The Honest Pros and Cons of Locum Tenens
A pros-and-cons list is only useful when the cons are real. Here are both sides, directly — and the working approaches experienced locums clinicians use to manage the trade-offs.
The Pros
1. Schedule Control
Design your own cadence. No employer-set call schedule, no mandatory overtime, no weekend rotations you didn’t choose. You decide when, where, and how much you work — and you can redesign that decision as your life changes.
2. Compensation Upside
Locum hourly rates run above permanent equivalents in most specialties — typically 20–30% higher. The gross figure on a locum contract is closer to what hits your account than most clinicians are used to seeing, because taxes and benefits aren’t being withheld by an employer. The Barton Salary Guide publishes current ranges by specialty and region.
3. Geographic Flexibility
Many assignments are local or regional. A clinician can stay close to home and eliminate commute time, or travel to new settings and geographies for variety. The choice is yours per assignment.
4. Cross-System Exposure
Working at different sites teaches clinicians how similar medicine gets practiced under different systems, with different patient populations, different formularies, and different workflows. That breadth compounds into clinical judgment and adaptability that permanent roles rarely build.
Callout: Bart, a CRNA with Barton, describes how locum tenens work makes him a better clinician. Read it here.
5. Defined Scope
A locum clinician arrives to do the clinical work and leaves when the shift ends. Administrative drag — committee meetings, institutional politics, performance reviews — is structurally lower than in permanent employment.
Why Clinicians Choose Locums
20–30%
Higher hourly pay in many specialties
50 States
Opportunities nationwide
100% Choice
Every assignment is optional
The Cons
1. No Employer Benefits
Health insurance, retirement match, disability coverage, and life insurance don’t come with a locum contract. They become your responsibility to build. The clinicians who manage this well build their own benefit stack deliberately rather than treating the gross contract rate as equivalent to a W-2 salary.
Barton’s partnership with Earned provides financial guidance built specifically for 1099 clinicians — entity decisions, retirement options, expense optimization, and the benefit structures that replace what a W-2 employer would have handled.
Good contracts. Good pay and arrangements. Able to get in with large companies with much less bureaucracy and start work much sooner through an efficient onboarding process.
2. Income Volatility
Unlike a biweekly salary, locums income arrives contract by contract. A gap between assignments is a gap in pay. The clinicians who manage this well treat their work as a portfolio. They keep the next opportunity moving while the current assignment finishes, and they build a financial buffer sized for the 1099 model.
Barton’s recruiters work actively to keep that pipeline continuous. The goal is that you’re evaluating your next opportunity before your current one ends, not scrambling to find coverage after a gap opens.
3. Cancellation as a Known Variable
Sites occasionally cancel before a start date or shorten an assignment mid-stream. The industry cancellation rate runs approximately 12–15% – but Barton’s assignment cancellation rate averages around 5%.
When a cancellation surfaces, Barton’s role is transparent, immediate communication and a queue of alternate opportunities ready to engage.
Industry completion rate
Barton completion rate
4. Facility-Fit Risk
A site can look right on paper and feel wrong on day one. Maybe the case mix is heavier than described, or the supervision structure isn’t what was presented, or the equipment is inadequate for the work. Section 6 covers how to vet for fit before signing. Section 11 covers what to do when the fit is wrong despite the vetting.
Barton evaluates more than 123 match variables before presenting an opportunity — combining AI-powered ranking with human decision-making — to reduce the gap between what’s described and what you walk into.
5. Time Away from Home
One of the biggest misconceptions about locum tenens is that every assignment requires extensive travel. In reality, many clinicians build successful locums careers by taking assignments close to home, commuting to nearby facilities, or choosing travel only when it fits their goals.
The key is finding the rhythm that works for you. Maybe that’s staying local year-round, mixing in the occasional travel assignment, or taking longer-distance opportunities during a season when you have more flexibility. Your ideal schedule can evolve as your career, family, and priorities change.
Permanent Employment Vs. Locums Comparison
| Category | Permanent Employment | Locum Tenens |
|---|---|---|
| Schedule | Set by employer, often including nights/weekends/call | Self-designed; adjusted per contract |
| Pay structure | Predictable biweekly salary, taxes withheld | Higher hourly rate, 1099; clinician manages taxes |
| Benefits | Health, retirement, disability, life — employer-provided | Self-managed; higher gross income intended to absorb costs |
| Stability | Predictable; terminated only for cause | Contract-based; subject to site cancellation |
| Flexibility | Limited; employer approval required for changes | High; clinician accepts/declines per opportunity |
| Administrative load | Committees, reviews, institutional obligations | Lower; primarily clinical |
| Career growth | Institutional ladder, titles, tenure | Clinical depth and breadth; business autonomy |
The right model depends on what you’re building this year.
What's My Fit?
The bottom line
Every career choice comes with trade-offs, and locum tenens is no exception. The goal isn’t to ignore those realities. It’s to understand them and have the right support system in place. The best locum tenens partners help you navigate everything from finding assignments that fit your lifestyle to credentialing, licensing, travel, and financial planning. That’s what turns locums from a series of one-off jobs into a sustainable, rewarding way to build your career.