Locum radiologist vs teleradiology: fixed vs variable cost

The comparison most imaging buyers run is locum radiologist vs teleradiology. One vendor against another comes later. A locum is what the department already knows how to buy, so it becomes the benchmark, and both options fill the same hole in the schedule. They price that hole in opposite ways: the locum charges for time whether or not a study arrives, and the panel charges for signatures. Everything else in the decision, lead time, subspecialty match and what happens on the last day of the assignment, follows from that one difference.

What does locum radiologist coverage cost per day?

No honest page publishes a locum day rate, because there is not one to publish. Agencies quote per assignment, and the quote moves with subspecialty, state, shift length, notice period and how thin the market is that month. AMN Healthcare's locum radiology listings post advertised hourly and daily pay against live assignments, and the spread across diagnostic, mammography and interventional work is wide enough that the page reads as a market range instead of a rate. AstraRad publishes no locum figure of its own and no rate of its own: rates are quoted per client from modality mix, volume and urgency, and the pricing page explains why.

What you can pin down is the shape of the invoice, which is where locum comparisons usually go wrong. The physician rate is the part everyone quotes. The all-in cost adds the agency's fee, travel, lodging, per diem, professional liability coverage including tail, and the administrative hours your own medical staff office spends on licensure and privileging for a physician who will be gone in six weeks. Ask the agency for one all-in daily figure with every line named, and ask which of those lines it absorbs and which it passes through. A quote that names only the physician rate is not a quote you can compare against anything.

How do fixed and variable coverage compare across a real month?

Reduce it to three numbers you already have or can ask for.

1. D, the all-in locum cost of one covered day, from the paragraph above.
2. N, the number of studies that actually arrive on a covered day. Pull it from your own PACS for the last twelve months, by day of week. An average hides the problem.
3. R, your quoted per-report rate for that modality mix and priority tier.

A locum day costs D whatever happens. The same day read per report costs N times R. The two are equal when N equals D divided by R, so D divided by R is the daily study count at which the models cross. Below that count, per report is cheaper. Above it, the day rate is.

Now run it against your real calendar, day by day. Nights, weekends and holidays are exactly the days when N is smallest and least predictable, and they are also the days locums are most often booked. A Sunday that brings six studies costs a full day rate under one model and six reports under the other. A Tuesday running at three times your median volume inverts that. The month is the sum of both, so a facility with spiky volume can be on the wrong side of the crossover on most of its covered days and still see a flattering monthly average.

Two adjustments make the arithmetic honest. Count only covered days, not calendar days, because a locum booked in blocks bills the block. And if your locum arrangement returns preliminary reads that your own radiologists finalize in the morning, add the cost of that second signature, which is your staff's hours and does not appear on the agency invoice. Our breakdown of what teleradiology costs and the in-house versus outsourced comparison carry the same arithmetic against a salaried hire instead of a locum.

How long does it take to put a locum in your reading room?

Two queues set the start date, and the agency controls neither.

The first is licensure. A radiologist must hold a license in the state where your patients are located. Our licensing hub sets out the routes: a traditional application to the state medical board commonly runs 8 to 16 weeks or more, and the Interstate Medical Licensure Compact compresses the same full license to roughly 2 to 4 weeks in member states. Some states are not compact members at all.

The second is privileging. Under 42 CFR 482.22, your governing body grants privileges to each physician who reads for your hospital, and that decision moves on the credentials committee and board meeting calendar, which your staffing calendar has no purchase on. Whatever the agency promises, the board meets when the board meets.

Both queues restart for the next locum. That is the structural difference: a locum engagement buys one physician's access to your facility, and the access expires with the physician. A teleradiology panel amortises the same work across every study it will ever read for you. AstraRad's radiologists are licensed in all 50 US states, and every read is performed inside the United States. That is a payment condition as much as a policy one. The Medicare Benefit Policy Manual, Chapter 16 states that where a radiologist practicing abroad analyzes imaging performed on a beneficiary in the United States, Medicare pays neither the radiologist nor the facility for that work.

Does a locum radiologist match the subspecialty your worklist needs?

A locum engagement is one physician with one fellowship, and in a tight market it is whichever physician is available for those dates. A community worklist is not shaped that way. It carries neuro, MSK, body, chest, breast, cardiac, pediatric and nuclear studies inside the same week, and the studies most likely to sit outside a single fellowship are the ones least likely to wait.

Per-study routing is the structural answer: the match is made when the study arrives, so a coronary CTA reaches a cardiac imager and a pediatric abdominal CT reaches a radiologist who reads children every shift. That is a property of a panel, not of a person, and it is the one difference between the two models that no locum quote can close. Where a facility needs both, overflow radiology reads covers the studies the on-site physician does not read while the locum covers the ones they do.

What happens to coverage when the locum's assignment ends?

The assignment has an end date, and on that date you are either extending at a renegotiated rate or you are uncovered again. That is not an edge case; it is the intended use. In AMN Healthcare's 2022 Survey of Locum Tenens Staffing Trends, 70 percent of the healthcare executives surveyed said they use locum tenens providers to maintain services while they seek to fill openings in their permanent staff, and 88 percent had used locum providers of some kind in the prior 12 months. Radiology specifically appeared in 14 percent of responses in the 2022 edition, against 11 percent in 2019, 7.0 percent in 2016 and 4.5 percent in 2014. Two hedges belong on those figures: the survey reports 202 completed responses and states that a margin of error was not calculated, and the publisher is itself a locum staffing firm, so treat the direction as informative and the level as approximate.

A bridge is the right tool when there is something to bridge to. It becomes expensive when the permanent search runs long, because each renewal re-enters the same rate negotiation from a weaker position, and each new physician re-enters the licensure and privileging queues above. A per-report agreement has no assignment end date to defend against and no minimum to grow into, so a quiet month costs what a quiet month is worth. The same property is what makes it useful for weekend and holiday coverage, which carries a factor-by-factor table against locum coverage, and for overnight coverage costs.

Is locum coverage worse care?

The published evidence does not support a blanket competence objection. A 2017 JAMA study of Medicare inpatients compared care by locum tenens and non-locum internal medicine physicians across 1,818,873 admissions from 2009 to 2014 and found no significant difference in 30-day mortality, 8.83 percent against 8.70 percent, with an adjusted difference of 0.14 percent. Patients treated by locum physicians did have higher Part B spending, $1,836 against $1,712, a mean length of stay longer by 0.43 days, and 30-day readmissions lower by 1.00 percentage point. Read that carefully before carrying it across: the study covers general internal medicine inpatient care. Imaging interpretation is a different question, and the window closed in 2014.

The same AMN survey reports that 62 percent of the health facility managers surveyed rated the skill level of locum tenens physicians as excellent or good and 70 percent rated them worth the cost, with the same two hedges attached.

So the case against a locum is not a case about the physician. It is a case about economics on thin days, about lead time, about one fellowship against a worklist, and about what the calendar looks like the week the assignment ends. Where quality is the question, ask both options for the same evidence: the double-read sampling rate, the measured major discrepancy rate, the window those numbers cover, and how a discrepancy is closed with the reader. AstraRad's are published and dated on the SLA page.

Locum radiologist vs teleradiology: when each one is right

A locum is the right answer whenever the gap needs a physician in the building. Fluoroscopy, image-guided biopsies, arthrograms, contrast reaction response and technologist supervision all require presence, and no remote panel covers any of them. The same is true of a department that needs someone at the tumor board, in the hallway and on the protocol committee for a defined stretch of weeks.

A locum is the wrong answer when the gap is a worklist. Then you are paying for the hours between studies, buying one fellowship's coverage of a mixed queue, and re-entering the licensure and privileging queues every time the assignment turns over.

Before you sign the locum contract

Put the same four questions to the agency and to any teleradiology panel you are considering, including this one. What is the all-in daily or per-report cost with every line named. What is the earliest date a physician can legally sign a report for a patient in our state, and what sets that date. Which subspecialties are covered, and what happens to a study that falls outside them. And what does coverage look like on the day this agreement ends.

Then run the arithmetic above against your own twelve months of volume by day of week. A monthly average is the number that hides the answer. Locum radiologist vs teleradiology resolves on that arithmetic far more often than on any argument about who reads better. If you want the per-report side of the comparison priced for your own modality mix, ask us for a rate card. The rest of the staffing comparisons live in the teleradiology resource library.