Build a Locum Tenens and Moonlighting Practice as a Physician

1. 1

   Treat coverage work as a business, not a stopgap

   The shift in mindset is the whole idea: locum tenens run deliberately gives you schedule and location control at roughly $100 to $300 per hour, often with malpractice and travel covered. Build it with an entity, a licensing strategy, and rate negotiation, the way you would any business.

2. 2

   Build a multi-state licensing strategy

   Assignments follow demand across states, so proactive licensing keeps you ready. Check whether the Interstate Medical Licensure Compact speeds things for you, and get licensed before you need the work, since licensing takes time.

3. 3

   Choose agencies, direct contracts, or both

   Reputable agencies source assignments, handle credentialing, and often provide malpractice for a cut; direct facility contracts pay more but require doing that work yourself. Read agency terms carefully for non-competes and cancellation clauses.

4. 4

   Set up the tax and entity structure

   Locum income is typically 1099, so work with an accountant on an entity, self-employment tax, quarterly estimates, deductions, and retirement savings. This protects a high hourly rate from quiet erosion.

5. 5

   Verify malpractice on every assignment

   Confirm in writing who provides coverage, whether it is occurrence or claims-made, and whether tail coverage is included. A malpractice gap can surface years later, so make this a non-negotiable checklist item.

6. 6

   Negotiate rates and keep the calendar full

   Know your specialty's going rate, negotiate from real numbers, and take some harder-to-fill assignments, which pay more. Your income is rate times booked hours, so filling the calendar is the ongoing work.

7. 7

   Use it as freedom or as a bridge

   Some physicians run locum full-time for the flexibility; others use it to bridge income while building another business or trying practice settings before committing. Decide what role it plays for you and structure your bookings around that goal.

Do not take our word for the money. Put your own numbers in and see what this idea has to earn before it works. Free, instant, no account needed.

Best for: Licensed physicians who want to control their schedule and location while staying clinical, whether full-time locum or moonlighting alongside a primary job

Not for: Not for anyone without an active medical license; this is clinical work. Not for a physician who wants a fixed, predictable, one-location routine, because the model trades stability for flexibility and income can vary with how much you book. And not for someone unwilling to manage the business side (licensing, taxes, malpractice verification, rate negotiation), since that operating work is what turns coverage shifts into a real practice.