Karen Melde, a locum tenens nurse practitioner based in Atlanta, gave 60 days’ notice at her permanent practice in 2021, walked away from a morning schedule that once listed no fewer than 27 patients, and has not looked back. Now 71, she covers paediatric clinics across the United States on a contract-by-contract basis, earning around $100 per hour compared with the $70–$75 she received in permanent employment, a rise of roughly 25%.
Her story, told to Business Insider, reflects a broader shift in how healthcare systems are filling gaps in clinical cover. The locum tenens model, from the Latin meaning ‘to hold the place of’, places temporary practitioners into clinics, urgent-care centres and hospitals when permanent staff are on maternity leave, sick leave or otherwise absent.
A Locum Tenens Nurse Practitioner in Six States
Since soft-retiring, Melde has worked in Georgia, Maine, Alaska, California, Virginia and Tennessee. The assignments have taken her to places far outside the standard metropolitan circuit. In Utqiaġvik, Alaska, she served Native Alaskan populations; in San Bernardino County, she worked across several tribal clinics. Her specialties include ADHD diagnosis and medication prescribing, asthma management, well-child appointments and sports physicals.
Accommodation comes with the role. Employers have housed her in high-end Airbnbs at no cost to her, including a Victorian colonial house in rural Maine near the Canadian border, where serious cases had to be airlifted to Bangor, up to three hours away by car. In Tennessee, she spent time on a deck overlooking a lake, staying in a two-bedroom, two-bathroom condo inside a resort community with five golf courses and hiking trails, the rent covered in full by the federally qualified health centre employing her.
Her husband Ken, 73, remains at their Atlanta home during her placements, caring for the family dog. He rarely joins her on assignment, though Melde says the successive breaks from their shared routine have left them enjoying each other’s company more.
Why the Locum Tenens Market Keeps Growing
Melde’s arrangement sits inside a fast-expanding sector. According to Barton Associates, the locum tenens market is projected to reach $8.8 billion in market size in 2025, with demand driven in part by persistent shortages in rural and underserved areas. Barton Associates also notes that as of March 2024, 66.7% of Primary Care Health Professional Shortage Areas (HPSAs) were in rural locations, the precise geographies where practitioners like Melde are most likely to be deployed.
Yet the pipeline of practitioners willing to take those placements remains thin. Data from Medicus HCS shows that as of October 2025, approximately 2.5% of nurse practitioners in the United States, or about 1 in 39, work locum tenens jobs as a career. That figure underlines both the relative novelty of the model within the NP profession and the scale of unfilled demand that practitioners entering this space are stepping into.
The paediatric specialism Melde practises faces particular pressure. AMN Healthcare has warned of a ‘forecasted critical shortage of PNPs over the next decade’, which makes experienced paediatric NPs willing to travel a scarce and sought-after resource for clinic managers trying to maintain continuity of care.
For Melde, the financial upside was not the primary motivation. She describes the move as driven by exhaustion with the volume-driven model of her permanent role, where a 27-patient morning was the final straw, and a desire to stay clinically active without the friction of institutional politics. Her hourly rate, received through an agency, delivers the 25% premium over her former permanent salary that now helps fund road trips to state parks with Ken between assignments.
Next postings are in prospect in Idaho, Rhode Island and Massachusetts, with Melde currently interviewing for those positions. She has stated her intention to continue as a locum for as long as she is able, a commitment that, given the scale of the projected paediatric NP shortage, is likely to find no shortage of takers on the clinic side either.