Most healthcare organizations did not plan to rely this heavily on locum tenens coverage. A few years ago, locums were the bridge you used when a search ran long or a provider went on unexpected leave. The assumption was always that the situation would stabilize and you would get back to a fully permanent model.
That assumption has not held up. What we are seeing across the market right now is that many organizations can no longer maintain consistent coverage with permanent hires alone, and that is not a temporary condition. The shortage is structural, it is worsening in specific specialties, and the organizations that are managing it well are the ones that stopped treating locum tenens as an emergency measure and started treating it as part of how they staff.
The data from 2024 and 2025 confirms what we are seeing in real searches. The question is no longer whether to use locums. It is where, how much, and how to build it into a strategy that actually works.
The Numbers Behind the Shift
The most telling statistic in recent AAPPR benchmarking data is not the overall usage figure. It is the rate of change. Organizations used locum tenens as a stopgap in 16.4 percent of physician searches in 2024, which was nearly double the 9.2 percent reported the year before. That kind of year-over-year movement does not happen because a few more organizations discovered locums as an option. It happens because searches are staying open longer than expected, candidate pipelines are thinner than projected, and leadership teams that planned to wait out the shortage are realizing they cannot.
CompHealth found that actual locum utilization in 2024 came in 25 percent higher than what facilities had originally budgeted for. That gap between projection and reality is important. It means organizations are still underestimating how hard their searches will be and how long coverage gaps will last. Many of the searches we work on that were expected to close in three to four months are running six to nine.
The longer-term pressure driving all of this is not going away. The AAMC projects a physician shortage of between 37,800 and 124,000 providers by 2034. More than two in five active U.S. physicians are currently over the age of 55. The Staffing Industry Analysts reported 17 percent growth in the locum tenens market in 2023, with expansion continuing through 2026. The pipeline is not catching up. Locum tenens is not filling a temporary gap. It is compensating for a workforce that is aging out faster than being replaced.
Where Locum Demand Is Highest — and Why It Makes Operational Sense
Specialty-level locum demand is not random. The pattern you see in the data follows a logic: the specialties with the highest locum usage are exactly the ones where a coverage gap has immediate, measurable revenue and patient safety consequences.
Among specialties with at least 50 physician searches on record, AAPPR data shows the top five for locum usage:
- Anesthesiology — 65.4%
- Pediatrics — 47.5%
- Urgent Care — 41.5%
- Hospital Medicine — 30.1%
- Emergency Medicine — 24.4%
What those percentages mean in practice:
Anesthesiology at 65.4 percent means the OR does not run without locum coverage. Every day an anesthesiology position sits open is a day of surgical revenue that does not happen. Hospitals do not delay cases indefinitely while a search progresses. They call a locum agency. The 62.5 percent of anesthesiology searches that remained unfilled after a full year in the AAPPR data tells you everything about why that is the case.
Pediatrics at 47.5 percent reflects a specialty where rural and semi-rural markets have largely lost the ability to attract permanent candidates. In some regions, locum pediatricians are what stand between a functional pediatric service and families driving two hours to the nearest alternative. That is not hyperbole. It is what the access data looks like.
Emergency medicine at 24.4 percent is moving in a direction that concerns us. Burnout in emergency medicine is acute and well-documented, and it is changing retention patterns in ways that make EM increasingly hard to staff permanently. We are seeing more experienced EM physicians shift to locum arrangements as a way of staying in the specialty without the grind of a full-time position. That changes the calculus for organizations banking on permanent hires to anchor their ED coverage.
Beyond the Top Five: Where Else Pressure Is Building
Psychiatry is the specialty we talk about most when it comes to access crisis. The Health Resources and Services Administration reports that more than 160 million Americans live in areas designated as mental health provider shortage areas. In rural markets, the situation is not just difficult. In many cases, a permanent psychiatry hire is not a realistic goal regardless of compensation. Locum psychiatrists are frequently the only viable path to keeping behavioral health services operational.
Primary care and internal medicine are often overlooked in locum discussions because the urgency feels less acute than in procedural or surgical specialties. But Doximity’s 2025 data identified internal medicine and family medicine as the two most in-demand locum specialties by job posting volume. The demand is there. The difference is that primary care gaps tend to show up in access and quality metrics over time rather than in an immediate OR shutdown, which makes them easier for organizations to defer addressing. That deferral has a cost.
Surgical specialties as a category are trending upward in locum demand. The American College of Surgeons reported that surgical residency matches in 2025 beat the prior year’s record by more than 4 percent. That is good news that is still not enough. The AAMC still projects a shortage of 15,800 to 30,200 surgical physicians by 2034. Supply is growing, but not at the pace the workforce math requires.
Neurology, OB-GYN, and gastroenterology are all dealing with converging pressures: early retirement waves in some markets, rural access gaps, and disease prevalence that is rising faster than the available workforce. In a growing number of those situations, locum coverage is not a bridge to something permanent. It is the primary delivery mechanism for care.
Geography: Where Locums Have Stopped Being Optional
AAPPR data shows locum tenens was used in 15.8 percent of urban physician searches, 13.9 percent of rural searches, and just 5.2 percent of suburban searches in 2024. The suburban number is notable because it reflects markets where permanent recruiting still functions relatively normally. Urban and rural markets tell a different story.
In rural markets specifically, the conversation has shifted. Organizations that once used locums to cover while a permanent search was underway are now using locums as the staffing model, full stop. There is no permanent search planned for certain positions because the organizations know from experience that running one in their market will not produce a hire. Locum tenens is not supplementing their workforce strategy in those cases. It is their workforce strategy.
For urban markets, the driver is different. Competition for the same pool of candidates is intense, searches are taking longer, and organizations are using locums to protect patient volume and team morale while permanent searches progress. Letting a coverage gap sit unaddressed while a search runs eight or ten months creates downstream problems that are harder to fix than the original gap.
Why Physicians Are Choosing Locums
The supply side of this equation has changed in ways that are not fully reflected in how most organizations think about recruitment. The assumption has been that locum physicians are providers who could not find a permanent position, or who are in a transitional moment. That is not who is driving locum growth right now.
Doximity’s 2025 data found that more than 63 percent of physicians are already working locum tenens or actively considering it within the next five years. The motivations are real and varied:
Schedule control is the reason cited by 29 percent of locum physicians in CompHealth data. For physicians who have spent years in schedules that were not their own, the ability to work when and where they choose is not a minor perk. It is a fundamental change in how they experience their career.
Burnout recovery is a driver that does not always show up cleanly in survey data but comes through clearly in individual conversations. Physicians who are exhausted by the administrative load, the documentation burden, or the culture of a particular system are using locum work as a way to stay in medicine without staying in the conditions that were wearing them down. For some, it becomes permanent. For others, it is the thing that makes a permanent role possible again.
Physicians approaching retirement are using locums to scale back without fully stepping away. Rather than going from full-time to nothing, they are working locum assignments at a pace that suits their life. That population represents a meaningful portion of available locum supply in several specialties, and organizations that can work with that flexibility benefit from providers with deep experience who would not be available in a traditional hiring process.
Residents and fellows coming out of training are using locum assignments to evaluate organizations and markets before committing. The willingness to walk into a permanent offer without knowing what the day-to-day reality is has decreased significantly among younger physicians. Locum work lets them see the inside of a system before they sign a long-term contract.
That last point matters for permanent recruiting. The provider your organization wants to hire permanently may already be open to a locum arrangement first. That is not a consolation prize. It is an opportunity to make a genuine case for your organization in a way that a job posting cannot.
What This Means for How Organizations Should Be Thinking
The organizations that are navigating this market effectively have stopped treating permanent and locum hiring as separate decisions made by different people at different times. They are making them together at the beginning of a workforce planning conversation, not after a gap has already become a problem.
What that looks like in practice: using locum coverage to protect service line continuity while a permanent search runs, rather than waiting to see if the search closes before calling for coverage. Building locum relationships before they are needed urgently, because the market for locum coverage in high-demand specialties is competitive and availability is not guaranteed. Recognizing that a physician who takes a locum assignment with your organization is also evaluating you as a potential permanent employer.
Organizations that are still treating locums as an emergency-only tool are, in most cases, consistently behind. They are reacting to gaps instead of managing ahead of them, paying premium rates for last-minute coverage, and losing candidates who would have been available if the conversation had started earlier.
The workforce reality in physician staffing right now is not going to simplify in the near term. Shortages in the specialties driving the most locum demand are projected to deepen through the end of the decade. The organizations that will staff most effectively through that period are not the ones waiting for conditions to normalize. They are the ones building models that work in the conditions that actually exist.
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Sources
AAPPR 2025 Physician and Provider Recruitment Benchmarking Report — aappr.org
AMN Healthcare 2024 Survey of Locum Tenens Physicians and Advanced Practitioners — amnhealthcare.com
Doximity 2025 Physician Compensation Report — doximity.com
CompHealth State of Locum Tenens Report, 2025 — comphealth.com
AAMC Physician Shortage Projections, 2021-2034 — aamc.org
HRSA Mental Health Provider Shortage Data — hrsa.gov
Staffing Industry Analysts, 2026 Healthcare Staffing Trends — staffingindustry.com
American College of Surgeons, 2025 Residency Match Data — facs.org
