Disrupting the Locums Model and Restoring Physician Autonomy

1. Hospital Administrators Aren't the Enemy. They're Navigating a Complex System

A common source of friction between physicians and hospital leadership is a simple mismatch in perspective. Joe addressed this head-on: most hospital executives are genuinely trying to do the right thing. They are just operating under financial pressures that clinicians rarely see.

One of the most eye-opening dynamics Joe described is cross-subsidization, how profitable service lines internally fund less profitable ones. OB-GYN deliveries are a prime example. Hospitals often lose money on labor and delivery, but those losses are offset by NICU revenue. When a rural hospital lacks a NICU, that subsidy disappears, which is a key reason so many rural OB programs are shutting down.

The shift toward outpatient surgery and ASCs tells a similar story. While moving procedures to an ambulatory setting is better for patients and often more efficient, it reduces hospital reimbursement while leaving the same fixed overhead in place: staffing, equipment, facilities. That tension explains why health systems have been slow to embrace the shift, even as patient demand pushes them that way.

The takeaway for physicians: understanding these macro forces makes it far easier to engage productively with hospital leadership and to advocate more effectively for what patients and physicians actually need.

2. The Traditional Locums Model Is Broken. And Everyone Knows It.

The staffing agency model has long been the go-to solution for hospitals that need physician coverage. Joe's verdict? It kind of works, but at a steep cost to everyone involved.

Traditional locums agencies typically capture around 40% overhead on top of what a physician earns. That markup funds a sales-driven model that is not always aligned with what doctors or hospitals actually need. Agencies are incentivized to place physicians as quickly as possible at the highest contract rate, not necessarily to find the right long-term fit. The result is a high-turnover, short-term mentality that leaves both sides underserved.

There is also a transparency problem. Joe compared it to buying a home. When you hire a real estate agent, you know what commission they are earning. In locums, most physicians have no idea how much the agency is taking. That opacity is fundamentally unfair to the physicians who are the actual source of value.

And then there are buyout clauses. $20,000 fees that kick in if a hospital wants to bring a physician on permanently. These create a perverse incentive against long-term relationships, and physicians often do not realize those costs are likely being extracted from their own compensation packages.

3. Sendit Gigs: The Uber Model for Physician Staffing

Joe's solution is Sendit Gigs, a marketplace platform that connects physicians directly with hospitals, with full transparency on compensation, availability, and fit. The analogy he uses is simple: the difference between a taxi and Uber. Both get you where you're going. One does it with friction, opacity, and middlemen. The other is seamless.

A few things that set Sendit apart:

• Compensation transparency from day one. Physicians set their own rates upfront. Hospitals see those rates before any conversation begins. No surprises. No wasted time.
• A shared availability calendar. Physicians upload their schedule. Hospitals can book directly. No back-and-forth through multiple coordinators.
• No buyout fees. If a hospital wants to bring a physician on full-time after working together through Sendit, they can, without a penalty. Joe's philosophy is simple: if both parties found a good fit, that is a win.
• A credentialing wallet. Documents are collected once and stored securely. Since roughly 90% of credentialing requirements are identical across hospitals, that information can be shared quickly, eliminating one of the biggest friction points in the process.
• Reputation management. The goal is to get to the point where both parties are rating their experience, creating an accountable and transparent relationship.

The overhead? Just 9% on top of the physician's rate. A fraction of what traditional agencies charge.

4. Gig Work Is Not Just for Burnt-Out Doctors. It Is a Strategic Career Move.

Joe reframes the concept of locums work entirely. Rather than viewing it as a last resort for physicians in transition, he sees it as a form of fractional work, the same model that has become standard in the startup world, where fractional CFOs, CMOs, and sales leaders are common.

Consider the physician profiled on the Sendit platform: a doctor who lives in an RV with his family, travels to a new location each month, works seven shifts, earns competitive income, and spends the other 21 days with his kids. That is not a workaround. That is intentional lifestyle design.

For physicians facing burnout, uncertainty about employment stability, or a desire for more flexibility, gig-based work offers a genuine alternative. It provides a financial safety net, the ability to explore different hospital cultures and communities, and critically, the autonomy that many physicians feel they have lost in an increasingly employed model.

5. Physicians Are the Spice. And They Should Act Like It.

Joe closed with what might be the most important message of the entire conversation. It was not about technology or startups. It was about physician self-worth.

Borrowing a line from Dune, "He who controls the spice controls the universe," Joe made the case that physicians are the spice in healthcare. Every prescription, every procedure, every dollar of revenue flows through a physician. And yet too many doctors enter negotiations without a clear sense of their own market value.

Sendit includes a compensation checker on its website so any physician working locums, or considering it, can compare what they are currently earning against what they could be earning through a transparent platform. The goal is simple: arm physicians with information so they can advocate for themselves.

Want to Learn More or Create a Profile?

Visit Senditgigs.com/pnc-podcast for a special page created for PNC Podcast listeners. You can sign up for the newsletter, create a profile in about four minutes, and use the compensation checker to see what your time is worth in today's market.

There is no commitment and no obligation when you create a profile. When a match comes in that fits your criteria, you will be notified. If it does not feel right, you move on.

The control is yours. Exactly how it should be.