Locum Tenens for Physicians: How It Works, Pay Factors and Contracts

How to get started, step by step

Turn the idea into a specific next action. These are preparation steps, not approval to perform a role.

1. Choose a setting and assignment length, then write your clinical limits: procedures, call, solo coverage and patient groups.
2. Make a readiness list with the hiring team: state authorizations, privileges, credential verification, orientation and clinical-system access. Put an owner beside every unfinished item.
3. Ask for the paid schedule, call terms, travel arrangements and cancellation process before blocking dates or booking travel.
4. Compare the complete written offer against your assignment brief. Keep any unresolved term visible rather than filling it with what another facility usually does.

Where to look and who to ask

Use search terms and contacts that fit this work. Check the actual source and current requirements; these suggestions are not verified openings or Saile inventory.

• Search the physician career resource for locum tenens, temporary physician and your specialty, then narrow geography.
• Check facility career pages and ask their clinical hiring or medical-staff team how temporary coverage is recruited.
• Share your dates, eligible states and exact scope when asking about assignments. A broad willingness to travel is less useful than a specific brief.

JAMA Career Center — professional search resource, not an opening endorsement

Scheduling and payment realities

Put call, travel days, orientation, documentation and recovery time next to the paid shifts. Ask which dates are tentative and which are confirmed. A long assignment can have a different effect on your main job than occasional local coverage.

Keep gross pay and taxes separate

For federal employment taxes, the IRS considers control and the relationship, not only the contract label. Self-employed individuals generally pay income and self-employment tax and may need estimated payments. Keep payment and expense records and ask a tax professional about your actual arrangement; this guide does not calculate take-home pay.

IRS: Independent contractor or employee
IRS: Self-employed individuals tax center

Before you say yes: a final checklist

Do not let an unanswered question become an assumed term.

• Scope fits my expertise and any required authorizations.
• Time, deliverables, payment unit and expenses are written.
• Outside-work approval, conflicts and confidential-data handling are checked.
• Coverage, escalation or review responsibilities are clear.
• Starting and ending the engagement each have a written process.

What the primary sources say

A locums assignment usually means a new site, and sometimes a new state. A license, facility privileges and a DEA registration are separate items. Ask who starts each one and how long each takes before you agree to a start date.

For controlled substances, the federal rule on separate registrations says a separate DEA registration is required for each principal place of business or professional practice at one general physical location where controlled substances are dispensed. It excludes an office where a practitioner only prescribes, but only if the practitioner is registered at another location in the same State and no controlled-substance supplies are kept there. If the assignment is in a different state, or you will administer or dispense on site, do not assume your current registration covers it. Ask the facility and the DEA registration office.

The Interstate Medical Licensure Compact Commission says licenses are issued by participating states, not by the Commission. A Compact application can still mean one state license per state you choose, with its own fee and timeline.

21 CFR 1301.12: Separate registrations for separate locations

Taxes and travel on a locums assignment

The IRS explains in Publication 463 that travel expenses are deductible when you travel away from your tax home. Your tax home is generally your regular place of business or post of duty, regardless of where your family home is. If you have more than one regular place of business, your tax home is your main place of business. If you have no regular or main place of business because of the nature of your work, your tax home may be the place where you regularly live. An itinerant, with no regular place of business and no place where they regularly live, is never considered to be traveling away from home and cannot claim a travel expense deduction.

The IRS also separates temporary from indefinite assignments. If an assignment away from your main place of work is temporary, your tax home does not change. Generally, a temporary assignment in a single location is one that is realistically expected to last, and does last, one year or less. If it is realistically expected to last more than one year, whether or not it does, the location becomes your new tax home and you cannot deduct travel expenses there. A series of assignments to the same location, each short but together covering a long period, may be considered indefinite.

This matters if you take repeat locums work at one hospital or in one town. Keep a record of where your main practice is, how long each assignment was expected to last at the start, and where you actually live. Ask a tax professional how these rules apply to you. Treat any quoted housing or travel stipend as pay you must account for, and ask whether it is reported to you on a tax form.

IRS Publication 463: Travel, gift, and car expenses

Credentialing, privileges and the start date

Under the Medicare hospital condition on medical staff, the medical staff must examine the credentials of eligible candidates and make recommendations to the governing body on appointment, which then appoints in line with State law and the staff bylaws. In plain terms, a hospital does not hand out privileges because a staffing firm sent a resume. Someone on the medical staff side has to review your file, and that step can run on the hospital's calendar, not the agency's.

The National Practitioner Data Bank lets a licensed practitioner run a self-query to see any reports that match their profile, including medical malpractice payments and adverse licensure or privileges actions. Running one before you apply lets you see what a facility may see and prepare an explanation for anything unexpected. A license, privileges and, where it applies, a DEA registration are separate items that start on separate clocks. Ask who starts each one, who pays the fees, and what the earliest realistic first day is.

If a start date is promised before the license and privileges are in hand, ask who bears the cost if the start slips. Get that in writing. A short assignment can end before the credentialing does.

42 CFR 482.22: Condition of participation, medical staff

NPDB: Self-query basics

Malpractice coverage for short assignments

The National Association of Insurance Commissioners describes two basic forms of medical malpractice policy. A claims-made policy responds to a claim reported while the policy is in force and during any applicable extended reporting period. An occurrence policy covers a loss that occurs during the policy period, regardless of when the claim is made, even after the policy has been canceled.

For a locums job, the form decides what happens after you leave. Ask who buys the coverage, whether it is claims-made or occurrence, what the limits are, and whether you are named on a group policy. If the policy is claims-made, ask whether tail coverage, meaning an extended reporting period, is included, who pays for it and for how long it lasts. Ask whether the coverage extends to every state and site where you will work, and get a certificate of insurance before the first shift. Do not rely on your main employer's policy for separate locums work unless the insurer confirms it in writing.

NAIC: Medical malpractice insurance

Questions to put to the agency or the facility

Ask whether you are placed through an agency or contract directly with the facility, and who the contract is with. Ask for the pay rate in writing and what it covers: hourly or daily rate, call pay, overtime, travel time, and what happens when a shift is canceled or the census drops. Ask who books and pays for travel and housing, and whether any of it is taxable pay to you.

Ask what the contract says about ending early, and whether either side must give notice. Ask about non-compete or non-solicitation terms that could keep you from working with the facility or its affiliates later. Ask about the electronic record system, orientation, and the support staff and back-up you will have on your first shift. Ask who your contact is if something goes wrong at the site at night.

Read the contract in full, and have a lawyer review it if the terms are unusual. A locums assignment is a business arrangement, so the answers belong in writing before you agree.