Insights From Wapiti

For many U.S. physicians seeking flexible work options, locum tenens and per diem roles offer alternatives to traditional full-time employment. In simple terms, a locum tenens physician temporarily fills in for another provider for a fixed period, while a per diem clinician works on an as‑needed, day-to-day basis. 

Comparison: Locum Tenens vs Per Diem

The table below outlines the major differences between locum tenens and per diem physician work. It covers typical contract terms, scheduling, pay and benefits, credentialing, travel requirements, malpractice coverage, and lifestyle impact. This side-by-side comparison helps highlight how each arrangement works in practice.

Each row above summarizes general trends. For example, locum tenens pay is often negotiated as a fixed daily or weekly rate (sometimes with travel stipends), whereas per diem pay is hourly and typically higher per hour to offset lack of benefits. Locum contracts guarantee a block of work (and income) for weeks or months, while per diem work guarantees nothing beyond each shift. The difference in credentialing is important too: locum agencies usually handle paperwork across multiple sites, while per diem doctors often work with a single facility’s HR department for credentials.

Contract Length and Scheduling

Locum tenens assignments come with defined start and end dates. A contract might be a 2-week coverage, a 3-month maternity leave fill-in, or even longer. Once you accept a locum assignment, you agree to the schedule laid out in your contract (e.g. specific days, shifts, or hours per week). Many agencies pride themselves on flexibility. For example, at Wapiti, providers can build schedules to meet their needs, whether picking up just a few shifts or making a full-time locum career. But during each assignment, the schedule is mostly fixed and reliable.

Per diem work has no commitment beyond individual shifts. Facilities call on per diem doctors as needed (sometimes at short notice) and offer available shifts. The physician then chooses whether to accept. This model means maximal scheduling freedom; you might work only when it fits your life, but you also have no guarantee of any work. If shifts are scarce one month, your income can dip accordingly. On the other hand, if you have other priorities (family, travel, education), per diem lets you adapt day-to-day.

In short: locum = stable, block-schedule under a contract; per diem = as-needed, pick-your-shifts flexibility. Locum work can allow flexible scheduling within the structure of each assignment, while per diem offers the ultimate choice of “when I want to work,” albeit with uncertainty of hours.

Compensation and Benefits

Locum Tenens: 

Because locum physicians fill in staffing gaps, pay rates tend to be competitive. Contracts often specify a daily or weekly rate (for example, $X per day or $Y per week). These rates are frequently higher than a full-time equivalent, since they offset the lack of employee benefits and the inconvenience of temporary work. 

Crucially, most locum agencies or facilities cover ancillary costs: travel expenses (flights, car rental), lodging or a housing stipend, and malpractice insurance during the assignment. In other words, you arrive and start working without worrying about those costs. Wapiti explicitly provides malpractice coverage, travel assistance, and credentialing for its providers. Some locum contracts even include health insurance stipends if assignments are very long.

Per Diem: 

Per diem doctors are typically paid an hourly or per-shift rate. That rate is often high to compensate for the lack of benefits (no health insurance, paid time off, etc.) and for filling in on short notice. For example, if a full-time ED physician makes $X/hour including benefits, a per diem ED shift might pay significantly more per hour. However, per diem shifts come with no employer-provided perks: travel, housing, health insurance, and retirement are all up to the provider. 

Credentialing and Licensing

Locum Tenens: 

Agencies simplify the onboarding process for each new assignment. When you join a locum tenens agency, their team often helps you compile licenses, certificates, and references, and then submits credentialing applications to each facility. They often track expiration dates for your license and training, and may even help with multistate licensing if you travel across state lines. Wapiti provides credentialing assistance as part of our service. In effect, you maintain one profile with the agency, and they manage the paperwork for each assignment. This can speed up credentialing by centralizing documentation.

Per Diem: 

Per diem providers typically work within one hospital system or local group of facilities. Credentialing is done on a facility-by-facility basis. Often the HR or medical staff office will guide you through paperwork, but it’s less streamlined. If you work per diem at multiple hospitals, you may need multiple credentialing processes. There’s usually no third-party agency to help and because of that you (or a local recruiter) handle it. Because per diem schedules are unpredictable, facilities may fast-track credentialing for a known provider, but it varies. The key point: locum agencies generally take on most credentialing tasks, whereas per diem doctors and facilities share that burden.

Travel and Practice Location

Locum Tenens: 

Travel is a hallmark of locum tenens work. Many locum jobs are in rural or underserved areas, or simply in cities far from your home. Agencies arrange assignments nationwide, so you may cross state lines frequently. Wapiti, for example, specializes in placing providers in rural locations. Typically, the agency pays for or reimburses transportation (flights, mileage) and lodging so you can focus on patient care. This aspect of the job can be exciting for adventurous physicians; it’s an opportunity to see new places and practice in varied settings.

Per Diem: 

Travel is usually minimal. Per diem shifts are often at hospitals or clinics near where you live or already have privileges. You likely commute from home in the morning and return home after a shift. Occasionally, a hospital might ask a per diem doctor to work a block at a satellite location, but generally, travel reimbursements don’t apply. If a per diem physician does travel for a shift, expenses are usually out-of-pocket (though some employers might offer a flat stipend). Overall, per diem work is far less “travel-heavy” than locum tenens work.

Malpractice and Insurance

Locum Tenens: 

One advantage of locum work is malpractice coverage. Most locum tenens positions include malpractice insurance (usually tail coverage) provided by the agency or the hiring facility for the duration of the assignment. This means you can work under the protection of a professional liability policy without buying an extra policy. (However, you may want your own umbrella coverage for travel). Because of this, locum tenens doctors save on insurance costs and paperwork.

Per Diem: 

Malpractice arrangements vary. If you have hospital privileges, the facility often covers your liability insurance while you are on shift (similar to how they cover staff physicians). However, some per diem or independent contractors must carry their own malpractice insurance. Typically, per diem work is shorter and less frequent, so hospitals sometimes extend their coverage to cover you on shift, but it’s crucial to confirm. In any case, per diem doctors should ensure they have adequate malpractice insurance, either via the hospital’s coverage or privately.

Lifestyle, Flexibility and Burnout

Locum Tenens Lifestyle

Locum tenens work offers built-in variety and downtime. Physicians on locum contracts may work intensively for a few weeks or months, then take a full break between assignments. This can significantly improve work-life balance: you can plan vacations, personal time, or moonlight in between gigs. Many doctors report less burnout because they avoid hospital politics and can “reset” between contracts. Providers often choose locum work for the flexible, freedom-based lifestyle and travel opportunities. On the flip side, constantly adapting to new hospitals, teams, and EMR systems requires resilience. The travel and change of scenery can be a perk for those who enjoy adventure, but it can also be tiring for others.

Per Diem Lifestyle: 

Per diem work centers you around a home base. You work when you want and take off when you want. This extreme flexibility can be ideal for physicians who have significant commitments outside of work (family, research, hobbies). For example, a doctor finishing their residency might do a few per diem shifts while job searching. Because there’s no long-term schedule, many find per diem less exhausting day-to-day. However, the lack of steady routine and team continuity may feel isolating to some; you might not feel like a core member of the care team, and you won’t have guaranteed camaraderie. Also, while burnout is often linked to too much work, it can also come from professional isolation, which is a risk in per diem practice.

Choosing the Right Path

Deciding between locum tenens and per diem depends on your career goals and personal preferences. Ask yourself:

• Flexibility vs Stability: Do you prefer pre-arranged work blocks (locum) or total freedom shift-by-shift (per diem)?

• Travel Tolerance: Are you eager to travel and work in new places (locum), or would you rather stick close to home (per diem)?

• Income Needs: Are you looking for guaranteed earnings over a contract (locum) or are you satisfied earning only when you choose to work (per diem)?

• Support Systems: Do you want an agency to handle credentialing and malpractice (locum), or are you comfortable coordinating directly with one facility (per diem)?

• Career Stage: New graduates often start with locum tenens to gain experience or fill income gaps, while late-career physicians sometimes use per diem to ease into retirement.

Your answers will guide your choice. Remember, it’s not necessarily an “either/or” – many physicians blend both approaches, picking up locum gigs between times they work per diem at a favorite clinic.

Getting Started and Next Steps

Both locum tenens and per diem opportunities can be explored through staffing agencies and hospitals. If you’re interested in locum tenens work, Wapiti Medical Staffing offers resources to help physicians get started, including an Official Locum Guide with tips on the application process and lifestyle. To browse current locum tenens assignments, check the Providers page or Search Jobs portals.

For physicians seeking per diem positions, consider contacting local hospitals or clinics directly. Many facilities maintain a per diem pool.