Locum Tenens Physician: What It Means and How It Works
A locum tenens physician workforce of roughly 52,000 doctors annually, representing about 7% of the available U.S. physician population, is no longer an emergency resource at the edge of hospital operations. CHG Healthcare's locum tenens report also describes a workforce that has expanded since 2015 and now supports both full-time and part-time clinical careers. For cardiology leaders, the implication is direct: locum tenens should be managed as a controllable capacity tool, not treated as an embarrassing placeholder until permanent recruitment succeeds.
Table of Contents
What a Locum Tenens Physician Actually Does Today - Who pays and who bills
How the Locum Tenens Workforce Has Changed - Workforce comparison
Where Cardiology Programs Use Locum Coverage - Match the assignment to the bottleneck
Credentialing, Licensing, and Billing Rules That Matter - Licensing and credentialing - Medicare billing
Pay Models, Revenue Impact, and Access Equity - Access beyond the major metro
Pros, Cons, and How to Vet a Staffing Partner - The trade-off for each side
A Short Playbook for Engaging a Cardiology Staffing Partner - Build the request around capacity - Set controls before the first candidate - Manage the exit and the conversion
What a Locum Tenens Physician Actually Does Today
A locum tenens physician enters a defined clinical coverage arrangement for a hospital, health system, group, or practice. The assignment may cover outpatient cardiology, inpatient consultation, procedural work, call, or a combination of services. The physician practices under the host organization's medical staff rules, uses the host's clinical systems, and works within the privileges approved for that facility.
For the hiring organization, the role is operational rather than symbolic. The hospital identifies the exact coverage slot, confirms the scope of practice, supplies the clinical infrastructure, and coordinates onboarding. A staffing agency may hold the commercial agreement, coordinate travel and lodging, manage credentialing documents, and arrange malpractice coverage for the assignment. The agency exists because state licensure, payer administration, credentialing, and coverage risk create work that most medical staff offices and clinicians don't want to manage independently.
For the clinician, the arrangement is a discrete engagement with defined dates, duties, compensation, and travel terms. A cardiologist may accept block weeks, weekend call, clinic days, inpatient coverage, or a longer assignment while retaining control over where and when to work. The clinician generally isn't assuming an equity obligation in the host practice, and the assignment doesn't automatically convert into permanent employment.
Who pays and who bills
Payment flows depend on the contract, but the hospital typically pays the staffing agency, and the agency pays the physician under the assignment terms. The host organization generally controls the clinical setting and supplies the tax identification and billing infrastructure used for covered services. That distinction matters because a locum tenens physician isn't necessarily a W-2 employee of the hospital.
CMS states that locum tenens physicians don't bill Medicare directly. Instead, Medicare payment for covered services is made in the name and billing number of the regular physician or medical group that hired the substitute, as described in CMS guidance on locum tenens billing. The host group therefore owns the practical responsibility for claim submission, payer rules, documentation, and reconciliation.
Locums also shouldn't be framed only as a substitute for permanent recruitment. A well-designed assignment preserves cath lab access, keeps inpatient consults moving, supports referral relationships, and prevents permanent clinicians from absorbing unsustainable call. The right question is whether the coverage slot protects the program's capacity while leaders recruit, redesign, or deliberately maintain a flexible workforce.
How the Locum Tenens Workforce Has Changed
In less than a decade, the locum tenens workforce has expanded from a retirement-adjacent option into a broader physician staffing channel. The 2026 industry outlook published in the National Library of Medicine reports that physicians who had ever worked locums increased from 20% in 2016 to 41% in 2025. Physicians currently working locums increased from 5% to 14%, and 35% of clinicians with locum experience had completed an assignment within the prior year.
Career timing has shifted with it. According to the CHG report, 59% of physicians with locum experience accepted their first assignment within 10 years of completing training. Reporting summarized in the National Library of Medicine review found that 81% began immediately after training or during mid-career, while 19% started after retirement.
Workforce comparison
Indicator | Pre-2020 Norm | Current Data |
|---|---|---|
Physicians who had ever worked locums | Often viewed as a retirement-adjacent option | 41% in 2025, compared with 20% in 2016 |
Physicians currently working locums | Commonly treated as a limited bridge | 14% in 2025, compared with 5% in 2016 |
First assignment timing | Frequently associated with late career | 59% took a first assignment within 10 years of training |
Current and prior experience | Smaller specialist niche | 57,000 physicians, or 8% of U.S. physicians, were currently working locums in May 2024, with another 27% reporting prior experience |
Physicians choose locums for practical reasons. Block schedules can reduce call fatigue, create room for family obligations, and let clinicians test a new practice setting before making a permanent move. For cardiologists, that flexibility can support continued clinical work without committing immediately to partnership, relocation, or a full employed schedule.
Hospital economics have changed as well. An open cardiology position can restrict clinic appointments, inpatient coverage, procedures, referrals, and call distribution. Leaders should compare locum expense with the contribution margin and access value lost when those services remain unavailable during recruitment.
That is the workforce shift hospital executives should act on. Locum coverage is a controllable capacity tool, not merely a temporary patch. It can place cardiology coverage where permanent recruitment is slowest, including markets with documented access shortages and Health Professional Shortage Area distribution, while leadership decides whether to recruit, redesign the service, or maintain a flexible staffing model.
Executive takeaway: A permanent vacancy is an operating problem with an HR label. Locum coverage lets leadership protect clinical capacity and revenue while the long-term employment decision remains unresolved.
Where Cardiology Programs Use Locum Coverage
Cardiology programs rarely need a generic “cardiologist.” They need a specific clinician in a specific workflow, with privileges that match the service line and a schedule that protects access. The assignment should begin with the bottleneck, not the job title.
A program director may need an interventional cardiologist for block weeks while a partner takes fellowship leave or a sabbatical. The coverage shape could be full-time weeks, scheduled cath lab days, or weekend call. The credentialing file must confirm the physician's PCI experience, current privileges, and facility-specific procedural requirements before the first case.
Electrophysiology creates a different problem. EP-trained permanent candidates remain difficult to recruit in many markets, while mapping and ablation capacity can sit idle when a single physician is unavailable. An EP locum may cover defined lab blocks, consults, device work, and call. Device credentialing, procedure logs, and approval for the precise EP services matter more than a broad cardiology CV.
Match the assignment to the bottleneck
Advanced heart failure and LVAD programs need clinicians who can enter a specialized workflow quickly. A fellowship-trained physician may cover inpatient service, transplant evaluation, clinic, or call during a permanent recruitment gap. The hospital should verify training, program-specific privileges, and the clinician's ability to work within the existing multidisciplinary model.
Cardiac surgery coverage is even less tolerant of ambiguity. When a cardiothoracic surgeon leaves mid-quarter, the hospital may need full-time weeks, defined operative blocks, weekend call, or coverage across two nearby states. State licensure, operative privileges, ICU expectations, and handoff procedures need to be settled before contracting. A cardiac surgeon who can cover the operating room but not the associated postoperative workflow won't solve the program's real problem.
Rural and critical-access hospitals often require a broader arrangement. A cardiologist may provide clinic, inpatient consultation, emergency response, and scheduled call, while tele-cardiology supports selected remote interactions. The hospital must define what the physician handles locally, what can occur remotely, and how urgent transfers are managed.
Academic medical centers use locums during research blocks, parental leave, phased retirement, and faculty transitions. These assignments may be limited to clinic, consults, imaging interpretation, call, or a blend of services. Most programs combine two or three coverage shapes in a single quarter, so a single undifferentiated request usually produces poor matches.
Credentialing, Licensing, and Billing Rules That Matter
Administrative readiness determines whether a locum tenens physician starts on schedule. Hospitals often focus on finding the clinician first and discover later that a license, privilege, payer file, or malpractice document is incomplete. That sequence is backwards.
Licensing and credentialing
State licensure must match every location where the physician will practice. Multi-state work can require separate applications, verifications, fingerprints, and controlled-substance documentation. The Interstate Medical Licensure Compact can streamline the process for eligible physicians, but it doesn't eliminate the hospital's responsibility to confirm the license status and scope.
Credentialing teams should verify education, training, board status where applicable, work history, references, claims history, sanctions, procedure logs, and current certifications. Cardiology requires specialty-specific review. An interventional cardiologist, electrophysiologist, advanced heart failure physician, and cardiothoracic surgeon need different privilege files, even when they share the same broad specialty label.
Payer enrollment creates a separate dependency. The medical staff office may approve privileges while the revenue-cycle team still lacks the documentation required for claims. The hospital should assign an internal owner for payer enrollment, license expiration tracking, and final approval rather than assuming the agency owns every compliance decision.
Medicare billing
Under Medicare rules, a regular physician may bill for covered visit services furnished by a locum tenens physician only when the regular physician is unavailable, the patient seeks care from that physician, the substitute is paid on a per diem or similar fee-for-time basis, and the substitute's service period doesn't exceed 60 continuous days. Claims must identify the arrangement with HCPCS modifier Q6, according to the CMS transmittal describing the locum tenens requirements.
The hospital or group should also verify that documentation supports the billed service and that the claim uses the correct billing number. CMS's rule that the locum doesn't bill Medicare directly makes ownership clear. Revenue-cycle leaders need a written workflow covering encounter documentation, claim submission, modifier use, payment reconciliation, and exceptions that require compliance review.
Malpractice coverage should be equally explicit. The contract must state who provides coverage, the policy limits, the assignment period, and whether tail protection applies. Medical staff leaders still need to confirm the clinician's coverage before the first clinical day.
Pay Models, Revenue Impact, and Access Equity
Locum economics should be judged by the clinical capacity an assignment preserves. Comparing a temporary rate with an employed salary alone ignores idle cath lab time, delayed referrals, missed consults, and permanent physicians working beyond sustainable capacity.
Three pay structures appear most often in cardiology:
Pay Model | Typical Range | Best Fit | Revenue Leakage Offset |
|---|---|---|---|
Daily rate | Varies by specialty, scope, location, call, and schedule | Block coverage, inpatient service, interventional or surgical assignments | Protects scheduled clinical capacity and call continuity |
Hourly rate | Defined by clinical hours and call-back terms | Clinic, consults, tele-cardiology, imaging, and partial coverage | Matches spend to actual hours while preserving access |
Per-procedure or revenue-share model | Contract-specific | Select procedural arrangements with clear production definitions | Aligns payment with delivered procedures or collections |
A vacancy can create substantial downstream exposure. A 2025 industry analysis estimated annual revenue risk of up to $2.6 million for a single physician vacancy left open and reported that 46% of organizations use locums to prevent revenue loss (Medical Economics analysis). Hospitals should treat that figure as a planning reference, not an automatic justification. The business case comes from comparing the locum invoice with the margin threatened by lost referrals, procedures, imaging, and inpatient throughput.
Access beyond the major metro
Locum coverage also distributes capacity toward communities that permanent recruitment often misses. A 2026 House testimony reported that 71% of jobs worked by locum physicians were in federally designated Health Professional Shortage Areas (House testimony on physician workforce access). The same testimony estimated that 165,000 physicians have engaged in locum work. Keep those figures separate: the first describes assignment distribution, while the second describes physician participation.
That pattern makes locums relevant to rural hospitals and underserved communities, not only large systems protecting procedural capacity. For cardiology leaders, the access question is practical: can temporary coverage keep consults, diagnostics, and follow-up appointments available while the organization recruits?
CFOs should separate gross cost from net impact. Gross cost includes the clinical rate, travel, lodging, agency margin, credentialing work, and administrative time. Net impact includes protected collections, avoided cancellations, preserved referral capture, and permanent physicians' availability for their intended work. Use this physician compensation models overview to compare temporary arrangements with broader compensation structures, rather than reducing every decision to the quoted rate.
Pros, Cons, and How to Vet a Staffing Partner
Hospitals gain speed and coverage from locums, but they pay for flexibility. The daily expense can exceed the apparent cost of permanent staffing, onboarding still consumes internal labor, and changing clinicians can affect patient experience. Clinicians receive schedule control and assignment variety, but they give up the stability of employee benefits, a fixed referral base, and long-term continuity with one team.
The trade-off for each side
For hospitals, the strongest benefit is coverage security. A staffed cath lab or consult service can protect patient access while recruitment proceeds. The cost is onboarding friction, especially when privileges, payer files, and state licenses require separate review.
For clinicians, the central benefit is schedule control. A cardiologist can choose block assignments, local work, travel, or a gradual transition away from a permanent role. The trade-off is that compensation may not include the same benefits, institutional support, or durable referral relationships associated with employment.
The staffing partner determines whether those trade-offs remain manageable. Four criteria deserve explicit weighting:
Cardiology-specific credentialing: The partner should understand fellowship training, echo interpretation, cath lab privileges, EP procedure requirements, LVAD programs, and cardiac surgery scope.
Speed to presentation: Leaders should track how quickly qualified candidates appear, not how many names enter a database.
Transparent cost structure: The contract should separate clinical compensation, travel, lodging, malpractice, administrative charges, and any conversion terms.
Cultural-fit screening: A technically qualified physician can still fail if communication style, documentation habits, call expectations, or team behavior conflict with the host program.
High-volume generalist agencies may offer broad reach, but specialty cardiology partners can screen for the clinical details that determine whether a candidate is usable. A hospital should ask for references from comparable programs and review actual CVs before signing.
Contract warning: Vague non-compete language, surprise exclusivity clauses, and refusal to provide clinician references are reasons to pause, not details to negotiate after execution.
The locum tenens staffing agency guide offers a useful framework for comparing agency models. The hospital's own due diligence still needs to cover insurance, compliance history, payment practices, escalation procedures, and the agency's process for replacing a clinician who doesn't meet expectations.
A Short Playbook for Engaging a Cardiology Staffing Partner
A successful locum engagement starts with a measurable coverage definition. “Need a cardiologist quickly” is not a specification. The request should state the subspecialty, clinical setting, procedures, call burden, expected schedule, patient volume, privileges, start date, assignment duration, and the operational problem the physician must solve.
Build the request around capacity
Program leaders should quantify the gap in wRVUs, clinic sessions, procedure blocks, or call-coverage nights. The metric doesn't need to be perfect. It needs to tell the staffing partner whether the hospital needs an interventional block physician, an inpatient cardiologist, an EP lab specialist, a heart failure clinician, or a cardiac surgeon.
The hospital should then appoint one internal owner for licensing, credentialing, payer enrollment, and medical staff communication. A staffing partner can coordinate the file, but the hospital still controls its approval process. For non-remote cardiology roles, a 14- to 21-day presentation window is a practical internal benchmark for receiving qualified candidates, provided the request is specific and the market supports it.
Set controls before the first candidate
The vendor scorecard should include:
Subspecialty fill rate: Measure qualified placements, not raw submissions.
Presentation speed: Track the time from requisition approval to usable CV.
Credentialing readiness: Require a complete credentialing file within 72 hours of contract execution when the physician has supplied the necessary records.
Malpractice terms: Confirm coverage limits, assignment dates, claims handling, and tail obligations.
Communication ownership: Name the recruiter, credentialing contact, clinical escalation lead, and hospital decision-maker.
The hospital should decide whether the assignment requires a day-one start or can tolerate a flexible launch. That decision changes the acceptable candidate pool and the amount of internal preparation required.
Manage the exit and the conversion
Off-boarding needs the same discipline as onboarding. The handoff should cover pending results, unresolved consults, follow-up responsibility, procedure logs, access termination, equipment return, and final billing reconciliation. Written KPI reviews at 30, 60, and 90 days should assess coverage delivered, documentation quality, clinical fit, schedule adherence, and financial performance.
If a locum becomes a permanent candidate, the conversion discussion should begin with clinical value and market alignment, not an automatic reset of compensation baselines. The hospital should define conversion fees and timelines before the assignment starts. For cardiology, an exclusive MSP-style engagement can simplify accountability when one partner has demonstrated specialty reach. A multi-vendor roster may be more appropriate when the system needs different channels for interventional cardiology, EP, heart failure, and cardiac surgery.
American Cardiology Group provides locum tenens coverage for cardiology and cardiac surgery roles, coordinating candidate matching and credentialing support for hospitals and health systems. Leaders managing a cardiac coverage gap can review available options and connect with American Cardiology Group to discuss a defined temporary assignment, permanent search, or combined workforce plan.
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