In the first of a three-part series on reforming the locum tenens industry, I will be identifying the industry’s biggest challenges. In part two, we will describe why centralization is the key to overcoming these challenges. Part three will close out the series with a practical guide to organizational reform.
My favorite problems are the ones you solve by getting everyone in a room together. So, when our TrustWorks team was offered the privilege of facilitating the Hallmark Locums Summit, I accepted it with high hopes for some productive conversations. Hallmark hosted the summit in order to bring everyone with a stake in locum tenens together in one room to discuss how to move the industry forward. The agencies, health systems, and platform partners who gathered that day, each bringing their own pain points from the locum ecosystem, absolutely delivered.
Everyone agreed that locum tenens isn’t going anywhere, but also that it’s still getting in its own way. Workforce shortages, clinician burnout, and uneven access to care have made temporary staffing a permanent fixture in healthcare delivery.
To achieve its full potential, the industry must tackle three fundamental challenges: accelerating time to value, improving fee transparency, and identifying credible performance metrics, especially for comparing locum providers to full-time staff. While these aren’t new problems, the level of alignment I’m seeing across health systems, agencies, and providers makes me believe that these issues are longer being ignored.
1. Accelerating Time to Value
To put it in plain English, we need to shorten the time it takes to fill a vacancy. It’s an existential challenge that involves addressing bottlenecks in every step of the process: position requirements, candidate presentations, credentialing, staff applications, and scheduling. The right to represent and name clear processes emerged as a particularly point of friction between health systems and agencies, but they stood on common ground that reform was needed.
For agencies, these bottlenecks lead to slower turnaround on fees; for health systems, it’s delays in filling critical roles; and for clinicians, it translates to lost earnings and productivity. Discussing how to accelerate time to value was a good starting point for our summit because it unearthed how so many of the symptoms of dysfunction come down to a few common causes.
2. Improving Fee Transparency
One of the most persistent frustrations I hear across the industry is the lack of transparency, especially around fees. Instead of a black box, health systems want clear, upfront communication about all costs, including the agency’s markup. Agencies want credit for performance that goes beyond speed or fill rates. Providers want to be evaluated fairly and rewarded for excellence, not treated as interchangeable labor.
Instead, the industry still relies on fragmented data, anecdotal feedback, and informal reputations. Information on provider performance, assignment outcomes, and program effectiveness is often siloed or incomplete, creating a low-trust environment among partners. Without greater transparency, friction and inefficiency will continue to define the locum experience.
This issue is closely tied to the challenge of assessing fair market value. Health systems struggle to interpret rate variation across geography, urgency, and scheduling, while agencies spend more time defending pricing than demonstrating value. Without shared benchmarks, mistrust will only grow while fair market value remains an unnecessary mystery.
3. Identifying Credible Performance Metrics
Perhaps the most consequential gap I see is the lack of meaningful performance metrics, particularly when comparing locum providers to their full-time counterparts.
It’s easy to track fill rates, time-to-fill, and credentialing timelines with precision. But when it comes to clinical outcomes, reliability, patient satisfaction, or team integration, the data often disappears. As a result, we struggle to answer a fundamental question: how do locum providers actually perform relative to full-time staff?
This matters because health systems need confidence that temporary coverage doesn’t mean compromised care. Providers, for their part, also want their performance judged on the outcomes they create. And agencies want credit for delivering high-performing clinicians, not just available ones.Without better evidence, locums are assumed to be replacement level at best, but everyone in the industry would benefit from a shared language of performance tracking.
From Identification to Action
Because these challenges around transparency, fair market value, and performance measurement create downstream friction everywhere else in the system, their full consequences are not always appreciated. That’s why this Locum Summit was so encouraging, because I saw first-hand how aware and aligned the industry has become. Across health systems, agencies, and providers, there is growing consensus that these problems are shared and solvable.
There is real appetite for clearer governance, standardized processes, and common metrics. Conversations around name clear reform, standardized restriction periods, centralized tracking, and quarterly business reviews all point to the same conclusion: the industry is ready to mature. Technology will help, but it won’t solve this by itself. Reducing bottlenecks, improving transparency, and advancing credible performance measurement matter just as much.
Now, identifying problems is one thing, and actually doing something about them is another. In our next installment of Fixing Locum Tenens, Michelle Sanchez-Bickley Chief Client Success Officer at Hallmark, will share how to overcome these challenges by centralizing locum tenens through a vendor management system.