Step-by-Step Guide to Vetting a New Locum Agency or Recruiter

Step-by-Step Guide to Vetting a New Locum Agency or Recruiter

It is 9:30 p.m. You just finished a brutal outpatient clinic day as a newly minted attending. You are half-scrolling, half-zoning out when an email pops up:

“We have an urgent need in your specialty. $2,200/day. Flights, lodging, and rental car included. Can we talk tomorrow?”

You have no idea who this recruiter is. The agency name rings a faint bell. You are tempted. You also do not want to walk into a malpractice nightmare, get paid late, or discover the “$2,200/day” becomes $1,500 after a dozen hidden deductions.

Here is how you vet them properly. Step by step. Before you sign anything. Before you waste time on phone calls that go nowhere.

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Step 1: Do a Hard Background Check on the Agency

Start with the agency, not the individual recruiter. Good recruiter working for a shady agency is still a problem.

1. Quick credential and reputation check

Do this in order. It takes 15–20 minutes if you are efficient.

1. Check basic legitimacy

   • Website: Is it professional, functional, and clear about services and specialties?
   • Physical address: Real office address, not “virtual space” or P.O. box only.
   • Phone number: Call the main line during business hours. Does a real person answer?

2. Look for national affiliations Focus on:

   • NALTO (National Association of Locum Tenens Organizations)
   • NAPR (National Association of Physician Recruiters)

   Membership in NALTO in particular is a positive sign. It means:

   • They follow some industry standards for pay, transparency, and dispute resolution.
   • You at least have a third party to complain to if something goes sideways.

   Not being a member is not an automatic dealbreaker, but if they are not, I want the rest of their profile to be squeaky clean.

3. Search for complaints and lawsuits In Google, search:

   • "[Agency Name]" + "ripoff" + "complaint" + "lawsuit" + "scam"
   • "[Agency Name]" + "locum" + "reviews"

   Red flags:

   • Consistent reports of late payment or nonpayment
   • Bait-and-switch complaints: rate changed after arrival, call burden misrepresented
   • Repeated comments about visa/credential mismanagement

4. Check LinkedIn and staff

   • Look up the company and recruiters on LinkedIn.
   • Does this agency have multiple recruiters, credentialing staff, leadership?
   • Does the recruiter have a history in locums or did they start last month selling gym memberships?

2. Compare them against known players

You do not need to memorize every agency, but you should have a sense of the landscape.

Category	Typical Features
Large national firms	Big hospital contracts, standardized processes
Mid-size regional	Strong in certain states or specialties
Boutique/niche firms	Focused on one specialty, more personalized
One-person shops	Variable quality, high risk if no track record

I am not saying “big = good, small = bad”. I am saying: the smaller or newer they are, the more proof you need that they pay on time, treat you fairly, and actually know what they’re doing.

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Step 2: Evaluate the Recruiter as a Professional Partner

You are not just picking a company. You are picking the human being who will control what information you get and how problems are handled.

1. Pay attention to how they first contact you

• Did they cold-call your hospital line during clinic? That is sloppy and disrespectful.
• Did they:
  • Introduce themselves and the agency clearly?
  • State how they got your information?
  • Offer specific jobs or just “We have a lot of opportunities”?

Sloppy first contact often equals sloppy follow-through.

2. Ask them direct, specific questions

You want clarity, not smooth talk. Here is a script you can use on the first real call:

• “How long have you been recruiting physicians? In which specialties?”
• “How many physicians do you currently place per year, roughly?”
• “Do you work with my specialty a lot? Which settings—hospitalist, ED, outpatient?”
• “Can you walk me through the end-to-end process from now to first paycheck?”

Listen for:

• Concrete details.
• A clear timeline.
• Comfort talking about logistics (credentialing, state license, malpractice).

If they dodge or overhype, you are dealing with a salesperson, not a partner.

3. Test their transparency about the job and the money

On the first or second call, ask:

• “What is the guaranteed daily/shift rate for this assignment?”
• “What counts as a ‘day’ for billing? Start/stop times?”
• “Is this W-2 through your agency or 1099 independent contractor?”
• “How is overtime, extra call, or extra shifts paid?”
• “Who pays for malpractice and what are the limits?”

Watch for:

• Concrete numbers.
• No hesitation about giving a rate range.
• No “It depends, let me get back to you” repeated for everything.

One or two “I need to confirm that” is fine. Five or six is a sign they are not in control of the details.

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Step 3: Validate Their Financial Reliability and Payment Process

This is where physicians get burned the most—late payment, confusing deductions, or constant “processing” delays.

1. Confirm basic payment mechanics

Ask these questions explicitly:

• “How frequently are physicians paid? Weekly, biweekly, monthly?”
• “Is pay tied to timesheet approval or to dates worked?”
• “What is the exact timeline from submission of timesheet to money in my account?”
• “Do you pay by direct deposit? Any fees or mandatory payroll cards?”
• “What documentation do you need from me before I can be paid? W-9, direct deposit form, credentialing complete, etc.?”

They should be able to describe this like they have done it thousands of times.

2. Ask for references—then actually call them

You are hiring them. So you do reference checks. Do not skip this.

Ask:

• “Can you give me the names of 2–3 physicians you have placed in my specialty in the last 12 months who are willing to speak to me?”

When you talk to those physicians, ask:

• “How long have you worked with this agency and recruiter?”
• “Have you ever been paid late? If so, how late and how was it handled?”
• “Did the job match what you were told before you went?”
• “How did they respond when problems came up on site?”
• “Would you still be willing to recommend them to a close friend?”

If they hesitate or give a lukewarm endorsement, treat that as data.

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Step 4: Scrutinize the Malpractice Coverage and Legal Setup

This part is not “details”. It is your license and your future employment.

1. Understand malpractice coverage

Ask the recruiter to send the malpractice coverage summary in writing. Then confirm:

• Type:
  • Claims-made or occurrence?
• Limits:
  • $1M / $3M is common. Lower than that? I would ask why.
• Tail coverage:
  • “Who is responsible for tail coverage if a claim arises after I stop working there?”
• Coverage scope:
  • Are all practice locations, procedures, telehealth covered?
  • Are moonlighting or side jobs excluded?

If they cannot answer or give you the policy summary, that is a major red flag.

2. Clarify the employment relationship

You must know who your legal “employer” is. Ask:

• “Will I be an employee of the agency (W-2) or an independent contractor (1099)?”
• “Is there a separate services agreement between me and the agency?”
• “Is there a separate contract between me and the facility, or is it only between you and the facility?”

Why this matters:

• 1099: You run your own business. You handle all taxes, benefits, retirement. More flexibility, more complexity.
• W-2: They handle taxes, sometimes basic benefits. Less tax flexibility, but simpler.

If they do not understand the difference or gloss over this, you are dealing with amateurs.

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Step 5: Dissect the Contract—Before You Sign Anything

This is where most of the traps are hidden. Non-competes, clawbacks, cancellation penalties, vague call expectations.

You need at least two levels of review:

1. Your own structured review.
2. An attorney review for any long-term or high-dollar arrangement.

1. Core clauses you must examine

Look for these in the agreement:

1. Scope of work and duties

   • Clear description of:
     • Facility name and location.
     • Setting (inpatient, outpatient, ED, ICU).
     • Expected census/volume.
     • Call burden (frequency, in-house vs. beeper, weekends).

2. Compensation details

   • Base rate per day/shift/hour.
   • Overtime rules: when it kicks in and at what rate.
   • Call stipend vs. productivity for call.
   • What happens with no-shows or low census days:
     • Guaranteed minimum hours or daily rate?
     • Are you sent home unpaid if census low?

3. Expenses and reimbursements

   • Travel: flights, mileage, car rental, parking.
   • Lodging: hotel vs. apartment, nightly cap, who books?
   • Licensure: Are new state licenses paid for? In full or capped?
   • Credentialing costs, drug screens, immunizations: whose responsibility?

2. Non-compete and restriction clauses

This is where agencies quietly lock you in.

Look for language like:

• “Physician shall not accept employment or engage in services directly with any facility introduced by Agency for a period of X months within Y miles.”

Questions to ask:

• “What is the exact duration of any non-compete?”
• “What geographic radius does it cover?”
• “If the hospital wants to hire me full-time, is there a buyout? What is it?”

Harsh rule of thumb:

• If the non-compete prevents you from working at a facility for more than 12–18 months after a short locum stint, that is excessive.
• If it tries to block you from any facility in an entire metro area or state, I would walk.

3. Cancellation and penalty terms

Both sides need a way to cancel. The key is whether the penalties are fair.

Look for:

• Physician cancellation:
  • How much notice do you need to give?
  • Are there penalties (cost of travel, flat fee per canceled shift)?
• Facility/agency cancellation:
  • How much notice must they give you?
  • Do you get any guaranteed payment for canceled shifts with short notice?

A fair setup might be:

• 30 days’ notice by either party with no penalty.
• If the facility cancels inside 14 days, you get partial or full payment for a minimum number of shifts.

If cancellation terms are one-sided, the agency sees you as disposable.

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Step 6: Validate Their Operational Competence (Credentialing, Travel, Support)

Agencies that cannot manage logistics will waste your time and ruin assignments.

1. Ask for a clear onboarding timeline

You want them to explain the steps like this:

1. Signed agreement.
2. Credentialing packet sent within X days.
3. Typical credentialing time at this facility is Y weeks.
4. Licensing support (if needed) runs in parallel and takes Z weeks.
5. Travel arrangements confirmed by [X days] before start date.

If they cannot explain timelines and specific steps, they are winging it.

2. Probe their support structure

Ask directly:

• “Who is my main point of contact once I am on assignment?”
• “If I have a clinical concern at the site, who do I call?”
• “If there is a problem with my schedule, who fixes it—the facility or you?”
• “Can you give me an example of a serious issue that came up for a physician and how you addressed it?”

Pay attention to:

• Do they name individuals (account manager, credentialing specialist), or is it all vague “our team”?
• Do they have a 24/7 line for urgent issues?

3. Check how they handle travel and housing

Sloppy travel/housing is one of the biggest sources of misery.

Ask:

• “Do you book travel, or do I and then get reimbursed?”
• “What class of hotel is typical? Do you have maximum nightly rates?”
• “If housing is unsafe or unacceptable, what recourse do I have?”
• “Do I get a per diem for food? Any caps to know about?”

You are a professional, not a backpacker. If they are putting people in questionable motels to save $20 a night, move on.

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Step 7: Cross-Check the Assignment with Independent Sources

Never rely fully on the agency’s description of the job. They are not on the ground seeing patients.

1. Ask for direct facility contact

Request:

• “Can I speak to a physician currently working there, and if possible, the medical director or chief of staff?”

Questions to ask those people:

• “What is the real census and workload like?”
• “How is nursing support? Ancillary staff? Techs?”
• “How are call burden and backup coverage in practice?”
• “Why are they using locums—growth, turnover, bad leadership?”

If the agency balks at you talking to people on site, that is a problem. Good facilities are usually fine with this.

2. Do your own quick facility research

Look up:

• Hospital quality scores: Leapfrog, Medicare’s Care Compare, local health system reputations.
• Google reviews: Yes, patients can be unreasonable, but patterns matter. “Always understaffed, long waits, rude staff” is a pattern.

You are not just protecting your sanity. You are protecting your clinical reputation by avoiding dangerous setups.

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Step 8: Build Your Own Shortlist of “Trusted” Agencies

Locums is not a one-time thing for many physicians. You want a stable of 2–4 agencies you trust over the long haul.

Typical Locum Agency Usage by Physicians

Category	Value
1 Agency	25
2–3 Agencies	55
4+ Agencies	20

Here is how to formalize that:

1. Track your experiences After each assignment, jot down:

   • Was the pay accurate and on time?
   • Did the job match the description?
   • How responsive were they to issues?

2. Rank agencies and individual recruiters You will quickly learn that:

   • Some agencies are good but you got stuck with a mediocre recruiter.
   • Some recruiters are rock stars who move with speed and transparency.

3. Drop low performers quickly If they:

   • Misrepresent jobs.
   • Pay late more than once.
   • Pressure you to sign contracts without time to review.

   Then stop working with them. You are not obligated to “give them another chance.”

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Practical Vetting Checklist (Use This Before Saying Yes)

Before you agree to an assignment or to work with a new agency, you should be able to answer “Yes” to at least 90% of this:

Physician Vetting Locum Agency Process

Step	Description
Step 1	New Agency Contact
Step 2	Research Agency Reputation
Step 3	Screen Recruiter on Phone
Step 4	Confirm Pay and Malpractice
Step 5	Review Contract in Detail
Step 6	Speak to Facility Contact
Step 7	Decide to Accept or Decline

Agency

• I confirmed they exist, have a real office, and a functioning website.
• I checked for NALTO/NAPR membership or equivalent credibility.
• I found no serious pattern of legal or payment complaints.

Recruiter

• They answered specific questions clearly.
• They gave me concrete rates and details without constant deflection.
• They provided at least two physician references I was able to contact.

Money and legal

• I know exactly how and when I will be paid.
• I have malpractice coverage details in writing.
• I know whether I am W-2 or 1099 and what that means for me.

Contract

• Scope of work, duties, and call expectations are clearly defined.
• Non-compete terms are limited and reasonable.
• Cancellation terms are not one-sided.
• I had time for legal review for anything beyond a simple one-off shift.

Operational

• I know the expected timeline from now to first shift.
• I have a named contact for credentialing and for issues on assignment.
• Travel and housing policies are clear and acceptable.

If you cannot get straight answers or documents for these, you are not “being difficult.” You are being a professional.

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FAQ

1. Do I really need a lawyer to review every locum contract?
No. For a one-off, short-term, clearly written assignment with no broad non-compete, many physicians review it themselves. But if:

• The contract includes long non-competes.
• There are complex clawbacks or penalties.
• You are planning substantial, ongoing work with the same agency. Then paying for a lawyer who understands physician contracts is money well spent.

2. How many locum agencies should I work with at once?
I recommend 2–3 at most. Enough to keep your options open and competitive, not so many that you are drowning in calls and duplicate job offers. Over time, you will naturally favor 1–2 who consistently deliver honest information, smooth logistics, and on-time pay.

3. What is the biggest red flag when vetting a new locum agency or recruiter?
Aggressive pressure with vague details. If they push you hard to “lock in this rate today” but cannot or will not give you:

• A written rate confirmation.
• Clear duty and call descriptions.
• Transparent contract terms. Then walk away. Fast. Reputable agencies know that good physicians need time and data to decide.

4. Can I negotiate locum tenens rates, or are they fixed?
You can almost always negotiate something. Rate, schedule flexibility, travel class, call pay, or housing quality. The trick is to negotiate before credentialing starts and before you sign. Phrase it simply: “Given my experience and this workload, I am looking for [$X/day or $X/hour]. Is there room to move toward that?” If the recruiter never negotiates anything for you over multiple assignments, they are not truly advocating for you.

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Bottom line:

1. Treat agencies and recruiters like you would any contractor you hire: check credentials, references, and contracts.
2. Do not ignore your own red flags—vague answers, pressure, and sloppy logistics usually predict trouble.
3. Build a small, trusted bench of agencies and recruiters, and drop anyone who cannot consistently deliver honesty, clarity, and on-time pay.