10 Lies Your Locum Agent Has Told You
“It’s easy money.” “You’ll have total flexibility.” “We’ll handle everything.”
If you’ve ever talked to a locum recruiter, you’ve probably heard some version of this sales pitch. And while locum tenens work can be a great fit for many physicians, the truth is that agencies don’t always make it easy to find that perfect role. The industry is full of smoke and mirrors, especially for those new to the game. In this post, I’ll break down some of the most common myths agencies use to hook clinicians—and what you actually need to know to make it to an agreeable contract.
“I need your CV before I can talk to you about our available positions.”
In general, the agent-physician relationship is exclusive once it’s been started, and it starts with your CV. Most agents will not tell you this, but once you have shared your CV, the agent who enters into the company system is the only agent you can work with — even if you later decide that you don’t trust them, or they are otherwise not a good fit. There are also horror stories out there of physicians discovering they have been “presented” for a role (more on that later) without their knowledge or permission, tying them to an agent or agency they may not have intended to work with. A reputable agent will work to earn your trust: they will ask questions about the types of roles you are looking for, if you’re willing to travel and how far, specific needs around accommodation, and your desired compensation, then discuss details of jobs that match your preferences before requesting your CV when you are ready to move forward with being “presented” to a facility. When I share my CV, I watermark it specifically to state which agency I am sharing it with and the facility I am interested in. At this point, I’m tempted to walk away from any agent who starts a conversation this way, but instead I usually take a deep breath and decline to send my CV over, leaving the ball in their court to course-correct.
“That rate is just too high. The going rate for your specialty is . . .”
It’s possible your locum agent is giving you an honest estimate of the available rates for locum work in your specialty. It just hasn’t been my experience, and here’s why: Locum agencies pitch their services to hospitals or medical practices for a certain fee — $X per day or $Y per hour of contracted physician time. Once the facility agrees, they go out and look for a physician to a provide services for a portion of that fee. The less they pay you, the more they can keep for themselves. It pays them to let you believe your desired rate is unreasonable. In fact, many of the online articles with stated locum rates are owned and run by agencies — provider service agreements often prohibit physicians from sharing details about their rates publicly. If you have a network of physicians who do locum work in your specialty, chat with them about the rates they are getting to establish your baseline. If you don’t have a network yet, you’ve got two options: you can try and estimate reasonable pay for locums based on MGMA salary data or . . . use the tried-and-true negotiation tactic: just ask for more and see what happens. For the first 6 months I did locums I just threw out a bigger number each time I spoke to an agency until I hit a ceiling. I was still underpaid by at least $45/hour in my first locum role, but I got $30 more than the agencies initially offered me.
“Ok, fine. Some doctors in your specialty do get that rate, but I can’t pay you that because . . .”
“… you’re not board-certified yet.”
“… you have a pending malpractice claim.”
“… this is an inpatient job.”
“… this is an outpatient job.”
“… the facility is local. Travel jobs pay more.”
“… the facility is far from you, and we would have to pay for your travel.”
“… mercury is in retrograde.”
You get the idea. If you end up signing a contract to provide services at a facility, you will be asked to do the same work regardless of your distance from residency, board certification status, malpractice claims, or anything else. Travel is reimbursed by the facility separate from the physician services fee. There is no rhyme or reason. These are just ways for the agent to try and justify a rate that puts more money in their pocket. When I first started looking for locum position, I spoke an agent who was representing a facility looking for outpatient coverage. I stated by desired rate and backed it up by saying I had done my research on what locum in my specialty pays. “Oh, that must be for inpatient!”, my agent responded kindly. “Outpatient pays less because its 8am-5pm with no overnights or weekends”. I suspected she wasn’t being honest, but she was not suggesting a huge difference. A few months later, the facility decided they really wanted inpatient call coverage. This time, the agent claimed outpatient pays more because of the higher number of expected patient encounters in the office versus on-call coverage. Luckily, I had our texts to refer to and by then, I had connected with a network of docs who set me straight on how much to request.
“Let’s present you for the role now. It doesn’t bind you to anything.”
This one is a half-truth, but it is particularly insidious. Allow me to explain: when a locum agency enters a client agreement with a facility or practice, the contract usually includes a “non-compete” clause stating that the facility will not work with any physician the agency introduces (“presents) to them in any capacity for up to two years. Breach of this clause could mean the facility owes the agency up to $35,000 (sometimes more) in “buyout fees”. Because the client agreement is signed before the agency even goes out to scout for physicians, it applies to you, even if you have not actually signed a contract! So sure, you can decide you do not want a position after you’ve been presented, but that’s not the issue. If you do want the position but can’t reach an agreement with the agency on the rate or find a portion of the provider service agreement objectionable, you have lost a significant amount of negotiating power. Once you’ve been presented, you can’t work directly with the facility (unless they’re willing to pay the buyout fee) and you can’t shop around to another agency that might have terms you find more agreeable. Don’t get tied down.
“I can’t confirm the rate (or other details) for this position until after the presentation.”
See #4. This is a ploy to lock you into the noncompete and steal your bargaining power before the negotiation has even begun. A conscientious agent will offer some transparency. They will share the full description of the practice (roles and responsibilities, expected volume, details about staffing etc.), rates, and a copy of their provide service agreement so you can both be comfortable the role is a good fit before you move forward. And if there are details they don’t have, they will reach out to the facility to clarify. Let’s face it, it’s not a good use of the facility’s time to interview a bunch of providers who are actually looking for a position that is worlds away from the one they’re trying to fill. When faced with this one, I calmly reiterate that I am not able to decide if I am interested in presentation until I have the details and redlined copy of the service agreement.
We can’t make any changes to the provider service agreement.
Speaking of the service agreement, it’s negotiable. Everything is negotiable. Common (and reasonable) changes to request are:
removing the non-compete clause or revising it to make the time period shorter (e.g. 6 months instead of 2 years), decrease the buyout fee, or limit it to the specific facility (versus all partner facilities or all of the agency’s clients).
removing the indemnification clause or revising it to balance your legal risk with the agency’s.
adding payment and cancellation guarantees so that if the agency or client cancels a shift with less than a certain number of days’ notice, the agency is still required to pay your fee, regardless of if the client pays them.
clarifying the type of professional liability coverage and stipulating that the agency pay tail coverage in the event of a lapse in a claims-made policy.
You may not get everything you want in a negotiation, but refusal for an agency to discuss your desired changes or make reasonable adjustments is a red flag. Don’t walk away, run.
“I presented you for your desired rate, but the client declined. Their maximum is . . .” OR “We can present you for that rate, but the client may choose someone cheaper.”
I cannot stress this one enough. The client has no idea what you are being paid. The client has no idea what you are being paid. THE CLIENT HAS NO IDEA WHAT YOU ARE BEING PAID. See #2 above. The agency charges the client a set fee, then negotiates with you to decide what portion of the fee they will pay for your time. They won’t share that fee with you; and they won’t share your cut with the client. When an agent says this, what they usually mean is that they spoke with their agency colleague on the facility side, and they’ve decided together that they individually need higher commissions, or the agency needs a larger profit margin. I fell for this one early on. despite trying to do everything right: For my first contract, I did not agree to presentation until I had details, I pushed back on the low rate the agency offered, I reviewed the PSA and requested changes to the noncompete and confirmation of tail coverage and payment guarantee. After my interview, my agency sent a text message — the client loved me, but they could only afford to pay $15 less than the hourly rate I had negotiated. I hesitated and sought advice from a friend who have never locums. She thought $15 wasn’t such a big deal and I moved ahead with the agreement. A few weeks later, I found a social media group of locum physicians in my specialty. It only took a few minutes of scrolling through the posts to realize I’d been had! Not only could the client not have objected to my fee, but I was being paid $45 less than the average for my specialty. I called my agency immediately letting them know I was hip to the game and demanding my original rate be honored. They agreed, but it was the beginning of the end for that partnership. Feel free to professionally reveal that you are aware they facility pays the agency a set fee and the agency then negotiates with the doc. Then sit back and wait for the response.
“Yes, we’re offering less than your desired rate, but it’s because we pay for everything!”
This is another half-truth that agencies often use to justify lower rates. In addition to stipulating the hourly fee the facility will pay the agency for every hour of your time, the client agreement will state that the client reimburses the agency for documented expenses incurred to get you to an assignment including airfare, accommodation, rental care and licensing or credentialing fees. So, the agency claims they have to pay you a smaller portion of their fee because they are paying for your expenses out of pocket, but they are actually charging those expenses back to the facility and keeping a health profit margin. Also, they don’t pay for everything. Before you agree to a rate just because it seems reasonable when you divide your salary by the number of hours you spend seeing patients and doing administrative work, consider the benefits you now have to cover yourself as an independent contactor: health and disability insurance, worker’s compensation, and retirement contribution matches, among others. I provided over 700 hours of coverage before ending my first locum contract. Over that time, the $15 per hour my agency tried to shave off my fee added up to over $10,000. That’s almost a year of health insurance premiums. Your requested rate should be based on your data driven bottom-line for what you will accept, and it is separate from reimbursable expenses. Even small differences add up.
“That’s nice that you were able to get that rate, but it won’t last. In a few months, they’ll stop scheduling you.”
This is verbatim what my locum agent said to me when I walked away from my first contract after several unsuccessful attempts to renegotiate my pay. I had shared several other contracts demonstrating that I was being paid $40-60 more per hour than her agency was paying me. No longer able to claim that my expectations were unreasonable, she played her last gaslighting card — they’re paying you that now, but it’s not sustainable. They will find someone cheaper and shut you out. Nearly a year later, those contracts are still going strong. In fact, as I’ve expanded my locum practice, the agencies I’ve worked with now are often asking me to pick up more dates that I have to spare. I am the one turning them down. Sure, agents will preferentially schedule a physician who accepts lower fees over you if they can help it. But the nature of locum work is that is transient, and you always have to keep your eyes peeled for signs a contract may be winding down and your ears to the ground for new opportunities. Being cheap is no guarantee; there can always be someone cheaper. In fact, every time a physician accepts a lower rate it brings the whole professions bargaining power down. Don’t be the rate-limiting step.
“No one will want to work with you if you keep trying to do this on your own terms.”
Another verbatim text from the agent I parted ways with. She seemed so sweet and accommodating when she was pulling the wool over my eyes with low rates and unfavorable contract terms but quickly changed her tune once I started to advocate for myself. Not only have I continued to work successfully with other agencies and facilities, but she has since reached out to me to gauge my interest in picking up some work through her agency. I considered pointing out the irony that the person who said no one would want to work with me was back in my messages asking to do exactly that, but instead I politely let her know that my calendar is full, and I am not looking for any additional work at this time. Self-advocacy isn’t dangerous in locum tenens; it’s essential. The key is to be professional in your communication and always leave the door open to work together in future . . . if the situation aligns with your terms, of course.
Locums can open doors—but not if you’re walking in blind. Knowing the red flags and recognizing recruiter spin is the first step to finding gigs that actually work for you. If you're just getting started or you’re tired of the bait-and-switch, you're in the right place. Stick around, subscribe, and let’s build careers with intention.
Thanks for reading! Have thoughts, questions, suggstions for future posts, or your own story to share? Drop a comment below—I’d love to hear from you.