Two Different Cost Structures, Not Two Prices for the Same Thing
A direct-hire placement fee is a one-time cost for a permanent solution. Locum tenens is an ongoing cost for temporary coverage. Comparing them head-to-head only makes sense once you're honest about which problem you're actually solving — a permanent vacancy, or a gap that needs bridging while you fill one.
What Locum Coverage Actually Costs
Locum pay rates vary by specialty, location, and demand — the ranges below reflect publicly reported provider pay rates as of mid-2026, drawn from major locum staffing platforms:
- Psychiatrist (MD/DO): Provider pay commonly runs $200–$300/hour, with a typical working range closer to $210–$250/hour for standard outpatient coverage. Call coverage and rural/underserved assignments often command a premium.
- PMHNP: Provider pay commonly runs $85–$140/hour depending on setting and acuity.
Important: what a facility actually pays a locum staffing agency (the "bill rate") typically runs higher than the provider's own pay rate — the difference covers the agency's margin, malpractice coverage, and often travel/lodging for the provider. Get a real bill-rate quote from your locum vendor before running your own numbers; provider pay rates alone will understate your actual cost.
A Worked Example
Take a mid-career PMHNP role with a $130,000 target salary, and a facility that sees 12 patients/day at an average $150 reimbursement (consistent with the assumptions in our PMHNP vacancy cost guide):
On provider-pay-rate math alone, roughly six to seven weeks of locum coverage costs about the same as a direct-hire placement fee — and actual bill rates (which include agency margin) typically shorten that break-even window further, often into the 4–6 week range. Beyond that point, direct hire is very likely the cheaper option, and it also stops the clock on turnover risk entirely, since locum coverage is temporary by design.
When Locum Genuinely Makes Sense
- Bridging a search in progress. If you already have a direct-hire search underway and need coverage for the gap, locum is doing exactly the job it's built for.
- Genuinely short-term needs. Parental leave coverage, a provider's medical leave, or a seasonal volume spike — situations with a known, short end date.
- Testing a new service line. Before committing to a permanent hire for a program you're not sure will stick, locum lets you validate demand first.
When Direct Hire Is Clearly the Better Math
- Any role you expect to need for 3+ months, with no defined end date. Past the break-even window shown above, ongoing locum costs compound while a placement fee is fixed.
- Roles central to continuity of care. Rotating locum coverage is genuinely harder on patient relationships and treatment continuity than most administrators initially assume — a real cost that doesn't show up on an invoice.
- Anywhere payer credentialing matters. A permanent hire is worth fully credentialing with every payer; locum providers often aren't, which can limit which patients they can actually see.
The Honest Middle Path
Most practices don't actually face a binary choice — they use locum coverage while running a direct-hire search, rather than instead of one. That's usually the financially soundest approach: it stops the revenue bleed of a vacancy immediately, without abandoning the better long-term economics of a permanent hire.
Saltlanding's contingency-only fee structure means starting a direct-hire search costs nothing upfront — so there's rarely a reason to delay starting one just because you also need interim locum coverage. Reach out to talk through your specific situation.