How to Choose Locum Tenens Agencies, Read Contracts, and Build a 2–3 Firm Bench

If you are exploring locums, your first recruiter does not have to become your whole strategy. Early on, the smartest move is usually to build a small bench of two to three agencies so you can compare opportunities, learn how different firms operate, and keep your options open.

Too many physicians start locums by saying yes to the first person who calls. That may be enough to land a first assignment, but it is not the same thing as building a durable, independent locums practice. If you want more control over where you work, how you are represented, and which contracts you sign, you need a better system. For a quick primer on how the overall process works, you can start with How Does Locum Tenens Work?.

Why a 2–3 firm bench works early

Working with one agency from day one can leave you dependent on a single recruiter, contract channel, or MSP relationship. Working with ten agencies creates noise, duplicate submissions, and confusion. A deliberate bench of two to three gives you the middle ground.

A small bench helps you:

• Diversify access. Different firms hold different hospital relationships, specialty contracts, and vendor channels.
• Increase leverage. When more than one agency understands your profile, you have more room to compare rates, schedules, and terms.
• Reduce dependency. You are less likely to get boxed into one agency’s version of the market.
• Learn faster. You quickly see who communicates clearly, who understands your specialty, and who treats you like a long-term partner instead of a transaction.

The goal is not to stay spread out forever. The goal is to start wide enough to make an informed choice, then narrow later if one firm consistently earns more of your business.

Get clear on what you need first

Before you evaluate agencies, get specific about your own operating preferences. Agencies are only useful to the extent that they match the kind of work and life you actually want.

Clarify:

• Clinical fit. Settings, case mix, call patterns, and assignment types that are a “yes” for you—and what is a hard no.
• Workload. How many days, shifts, or weeks you actually want to work each month, including nights and weekends.
• Geography and travel. Your realistic radius and what kind of travel (drive vs flight) you are genuinely willing to sustain.
• Deal breakers. Unsafe staffing, unclear expectations, chronic late pay, poor communication, or cultures you do not want to repeat.

This sounds basic, but it changes the whole conversation. Instead of reacting to whatever jobs are open, you start evaluating agencies against your criteria. If you want help defining those criteria, the Era guide on how to become a locum tenens physician walks through the early planning questions in more detail.

Evaluate agencies like a founder

When you evaluate locum tenens agencies, think less like an applicant and more like a business owner choosing representation. The physicians who get the most from locums treat agency selection as a strategic decision — comparing how each firm handles pay, credentialing, and communication before committing, and keeping a two-to-three firm bench so no single agency controls their access to work.

A few questions matter most.

1. Do they explain things clearly?

Pay structure, travel support, malpractice coverage, and how they work with facilities should all be easy to understand. If basic questions get slippery answers early, that usually does not improve later.

Plain-language explanations about credentialing, onboarding, and how assignments wrap up should match what you see in clear explainers like Era’s “How Does Locum Tenens Work?” rather than leaving you guessing.

2. Do they understand your niche?

A strong recruiter should be able to talk intelligently about your case mix, settings you thrive in, and what makes an assignment realistic or risky for someone with your background. If the conversation feels like they are just reading a job order, it probably is.

If you are building a career around specific niches—rural labor and delivery, pediatric oncology call coverage, inpatient adult psychiatry, or weekend-only procedural coverage—look for partners who already place physicians into those exact practice environments and can speak to the real-world workflow, staffing, and expectations. Era’s rural content, for example, is built around concrete realities in critical access hospitals, not generic “flexibility” claims.

3. Are they operationally solid?

Credentialing, travel, onboarding, and communication are where agencies either create trust or create friction. A smaller agency can absolutely outperform a larger one here if its internal processes are tight and the same people stay with you from search through assignment logistics.

You should not feel like you are starting from scratch with a new team on every step. The best experiences feel like one continuous, competent handoff—recruiter, credentialing, travel, and back again—without you chasing updates.

4. Do they act physician-first?

Look for agencies that:

• Encourage you to read and question contracts.
• Proactively flag weak or misaligned assignments instead of just pushing to “get it filled.”
• Do not use fear or scarcity to rush you into decisions.

In a physician-first relationship, you feel like the client, not the inventory.

In general, larger firms are built for volume. Smaller firms are often better at depth. There are good and bad actors on both sides; the point is to notice which behavior you are actually experiencing.

Read the contract like it matters

A locums contract is not just paperwork. It is where your autonomy is either protected or narrowed.

Pay close attention to:

• Pay structure. Hourly versus daily, minimums, overtime, call, and callbacks—and how those are documented, not just described over the phone.
• Cancellation terms. How much notice is required and what, if anything, you are paid if the facility cancels.
• Scope and expectations. Patient volumes, procedures, sites, admin work, and floating expectations across units or locations.
• Malpractice and tail. Who carries it, what the limits are, and whether any indemnification language shifts unusual risk onto you.
• Restrictions. Non-solicitation, non-competes, or provisions that limit your ability to work elsewhere in the future.

You are not being difficult by asking questions here. You are doing what any responsible 1099 professional would do when signing a business agreement.

Understand MSPs and VMS as they may narrow your options

Many hospitals now use MSPs and VMS platforms to manage locums staffing. For physicians, that can mean another layer between you and the actual clinical leaders, and sometimes constraints on how you can approach specific facilities.

That does not mean you should avoid these roles. It does mean you should understand the structure:

• Ask whether the assignment is going through an MSP or VMS.
• Confirm whether multiple agencies can submit to the same opening or if there is a primary vendor.
• Use one agency per opportunity to avoid double-submission problems.
• Keep a simple log of where you have been presented and by whom.

The best agency partners do more than route your CV into a portal. They help you understand the channel, advocate for fit, and prevent avoidable conflicts. Era’s rural hospitals content walks through how these relationships often work at critical access and regional facilities, which can help you frame better questions for any recruiter.

Build your bench, then narrow with intention

Once you know what you want, start with a few conversations rather than one.

A simple process works well:

1. Start with four or five conversations. Include a mix of large and smaller, relationship-driven firms. Notice who listens and who just pushes openings.
2. Select two or three core partners. Prioritize agencies that understand your specialty, ask good questions, and follow through.
3. Share a clear profile. Send each bench agency a concise summary of your ideal assignments, capacity, compensation targets, and non-negotiables. This is where your personal brand as a locums physician—how you show up across assignments—starts to matter.
4. Review performance every six to twelve months. Ask which agencies actually brought you aligned opportunities, advocated in contracts, and respected your time.

Over time, you may decide one primary agency has earned most of your work. That is fine. The key is that you got there from a position of information and leverage, not from default.

If part of your goal is rural work, you can use Era’s guide to finding rural locum jobs and our list of top rural physician temp companies as one input as you build your bench. Cross-reference your target facilities with agencies who actually have relationships there.

Where Era fits

Era Locums is an independent, women-owned, physician-first agency built for exactly this kind of relationship. The team comes out of large-agency backgrounds but chose to build something smaller on purpose: fewer physicians, deeper relationships, and strong execution behind the scenes.

In practical terms, that looks like:

• Straightforward conversations about rates, contracts, and fit.
• A single, consistent team walking with you from search through credentialing and travel.
• A bias toward long-term partnership over short-term “ownership”—acting as one part of your bench, not the only door you can walk through.

Early in your locums journey, building a small, intentional bench is often the right move. Later, you may narrow to one primary partner. The difference is that the choice stays with you.

Frequently asked questions

How many locum tenens agencies should I work with?

Early in your locums career, a bench of two to three agencies usually works best. It is enough to compare opportunities, rates, and communication styles without creating duplicate submissions or confusion. Over time, you may narrow to one primary partner who consistently brings you aligned work.

Is it okay to sign with more than one locum tenens agency?

Yes. Most locum tenens agreements are non-exclusive, so you can work with several agencies at once. The key rule is to use only one agency per specific job opening to avoid double-submission problems, and to keep a simple log of where each agency has presented you.

What should I look for when choosing a locum tenens agency?

Look for clear explanations of pay, travel, and malpractice coverage; genuine understanding of your specialty and goals; strong operational support; and a physician-first approach that does not pressure you into poor-fit assignments. It also helps to confirm an agency’s credibility — you can check whether a firm is listed in the NALTO member directory, since NALTO members agree to a shared code of ethics.

What contract terms matter most for locum tenens physicians?

Pay close attention to pay structure and minimums, cancellation terms, scope and expectations, malpractice and tail coverage, and any restrictions such as non-solicitation or non-compete clauses. As a 1099 professional, reading and questioning these terms is simply good business.

Build your bench with Era

If you are ready to add a physician-first agency to your bench, Era Locums would love to be one of your two or three. Get started with Era and connect with a team that puts your autonomy, fit, and long-term goals first.