Medical recruitment agencies generally work on a commission which they generally take from the employer. So if they don’t place a doctor they do not get paid. Commissions can vary widely but can be as high as 20% in some cases. As a doctor, it is important to understand that this commission does not come from your package, it is calculated on top of your package. So if you are on a permanent placement you should get the same rates of pay as your peers. And if you are on a short-term locum placement you are obviously getting premium rates of pay anyway.