Healthcare delivery in government settings is defined as much by service and responsibility as by the organizations where care is delivered.
From military treatment facilities and Veterans Affairs medical centers to correctional institutions, clinicians often work within systems designed to serve populations whose proximity to care depends on sustained staffing and operational continuity. The settings differ widely, and so do the challenges they present.
A Department of Defense installation, an Indian Health Service clinic, a federal corrections facility, and a state behavioral health program may function under distinct procurement rules and cultural expectations. Yet all rely on a stable clinical workforce to meet patient needs.
Locum tenens opportunities in these agencies often require physicians and advanced practice providers to navigate extensive credentialing, compliance, and onboarding requirements while practicing in highly structured organizations. Some assignments necessitate security clearances; others require a willingness to practice within hierarchical systems that may feel unfamiliar to providers accustomed to greater autonomy.
For many clinicians, however, those same characteristics can be part of the appeal, offering the chance to serve veterans, military families, tribal communities, correctional populations, and other historically underserved groups.
Temporary healthcare staffing has become an important component of that framework, though not always in the usual sense. Short-term assignments can help address immediate staffing gaps. Longer-term contract arrangements are more like ongoing workforce solutions. As needs evolve, the lines between staffing models continue to shift.
Recently, we spoke with leaders from Floyd Lee Locums, Alumni Healthcare Staffing, and Medstaff National Medical Staffing, three firms with extensive experience supporting government staffing and recruiting. Together, their perspectives offer a multifaceted view, from provider engagement and operational coordination to contracting and workforce strategy, while underscoring a common goal: helping government facilities maintain access to consistent, quality patient care.
Mission Beyond the Assignment
When Natasha Lee, CEO, co-founded Floyd Lee Locums, she set out to build something she believed in. Partnering with government agencies followed naturally, because that’s where the patients who most need a physician often have the fewest options. It’s also where the compensation gap between mission and market pay is most visible. At VA facilities, IHS clinics, and military installations, rates typically run below what private-sector assignments pay. That can be a problem for most staffing firms. For Lee, it became a filter.
“Once clinicians understand that you have opportunities of this nature, it’s like a light switch goes off,” she said. “There’s a network of doctors across the country who literally live for this kind of work.”
That network, she noted, is largely self-organizing. Physicians who have done mission-driven government work tend to stay connected to it, and to each other. When a high-stakes assignment becomes available, word travels.
Lee believes that sense of purpose stems from an understanding of what these assignments make possible.
“Government facilities often serve communities facing persistent physician shortages, and staffing gaps can have immediate repercussions for a pathway to care,” she said. “Locums play an important role in maintaining continuity of services and helping these organizations continue to operate effectively when permanent staffing falls short.”
“Government facilities often serve communities facing persistent physician shortages, and staffing gaps can have immediate repercussions for a pathway to care. Locums play an important role in maintaining continuity of services and helping these organizations continue to operate effectively when permanent staffing falls short.”
Caring for Diverse Communities
The range of populations Lee’s firm serves illustrates just how broad this segment of locum tenens staffing can be.
A program she’s especially proud of, now in its third year, involves placing physicians to conduct disability examinations for veterans. Demand is steady and shows no sign of easing. But veterans are only one of the populations Lee’s company supports. At a tribal health facility in rural Oklahoma, providers work alongside a care team that includes an indigenous medicine man on staff, a practice rooted in the community’s traditions and integrated into how care is delivered there. Diabetes prevalence is high, and cultural orientation is not optional.
Lee points to one surgeon who has become closely associated with the Oklahoma facility. Trained in the US Navy, he brings a breadth of surgical experience that’s increasingly uncommon in highly specialized practice environments. His ability to perform a wide range of procedures allows patients in the community to receive care locally that might otherwise require hours of travel.
For Lee, the arrangement reflects one of the most crucial aspects of locum work, which is extending reach to specialized care in places where it may not otherwise exist.
A contract that was especially meaningful to her is one that had no template.
In 2021, as Afghan refugees began arriving on US military bases, her firm was asked to provide medical coverage for what became a nine-month humanitarian operation involving more than 80,000 people. They placed approximately 120 physicians across multiple bases.
“Our doctors were living in tents and working in tent hospitals,” she recalled. “One pharmacist walked into an empty structure and built an operational pharmacy by himself.”
The scale was unlike anything they’d handled before, and so was the emotional weight of the work. Lee described a pediatrician who returned from the deployment changed by the experience of caring for the refugees.
According to Lee, the physician later described it as the most incredible experience of their career and said it would stay with them for the rest of their life. The provider spoke about how grateful the refugees were to be there, be safe, get access to medical care, and have a chance at a new life.
Among the patients seen during that deployment was an Afghan woman who gave birth to the first baby born on American soil from the group. The delivery became one of many moments that underscored the unpredictable nature of the assignment and the wide range of needs clinicians were called upon to meet.
Lee described the operation as the first time the US government partnered with a private staffing firm for a humanitarian medical deployment at that scale. While she was coordinating physician placements for the refugee operation, a former Joint Base Charleston commander she had been consulting with on other matters was simultaneously flying those same refugees into the country. Neither knew the other’s role until after the fact.
Finding the Right Fit
Not every clinician is suited for government locum work, and Lee is straightforward about that. Government healthcare settings operate within chains of command, established protocols, and institutional cultures that reward structure over improvisation.
“You don’t know any of the staff. You’re not familiar with the equipment and how certain things are done from a charting perspective,” she said. “And literally, you have to quickly be able to figure out where information lives and who the go-to people are. It takes a very adaptive personality.”
In correctional facilities, it goes a step further. Security is the governing priority, and clinical staff operate within those constraints regardless of their medical judgment. It can be a significant shift for providers accustomed to setting the terms of their own practice.
“The clinicians who thrive,” Lee said, “tend to be those who come prepared for the adjustment and find meaning in the environment rather than friction.”
“The clinicians who thrive tend to be those who come prepared for the adjustment and find meaning in the environment rather than friction.”
Locums as Career Reinvention
For some physicians, locum practice within government institutions offers an opportunity to reshape their careers around changing priorities and personal goals.
Lee described an oncologist who restructured his entire schedule around a government assignment model: one week seeing patients in person, two weeks working via telehealth, one week off.
“The arrangement was built deliberately around his teenage daughters and the time he wanted to be present for them,” she said. “Now, he has a new lease on his career.”
That story reflects a broader shift in how the practice alternative is perceived. Lee views that flexibility as one of the reasons perceptions around locums have changed so dramatically.
A decade or two ago, working locum tenens carried a stigma in some corners of medicine. It was seen as what you did between jobs, not as a legitimate career path. That perception has changed, and locum opportunities within government agencies, with their longer assignment durations, structured environments, and mission-driven purpose, have played a role in that change.
For the right clinician, these assignments offer something that could be harder to find in a large health system. They provide a sense of purpose that shows up on the schedule.
Making Complex Systems Work
Successfully placing a locum tenens physician in a government setting depends on far more than clinician availability. Multiple departments, stakeholders, and approval processes must align before a contract can move forward.
Jeffrey Reynolds, Vice President of the Government Division at Alumni Healthcare Staffing, joined the locum staffing company in 2016 and entered the government space in late 2019, just months before the COVID-19 pandemic reshaped healthcare workforce planning across the country. Today, he describes it as a discipline that rewards preparation and punishes assumptions.
The facilities his firm supports include IHS clinics, state and county correctional facilities, and various local government programs. Each comes with its own procurement structure, compliance expectations, and onboarding requirements. What makes government staffing distinct, in Reynolds’ view, is the volume of requirements and the number of people responsible for each one.
“When you’re working with a government location such as IHS, someone manages security, another person specifically handles the physician details, someone else oversees housing on-site, another individual is in charge of travel, and someone else handles invoicing,” he said. “There are a lot of different names and a lot of people you need to coordinate with.”
On the private side, a single medical staff office typically manages the full credentialing process. On the government side, that work is distributed across departments that may not communicate with each other unless the agency ensures they do.
For Reynolds, that coordination role is part of the value a locum staffing firm brings to government clients. Many facilities lack dedicated recruiting teams or the internal resources needed to manage sourcing, credentialing, travel logistics, and onboarding on their own. Agencies step in to provide that expertise so administrators can remain focused on patient care and daily operations.
“When you’re working with a government location such as IHS, someone manages security, another person specifically handles the physician details, someone else oversees housing on-site, another individual is in charge of travel, and someone else handles invoicing. There are a lot of different names and a lot of people you need to coordinate with.”
No Margin for Error
The consequences of a missed credentialing step in a government setting are immediate and non-negotiable.
“There are no emergency privileges in the government world,” Reynolds said. “If something’s missing and a provider is on-site and ready to start, they’re going to say, ‘Nope, you’re not ready to go because you’re missing this.’”
A clinician who arrives at the facility with incomplete documentation cannot begin seeing patients. There’s no workaround, no grace period, and no supervisor who can authorize a temporary exception, which means the placement stalls until the gap is closed.
Reynolds responds to that reality with a structured check-in process. His firm conducts conversations with clinicians at the one-day, one-week, and one-month marks after an assignment begins, specifically to catch problems before they become crises.
“Let’s say someone’s in the middle of a remote part of Arizona, and I need to get them home,” he said. “If I have a hotel lined up for six months and an airport three hours away, the open line of communication needs to be there.”
And it runs in both directions. Reynolds is direct with physicians and APPs before they accept an assignment, and equally frank with facilities about what the onboarding process requires.
“Providers who hesitate at the complexity often do so because they expect credentialing to move at a slower pace,” he said. “I tell them it doesn’t have to. ‘I have the contract in hand. I’ll walk you through it.’”
That preparation extends to the facilities he and his team support and the settings they operate in.
“Providers who hesitate at the complexity often do so because they expect credentialing to move at a slower pace. I tell them it doesn’t have to. ‘I have the contract in hand. I’ll walk you through it.’”
Filling Critical Coverage Gaps
Reynolds points to IHS and correctional facilities as the two settings where demand is most consistent.
IHS clinics are typically located in rural or remote communities with limited reach to providers, and the logistics of getting a physician there, housed, and oriented add layers that many conventional locum assignments don’t require. Alumni has placed clinicians on these assignments for more than six years, directly and through federal supply schedule contracts.
One account Reynolds shared began with a job board site posting. About five years ago, he was using a tool to monitor county and state job listings when he came across a psychiatry opening at a correctional facility. The posting had gone up because the psychiatrist who had worked there for 25 years retired with little notice, leaving administrators searching for a replacement. They’d never worked with a locum tenens staffing agency before and were unfamiliar with the credentialing, malpractice, and onboarding requirements involved.
Reynolds called them.
“I said, ‘I have the providers and can do all the credentialing for you.’ And they were like, ‘Wait, how do you know how to do that?’”
He took them through the process. The facility put the position out to bid, his firm responded, and Reynolds had candidates ready. The contract was awarded.
Creating Stability Through Continuity
What happened after that initial locum placement is the part Reynolds comes back to.
His team placed three part-time psychiatrists at the facility. Every one of them is still there, more than three years later, and the schedule, as Reynolds describes it, practically runs itself.
“That schedule is locked, loaded, no issues,” he said. “The providers have been there all this time because they enjoy practicing at the facility so much. When you have that kind of stability, it functions without interruption. It’s almost like you ‘set it and forget it.’”
The facility no longer worries about psychiatric coverage. They know which clinician is working on any given Tuesday. The clinical director knows who to call, and payroll knows the schedule. In a setting where a single physician vacancy once created an operational crisis, that predictability carries real weight.
And it extends beyond scheduling. Providers become familiar faces to patients and staff, relationships develop over time, and the facility avoids the disruption that can accompany frequent turnover.
For Reynolds, the story illustrates something broader about what government locum tenens work can become when it’s handled well. The first call to that facility was a cold one. The relationship that followed has outlasted most permanent hires.
“It always goes back to continuity of coverage,” he said. “Those psychiatrists know who they’re going to see. The staff knows who’s coming in. Why go elsewhere?”
Beyond Traditional Locums
Mark Stinnett, President of Medstaff National Medical Staffing, has spent more than three decades in healthcare staffing. He’s worked government contracts, walked the halls of military installations, and watched the federal contracting landscape reshape itself more than once. When he talks about locum staffing within government settings, he doesn’t reach for optimism as a starting point. He leads with precision.
“Locum tenens is very different than government contracting,” Stinnett said. “The latter is a must-fill obligation rather than a best-effort arrangement. It’s very much contract management in orientation, and it’s a commitment you’re making. If you don’t fulfill it, there are repercussions, which could be financial, contractual, or suspension from the contract.”
It is a distinction many staffing firms might overlook when they pursue locum opportunities in federal and state settings. A facility may work with five agencies or 30. If one placement falls through, another agency takes a shot. But the government doesn’t operate that way. When a contract is awarded, the expectation is delivery, and the penalties for falling short are written into the agreement.
These contracts also prohibit turnover in ways that have no private-sector equivalent. The language may specify that a provider cannot leave within a defined period. If turnover occurs anyway, the locum staffing company absorbs the consequences, including negative performance ratings that can affect future awards.
“How you begin has everything to say about how it will end,” Stinnett said.
Built for the Long Haul
The sales cycle alone separates government contracts from almost everything else in the locum staffing industry.
On the traditional side, a placement can move from submission to start in a matter of days. A government contract may take months from initial engagement to award, and privileging can add another six months before a provider sees a single patient. Stinnett frames this as a business reality that a firm must be structured to absorb.
“Retention becomes a very difficult and challenging part of delivery in the government market,” he said. “Many clinicians won’t wait on a six-month onboarding process.”
That attrition happens before the assignment even begins. A physician who agrees to a government locum opportunity in January may have accepted a different assignment by July. Managing that gap requires recruiting deeper than the immediate need, maintaining relationships over long timelines, and having the infrastructure to support a process that moves on the government’s schedule, not the market’s.
Stinnett is equally direct about the physical commitment the best government engagements require. His own contract history shows a consistent pattern.
“Providers who relocate and embed themselves in the assignment community have significantly higher retention,” he observed. “I think the commitment level of those who treat the placement as a long commute is more temporary.“
Relocation willingness can serve as an important performance variable for staffing firms, one that extends beyond lifestyle preferences.
“Providers who relocate and embed themselves in the assignment community have significantly higher retention. I think the commitment level of those who treat the placement as a long commute is more temporary.“
Fewer Contracts, Bigger Stakes
The structural change Stinnett describes is significant, and it runs counter to the narrative that government healthcare staffing is simply expanding.
According to Stinnett, the Defense Health Agency (DHA) and the VA have moved decisively over the past decade toward large indefinite delivery, indefinite quantity contracts, known as IDIQ contracts. These agreements consolidate staffing needs across physician, nursing, allied health, and administrative categories into single procurement vehicles. The DHA Medical Q-Coded Support and Services – Next Generation (MQS2-NG) is a 10-year, multiple-award IDIQ contract worth up to $43 billion. The VA issued a comparable contract valued at roughly $23 billion over 10 years, with only eight companies awarded a place on it.
“The government’s utilization of locum tenens in the purest sense has really diminished over the last five years,” Stinnett said. “They’re looking for more longer-term contract management solutions to satisfy their staffing needs.”
This consolidation can limit entry to federal opportunities for small and mid-sized staffing firms. Access to VA and DHA work increasingly runs through a small number of prime contractors. Everyone else operates as a subcontractor, if they can secure the relationship at all.
The Professional and Allied Healthcare Staffing Services Federal Supply Schedule 621 I, once the primary vehicle through which government agencies purchased short-term physician staffing, has declined to the point of near-obsolescence for major federal buyers. The Department of Corrections remains one of the few government settings still using it with any regularity, though Stinnett notes that work carries its own risk exposure that makes it a complex niche.
Preparing for What’s Next
Government healthcare staffing faces pressure from multiple directions over the next several years, including shifts in how these services are purchased and state legislative activity.
Stinnett, who serves on NALTO’s Board of Directors, has spent significant time on Capitol Hill, along with other NALTO board representatives, advocating on a specific issue: a growing wave of state and federal laws that challenge independent contractor classification for locum tenens providers.
“The next five to 10 years will be critical for our industry, and that’ll affect government contracting as well,” he said. “It used to be about making phone calls, sending contracts, and filling jobs. It’s not that way anymore. You almost need a legal team available to really understand compliance.”
Every state that passes new independent contractor restrictions adds another tier of complexity for locum agencies operating across multiple jurisdictions. The question of whether federal contract requirements preempt state labor laws has not yet been resolved in court. When it is, the outcome will have repercussions that reach well beyond government work.
For firms considering government staffing and recruiting as a growth strategy, Stinnett’s view is measured. He estimates that total federal healthcare staffing expenditure across agencies falls somewhere in the range of $60 billion to $70 billion over the next 10 years and doesn’t see that demand diminishing anytime soon.
But a viable path to VA and DHA work has lengthened. Credentialing infrastructure, program management capabilities, technology platforms, and compliance resources all require upfront investment before the first contract is awarded. A firm can’t build that capacity in a quarter and expect results.
“It’s not a market niche for everybody,” Stinnett said. “It’s a multi-year process to get your foot in the door.”
“The next five to 10 years will be critical for our industry, and that’ll affect government contracting as well. It used to be about making phone calls, sending contracts, and filling jobs. It’s not that way anymore. You almost need a legal team available to really understand compliance.”
A Shared Purpose
Taken together, these perspectives reflect a locum tenens staffing landscape that resists simple description. Each healthcare setting presents its own practical demands, compliance requirements, and patient population. The firms working in this space may approach those realities differently, but they share a common understanding. Serving government facilities well requires more than filling a shift.
These assignments offer something distinct for clinicians, whether it’s mission-driven purpose, structured environments, or a different relationship to practice. For staffing partners, they require infrastructure, patience, and a willingness to operate within systems that move on their own terms. Consistent, quality care in government settings depends on it.
As the procurement landscape continues to shift, the agencies and providers who understand that complexity are the ones best positioned to sustain it.
