More than 63% of physicians are already working locum tenens or considering it, according to Doximity’s 2025 Physician Compensation Report, which polled nearly 1,200 U.S. physicians in April and May 2025. Flexible work has moved from the margins to the mainstream.
So the question for most physicians is no longer whether flexible work is a real option. It is which model fits your specialty, your schedule and the next five years of your career. This guide compares the main options side by side, with the questions worth asking before you sign anything.
Why so many physicians are rethinking how they work
The pressure is not new, but the numbers are hard to ignore. In Doximity’s 2026 Physician Compensation Report, 82% of physicians said they are overworked. Forty-six percent said they are considering early retirement, up from 34% a year earlier. And 44% said they are somewhat or very likely to leave clinical practice within two years.
Burnout is improving overall, but not evenly. The American Medical Association reported in April 2026 that 41.9% of physicians had at least one symptom of burnout in 2025, down from 43.2% in 2024. By specialty, the picture looks different:
- Emergency medicine: 49.8%, the highest of any specialty
- Urological surgery: 49.5%
- Family medicine: 45%
- Cardiology: 43.5%
The AMA tied those gaps to “differences in workload, administrative burden, clinical environment, staffing support.” In other words, a lot of burnout lives in how the work is structured. That is exactly what a different work model can change.
Physicians are also willing to make trade-offs to get there. In 2025, 77% of physicians told Doximity they would accept, or had already accepted, lower compensation for greater autonomy, up from 71% in 2023 (Doximity, July 2025).
Four ways to work, compared
There is no single right answer. There is a right answer for where you are now.
| Model | Commitment | Best fit for | Watch for |
|---|---|---|---|
| Locum tenens | Time-limited assignments, from a few shifts to several months | Supplementing income, testing a region, bridging between roles, late-career flexibility | Credentialing lead time, travel load, how far ahead the schedule is set |
| Contract-to-hire | A defined trial period (Inspire uses 90 days) before a permanent offer | Physicians who want to know the team and the culture before committing | Clear conversion terms and what happens if either side passes |
| Direct placement | Permanent role | Physicians ready to put down roots | Fit: schedule, call expectations, leadership and community |
| Contract staffing in a managed department | Long-term, steady schedule within a staffed department | Physicians who want stability without hospital employment | Who manages the department and how coverage gaps are handled |
Locum tenens is the most flexible option, and it is rarely all-or-nothing. Many physicians use it to supplement a primary role, test a new region or bridge between positions rather than as a full-time career. More on how it works at Inspire is on our locum tenens page.
Contract-to-hire gives both you and the facility a real look at each other before anyone signs a long-term agreement. For physicians who have been burned by a job that looked right on paper, this is often the smartest middle path.
Direct placement is the traditional route, and still the right one for many. The difference a good partner makes is in the fit: knowing the schedule, the culture and the pay before you invest months in an interview process.
Contract staffing suits physicians who want a steady schedule in a well-run department without becoming a hospital employee. Inspire offers this model for emergency departments in the Southeast.
How the right fit changes by specialty
Your specialty shapes which model makes sense. A few patterns worth considering:
- Emergency medicine. Shift-based work translates naturally to locums and contract staffing, and Doximity ranks emergency medicine among the five most in-demand locum specialties. With burnout at 49.8%, the highest of any specialty in the AMA’s data, schedule control matters here more than almost anywhere. Our earlier piece on part-time ER shifts goes deeper.
- Cardiology. Facilities without enough cardiology coverage often need help with specific clinic days or call blocks. That creates room for physicians who want to add a defined, limited commitment on top of a primary role.
- Orthopedics. Doximity ranks orthopaedic surgery among the three highest-paid specialties. For many orthopedists, the draw of locums or contract work is less about income and more about choosing the cases, the facility and the pace.
- Primary care. Internal medicine and family medicine top Doximity’s list of the most in-demand locum specialties. Contract-to-hire is especially useful here, because a primary care role is a long relationship with a patient panel and a community.
- Urology. With burnout at 49.5%, nearly level with emergency medicine, urologists have strong reason to look closely at workload and call structure in any role they take next.
To see how compensation compares across specialties and models, download Inspire’s 2026 Physician Salary Guide.
Six questions to ask before you sign anything
Whichever model you choose, these questions separate a good placement from one you will be trying to leave in six months.
- Can I see the facility, the schedule and the pay before I apply? You should not have to commit to a process to learn the basics.
- Who handles credentialing, and how long will it take? Credentialing commonly runs 60 to 90 days. Know who is doing the paperwork and when you can realistically start.
- How far ahead is my schedule set? Two months of visibility is a reasonable standard. Last-minute schedules are a burnout risk of their own.
- What support comes with the role beyond pay? Ask about travel, lodging, scheduling help and who supports you if a problem comes up on assignment.
- What is the culture actually like? Ask about the team, the leadership and how the department handles a hard night.
- What happens if it is not the right fit? A good partner has an answer before you need one.
What working with Inspire looks like
Inspire was built around fit before fee. We give you the full picture, including facility, schedule and compensation, before you apply. We handle the full 60 to 90 day credentialing process. We build schedules two months in advance. And within a week of your first conversation, we present hospital options and their pay rates.
We place physicians and advanced practice providers nationwide, with a deep network across the Southeast. Learn more on our For Physicians page.
Frequently asked questions
Yes. Many physicians use locums to supplement a primary role. More than 63% of physicians already work locums or are considering it, according to Doximity.
It depends on your specialty, the region and how many shifts you take. Locum assignments often include travel and lodging on top of pay. Inspire’s 2026 Physician Salary Guide compares compensation across specialties.
Typically 60 to 90 days. Starting the conversation early is the easiest way to avoid delays.
A defined trial period, often 90 days, after which you and the facility decide whether to move to a permanent role.
Internal medicine, family medicine and OB-GYN top Doximity’s 2025 list, with anesthesiology and emergency medicine close behind.
For more answers, visit our FAQ.
Find the model that fits
The best work model is the one that fits your specialty, your schedule and your life right now, and it can change as you do. If you want to see what is open in your specialty, with the facility, schedule and pay up front, start here.
