Locum tenens allows you to travel the country while earning a highly competitive wage, but not all states pay the same. Locumstory analyzed the past 12 months of locum tenens pay data from two of the largest locum tenens staffing agencies to identify the top-paying states in 2025. Here are the top 10 highest-paying states for locum tenens physicians, based on average daily pay rate, along with insights into what’s driving demand for locums in each location.
1. Arkansas: 132%
Arkansas leads the 2025 list of highest-paying states for locum tenens physicians. Nearly every county in the state is classified as a health professional shortage area (HPSA), with especially acute needs in primary care and psychiatry. Nearly 44% of residents live in rural areas where they have less access to healthcare. This geographic reality makes recruitment and retention of full-time physicians even more challenging.
The state’s aging medical workforce and limited pipeline of new providers — only one in-state medical school serves all of Arkansas — add pressure to hire locum tenens clinicians at competitive rates.
2. Mississippi: 128%
Mississippi breaks the top 10 at #2 on this year’s list, driven by a combination of rural access challenges and one of the lowest physician-to-population ratios in the country. Like Arkansas, nearly all of Mississippi’s counties are designated as full HPSAs, and many of its rural hospitals rely heavily on locum coverage to maintain critical services.
Mississippi ranks last, or close to last, in almost every leading health outcome, including high rates of chronic illness. More than half of Mississippi's counties are considered maternity care deserts. Beyond obstetrics and gynecology, specialties like internal medicine and psychiatry are in particularly short supply.
3. Delaware: 127%
While Delaware slips to third place, it remains a top-paying state for locum tenens, with pay well above the national median. Physician shortages persist in Delaware due to its lack of a medical school and rapid population growth. Students who aspire to become doctors must leave the state for their education and typically do not return to practice there.
Many areas within Delaware remain federally designated as underserved, and growing demand across primary and specialty care continues to outpace local supply.
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4. Colorado: 125%
Colorado climbs one spot this year amid an ongoing physician shortage projected to reach 2,400 doctors by 2030. In part due to this physician shortage, Colorado pays its locum tenens providers 125% of the national median. Additionally, rural counties and ski resort towns often face seasonal surges in demand, creating additional need for locum coverage.
The state’s aging physician workforce, with nearly a third of physicians nearing retirement age, causes physician shortages and further fuels a robust market for locum tenens. Over 50 of Colorado’s counties are designated as HPSAs, with OB/GYNs, anesthesiologists, and internal medicine physicians comprising the most needed specialties.
5. West Virginia: 124%
Locum tenens providers earn 124% of the national median in West Virginia, which rose from number six to number five on this year’s list. West Virginia continues to offer strong compensation for locum physicians.
Over 95% of its counties are designated HPSAs, and many healthcare facilities have closed in recent years, creating wide access gaps. All but two West Virginia counties are designated as HPSAs.
West Virginia also faces significant healthcare staffing challenges, particularly in family medicine and behavioral health, due to an aging workforce, declining college enrollment, increased burnout, and the COVID-19 pandemic. Additionally, it ranks as the nation’s unhealthiest state with the highest number of drug overdoses, the highest percentage of adults who smoke, the highest rate of adults who are obese, and the second-shortest life expectancy.
What's the trend? Compare 2024's list of top paying states for locums
6. Ohio: 122%
Ohio makes its debut on the list of top-paying states for locum tenens physicians, offering compensation at 122% of the national median. Ohio enters the top 10 because of widespread shortages across both urban and rural areas. Over half (57 out of 88) of Ohio’s counties are HPSAs. Compounding the issue, Ohio is projected to face a deficit of 1,200 primary care physicians by 2025.
Several hospital systems in the state rely on locums to maintain service levels, especially in underserved inner-city and Appalachian regions. Notably, over 2.4 million Ohio residents live in areas identified as HPSAs, underscoring the widespread nature of these shortages.
7. South Dakota 119%
South Dakota remains a high-paying locum destination but dropped three spots from last year. Nearly 43% of the state’s population lives in rural areas, and nearly half of its counties lack mental health providers altogether.
Harsh winter weather and geographic isolation make it harder to recruit staff, and locums often help fill gaps in emergency rooms and primary care clinics across the state.
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8. Michigan: 118%
Michigan climbs two spots this year, continuing to pay above the national median for locum coverage at 118%. It faces challenges similar to other states, including an aging population, retiring physicians, and burnout due to the COVID-19 pandemic, creating a consistent demand for physicians. Additionally, 65 of Michigan’s 83 counties are designated as HPSAs, and nearly all affected counties are rural.
Specialties like cardiology, psychiatry, and family medicine remain in high demand, especially in the Upper Peninsula and northern counties.
9. Indiana: 118%
Indiana retains its position on the 2025 list.
Over half of Indiana’s 92 counties have a primary healthcare provider shortage, which may explain the state’s higher locum tenens physician salaries (118% of the national median). Additionally, the state ranks tenth on the list of unhealthiest states. Indiana also has a severe lack of mental health professionals and needs to add nearly 300 psychiatrists to address the shortage.
Hospitals and health systems are turning to locums to fill gaps in psychiatry, pediatrics, and emergency medicine.
10. Tennessee: 116%
Tennessee closes out the top 10 this year, having dropped several spots but still paying well above the median (116%). The state continues to face population growth, healthcare access disparities, and a high burden of chronic disease — all of which contribute to rising demand for locum coverage.
Tennessee also ranks 47th in the nation for public health outcomes and 37th for healthcare access, according to the U.S. News and World Report. Because of these factors, hospitals pay locum tenens providers well above the national median. The majority of Tennessee counties are designated HPSAs, and rural hospitals in particular depend on temporary physicians to maintain continuity of care.
Locum tenens pays well — especially in high-need states
Accepting assignments in an unfamiliar state can be rewarding and lucrative, especially if you’re willing to work in high-need and rural areas.
From the Mississippi Delta to the Colorado Rockies, the highest-paying states for locum tenens often share the same characteristics: underserved populations, physician shortages, and geographic or seasonal hiring challenges. If you're open to flexibility — and the rewards that come with it — these high-demand locations offer both purpose and strong compensation.