Hiring a Locums Physician for Your Private Practice
Maintaining steady operations is one of the more underrated challenges of independent practice ownership, as most private practices deal with staffing issues at some point. One solution that you may find yourself considering when you’re particularly short staffed is whether it makes sense to hire a locums physician to provide coverage so that you can maintain availability for your patient panel and not leave revenue on the table. That said, bringing in an outside physician, even temporarily, comes with its own set of logistics: credentialing timelines, contract terms, cost structures, and getting your staff and patients comfortable with someone new. We've seen practice owners in our physician communities have very different experiences with locums, from smooth, low-drama coverage to frustrating mismatches in expectations. The big takeaway is that a little upfront diligence goes a long way. Below, we'll cover what hiring a locum tenens physician actually involves, the pros and cons from the practice owner's side, and what you should know before signing an agreement with a locums company.
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When does hiring a locums physician to provide coverage for your practice make sense?
"Locum tenens" literally means "to hold the place" in Latin, and that’s exactly how most private practices use these physicians. Generally speaking, hiring a locums physician long term doesn’t make sense. For long term needs in a private practice, you’re most likely going to want physicians that can build relationships with your patients and referring clinicians, who understand the systems and don’t need to be trained in practice operations, and who are incentivized to generate as much revenue as possible.
That said, especially with physician shortages amplifying and healthcare utilization skyrocketing, practices are increasingly finding themselves short staffed or running at max capacity. This means that in small to mid size practices, even temporary absences such as maternity or paternity leaves, an extended vacation, or an unexpected diagnosis or injury can really hamper the ability of a practice to operate normally or generate the revenue needed. Throw in a more complicated situation like a retirement or a doctor leaving before a replacement physician is hired, and impact on the financial stability of the practice compounds.
If the other physicians in the practice can not (or will not) cover by working extra, the practice may find itself in a situation where they need a solution. It doesn’t make sense to hire another physician if it’s a short term problem, and even if it’s a long term problem, it may take time to find, hire, and onboard the right fit.
As such, many private practices in this situation have turned to contracting locums agencies or physicians. Coverage arrangements can range from a few shifts to several months, and may consist of using one physician or different physicians.
PSG Resource: Our Physician Side Gigs job board allows you to publicize locums openings at your practice at a low cost, if you’re willing to hire directly. We publicize these opportunities to our online communities as well as through our weekly newsletter. Click on the link for more information.
Pros of hiring a locum tenens doctor for your practice
Physicians can take real time off without worrying about continuity of care or absorbing all the costs of overhead
A locum lets you or other doctors step away for parental leave, illness, caregiving, or simply a vacation without pausing patient care or (at least some of) your revenue streams. For solo and small-group practices in particular, this can be the difference between actually disconnecting and feeling tethered to the office the entire time you're supposedly away, or feeling like you have to cut short your time off to get back right away.
You get a flexible staffing solution for unplanned coverage gaps or times of increased volume
Locums aren't just for planned time off. They're also a practical bridge when a physician departs unexpectedly, when recruiting for a permanent role is taking longer than hoped, or when patient volume temporarily outpaces your existing staff's capacity. For example, certain seasons in certain specialties may be busier than others or have more vacation requests, but hiring a year round physician to cover those times may not make sense.
Patients keep access to care and continuity is preserved
Rather than sending patients elsewhere or canceling weeks of appointments, a locum allows your practice to keep seeing patients, refilling medications, and following up on chronic conditions while you work diligently towards hiring a physician.
You can "trial" a potential long-term hire
Some practices use locum arrangements as an extended working interview, bringing in a physician on a temporary basis before offering (or being offered) a permanent position. This lets both sides get a real feel for fit before committing.
Agencies can handle much of the administrative lift and allow you to focus on your own practice and keep your routine
It can be very disruptive to your own routine or preferred practice patterns to have to cover for somebody being out, even if you can technically do it. Reputable locum agencies typically manage sourcing, initial vetting, malpractice coverage, and logistics like travel and lodging, which can significantly reduce the burden on your practice while allowing you to maintain your status quo.
Potential cons and risks of hiring a locum tenens physician
Credentialing and licensing timelines can catch you off guard
Depending on the scenario, you may find that credentialing, privileging, and payer enrollment take longer to fill a gap than the notice you have that you’ll be short staffed. Planning several months ahead, where possible, makes a big difference, but that’s just not always the case when a physician falls ill or quits suddenly.
Fit isn't guaranteed
A locum may be highly competent clinically and still be a mismatch for your practice's workflow, culture, or patient population. Personality and communication style matter, especially in a small practice where staff and patients interact closely with whoever is in the exam room.
Costs can add up, especially on short notice
Urgent, last-minute placements tend to command a premium, and travel or lodging costs can increase the total price tag beyond what a longer, planned engagement would cost.
Staff and patients need time to adjust
Even a great locum will do some things differently than you do. Staff may need to spend real time getting the locum up to speed on your systems and preferences, and some patients may be hesitant to see someone unfamiliar, at least at first.
Quality and reliability vary by agency and individual
Just as with any contractor relationship, experiences with locum agencies and individual locum physicians can vary considerably. Some practice owners report excellent, low-drama placements, while others describe mismatched expectations, communication issues, or last-minute cancellations.
Run the business case for hiring a doctor via a locum tenens arrangement before you embark on the process
Before making the decision to go forward with finding a locum tenens physician for your practice’s needs, you’ll want to do a few things.
Quantify exactly what coverage you need: days/hours and skillsets
Decide exactly what you want the physician to do: expected patient volume, procedures or office visits (or both), new patients versus established patients, after hours coverage, refills and inbox management/coverage, reviewing results, prior authorizations, APP supervision, etc
Run calculations to ensure that a locums physician will generate enough revenue to justify the cost (remember, it’s not just about the hourly rate, but also all the costs below
Ensure that the administrative hassles involved make sense for short term needs
How much does it cost to hire a locum tenens?
Cost varies widely by specialty, geography, urgency, and whether you go through an agency or a more independent arrangement. Agency placements typically bundle the physician's daily or hourly rate with the agency's fee, and many agencies also cover travel, lodging, and malpractice insurance as part of the package. If you’re not paying a locums agency, you’ll likely be able to get a far better hourly rate, but you’ll be responsible for the costs of housing, travel, credentialing, licensing, etc as well as malpractice, and these costs can add up quickly.
It's worth comparing the full cost of a locum against the cost of the alternative, which is usually lost revenue, overtime for existing staff, or patients seeking care elsewhere during a coverage gap. Many practice owners find that when framed that way, the cost of a well-matched locum is easier to evaluate.
How should you structure compensation?
There are many possibilities depending on your preference and that of the physician you’re bringing in. Common arrangements include hourly rates, daily/per diem rates, shift rates, a flat fee for a gig, agency rate + expenses, and a direct contract with the physician with specialized terms.
If you’re hiring through an agency, make sure you ask for a breakdown of the physician compensation, agency markup/fee, travel and lodging and other expenses such as a per diem or meals budgets, malpractice, credentialing, and other services.
Determine what you’re paying for
You’ll want to understand what the above payments include, or if they’re just a baseline for the scheduled hours. Usually, it makes sense to negotiate a buffer or conditions for extra hours if needed and/or a daily minimum. You’ll also want to clarify what happens with cancellations, no shows, extra hours, nights/weekends/holiday coverage, and extra hours beyond contracted hours.
What does hiring a locum tenens actually involve on the administrative side?
For a practice owner, bringing on a locum is closer to a compressed hiring and onboarding process than simply "borrowing" a colleague for a few weeks. Depending on your state and specialty, you'll typically need to manage:
Credentialing and privileging, which can take anywhere from a few weeks to a few months depending on the facility and payers involved
Malpractice coverage confirmation, either through the locum's agency or your own policy - you’ll want to know any coverage limits, occurrence versus claims made, who pays for tail coverage if applicable, and if the policy covers every service/location you need the physician to provide coverage for
Licensing verification in your state, including any temporary or expedited licensure options
DEA registration if applicable
EHR and system access, plus a plan for how much on-the-job training your staff will need to provide
Payer enrollment or billing arrangements, since some payers require their own credentialing steps before a substitute physician can bill under your practice (ensure you know whose NPI will be used for claims submissions, if you can bill their services with your existing contracts, if "incident-to" billing is okay or if a physician needs to bill under their own credentials, and who handles coding and documentation
Hospital privileges if relevant
Background checks, references, malpractice history, & verification of training/education
Because several of these steps have long lead times, most practice owners find that the timeline is the biggest constraint. Locums placed on short notice for an unplanned absence often move faster through abbreviated credentialing, while planned leaves benefit from starting the process months in advance.
Decide about direct hiring versus going through a locums company or staffing agency
There are so many ways to approach hiring, but broadly speaking, most locums will be employed or contracted directly by your practice, or by a locums company employing a physician and contracting your practice. The distinction matters, because it affects taxes, benefits, liability, termination, credentialing, compensation, and more. It will also affect how you can deal with any potential issues that might arise during the course of the assignment. Using a locums agency may expose you to a wider talent pool than you may organically have via your network, so many practices use locums companies for practical purposes.
PSG Resource: If you want to hire a locums hire directly for your private practice, we do publish locums opportunities through our weekly newsletter and job board without taking cuts on the hourly rate. See more information here.
What to look for before signing a locum tenens agreement
Vet the agency, not just the physician
Ask how the agency screens and credentials its physicians, how quickly they can place someone if your timeline is tight, and whether they carry (or require) malpractice coverage. Request a sample contract and read it closely before you're under time pressure to sign.
Confirm your own malpractice coverage
Talk to your medical professional liability carrier before finalizing a locum arrangement. Coverage requirements and gaps can vary by state and by carrier, and you'll want to know upfront whether the locum needs their own policy, needs to be added to yours, or is covered through the agency.
Put expectations in writing
Spell out schedule, call responsibilities, patient volume expectations, documentation standards, and how urgent issues should be handled while you're away. A clear, specific agreement reduces the odds of a mismatch mid-assignment.
Prepare your staff, not just your systems
Give your team enough notice and context to get comfortable with the transition. Staff buy-in has a real effect on how smoothly a locum's tenure goes, since they're the ones training the locum on daily workflows and fielding day-to-day questions.
Ask locum candidates about their own priorities
Locums take these assignments for a range of reasons: travel, flexibility, semi-retirement, or testing out a practice before committing longer term. Understanding what a candidate is looking for can help you gauge whether the assignment, and your practice, is a good match for them too.
Conclusion
Hiring a locum tenens can give practice owners something that's genuinely hard to come by in independent practice: the ability to step away, whether for a planned leave or an unplanned gap, without sacrificing patient continuity or revenue. It also comes with real logistics to manage, including credentialing timelines, cost considerations, and the work of getting your staff and patients comfortable with someone new.
The experience tends to hinge on the individual match between your practice and the locum, so it's worth investing time upfront: vet the agency, confirm your coverage, put expectations in writing, and give your team the context they need to support the transition. Done well, a locum tenens arrangement can let you take the time off you need while keeping your practice running smoothly in your absence.
Related resources for physicians
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