What is locum tenens? Meaning, how it works, and how locum pay is set
Locum tenens is temporary clinical coverage, usually by a physician or advanced practice provider, filling in for a role that is vacant or whose holder is away. The clinician works at the facility for days, weeks or months, then moves on. Most locum work is arranged by a locum tenens agency, and most locum physicians work as independent contractors.
This guide covers what the term means, who works locums, how an assignment actually comes together, and how locum pay and bill rates are structured.
Locum tenens meaning
The phrase is Latin for “to hold the place” (literally, one holding a place). A locum tenens clinician holds someone else's place: they cover a schedule that would otherwise go unstaffed. In practice people shorten it to “locums,” and a clinician on assignment is “a locum” or “doing locums.”
Who works locums:
- Physicians across most specialties, from hospital medicine, emergency medicine and anesthesiology to psychiatry, radiology and surgical specialties.
- Nurse practitioners and physician assistants (APPs), in primary care, urgent care, hospital medicine, behavioral health and specialty clinics. “Locum tenens nurse practitioner” roles let an NP try a new state or setting without a permanent commitment, subject to that state's practice and collaboration rules.
- CRNAs (certified registered nurse anesthetists), often alongside locum anesthesiologists to keep operating rooms running.
Registered nurses on temporary contracts are usually called travel nurses, not locums. The distinction matters because the two work under different employment models, covered below.
Why facilities use locum tenens
- Vacancies. Recruiting a permanent physician can take many months. Locums keep the service line open in the meantime.
- Leave. Parental leave, medical leave, sabbaticals and vacation all leave schedule gaps.
- Rural and underserved coverage. Smaller hospitals and clinics that can't support a full permanent group use locums for ongoing or recurring coverage.
- Volume spikes. Seasonal census, a new service line or a backlog of procedures can outrun the permanent team.
- Recruitment gaps and transitions. When a group dissolves, a contract changes hands or a key physician leaves suddenly, locums bridge the gap and protect revenue.
For a facility the cost comparison is not locum rate vs permanent salary. It is locum cost vs the revenue lost, the diversions and the burnout of the remaining team if the schedule goes uncovered.
How a locum tenens assignment works
- The agency
- A locum tenens company contracts with the facility, sources the clinician, and manages the assignment. Facilities often work with several agencies, sometimes through an MSP or VMS (see MSP vs VMS).
- Credentialing and privileging
- The agency gathers and verifies education, training, board certification, work history and references. The facility's medical staff office then grants privileges. This is usually the slowest step, and it can take weeks to months.
- Licensing
- The clinician needs an active license in the state where they practice, plus DEA registration where relevant. The Interstate Medical Licensure Compact speeds up physician licensing in participating states. Agencies often help with, and pay for, new state licenses.
- Malpractice coverage
- Typically provided by the agency for the assignment, including tail coverage if the policy is claims-made. Clinicians should confirm the policy type and limits before signing.
- Travel and housing
- For out-of-area assignments, the agency usually books and pays for flights, lodging and a rental car.
Locum tenens 1099 vs W-2
Most locum physicians work as 1099 independent contractors. The agency pays a gross rate with no tax withholding. The clinician pays self-employment tax, funds their own health insurance and retirement, and can deduct eligible business expenses. Some agencies place NPs, PAs and CRNAs on W-2 instead, depending on the agency, the state and the setting.
Travel nurses are the contrast. They are usually W-2 employees of the agency, with a taxable hourly base plus non-taxable housing and meals stipends when they qualify. That structure is explained in the travel nurse pay breakdown. To compare a 1099 locum rate with a W-2 offer after self-employment tax and benefits, use the 1099 vs W-2 calculator.
Worker classification and tax treatment depend on your individual situation and state law. This is a general explanation, not tax or legal advice.
How locum pay and bill rates are structured
Locum pay is quoted in a few common ways:
- Daily rate. A flat amount per day or shift, common in hospital medicine and outpatient work.
- Hourly rate. Common in emergency medicine, anesthesia and APP roles, often with overtime above a set number of hours.
- Shift rate. A fixed amount per 12- or 24-hour shift.
- Call pay. A stipend for each call period, plus an hourly rate if called back in.
The facility pays the agency a bill rate. It has to cover the clinician's rate, malpractice insurance, travel and housing, licensing and credentialing costs, and the agency's margin. Illustrative: a generic physician assignment, 10-hour days. The figures show structure only, not market rates for any specialty.
| Line item | $/hr | What it is |
|---|---|---|
| Bill rate | $260.00 | Paid by the facility |
| Clinician rate (1099) | $190.00 | $1,900 per 10-hour day, no employer payroll tax |
| Malpractice | $15.00 | Assignment coverage, including tail |
| Travel and housing | $12.00 | Flights, lodging, rental car |
| Licensing and credentialing | $5.00 | Spread over the assignment's hours |
| Agency gross margin | $38.00 | 14.6% of the bill rate |
Two things change this math in practice. Short assignments carry the same credentialing and licensing cost over far fewer hours. And malpractice cost varies sharply by specialty, so a procedural or obstetric assignment carries a much larger insurance line. For the general mechanics of spreads and margins, see bill rate vs pay rate.
Locum tenens vs travel nursing vs permanent roles
| Locum tenens | Travel nursing | Permanent | |
|---|---|---|---|
| Typical clinicians | Physicians, NPs, PAs, CRNAs | RNs, plus allied travelers | All |
| Employment | Usually 1099 contractor | Usually W-2 agency employee | W-2 facility or group employee |
| Pay structure | Daily, hourly or shift rate, plus call | Taxable base plus housing and M&IE stipends | Salary or productivity model plus benefits |
| Length | A few days to many months, often recurring | Commonly 13 weeks | Ongoing |
| Malpractice | Usually provided by the agency | Facility and agency liability coverage | Provided by employer |
| Benefits | Clinician funds their own | Agency benefits, often optional | Full employer benefits |
| Main friction | Licensing and privileging lead time | Compact licensing helps, onboarding per facility | Recruiting time and cost |
Pros and cons for clinicians and facilities
For clinicians
- Pros: control over schedule and location, higher gross pay than many permanent roles, less committee and administrative work, a way to try a practice before joining it.
- Cons: no employer benefits, self-employment tax and quarterly estimates, repeated credentialing paperwork, time away from home, less continuity with patients and colleagues.
For facilities
- Pros: fast coverage for gaps, protected service-line revenue, flexibility to scale with volume, a bridge while recruiting permanently.
- Cons: higher hourly cost, credentialing workload for the medical staff office, onboarding and continuity challenges, and reliance on a temporary workforce if permanent recruiting stalls.
Why locum pay varies by specialty and geography
People search for “locum tenens salary by specialty” because the spread between specialties is wide. The drivers are consistent even when the numbers move:
- Supply and demand. Specialties with national shortages and long permanent recruiting cycles command the highest locum rates.
- Call burden. Assignments with heavy overnight or weekend call pay more, and call pay is often a large share of the total.
- Procedural work and malpractice. Higher insurance cost and procedural skill raise both the bill rate and the clinician rate.
- Location. Rural and hard-to-reach sites often pay more to attract coverage, as do states with slow licensing.
- Notice and length. Last-minute and very short assignments carry premiums. Long, predictable assignments often trade rate for stability.
Published figures go stale quickly, and permanent compensation surveys (see ClinicalRate vs MGMA) don't describe the locum market. For current rates by role, state and metro, including physician and APP roles, use the ClinicalRate Rate Explorer.
Frequently asked questions
What does locum tenens mean?
Locum tenens is Latin for “to hold the place.” In healthcare it means a clinician, usually a physician, nurse practitioner, physician assistant or CRNA, who temporarily fills a role that is vacant or whose holder is away.
Are locum tenens physicians employees or contractors?
Most locum physicians work as 1099 independent contractors, paying self-employment tax and funding their own benefits. Some agencies place NPs, PAs and CRNAs on W-2. Travel nurses, by contrast, are usually W-2 employees of their agency.
Who pays for malpractice insurance on a locum assignment?
The locum tenens agency typically provides malpractice coverage for the assignment, including tail coverage when the policy is claims-made. Clinicians should confirm the policy type and limits before accepting an assignment.
How are locum tenens rates structured?
Clinicians are usually paid a daily, hourly or shift rate, plus call pay. The facility pays the agency a higher bill rate that also covers malpractice insurance, travel and housing, licensing and credentialing, and the agency’s margin.
Can nurse practitioners work locum tenens?
Yes. Nurse practitioners and physician assistants work locum assignments in primary care, urgent care, hospital medicine, behavioral health and specialty clinics. They need a license in the state of the assignment and must meet any state collaboration or supervision rules.
Why does locum pay vary so much by specialty?
Locum rates track supply and demand, call burden, procedural work and malpractice cost, location, and how much notice the facility gives. Specialties with national shortages and heavy call usually pay the most.