Locum-to-perm in oncology: when it works, when it backfires.

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Locum-to-perm conversion is one of the most useful tools in oncology hiring. It's also one of the most over-used and under-managed. Done well, it produces a hire who's already proven themselves in your environment, with your equipment, with your team. Done poorly, it produces a six-month vacancy and a damaged relationship with a clinician you'd otherwise have hired.

Here's the pattern we've seen across hundreds of conversion conversations.

When it works.

The role was permanent from day one — locum was just the entry path.

The cleanest conversions happen when the program knows it has a permanent need, the candidate knows that permanent role exists, and the locum stretch is just a runway to credentialing finalization, relocation logistics, or contract finalization. Both sides go into the engagement with conversion as the explicit goal, not as a maybe.

These conversions almost always close. The "trial period" framing isn't really a trial — it's a structured handoff with the paperwork built in.

The candidate was open to relocation but cautious about the program.

Senior physicists and physicians evaluating a relocation to an unfamiliar program often want to actually work in the environment before they uproot a family. Locum stretches of 90–180 days give them that exposure. If the program is what was advertised, conversion is straightforward. If something's off — leadership culture, equipment realities, case volume — they self-select out before anyone has overcommitted.

This is a healthy pattern. The candidate gets confidence, the program gets a real-world audition, and the worst case is an amicable exit before either side is invested.

The program needed to validate the role itself.

Sometimes the question isn't whether a specific candidate is a fit — it's whether the role as scoped is actually a real role. A new SBRT program, a satellite expansion, a service-line build. Bringing in a locum specialist for a defined period lets the program test demand, refine workflows, and validate the FTE before committing to a permanent line.

When it backfires.

The "locum" was secretly a perm role with no perm budget approved.

This is the most common failure pattern. Leadership wants a permanent hire but hasn't gotten finance approval, so they staff the role on locum rates indefinitely with vague conversion promises. The clinician notices. They're paid as a contractor for what's clearly a permanent operating need. Eventually they accept a real permanent offer somewhere else, and the program is back at zero — except now they've burned six months of locum spend and lost the relationship.

If the role is permanent, get the budget approved before you bring someone in on locum framing. Locum-to-perm only works when the perm offer is real and timeline-bounded.

Conversion terms were never written down.

"We'll talk about converting at six months" is not a plan. It's a wish. Without specifics — comp range, conversion fee structure, timeline, performance criteria — both sides drift into different expectations. The clinician thinks the conversion is automatic; the program thinks it's contingent on a new approval cycle.

Good locum-to-perm engagements have the conversion terms in writing on day one. Conversion comp range. Buyout fee or transition structure with the staffing partner. Performance milestones if any. Timeline trigger. None of this is complicated; it just has to exist before the engagement starts.

The program kept the candidate at locum rates too long.

Locum rates are higher than W2 rates by design — they include the contractor's cost of benefits, taxes, and risk. Past 4–6 months in the same role, the clinician starts doing the math on what they'd be making W2 elsewhere. Programs that string locum engagements out for 9–12 months "while we figure out the budget" routinely lose the candidate to a permanent offer with worse base comp but better total package.

What good conversion looks like.

The pattern is simple even if the execution takes discipline:

• Decide upfront whether conversion is the goal. If it is, say so.
• Get the permanent budget approved before the locum starts.
• Put conversion comp, fee structure, and timeline in writing on day one.
• Set the conversion conversation for month three or four — not month nine.
• Treat the locum stretch as the first few months of employment, not a separate transactional engagement.

Programs that do this convert 70%+ of their locum-to-perm engagements. Programs that don't convert 20% and wonder why their permanent searches keep starting over.