Start with the clearance decision, not an open date
A physician considering occasional coverage should ask the clinical department what must be approved before joining its schedule. An active medical license establishes state authority; it does not establish permission to perform every procedure at a particular hospital. The AMA credentialing preparation guide describes verification of education, training, experience and professional records. Ask whether your file is complete, which privileges have been granted and who can communicate the final clearance decision. A recruiter’s request for availability is not the same as clinical approval. Keep interest, tentative scheduling and permission to start as separate conversations.
Describe the work you currently perform rather than submitting a specialty name alone. If the proposed shifts involve unfamiliar acuity, equipment or procedures, explain those differences to the department. Orientation and backup should match the assignment, even when the commitment is occasional.
Three labels that answer different questions
Per diem commonly describes work offered on an as-needed or individual-shift basis. Locum tenens describes temporary physician coverage for an assignment. Moonlighting describes additional work alongside a primary job or training role. These descriptions can overlap: an extra local shift might be both per diem and moonlighting. None of the labels, by itself, establishes employee status, a particular payment unit or a universal credentialing shortcut. Ask the organization to describe the agreement rather than using the label to infer its terms.
Compare the service, location and responsibility before comparing flexibility. A locums block may involve travel and a defined service commitment. A local per diem arrangement may require recurring availability. Moonlighting may require outside-work approval from a primary employer or training program. These are questions to resolve, not promises about every job bearing the name.
Map the shift from arrival to handoff
Imagine an occasional inpatient shift offered around your main schedule. Ask when responsibility begins: receiving handoff, checking results, attending a briefing or starting patient encounters. Identify who receives unresolved issues when the shift ends and who can be contacted later. This hypothetical example illustrates an agreement review; it does not describe a current opening. The purpose is to uncover responsibilities that a calendar block cannot show.
Clarify whether the role includes admissions, procedures, cross-coverage or call. Ask how the department allocates work when volume changes and what happens if a case exceeds your approved scope. Protect recovery time and your main-job obligations. Availability should mean you can carry the clinical responsibility, not simply that you have an empty square on a calendar.
Payment structure belongs in the written agreement
A per diem offer may describe compensation by hour, shift or another defined unit. Ask which activities are included, how additional time is recorded and whether mandatory orientation or administrative work is paid. Cancellation and early departure should be addressed explicitly. Do not assume that an annual salary benchmark predicts what a discrete clinical shift pays. This guide quotes no gig rate or earnings forecast.
Keep payment structure separate from classification. For federal employment taxes, the IRS considers behavioral control, financial control and the relationship between the parties. Calling an arrangement per diem or issuing a particular form does not settle that analysis. Ask who employs or contracts with you, what benefits or expenses are included and which questions should go to your tax adviser.
IRS: Independent contractor or employee
Continue with Physician moonlighting: extra shifts without a vague commitment or Locum Tenens for Physicians: How It Works, Pay Factors and Contracts.
Insurance must name the actual clinical work
Ask for confirmation that professional liability coverage applies to the site, service and procedures you will perform. A policy connected to your primary job may not cover outside work. The AMA’s tail insurance guidance explains why departure from claims-made coverage needs attention. Ask about the reporting terms, retroactive coverage where applicable and any extended reporting protection after the policy ends. Get the insurer’s answer for your circumstances rather than relying on a colleague’s arrangement.
The agreement should identify who arranges coverage and who is responsible for any required tail. Occurrence and claims-made policies operate differently; neither a short engagement nor employee status answers every coverage question. Save the relevant documents with the assignment agreement so a later staffing change does not erase the record of what was confirmed.
Keep a small, usable readiness file
Prepare a current license list, training history, certification status, recent clinical experience and the professional references requested by the organization. ABMS certification assesses specialty knowledge and skills; it is separate from state licensure and facility privileges. Use the FSMB board directory to find the responsible medical board when a state authority question remains unresolved. Do not invent a completion date for a verification still owned by another organization.
A practical file also records your assignment boundaries: approved service, clinical supervisor or escalation contact, system access, scheduled availability and insurance confirmation. Review each item when the site or duties change. A clearance for one department should not be treated as automatic approval for another. Keep protected clinical information in the organization’s authorized systems, not in your personal readiness notes.
ABMS: Specialty and subspecialty certificates
FSMB: Contact a state medical board
Move from an inquiry to a workable commitment
Request a written scope and discuss it with the clinical lead before accepting offered shifts. Use the linked moonlighting guide for primary-job conflicts and the locum-tenens guide for longer temporary assignments. If your work may include virtual encounters, add the patient-state licensing checks described in the telemedicine guide rather than assuming a facility-based agreement covers remote practice.
Keep your Saile profile current with credentials and realistic work preferences, then check the app for relevant opportunities. This page is educational and does not establish that a suitable opening exists. A useful next step is a resolved question: which approval remains outstanding, who owns it and what information do they need from you? That is more actionable than an unsupported promise of a start date.
Questions about this work
What should I check: start with the clearance decision, not an open date?
A physician considering occasional coverage should ask the clinical department what must be approved before joining its schedule. An active medical license establishes state authority; it does not establish permission to perform every procedure at a particular hospital. The AMA credentialing preparation guide describes verification of education, training, experience and professional records. Ask whether your file is complete, which privileges have been granted and who can communicate the final clearance decision. A recruiter’s request for availability is not the same as clinical approval. Keep interest, tentative scheduling and permission to start as separate conversations.
What should I check: three labels that answer different questions?
Per diem commonly describes work offered on an as-needed or individual-shift basis. Locum tenens describes temporary physician coverage for an assignment. Moonlighting describes additional work alongside a primary job or training role. These descriptions can overlap: an extra local shift might be both per diem and moonlighting. None of the labels, by itself, establishes employee status, a particular payment unit or a universal credentialing shortcut. Ask the organization to describe the agreement rather than using the label to infer its terms.
What should I check: map the shift from arrival to handoff?
Imagine an occasional inpatient shift offered around your main schedule. Ask when responsibility begins: receiving handoff, checking results, attending a briefing or starting patient encounters. Identify who receives unresolved issues when the shift ends and who can be contacted later. This hypothetical example illustrates an agreement review; it does not describe a current opening. The purpose is to uncover responsibilities that a calendar block cannot show.
Does this guide establish an available opening?
No. Check an actual listing and confirm its requirements with the hiring organization; this educational page does not promise an opening.
Does an occupational wage establish a side-gig rate?
No. Employee occupational wages are source context, not a quote for contractor work or an individual shift. Review the actual written agreement.
Sources and scope
- AMA: Physician credentialing preparation guide
- IRS: Independent contractor or employee
- AMA: Understanding tail insurance
- ABMS: Specialty and subspecialty certificates
- FSMB: Contact a state medical board
General information, not legal, tax or insurance advice. Confirm details with the source and with your state board, employer or insurer.