What Is Locum Tenens? A 2026 Guide for Healthcare Employers

Locum tenens is temporary medical staffing. A physician, nurse practitioner, physician assistant, or other licensed provider fills in at a hospital, clinic, or health system for a defined period, usually through a staffing agency that handles sourcing, credentialing, and malpractice coverage. The term comes from Latin for "to hold the place of," and that's a fairly literal description of the job: someone stands in the gap until the organization has permanent coverage again.

It's grown well past the occasional maternity-leave fill-in. Staffing Industry Analysts put the U.S. locum tenens market at $9.6 billion in 2025, on track for roughly $9.9 billion in 2026. Weatherby Healthcare's 2026 physician survey found 14% of physicians currently work locum tenens, up from 5% a decade ago, and 41% have done it at some point in their career. This is no longer a stopgap. For a lot of physicians and a lot of hospitals, it's a standing part of how staffing gets done.

Where the term comes from, briefly

Locum tenens dates back to British medicine, where it originally described a doctor covering for a colleague on leave. The U.S. version formalized in the 1970s when a University of Utah program started placing physicians in rural areas that couldn't otherwise recruit. The core idea hasn't changed: get a qualified provider into a seat that would otherwise sit empty.

How locum tenens staffing actually works

Most locum tenens placements run through an agency rather than direct hire, mainly because the agency absorbs the parts employers don't want to manage themselves.

That includes primary source verification and credentialing, which for a physician can mean confirming board certification, DEA registration, state license history, malpractice claims history, and hospital privileging, all before the provider sets foot on site. We've written up what actually makes credentialing go smoothly versus where it typically stalls. It includes malpractice coverage, which agencies typically carry on the provider's behalf so the hiring facility isn't exposed. It includes housing and travel logistics for assignments that require relocation. And it includes the contract itself: rate, schedule, assignment length, extension terms, and what happens if either side wants to end the arrangement early.

Assignment length varies widely. Some locum tenens roles run a single weekend to cover a call schedule gap. Others run months, covering an extended leave or bridging a permanent search. A growing share are recurring: the same provider comes back for a set number of shifts a month over a long stretch, which starts to look less like "temp staffing" and more like a flexible permanent relationship.

Who actually uses locum tenens

The stereotype is a rural hospital that can't recruit permanent physicians, and that's still a real and significant use case. Roughly one in five Americans is now over 65, and demand for care in exactly the places that struggle to recruit permanent staff keeps climbing.

But the buyer base is broader than that now:

Health systems use locum tenens to cover parental leave, sabbaticals, and unexpected departures without leaving a service line uncovered. Specialty groups use it to handle seasonal volume swings, particularly in emergency medicine and behavioral health. Telehealth companies use it to scale provider capacity up or down without the fixed cost of full-time hires, especially across multiple state licenses, which is its own planning exercise for smaller operators licensing under 10 providers. And organizations mid-search for a permanent hire use it as a bridge so a vacancy doesn't turn into a service line that's temporarily shut down.

Types of locum tenens providers

Physicians are the classic locum tenens hire, and demand skews toward the specialties where the national shortage is worst: family medicine, psychiatry, anesthesiology, emergency medicine, and hospital medicine.

Advanced practice providers are the fastest-growing part of the picture. SIA's staffing benchmarking data shows locum revenue for nurse practitioners, physician assistants, and CRNAs growing well ahead of physician locum growth, and the Bureau of Labor Statistics projects nurse practitioner jobs to grow over 40% through 2034. For employers, that shift matters: APPs often cost less per shift than a physician and can be licensed and deployed faster, which makes them a practical lever for organizations trying to close coverage gaps without waiting on a physician search.

Locum tenens vs. travel nursing vs. per diem vs. permanent placement

These terms get used interchangeably by people outside staffing, and they shouldn't be, because the contract structure is different in each case.

Locum tenens almost always refers to licensed independent providers: physicians, NPs, PAs, and similar roles that require a state medical or nursing license and typically malpractice coverage. Travel nursing covers RNs and other nursing staff on assignments that usually run 13 weeks, often with a housing stipend built into the package, and the licensing timeline for that group can vary sharply by state, New York being a good example of how much. Per diem staffing is shift-by-shift, filled locally, with no relocation and typically a shorter commitment on both sides. Permanent placement is what it sounds like: a direct hire onto the organization's own payroll and benefits, with the agency (if one is involved) collecting a placement fee rather than an ongoing markup.

The practical difference for an employer is commitment length and cost structure. Locum tenens and travel nursing carry a premium built into the bill rate. Per diem is more flexible but harder to guarantee coverage with. Permanent placement is the cheapest option per shift over time but the slowest to fill and the least flexible if needs change.

What locum tenens actually costs

The bill rate a facility pays isn't the same as what the provider takes home. It typically bundles the provider's pay rate, the agency's margin, and often travel, housing, and malpractice coverage into one number. That's why locum tenens looks expensive on a per-shift basis next to a permanent salary divided into a daily rate, even though the comparison isn't apples to apples: a permanent hire also carries benefits, PTO, recruiting cost, and turnover risk that don't show up in that simple math.

The honest way to think about cost is total cost of an unfilled shift versus total cost of a filled one. An empty OR block or an ED without adequate coverage has a real financial and clinical cost, and it's often larger than people assume: we've broken down what an open physician position actually costs per day it stays open. For most organizations, the question isn't whether locum tenens is expensive. It's whether it's cheaper than the alternative of not having coverage at all.

Licensing: the part that slows everything down

The single biggest bottleneck in locum tenens staffing isn't finding a willing provider. It's getting that provider licensed to practice in the state where the shift is.

The Interstate Medical Licensure Compact has made this faster for physicians. As of mid-2026, 44 states plus D.C. and Guam participate, and a qualified physician can typically get a new state license through the compact in a matter of weeks instead of months. It doesn't cover everyone: California, New York, and Florida are notably outside it, so an organization staffing across those states still needs traditional licensing timelines built into its planning. We've written a full breakdown of what the IMLC means for healthcare employers if licensing speed is the thing slowing down your staffing plan.

How to evaluate a locum tenens partner

A few things worth checking before you sign with any staffing agency, locum tenens or otherwise:

Speed to credential matters more than almost anything else, since a provider who's a great fit but takes ten weeks to clear compliance doesn't solve an urgent gap. Ask for real average time-to-place numbers, not marketing copy. Malpractice coverage terms should be spelled out in writing, including coverage limits and tail coverage if the assignment ends. Fill rate on hard-to-staff specialties tells you more than a general placement percentage. And contract flexibility, meaning how easily you can extend, shorten, or convert an assignment to permanent, tends to matter more once you're a few months into a relationship than it does on day one. We've laid out a fuller strategic framework for choosing a locum tenens partner if you want to go deeper than this checklist.

If you're comparing options, we've put together direct breakdowns against two of the larger national platforms: DirectShifts vs. AMN Healthcare and DirectShifts vs. OpenLoop.

Frequently asked questions

What's the difference between locum tenens and travel nursing?Locum tenens refers to temporary placements for licensed independent providers like physicians, NPs, and PAs. Travel nursing refers specifically to RNs and other nursing staff, typically on 13-week assignments.

How long do locum tenens assignments typically last?Anywhere from a single weekend shift to several months. Recurring arrangements, where the same provider returns for regular shifts over an extended period, are increasingly common.

Do locum tenens physicians need a separate license for every state they work in?Generally yes, though the Interstate Medical Licensure Compact speeds up the process significantly for the 44 participating states. States outside the compact, including California, New York, and Florida, still require the traditional licensing process.

Is locum tenens more expensive than hiring a permanent provider?The bill rate is usually higher per shift, but that rate bundles the provider's pay, agency margin, malpractice coverage, and often travel costs. A fair cost comparison has to account for what an unfilled shift costs the organization, not just the sticker price of the locum rate.

Can telehealth companies use locum tenens providers?Yes, and it's one of the fastest-growing segments of the market. Telehealth organizations use locum tenens to scale provider capacity across multiple state licenses without committing to full-time headcount in every state they serve.

What's the difference between locum tenens and per diem staffing?Per diem is typically local, shift-by-shift work with no relocation involved. Locum tenens often involves travel and a defined assignment length, and applies specifically to licensed independent providers rather than the broader clinical staff per diem usually covers.

For more on this topic, browse our full locum tenens coverage, or book a demo and we'll walk through your specific staffing need.