Locum tenens used to be the fast lane. A hospital had a coverage gap, an agency sent a physician, and the credentialing paperwork trailed behind the clinical work. Billing caught up eventually. Nobody bothered to count the days in between.
In 2026, the days in between are the story, and the cost of those days is rewriting how health systems hire. The physician shortage hasn’t eased. The AAMC projects a shortfall of up to 86,000 physicians by 2036, and locums moved from stopgap to a planned line on the workforce budget.
What changed is the onboarding math sitting behind every hire.
What Is the Hidden Cost Everyone Missed?
The hidden cost isn’t the agency fee or the daily rate. It’s the revenue a credentialed physician can’t bill while payer enrollment finishes. A locum can be licensed, privileged, and standing on the floor while the payer file still shows them as out of network. The service happens, the claim doesn’t clear, and many payers are unlikely to backdate to the start date. Much of the enrollment gap is revenue the system may never book.
Why This Is Reshaping Hiring Now and Not Five Years Ago
Two things shifted at once. Locum volume climbed as permanent recruiting timelines stretched, so more of the clinical schedule now runs through temporary providers. Payer enrollment queues also got longer and less forgiving. A paperwork nuisance became a revenue problem the CFO can see on a dashboard.
Systems that used to absorb a few weeks of unbilled coverage now absorb months, across dozens of clinicians at a time. The line item is too big to ignore.
How Long Onboarding Actually Takes
Longer than most operators assume. The timeline is stacked, not parallel, so a delay in one place moves the finish line for everything after it.
- Licensure. State medical boards run on their own clocks. Multi-state work through the IMLC can compress this to days once the State of Principal License issues a Letter of Qualification.
- Primary source verification. Every school, residency, license, and prior affiliation gets confirmed at the source. Packets stall here when a document is missing or a signature is stale.
- Privileging. Medical staff committees meet on their own schedule, and a missed meeting can add a month.
- Payer enrollment. The step that decides whether the work is billable. It runs after everything else and finishes when the last payer says so.
What Health Systems Can Actually Do About It
Operators pulling ahead treat the packet itself as the asset. A clean, complete, submission-ready file tends to move through queues faster than a technically compliant one with small gaps that trigger back-and-forth. Some systems build that capacity in-house. Others hand it to a specialist team that produces ready-to-submit credentialing packets so internal staff can focus on committee prep and payer follow-through.
The pattern in 2026 is clear. Systems shortening the gap between start date and first billable claim aren’t chasing cheaper locums; they’re chasing faster paperwork.
