Locum tenens compensation varies more by specialty than almost any other factor in physician pay. An emergency medicine physician and a family medicine physician can be working the same 40-hour week for the same hospital system and earning vastly different amounts.
Whether you’re already working locum assignments and looking to maximize what each placement returns, evaluating a switch from your current agency, or finishing training and considering locum tenens as an early-career path, knowing what your specialty realistically commands in the current market is essential for evaluating any opportunity.
This guide covers locum tenens pay across physician specialties and advanced practice roles, explains what shapes the numbers, addresses the tax reality that most salary guides skip, and gives you a practical framework for evaluating compensation in your specialty.
Quick Facts: Locum Tenens Compensation 2026
- Full-time locum tenens physicians earn the equivalent of $200,000 to $830,000 or more annually, depending on specialty, location, and assignment type
- The highest-compensated locum specialties are neurosurgery, cardiovascular/thoracic surgery, anesthesiology, and hematology & oncology, with full-time equivalent annual earnings reaching $830,000
- Hematology & oncology is consistently among the highest-demand locum specialties, with top-end placements approaching the upper bound of the physician compensation range
- Rural and underserved markets typically pay a 10–25% premium over urban centers across most specialties
- Most locum assignments include housing, travel, and malpractice coverage in addition to base pay, adding $20,000–$40,000 in effective compensation annually
- Locum tenens providers work as 1099 independent contractors, paying 15.3% self-employment tax on net income
- The Interstate Medical Licensure Compact, with more than 40 member states, is the primary mechanism most locum physicians use to access multi-state placements efficiently
Locum Tenens Compensation Overview
Locum tenens providers are paid per clinical hour worked, not on a fixed annual salary. Pay applies to scheduled clinical hours only, not administrative time, chart review outside of shift hours, or unpaid call coverage. Throughout this guide, we present typical earnings as full-time equivalent annual figures to make them directly comparable to permanent salary benchmarks. The annualization assumes approximately 2,000 clinical hours per year, which is a reasonable benchmark for a provider working consistent locum assignments.
What pay alone does not show is the full compensation picture. Most locum assignments also include a housing stipend or fully covered accommodations at the assignment location, round-trip travel reimbursement, and malpractice insurance coverage for the duration of the assignment. When you aggregate those benefits, the effective value of a locum assignment is often 15 to 25 percent higher than the headline figure suggests. A physician earning the equivalent of $400,000 annually with housing and travel covered is receiving meaningfully more than a physician earning the equivalent of $430,000 annually who is covering those costs independently.
Three structural factors shape where you sit within your specialty’s compensation range. Geography is the largest single lever: rural and underserved markets pay a 10 to 25 percent premium because they must, while urban academic medical centers typically have more applications for fewer positions and less compensation pressure. Practice setting matters next: Level I trauma centers, high-volume emergency departments, and complex surgical hospitals pay more than outpatient clinics or low-acuity urgent care settings. Experience and credentials shape access to the upper end of any specialty range, with board-certified providers and those with documented procedural volume consistently accessing premium positions.
Locum Tenens Salary by Specialty: Physician Pay
The tables below reflect typical full-time equivalent annual earnings for locum tenens physicians across specialties. Locum compensation is set per clinical hour worked, so the figures here annualize at approximately 2,000 clinical hours per year. Presented this way, the figures are directly comparable to permanent salary benchmarks reported in surveys like the Medscape Physician Compensation Report and the Doximity Physician Compensation Report. These ranges represent typical market conditions as of 2025–2026 and individual compensation varies based on the factors described in this guide.
Primary Care and Generalist Specialties
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| Family Medicine | $210K–$300K | Strong demand in rural and underserved markets |
| Internal Medicine | $230K–$330K | Hospitalist roles drive significant volume |
| Hospitalist (General) | $230K–$310K | High placement volume; schedule often 7 on/7 off |
| Pediatrics (General) | $200K–$290K | Demand highest in outpatient and rural settings |
| Urgent Care | $190K–$280K | Broad supply of providers; consistent volume of positions |
Primary care and generalist roles offer something that higher-compensation specialties often do not: volume and scheduling predictability. The number of available locum placements in family medicine and internal medicine is significantly larger than in subspecialty medicine. For providers who prioritize schedule consistency and geographic flexibility over peak earnings, primary care locum work is a highly viable long-term strategy.
Emergency and Acute Care
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| Emergency Medicine (ABEM) | $450K–$620K | Premium for board certification is consistent across markets |
| Emergency Medicine (Non-ABEM) | $340K–$470K | Strong demand; gap vs. ABEM is narrowing in high-need markets |
| Critical Care / Intensivist | $430K–$590K | High-acuity shifts; demand driven by ICU coverage needs |
| Trauma Surgery | $500K–$690K | Short supply of qualified locum providers; compensation reflects scarcity |
Emergency medicine is the specialty most frequently cited by physicians exploring locum work. In a Sermo physician survey, 55 percent of physicians named emergency medicine as their preferred specialty for locum practice, ahead of internal medicine at 22 percent and anesthesiology at 12 percent. The combination of strong compensation, shift-based scheduling with clear start and end times, and near-universal demand makes emergency medicine one of the most structurally suited specialties for locum practice. The ABEM certification premium is real and consistent, typically adding the equivalent of $80,000 to $140,000 per year over non-ABEM equivalent roles. For a deeper breakdown, see All Star’s Emergency Medicine Salary Guide.
Surgical Specialties
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| General Surgery | $450K–$620K | 7-day blocks common; service line coverage drives demand |
| Orthopedic Surgery | $480K–$700K | Sub-specialty focus (spine, joint, trauma) affects compensation |
| Otolaryngology (ENT) | $390K–$540K | Procedural subspecialty; sinus and head/neck procedural volume drives locum demand |
| OB-GYN | $390K–$570K | Demand driven by labor and delivery coverage needs |
| Pediatric Surgery | $480K–$720K | Tertiary children’s hospitals and pediatric service line coverage drive demand |
| Cardiovascular/Thoracic Surgery | $570K–$780K | Very limited supply; top of the surgical compensation range |
| Neurosurgery | $590K–$830K | Highest-compensated surgical specialty in most markets |
Surgical locum assignments typically run in 7-day blocks that combine OR time, clinic, and call responsibilities. Hospital service line closures and recruitment-driven coverage gaps are major demand drivers across surgical specialties, particularly for general surgeons and pediatric surgeons covering rural critical access hospitals and tertiary children’s hospitals where surgical service is otherwise at risk. Assignment lengths of one to three months are standard, with longer placements available at facilities managing extended coverage gaps. The premium for procedural volume applies here: a general surgeon covering a high-volume trauma OR earns toward the top of the range; one covering a low-acuity outpatient surgical center earns toward the bottom.
Medical Specialties and Subspecialists
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| Anesthesiology | $570K–$830K | Demand consistently outpaces supply in most markets |
| Cardiology (Invasive/Interventional) | $470K–$680K | Cath lab and PCI volume drives premium over non-invasive |
| Cardiology (Non-Invasive) | $350K–$520K | Echo, stress, nuclear interpretation roles |
| Radiology (Diagnostic) | $390K–$570K | Teleradiology roles expand geographic flexibility |
| Gastroenterology | $430K–$610K | Endoscopy volume a key compensation driver |
| Hematology & Oncology | $400K–$830K | Among highest-demand locum specialties; top-end placements approach physician compensation ceiling |
| Dermatology | $330K–$490K | Strong outpatient demand; Mohs expertise commands premium |
| Neurology | $330K–$490K | Telestroke roles increasing availability and flexibility |
| Psychiatry | $350K–$520K | Severe shortage markets; telehealth roles widely available |
| Nephrology | $310K–$470K | Dialysis and hospital consult roles both available |
| Urology | $390K–$550K | Geographic shortage drives consistent locum demand |
| Endocrinology | $270K–$390K | Lower compensation range; consistent demand in underserved markets |
Anesthesiology and hematology & oncology sit at the top of the medical subspecialty compensation range. Hematology & oncology is consistently among the highest-demand specialties in locum staffing, with top-end placements at high-volume infusion centers and specialized cancer programs approaching the upper bound of the physician compensation range. Anesthesiology demand consistently outpaces supply in most markets, particularly for surgical center and trauma center coverage. Compensation in this guide for radiology refers to physician radiologists (MD/DO board-certified by the American Board of Radiology), not radiologic technologists or imaging technicians; teleradiology roles are a structural advantage unique in locum medicine, allowing diagnostic radiologists to work remotely across multiple facilities simultaneously, which changes the economics of part-time locum work significantly.
Demand for locum urologists is structurally high: the American Urological Association reports that more than 60 percent of U.S. counties have no practicing urologist, creating sustained coverage gaps that locum providers fill across rural and underserved metro markets alike. Psychiatry is notable for the combination of severe shortage conditions and expanding telehealth availability, making it an unusually accessible specialty for flexible locum arrangements.
For detailed salary breakdowns by specialty, see All Star’s specialty salary guides for anesthesiologists, cardiologists, radiologists, gastroenterologists, hematology and oncology physicians, and urologists.
Locum Tenens Pay for Advanced Practice Providers
All Star Healthcare Solutions also places advanced practice providers — CRNAs, nurse practitioners, and physician assistants — across multiple specialties. Physician placements are All Star’s primary focus, and the APP locum market complements rather than substitutes for that work. The market for APP locum placements is strong and expanding, driven by the same physician shortage dynamics that fuel physician locum demand. CRNAs in particular access compensation approaching the physician range in high-demand markets.
| Role | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| CRNA | $350K–$510K | Highest-earning APP in locum placements; approaches physician range |
| Psychiatric NP | $160K–$260K | Acute shortage markets; telepsych roles available |
| Surgical PA | $150K–$230K | First-assist OR roles; specialty-trained PAs access higher compensation |
| Family Practice NP | $130K–$200K | Volume of positions is high; rural premium applies |
CRNAs are the highest-earning APPs in locum placements, with full-time equivalent earnings that approach the physician range in high-demand markets. For NPs and PAs, compensation varies significantly by specialty and by state. Independent practice authority states, where NPs can practice without physician supervision, typically offer higher compensation for NPs because facilities can deploy them in a broader range of roles. Surgical PAs with documented first-assist experience and subspecialty training access higher compensation than generalist PAs.
A note for nurse practitioners: All Star does not place NPs in California due to that state’s W-2 employment requirements for NP locum work. NP placements are available in all other states.
How Locum Tenens Compensation Compares to Permanent Salaries
The comparison between locum compensation and a permanent employed position is not as simple as comparing per-hour figures to annual salaries. Three factors consistently shift the calculation in locum’s favor for providers who understand them.
The effective compensation premium adds real dollar value beyond the headline figure. Housing, travel, and malpractice coverage included in a locum package mean a provider on a six-month assignment with fully covered accommodations is not paying rent or commuting costs at a second location. Aggregate those benefits across a full year and the value typically ranges from $20,000 to $40,000 above the headline figure, based on typical housing stipends of $2,000–$3,000 per month and round-trip travel reimbursements across a standard locum placement.
The earnings ceiling is higher in locum work than in W-2 employment. Recent Medscape and Doximity compensation reports place average employed physician earnings in the low $300,000 range across most specialties, with primary care below that benchmark and procedural specialties above it. A locum provider working consistent assignments in a high-demand specialty can meaningfully increase annual earnings beyond those benchmarks by choosing higher-compensation markets, adding short-notice flexibility, or accumulating experience that unlocks access to premium positions.
The trade-offs are real, however, and need to be accounted for accurately. Locum providers receive no employer benefits: no health insurance contribution, no retirement match, no paid time off. Self-employment taxes add to the cost. Bureau of Labor Statistics data on civilian employer costs places the value of benefits at approximately 30 percent of total compensation for management and professional roles, which is the practical reason a locum provider needs to account for roughly 15 to 25 percent more in gross earnings to net the same take-home value as a salaried position with comparable benefits.
| Comparison Point | Locum | Permanent W-2 |
|---|---|---|
| Base pay structure | Per clinical hour worked | Annual salary |
| Housing/travel | Typically covered by agency | Not covered |
| Malpractice | Typically covered by agency | Covered by employer |
| Health insurance | Provider’s responsibility | Employer contribution |
| Retirement | Provider’s responsibility | Employer match |
| Self-employment tax | 15.3% on net income | Half paid by employer |
| Schedule flexibility | High | Lower |
| Earnings ceiling | No cap | Often capped by contract |
For most physicians in high-demand specialties working consistent locum assignments, total compensation exceeds what a salaried permanent position offers. The breakeven calculation shifts toward locum faster than most providers expect once the full package is counted.
Key Compensation Factors
Beyond specialty, location, and practice setting, several additional factors shape what a locum provider earns. Understanding them helps you evaluate offers accurately and identify where you have negotiating leverage.
Education & Certifications
Board certification is the baseline expectation for competitive locum tenens compensation across most specialties. Subspecialty fellowship training in procedural areas — interventional cardiology, regional anesthesia, surgical oncology, telestroke neurology — commands meaningful premiums over generalist board-certified equivalents. The Interstate Medical Licensure Compact, with more than 40 member states, streamlines multi-state licensing and is the primary mechanism most locum physicians use to access higher-compensation positions across multiple states.
Practice Factors
Day-to-day practice characteristics shape compensation significantly. Call requirements, including overnight and weekend coverage, add to effective compensation through hourly premiums or per-call stipends. Patient volume and acuity matter: high-volume trauma centers and complex surgical hospitals pay top-of-range, while low-acuity outpatient settings sit at the lower end. Locum assignments typically minimize the administrative burden of permanent roles, allowing providers to focus on clinical work.
Market Demand
Locum tenens demand is driven by the persistent national physician shortage, which the Association of American Medical Colleges projects will reach up to 86,000 unfilled positions by 2036. Industry estimates indicate that approximately 85 percent of U.S. hospitals use locum tenens coverage to maintain consistent patient access during physician recruitment cycles, leave situations, seasonal volume fluctuations, and service line closures or restructurings. Urgent coverage needs typically pay 10 to 20 percent above standard market compensation, creating opportunities for providers with schedule flexibility.
Tax and Financial Considerations for Locum Providers
Locum tenens providers work as 1099 independent contractors. No employer withholds federal or state income tax from your pay. No employer covers half of your Social Security and Medicare contributions. This is the most practically significant financial difference between locum and employed work, and the most consistently skipped topic in every locum salary guide on the internet.
Self-employment tax is 15.3 percent on top of income tax. W-2 employees pay 7.65 percent of this (the employee share of FICA), with the employer covering the other 7.65 percent. As a 1099 contractor, you pay both sides. On $200,000 in net locum income, that is approximately $30,600 in self-employment tax before income tax is even calculated.
You are responsible for quarterly estimated tax payments. The IRS expects self-employed individuals to pay estimated taxes four times per year. Missing or underpaying these can result in underpayment penalties in addition to the underlying tax liability. This is not optional. Work with a CPA who specializes in physician finances to set your quarterly payment schedule from day one.
The offsets are meaningful. The 1099 structure that creates the tax burden also creates deductibility options that W-2 employees do not have. Business expenses that are ordinary and necessary to your locum practice are generally deductible. These include licensing fees, professional association dues, continuing medical education, and in some cases business travel and equipment. Malpractice coverage that you pay independently is typically deductible. High-income earners should evaluate whether an S-Corporation election makes sense, as it can reduce self-employment tax liability significantly at certain income levels.
This section is not tax advice. Physician tax situations are individual and variable. Before your first locum assignment, consult a CPA with experience in physician independent contractor arrangements.
The All Star Advantage
Competitive compensation is one piece of career satisfaction. With more than two decades placing locum providers across 85 specialties in all 50 states, All Star Healthcare Solutions supports providers across every dimension of locum practice — from compensation negotiation to credentialing to assignment matching to ongoing support. Here’s what sets us apart.
Expert Compensation Negotiation and Market Intelligence
Our consultants work with real placement data across specialties, states, and facility settings. We negotiate on your behalf and clarify the full package, from housing stipends to CME allowances to malpractice coverage. If a quoted figure sits below the ranges shown in this guide for your specialty and geography, your consultant will walk through the assignment specifics that justify the offer or negotiate appropriate adjustments.
Comprehensive Credentialing and Licensing Support
We manage the entire credentialing process from start to finish, handling document collection, primary source verification, and direct communication with facility credentialing offices. We coordinate Interstate Medical Licensure Compact filings for eligible physicians and manage state-by-state licensing for those outside IMLC scope, removing a substantial administrative burden from the provider’s side.
Flexible Assignment Options Matching Your Goals
Whether you want short-term coverage between assignments, an extended contract to evaluate a new market, locum-to-permanent conversion, or a flexible mix of placements, we provide options that match your goals. Our network of more than 150 hospital systems and more than 400 facilities provides access to roles across critical access hospitals, community hospitals, academic centers, and telehealth opportunities.
24/7 Dedicated Support Throughout Your Assignment
Your assigned consultant remains your advocate from initial conversation through the end of every assignment, available around the clock for urgent matters and checking in regularly to ensure your assignment meets expectations. We coordinate housing, travel, and credentialing logistics so you can focus on patient care.
Ready to Explore Locum Tenens Opportunities?
Whether you’re already working locum assignments and considering a different agency, evaluating your first locum placement, or building flexible practice into your long-term career plan, All Star Healthcare Solutions can help you understand what your specialty commands in the current market and identify assignments that fit your goals. Our specialty-focused consultants understand the compensation landscape across your practice area, the credentialing and licensing pathways that fit your situation, and what placements are currently available.
When you’re ready to talk specifics, we’re here.
Connect with a Specialty Consultant
Frequently Asked Questions About Locum Tenens Salary
What is the highest-paid locum tenens specialty?
Neurosurgery, cardiovascular/thoracic surgery, anesthesiology, and hematology & oncology consistently rank at the top of the locum compensation scale, with full-time equivalent annual earnings reaching $830,000 in high-demand markets. The highest figures reflect the combination of procedural complexity, fellowship-level credentials, and consistent national shortages of qualified providers.
How much can a locum tenens physician earn in a year?
A physician working full-time locum assignments, approximately 2,000 clinical hours annually, can earn between $200,000 and $830,000 or more depending on specialty. Emergency medicine physicians working consistent assignments typically earn $450,000 to $620,000. Neurosurgeons or cardiovascular surgeons in high-demand markets can exceed $700,000. Hematology & oncology placements at high-volume centers can reach the upper bound of physician compensation. Primary care physicians and generalists typically earn $200,000 to $330,000. Most physicians working consistent locum assignments earn more per year than they would in a comparable permanent position.
Do locum tenens physicians pay more taxes than salaried doctors?
Yes, locum providers pay self-employment tax of 15.3 percent on net income, in addition to federal and state income tax. W-2 employees share this burden with their employer, who covers half. The practical implication is that a locum provider earning $250,000 pays roughly $38,000 in self-employment tax that a salaried physician at the same gross income does not. Legitimate deductible business expenses offset this partially, and high earners may benefit from an S-Corporation structure. Consult a physician-specialist CPA before your first assignment.
Can nurse practitioners and physician assistants work locum tenens?
Yes. APP locum placements are a significant segment of the market, though physician placements remain All Star’s primary focus. CRNAs, psychiatric NPs, surgical PAs, and family practice NPs are among the most actively placed APP roles in locum staffing. CRNAs earn at levels approaching the physician compensation range in many markets. NP and PA compensation varies by specialty, experience, and state practice authority. All Star does not place NPs in California due to that state’s W-2 employment requirements; NP placements are available in all other states.
How does locum tenens pay compare to a permanent position?
For most physicians in high-demand specialties, locum tenens work generates higher gross income than a permanent employed position at equivalent hours. The locum compensation premium, combined with covered housing, travel, and malpractice, typically more than offsets the self-employment tax and benefits gap. The comparison is most favorable for providers in procedural specialties, those willing to work in underserved markets, and those with schedule flexibility to take short-notice assignments.
What’s the highest-paying state for locum tenens work?
The highest-paying states for locum tenens work are typically those with the most acute provider shortages relative to population. Rural states across the Mountain West (Wyoming, Montana, Idaho), parts of the upper Midwest (North Dakota, South Dakota), and rural areas of Alaska consistently rank at the top for locum compensation premiums across multiple specialties. Within most states, rural and underserved areas pay 15–25% above state metro rates, and certain shortage-designated regions in California, Texas, and Florida also command meaningful premiums.
Do rural locum tenens assignments pay more than urban ones?
Yes, in most specialties rural assignments pay 10–25% above urban baseline compensation, and the premium can reach 30% or more for hard-to-fill subspecialty roles in critical access hospitals. The differential exists because rural facilities have fewer alternative coverage options, often face genuine patient access pressures during coverage gaps, and must compete against urban and metro assignments for the same pool of qualified providers. The trade-off is location and travel; most locum providers find the compensation premium and the often-shorter assignment lengths in rural settings make these placements highly attractive.
What’s the difference between agency-placed and direct-hire locum tenens work?
Agency-placed locum tenens work consolidates credentialing, malpractice coverage, housing, travel, gap-filling between assignments, and licensing support through a single staffing partner. Direct-to-facility placement requires the provider to self-manage each of these functions, which adds significant administrative cost and time burden. Agency placement typically produces higher net effective compensation once the cost of self-managing each administrative function is counted, including the value of the provider’s own time. Most experienced locum providers work through agencies for these reasons.
Data Sources
- Locumstory 2025 Specialty Compensation Trends
- Sermo Physician Survey on Locum Tenens
- IRS Topic No. 554: Self-Employment Tax
- Association of American Medical Colleges: 2024 Physician Workforce Projections
- American Urological Association: Annual Census
- Bureau of Labor Statistics: Employer Costs for Employee Compensation
- Federation of State Medical Boards: Interstate Medical Licensure Compact
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Locum tenens compensation varies more by specialty than almost any other factor in physician pay. An emergency medicine physician and a family medicine physician can be working the same 40-hour week for the same hospital system and earning vastly different amounts.
Whether you’re already working locum assignments and looking to maximize what each placement returns, evaluating a switch from your current agency, or finishing training and considering locum tenens as an early-career path, knowing what your specialty realistically commands in the current market is essential for evaluating any opportunity.
This guide covers locum tenens pay across physician specialties and advanced practice roles, explains what shapes the numbers, addresses the tax reality that most salary guides skip, and gives you a practical framework for evaluating compensation in your specialty.
Quick Facts: Locum Tenens Compensation 2026
- Full-time locum tenens physicians earn the equivalent of $200,000 to $830,000 or more annually, depending on specialty, location, and assignment type
- The highest-compensated locum specialties are neurosurgery, cardiovascular/thoracic surgery, anesthesiology, and hematology & oncology, with full-time equivalent annual earnings reaching $830,000
- Hematology & oncology is consistently among the highest-demand locum specialties, with top-end placements approaching the upper bound of the physician compensation range
- Rural and underserved markets typically pay a 10–25% premium over urban centers across most specialties
- Most locum assignments include housing, travel, and malpractice coverage in addition to base pay, adding $20,000–$40,000 in effective compensation annually
- Locum tenens providers work as 1099 independent contractors, paying 15.3% self-employment tax on net income
- The Interstate Medical Licensure Compact, with more than 40 member states, is the primary mechanism most locum physicians use to access multi-state placements efficiently
Locum Tenens Compensation Overview
Locum tenens providers are paid per clinical hour worked, not on a fixed annual salary. Pay applies to scheduled clinical hours only, not administrative time, chart review outside of shift hours, or unpaid call coverage. Throughout this guide, we present typical earnings as full-time equivalent annual figures to make them directly comparable to permanent salary benchmarks. The annualization assumes approximately 2,000 clinical hours per year, which is a reasonable benchmark for a provider working consistent locum assignments.
What pay alone does not show is the full compensation picture. Most locum assignments also include a housing stipend or fully covered accommodations at the assignment location, round-trip travel reimbursement, and malpractice insurance coverage for the duration of the assignment. When you aggregate those benefits, the effective value of a locum assignment is often 15 to 25 percent higher than the headline figure suggests. A physician earning the equivalent of $400,000 annually with housing and travel covered is receiving meaningfully more than a physician earning the equivalent of $430,000 annually who is covering those costs independently.
Three structural factors shape where you sit within your specialty’s compensation range. Geography is the largest single lever: rural and underserved markets pay a 10 to 25 percent premium because they must, while urban academic medical centers typically have more applications for fewer positions and less compensation pressure. Practice setting matters next: Level I trauma centers, high-volume emergency departments, and complex surgical hospitals pay more than outpatient clinics or low-acuity urgent care settings. Experience and credentials shape access to the upper end of any specialty range, with board-certified providers and those with documented procedural volume consistently accessing premium positions.
Locum Tenens Salary by Specialty: Physician Pay
The tables below reflect typical full-time equivalent annual earnings for locum tenens physicians across specialties. Locum compensation is set per clinical hour worked, so the figures here annualize at approximately 2,000 clinical hours per year. Presented this way, the figures are directly comparable to permanent salary benchmarks reported in surveys like the Medscape Physician Compensation Report and the Doximity Physician Compensation Report. These ranges represent typical market conditions as of 2025–2026 and individual compensation varies based on the factors described in this guide.
Primary Care and Generalist Specialties
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| Family Medicine | $210K–$300K | Strong demand in rural and underserved markets |
| Internal Medicine | $230K–$330K | Hospitalist roles drive significant volume |
| Hospitalist (General) | $230K–$310K | High placement volume; schedule often 7 on/7 off |
| Pediatrics (General) | $200K–$290K | Demand highest in outpatient and rural settings |
| Urgent Care | $190K–$280K | Broad supply of providers; consistent volume of positions |
Primary care and generalist roles offer something that higher-compensation specialties often do not: volume and scheduling predictability. The number of available locum placements in family medicine and internal medicine is significantly larger than in subspecialty medicine. For providers who prioritize schedule consistency and geographic flexibility over peak earnings, primary care locum work is a highly viable long-term strategy.
Emergency and Acute Care
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| Emergency Medicine (ABEM) | $450K–$620K | Premium for board certification is consistent across markets |
| Emergency Medicine (Non-ABEM) | $340K–$470K | Strong demand; gap vs. ABEM is narrowing in high-need markets |
| Critical Care / Intensivist | $430K–$590K | High-acuity shifts; demand driven by ICU coverage needs |
| Trauma Surgery | $500K–$690K | Short supply of qualified locum providers; compensation reflects scarcity |
Emergency medicine is the specialty most frequently cited by physicians exploring locum work. In a Sermo physician survey, 55 percent of physicians named emergency medicine as their preferred specialty for locum practice, ahead of internal medicine at 22 percent and anesthesiology at 12 percent. The combination of strong compensation, shift-based scheduling with clear start and end times, and near-universal demand makes emergency medicine one of the most structurally suited specialties for locum practice. The ABEM certification premium is real and consistent, typically adding the equivalent of $80,000 to $140,000 per year over non-ABEM equivalent roles. For a deeper breakdown, see All Star’s Emergency Medicine Salary Guide.
Surgical Specialties
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| General Surgery | $450K–$620K | 7-day blocks common; service line coverage drives demand |
| Orthopedic Surgery | $480K–$700K | Sub-specialty focus (spine, joint, trauma) affects compensation |
| Otolaryngology (ENT) | $390K–$540K | Procedural subspecialty; sinus and head/neck procedural volume drives locum demand |
| OB-GYN | $390K–$570K | Demand driven by labor and delivery coverage needs |
| Pediatric Surgery | $480K–$720K | Tertiary children’s hospitals and pediatric service line coverage drive demand |
| Cardiovascular/Thoracic Surgery | $570K–$780K | Very limited supply; top of the surgical compensation range |
| Neurosurgery | $590K–$830K | Highest-compensated surgical specialty in most markets |
Surgical locum assignments typically run in 7-day blocks that combine OR time, clinic, and call responsibilities. Hospital service line closures and recruitment-driven coverage gaps are major demand drivers across surgical specialties, particularly for general surgeons and pediatric surgeons covering rural critical access hospitals and tertiary children’s hospitals where surgical service is otherwise at risk. Assignment lengths of one to three months are standard, with longer placements available at facilities managing extended coverage gaps. The premium for procedural volume applies here: a general surgeon covering a high-volume trauma OR earns toward the top of the range; one covering a low-acuity outpatient surgical center earns toward the bottom.
Medical Specialties and Subspecialists
| Specialty | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| Anesthesiology | $570K–$830K | Demand consistently outpaces supply in most markets |
| Cardiology (Invasive/Interventional) | $470K–$680K | Cath lab and PCI volume drives premium over non-invasive |
| Cardiology (Non-Invasive) | $350K–$520K | Echo, stress, nuclear interpretation roles |
| Radiology (Diagnostic) | $390K–$570K | Teleradiology roles expand geographic flexibility |
| Gastroenterology | $430K–$610K | Endoscopy volume a key compensation driver |
| Hematology & Oncology | $400K–$830K | Among highest-demand locum specialties; top-end placements approach physician compensation ceiling |
| Dermatology | $330K–$490K | Strong outpatient demand; Mohs expertise commands premium |
| Neurology | $330K–$490K | Telestroke roles increasing availability and flexibility |
| Psychiatry | $350K–$520K | Severe shortage markets; telehealth roles widely available |
| Nephrology | $310K–$470K | Dialysis and hospital consult roles both available |
| Urology | $390K–$550K | Geographic shortage drives consistent locum demand |
| Endocrinology | $270K–$390K | Lower compensation range; consistent demand in underserved markets |
Anesthesiology and hematology & oncology sit at the top of the medical subspecialty compensation range. Hematology & oncology is consistently among the highest-demand specialties in locum staffing, with top-end placements at high-volume infusion centers and specialized cancer programs approaching the upper bound of the physician compensation range. Anesthesiology demand consistently outpaces supply in most markets, particularly for surgical center and trauma center coverage. Compensation in this guide for radiology refers to physician radiologists (MD/DO board-certified by the American Board of Radiology), not radiologic technologists or imaging technicians; teleradiology roles are a structural advantage unique in locum medicine, allowing diagnostic radiologists to work remotely across multiple facilities simultaneously, which changes the economics of part-time locum work significantly.
Demand for locum urologists is structurally high: the American Urological Association reports that more than 60 percent of U.S. counties have no practicing urologist, creating sustained coverage gaps that locum providers fill across rural and underserved metro markets alike. Psychiatry is notable for the combination of severe shortage conditions and expanding telehealth availability, making it an unusually accessible specialty for flexible locum arrangements.
For detailed salary breakdowns by specialty, see All Star’s specialty salary guides for anesthesiologists, cardiologists, radiologists, gastroenterologists, hematology and oncology physicians, and urologists.
Locum Tenens Pay for Advanced Practice Providers
All Star Healthcare Solutions also places advanced practice providers — CRNAs, nurse practitioners, and physician assistants — across multiple specialties. Physician placements are All Star’s primary focus, and the APP locum market complements rather than substitutes for that work. The market for APP locum placements is strong and expanding, driven by the same physician shortage dynamics that fuel physician locum demand. CRNAs in particular access compensation approaching the physician range in high-demand markets.
| Role | Equivalent Annual Earnings (FTE) | Notes |
|---|---|---|
| CRNA | $350K–$510K | Highest-earning APP in locum placements; approaches physician range |
| Psychiatric NP | $160K–$260K | Acute shortage markets; telepsych roles available |
| Surgical PA | $150K–$230K | First-assist OR roles; specialty-trained PAs access higher compensation |
| Family Practice NP | $130K–$200K | Volume of positions is high; rural premium applies |
CRNAs are the highest-earning APPs in locum placements, with full-time equivalent earnings that approach the physician range in high-demand markets. For NPs and PAs, compensation varies significantly by specialty and by state. Independent practice authority states, where NPs can practice without physician supervision, typically offer higher compensation for NPs because facilities can deploy them in a broader range of roles. Surgical PAs with documented first-assist experience and subspecialty training access higher compensation than generalist PAs.
A note for nurse practitioners: All Star does not place NPs in California due to that state’s W-2 employment requirements for NP locum work. NP placements are available in all other states.
How Locum Tenens Compensation Compares to Permanent Salaries
The comparison between locum compensation and a permanent employed position is not as simple as comparing per-hour figures to annual salaries. Three factors consistently shift the calculation in locum’s favor for providers who understand them.
The effective compensation premium adds real dollar value beyond the headline figure. Housing, travel, and malpractice coverage included in a locum package mean a provider on a six-month assignment with fully covered accommodations is not paying rent or commuting costs at a second location. Aggregate those benefits across a full year and the value typically ranges from $20,000 to $40,000 above the headline figure, based on typical housing stipends of $2,000–$3,000 per month and round-trip travel reimbursements across a standard locum placement.
The earnings ceiling is higher in locum work than in W-2 employment. Recent Medscape and Doximity compensation reports place average employed physician earnings in the low $300,000 range across most specialties, with primary care below that benchmark and procedural specialties above it. A locum provider working consistent assignments in a high-demand specialty can meaningfully increase annual earnings beyond those benchmarks by choosing higher-compensation markets, adding short-notice flexibility, or accumulating experience that unlocks access to premium positions.
The trade-offs are real, however, and need to be accounted for accurately. Locum providers receive no employer benefits: no health insurance contribution, no retirement match, no paid time off. Self-employment taxes add to the cost. Bureau of Labor Statistics data on civilian employer costs places the value of benefits at approximately 30 percent of total compensation for management and professional roles, which is the practical reason a locum provider needs to account for roughly 15 to 25 percent more in gross earnings to net the same take-home value as a salaried position with comparable benefits.
| Comparison Point | Locum | Permanent W-2 |
|---|---|---|
| Base pay structure | Per clinical hour worked | Annual salary |
| Housing/travel | Typically covered by agency | Not covered |
| Malpractice | Typically covered by agency | Covered by employer |
| Health insurance | Provider’s responsibility | Employer contribution |
| Retirement | Provider’s responsibility | Employer match |
| Self-employment tax | 15.3% on net income | Half paid by employer |
| Schedule flexibility | High | Lower |
| Earnings ceiling | No cap | Often capped by contract |
For most physicians in high-demand specialties working consistent locum assignments, total compensation exceeds what a salaried permanent position offers. The breakeven calculation shifts toward locum faster than most providers expect once the full package is counted.
Key Compensation Factors
Beyond specialty, location, and practice setting, several additional factors shape what a locum provider earns. Understanding them helps you evaluate offers accurately and identify where you have negotiating leverage.
Education & Certifications
Board certification is the baseline expectation for competitive locum tenens compensation across most specialties. Subspecialty fellowship training in procedural areas — interventional cardiology, regional anesthesia, surgical oncology, telestroke neurology — commands meaningful premiums over generalist board-certified equivalents. The Interstate Medical Licensure Compact, with more than 40 member states, streamlines multi-state licensing and is the primary mechanism most locum physicians use to access higher-compensation positions across multiple states.
Practice Factors
Day-to-day practice characteristics shape compensation significantly. Call requirements, including overnight and weekend coverage, add to effective compensation through hourly premiums or per-call stipends. Patient volume and acuity matter: high-volume trauma centers and complex surgical hospitals pay top-of-range, while low-acuity outpatient settings sit at the lower end. Locum assignments typically minimize the administrative burden of permanent roles, allowing providers to focus on clinical work.
Market Demand
Locum tenens demand is driven by the persistent national physician shortage, which the Association of American Medical Colleges projects will reach up to 86,000 unfilled positions by 2036. Industry estimates indicate that approximately 85 percent of U.S. hospitals use locum tenens coverage to maintain consistent patient access during physician recruitment cycles, leave situations, seasonal volume fluctuations, and service line closures or restructurings. Urgent coverage needs typically pay 10 to 20 percent above standard market compensation, creating opportunities for providers with schedule flexibility.
Tax and Financial Considerations for Locum Providers
Locum tenens providers work as 1099 independent contractors. No employer withholds federal or state income tax from your pay. No employer covers half of your Social Security and Medicare contributions. This is the most practically significant financial difference between locum and employed work, and the most consistently skipped topic in every locum salary guide on the internet.
Self-employment tax is 15.3 percent on top of income tax. W-2 employees pay 7.65 percent of this (the employee share of FICA), with the employer covering the other 7.65 percent. As a 1099 contractor, you pay both sides. On $200,000 in net locum income, that is approximately $30,600 in self-employment tax before income tax is even calculated.
You are responsible for quarterly estimated tax payments. The IRS expects self-employed individuals to pay estimated taxes four times per year. Missing or underpaying these can result in underpayment penalties in addition to the underlying tax liability. This is not optional. Work with a CPA who specializes in physician finances to set your quarterly payment schedule from day one.
The offsets are meaningful. The 1099 structure that creates the tax burden also creates deductibility options that W-2 employees do not have. Business expenses that are ordinary and necessary to your locum practice are generally deductible. These include licensing fees, professional association dues, continuing medical education, and in some cases business travel and equipment. Malpractice coverage that you pay independently is typically deductible. High-income earners should evaluate whether an S-Corporation election makes sense, as it can reduce self-employment tax liability significantly at certain income levels.
This section is not tax advice. Physician tax situations are individual and variable. Before your first locum assignment, consult a CPA with experience in physician independent contractor arrangements.
The All Star Advantage
Competitive compensation is one piece of career satisfaction. With more than two decades placing locum providers across 85 specialties in all 50 states, All Star Healthcare Solutions supports providers across every dimension of locum practice — from compensation negotiation to credentialing to assignment matching to ongoing support. Here’s what sets us apart.
Expert Compensation Negotiation and Market Intelligence
Our consultants work with real placement data across specialties, states, and facility settings. We negotiate on your behalf and clarify the full package, from housing stipends to CME allowances to malpractice coverage. If a quoted figure sits below the ranges shown in this guide for your specialty and geography, your consultant will walk through the assignment specifics that justify the offer or negotiate appropriate adjustments.
Comprehensive Credentialing and Licensing Support
We manage the entire credentialing process from start to finish, handling document collection, primary source verification, and direct communication with facility credentialing offices. We coordinate Interstate Medical Licensure Compact filings for eligible physicians and manage state-by-state licensing for those outside IMLC scope, removing a substantial administrative burden from the provider’s side.
Flexible Assignment Options Matching Your Goals
Whether you want short-term coverage between assignments, an extended contract to evaluate a new market, locum-to-permanent conversion, or a flexible mix of placements, we provide options that match your goals. Our network of more than 150 hospital systems and more than 400 facilities provides access to roles across critical access hospitals, community hospitals, academic centers, and telehealth opportunities.
24/7 Dedicated Support Throughout Your Assignment
Your assigned consultant remains your advocate from initial conversation through the end of every assignment, available around the clock for urgent matters and checking in regularly to ensure your assignment meets expectations. We coordinate housing, travel, and credentialing logistics so you can focus on patient care.
Ready to Explore Locum Tenens Opportunities?
Whether you’re already working locum assignments and considering a different agency, evaluating your first locum placement, or building flexible practice into your long-term career plan, All Star Healthcare Solutions can help you understand what your specialty commands in the current market and identify assignments that fit your goals. Our specialty-focused consultants understand the compensation landscape across your practice area, the credentialing and licensing pathways that fit your situation, and what placements are currently available.
When you’re ready to talk specifics, we’re here.
Connect with a Specialty Consultant
Frequently Asked Questions About Locum Tenens Salary
What is the highest-paid locum tenens specialty?
Neurosurgery, cardiovascular/thoracic surgery, anesthesiology, and hematology & oncology consistently rank at the top of the locum compensation scale, with full-time equivalent annual earnings reaching $830,000 in high-demand markets. The highest figures reflect the combination of procedural complexity, fellowship-level credentials, and consistent national shortages of qualified providers.
How much can a locum tenens physician earn in a year?
A physician working full-time locum assignments, approximately 2,000 clinical hours annually, can earn between $200,000 and $830,000 or more depending on specialty. Emergency medicine physicians working consistent assignments typically earn $450,000 to $620,000. Neurosurgeons or cardiovascular surgeons in high-demand markets can exceed $700,000. Hematology & oncology placements at high-volume centers can reach the upper bound of physician compensation. Primary care physicians and generalists typically earn $200,000 to $330,000. Most physicians working consistent locum assignments earn more per year than they would in a comparable permanent position.
Do locum tenens physicians pay more taxes than salaried doctors?
Yes, locum providers pay self-employment tax of 15.3 percent on net income, in addition to federal and state income tax. W-2 employees share this burden with their employer, who covers half. The practical implication is that a locum provider earning $250,000 pays roughly $38,000 in self-employment tax that a salaried physician at the same gross income does not. Legitimate deductible business expenses offset this partially, and high earners may benefit from an S-Corporation structure. Consult a physician-specialist CPA before your first assignment.
Can nurse practitioners and physician assistants work locum tenens?
Yes. APP locum placements are a significant segment of the market, though physician placements remain All Star’s primary focus. CRNAs, psychiatric NPs, surgical PAs, and family practice NPs are among the most actively placed APP roles in locum staffing. CRNAs earn at levels approaching the physician compensation range in many markets. NP and PA compensation varies by specialty, experience, and state practice authority. All Star does not place NPs in California due to that state’s W-2 employment requirements; NP placements are available in all other states.
How does locum tenens pay compare to a permanent position?
For most physicians in high-demand specialties, locum tenens work generates higher gross income than a permanent employed position at equivalent hours. The locum compensation premium, combined with covered housing, travel, and malpractice, typically more than offsets the self-employment tax and benefits gap. The comparison is most favorable for providers in procedural specialties, those willing to work in underserved markets, and those with schedule flexibility to take short-notice assignments.
What’s the highest-paying state for locum tenens work?
The highest-paying states for locum tenens work are typically those with the most acute provider shortages relative to population. Rural states across the Mountain West (Wyoming, Montana, Idaho), parts of the upper Midwest (North Dakota, South Dakota), and rural areas of Alaska consistently rank at the top for locum compensation premiums across multiple specialties. Within most states, rural and underserved areas pay 15–25% above state metro rates, and certain shortage-designated regions in California, Texas, and Florida also command meaningful premiums.
Do rural locum tenens assignments pay more than urban ones?
Yes, in most specialties rural assignments pay 10–25% above urban baseline compensation, and the premium can reach 30% or more for hard-to-fill subspecialty roles in critical access hospitals. The differential exists because rural facilities have fewer alternative coverage options, often face genuine patient access pressures during coverage gaps, and must compete against urban and metro assignments for the same pool of qualified providers. The trade-off is location and travel; most locum providers find the compensation premium and the often-shorter assignment lengths in rural settings make these placements highly attractive.
What’s the difference between agency-placed and direct-hire locum tenens work?
Agency-placed locum tenens work consolidates credentialing, malpractice coverage, housing, travel, gap-filling between assignments, and licensing support through a single staffing partner. Direct-to-facility placement requires the provider to self-manage each of these functions, which adds significant administrative cost and time burden. Agency placement typically produces higher net effective compensation once the cost of self-managing each administrative function is counted, including the value of the provider’s own time. Most experienced locum providers work through agencies for these reasons.
Data Sources
- Locumstory 2025 Specialty Compensation Trends
- Sermo Physician Survey on Locum Tenens
- IRS Topic No. 554: Self-Employment Tax
- Association of American Medical Colleges: 2024 Physician Workforce Projections
- American Urological Association: Annual Census
- Bureau of Labor Statistics: Employer Costs for Employee Compensation
- Federation of State Medical Boards: Interstate Medical Licensure Compact
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