Locum tenens work has become one of the most talked-about paths in American medicine. Hospitals need coverage fast. Clinics have open shifts they can’t fill. Doctors, nurse practitioners, and physician assistants want more control over their schedule and their paychecks. A healthcare staffing agency usually sits in the middle of this arrangement, matching providers to open assignments and handling the pay, the paperwork, and the credentialing.
But most providers still have basic questions. How does locum tenens pay actually work? Is it hourly or salaried? Can every specialty legally take locum assignments? This guide answers all of that in plain language, with real 2026 numbers and the legal details other guides skip.
What Is Locum Tenens Pay and How Is It Structured?
Locum tenens is a Latin term that means “to hold the place of.” It describes a temporary medical assignment where a provider fills in for a permanent staff member, or covers a gap a facility can’t fill on its own.
Locum tenens pay works differently than a normal job salary. Here’s the core structure:
- Providers get paid per hour, per day, or per shift worked—not a fixed yearly salary.
- Most locum tenens physicians, nurse practitioners, and physician assistants work as 1099 independent contractors, not W-2 employees.
- A staffing agency contracts with the facility, then pays the provider directly, usually through weekly direct deposit.
- Pay applies to scheduled clinical hours. Time spent on charting after a shift, unpaid call, or admin work is often not billed unless the contract says so.
A small number of locum tenens roles, especially longer-term hospital and government positions, use W-2 employment through the staffing agency instead. This changes the tax picture and sometimes limited benefits like paid time off, so it’s worth asking the agency which model a specific job uses before signing.
The Financial Silver Lining: 1099 Tax Write-Offs
Paying a 15.3% self-employment tax on your own can feel scary. But working as a 1099 contractor has a huge upside. You can write off business expenses to lower your taxes. This means you can deduct the cost of travel, housing, meals, and scrubs. You can also deduct licensing fees and medical tools. These write-offs can easily save you $15,000 to $30,000 a year in taxes.
What about working in different states? You will file a tax return in each state where you work. To protect you from being taxed twice, your home state gives you a nonresident state tax credit. This zeroes out the extra cost. Plus, taking jobs in states with no income tax, like Texas or Florida, makes your tax filings very simple.
If you’re new to temporary healthcare staffing, read our guide on What Is the Locum Tenens Staffing Model? to learn how agencies, healthcare facilities, and providers work together.
Hourly vs. Daily vs. Weekly Pay Rates Explained
Pay structure depends on the specialty and the setting.
Hourly pay is the most common model. Most outpatient clinics and specialty assignments in internal medicine, cardiology, and dermatology bill by the clinical hour.
Daily rates show up often in inpatient and procedural work. A hospitalist or surgeon might be paid a flat rate for a 12-hour or 24-hour shift, regardless of patient volume.
Weekly or block rates are common for longer rural and underserved-area contracts, where a provider commits to a set number of consecutive days, such as a 7-on/7-off cardiology or hospitalist schedule.
On top of the base rate, many contracts add:
- Call pay — a stipend for being on-call, even without being called in
- Overtime or extended-shift pay for hours beyond the standard shift
- Weekend and holiday differentials, which can run well above the base hourly rate
Can Every Healthcare Specialty Legally Work Locum Tenens in the U.S.?
This is the part most guides skip, and it matters. Not every provider type gets treated the same way under federal billing rules, and not every practice setting credentials providers the same way.
Physicians (MDs and DOs) can legally work locum tenens in every state and specialty. Every U.S. state requires an active medical license issued by that state’s state medical board, along with a National Provider Identifier (NPI) and, for most facility work, hospital credentialing and privileging through the facility’s medical staff office or a Credentials Verification Organization (CVO).
Medicare has a specific rule for physician locum tenens billing. Under the Centers for Medicare & Medicaid Services (CMS), a regular physician can bill for a substitute physician’s services under a fee-for-time compensation arrangement, commonly still called “locum tenens billing,” using modifier Q6 on the claim. This exception applies for up to 60 continuous days. This CMS provision applies only to physicians, MDs and DOs. Non-physician practitioners such as CRNAs, NPs, and PAs cannot be billed under this fee-for-time or reciprocal billing exception, with one narrow carve-out for physical therapists working in a health professional shortage area.
Nurse practitioners, physician assistants, and CRNAs can absolutely work locum tenens; the industry places thousands of them every year, but they bill Medicare directly under their own NPI, not through the physician substitute-billing exception above. Their ability to practice locum tenens also depends on state scope-of-practice law. Some states allow NPs full practice authority (no physician supervision required), while others require a collaborative or supervisory agreement with a physician. This directly affects which locum assignments an NP can legally accept in a given state, so it’s worth confirming scope-of-practice rules before booking a contract across state lines.
Podiatrists (DPMs) are fully licensed physicians for foot, ankle, and lower-leg care, credentialed through state podiatric medical boards and typically board-certified through the American Board of Foot and Ankle Surgery (ABFAS) or a related board. Podiatrists can and do work locum tenens assignments nationwide, especially covering nursing homes, outpatient clinics, and rural hospital consults.
Behavioral health and psychiatry providers can work locum tenens, but credentialing in behavioral health centers and state psychiatric hospitals often runs through a separate state Department of Mental Health approval process, in addition to standard hospital privileging.
Correctional facility work (state and federal correctional systems, county detention facilities) is legal for physicians, NPs, PAs, and psychiatric providers, but these assignments generally involve additional security clearance and facility-specific orientation beyond standard state licensure. Many correctional health systems also voluntarily follow National Commission on Correctional Health Care (NCCHC) standards, and providers working in NCCHC-accredited facilities must have credentialing documentation that meets those standards.
Outpatient clinics, including Federally Qualified Health Centers (FQHCs), follow HRSA-based credentialing rules in addition to state licensure, which can extend the credentialing timeline compared to a private outpatient practice.
Bottom line: every core physician specialty and most APP roles can legally practice locum tenens somewhere in the U.S. The real variable isn’t “can this specialty do locums”; it’s which billing rule and which credentialing pathway applies to that provider type in that specific setting.
Locum Tenens Salary by Specialty (2026)
Rates change often based on region, demand, and shift type. The ranges below reflect national averages compiled from multiple 2025–2026 industry compensation reports.
| Specialty | Typical Hourly Rate (2026) | Notes |
| Family Medicine | $120 – $145/hr | Steady demand; Monday–Friday clinic schedules are common |
| Internal Medicine | $120 – $150/hr | High assignment volume nationwide |
| Locum tenens hospitalist salary | $150 – $190/hr | Usually paid per 12-hour shift |
| Emergency medicine locums pay | $200 – $300/hr | 12- or 24-hour shifts; strong Southeast/Midwest demand |
| Locum tenens anesthesiology salary | $300 – $400/hr | Among the highest-paid locum specialties |
| Locum tenens cardiology salary | $250 – $350/hr | Invasive cardiology contracts often run shorter and pay higher |
| Critical care locums pay | $270 – $300+/hr | Full-time equivalent often exceeds $500,000/year |
| Psychiatry | $180 – $280/hr | High national shortage keeps demand consistent |
| General Surgery | $250 – $400/hr | Procedural volume drives pay |
| Locum tenens podiatrist daily rate | $1,000 – $1,200/day (roughly $130 – $150/hr) | Common in nursing home rounds and outpatient clinic coverage |
| Nurse Practitioner (locum) | $70 – $110/hr | Varies by state scope-of-practice authority |
| Physician Assistant (locum) | $65 – $115/hr | Surgical PAs with first-assist skills earn more |
| CRNA (locum) | $150 – $250+/hr | Among the highest-paid APP locum roles |
Rates reflect 2025–2026 industry compensation trends, cross-checked against the U.S. Bureau of Labor Statistics’ Occupational Outlook Handbook: Physicians and Surgeons and the MGMA 2026 Provider Compensation Data Report. Actual pay depends on location, facility type, and assignment urgency.
The Highest-Paying States for Locum Tenens (2026)
If maximizing income is your primary goal, where you practice matters as much as your specialty. According to 2026 compensation reports, the top-paying states for locum tenens include:
- Arkansas (128% of the national median): Driven by severe health professional shortage areas (HPSAs) and a highly rural population requiring external talent.
- Ohio (124% of the national median): High demand across both rural Appalachian facilities and urban centers experiencing primary care shortfalls.
- West Virginia (121% of the national median): High rates of chronic illness and facility closures have created urgent coverage needs.
- Missouri (121% of the national median): Rapid closure of rural hospitals has skyrocketed pay premiums to attract emergency and primary care providers.
- Delaware (120% of the national median): Lacks an in-state medical school pipeline, forcing healthcare networks to compete aggressively for out-of-state talent.
The Takeaway: Highly populated states like California and New York have steady job volumes but often pay lower average rates because they do not struggle as much to attract clinicians.
Locum Tenens Pay vs. Permanent Physician Salary
On an hourly basis, locum tenens pay usually beats permanent employed pay for the same specialty. One industry comparison found a permanent internal medicine physician earns close to $96 per hour on average, while a locum internal medicine physician earns closer to $136 per hour for comparable work.
But hourly rate isn’t the full picture:
| Factor | Locum Tenens | Permanent Position |
| Pay structure | Hourly/daily, 1099 contractor | Fixed annual salary, W-2 |
| Health insurance | Not included (self-purchased) | Usually employer-sponsored |
| Retirement match | Not included | Often included (401k match) |
| Paid time off | None (unpaid gaps between contracts) | Standard PTO/sick leave |
| Malpractice coverage | Usually covered by the agency, including tail coverage | Usually covered by the employer |
| Schedule control | High — choose your own contracts | Fixed by the employer |
A provider working a full, steady locum schedule can out-earn a permanent salary. A provider with frequent gaps between assignments may not. It comes down to how consistently a provider works.
How Does the Staffing Agency Make Money?
Some providers worry that staffing agencies “steal” a chunk of their pay. This is not true. Agencies do not take money out of your paycheck. Instead, they charge the healthcare facility a separate fee.
- Your Rate is Your Rate: If your contract says you make $200 an hour, you get exactly $200 an hour.
- The Facility Pays the Extra Fee: The hospital pays the agency your hourly rate, plus a separate service markup. While exact percentages vary by agency and contract, this extra amount is paid entirely by the facility. It covers your malpractice insurance, housing, and travel logistics.
You do not lose money by using an agency. The hospital pays them directly for finding a qualified provider to fill their empty shifts.
How Benefits Factor Into Locum Compensation
The hourly rate is only part of total compensation. Most reputable locum tenens agencies also cover:
- Housing — a stipend or fully furnished short-term housing near the assignment
- Travel — flights, mileage reimbursement, or rental car costs to and from the assignment
- Malpractice insurance, including tail coverage for claims made after the assignment ends
- License and credentialing costs — application fees for new state licenses
- Licensing support, particularly through the Interstate Medical Licensure Compact (IMLC), which speeds up multi-state licensing for physicians in eligible states
When these are added up, the effective value of a locum tenens assignment often runs 15–30% higher than the stated hourly rate alone. To learn about additional career and lifestyle benefits beyond compensation, read our guide on Why Choose Locum Tenens? Key Advantages You Should Know.
Factors That Affect Locum Tenens Pay
Several variables push locum tenens pay up or down:
- Specialty and subspecialty training — procedural and surgical subspecialties consistently pay more than generalist roles
- Geographic location — rural and medically underserved areas typically pay a 10–25% premium over urban markets to attract coverage
- Assignment urgency — last-minute or “STAT” openings often pay above the standard range
- Shift type — nights, weekends, holidays, and call coverage usually carry a pay differential
- Experience and board certification — board-certified providers with a strong track record can negotiate higher rates
- Facility type — government facilities, including VA hospitals and state-run institutions, sometimes pay a premium of roughly 10–20% over private-sector rates
- Assignment length — very short contracts (a weekend, a few days) often pay a premium per hour compared to multi-month contracts
How to Negotiate Your Locum Rate
A few practical steps help providers get a fair rate:
- Know the current market range for the specialty and region before the first call with a recruiter. Use more than one source to check.
- Ask what’s included — housing, travel, and malpractice coverage all have real dollar value. Confirm what’s covered before comparing offers.
- Clarify the pay structure — hourly, daily, or block rate — and whether call time, admin time, or travel days are compensated.
- Leverage flexibility — providers open to short notice, rural locations, or less desirable shifts often unlock higher rates.
- Get it in writing — the agency contract should spell out the rate, the schedule, what’s covered, and the cancellation policy before the assignment starts.
- Compare multiple agencies — rates for the same opening can vary between staffing agencies, since each one negotiates its own margin with the facility.
Final Thoughts
Locum tenens pay is built around flexibility: hourly or daily rates, 1099 contractor status, and benefits that come from the staffing agency rather than a single employer. Nearly every physician specialty, along with NPs, PAs, and CRNAs, can legally take locum assignments the details just shift depending on the billing rules and credentialing pathway for that specific role and setting. Knowing the going rate for a specialty, understanding what’s actually included in an offer, and confirming the legal and credentialing requirements for the setting all make it easier to evaluate whether a locum tenens assignment is worth taking.
Frequently Asked Questions
Is locum tenens pay taxed differently than a regular job?
Yes. Most locum tenens providers are 1099 independent contractors, meaning no taxes are withheld automatically. Providers are responsible for quarterly estimated tax payments and self-employment tax, but they can write off business expenses like travel, clinical tools, and CME to significantly lower their tax bill.
Do locum tenens providers get health insurance?
Not usually through the assignment itself. Most locum providers purchase their own health coverage, though some staffing agencies offer optional group plans.
Can new graduates work locum tenens?
Yes, though most facilities want at least some independent clinical experience or a completed residency/fellowship before offering higher-acuity locum assignments.
Does locum tenens pay vary by state?
Yes. States with provider shortages, higher costs of living, or aggressive recruiting needs often pay more, regardless of specialty.
Sources & References
- Centers for Medicare & Medicaid Services (CMS) / Noridian Healthcare Solutions — [Fee-for-Time Compensation Arrangements and Reciprocal Billing](https://med.noridianmedicare.com/web/jeb/specialties/locum-tenens-and-reciprocal-billing)
- U.S. Bureau of Labor Statistics — [Occupational Outlook Handbook: Podiatrists](https://www.bls.gov/ooh/healthcare/podiatrists.htm)
- U.S. Bureau of Labor Statistics — [Occupational Outlook Handbook: Physicians and Surgeons](https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm)
- U.S. Bureau of Labor Statistics — [Occupational Outlook Handbook: Nurse Practitioners](https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm)
- U.S. Bureau of Labor Statistics — [Occupational Outlook Handbook: Physician Assistants](https://www.bls.gov/ooh/healthcare/physician-assistants.htm)
- Medical Group Management Association (MGMA) — [Provider Compensation Data & Reports](https://www.mgma.com/data)
- National Commission on Correctional Health Care (NCCHC) — [Standards for Health Services](https://www.ncchc.org/standards/)
