How I decide whether to extend a locums assignment

The average locum tenens assignment lasts three months. When I first started as a locum, I swore I'd never extend one—I wanted to see a new city every 90 days. But after a few years on the road, I've learned something: eventually, you extend. Here's how I decide whether an assignment is worth staying for.

My experience at the site

Before deciding whether to extend, I ask myself a few questions about how things have actually gone:

Location and weather

Location matters more than people expect. If I've landed somewhere I genuinely enjoy, I'm already leaning toward yes. Weather plays into this too—both current and upcoming. If I'm in the Northeast and winter's rolling in, I'm less likely to extend. If I'm somewhere with great weather, like California or Florida, I'm much more open to staying.

The recruiter relationship

I also think about my relationship with my recruiter and my overall experience with the agency. I want a recruiter who:

If they've helped resolve issues at the site and gotten a good outcome, that builds trust—and makes me more likely to extend. If my recruiter is unresponsive or if I've had ongoing issues with the agency, that's often a dealbreaker.

Finances

Finances are one of the biggest factors. When I extend, I typically ask for a higher hourly rate or an extension bonus. Most of the time, the site agrees—which tells me they value my work and want me to stay. If a site or agency won't offer any financial incentive to extend, I'm far less inclined to say yes.

Negotiating an extension is a lot like negotiating your first contract. See what's on the table in part 4 of our NP locums guide: recruiters and contracts.

Personal reasons

Sometimes it's simply about life outside work. Maybe I'm ready for a break and want time off between assignments. Maybe I have international travel planned that I need to be free for. Or maybe it's the holidays, and I want to be home.

When I extended an assignment

I've extended assignments more than once, but the first time stands out. It was a geriatric clinic in Virginia—a value-based Medicare clinic where I was accountable for patient outcomes, which I genuinely liked. I also loved seeing the same patients month after month and building real relationships with them. When they offered me an extension, I asked for a pay increase and got an extension bonus instead. My recruiter had my back throughout—she advocated hard to make sure I was compensated fairly.

I ended up extending that same assignment several times, but I was careful to keep the total length under 12 months. That's an important rule of thumb: stay on one assignment for 12 months or longer, and you lose your travel benefits—your housing stipend and rental car become taxable. Worth keeping in mind before you sign on for another round.

When I didn't extend an assignment

Most locum assignments come with the option to extend, but I've turned plenty down. One was in California—a busy clinic where walk-ins meant I was regularly seeing more patients per day than I was comfortable with. I raised it with the Director, who brushed me off. I brought it to my recruiter, too, and nothing changed. Between the site and the recruiter, I didn't have the support I needed, so I declined the extension.

Another time, in Colorado, I actually enjoyed the work and the staff. But winter was coming, and as a Florida native, I wasn't about to stick around for snow. Instead of turning it down outright, I offered to extend it for one month rather than the full three—and they agreed. That's the part people don't always realize: an extension doesn't have to be all-or-nothing. Sites are often grateful for even a few extra weeks.

Final thoughts

Deciding whether to extend isn't about following a formula—it's about weighing the whole picture: the people, the pay, the place, and where you are in your own life right now. Some assignments will check every box and make staying an easy call. Others won't, and that's okay too. The freedom to say no is just as valuable as the freedom to say yes.

And if you're on the fence, remember you don't have to choose between all or nothing. A one-month extension can mean just as much—to you and to the site that wants you to stay. That's the real perk of locum life: every assignment, and every extension, is yours to negotiate.

Thinking about an assignment extension of your own? Talk to your recruiter about what you want—rate, timeline, location—before you say yes or no. The more specific you are, the more room they have to negotiate on your behalf. Give us a call at 800.453.3030 or view today’s NP job opportunities.