The Complete Guide to Locum Tenens Agencies

A skill check for article writing — moving forward with the detailed instructions provided.

I showed up at my first hospital administrator meeting expecting to hire a doctor the same way you’d hire a contractor — post the need, get a few bids, pick someone. Three weeks later, the locum was still waiting on credentialing, the facility was paying for an empty call schedule, and the agency I’d used was unreachable at 11pm when the first shift started without coverage. Nobody had told me there was a difference between agencies that actually manage this process and ones that just forward resumes.

That experience sent me down a deep research spiral on how locum tenens agencies actually work — what separates the good ones from the ones that ghost you mid-crisis, what the contracts really say, and what physicians wish hiring administrators understood (and vice versa).

The Short Version:

A good locum tenens agency handles credentialing, licensing, malpractice, travel, housing, and contract logistics so physicians can focus on patients and facilities can focus on care. The difference between agencies comes down to specialty depth, credentialing speed, and how they behave when something goes wrong at 2am.

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Key Takeaways

• NALTO® membership signals an agency follows ethical placement standards — it’s the first filter worth applying
• Credentialing to JCAHO standards is non-negotiable; agencies that skip pre-screening create privileging delays that cost facilities weeks
• Physicians should maintain at least five active state licenses to maximize assignment access
• The bill rate (what facilities pay) covers more than physician pay — it funds credentialing, insurance, logistics, and the recruiter relationship

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What a Locum Tenens Agency Actually Does

Here’s what most people miss: a locum tenens agency isn’t a staffing agency in the traditional sense. It’s closer to a full-service operations partner for a physician’s temporary practice — and a logistics coordinator, insurance handler, and contract negotiator rolled into one for the facility side.

On the physician side, a full-service agency manages:

• State licensing — tracking application timelines, gathering documents, following up with medical boards
• Credentialing — primary source verification, JCAHO-standard malpractice documentation, facility privileging packets
• Malpractice coverage — providing tail or occurrence coverage so physicians aren’t exposed mid-assignment
• Travel and housing — booking flights, hotels, extended stays, or furnished apartments (or paying a stipend if physicians prefer to arrange their own)
• Contract negotiation — advocating for competitive rates and reviewing terms before signature
• Weekly payment via direct deposit — so physicians aren’t chasing invoices

On the facility side, the same agency is simultaneously running background checks, confirming specialty competency, coordinating with your credentialing department, and serving as the point of contact if anything breaks down mid-assignment.

Dr. Rip Patel, an emergency medicine physician who has done both agency-placed and independently-negotiated locum work, puts it plainly: agencies “make sure that everything is set up on time, such as travel and housing arrangements. This way you’ll be all set before you start your first shift.” That sounds obvious until you’ve watched a solo-arranged placement fall apart because a license verification took three extra days and nobody owned the problem.

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The Agency Landscape: Not All Created Equal

The locum tenens industry has no central registry. There’s no single place a physician or administrator can search and find every available assignment or every reputable agency. That’s both a frustration and a filter — the agencies that survive on word-of-mouth and physician loyalty tend to be the ones worth working with.

NALTO® (National Association of Locum Tenens Organizations) sets the closest thing the industry has to professional standards. Member agencies agree to ethical placement practices, transparent compensation, and provider-matching standards. It’s not a guarantee of quality, but it’s the baseline filter. If an agency isn’t a NALTO member, ask why.

Beyond membership, the meaningful differentiators are:

CompHealth, LocumTenens.com, and CoreMedical Group are among the larger players — CompHealth leans on experienced recruiters for both first-timers and established locum physicians, CoreMedical focuses on matching around lifestyle goals (debt payoff timelines, travel preferences), and LocumTenens.com markets itself on handling the full business side so physicians don’t have to think about anything except the clinical work.

Smaller regional agencies often have deeper facility relationships in specific markets. Bigger isn’t always better — it depends on whether the agency’s recruiter network actually knows your specialty.

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How to Hire a Locum (The Facility Side)

Most facilities approach this backwards. They call an agency before they’ve defined what they need, which leads to a credentialing delay when the placed physician doesn’t match the actual scope.

Before you contact a single agency, get specific:

1. Specialty and subspecialty — “hospitalist” and “nocturnist” have different coverage implications
2. Pay range — know your bill rate ceiling before you negotiate
3. Patient volume — what’s a realistic daily census or procedure count?
4. Call requirements — in-house, home call, phone only?
5. EMR system — Epic, Cerner, or something proprietary? Factor in orientation time
6. Procedures required — intubation, central lines, scope work? Credentialing packets differ
7. Credentialing timeline — how many weeks can you wait before the gap causes real harm?

Pro Tip:

Give this information to every agency you contact simultaneously. The first agency to present a credentialed candidate who matches your spec wins the placement. Speed rewards preparation.

Once you’ve contacted agencies, the contract you’ll sign will define: the parties (hospital, agency, physician as independent contractor), the bill rate and payment terms, assignment details, on-call scope, travel and housing logistics, licensing timelines, dispute resolution, and a non-solicitation clause preventing direct-hire without a buyout period. Read the non-solicitation terms before you sign — they vary significantly and can affect your ability to convert a strong locum to a permanent hire.

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How to Work With an Agency (The Physician Side)

The consensus among physicians who’ve figured this out: start with agencies, especially for your first few assignments. The operational complexity — licensing, credentialing, malpractice, housing — is real, and agencies absorb it at no direct cost to you (they make their margin on the bill rate spread).

A few things nobody tells you until you’re already behind:

Maintain at least five active licenses. This is the single most actionable thing a physician can do to maximize assignment access. States have different processing times — some are months, some are weeks. If you only have one or two licenses when a good assignment opens, you may miss it entirely. Five is the recommended floor.

Build your reference bank early. Agencies typically want 6-12 months of verifiable references. If you’re transitioning out of a long-term employed position, make sure you have recent contacts who can turn around verification quickly. Gaps in your reference history slow credentialing more than almost anything else.

Work with multiple agencies simultaneously. This is standard practice, not disloyal. No single agency has access to every assignment, and having multiple recruiters working on your behalf broadens your options without any downside. Be transparent that you’re doing this — good recruiters expect it.

Negotiate through the agency. Agencies advocate for higher rates because their margin improves with your rate. Use that alignment. If you’re an experienced physician with specialty certifications or subspecialty skills, your recruiter should be pushing for premium pricing on your behalf.

Reality Check:

The “going direct” route — bypassing agencies and negotiating directly with facilities — is possible and sometimes lucrative for established physicians. But it requires you to manage licensing, credentialing, malpractice, contracts, and logistics yourself. Most physicians who’ve done both report that the operational overhead of going direct isn’t worth it until you have existing relationships at specific facilities and a well-oiled administrative process. Even then, many keep one or two agency relationships active for the flexibility.

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What’s in the Contract

Locum tenens contracts have three parties: the healthcare facility, the agency, and the physician (as an independent contractor). The physician typically signs an agreement with the agency; the facility signs separately with the agency. You may never see the facility’s side of the contract.

Key terms to scrutinize on the physician side:

• Scope of work — what clinical activities are explicitly covered by malpractice?
• On-call requirements — are they compensated separately or bundled into the daily rate?
• Cancellation terms — what happens if the facility cancels 48 hours before your flight?
• Licensing and credentialing costs — who pays for state license fees? (Standard is agency-covered, but verify)
• Housing and travel specifics — what’s included, what’s a stipend, what’s reimbursable?
• Non-solicitation — how long and how broad is the restriction on going direct with this facility?
• Dispute resolution — which state’s law governs? Which forum for arbitration?

If the contract language is ambiguous on any of these points, ask the agency for clarification in writing before you sign. A staffing agent who’s invested in the relationship will want clean terms — ambiguity creates problems mid-assignment that nobody wants.

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Comparison: Service Models

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Future of the Industry

Locum tenens demand isn’t slowing. Physician shortages in rural and underserved markets, post-pandemic burnout driving permanent physicians toward flexible arrangements, and healthcare systems’ increasing comfort with temporary staffing all point toward sustained demand. The agencies competing for the next decade will differentiate on credentialing speed (the biggest friction point in the current model), specialty niche depth, and technology — better matching tools, faster licensing coordination, and more transparent rate reporting.

Telemedicine is also expanding what “locum” means — remote coverage for rural EDs, telehealth specialty consults, and cross-state credentialing are creating new assignment categories that the traditional agency model is still adapting to.

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Practical Bottom Line

If you’re a physician considering locum work: start with two or three NALTO-member agencies, get your five state licenses active before you need them, and let the agency handle the logistics. The operational overhead isn’t where your time should go.

If you’re an administrator trying to fill a gap: define your spec completely before contacting anyone, work multiple agencies in parallel, and read the non-solicitation clause before you sign anything. The agency relationship works best when you treat it as a long-term partnership, not a one-time transaction.

The agencies worth working with — on either side — are the ones who behave well when something goes sideways. Ask every agency you’re evaluating: “What happens if there’s a problem mid-assignment?” Their answer will tell you everything about whether they’re actually a partner or just a placement service.

For a deeper look at how specific agency types compare, see our complete guide to locum tenens agencies.