Locums CME #99 | Locum Tenens & Career Transitions, 2026’s Most In-Demand Locum Specialties, Physician Pay Cools While Bonuses Climb & More

Editor’s Note

Compensation keeps splitting into pieces that no longer move together. Base pay growth has slowed for many physicians this year, even as bonus structures and specialty-specific demand pull in a different direction. Scope of practice for other clinicians is shifting in a similarly uneven way, expanding in a handful of states while staying tightly held in most others.

New tools keep promising to hand time back to physicians, and this issue tracks a couple of very different attempts at that. Some of that promise runs into the same administrative and financial strain it’s meant to solve. Burnout keeps circling back to control rather than effort, and the fixes that actually help tend to change the structure of the work, not the person doing it.

Locum tenens comes up again as an alternative that changes the work rather than the person. It shows up in how physicians navigate career transitions, in where specialty demand is heaviest right now, and in the ventures some providers are building alongside their clinical work. The common thread is choosing the shape of your practice on purpose, rather than letting the default settle it for you.

– The Locumpedia Editorial Team

Lead Story

Physician Pay Growth Cooled in 2026, But Bonuses Didn’t

September 3, 2026 | Medical Economics

Base salary growth for physicians cooled to between roughly 3% and 4% nationally this year, down from the 5% to 6% pace common right after the pandemic. That finding comes from a 2026 employment report built from 4,417 actual signed physician contracts rather than self-reported survey answers. Employers haven’t pulled back on total compensation. They’ve restructured it instead, with median bonus opportunity climbing 12% year over year even as base pay rose just 2%.

Signing bonuses now carry a median value of $25,000 and can run as high as $57,500 depending on specialty. Non-compete clauses remain widespread despite last year’s regulatory upheaval, since the FTC’s proposed nationwide ban was formally abandoned in September 2025, leaving enforcement to a patchwork of state rules. Regional pay gaps widened too, with Midwest and Southern markets leading on raw pay while coastal markets lag once the cost of living is factored in.

For anyone weighing a locum assignment against a permanent offer, the headline base number tells only part of the story. Contract structure, meaning work relative value unit conversion rates, quality metric definitions, termination clauses, and call pay, often matters more to long-term financial outcomes than the base salary line itself. As compensation becomes more bonus-heavy, comparing how it’s earned can matter as much as comparing the headline numbers.

Your Locums Prescription

In What States Can Physician Assistants Practice Independently?

September 8, 2026 | Barton Associates

As of September 2026, the American Academy of Physician Associates identifies eight states with what it calls an optimal PA practice environment: Iowa, Maine, Montana, New Hampshire, North Dakota, South Dakota, Utah and Wyoming. Several other states no longer require every PA to be formally supervised by, or under written collaboration with, a specific physician, provided the PA meets certain experience and setting requirements. Independent doesn’t mean unsupervised in every sense, though, since AAPA itself prefers the term Optimal Team Practice over independent practice, and PAs still work within consultation, referral and credentialing requirements no matter the state.

State-by-state variation means a PA locum assignment can look very different in practice depending on where it’s located, even when the paperwork calls both of them independent. Multi-state licensing isn’t any faster through the PA Licensure Compact yet either. The compact has been activated, but PAs cannot yet apply for compact privileges. The technology needed to issue compact practice privileges is still being built, with multi-state practice projected to begin in 2027. Checking a facility’s specific collaboration requirements before accepting an assignment remains the safer move than assuming reciprocity.

From Career Gaps to Career Momentum: How Locum Tenens Supports Career Transitions

September 1, 2026 | Jackson and Coker

Physician careers are rarely a straight line. Parental leave, a relocation for a partner’s job, burnout recovery, the uncertainty right after training ends, or a slow wind-down toward retirement all interrupt the plan at some point between residency and retirement. Traditional career structures tend to offer only two options at that moment, staying fully employed or stepping away entirely, with little built for the space in between.

Locum tenens work fills that middle ground, letting physicians maintain income and stay clinically engaged while they sort out what’s next. A rushed job decision to avoid a resume gap, or a real income gap from stepping away briefly, are both costs of not having a third option. Assignments during a transition offer continuity and greater flexibility, whether that transition means entering practice, returning from time away, relocating, or scaling down gradually toward retirement.

Locums Trends: The Most In-Demand Specialties of 2026

September 10, 2026 | Hayes Locums

More than 90% of healthcare facilities now rely on locum tenens to cover staffing gaps and keep service lines open. Urology remains one of the tightest, with more than 60% of US counties having no practicing urologist and trauma centers facing stricter on-call specialist requirements to keep their certification. Cardiology is similarly stretched, with nearly half of US counties, and about 86% of rural counties, having no practicing cardiologist even as cardiovascular case volume keeps climbing.

Gastroenterology demand traces partly back to the pandemic, when a pause in elective procedures created a screening backlog that pushed many retirement-age GIs to leave early rather than wait it out. Radiology shows a different pattern, since more radiologists want to work remotely post-pandemic, leaving facilities to lean on locum coverage specifically for on-site and interventional needs. Advanced practice providers round out the list, increasingly built into care teams across nearly every specialty as one answer to a physician shortage that can’t be solved through physicians alone.

AI on Call

• OpenEvidence released a family of four medical AI models for clinicians, including Osler for five-second answers, Sackett for deeper 30-second evidence reviews, and Darwin, now in a limited research preview, which scored a perfect result on the MedQA licensing-exam benchmark.
• Doximity’s 2026 Physician Compensation Report finds many physicians see AI as a financial and lifestyle asset rather than a threat, even as average compensation growth continues to moderate, rising just 2% from 2024 to 2025.

Wellness Retreat

5 Ways to Beat Mid-Career Physician Burnout

August 26, 2026 | KevinMD

Mid-career blahs are common, and a Becker’s Hospital Review survey found administrative work, cited by 66% of physicians, was their most frequently reported challenge. Many doctors say income is what keeps them in a job that no longer fits, but it’s more often the loss of autonomy and control driving the discontent. Staying disconnected at work tends to show up later in declining patient satisfaction scores and weaker online reviews.

There’s no perfect moment to make a change, whether that’s negotiating a different role, scaling back hours, or considering a different practice structure entirely. The options available at mid-career are broader than they feel from inside a stalled routine. Waiting for the right time can mean putting off changes that could make work more fulfilling.

A Cure for Physician Burnout Is Better Use of Patient Data

September 14, 2026 | Fast Company

Primary care physicians spend more than half their working week on computer-based recordkeeping, while more than 35% say they’re considering leaving their jobs within two years. That’s a number the country can’t easily absorb given a projected shortage of up to 86,000 physicians by 2036. The strain doesn’t come from electronic records alone, since chaotic workplaces, low control over pace, and organizational culture compound it.

The proposed remedy here is structural rather than personal, arguing that connected patient data, not mindfulness apps or wellness stipends, is what actually gives physicians back their time. When data moves with the patient across every provider who touches their care, a physician can act before a hospital readmission instead of reconstructing it after the fact. The authors argue that better-connected data could reduce time spent tracking down information and give physicians more time for patient care.

Doctors’ Notes

Steady and Strategic: Medscape Hospitalist Wealth & Debt Report 2026

September 4, 2026 | Medscape

Three in 10 hospitalists reported a net worth of $2 million or more, compared to four in 10 physicians overall, according to the 2026 Medscape Physician Wealth & Debt Report. Hospitalists bill mainly for assessment and management rather than procedures, closer to pediatrics, internal medicine, and psychiatry than to the higher-earning surgical specialties. That gap shows up most for hospitalists early in their careers, when lower compensation and lower net worth tend to move together.

The advice from financial planners surveyed is to stop evaluating investments on a 12-month view. A 30-year horizon changes what looks like a reasonable strategy versus a stressful one, particularly for a hospitalist weighing how aggressively to invest early on. Taking the long view can keep short-term changes from driving an investment strategy built for decades.

The Economics of Going Home on Time

September 7, 2026 | White Coat Investor

Staying 60 minutes late after every shift adds up to the same time commitment as working 16 additional shifts a year, or a full month worked for free. Ninety minutes late per shift comes out to nine full days a year, real days that could go toward a trip or genuine rest instead. Stretched across a 30-year career at 14 shifts a month, staying just 60 minutes late each time adds up to more than three years worked without pay.

Socializing at work is often framed as harmless, but it’s really trading time during a shift for time after it. Being more focused during the busy stretch of a shift is one of the more direct ways to reclaim that hour, without needing a bigger structural change. Tracking the hours actually worked, rather than only those scheduled, gives physicians a clearer picture of what they’re truly earning for their time.

How to Start a Cash-Pay Telehealth Practice, with Dr. Ashley Caravelli

September 15, 2026 | Physician Side Gigs Podcast

Host Dr. Nisha Mehta talks with Dr. Ashley Caravelli, a family medicine physician and menopause specialist, about launching her own cash-pay telehealth practice, Axis Precision Health, in six months. They walk through the business, legal, and operational decisions involved, from setting up an entity and choosing an EMR to securing malpractice coverage and navigating telehealth licensing across states.

The conversation also covers keeping startup costs low by deciding what to DIY versus outsource, and structuring a cash-pay patient experience around transparent pricing and memberships. Word of mouth and an existing professional network mattered more to finding first patients than paid marketing. Calculating a break-even point and maintaining other income, including through locum work, can reduce the pressure to turn a profit immediately while building a new venture.