For advanced practice providers, flexibility isn’t just a perk; it’s a necessity. With rising patient demand, heavier workloads, and increasing burnout, finding a career path that supports professional growth and personal well-being is more important than ever.
Shifting healthcare models and evolving state regulations continue to reshape how APPs practice, creating new opportunities. Two primary career paths – locum tenens and independent practice – offer distinct advantages.
Suppose you’re looking for long-term stability, complete control over patient care, and the ability to build your own business. In that case, independent practice may be the right fit, especially in states with full practice authority. While this route comes with added business responsibilities, it also offers greater financial rewards and the freedom to shape your clinical approach.
On the other hand, locum tenens allows you to fill staffing gaps in hospitals, clinics, and other healthcare settings when, where, and how often you like. This option is ideal for APPs seeking variety, higher earning potential, and the ability to balance work with personal commitments. Plus, unlike independent practice, there are no business management responsibilities, making it a low-risk way to explore different healthcare settings before settling in permanently.
Continue reading to compare autonomy, flexibility, and financial opportunities for both locum tenens and independent practice. We’ll weigh the benefits and challenges, and explore key considerations to help you choose the best path for your future as an APP.
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How State Regulations Shape APP Autonomy
Independent Practice
This option gives APPs complete control over patient care, scheduling, and business operations. However, the level of autonomy varies by state. Some states grant full practice authority to nurse practitioners and CRNAs, allowing them to diagnose, treat, and prescribe independently; others require collaborative agreements with physicians.
In 27 states and Washington, D.C., NPs can diagnose, treat, and prescribe without physician oversight. States with the highest level of NP independence include Alaska, Arizona, Colorado, Maine, New Mexico, and Oregon.
CRNAs can practice without physician supervision in 25 states, including California, Iowa, Minnesota, Nebraska, and Washington.
Physician assistants (or physician associates, if you prefer!) typically work under the supervision of a licensed physician, collaborating closely on patient care. However, there’s a growing trend towards expanding the scope of PA practice. Several states have enacted legislation granting physician PAs greater autonomy, allowing them to perform more medical procedures and make treatment decisions without direct physician oversight.
Iowa, Montana, New Hampshire, North Dakota, Utah, and Wyoming have modernized their regulations to remove supervision requirements. Additionally, states like Colorado and Minnesota have passed laws reducing or eliminating physician oversight for PAs. Further, Delaware, Utah, Washington, Wisconsin, West Virginia, Nebraska, Virginia, Ohio, Oklahoma, Maine, Colorado, Minnesota, and Tennessee have enacted the PA Licensure Compact, which facilitates multistate practice for PAs.
As a result of these regulatory changes, many APPs now have the flexibility to practice independently, allowing them to establish long-term relationships with their patients. Unlike locum tenens advanced practice providers, independent practice APPs can cultivate their unique clinical philosophy over time while also shaping a business that aligns with their vision. This autonomy enables them to build their own practice and hire preferred colleagues.
Locum Tenens
While locum tenens clinicians don’t own their practice, they often work at the top of their scope, sometimes more independently than in permanent roles. Locum tenens assignments allow APPs to make independent clinical decisions within the terms of their contract. Since they fill staffing gaps, they are usually trusted to work with minimal oversight, especially in rural or underserved areas where their skills are in high demand and fewer providers are available.
Unlike permanent positions, where hospital policies or administrative duties may restrict decision-making, locum tenens APPs focus solely on patient care without long-term management responsibilities. However, the level of control varies by assignment. Some facilities allow hospitalist NPs to work independently; others require physician consultation.
Similarly, a locum tenens CRNA may have full autonomy in an outpatient surgical center but need physician oversight in a hospital setting. Remember that, like independent practice, locum tenens APPs’ authority over medical decisions varies by state.
Building a Schedule That Works for You
Independent Practice
Unlike the rigid scheduling and heavy patient loads often tied to permanent healthcare roles, independent practice gives APPs the freedom to shape their own schedules. This flexibility allows APPs to balance their professional responsibilities with personal commitments while ensuring they can provide high-quality care without taking on an unsustainable workload.
Having control over their schedule is especially valuable for APPs looking to prevent burnout, tailor their work hours, or focus on a specific patient population. Independent practice creates new opportunities:
- Seeing fewer patients per day allows for more personalized care
- Adjusting clinic hours to accommodate family needs
- Or building a specialized practice in a particular area of medicine
By offering this level of autonomy, independent practice supports a healthier work-life balance and empowers APPs to shape a career that reflects their professional goals and personal aspirations.
Locum Tenens
A career in temporary clinical work offers APPs the flexibility to control their schedules. This model allows clinicians to choose when, where, and how often they work, giving them the freedom to prioritize work-life balance, explore different career experiences, and create a schedule that fits their personal and professional goals.
Assignments vary in length, from a few days to several months, allowing APPs to tailor their workload to their lifestyle. Some take on short-term contracts to supplement their income, gain experience in different healthcare settings, or explore new specialties. Others prefer longer commitments for financial stability without the long-term constraints of a permanent role. This work also provides the flexibility to take extended breaks, whether to travel, pursue personal interests, or focus on professional development, without worrying about job security.
Beyond scheduling freedom, temporary assignments expose APPs to various practice settings, from small rural clinics to large urban hospitals. This diversity strengthens clinical skills, broadens perspectives, and helps clinicians build a strong professional network. By experiencing different healthcare environments, APPs gain valuable insight into potential career paths and make informed decisions about their long-term goals.
With its combination of flexibility and diverse opportunities, locum tenens empowers APPs to build a fulfilling career on their terms, one that aligns with their professional ambitions and personal aspirations.
Maximizing Financial Potential: Which Path Pays More?
Independent Practice
Independent practice offers greater financial control and long-term earning potential than a salary position. Unlike a fixed salary, independent APPs can set their rates, expand services, and grow patient volume to increase revenue. Over time, a well-managed practice, developing a loyal patient base, can generate higher earnings than traditional employment or even locum tenens work.
While independent practice comes with overhead costs like office space, staffing, and malpractice insurance, APPs can optimize expenses and retain more profits. Tax benefits, such as deductions for equipment, office expenses, and professional development, offer significant financial advantages unavailable to salaried employees or locum contractors.
Compared to locum tenens, which provides higher short-term pay but inconsistent assignments, independent practice builds a stable, predictable income over time.
Locum Tenens
Because healthcare facilities often rely on locum tenens APPs to fill urgent staffing needs, they offer competitive hourly rates that can exceed those of salaried roles.
Check out our Guide to Locum Tenens & Full-Time APP Salaries.
Some locum tenens assignments include travel stipends, furnished housing, and malpractice insurance coverage, significantly reducing out-of-pocket expenses. These benefits make locum tenens especially attractive for APPs who want to maximize their income while minimizing personal costs associated with relocation or liability coverage.
However, income predictability is a key consideration in locum work. Since assignments are temporary, APPs may experience gaps between jobs, leading to fluctuations in earnings. This inconsistency can be managed by lining up assignments in advance or working with a healthcare staffing agency that helps secure continuous opportunities.
Which Career Path Will Help You Reach Your Goals?
Both independent practice and temporary clinical work offer rewarding career paths for APPs, each with distinct advantages. Independent practice provides long-term stability, full control over patient care, and the opportunity to build a thriving business. Locum tenens assignments are ideal for those seeking flexibility, variety, and strong earning potential. They allow APPs to choose when and where they work, avoid administrative burdens, and gain experience in diverse healthcare settings.
OnCall Solutions is here to help you explore your options. Whether you’re seeking flexibility, stability, or new opportunities, we connect you with roles that align with your expertise and career goals. Partner with a team that understands your needs and supports your success so that you can build a fulfilling, flexible, and financially rewarding career. Connect with us today.
