Locum Tenens and Temporary Practice Guide | MedXL

Locum tenens work, filling a role temporarily while a position is vacant or a colleague is away, has grown from a stopgap into a deliberate career choice for physicians and other clinicians across the United States and Canada. Done well, it offers schedule control, varied experience, and often strong earnings; done carelessly, it produces licensing headaches, contract disputes, and tax surprises. This guide covers how locum work actually operates in both countries and how to protect yourself while benefiting from it.

How locum tenens work is structured

A locum assignment involves three parties in most cases: you, the facility that needs coverage, and often an agency that connects the two. Assignments range from a single weekend of call coverage to multi-month placements, and common patterns include:

• Vacancy coverage while a facility recruits a permanent hire
• Leave coverage for parental leave, illness, or sabbaticals
• Surge or seasonal coverage, including rural and remote rotations
• Ongoing part-time coverage, where a facility permanently relies on rotating locums

In the US, locum physicians typically work as independent contractors, engaged directly or through staffing agencies, with the agency often arranging travel, housing, and malpractice coverage. In Canada, locum work is frequently coordinated through provincial locum programs, health authorities, or individual practices, and compensation may flow through fee-for-service billing, contracts, or per-diem arrangements depending on the province and setting. The structures differ enough that experience in one country does not transfer directly to assumptions about the other.

Licensing and credentialing: the real constraint

Your ability to take assignments is gated by licensure, and this is where planning pays off most.

• United States. You need a full license in each state where you practice. The Interstate Medical Licensure Compact expedites obtaining licenses in participating states for eligible physicians, but it is an expedited process, not a single national license. Nurses have the Nurse Licensure Compact with its own membership map. Verify current participation and eligibility on the compact websites and with each state board.
• Canada. Licensure is provincial, through each College of Physicians and Surgeons or equivalent regulator. Several provinces offer defined locum or provisional license classes, and there are programs aimed at easing short-term coverage in underserved areas. Requirements, license classes, and processing vary by province; consult the destination college directly and early.
• Credentialing and privileging. Beyond the license, every facility must credential you. Agencies often manage the paperwork, but the underlying documents are yours to supply: complete employment history, references, certifications, and procedure logs where relevant. A well-organized credentialing packet is the single biggest accelerator of your availability.

Start license applications well before you need them. Processing times vary widely and are outside your control; never rely on informal estimates of how fast a board or college will move.

Money: pay, expenses, and taxes

Locum compensation is usually higher per shift than permanent employment, reflecting the absence of benefits and the inconvenience premium. Treat the comparison honestly by counting everything.

• What you gain: higher hourly or daily rates, often paid travel and housing, and control over how much you work.
• What you give up: employer-paid health and retirement benefits (especially significant in the US), paid leave, and continuity of income between assignments.
• Taxes. As an independent contractor in the US you handle self-employment tax and estimated payments; in Canada, locum earnings often flow as self-employed or professional income with provincial variation in billing arrangements. Cross-border work adds treaty and residency complexity. Engage an accountant experienced with clinician contractors in your country before your first assignment, not at tax time.
• Insurance. Confirm exactly what malpractice coverage applies to each assignment, who pays for it, whether it is occurrence-based or claims-made, and who covers the tail if claims-made. In Canada, confirm your protection through the Canadian Medical Protective Association or applicable provider covers the province and work type. Put the answers in writing.

Never fabricate assumptions about rates: they vary by specialty, region, urgency, and setting. Compare multiple offers and ask agencies to break out what is included.

Reading a locum contract

Every locum engagement deserves a written agreement, and a careful read. Watch for these clauses:

1. Scope and schedule. Exact duties, call obligations, patient volumes, and supervision or support available. Vague scope invites scope creep.
2. Cancellation terms. What happens if the facility cancels late, and what notice you owe them. Cancellation asymmetry is the most common source of locum grievances.
3. Malpractice coverage, including tail responsibility, as above.
4. Non-compete and non-solicitation. Some agreements restrict you from later taking permanent work with the client facility except through the agency, or charge conversion fees. Understand these before you fall in love with a site.
5. Payment terms: rate, overtime or call premiums, invoicing process, and payment timelines.
6. Expenses: what travel, housing, licensure, and credentialing costs are reimbursed, and how.

Have contracts reviewed by licensed counsel familiar with healthcare contracting in your jurisdiction, particularly for long assignments or unfamiliar structures. The review fee is small against the downside of a bad clause.

Is locum work right for you now

Locum practice fits some career stages better than others. It tends to work well for:

• Early-career clinicians sampling practice settings before committing
• Experienced clinicians seeking schedule control, travel, or gradual retirement
• Anyone bridging between permanent roles, relocations, or training stages
• Clinicians drawn to rural and underserved coverage, where need is persistent in both countries

It fits poorly when you are seeking mentorship-heavy development, deep continuity with patients, or maximum benefit accrual, or when family logistics make travel costly. Many clinicians blend models: a permanent part-time anchor plus periodic locum assignments.

Ask facilities and agencies pointed questions before accepting: Why is the position vacant? What happened to the last locum? What does orientation include? What EHR is used and what training is provided? How is after-hours support arranged? Weak answers predict difficult assignments.

Working with agencies and finding assignments

Agencies vary in quality. Signals of a good one include transparent contracts, named credentialing support, responsive problem-solving mid-assignment, and willingness to share the facility's identity and history early. Register with more than one, and keep your own records of every commitment.

You can also source opportunities directly: hospital career boards list temporary and locum roles alongside permanent postings, and provincial locum programs advertise coverage needs. MedXL's job search aggregates healthcare postings from hospital and health-system career boards across the US and Canada, and filtering by specialty and region is a practical way to see which employers repeatedly need coverage in the places you want to work.

Keep your own credentialing file complete and current: licenses, certifications, immunization records, references, and employment history. Locum careers are won by clinicians who can say yes quickly.

Key takeaways

• Locum work trades benefits and continuity for rate, flexibility, and variety; count the full package when comparing to permanent roles.
• Licensure is the binding constraint: state-by-state in the US (with compact expediting for the eligible), province-by-province in Canada. Apply early and verify requirements with each board or college.
• Confirm malpractice coverage, including tail responsibility, in writing for every assignment.
• Read cancellation, non-compete, and payment clauses carefully, and use licensed counsel for contract review.
• Vet facilities and agencies with direct questions about vacancies, support, and past locums.
• A complete, current credentialing packet is your biggest competitive advantage in temporary practice.

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