A hospital administrator I know once described her first locum hire as “signing a lease on an apartment you’ve never seen.” The agency rep was charming, the placement happened fast, and the physician showed up Day 1 to a 40-patient clinic day — when the recruiter had described it as “light volume.” Nobody lied, exactly. Nobody had asked the right questions.
That’s the real risk with locum tenens agencies: not fraud, but friction. The gap between what you assume and what’s contractually documented.
The Short Version:A reputable locum tenens agency should cover placement, malpractice, licensing, and travel at zero cost to the provider. The questions below separate agencies that actually do this from ones that just say they do. Print this list before your next call.
Key Takeaways
- Assignments run 1 day to 1 year — nail down exact dates, hours, and call burden before signing
- Reputable agencies charge facilities, not providers; you should never pay placement or credentialing fees
- Malpractice tail coverage and payment terms (look for NET 15) are negotiable and must be documented
- High physician turnover at a facility is a red flag — ask directly how many left in the last 12–18 months
For context on how agencies are structured and evaluated before you start asking questions, see The Complete Guide to Locum Tenens Agencies.
The 15 Questions
1. Do you charge the provider any fees — ever?
This one’s non-negotiable. Reputable agencies — NALTO members, NCQA-credentialed firms — cover job placement, malpractice insurance, and travel costs at no charge to the provider; the facility pays the agency. If an agency hedges on this or mentions “processing fees,” that’s your answer.
2. What are the exact start and end dates, daily hours, and weekly total?
“Standard schedule” is not an answer. Get it in writing: specific dates, hours per day, hours per week, and whether weekends are included. Vague terms are how physicians end up working 60-hour weeks at a “light” placement.
3. What is the call burden — frequency, type, and whether it’s in-house or remote?
Call is where assignments quietly break down. Ask how many nights per week, whether it’s phone-only or in-house, and what triggers a callback. One or two call shifts a week is very different from every-third-night with mandatory return.
4. What was the realistic patient volume for the last locum in this position?
The single most important question on this list. Ask specifically: how many patients per hour, what was the typical daily census, and — critically — would that provider return? Answers like “it varies” or “totally manageable” are not answers.
Reality Check:Physicians who accept vague volume assurances routinely describe walking into “absolute chaos” on Day 1. One data point from a prior locum is worth more than any recruiter’s summary.
5. How many physicians left this department in the last 12–18 months?
High turnover is a facility-level warning sign, not a staffing coincidence. If a department has been running on continuous locums for over a year, ask why permanent hiring hasn’t resolved it. Long-term locum dependency often signals an environment that burns people out.
6. Who provides malpractice coverage, what are the limits, and who handles post-assignment claims?
This is where providers get hurt. Confirm whether coverage is occurrence-based or claims-made. If claims-made, who pays for tail coverage after the assignment ends? Get the policy limits in writing — $1M/$3M is a common floor, but it varies by specialty and facility.
7. Does your agency facilitate state licensing, and do you have alliances with state medical boards?
Credentialing delays kill placements. Strong agencies have established relationships with state boards that accelerate licensing timelines. Ask specifically: will you manage the application, and what’s the average time-to-credential in the target state?
8. What are the payment terms, and what does the timesheet approval process look like?
Payment tied to timesheet submission is standard. Barton Associates, for instance, operates on NET 15 upon timely submission — meaning you’re paid within 15 days of an approved timesheet. Ask: who approves, what’s the deadline, and what happens if approval is delayed on the facility side.
Pro Tip:Get the name and title of the person who approves timesheets before you start. “The billing department” is not a point of contact.
9. What does the scope of practice cover, and what procedures am I expected to perform?
Don’t assume specialty alignment means procedural alignment. A hospitalist role at one facility may include procedures that another site handles through a separate service. Confirm specific procedures, documentation systems, and whether there are mid-levels or support staff.
10. What are the travel and lodging arrangements — and what’s your policy on companions or pets?
Top-tier agencies handle flights, rental cars, and housing. Ask whether lodging is agency-arranged or stipend-based, whether a travel companion can be accommodated, and who covers parking and incidentals. These details affect whether a 3-month assignment is livable.
11. Is there paid orientation, and what support exists on Day 1?
Walking into an unfamiliar EMR with a full patient panel and zero orientation is genuinely dangerous. Ask whether there’s a paid orientation day, who the go-to support contact is, and whether IT support is on-site or remote.
12. What is the cancellation policy — for both sides?
Facilities cancel assignments; it happens. Ask what notice the agency requires, whether you’re compensated for short-notice cancellations, and under what conditions you can exit without penalty. The Student Doctor Network forums are full of providers who didn’t ask this and found themselves locked in.
13. Are you a NALTO member, and how do you handle credentialing verification?
NALTO (National Association of Locum Tenens Organizations) membership indicates adherence to ethical standards around primary source verification and provider treatment. It’s not a guarantee of quality, but its absence — especially combined with other vague answers — is a signal.
14. What’s the sick day and emergency coverage policy?
If you get sick mid-assignment, who covers? Is there a backup provider, and are you financially penalized for legitimate illness? This matters less for short assignments but becomes significant for anything over 4–6 weeks.
15. What are my options at the end of the assignment — can I convert to permanent, extend, or transition independently?
Some agencies include exclusivity clauses that prevent direct hire by the facility for a period after placement. Know what you’re agreeing to. If you find a role you love, you don’t want a contract standing between you and a permanent offer.
Quick Comparison: What Good vs. Mediocre Agencies Look Like
| Factor | Strong Agency | Red Flag |
|---|---|---|
| Provider fees | Zero | Any fee to provider |
| Malpractice | Provided + tail explained | ”You’ll need to arrange that” |
| Credentialing | Managed + board alliances | ”You handle licensing” |
| Payment terms | NET 15, named approver | Vague or “net 30–45” |
| Volume transparency | Prior locum data available | ”Standard caseload” |
| Cancellation policy | Written, mutual | Unilateral or undefined |
| NALTO membership | Yes | Not a member, can’t explain why |
Practical Bottom Line
Go into your next agency call with this list open. The questions aren’t aggressive — they’re professional. Any recruiter worth working with will answer them without hesitation, and the ones who get evasive are telling you something important.
Start with questions 1, 4, and 6. If those answers are crisp and specific, keep going. If they’re vague, the rest of the conversation is probably going to be more of the same.
For a broader framework on evaluating and comparing agencies side by side, the complete locum tenens agency guide covers NALTO membership, NCQA credentialing standards, and how to read contract language before you sign.
The right agency makes temporary work feel sustainable. The wrong one makes a 13-week assignment feel like a trap you negotiated yourself into.
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Nick built this directory to help hospital administrators find reputable locum tenens agencies without wading through vendors who oversell their provider networks — a credibility gap he discovered while researching physician staffing options for a rural health system facing an unexpected specialist vacancy.