About 57,000 physicians, roughly 8% of U.S. doctors, say they currently take locum tenens assignments, according to CHG Healthcare’s 2025 State of Locum Tenens Report. Hospital medicine makes up a big share of that. Medicus estimates that about 13.4% of hospitalists have worked locums at some point.

Demand for hospitalists isn’t slowing down. An aging population means more inpatient care, and many hospitals still can’t hire permanent staff fast enough.

If you’re considering work as a locums hospitalist, this guide covers what the role involves, the real pros and cons, and five tips for getting started on the right foot.

Key Takeaways

About 57,000 U.S. physicians take locum tenens assignments, and hospitalists are among the most requested specialties.
Locums hospitalists fill temporary coverage gaps, most often in community and rural hospitals.
Many locum hospitalist jobs pay roughly $180 to $200 an hour, though advertised rates often bundle in travel and housing stipends.
As a 1099 contractor, you handle your own quarterly taxes, retirement plan, and insurance.
Starting licensing and credentialing early, months before your first shift, prevents most of the delays physicians run into.

Table of Contents

Who Is a Locum Hospitalist?

A locums hospitalist is a hospital medicine physician who covers inpatient care on a temporary basis. You might fill in during a permanent physician’s leave, cover a staffing gap while the hospital recruits, or pick up extra shifts during a busy season.

“Locum tenens” is Latin for “one who holds the place.” That’s the job in a nutshell.

Most locums hospitalists find assignments through a locum tenens agency. The agency matches you with facilities, negotiates your rate, and usually helps with licensing and credentialing.

You’ll find locum hospitalists in big urban medical centers, but the need is greatest in smaller communities, where one physician leaving can leave a whole hospital short. Common settings include:

Community hospitals
Critical access hospitals in rural areas
Veterans Affairs (VA) and Indian Health Service facilities
Long-term acute care hospitals
Rehabilitation centers

Day to day, the work looks a lot like any hospitalist job. You admit and round on patients, coordinate with specialists and nursing staff, handle discharges, and keep care moving. Some assignments are nocturnist roles covering nights only. Others put you in a small hospital where you also respond to rapid responses and codes.

New to the concept? Our guide on what locum tenens means covers the basics.

Pros and Cons of Becoming a Locum Hospitalist

Locums work suits some physicians perfectly and frustrates others. Here’s an honest look at both sides.

Pros

1. Many Expenses Are Tax-Deductible

Locum work comes with costs a W-2 job doesn’t. Flights, rental cars, lodging, extra state licenses, and DEA registrations add up quickly.

The upside is that unreimbursed business expenses are generally deductible when you work as an independent contractor. That can include licensing fees, board certification, CME, malpractice premiums you pay yourself, and travel your agency doesn’t cover.

There’s a catch, though. If your agency already reimburses an expense, you can’t deduct it again. Good recordkeeping matters here. Save receipts and track which costs were paid back.

2. You Can Earn a High Hourly Rate

Hospitals pay a premium to fill urgent gaps. AMN Healthcare’s current hospitalist listings show rates of roughly $179 to $200 per hour, with nocturnist roles at the higher end. Their past-year hospitalist placements averaged about $347,000 annualized.

Read those numbers carefully. Advertised rates often include meal, incidental, and housing reimbursements. Your actual taxable pay may be lower than the headline figure.

Rates also vary a lot by state, facility type, and how quickly the hospital needs coverage. Our breakdowns of locum tenens salary and hospitalist salary can help you compare offers.

3. You Get Control Over Your Schedule

This is the reason many physicians try locums in the first place.

You pick your assignments. If you don’t want nights, you don’t take nocturnist roles. Many hospitalist assignments already run on a seven-on, seven-off block schedule, and you can stack time off between contracts.

That control seems to help. In CHG’s 2025 report, 43% of physicians said locum assignments gave them relief from burnout. Physicians also cited supplementing their income (47%) and controlling their own schedule (29%) as top reasons for doing locums.

Cons

1. Frequent Travel

The best-paying assignments are rarely close to home. You may spend weeks in a town you’ve never visited, working in an unfamiliar hospital with a new EHR and a new team.

For some physicians that’s the fun part. For others, especially those with kids in school or a partner with a local job, it gets old fast.

There’s also lost income to account for. Each new state license costs money, and you can’t work there until the license and credentialing are done.

2. You Handle Your Own Taxes

At a W-2 job, your employer withholds taxes from every paycheck. Most locum hospitalists are paid as 1099 independent contractors, so nothing is withheld.

That means you’re responsible for:

Quarterly estimated tax payments to the IRS
Self-employment tax for Social Security and Medicare
State tax returns, possibly in several states if you work across state lines

Miss a quarterly payment and you may owe an underpayment penalty. The IRS estimated tax guidance explains the deadlines and how the safe harbor rules work.

Not every locum job is a 1099 role. Some agencies hire locums as W-2 employees, which changes your tax picture completely. Ask before you sign. Our guide to independent contractor vs. employee contracts explains the difference.

3. Insurance Gets More Complicated

As a contractor, you’re usually on your own for health insurance, disability coverage, and retirement savings. Comparing deductibles, networks, and out-of-pocket maximums takes time most physicians would rather spend elsewhere.

Malpractice coverage deserves extra attention. Most agencies provide it, but the type matters. An occurrence-based policy covers any incident that happened during your assignment, no matter when the claim is filed. A claims-made policy only protects you while it’s active, unless tail coverage is included. Our article on claims-made vs. occurrence-based coverage walks through how each works.

Disability insurance is the other gap physicians tend to miss. Without an employer group plan, your income has no protection if an illness or injury keeps you from working. An individual own-occupation policy is worth a look. See our guide to disability insurance for self-employed physicians.

5 Tips for Becoming a Successful Locum Hospitalist

Locums rewards physicians who plan ahead. These five tips will help you land better assignments and keep more of what you earn.

1. Define What You Want

Start with why. Paying down student loans faster, testing out a region before committing to a permanent job, and stepping back from a burnout-heavy schedule all point toward different assignments.

Then get specific. How long do you want each assignment to last? A few weeks, or several months at the same hospital? Would you rather work days, nights, or weekends only?

Census matters too, and it varies more than people expect. One California listing on AMN’s site shows a census of over 280 patients with 40 admits a day. A New Mexico weekend role shows three or four. Same specialty, very different jobs.

Knowing your limits up front makes it much easier to turn down the wrong offer.

2. Stay Flexible

The physicians who get the best assignments are usually the ones who say yes to more of them.

That’s becoming more important, not less. Locumsmart reported a surge in locum demand in 2025, but noted signs of that demand tapering in 2026. In a softer market, physicians willing to work in rural hospitals or smaller cities still have plenty of options. Those who will only work close to home may find fewer.

Clinical range helps too. Many locum hospitalist roles, especially in small hospitals, include ICU coverage or cross-cover. If you’re comfortable with central lines, arterial lines, and lumbar punctures, you’re more marketable and in a stronger position to negotiate your rate.

3. Start Early

Licensing and credentialing take longer than most first-time locums expect.

Based on current AMN hospitalist listings, hospital credentialing alone typically runs 45 to 90 days. That’s after you already hold an active license in the state. A brand-new state license can add months on top of that.

Facilities will usually ask for:

An active state medical license
DEA registration for that state
Board certification or board eligibility
BLS and ACLS certification
Professional references and work history

If you plan to start locums right after training, begin these conversations during your final year of residency or fellowship. Our guide to hospital credentialing explains what to expect.

If you’ll work in multiple states, look into the Interstate Medical Licensure Compact (IMLC). As of April 2026, the Compact includes 43 member states plus two U.S. territories. Once you receive your letter of qualification, it stays valid for a year, and you can request licenses in additional member states during that window.

4. Choose the Right Locum Tenens Agency

A good agency does far more than send you job listings. The best ones handle licensing paperwork, coordinate credentialing, book travel, and negotiate your rate.

Before you commit, ask each agency:

Do you pay for licensing and credentialing costs?
Is the malpractice coverage occurrence-based, or claims-made with tail coverage?
Do you book and pay for travel and housing, or reimburse it later?
Will I be paid as a 1099 contractor or a W-2 employee?
How quickly do you pay after I submit my hours?

Many physicians work with two or three agencies at once to see more opportunities. Compare our lists of the best locum tenens agencies and top NALTO-member locum companies to narrow your options.

Read every agreement closely before you sign. Non-compete language, cancellation terms, and buyout clauses can limit where you work later. A physician contract review catches these before they cost you.

5. Talk to a Financial Expert

Going 1099 changes your finances in ways that are easy to underestimate.

Quarterly taxes are the obvious one. But the bigger opportunity is often retirement savings. A Solo 401(k) lets you contribute as both the employee and the employer. For 2026, that means up to $24,500 in employee deferrals plus an employer profit-sharing contribution, up to a combined $72,000 before catch-up contributions. Physicians 50 and older can add $8,000 more, and those aged 60 to 63 can add $11,250.

One thing to watch if you moonlight locums while keeping a W-2 job: the $24,500 employee deferral limit applies across all your 401(k) plans combined. Your employer-side contributions in the Solo 401(k) are separate, though, so there’s still room to save.

A financial advisor who works with physicians can help you:

Set up quarterly tax payments so you avoid penalties
Choose between an LLC, S corp election, or sole proprietorship
Track deductible expenses like CME, licensing, and unreimbursed travel
Pick the right disability and malpractice coverage
Build a retirement plan that keeps working during gaps between assignments

Our tax planning team works with locum physicians on exactly these questions.

Let Physicians Thrive Help You on Your Locums Journey

Locum work can be one of the most flexible and best-paying ways to practice hospital medicine. It works best when you start early, know what you want, and have the right people reviewing your contracts and finances.

That’s where Physicians Thrive comes in.

With over 20,000 contracts negotiated to date, our advisors help physicians secure fair agreements and higher pay. We also help you keep more of what you earn through smarter tax planning, insurance, and retirement strategy.

Reach out to us today to get started.