The Complete Guide to Locum Tenens Opportunities for Physicians

Understanding Locum Tenens: What It Is and Why It Matters

Locum tenens—Latin for “to hold the place”—refers to physicians and advanced practice providers who temporarily fill clinical roles at hospitals, clinics, and other healthcare facilities. Instead of being permanently employed at one institution, a locum tenens physician works defined assignments ranging from a few days to several months (or more), usually arranged through a staffing agency.

Historically, locum work emerged to support underserved and rural areas, but it has evolved into a mainstream, multi‑billion‑dollar segment of healthcare staffing. Today, locum tenens opportunities exist across nearly all specialties and practice settings, including:

• Academic medical centers
• Community hospitals
• Rural critical access hospitals
• Outpatient clinics and urgent care centers
• Telemedicine platforms
• Correctional facilities, IHS, VA, and other government systems

For residents, fellows, and early‑career physicians, understanding this world early can dramatically widen your career options. Whether your long‑term goal is academic medicine, private practice, or a portfolio of clinical and non‑clinical roles, locum tenens can be a powerful tool for financial stability, skill development, and lifestyle flexibility.

How Locum Tenens Contracts Work (In Simple Terms)

While details vary by agency and site, most locum tenens arrangements share a similar structure:

• You are an independent contractor (most commonly via 1099 in the U.S.), not an employee.
• You sign a contract with the locum agency, and the agency signs a separate contract with the facility.
• The facility pays the agency, the agency pays you an agreed hourly or daily rate.
• Travel, housing, and malpractice are often covered or reimbursed by the agency (though details matter).

Assignments typically specify:

• Dates and schedule (days, nights, weekends, call)
• Expected workload (patients per day, admissions, procedures)
• Pay structure (hourly vs. per shift, overtime, call pay)
• Licensing and credentialing responsibilities

Understanding these basics now will help you ask smarter questions and negotiate better once you’re ready to take your first travel physician jobs.

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Who Should Consider Locum Tenens? Matching Opportunities to Career Stage

Locum tenens is not a one‑size‑fits‑all path. Your goals, family situation, and risk tolerance should guide how (and whether) locum work fits into your career.

Locum Tenens as a Resident or Fellow (Planning Ahead)

You cannot work independently as a locum tenens physician until you have:

• Completed training (or are very close with state/board allowances)
• Obtained a full, unrestricted medical license
• Secured appropriate board certification or board eligibility

However, you can start planning during residency or fellowship by:

• Learning common locum contract terms
• Attending agency information sessions at your program
• Talking to alumni who’ve done locum work
• Deciding if you might want a gap year or hybrid career after graduation

Locum tenens can be especially appealing if:

• You are undecided about long‑term geography or practice type
• You want to aggressively pay down student loans early
• You value flexibility and autonomy more than a traditional employment track

Early‑Career Attending: Gap Years, Travel, and Exploration

The first 3–5 years after training are when many physicians experiment with locum work. Common scenarios:

• Gap year between training and a permanent job
• Test‑driving regions or settings (e.g., academic vs. community, rural vs. urban)
• Building a financial cushion before joining a group or buying into partnership
• Couples matching “phase two” if you and a partner need flexible geography

For early‑career physicians, locum tenens can serve as:

• A “paid residency in the real world” to explore different practice models
• A way to prevent early career burnout by choosing assignments aligned with your values
• A strategic bridge if your match or job search did not go as planned

Mid‑Career and Late‑Career Physicians: Flexibility and Transition

Plenty of established physicians turn to locum work to:

• Reduce call or night shifts while maintaining income
• Transition out of full‑time practice gradually
• Relocate closer to family without committing immediately
• Step back from leadership roles while still practicing

In these scenarios, locum tenens offers control over volume and schedule—critical levers for extending a sustainable clinical career.

Personality and Lifestyle Fit

Locum tenens tends to work best for physicians who:

• Tolerate uncertainty and new environments
• Communicate clearly and adapt quickly to different EMRs and workflows
• Are comfortable as “the new person” repeatedly
• Can manage personal finances and taxes proactively

If you prefer long‑term team relationships, hospital politics, and a single EMR, locum work may still be useful—but likely as an occasional supplement rather than your primary career structure.

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Types of Locum Tenens Opportunities and Practice Settings

Locum tenens is not just one type of job. Understanding the different structures will help you match assignments to your goals.

By Duration: Short‑Term vs. Long‑Term Assignments

1. Short‑Term Assignments (a few days to 4 weeks)

   • Coverage for vacations, CME, or brief staffing gaps
   • Common in anesthesia, emergency medicine, hospitalist work, and some surgical specialties
   • Useful if you already have a home base and want occasional extra income

2. Medium‑Term Assignments (1–6 months)

   • Maternity/paternity leaves, extended medical leaves, or recruitment gaps
   • More continuity with staff and patients
   • Good for testing a region or hospital before considering a permanent role

3. Long‑Term Assignments (6–24+ months)

   • Sometimes function like “try‑before‑you‑buy” positions
   • Can bridge between full‑time positions or relocation
   • May offer higher stability but slightly less flexibility

By Location: Local vs. Travel Physician Jobs

• Local locums:

  • Assignments within driving distance of your home
  • You may commute or stay in provided housing during shifts
  • Lower disruption to your personal life, often lower travel benefits

• Travel physician jobs:

  • Assignments requiring flights or significant travel
  • Agency typically arranges flights, rental car, and housing
  • Better suited to those who enjoy new places and can be away from home

Some physicians build careers around seasonal patterns—for example, working in a northern state in summer and a southern/warmer state in winter.

By Setting: Inpatient, Outpatient, and Hybrid Roles

• Inpatient (e.g., hospitalists, intensivists, EM):

  • Shift‑based, with clear start/end times
  • High intensity but predictable off‑time
  • Often ideal for block scheduling (7-on/7-off)

• Outpatient (e.g., primary care, psychiatry, some subspecialties):

  • Clinic hours, panel continuity varies
  • May require more relationship‑building with staff and patients
  • Good for those who value longitudinal care but want contract flexibility

• Hybrid roles (consult services, perioperative, subspecialty clinics plus call):

  • Can offer procedural variety and teaching opportunities
  • Important to clarify call expectations and backup systems in the contract

Specialty‑Specific Considerations

• Hospital medicine & EM:

  • High volume of locum opportunities
  • Many facilities familiar with onboarding short‑term staff
  • Competitive rates; schedule flexibility is a major draw

• Psychiatry & Neurology:

  • Growing demand, including telemedicine options
  • Often longer assignments with better continuity of care

• Surgery & Procedural Specialties:

  • Fewer but often higher‑paying assignments
  • Must carefully vet support systems, equipment, and call burden

• Primary Care / Family Medicine / Internal Medicine (outpatient):

  • Opportunities in community clinics, rural sites, and urgent care
  • Important to understand patient population, panel ownership, and documentation expectations

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Benefits and Risks of Locum Tenens: A Balanced View

Locum tenens can be life‑changing—in good and challenging ways. Weigh both sides before fully committing.

Advantages of Locum Work

1. Flexibility and Autonomy

   • You choose when and where to work.
   • You can step away for travel, family needs, or personal projects.
   • You’re less enmeshed in institutional politics, committees, and long‑term obligations.

2. Potential for Higher Earnings

   • Locum tenens physicians are often paid premium rates for filling urgent or hard‑to‑staff roles.
   • With efficient scheduling, you may earn more per clinical day than in many salaried positions.
   • Strategic use of high‑pay periods (e.g., holidays, remote locations) can accelerate debt repayment.

3. Geographic and Practice Variety

   • Experience diverse systems, populations, and EMRs.
   • Learn what you want (and don’t want) before signing a long‑term contract.
   • Build a broad professional network across states and institutions.

4. Reduced Non‑Clinical Burden

   • Less administrative overhead, committee work, and local politics.
   • You’re generally shielded from long‑term responsibilities like partnership tracks, productivity targets, and local turf battles.

5. On‑Ramp or Off‑Ramp for Career Transitions

   • Smooth transitions between academic and community roles.
   • Gradual step‑down toward retirement while maintaining skills and income.

Risks and Trade‑Offs

1. Income Variability and Lack of Benefits

   • Work can be cyclical; assignments may be delayed or cancelled.
   • As an independent contractor, you are typically responsible for:
     • Health insurance
     • Retirement savings
     • Disability insurance
     • Paid time off (there is none—you’re paid only when you work)

2. Tax and Financial Complexity

   • 1099 income means paying self‑employment taxes and quarterly estimates.
   • You may need an accountant and should consider entity structures (e.g., LLC, S‑Corp) with professional guidance.

3. Less Control Over Systems and Culture

   • You’re often parachuted into environments with established workflows.
   • Limited influence to change chronic issues or system problems.
   • Risk of “scapegoating” if expectations aren’t clearly defined at the outset.

4. Professional Isolation

   • Repeated short stints can make it harder to build long‑term collegial relationships.
   • Mentorship and leadership opportunities may be reduced.

5. Licensing and Credentialing Fatigue

   • Multiple state licenses and hospital credentials can be time‑consuming.
   • Background checks, references, and paperwork are repetitive.

How to Decide if Locum Tenens Is Right for You

Ask yourself:

• Do I value schedule control over traditional benefits and stability?
• Am I comfortable handling personal finances and taxes proactively?
• Can I handle frequent adaptation to new teams and EMRs?
• Is my family or partner supportive of potential travel and irregular schedules?

If your answers lean toward yes, locum tenens could be a strong fit—either as your primary career structure or a strategic complement to a permanent job.

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How to Start: From Residency to Your First Locum Assignment

This section walks through the practical steps to move from interest to action.

Step 1: Get Your Foundations in Order

Before you can take locum tenens opportunities, you need:

• Full, unrestricted medical license (or multiple state licenses)
• DEA registration and any required state‑specific controlled substance permits
• Board certification or board eligibility documentation
• Updated CV with clear dates, training, and employment
• References (program director, supervising attendings, recent colleagues)

If you’re still in training, start assembling:

• Procedural logs
• Case lists (if relevant)
• Up‑to‑date immunization and health records (TB, hepatitis, etc.)
• Copies of diplomas, board scores, and prior licenses

Step 2: Understand the Agency Landscape

Most locum tenens physicians work through staffing agencies. There are:

• Large national firms with high volume
• Medium‑sized regional agencies
• Boutique firms focused on specific specialties

When evaluating agencies:

• Ask colleagues which agencies they’ve had good experiences with.
• Look for transparent communication about rates and contract terms.
• Clarify what they cover: travel, housing, malpractice (tail?), licensing assistance.

You are not limited to one agency; many physicians work with 2–3 to increase opportunities, but be careful about overlapping submissions to the same job.

Step 3: Clarify Your Priorities and Parameters

Before you say yes to your first assignment, define:

• Preferred geography (states, climates, proximity to airports or family)
• Schedule preferences (days vs. nights, call expectations, block schedules)
• Minimum acceptable rate (per hour or per shift)
• Deal‑breakers (unsafe staffing ratios, certain EMRs, unsupported high‑risk procedures)

Having this internal framework helps you evaluate offers quickly and avoid burnout.

Step 4: Evaluate and Negotiate Assignments

When an agency presents a job, ask specifics:

• Average daily census or patient volume
• Support staff numbers and roles (NP/PAs, residents, scribes)
• EMR system and availability of training
• Call schedule and backup availability
• Orientation time and expectations for productivity

On pay, consider:

• Base rate and how overtime is defined (e.g., after 8, 10, or 12 hours)
• Call‑back pay, weekend differentials, holiday rates
• Cancellation policies (what if the hospital cancels late?)

You can and should negotiate. Common negotiable items:

• Rate (especially if you have in‑demand skills or flexibility)
• Schedule blocks (e.g., 7-on/7-off vs. scattered shifts)
• Travel arrangements (e.g., driving vs. flight preferences)

Step 5: Prepare for Day One (Clinical and Logistical)

Before you arrive:

• Confirm travel, housing location, and check‑in instructions.
• Clarify where and when to report on the first day.
• Request orientation schedule and any pre‑reading or online modules.
• Pack key items:
  • White coat, stethoscope, ID badges from prior institutions (for reference only)
  • List of your logins, DEA, license numbers
  • Comfortable shoes, backup scrubs if allowed

On day one, focus on:

• Meeting key contacts (charge nurses, unit managers, chief or lead physician)
• Learning critical workflows (admissions, discharges, consults, escalation pathways)
• Understanding emergency protocols and codes

A strong, adaptable start sets the tone for your reputation as a reliable locum tenens physician and increases the odds you’ll be invited back or offered premium shifts.

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Practical Tips for Success and Long‑Term Sustainability

Beyond the basics, long‑term success in locum work hinges on strategy, professionalism, and financial planning.

Clinical and Professional Best Practices

1. Arrive Early and Over‑Communicate

   • Show up 10–15 minutes early for each shift, especially during your first week.
   • Clearly hand off patients and document thoroughly to build trust quickly.

2. Respect Local Culture While Observing Carefully

   • Each hospital has its own norms; avoid criticizing or comparing sites.
   • Where safe and appropriate, share best practices you’ve seen elsewhere—but tactfully.

3. Learn the EMR Efficiently

   • Accept training whenever offered; ask for cheat sheets or templates from peers.
   • Build a personal list of EMR shortcuts and workarounds over time.

4. Document Defensively but Efficiently

   • You may not be on site to clarify notes later; clear and complete documentation protects you.
   • Use smart phrases, macros, or templates when available to maintain speed.

5. Protect Your Reputation

   • Agencies share informal feedback; so do hospitals.
   • Be the physician they want back: reliable, collegial, and solution‑oriented.

Financial Planning and Taxes for Locum Physicians

As a 1099 independent contractor (common in locum work):

• Set aside 25–35% of your income for federal and state taxes, depending on your bracket.
• Pay quarterly estimated taxes to avoid penalties.
• Track deductible expenses such as:
  • Licensing and board fees
  • CME and conferences
  • Work‑related travel not reimbursed
  • Professional services (tax prep, legal advice)

Consider working with:

• A CPA familiar with physician 1099 income
• A financial planner to help with retirement accounts (SEP‑IRA, Solo 401(k), etc.)
• An attorney for contract review, especially early in your locum career

Work–Life Balance, Burnout, and Mental Health

Locum tenens can tempt you to overwork due to attractive rates. To stay sustainable:

• Set annual or quarterly maximum work hours or shifts for yourself.
• Schedule protected time off—treat it as non‑negotiable.
• Maintain social and family connections despite travel; use video calls, planned visits.
• Seek local support—many sites have physicians who regularly take locum assignments and can be allies.

Building a Long‑Term Career Strategy with Locum Tenens

Locum work doesn’t have to be “all or nothing.” You can:

• Combine a part‑time employed role with periodic locum shifts.
• Use locum assignments to explore academic sites before pursuing a faculty position.
• Focus on underserved or rural communities as a mission‑driven career.

Revisit your goals annually:

• Are you using locum tenens intentionally or drifting into assignments by default?
• Do your current locations and schedules still serve your personal and family priorities?
• Is now the right time to transition to (or away from) a more permanent role?

When done strategically, locum tenens becomes a tool to shape your life, not just a job that happens to you.

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FAQs: Locum Tenens for Residents and Early‑Career Physicians

1. Can I do locum tenens work during residency?
Generally no, not as an independent locum tenens physician. Most locum roles require a full, unrestricted medical license and board eligibility or certification. However, you can moonlight under your training license at your own or affiliated institutions, depending on program and state rules. Use residency to learn about locum work, build your CV, and prepare for post‑training opportunities.

2. How much can a locum tenens physician earn compared to a salaried role?
It varies widely by specialty, region, and demand. Hourly or daily rates are often higher than the effective hourly pay in many employed positions, especially in high‑need areas or less desirable shifts (nights, holidays, rural sites). However, remember that 1099 income doesn’t include employer‑paid benefits, retirement contributions, or paid time off. A fair comparison must factor those in.

3. Do I need multiple state licenses to get good locum tenens opportunities?
Not necessarily, but multiple licenses expand your options. Many assignments are available with a single license in populous states, but adding licenses—especially via the Interstate Medical Licensure Compact when eligible—can open high‑pay, high‑flexibility travel physician jobs. Some agencies will reimburse or assist with licensing if you commit to assignments in those states.

4. Is locum tenens a safe long‑term career choice, or just a temporary solution?
For many physicians, locum work is a sustainable long‑term career path. Others use it as a bridge between permanent roles or during specific life phases (debt repayment, relocation, family transitions). Stability depends on your specialty, flexibility, financial planning, and willingness to manage the business side of being an independent contractor. With deliberate planning and boundaries, locum tenens can form the backbone of a stable, satisfying medical career.

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Locum tenens opportunities offer a unique combination of flexibility, earning potential, and professional variety. Whether you’re a resident planning your first year out or an attending rethinking your trajectory, understanding this world positions you to design a career—and a life—that fits your values, rather than forcing your values to fit a job.