Question 1

How much do locum tenens physicians earn per hour?

Accepted Answer

Locum tenens physicians typically earn $150–$350/hour depending on specialty, geographic location, and shift type. Emergency medicine and hospitalist shifts commonly pay $200–$300/hour. Primary care and family medicine range from $150–$220/hour. Psychiatry locums often command $200–$300/hour due to chronic shortage. Rural, critical access, and frontier sites typically add a 10–30% premium over comparable urban rates. Your agency takes a margin of roughly 20–35% on top of your rate, so always negotiate your W-2 or 1099 rate directly.

Question 2

How do locum tenens 1099 taxes work and how much should I set aside?

Accepted Answer

Most locum physicians are paid as 1099 independent contractors, meaning no taxes are withheld. You owe self-employment tax (15.3% on the first $168,600 of net earnings in 2024, 2.9% above that) plus federal income tax. A safe target is setting aside 30–35% of gross locum income. Key deductions: mileage ($0.67/mile in 2024), home office, medical licensing fees, DEA registration, CME costs, professional dues, stethoscopes and medical equipment, and health insurance premiums. Max out a SEP-IRA (up to 25% of net self-employment income, max $69,000 in 2024) or solo 401(k) to dramatically reduce your taxable income. Pay quarterly estimated taxes by April 15, June 15, September 15, and January 15 to avoid IRS penalties.

Question 3

Does my locum tenens agency provide malpractice insurance and do I need tail coverage?

Accepted Answer

Most established locum tenens agencies provide malpractice coverage during your assignment, either occurrence-based or claims-made. Occurrence policies cover any incident that happened during the policy period regardless of when the claim is filed — no tail needed. Claims-made policies only cover claims filed while the policy is active, so a tail policy is required when coverage ends. Confirm before signing: (1) what type of coverage the agency provides, (2) whether they purchase tail coverage automatically when your contract ends, and (3) the per-occurrence and aggregate limits (typically $1M/$3M or $2M/$6M). If you work with multiple agencies or take independent contracts, purchase your own occurrence-based policy. Tail coverage for a claims-made policy typically costs 1.5–2× the annual premium.

Question 4

How long does hospital credentialing take for locum tenens physicians?

Accepted Answer

Hospital privileging and credentialing for locum physicians typically takes 60–120 days from application submission. The process involves primary source verification of your medical license, DEA registration, board certification, training, and malpractice history. Start the credentialing process immediately after signing your contract — delays in submitting paperwork push your start date. Most agencies have a credentialing team that manages the process; your job is to respond to document requests within 24–48 hours. If you need a new state medical license, standard processing takes 4–12 weeks depending on the state. The Interstate Medical Licensure Compact (IMLC) allows physicians to obtain licenses in 40+ member states through a streamlined process, typically 30–60 days per additional state.

Question 5

How long are locum tenens contracts and can I choose assignment length?

Accepted Answer

Locum tenens contract lengths range from single shifts to 12+ month engagements. Most assignments run 4–13 weeks. Short-term fills (1–4 weeks) typically pay a higher per-shift rate but require more travel and offer no housing stability. Mid-length contracts (6–13 weeks) are the most common and often include furnished housing, round-trip travel, and a competitive daily or hourly rate. Long-term contracts (3–12 months) offer the most stability and sometimes include a monthly housing stipend that you can profit from by finding cheaper housing than what the agency budgets. You negotiate length directly — agencies always prefer longer commitments, giving you leverage. Most physicians work with 2–3 agencies simultaneously to keep their calendars full and compare rates across assignments.

Question 6

What is the Interstate Medical Licensure Compact (IMLC) and should I use it?

Accepted Answer

The Interstate Medical Licensure Compact (IMLC) is an agreement among 40+ states that allows eligible physicians to obtain medical licenses in multiple member states through a single streamlined application. To qualify, you must designate a State of Principal License (SPL) where you are licensed, primarily reside or practice, and pay income tax. IMLC licenses typically take 30–60 days per state and cost $700–$1,000 per state depending on the state's fee. It is highly recommended for locum physicians who want flexibility across multiple states — the traditional licensing process takes 3–6 months per state. States not yet in the compact (including California) require a separate standard application.

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