Staffing, recruiting & HR services
Books and taxes for locum tenens agencies.
Physician and dentist contracts by the week, hospital privileging and credentialing costs, malpractice tail coverage, and travel stipends between assignments. Gus sorts it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
April came in at $36,600. The emergency medicine placement at Crestwood ran a full month with no gaps, so its high bill rate carried a bigger share of the month than usual.
- Crestwood Regional payoutContract billings
- CompHealth marketplace payoutContract billings
- Physician payroll runPhysician pay
- Hospital privileging feesCredentialing costs
- Malpractice tail coverage premiumMalpractice coverage
Why your books are different
Locum tenens agency books go wrong in the same four places.
A generalist sees deposits and a physician paycheck. Your business runs on hospital privileging that can take weeks before a physician ever works a shift, malpractice coverage that follows the doctor even after an assignment ends, and bill rates far higher than any other staffing trade. When the books don't know that, cost per placement is impossible to see clearly.
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1
Credentialing and privileging costs land before any billing does
Getting a physician privileged at a new hospital can take weeks and real money in verification and application fees, all before a single shift is billed. If that cost isn't tracked against the specific placement, it just looks like a loss with no context.
What we doKeeps credentialing and privileging costs tied to the placement they're for, so upfront cost is visible against what that assignment eventually earns. -
2
Malpractice tail coverage gets missed after an assignment ends
Some malpractice arrangements require tail coverage, insurance that extends after a physician's assignment is over, and if it isn't tracked as an ongoing cost tied to a past placement, it's easy to lose sight of what's still owed.
What we doFlags malpractice tail coverage obligations by physician and assignment so a cost from a finished contract doesn't get forgotten. -
3
High bill rates make one placement look like the whole business
A single specialist placement can bill more in a week than several general staffing placements combined, so one contract ending or starting can swing the monthly number hard enough to hide what's actually going on elsewhere.
What we doKeeps billings tagged by placement so a single high-value contract doesn't obscure the trend across the rest of the roster. -
4
Travel and housing stipends between assignments get mishandled
A traveling physician between assignments may still receive housing or travel support under specific IRS travel rules. Coded like regular pay, it gets taxed when it shouldn't be.
What we doKeeps stipends in their own line, tied to the assignment, so they're not taxed as wages when the travel rules are actually met.
Your categories
The categories Gus keeps for a locum tenens agency.
Set up once for high-value contracts and credentialing-heavy placements. You never pick a category. He does, and an accountant checks it.
Money in
- Contract billingsWeekly or daily rate invoices for physician and specialist placements, tagged by assignment.
- Marketplace billingsContracts sourced through a locum marketplace such as CompHealth or a similar exchange.
- Extension billingsAssignments renewed past their original contract length.
- Direct hire conversion feesWhat a facility owes if it hires a locum physician on permanently.
Money out
- Physician and specialist payW-2 or 1099 pay for placed clinicians, tracked by assignment.
- Credentialing and privileging costsHospital application, license verification, and background check fees per placement.
- Malpractice coverageOccurrence coverage and any tail coverage extending beyond an assignment's end.
- Travel and housing stipendsNon-taxable travel support between and during assignments, kept apart from pay.
- Marketplace and referral feesWhat a locum exchange keeps for matching contracts.
- Recruiter and sourcing costsSpecialty-specific job boards and recruiter commissions for filling contracts fast.
What we watch for you
- Margin by assignment
Bill rate minus pay, credentialing, and coverage costs, per contract. Shows which assignments were actually worth the upfront cost.
- Credentialing cost per placement
What it costs to get a physician working, tracked against how long the assignment ran.
- Days from offer to first billable shift
How long privileging takes before revenue starts. A stretching number means credentialing needs a look.
- The set-aside
What you'll owe once credentialing costs and coverage are weighed against billings, tracked every month.
Ask Gus
Things locum tenens agency owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
Yes, once her billings from the month are counted against it, that placement is running a strong margin. I kept the upfront cost tied to her assignment so you could see that clearly.
Possibly, if tail coverage applies to her arrangement. I've flagged it so it doesn't get missed, and the accountant can confirm what's still owed.
Looks like it. I tag billings by assignment, so once that one contract is set aside, the rest of your placements are tracking close to a normal month.
The tax side
The tax side of a locum tenens agency.
Most of what goes wrong here is timing and classification at high dollar amounts. Credentialing cost booked with no context, and a physician paid the wrong way for how they actually work.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Worker classification for physiciansA physician working a facility's schedule under its supervision is usually treated as an employee for that assignment, though many locum physicians work as independent contractors with real control over their own schedule. The details of each arrangement matter.
- Non-taxable travel stipendsHousing and travel support for a physician between or during assignments can often be paid tax-free under IRS travel rules when a genuine tax home is maintained elsewhere.
- Form 1099-NEC for contractor physiciansAny physician working as a contractor rather than an employee who is paid $2,000 or more in 2026 gets a 1099-NEC by January 31.
- The pass-through deductionMost owners can take up to 20 percent of business profit off their taxable income, a benefit that comes out right when margin by assignment is tracked all year.
Deductions locum tenens agencies miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Credentialing and privileging fees
- Malpractice and tail coverage premiums
- Marketplace and referral fees
- Specialty-specific job board postings
- Background check and license verification fees
- Recruiter commissions
- Recruiter travel to facility site visits
- Contract and credentialing management software
- Phone and laptop for recruiting coordinators
- Trade association dues
- Card processing fees on facility payments
- Referral bonuses for physician leads
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A locum tenens agency year, kept every month.
Credentialing runs on its own weeks-long clock and contracts vary wildly in size. Your taxes still land on a fixed schedule, and your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Reset the roster and books
Last year's return gets started, contractor physician 1099s go out, and a monthly set-aside begins so April isn't decided by which contracts ran longest.
- April
Filed between assignments
Your return is filed and signed without disrupting an active placement. No surprise bill, since the set-aside has been building since January.
- July
Assignment margin at the midpoint
Where margin by assignment stands at the midpoint, and whether a few large contracts changed what you'll owe.
- October
Before winter coverage demand
Emergency and hospitalist coverage needs often climb heading into winter. Gus looks at credentialing pipeline and malpractice obligations before the ramp.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for locum tenens agencies. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions locum tenens agency owners ask first.
Is credentialing cost really worth tracking separately from everything else?
Yes. Privileging a physician at a new hospital can cost real money before any billing starts. Gus ties that cost to the specific placement so you can see whether it paid off once billings come in.
How does Gus handle malpractice tail coverage after an assignment ends?
He flags tail coverage obligations by physician and assignment, so a cost tied to a finished contract doesn't get lost or forgotten in the books.
One huge ER contract makes our month look inflated. Can Gus separate that out?
Yes. He tags billings by assignment, so a single large contract doesn't hide how the rest of your placements are actually performing.
Are our physicians employees or contractors for tax purposes?
It depends on the arrangement. Many locum physicians genuinely control their own schedule and work as contractors, while others work more like employees. Gus flags each situation for the accountant to confirm.
Do travel stipends for physicians between assignments get taxed?
Often not, if the physician has a real tax home elsewhere and the travel rules are met. Gus keeps stipends separate from pay so they aren't taxed as wages by mistake.
Our books are behind after a run of high-value contracts closing fast. Can we catch up?
Yes. Send the bank statements and credentialing records you have. Gus ties upfront costs back to each assignment, and most owners see where they stand within a week.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever