Locum Negotation: Tips for Success
I thought I negotiated a fanstastic rate for my my locum job back in 2024. I had been preparing for months. I knew not to share my CV in advance and that I could ask for a slightly higher rate if the position was local or if the posting had been open for a long time. I did some research online, spoke to a few recruiters from different companies, and chatted with a friend who worked as a locum physician for a few months at the end of her residency. All that data suggested an hourly rate of about $200 was a good benchmark.
When a job came up in my area with a busy practice, I felt ready. The recruiter offered just under $200. I asked for a few dozen dollars more, assuming we would land somewere in the middle and it worked! The recruiter agreed to increase the rate by $30 above their initial offer. I gave myself a high-five and gave the recruiter permission to present me to the facility, locking me in to a contract with their agency.
It took a few months before I realized my victory was hollow. I was being paid below the market rate for a position with much higher volume and acuity that most locum roles. Here is everything I wish I knew back then:
You can’t trust everything you read on the internet
My benchmark was based on various blogs I’d read online, inlcuding one that pops up near the top of the search page for “locum pay” that quotes broad ranges for each specialty. At the time, it quoted a range of $150 - $200 hourly for OBGYN locums. At first glance, it’s not clear who writes the blog with its muted palette of secondary colors. The “About Us” page refers vaguely refers to “began as a campaign to tell the “story” of the locum tenens industry”. I assumed it was written by a physician who wanted to stay anonymous online. It never occured to me to read the fine print at the bottom of the page, which shows the blog copyright belongs to a corporation that owns several locum agencies and a vendor management system. It makes sense now that the blog primed me to accept the lowball rate offered by locum recruiter: it was written by an agency. Agency websites tend to post estimates for locum pay as well, and specifically extrapolate them into annual salaries that sound high. But those blogs don’t mention the number of hours at their unfavorable rates you would have to work to make that salary and don’t account for the cost of benefits you would usually get from an employer that you are not responsible for on your own.
A post published on that same blog in September 2025 gives a current range of $150-$225 as an hourly range for OBGYN. I have no problem telling you that since that first job I’ve never even considered accepting anything in that range.
Sources need to be current as well as trustworthy
The reason I accepted a low rate for my first locum job is simple: I didn’t know any better. I didn’t know the industry and I had no idea what to expect. I did speak with a friend who had worked OBGYN locums and was willing to share the rates she had earned with me. However, she hadn’t worked locums for several years at that point, and unbeknownst to both of us, OBGYN locum pay has changed significantly since the pandemic. Additionally, her jobs had mostly been in government and Indian Health Services roles, which typically do not pay as well as the private sector. There are several communities of physicians who work in locum tenens roles online and if you are considering this path, I strongly suggest joining one of those groups and getting some information on what jobs in your speciality are paying right now.
Beware the bait and switch
Falling for a low rate was not the only error I made in negotiating that first locum role. After my interview with the practice, my recruiter texted me late at night. She had good news and bad news. The good news was the practice was impressed with my interview and wanted to bring be on board. The bad news was the practice couldn’t afford my rate. They were insisting they couldn’t pay more than $205 an hour. Still above the inaccurate benchmark I had set based on faulty data, but less than the rate I had agreed to in order to presented. Would I be willing to accept that reduced rate? The recruiter wasn’t giving a true choice, and she knew it. Because she had presented me, she and her agency now owned me at this facility. I could either accept the rate or walk away from the opporunity entirely. Once again, my inexperience worked against me. Locum agencies do not disclose the physician’s rates their clients. The facility had not declined my rate; they had no idea what I was being paid. The agency had decided they would rather keep the $15 difference between their initial offer and this new rate, and they were being dishonest - lying about the source of the change and hoping I would be less likely to push back against the group of docotrs I had just met and offered to help. You might be thinking that $15 is not a big deal, but it adds up. I covered just over 700 hours of call in eight months on that assignment. A consistent assignment over a full year could lead to 1000 hours of coverage or more over the course of a year, during which $15 per hour would add up to $15,000 pre-tax dollars left in a corporate bank account when you could be using it to pay for health or disability insurance.
Now when I negotiate with a locum agency I ask them to confirm my base rate, holiday pay and overtime pay in writing before I agree to presentation. I look out for red flags. If the recruiter says they are “happy to present at that rate and see what the facility says” or that they “think we can get that rate but the won’t know for sure until the facility meets you” or declines to confirm the rate in writing, I tell them in no uncertain terms I cannot move forward until the rate is confirmed.
The rate is the rate
I didn’t make the switch to locums until I was over a decade into my career and I was lucky not to have any malpractice judgements or settlements on my record, but I’ve heard all manner of manipulative language from recruiters to try and keep money away from the physician and in their pocket. Recruiters will tell you that the best rates are only availble to
board-certified physicians
physicians with x years or experience
physicians z years out of residency
physicians who have attended 1 million births or performed 3000 hysterectomies in the past 30 days
physicians with no history of malpractice claims, judgments, or settlements.
All of that is bullshit. The client is paying the agency a certain amount of money to provide a physician to perform clinical services. The work you will be asked to do won’t be any different based on your years of experience or professional liability history, so your pay shouldn’t be other. Honestly, if a recruiter starts down this path I laugh and move to end the conversation.
Money isn’t everything
It’s common for recruiters and locum newbies to focus on the hourly rate in their initial negotiations. But there is a whole contract involved in signing up for a locum assignment and the terms laid out there was just as important - even more so - than how much you will be paid per hour. I eventually discovered that my recruiter had lied about my rate and confronted her. The agency increased my rate, but told the facility I was demanding a raise and that was just the first of a series of unprofessional choices made by the agency. I ultimately chose to end my contract early. The practice I had been covering was understanding and they would have liked to keep working with me, but I was stuck in a 2-year noncompete which I had not bothered to negotiate down to a year. While luckily it never came up I realize now I had no contractual guarantee of payment in the agency or facility cancelled a shift at the last minute. Other contracts I’ve reviewed (and either walked away from or successfully rengotiated) have included clauses that would:
allow the agency and their client to cancel my shifts at any time, but would leave me with no ability to cancel shifts, even for emergencies.
allow the agency to provide malpractice insurance below the usual $1M/3M coverage standard at the client or agency’s discretion; or do not include an obligation for the agency to provide tail coverage.
block me from working with the client as long as I have any active contract with the agency or block from working with any facilities that are owned by the same company as the client, even if I’ve never been presented to or worked at the facility.
allow the agency to collect the recruitment fee they’ve negotiated with the facility from me if the facility wishes to work the me directly.
stipulate that in that event of a legal conflict I would be responsible for all arbitration fees - both mine and the agency’s.
There are more, but that’s for another post. The bottom line is
Learn about the market from other (current) locum physicians. The agencies have a financial incentive to promote lower compensation rates for doctors. Dividing your current salary by a hundred hours a week doesn’t work either - locum work is flexible, but can be inconsistent, and you need to factor in the cost of health/disability/life insurance and paid time off that you would usually get from your employer. You can sometimes use the volume and acuity of the facility or your proximitiy to the site to request higher compensation, but your strongest bargaining position is to confidently quote current market rates for your specialty.
Use your leverage. You have the most power in a locum negotiation when the recruiter is vying for a chance to represent you - before you’ve shared your CV, before you’ve signed a service agreement, before the recruiter has done a name clear. That is the time to ask lots of questions about the site - how busy is it? how sick are the patients? what job responsibilities are expected? what type of malpractice insurance does the agency provide? what are the terms of the agency’s provider agreement and can they be changed to terms you find favorable? Once you’ve been presented, the agency owns you and has little incentive to agree to anything you request.
Don’t get tunnel vision. Money is important, but so are your professional reputation, protection from lawsuits, protection from sudden cancellation and loss of income, flexibility to work accept an employment offer from a client if that is mutually agreeable. Remember that the hourly fee is just part of your compensation and the other parts are worth protecting too.
Renegotiation is possible. It’s easy to get hoodwinked by a recruiter into accepting lower rates or unfavorable contract terms, but just because you have started the assignment that way doesn’t meet you have to continue. After I realized I had fallen for a bait and switch with my agency I requested a call with the recruiter and informed them that I wanted the rate I had agreed to or I would quit. They met my demand, even though they chose to use it to squeeze the client for more money. By that point, the client knew and like me (or at least found me competent) and so they were willing to pay a bit more to keep me on - though they shouldn’t have had to. A less dishonest set of recuiters would simply have increased the rate without involving the client.
✈️ Want more locum tips?
Thanks for reading! Have thoughts, questions, suggestions for future posts, or your own story to share? Drop a comment below - I’d love to hear from you.