Locum Physician Pay & Rates in Ontario, Explained

“What does a locum pay?” is one of the most common questions from Ontario physicians — and the honest answer is that it depends. Locum pay is negotiated, not fixed, and the structure matters as much as the headline number. This guide explains how locum compensation is put together, what drives it up or down, and how to think about take-home pay, without pretending there is a single going rate. For fee specifics, always work from the current OHIP Schedule of Benefits and confirm terms with each clinic.

The two main pay structures

Fee-for-service (OHIP billing)

In many family and walk-in clinic locums, the physician bills the Ontario Health Insurance Plan for the services they provide, using the fee codes in the OHIP Schedule of Benefits. What you earn therefore depends on patient volume and case mix — a busy clinic day generates more billings than a quiet one. In most fee-for-service arrangements the host clinic keeps an overhead split.

Sessional, hourly, or daily rate

In other settings — some hospital coverage and virtual care, for example — the clinic or organization pays an agreed rate for your time rather than per service. This gives predictable income regardless of volume, which can be attractive for coverage where patient flow is uncertain. The rate is negotiated for each arrangement.

What affects the rate

Because nothing here is standardized, it helps to know the levers that move locum compensation:

• Setting and specialty — family practice, walk-in, hospital, and virtual care all pay differently.
• Patient volume and acuity — in fee-for-service, more (and more complex) patients generally means higher billings.
• Hours and timing — evenings, weekends, holidays, and on-call can carry different terms.
• Location — rural and underserved communities sometimes have distinct programs or incentives.
• Overhead split — the percentage the clinic retains directly changes your net.
• Length and continuity — a single shift and a multi-month coverage block may be negotiated differently.

Understanding overhead and the split

In fee-for-service clinics, overhead covers the real costs of running the practice — rent, front-desk and nursing staff, the EMR, and supplies. The clinic typically funds this by retaining a share of billings, and the locum keeps the rest. The split is negotiated and varies from clinic to clinic, so treat any percentage you hear about as a starting point rather than a rule. Always confirm the exact split and what it includes before you agree to cover.

Take-home: from billings to your bank account

Gross billings or a quoted rate are not what lands in your account. Locums are generally self-employed, which means several costs come out of earnings:

• Income tax and CPP contributions.
• The overhead split (in fee-for-service arrangements).
• CMPA membership dues and other professional costs.
• Accounting, incorporation, or administrative expenses, if applicable.

Because the math varies with your situation, it is worth speaking to an accountant familiar with physician finances before committing to a busy locum schedule.

Negotiating your rate

You will negotiate better when you understand the setting. Ask about expected patient volume, the overhead split and exactly what it covers, hours and after-hours expectations, and how billing or payment is handled. Compare a few opportunities rather than accepting the first, and get the terms in writing. The Ontario Medical Association and the OHIP Schedule of Benefits are helpful for context on fees and billing.

PRN Doc makes it easier to compare real coverage opportunities across Ontario in one place. Join PRN Doc free to see current shifts. New to locum work? Start with how to become a locum doctor in Ontario and the complete guide to locum tenens in Canada.

Frequently asked questions