A locum tenens emergency physician is a licensed and credentialed clinician who provides temporary clinical coverage for an emergency department. These physicians are commonly used to address staffing gaps resulting from rapid departmental growth, unexpected vacancies, extended medical leave, or seasonal variations in patient volume.

By offering flexibility, locum tenens physicians help departments maintain safe, continuous patient care during periods when permanent staff are strained. As both academic and community emergency departments face rising clinical demand, locum tenens physicians have become an increasingly important operational human resource.

Although these physicians serve an essential function, their use warrants careful evaluation to ensure that both clinical performance and cost align with departmental needs. A recent study comparing productivity between permanent staff and locum tenens found that locum physicians were less efficient than permanent staff in patients per hour and RVU per hour but had similar 72-hour return rates.¹

Locum tenens physicians typically receive a higher hourly rate and generate additional expenses related to travel, lodging, and agency fees. Therefore, both cost and clinical metrics need to be monitored closely to mitigate any concerns of employed emergency physicians who may feel that the department is investing more in temporary coverage than in long-term staff development.

Transparency is key, and it is important to communicate clearly that locum tenens physicians are expected to meet or exceed the same performance standards as permanent faculty. Holding locum tenens clinicians to high expectations demonstrates respect for the efforts of the employed physician group and reinforces a sense of fairness and shared accountability.

Figure A. Example chart of locum tenens evaluation summary. Source: Elyse Hartleben, MD. Legend: The number “1” is the highest ranking; “5” the lowest ranking. In USD $ signs, the least expensive option is designated with a single $, the higher-priced options have more $. (Click to enlarge.)

A multiprong evaluation strategy allows an emergency medicine practice to assess whether locum tenens physicians are delivering high-quality clinical care, supporting departmental workflow, and offering value that justifies their cost. In Figure A, an overall evaluation based on multiple clinical care and logistical/administration components allows a department to judiciously evaluate locum tenens physicians. This framework is particularly important for a rapidly growing academic department, but the same principles can be applied to community practices, hybrid groups, or any emergency department considering locum coverage.

Efficiency and Patients per Hour

Evaluating clinical efficiency is central to understanding the contribution of a locum tenens physician. One common measure is patients per hour, adjusted for patient acuity and department conditions. A locum tenens physician should generally perform within the expected range of productivity for the group. A balanced assessment of efficiency ensures that locum tenens physicians integrate appropriately into the existing workflow.

Chart Completion and Documentation Quality

Timely chart completion is essential for accurate billing, continuity of care, and compliance with institutional standards. Locum tenens physicians should be evaluated on documentation turnaround time, chart completeness, and responsiveness to coding questions or documentation clarification requests. Establishing clear expectations for documentation helps prevent resentment and reinforces professionalism.

Cost Assessment

Cost is a major element of any locum tenens evaluation. The full financial picture includes the hourly rate, travel expenses, lodging, agency fees, onboarding costs, and any additional expenses tied to scheduling arrangements. Departments should quantify the total cost per shift and then evaluate whether the physician’s clinical productivity, reliability, and flexibility justify the investment. Tracking performance in relation to cost allows departments to determine whether ongoing engagement with a specific doctor is financially responsible.

Number of Shifts Offered per Quarter

Continuity is valuable in the emergency department. Tracking the number of shifts worked per schedule period helps identify which locum tenens physicians are contributing regularly to departmental operations. Doctors who work frequent or consistent shifts tend to understand local workflows, communicate more effectively with nursing staff, and adjust better to patient volume patterns. Those who work only sporadically may require repeated orientation sessions or may struggle with efficiency due to limited familiarity with the electronic health record or departmental processes. Regular shift patterns also help manage costs by reducing onboarding and travel-related expenses.

Patient Experience and Professionalism

Patient experience should remain a central component of any evaluation. Locum tenens physicians must be held to the same expectations for communication, empathy, professionalism, and patient-centered care as permanent faculty. Feedback from patients, nursing staff, and advanced practice clinicians can offer insight into whether a locum tenens physician is meeting departmental standards. Because locum tenens physicians represent the department and the hospital, their interactions with patients have lasting effects on the organization’s reputation. A strong emphasis on patient experience signals that quality is valued equally across all clinician groups.

Conclusion

As emergency medicine practices face rapid growth, staffing shortages, and rising patient demand, locum tenens physicians provide essential flexibility and continuity. However, their use requires thoughtful evaluation to ensure quality, fairness, and responsible financial management. A multiprong approach that includes efficiency metrics, documentation review, cost analysis, shift commitment, and patient experience offers a thorough picture of performance.

A transparent and consistent evaluation system is vital for maintaining trust between employed physicians and locum tenens physicians. Permanent faculty must be confident that temporary clinicians are held to the same standards of accountability, clinical performance, and professionalism. When departments clearly evaluate efficiency, documentation, cost, and patient experience, concerns about fairness and financial stewardship are reduced.

Holding locum tenens physicians to high standards reinforces that they are equal colleagues working toward shared goals rather than exceptions to the rule. For a growing academic department, this structured strategy supports accountability, morale, and operational stability. It is a versatile framework that can be applied to any emergency medicine practice seeking to incorporate locum tenens coverage while maintaining high standards of emergency care.

Dr. Otero is vice chair for Clinical Operations, director for the Health Executive and Administrative Leadership Fellowship, and a professor of emergency medicine at Froedtert Hospital at the Medical College of Wisconsin.

Dr. Hartleben is an assistant professor of emergency medicine, the Department of Emergency Medicine Physician Lead for Scheduling, and the assistant medical director of the Froedtert West Bend Emergency Department at the Medical College of Wisconsin.

Dr. Ponce is a clinical operations administrator in the Department of Emergency Medicine at the Medical College of Wisconsin.

Mr. Hudson is the financial lead for the Department of Emergency Medicine at the Medical College of Wisconsin.

Ms. Engel is the executive administrator-unit 6 for the Departments of Anesthesiology and Emergency Medicine at the Medical College of Wisconsin.

Reference

1. Nikolla DA, Zocchi MS, Black BS, et.al. Differences in Productivity and Clinical Care Between Permanent Staff, Employed Travel, and Locum Tenens Emergency Physicians. Ann Emerg Med 2025 Oct; 86 (4): 359-370.