From Dr. Cooper’s September perspective
A practical way to compare agency support, direct contracting responsibilities, scope, and the total assignment—not just one headline number.
AI-assisted editorial adaptation of Dr. William A. Cooper’s September 3, 2026 social-calendar text. The explanations and reader questions below are editorial additions, rather than a new first-person account by Dr. Cooper.
Understand what the agency is doing
Dr. William Cooper’s September post asks physicians to make the agency relationship a conscious decision. A staffing company can coordinate a facility relationship, applications, travel, scheduling, and insurance arrangements. The useful question is which services are actually included in your assignment and who remains accountable when a problem occurs. An agency fee is not automatically waste, and a direct agreement is not automatically a better deal.
Ask for a written description of the support you receive. Who collects documents? Who communicates with the medical staff office? Who arranges travel? Who answers a schedule dispute? Which expenses are covered? A list of specific responsibilities is more useful than a general promise that everything is handled.
Compare total responsibilities before comparing pay
Dr. Cooper’s original post refers to a broad agency spread estimate. This guide does not treat that estimate as a verified market benchmark. Contracts, facility arrangements, included services, and specialty needs vary. There is no universal percentage that tells you what an individual agency should keep.
Build a side-by-side comparison instead. List compensation, included hours, call, travel, housing, liability arrangements, administrative time, payment timing, and cancellation terms. Identify who carries each responsibility under each option. The difference between two quoted rates means little until the work and expenses being compared are the same.
Define scope before discussing the rate
Direct contracting can place more coordination on the physician and the physician’s business. Clarify the procedures, clinic obligations, call structure, working locations, handoffs, and backup before negotiating compensation. Ask how changes will be documented and approved. A conversation about doing whatever is needed leaves important questions unanswered.
The AMA’s guidance on physician duties and liability insurance highlights the importance of defined call obligations and explicit insurance responsibilities. A qualified adviser should review the actual agreement. The employment examples in that resource do not determine the terms of every independent contractor arrangement.
Choose a model you can operate well
Dr. Cooper describes direct opportunities as relationships that often develop through colleagues, training contacts, and professional networks. Treat that as his professional perspective, rather than a promise that a particular contact will produce an assignment. Evaluate your ability to manage the relationship and the operational work before deciding to contract directly.
Existing agency agreements can also affect a proposed direct relationship. Have appropriate counsel review any restrictions before approaching a facility. The decision is not whether agencies are good or bad. It is whether the support, obligations, and agreement fit the stage of your career and the assignment you are considering.
Frequently asked questions
Does direct contracting always pay more?
No. Compare the actual compensation, expenses, insurance arrangements, administrative work, payment terms, and risk allocation. A larger quoted rate alone does not establish a better net outcome.
Who handles credentialing in a direct agreement?
Clarify responsibility in the agreement and with the facility. A physician can prepare documents and coordinate an application; the institution controls its credentialing and privilege decisions.
What should be defined before the rate?
The procedures, setting, clinic duties, call, schedule, backup, and boundaries of responsibility. Then compare compensation for that defined scope.