Locum Tenens Playbook | How Clinicians Get Paid

The Short Answer

Locum tenens clinicians are paid as independent contractors (1099), typically bi-weekly direct deposit through their staffing agency. Pay is based on hours or days worked, with no taxes withheld at the source. Clinicians are responsible for quarterly estimated tax payments and self-employment tax on top of regular income tax.

Locums Income Is Built, Not Fixed

One of the biggest shifts in locum tenens is how you think about your income. Instead of earning a fixed salary from one employer, your annual earnings are built from the assignments you choose throughout the year.

That gives you flexibility. You might take a higher-paying assignment to reach a financial goal, then stay closer to home for your next one. Some clinicians prioritize premium rates in rural or high-demand locations, while others value predictable schedules, familiar facilities, or shorter commutes. Most build a mix that reflects their priorities.

The most successful locum clinicians don’t evaluate assignments in isolation. They think about how each opportunity fits into the bigger picture. Every contract becomes another building block toward their financial goals, lifestyle, and career.

By approaching locums this way, you gain something that’s difficult to find in a traditional employed role: the ability to design a career that evolves alongside your life.

Highest Paid Specialities

Rank	Specialty	Typical Annual Compensation	Typical Locum Rate
1	Neurosurgery	~700K–900K+	250–400+/hr
2	Cardiovascular & Thoracic Surgery	~650K–850K+	250–375+/hr
3	Orthopedic Surgery	~600K–800K+	225–350+/hr
4	Vascular Surgery	~550K–750K+	220–325+/hr
5	Urology	496K–559K	177–275/hr
6	Gastroenterology	~500K–650K	180–300/hr
7	Anesthesiology	~450K–600K	200–350/hr, with cardiac, pediatric cardiac, and OB anesthesia commanding the highest rates
8	Radiology (especially Interventional Radiology)	~450K–600K+	200–350+/hr, with IR consistently earning the strongest premiums

Source: Barton Associates Salary Guide 2026. Rates vary by geography, setting, and assignment specifics.

What's in Each Contract (and What's Not)

Every locum assignment starts with a compensation rate, whether that’s hourly, daily, or per shift, depending on your specialty and the facility. Barton also provides malpractice insurance, and many assignments include travel and lodging.

What isn’t included are the benefits you may be used to in a permanent role, like health insurance, retirement contributions, paid time off, and the employer’s share of payroll taxes. As an independent contractor, you’ll be responsible for planning for those expenses yourself.

The good news is that locum compensation is designed with that in mind. With thoughtful financial planning, many clinicians find they can cover those costs while still coming out ahead financially.

Three Tax Mechanics Every Locum Clinician Needs to Understand

Self-employment Tax

The IRS requires 1099 clinicians to cover both the employee and employer sides of Social Security and Medicare contributions. The combined rate is 15.3% on top of regular income tax, applied to net self-employment earnings. This is the number that surprises most first-year locum clinicians.

Quarterly Estimated Taxes

The IRS expects 1099 income earners to pay taxes quarterly, not annually. Estimated payments are due in mid-April, mid-June, mid-September, and mid-January.

Business Deductions

Many costs a W-2 employee pays personally become legitimate business deductions for a 1099 clinician. The deduction framework available to independent contractors can offset 20–35% of gross income for established locumpreneurs. The 1099 Tax Deductions for Healthcare Professionals guide covers the categories in detail.