Your First Locum Tenens Assignment: A Pre-Flight Checklist

Work the checklist in critical-path order — longest lead time first — because the licensing and credentialing clock, not your travel plans, determines whether you can legally work on day one. (1) Confirm your state medical license is active in the assignment state, or use an Interstate Medical Licensure Compact (IMLC) license where eligible. (2) Confirm your DEA registration is valid for that state, plus a state controlled-substance registration (CSR) where the state requires one. (3) Get the facility's medical staff office to confirm credentialing and privileging with a written start date. (4) Sign a contract that puts malpractice and tail terms in writing. (5) Confirm your scope of practice and call/backup expectations in writing. (6) Book and confirm travel and lodging, with who books and who pays spelled out. (7) Open an EIN and a dedicated business bank account. (8) Set an estimated-tax plan against a safe-harbor target with the four 2026 due dates. (9) Assemble a credentials folder, digital and physical. The table below pairs each item with its typical lead time and the one thing to confirm.

Start the moment an assignment is verbally confirmed — credentialing is the critical path, not travel. Hospital privileging commonly takes 60-120 days, with a realistic range of about 30 days to 6 months; a clean packet with an already-active in-state license can run roughly 4-8 weeks, and clinic-only roles can sometimes be done in about two weeks. Plan for 4-12+ weeks. The single biggest lever you control is responsiveness: returning verification forms, references, and document requests to the credentialing team the same day keeps your file moving. If you expect to work in several states, the IMLC can compress multi-state licensing — see how-to-start-locum-tenens. IMLC basics: a $700 application fee (the one-time fee covers the qualification process; each state you select still charges its own license fee), and your State of Principal License (SPL) must be either your primary residence or a state where you conduct at least 25% of your practice; Hawaii and Vermont are member states but are not SPL-eligible (you can hold a license in either through the Compact, but you cannot enter the Compact through them). IMLC issuance averages about 19 days once fees are paid, but the member count changes over time (it currently sits at roughly 44 member states and about 46 jurisdictions, including DC and Guam); verify the exact current count and your eligibility at imlcc.com before you rely on it.

Generally, yes. The DEA requires a separate registration for each principal place of business or professional practice at one general physical location where controlled substances are prescribed, administered, or dispensed, and a registration based on a given state license cannot authorize controlled-substance activity outside that state. So a clinician with an active license and an existing DEA number can still be unable to prescribe controlled substances on day one if the registration's address is in the wrong state. Under the DEA's published locum tenens policy you have three practical options: (1) if you are licensed and authorized to handle controlled substances in the assignment state, submit an address change on your existing registration for the temporary practice location — there is no fee to change an address, even temporarily, and it generally takes about a week to process (change it back to your primary location when the assignment ends); (2) obtain a new, concurrent DEA registration in the state; or (3) for hospital or institution-based practice, where the institution is DEA-registered, the institution agrees, and state law allows, work under the institution's DEA registration. Watch the state CSR landmine: several states (for example, Louisiana and Minnesota) require a separate state controlled-substance registration in addition to the federal DEA number, and these requirements vary by state. The federal DEA registration runs on a three-year term; renew it well before expiration. (A practitioner registration fee is set under 21 CFR 1301.13 — confirm the current amount on the DEA fee schedule rather than relying on a quoted figure.) CRNAs and AAs should confirm both their state prescribing scope and any state CSR requirement before arrival.

Get the load-bearing terms in writing before you sign — verbal assurances are not a contract. At minimum, confirm: malpractice coverage (carrier, limits, claims-made vs. occurrence, and who pays the tail); your exact scope of practice (which procedures are in and out of scope); call and backup expectations (frequency, supervising/collaborating coverage, escalation); cancellation terms (notice period and who can cancel); pay and timesheet mechanics (rate, overtime, who approves hours, payment timing); and the schedule (dates, shift length, time off). The malpractice and tail terms deserve the most scrutiny — see the next section and locum-tenens-key-contract-clauses for a deeper clause-by-clause walkthrough.

The agency usually provides malpractice coverage for the length of the assignment, typically at no cost to the clinician — but the policy type determines whether you are protected after you move on. An occurrence policy covers incidents that happen during the policy period no matter when the claim is later filed, so it needs no tail. A claims-made policy only covers claims filed while the policy is active (after its retroactive date), so when you leave the assignment you need tail coverage (an extended reporting endorsement) or your past work becomes functionally uninsured. Agencies usually pay the tail on claims-made policies — but 'usually' is not a contract, so tail responsibility must be expressly addressed in writing. Request a certificate of insurance and written confirmation of the carrier, the limits, the policy type (claims-made vs. occurrence), and whether tail is provided for all assignments. See locum-tenens-malpractice-tail-coverage for more.

Build the business backbone in parallel with credentialing. EIN: get one free directly from the IRS, issued instantly online in minutes — never pay a third-party 'EIN service.' An EIN lets you keep your SSN off W-9s and is commonly required to open a business bank account. Dedicated business bank account: open one to separate business from personal funds; many banks require an EIN to do so. See locum-tenens-business-bank-account-ein. Estimated taxes (2026 tax year): four payments are due April 15, June 15, and September 15, 2026, and January 15, 2027. Hit a safe harbor by paying 90% of your current-year tax OR 110% of your 2025 tax if your 2025 AGI exceeded $150,000 (100% if your AGI was at or under $150,000; the $150,000 threshold is $75,000 if married filing separately). Most attendings clear $150,000, so plan for 110%. Self-employment tax is 15.3% on your net SE earnings — 12.4% Social Security on earnings up to the 2026 Social Security wage base of $184,500, plus 2.9% Medicare with no cap; your SE base is 92.35% of net earnings, you deduct half of SE tax above the line, and Additional Medicare tax of 0.9% applies above $200,000 (single) / $250,000 (MFJ). QBI landmine: physicians, CRNAs, and AAs are a specified service trade or business (SSTB), so the §199A QBI deduction phases out to $0 once 2026 taxable income exceeds the SSTB top — $276,750 (single) / $553,500 (MFJ) — with the phase-in beginning at $201,750 / $403,500 (Rev. Proc. 2025-32). Do not assume a QBI deduction for a high-earning full-time locum. Retirement plan landmine for 2026: the SECURE 2.0 mandatory-Roth catch-up rule is in effect now — if your prior-year (2025) FICA wages exceeded $150,000 (the 2026 indexed threshold, up from the $145,000 statutory base), any age-50+ catch-up contributions to a workplace 401(k)/403(b)/457(b) must be made as Roth (after-tax). Because the rule is keyed to W-2 FICA wages, a sole proprietor or partner with no W-2 FICA wages (e.g., a solo 401(k) on Schedule C income) is generally not subject to it; an S-corp owner with W-2 wages over $150,000 is. See 1099-vs-w2-locum-tenens and locum-tenens-tax-deductions.

Arrive ready to start working, not still onboarding. Complete badge/ID issuance and get your EMR/EHR login plus any required training; sort out parking and the dictation/orders workflow. Confirm that the call schedule, backup or supervising-physician coverage, and escalation paths match what your contract says — if they differ, raise it immediately. Get the numbers for IT, pharmacy, and clinical questions, and meet the key staff (note names and roles). Confirm the timesheet submission process and who approves your hours. Bring a credentials folder, digital and physical: government ID/passport, your state license, DEA registration, board certifications, current ACLS/PALS/BLS cards, immunization records, and your recruiter and facility contacts.