Are locums hospitalist rates worth the loss of benefits and job security?
By Ryan Inman
Published · Updated
The short answer
Sometimes, for a season and on purpose. As a permanent default, usually not. The posted rates are real now, and they are on the record: AMN Healthcare lists its hospitalist and nocturnist locums jobs at $179 to $200 an hour in October 2026, with an average annualized pay of $347,000 across 488 locums hospitalist jobs over the last year.
A locums rate is still a bare number: it carries no employer payroll tax share, no retirement match, no health premiums, no disability or life coverage, no paid leave, and in many arrangements no malpractice tail, so the headline rate has to replace all of that and still clear the employed package before the flexibility is worth anything. Locums wins when the assignment premium is large, the gaps between assignments stay short, and you run the business side like a business. It loses a few percent at a time, when the rate merely looks higher than a salary.
Part of the internal medicine hub.
What the posted rates actually annualize to
Run the posted band against a full hospitalist schedule before you compare it with a salary. At $190 an hour, the middle of the AMN band, a 12 hour shift pays $2,280, because 190 times 12 is 2,280. A seven on seven off year is about 182 shifts, and 182 times $2,280 is $414,960 of gross receipts if every block is filled. That is the number that makes locums look unbeatable, and it assumes a full book of business with no gaps, no credentialing waits, and no cancelled blocks.
The same firm's own averages tell the second half of the story. AMN annualizes its 488 locums hospitalist jobs from the last year to an average of $347,000, and its currently open hospitalist jobs to an average of $362,000. The Wellhart hospitalist salary guide puts locum tenens hospitalist pay at $160 to $200 an hour. Barton Associates, working from its own salary tool, puts the locums income increase for hospitalist physicians at up to 37 percent over permanent pay. Set those against the employed anchors: a self reported hospitalist average of $314,000 at Physician Side Gigs, and an average adult hospitalist shift rate of $142 an hour in the Today's Hospitalist 2023 Compensation and Career Survey. The honest read: the hourly premium over employed shift rates is real, roughly $40 to $60 an hour at the posted band, and the average annualized locums figure lands only about 10 to 15 percent above the employed salary average before the benefits layer is priced. The premium lives at the top of the band and in a full calendar. It evaporates in gaps.
Build the employed total first
You cannot judge a locums rate against a salary. Judge it against the employed package's full cost. Start with the W2 base, then add the layer that never reaches a paycheck: the employer half of the 15.3 percent payroll tax, the retirement match (a 4 percent match on $300,000 is $12,000 a year), health premiums the employer carries, group coverage, malpractice with tail, licenses and CME, and any paid time the contract actually grants. On a seven on seven off schedule, add the value of schedule certainty itself: the employed hospitalist is paid for the off weeks' existence, while the locums physician earns only on days worked, so every unpaid week between assignments is a pay cut the rate has to absorb.
Then add the two items locums physicians most often forget to price. The first is forgiveness: working inside a nonprofit hospital as a 1099 locums physician usually means your legal employer is an agency or yourself, not the hospital, so those years may not count toward the 120 qualifying payments, and a physician mid count can strand years of progress. The second is the retirement menu: no 403(b), no governmental 457(b) with its separate $24,500 deferral for 2026, only the solo 401(k) you build yourself. The W2 or 1099 question on this site works the contractor premium math, and its rule holds here with interest: the contractor side needs to clear the employed package by about 25 to 30 percent before it is the same pay. Measured against that rule, a locums year has to gross roughly $390,000 to $410,000 to stand even with a $314,000 employed package once the layer is priced, which means holding rates near the top of the posted band for nearly every shift of the year.
Run the locums season deliberately
Where locums shines is as a season with a job to do. Paying off a loan balance outside a forgiveness track. Funding a reserve to the full 12 month level that sporadic income demands, because the waterfall's finished reserve for 1099 and sporadic income runs up to twelve months of expenses rather than the six a W2 employee targets. Testing a market or a hospital before signing employed. Bridging between positions without a noncompete fight. In each case the premium is aimed at a named target with an end date, and the business machinery gets built first: your own disability policy with own occupation language, since no group plan follows you, term life, a solo 401(k), quarterly tax estimates, and a separate account that holds the tax money and the gap money apart from spending. The tax and retirement machinery itself is worked in the locums taxes and retirement question on this site.
What locums should not be is the permanent plan you drifted into because the first rate sounded high. Price your last twelve months honestly each year: total locums income against the employed package total, including the benefits you bought yourself, the unpaid weeks, and the retirement room you lost. If the premium survived that audit, keep going with a clear conscience. If it did not, the employed market at $307,000 average and $314,000 hospitalist average in the current data is not a consolation prize. It is the better instrument, and it was all along.
Related questions
What does a locums year actually need to gross to match my employed package?
Roughly $390,000 to $410,000 to stand even with a $314,000 employed package once the benefits layer is priced. The contractor side needs to clear the employed package by about 25 to 30 percent before it is the same pay, which means holding rates near the top of the posted band for nearly every shift of the year.
I am mid count on PSLF. Do locums years inside a nonprofit hospital keep the count moving?
Usually not. As a 1099 locums physician, your legal employer is the agency or yourself, not the hospital, so those years may not count toward the 120 qualifying payments. A physician mid count can strand years of progress.
Sources
- AMN Healthcare, locum tenens hospitalist physician jobs (posted pay bands of $179 to $200 an hour on current hospitalist and nocturnist listings, an average annualized pay of $347,000 across 488 locums hospitalist jobs over the last year, and an average of $362,000 across currently open jobs, accessed October 2026)
- Wellhart, Hospitalist Salary Guide (locum tenens hospitalist pay of $160 to $200 an hour on average, accessed October 2026)
- Barton Associates, Locum or Permanent Positions: Which Pays More? (hospitalist physician income can increase by up to 37 percent in locum tenens work, per the Barton Associates salary tool, accessed October 2026)
- Today's Hospitalist, 2023 Compensation and Career Survey executive summary (average adult hospitalist shift rate of $142 an hour, survey of 2022 compensation, accessed October 2026)
- Physician Side Gigs salary database (internal medicine hospitalist average of $314,000, self reported, accessed October 2026)
- Medscape Physician Compensation Report 2026 (internal medicine average compensation of $307,000, accessed October 2026)
- Internal Revenue Service, Self Employment Tax (Social Security and Medicare Taxes) (the self employment tax rate is 15.3 percent, made of 12.4 percent for Social Security and 2.9 percent for Medicare, accessed October 2026)
- Internal Revenue Service, 2026 retirement plan limits (Notice 2025-67: 2026 elective deferral limit of $24,500, with a separate limit for governmental 457(b) plans, accessed October 2026)