Locums work is temporary medical staffing where physicians, nurse practitioners, and other healthcare providers fill in at facilities on short-term assignments rather than holding permanent positions. The term comes from the Latin “locum tenens,” meaning one who temporarily takes the place of another. What started in the 1970s as a solution for burned-out rural doctors in Utah has grown into an industry worth nearly $11 billion, with projections to more than double by 2035.
How Locums Work Got Started
The concept took shape when the Robert Wood Johnson Foundation funded a program at the University of Utah College of Medicine to create a network of physicians who could cover rural practices. The goal was simple: let rural doctors step away for continuing education without leaving their communities without care. That network proved the model worked, and staffing agencies soon commercialized the idea. Today, locums providers work in every specialty and every setting, from small-town clinics to major urban hospital systems.
Why Facilities Hire Locums Providers
Hospitals and clinics turn to locums staffing for a range of reasons. A physician goes on maternity leave and the practice needs someone to keep seeing patients. A rural hospital can’t recruit a permanent specialist and uses locums to maintain access. A health system is between hires and needs coverage during the gap. Seasonal patient surges, unexpected resignations, and provider burnout all create openings that locums workers fill.
Some specialties rely on locums providers more heavily than others. Data from the American Medical Association shows anesthesia leads the pack, with 65.4% of staffing searches in that specialty seeking locums coverage. Pediatrics follows at 47.5%, then urgent care at 41.5%, hospital medicine at 30.1%, and emergency medicine at 24.4%.
What an Assignment Looks Like
Locums assignments typically last anywhere from two weeks to two months, though the range extends in both directions. Some providers pick up a single weekend shift to earn extra income. Others string together back-to-back assignments across different cities and work locums full time for years, treating it as a career rather than a side gig. Seasonal work is also common, with some providers choosing to work intensively for part of the year and take extended time off.
When you accept an assignment, the staffing agency typically handles logistics. Standard arrangements include round-trip airfare or mileage reimbursement, a rental car or ground transportation, and private furnished housing for the duration of your stay. If you want to bring a partner, kids, or pets, most agencies will accommodate requests for larger spaces or pet-friendly units, though you may need to cover the cost difference or a pet deposit.
Pay and Tax Obligations
Locums providers generally earn more per hour than their permanently employed counterparts. On average, physicians working locums full time make over $32 more per hour than permanent staff physicians. The premium compensates for the lack of traditional employer benefits like retirement contributions, paid time off, and health insurance, which locums providers typically arrange on their own.
The tax situation is the biggest financial adjustment. Locums providers are classified as independent contractors and receive 1099 forms rather than W-2s. That means federal, state, and self-employment taxes are not automatically withheld from your pay. You’re responsible for setting aside a portion of each paycheck and submitting quarterly estimated tax payments to the IRS. Providers who work with multiple agencies in a single year will receive a separate 1099 from each one. Many locums workers set up a business entity or work with an accountant to manage deductions for travel, licensing fees, and other professional expenses.
Licensing Across State Lines
One of the practical hurdles of locums work is that medical licenses are issued state by state. If you want to take an assignment in a state where you’re not licensed, you need to obtain a license there first. The Interstate Medical Licensure Compact has simplified this process considerably, with 43 member states and 2 U.S. territories now participating. The compact creates a streamlined pathway for physicians to obtain licenses in multiple states without repeating the full application process each time. Staffing agencies often assist with the credentialing and licensing paperwork, but the process still takes time, so planning ahead matters.
Malpractice Insurance
Most locums staffing agencies provide malpractice insurance as part of the assignment package, but the details vary in ways that matter. The key distinction is between two types of policies. An “occurrence” policy covers any incident that happens during the policy period, regardless of when the claim is filed. A “claims-made” policy only covers claims filed while the policy is active. If a claims-made policy lapses and a patient files a lawsuit afterward, you could be unprotected unless you purchase extended reporting coverage, commonly called “tail” coverage.
Some agencies carry what’s known as a perpetual claims-made policy, which maintains blanket coverage for all providers as long as the agency renews the policy each year. Under this arrangement, individual providers don’t need to purchase their own tail coverage. Before starting any assignment, get written clarification from the agency’s risk manager about exactly how the policy works and what happens to your coverage after the assignment ends.
Who Locums Work Is Best Suited For
Locums appeals to providers at nearly every career stage, but for different reasons. New physicians sometimes use it to explore different practice settings and geographic areas before committing to a permanent position. Mid-career providers use it to escape burnout, supplement income, or regain schedule flexibility. Physicians approaching retirement often transition to locums as a way to reduce their workload without fully stepping away from practice.
The tradeoffs are real. You gain higher hourly pay, geographic variety, and control over your schedule. You lose the stability of a single workplace, established patient relationships, employer-funded benefits, and the simplicity of W-2 tax filing. Providers who thrive in locums work tend to be comfortable with change, skilled at adapting quickly to new electronic health record systems, and organized enough to manage their own finances and credentialing.