The Cost-Benefit of Taking Your First Locum Assignment

Most chiropractors who try locum work end up loving it. A meaningful minority try it once, hate it, and never come back. The difference usually comes down to whether they did the math honestly before saying yes.

This is the cost-benefit framework I wish someone had walked me through before my first coverage assignment.

The gross rate is not what you're getting paid

Let's say a clinic offers you $600/day for a 5-day coverage assignment. The gross is $3,000. The actual take varies enormously based on a handful of factors:

Subtract:

• Self-employment tax: 15.3% of net earnings = $459
• Federal income tax: depends on bracket, typically 12-24% of net = $300-$600
• State income tax: 0-13% depending on state = $0-$390
• Platform fee: typically 3-5% = $0-$150
• Travel costs: $200-$500 round trip
• Lodging: $400-$800 (unless clinic provides)
• Food on the road: $150-$250

Realistic net cash: somewhere between $600-$1,200 of that original $3,000.

This isn't to discourage you. It's to ground your expectations. A locum chiropractor netting $1,000/week of part-time coverage work, with full schedule flexibility and zero practice overhead, is doing very well by most measures.

What you're trading

Beyond the cash math, there's the opportunity cost. The question isn't "is $3,000 a lot?" — the question is "what else could I have done with that week?"

For chiropractors who own a practice, the trade-off is usually time. For chiropractors working as associates, the trade-off is usually vacation days or family time. For chiropractors doing locum work as primary income, the calculation is simpler.

What you're gaining besides cash

The cash-only analysis is incomplete. Many locum chiropractors find that the non-cash benefits matter more than the dollars:

• Geographic flexibility — you can structure work around where you want to live
• Schedule control — you decide when to work and when not to
• No practice overhead — no staff to manage, no equipment to buy
• Exposure to different practice styles — every clinic teaches you something
• Resume building for permanent placements
• Network expansion

These are real. They're also legitimately hard to value.

When the answer is clearly "yes"

A locum assignment is almost always a good move when:

• You're an associate or owner with a flexible schedule and a clear week available
• The rate is at or above your normal effective hourly equivalent
• The travel is minimal
• The clinic's practice style is similar enough that you'll be productive on day one
• The patient demographics are familiar to you
• You've done due diligence on the clinic

When the answer is probably "no"

A locum assignment is usually a bad move when:

• You'd have to close your own busy practice to take it
• The travel is significant ($600+ in airfare and hotel for a 3-day gig)
• The practice style is totally unfamiliar
• The clinic is being cagey about expectations or seems disorganized
• You're burned out
• The rate is significantly below your normal effective hourly

The first one is the hardest

If you're considering your first coverage assignment, the math will look less favorable than it should — because you're inexperienced, you're probably nervous, and you don't yet have the routine of travel + practice + return down to muscle memory.

This is normal. Your second and third assignments will be dramatically easier than your first. By the fifth, the logistics will feel routine.

A simple yes/no test

If you're still unsure, try this three-question test:

1. Cash test: Will the realistic net cash from this assignment cover your bills for the week, with at least a $500 cushion left over?
2. Energy test: Do you have the bandwidth to take on a new clinic this week?
3. Learning test: Will you come away from this assignment with a story, a contact, or a skill that's worth something?

If you can say yes to all three, take it. If you can say yes to two of three, probably take it. If only one, decline politely and wait for a better fit.

One more thing

The chiropractors who build sustainable, high-income locum careers are not the ones who take every assignment offered. They're the ones who turn down assignments that don't fit and develop a reputation for showing up exactly as advertised on the ones they accept.

Start picky.