How much do locum tenens physicians earn in 2026?

Locum rates in 2026 vary widely by specialty, geography, urgency, and shift type. Broad ranges from agency rate sheets and physician-finance survey data: hospitalists $140–$220/hr, emergency medicine $200–$350/hr, anesthesiology $250–$450/hr, psychiatry $180–$280/hr, primary care $100–$170/hr, surgical subspecialties $250–$600/hr. Premium 'crisis' coverage at rural sites can run 2–3x baseline. These are gross 1099 rates — you owe self-employment tax, benefits, and unreimbursed expenses on top.

Is locum tenens worth it for a physician?

It depends on your goals. Locum is most clearly worth it if you want (a) supplemental income on top of a W-2 attending job, (b) flexibility during a major life transition — relocation, partner career move, child care, parental illness, (c) geographic arbitrage to high-paying rural and underserved markets, or (d) a 'try before you buy' look at a hospital before signing a long-term contract. It is less clearly worth it if you value retirement-benefit accumulation through an employer 401k match, ACA-employer-mandate health coverage, or a predictable W-2 schedule.

How do locum tenens taxes work?

Locum physicians are nearly always 1099 independent contractors. That means you owe the full 15.3% self-employment tax (employer half plus employee half) on top of federal and state income tax, you have no employer 401k or health insurance, you are responsible for quarterly estimated taxes, and you can deduct ordinary-and-necessary business expenses (license fees, CME, travel between assignments, professional dues, malpractice tail if you pay it). Many locum physicians elect to form an S-Corp or LLC taxed as S-Corp once locum income exceeds roughly $80–$120K/yr to reduce SE tax — talk to a physician-focused CPA before you do.

Who pays for malpractice on locum assignments?

The locum agency or the contracting hospital almost always provides primary malpractice coverage during the assignment — that's standard and you should not accept any contract that doesn't. The question to ask is whether the policy is occurrence-based (covers acts during the policy period regardless of when claims are filed — preferred) or claims-made (requires a separate 'tail' policy to cover later-filed claims — risky unless tail is included). The other question: does the agency provide tail at no cost, or are you on the hook if you leave?

How long does locum credentialing take?

Plan on 60–120 days for new hospital credentialing from a cold start, occasionally shorter for an emergency-coverage need with an agency that maintains pre-credentialed rosters. State licensure is a separate timeline — most states are 4–12 weeks, a handful (California, Texas, Florida) routinely run 4–6 months. The Interstate Medical Licensure Compact has cut this dramatically for eligible physicians — typically 2–3 weeks for a Compact-issued license.

Home / Blog / Locum Tenens for Physicians 2026

Locum Tenens for Physicians in 2026: A Complete Guide to Pay, Taxes, Agencies & Tradeoffs

📅 Last updated: May 25, 2026 · ⏱ 14 min read · ✍️ MD Passive Income Team — written for physicians

Physician audience & disclosure. MD Passive Income is written for medical doctors — attendings, fellows, and residents — evaluating financial decisions specific to physician life. This is not the same publication as passiveincomemd.com. Nothing here is individualized financial, tax, or legal advice. Locum tenens contracts, tax structure, and malpractice coverage are highly individual decisions; pair this primer with a fee-only fiduciary, a physician-focused CPA, and a licensed attorney before you sign anything. This article may contain affiliate links to physician-finance and insurance partners; they do not influence editorial selection.

The short answer for busy physicians

Locum tenens — short-term physician staffing — is in 2026 the highest-paid and most flexible labor arrangement available to a board-eligible or board-certified physician. Gross hourly rates from $100/hr (primary care) to $600/hr (in-demand surgical subspecialties) sit well above W-2 hourly equivalents in most markets, and assignments can run anywhere from a single shift to year-long contracts. The trade-off is real: you are a 1099 contractor, you owe self-employment tax, you have no employer benefits, and your retirement contribution responsibility shifts entirely to you. For attendings layering locum on top of a W-2 base, the math is almost always favorable. For physicians considering locum as a primary career, the picture is more nuanced and benefits-driven.

How locum tenens works

A locum agency holds contracts with hospitals, clinics, and groups that have temporary coverage needs — a partner on parental leave, a planned vacation, an unfilled position pending a permanent hire, or a rural hospital that cannot recruit. The agency maintains a roster of credentialed physicians and matches them to coverage gaps. The agency pays you a 1099 hourly or daily rate, marks up that rate, and bills the client facility. Travel, lodging, ground transport, and primary malpractice are typically provided by the agency at no cost to you — this should be in the written contract before any verbal commitment.

Assignment length ranges from one weekend of call to multi-month contracts. Most agencies will accept "locum-tens-of-thousands" supplemental work — a few weekends a quarter — as readily as full-time travel work, and physicians do best when they choose a lane early: pure supplemental, pure travel, or hybrid.

Pay rates by specialty (2026 ranges)

The numbers below are gross 1099 hourly rates compiled from public agency rate sheets, physician-finance survey data, and reported assignment offers in 2026. Wide bands reflect huge geographic and urgency variation — a rural Mountain West site with a 72-hour-notice coverage gap will pay 2–3x the same specialty in a saturated metro.

Hospitalist: $140–$220/hr ($1,700–$2,600/12-hr shift).
Emergency medicine: $200–$350/hr.
Anesthesiology: $250–$450/hr.
Psychiatry (inpatient or telepsychiatry): $180–$280/hr.
Primary care (FM, IM, peds outpatient): $100–$170/hr.
OB/GYN: $200–$380/hr.
Radiology (teleradiology): $150–$320/hr or per-study.
Surgical subspecialties (neuro, ortho-trauma, cardiothoracic): $250–$600/hr plus call premiums.

What these numbers do not include: 15.3% self-employment tax on the first $168,600 of net earnings (2024 threshold; the 2026 figure is indexed), employer-paid health insurance, employer 401k match, paid time off, and CME stipend. To compare apples to apples with a W-2 attending base, multiply the gross hourly by roughly 0.65–0.75 to get a rough "W-2 equivalent" — and that's before you factor in unreimbursed CME, license renewals, board fees, and disability premium.

1099 taxes: what physicians need to know

The single most consequential financial fact about locum work: you are a 1099 independent contractor in nearly every case. The tax mechanics that change as a result:

Self-employment tax. You owe both halves of FICA — 15.3% on net earnings up to the Social Security wage base, then 2.9% Medicare (plus 0.9% Additional Medicare above $200K single / $250K married) on every additional dollar. Half of SE tax is an above-the-line deduction.
Quarterly estimated taxes. No employer is withholding. You are responsible for quarterly payments to the IRS (and most state taxing authorities) — miss them and you owe underpayment penalties.
Solo 401k. One of the strongest tax shelters available to a 1099 physician. In 2026 you can defer up to $23,500 as employee plus an employer profit-sharing contribution up to a combined $70,000 limit (subject to net earnings). Most physician CPAs strongly favor a solo 401k over a SEP-IRA for the backdoor-Roth-friendly accounting and the higher effective contribution room.
S-Corp election. Once locum net income exceeds roughly $80K–$120K/yr, an LLC taxed as S-Corp often reduces SE tax by paying you a reasonable W-2 salary and distributing the rest as K-1 income not subject to SE tax. Run this with a physician-focused CPA — the "reasonable salary" determination is audit-sensitive.
Deductibles you'll actually use. State medical license fees, DEA fees, board renewals, CME registrations and travel, professional dues, malpractice tail if you pay it, dedicated home-office space if applicable, and travel between assignments (not the airfare an agency pays for you — the agency-paid leg is not your expense).

Malpractice — the question to ask

Standard locum contracts include the agency or facility paying for primary malpractice coverage during the assignment. The question that matters: is the policy occurrence-based or claims-made? Occurrence policies cover any act during the policy period regardless of when the claim is later filed — once you're covered, you stay covered. Claims-made policies cover only claims filed while the policy is active — leave the agency, and you need a "tail" policy (also called extended reporting endorsement) to cover claims filed after your departure. Tail can run $5,000–$50,000+ for a physician with several years of work in a state. Get tail responsibility in writing before signing the assignment. The default offer at most reputable agencies in 2026 is occurrence coverage, or claims-made with agency-paid tail — accept nothing less.

Credentialing & licensure

Two clocks run in parallel: state medical license and hospital credentialing. State licensure varies wildly — most states are 4–12 weeks, California / Texas / Florida routinely run 4–6 months, the Interstate Medical Licensure Compact has cut Compact-issued licenses to 2–3 weeks for eligible physicians (board-certified, no malpractice history, primary state participates). Hospital credentialing on top of an active license is typically 60–120 days from a cold start, sometimes faster if the agency holds a pre-credentialed roster at that hospital.

If you're planning a locum career: get a Compact license early; let your agency know which other states you'll work in so they can start parallel applications; and keep your credentialing packet (current CV, NPDB query, references, exam scores, training verification) in a single shared folder you can hand to a new credentialer in an afternoon.

The major agencies in 2026

The locum staffing industry consolidated heavily in the 2020s. The five names physicians encounter most often:

CompHealth — broadest specialty coverage, largest internal recruiter team.
Weatherby Healthcare — sister company to CompHealth under CHG Healthcare, similar quality.
Locum Tenens.com — also CHG Healthcare; positioned at lower-friction marketplace experience.
Barton Associates — strong primary-care and advanced-practice presence.
Vista Staffing — emergency medicine, hospitalist, anesthesia specialty.

The practical advice from physicians who have worked locum: register with at least three agencies, accept assignments only after reading the written contract end-to-end, and verify everything verbal in writing — including the rate, tail policy, lodging, and what happens if the facility cancels the assignment before you arrive.

Pros & cons summary

Pros: Higher gross hourly rate than W-2; geographic flexibility; "try before you buy" before signing a permanent contract; supplemental income that compounds quickly into investment accounts; ability to pause without negotiating sabbatical with an employer.

Cons: No employer benefits (you buy your own health insurance, disability, retirement); SE tax bite; quarterly estimated-tax discipline; credentialing delays between assignments; no PSLF — locum income is not qualifying employment for Public Service Loan Forgiveness; some practice-pattern erosion if you work a narrow case mix.

Decision framework for residents and attendings

If you are a senior resident or fellow: consider a locum-heavy first year out of training only if (a) you have a clear personal reason to avoid commitment (relocating spouse, geographic uncertainty, family caregiving) and (b) you have a written plan to fund your own disability, life, and retirement coverage from day one. Own-occupation disability insurance is non-negotiable.

If you are a W-2 attending considering supplemental locum: the math almost always works. Add up the gross hourly, subtract roughly 35–40% for combined federal, SE, and state tax (assuming your day-job income already puts you in a high bracket), and the net is still well above what an extra shift at your primary job would pay. Stack it into a solo 401k.

If you are evaluating locum as a permanent career: model a full-year P&L including your own health insurance ($800–$2,000/mo for a family at your age), disability premium, life premium, malpractice tail risk, and retirement self-funding. The number you care about is take-home after benefits and tax, not gross hourly. A physician-focused CPA familiar with locum work can build this in an hour.

Frequently asked questions

How much do locum tenens physicians earn?

Specialty-dependent, $100–$600/hr gross 1099 in 2026. Premium crisis coverage runs 2–3x baseline.

Is locum tenens worth it?

Clearly yes for supplemental income on top of W-2, life-transition flexibility, geographic arbitrage, or "try before you buy" hospital evaluation. Mixed picture as a primary career — depends on benefits and retirement self-funding discipline.

How do locum taxes work?

1099 contractor; 15.3% SE tax; quarterly estimated payments; solo 401k available; S-Corp election common above $80–$120K net.

Who pays malpractice?

Agency or facility, almost always. Confirm occurrence-based or agency-paid tail in writing.

How long does credentialing take?

60–120 days hospital from cold start; 2 weeks to 6 months state license depending on state.