
“No estimate is perfect, but based on what we’re seeing moving from 2025 into 2026, the market looks broadly steady,” she said. “I don’t anticipate any sudden spikes that would structurally change demand.”
In her view, utilization patterns remain consistent, with no sharp shift up or down.
Medicus Healthcare Solutions’ CIO, Tom McLain, also sees the projection as aligned with recent history.
“Locums never had the rocket ship takeoff coming out of COVID like travel nursing. It’s been more steady, sustainable growth.”
McLain points to broader healthcare dynamics that continue to favor the model.
“We don’t see any change to the macro supply and demand equation,” he continued. “If anything, there are more providers retiring, an aging population, and continued unmet demand for healthcare access. Those fundamentals are still in place.”
“We don’t see any change to the macro supply and demand equation. If anything, there are more providers retiring, an aging population, and continued unmet demand for healthcare access. Those fundamentals are still in place.”
Ethan McWilliams, President, Locum Tenens of Elite365 and President of Wilderness Medical Staffing, agrees.
“I think the 4% forecast is a good benchmark for what to expect,” he said. “Locums is one of the more stable segments within healthcare staffing, and it remains solid. It should look a lot like last year.”
Based on his work across multiple locum companies and conversations within NALTO, McWilliams says the tone across the industry remains similar: solid fundamentals, modest gains, and few surprises.
Some firms, however, expect to outpace the broader market.
At Hayes Locums, Drew Cihlar, Senior VP, said the company is planning for stronger gains.
“Hayes is budgeting to outpace the projected locums market growth of 4% to 6% in 2026,” Cihlar explained. “For 2026, compared to what we had booked at this time in 2025, we’re beating those percentages.”
“Hayes is budgeting to outpace the projected locums market growth of 4% - 6% in 2026. For 2026, compared to what we had booked at this time in 2025, we're beating those percentages.”
For Tim Hand, CEO of Interim Physicians, the outlook is straightforward.
“Four to 5% sounds realistic,” Hand said. “It aligns with what we’re seeing.”
In a steady market, execution becomes the differentiator. Firms that grow faster, leaders suggest, will recruit well, manage costs carefully, and stay close to client demand.
Speaking of which …
Demand Isn’t Letting Up
If growth looks steady on paper, demand is the reason behind it.
Across conversations, leaders highlighted the same core drivers: persistent clinician shortages, widening rural access gaps, and health systems relying more on locums as a planned staffing strategy rather than a last-minute fix.
“The persistent shortage in clinicians really is the biggest market driver,” McLain said. “Whether it’s vacation coverage or a chronic shortfall of providers, hospitals still need solutions to maintain operating rooms, patient demand, and quality.”
He noted shortages become more acute by specialty and geography.
“The more specialized the role, the harder it is for rural facilities in particular. And newer providers are looking for more work-life balance, which also changes staffing math.”
Melissa Byington, Co-Founder and Board Member at Era Locums, sees the same supply and demand imbalance continuing to favor locums.
“There just aren’t enough physicians to meet demand,” she said. “The shortage is greater in rural America, and more physicians are looking for freedom, balance, and different ways to practice. That keeps locums demand strong.”
“There just aren’t enough physicians to meet demand. The shortage is greater in rural America, and more physicians are looking for freedom, balance, and different ways to practice. That keeps locums demand strong.”
Natasha Lee, CEO of Floyd Lee Locums, says it connects not only to access, but also to complexity and quality expectations.
“We have an aging population and more complex healthcare needs,” she said. “Facilities are not just looking for coverage. They need high-quality clinicians who can step into new environments quickly and be effective right away. That adaptability is part of what drives demand for experienced locums physicians.”
Health systems are also changing how they approach contingent staffing, says Ryan Hickey, VP at Engage Locums.
“Persistent coverage gaps in hard to fill specialties and geographies will continue to drive demand,” he explained. “But we are also seeing systems treat locums less like a stopgap and more like a built-in staffing lever to support retention, burnout management, and service line continuity.”
More Clinicians Want the Locum Life
Leaders say locum tenens is increasingly a deliberate career choice across generations, driven by flexibility, autonomy, and lifestyle control. That’s a far cry from past perceptions when it was often viewed as a late-career option or temporary detour.
Hansen has seen a shift in physician and advanced practice provider priorities toward independence and long-term career ownership.
“They’re increasingly valuing control over their schedule, work environment, and geographic choice,” she said. “They’re approaching locums more like independent professionals, thinking through career trajectory, financial planning, and long-term goals. They’re reclaiming control.”
“They’re increasingly valuing control over their schedule, work environment, and geographic choice. They’re approaching locums more like independent professionals, thinking through career trajectory, financial planning, and long-term goals. They’re reclaiming control.”
That autonomy theme shows up across the market, according to Byington, who sees more physicians approaching their careers with a business-owner mindset.
“Physicians are talking more about autonomy and value-aligned careers,” she said. “We’re seeing more physician-owned agencies and more doctors pursuing direct locums contracts. They want to be front and center in these decisions.”
Generational change is also reshaping entry into locums work. McWilliams says younger physicians are evaluating roles through a lifestyle lens, not just compensation.
“The first question is often about call burden and sustainability,” he said. “We’re seeing more younger physicians interested in locums right out of the gate, looking for flexibility and control over their schedule. There’s a real craving for that.”
“The first question is often about call burden and sustainability. We’re seeing more younger physicians interested in locums right out of the gate, looking for flexibility and control over their schedule. There’s a real craving for that.”
Lee says the shift is visible across career stages, not just among early adopters.
“Locums used to be associated with physicians near retirement. Now, we see doctors at every stage choosing it as a work style. In one physician panel we hosted, every doctor said the same thing: I wish I’d found locums earlier. They connect it directly to higher satisfaction and better work-life balance.”
Specialties to Watch in 2026
Demand isn’t just holding across locum tenens. Leaders say it’s getting more specific, more subspecialized, and more tied to service-line stability and revenue protection.
And it remains healthy across nearly every clinical category, McLain confirms, with several specialties consistently rising to the top.
“I’d say we see it almost in every specialty that there’s great need. But anesthesia and radiology continue to stand out. Those are specialties that support entire service lines inside the hospital.”
“I’d say we see it almost in every specialty that there’s great need. But anesthesia and radiology continue to stand out. Those are specialties that support entire service lines inside the hospital.”
He notes that anesthesia and radiology often sit at the center of larger workforce transitions, including hospital moves from outsourced to insourced physician group models, which can create temporary but large-scale coverage needs.
Hansen says the real growth signal sits one layer deeper than most market summaries suggest.
“The real growth signal is in subspecialties. We often talk at the specialty level, but the acute need shows up in highly nuanced subspecialties. Urology and GI are good examples, among others. They’re critical to access and system throughput, and when those roles are vacant, health systems feel it immediately.”
She also points to growing demand across oncology subspecialties, pathology, neurology, ophthalmology, and dermatology, where needs may be narrower but operationally important.
According to Hand, specialty demand also moves in cycles rather than straight lines.
“Specialties don’t go away, but sometimes they hibernate. Radiology is a good example. Years ago, it cooled off. Now, it’s back in high demand. Anesthesia and emergency medicine are strong right now too.”
He notes that clinician type demand is increasingly shaped by cost and return on investment pressures, especially as compensation levels shift within advanced practice roles.
Where Pressure Is Building
Demand remains solid, but leaders are clear that growth isn’t friction free. Margin pressure, tighter procurement controls, and operational complexity are making execution more challenging industrywide.
The greatest limitation isn’t demand, Hickey conveys, but the systems surrounding it.
“Friction is the biggest constraint. There are more procurement layers, tighter margins, and more reporting requirements. Agencies are being asked to do more with less spread, which puts a premium on operational discipline.”
“Friction is the biggest constraint. There are more procurement layers, tighter margins, and more reporting requirements. Agencies are being asked to do more with less spread, which puts a premium on operational discipline.”
Hickey notes that VMS and MSP models are reshaping how agencies compete.
“You can’t win on relationships alone,” he said. “You have to execute cleanly inside those systems. The speed from sourcing to patient contact, paired with consistency, is becoming a key differentiator for agencies and their ability to support access to care.”
Cost pressure at the facility level is also shaping buying behavior, according to McLain.
“Hospitals are operating under tremendous financial pressure from inflation and shifting payer mix,” he said. “While no organization wants to pay more for temporary labor, leaders realize that locum tenens play a critical role in maintaining coverage, keeping patient volumes steady, and ultimately protecting revenue and cash flow.”
Agencies are responding by reworking internal operations and resource-intensive processes such as credentialing and onboarding.
“A lot of our focus has been on productivity and efficiency, rethinking how we use technology and redesigning high-friction processes,” Hansen said. “The goal is to move faster and stay competitive for both facilities and clinicians, without sacrificing transparency or experience.”
Rate tension is becoming more visible, says Cihlar.
“We’re seeing more hospitals with financial challenges. Provider rates are holding steady or increasing because supply is tight, so agencies have to decide whether to tighten margins to gain share or protect the share they have.”
Execution capacity remains a practical limiter, Hand said.
“Recruitment is still the major constraint. You can only grow as fast as you can staff.”
Technology and AI: Useful Tools, Human Core
AI continues to be a hot topic across healthcare staffing, but most leaders describe practical, incremental use cases rather than sweeping disruption, at least in the near term.
The strongest early impact, several say, will likely be in documentation, credentialing, and back-office workflows.
For Cihlar, the opportunity lies in reducing administrative burden, especially around provider paperwork and credentialing.
“One of the biggest challenges with locums is credentialing. It’s a lot of paperwork, and there aren’t many shortcuts. Technology that helps share files between agencies and hospital credentialing teams can take some of that lift off the provider and make it easier to move between assignments.”
Cihlar identifies secure document sharing and integrated credentialing tools as practical advances that could improve the provider experience without changing the fundamentals of how placements happen.
Others expect AI to deliver the most value behind the scenes rather than in provider-facing interactions.
“I think the most influential changes with AI will come in the back office and middle office,” McWilliams said. “Credentialing, payroll, and those kinds of processes are still quite manual across the industry.”
He’s more cautious about using voice AI and automation on the recruiting front.
“Our physician partners often expect a person from the beginning. A ‘human plus AI’ approach in operations can be faster and increase capacity, but relationships remain the cornerstone of our business.”
Lee also expects adoption to be gradual and relationship centered.
“I don’t think you’ll ever replace the relationship between a consultant and a doctor or a consultant and a hospital client. People still want to pick up the phone and know someone’s there who understands the issue and will work to solve it.”
For now, leaders describe AI as a growing layer of support technology, not a substitute for execution, responsiveness, and trust.
“I don’t think you’ll ever replace the relationship between a consultant and a doctor or a consultant and a hospital client. People still want to pick up the phone and know someone’s there who understands the issue and will work to solve it.”
The Road Ahead
Beyond growth forecasts and demand drivers, several leaders say the deeper story is about who holds influence in the evolving locums ecosystem and how firms respond to structural change.
Byington points to a rising wave of physicians who want more control and a stronger voice in how they engage with agencies and health systems.
“There’s a growing cohort of physicians who don’t want to be the product in healthcare. They want to be in the room where decisions are made. They want control of their careers and how they practice.”
She also flags continued consolidation across staffing and MSP channels as a trend to watch.
“More consolidation and fewer access points isn’t always better for the industry,” she said. “Competition and choice are healthier than restriction and concentration.”
Hickey expects merger and acquisition activity across health systems to add another layer of operational complexity.
“As health systems consolidate, standardization around vendor strategy, procurement, and performance measurement will accelerate. That may create short-term complexity, but in the long run it will reward agencies that can operate consistently across environments. Scale alone won’t win. Operational precision will.”
The takeaway for agencies is direct and operational, according to Hand.
“If you’re staying the same, you’re shrinking. You have to get broader and deeper.”
He emphasizes fundamentals over trend chasing.
“It still comes down to quality of work, quantity of work, and excellence in customer service,” he said. “That’s what keeps you competitive with both facilities and clinicians.”
Taken together, leaders describe an industry that’s growing steadily but demanding sharper strategy, stronger execution, and closer alignment with clinicians and clients alike.
“It still comes down to quality of work, quantity of work, and excellence in customer service. That’s what keeps you competitive with both facilities and clinicians.”
