An Empirical Analysis of Litigation Involving Locum Tenens Neurosurgery and Spine Surgery in the United States in the Past 40 Years

BACKGROUND AND OBJECTIVES: Locum tenens refers to the professional activity of physicians who temporarily contract at hospitals or clinics to address staffing shortages, a practice that has grown substantially across all specialties, including neurosurgery, especially in the past few years due to events such as the COVID-19 pandemic. Neurosurgery carries one of the highest malpractice burdens of all medical specialties, yet no previous study has examined litigation specifically involving locum tenens neurosurgeons and spine surgeons. METHODS: A search of legal disputes (including malpractice claims and contract disputes) was performed in the legal database LexisNexis using terms related to neurosurgeons and spine surgeons acting as locum tenens or independent contractor physicians, with 2 independent reviewers screening all results. RESULTS: Of the 556 cases identified, 54 cases met the inclusion criteria, of which, 41 were malpractice, 8 were contract disputes, and 5 involved both. The cases spanned 27 states from 1980 to 2025. Defense verdicts comprised most outcomes (30/54, 55.6%), and the defense prevailed in 69% of cases where both a physician and hospital were named codefendants. Employment classification emerged as the most consequential legal variable regarding outcome of the litigation. When hospitals demonstrated a clear independent contractor status, they were frequently absolved of vicarious liability, shifting the legal burden toward the individual neurosurgeon. CONCLUSION: This is the first study to provide empirical data on the legal liability involving the practice of neurosurgery as locum tenens in the United States from 1980 to 2025. As locum tenens utilization continues to grow within neurosurgery, neurosurgeons must carefully review contracts, confirm malpractice coverage, and understand institutional liability frameworks before entering such a work model.