How much would it take...?

[BAM!]

How much would it take for you to do a few shifts each month at a per diem place 6 hrs from your home? Of course you'd have to spend a few nights there. Hotels are covered. 10 hr shifts.

I am interested in pure hourly rates as well as a comparison to your current hourly rate. Or any other metric you may think up.

Thx

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[Janders]

How much would it take for you to do a few shifts each month at a per diem place 6 hrs from your home? Of course you'd have to spend a few nights there. Hotels are covered. 10 hr shifts.

I am interested in pure hourly rates as well as a comparison to your current hourly rate. Or any other metric you may think up.

Thx

6 hour travel time? I'd do it for double my current rate. That way I would work 6-8/mo and still make solid salary.

I doubt anyone would pay double though. For 50% more, I would have done it prior to having kids, but now I value my free time more.

 

[GeneralVeers]

I travel 6 hours from home by airplane to do do locums and stay for 5-6 nights. The pay is approximately 225% of my gross from my prior full-time job. After deducting 401K, health insurance, disability etc, the net pay is about 175%. Still not too bad.

 

[deleted109597]

6 hours by car? Easily 200% per hour. That's pushing $500/hr. Not many places pay that.

 

[DeadCactus]

I travel 6 hours from home by airplane to do do locums and stay for 5-6 nights. The pay is approximately 225% of my gross from my prior full-time job. After deducting 401K, health insurance, disability etc, the net pay is about 175%. Still not too bad.

Do you have a family? How frequently are you working those strings? Is it your main gig or a supplemental job? How do you handle potential travel delays/cancelled flights?

I'm following my wife to wherever she needs to go next time we move. I'm entertaining the idea of a long distance commute like you're describing for pay and/or to start trying to break into the market I eventually want to settle in depending on where we end up for the next few years.

 

[GeneralVeers]

Do you have a family? How frequently are you working those strings? Is it your main gig or a supplemental job? How do you handle potential travel delays/cancelled flights?

I'm following my wife to wherever she needs to go next time we move. I'm entertaining the idea of a long distance commute like you're describing for pay and/or to start trying to break into the market I eventually want to settle in depending on where we end up for the next few years.

I usually work 12-15 shifts a month in 3 blocks, so I travel 3X per month. I generally plan to fly into whatever city I'm working in the night before, so if there is any travel delay I can always make my shift the next day. It is stressful, and probably not for those with young kids. It can be very lucrative though, and even just doing it temporarily for a year means you can save up a lot of money for a down payment on a home.

 

[BJJVP]

Do you have a family? How frequently are you working those strings? Is it your main gig or a supplemental job? How do you handle potential travel delays/cancelled flights?

I'm following my wife to wherever she needs to go next time we move. I'm entertaining the idea of a long distance commute like you're describing for pay and/or to start trying to break into the market I eventually want to settle in depending on where we end up for the next few years.

I fly 5 hrs to work once a month. I work 1.5 weeks straight through. It sounds brutal, but believe it or not, it is WAY better than what I used to do. There are many factors involved in why this is a better set-up for me:
1) Although I fly to work, my daily drive is only minutes away (as opposed to 45 min-1hr in traffic).
2) I see my family more. You spend less time at home than you think when you work a traditional EM schedule. For example, if your shift starts at 3pm, how much do you really see your family if the kids are in school (especially if you count the time for you to get ready and then commute to the hospital)? If you work a late evening or overnight shift, how much quality time are you really spending with your family the next day? Ask yourself, how many day shifts (start at 9am or earlier) do you really get in a given month?
3) You leave work at work. There's something about flying away from the state that makes you feel like you are on vacation and not just going home after a long day at work. My wife has noticed that mentally, I am actually better at home. Ironically, feelings of burnout come up way less often than before. I don't sit around thinking about work while she's trying to have a conversation with me nearly as often as I used to.
4) My time at home is in one huge block, which makes me healthier...I sleep every night and wake up every morning at the same time for several weeks in a row each month. I work out regularly...it was so hard to work out before when I was working constantly changing and randomly placed shifts. When my friends ask me what I am doing next week, I actually know the answer instead of having to consult my ED schedule.
5) Hour for hour, my net pay is higher by about 40% since I work in a state that's better for EM doctors. I don't make more annually as a result though. Instead, I took Birdstrike's advice and bought a relatively small home and just signed up for less shifts.

Downsides are minor:
1) My neighbors probably think I am a drug dealer, stay at home dad, work from home or just can't get a real doctor job in my home state. My friends in my home state are constantly telling me about job offers in my home state because they can't understand that this is actually a better deal for me (they are not EM people).
2) I don't feel like part of the medical community in my home state.
3) It's difficult to contribute to the hospital/EM group in non-clinical ways since you are not physically in the state most of the time.

I've been doing this for 2 years. I would not ever go back to the traditional EM schedule if I can help it. PM me for more details if you have any questions.

 

[GeneralVeers]

It also helps if you enjoy travel. I don't mind the travel component, as I have top level Executive Platinum with American and get upgraded to First about 90% of the time. Flying first and getting free cocktails and enough space certainly helps. Plus I turn all of those airmiles (currently have a balance of 275K) into free First Class international trips several times a year. Since work is covering the cost of domestic flying, I essentially get a $30-40,000 international First ticket for free. Also getting elite status with a hotel helps, as internationally you get free suite upgrades and free breakfast which can save you $1000's on a long vacation.

The reasons above are why I try to fly 3X per month to maintain my hotel and airline status. Airline and hotel points really are a tremendous tax-free benefit of the job.

 

[DeadCactus]

Thanks for sharing, that was really helpful. What are your thoughts on locums gig right out of residency? Is it a mistake to expose yourself to a constantly changing hospital system at a time when you're trying to nail down your independent practice?

 

[BJJVP]

Thanks for sharing, that was really helpful. What are your thoughts on locums gig right out of residency? Is it a mistake to expose yourself to a constantly changing hospital system at a time when you're trying to nail down your independent practice?

I highly recommend working in another state. However, I actually wouldn't recommend it for new grads for several reasons.
1) Your goal of your first job should be to get comfortable as an attending (getting a feel of your risk tolerance levels for admission, consults, diagnostic testing, etc). It is stressful enough as it is trying to do just that without going out of state to practice. It took me about a year to really get a feel of my "practice style." It still changes from time to time now 8 yrs later but the first year was a steep learning curve (and I felt I was a relatively confident senior resident).
2) You WILL do some silly things fresh out of residency. I ordered a CT abd/pelvis on almost every back pain over 50 looking for a AAA for my first 2 months...I didn't realize that this hospital had a huge drug seeking problem and everyone looked like they were dying when they were actually just withdrawing. I admitted a lot of atypical CP. Anyways, the staff there was more forgiving because they thought I was staying there for the long term and wanted to keep me. If I had been a locums physician, they may or may not have wanted me back next month...I don't really know.
3) From what I hear, a lot of locums sites have trouble recruiting for a reason. Maybe a poor work environment. Maybe just the lack of a stable group of EM physicians makes it hard to change the ED for the better...it also leads to less respect for the ED from the rest of the medical staff...this just an assumption and I don't know this from any real extensive experience.

 

[BAM!]

When you guys travel to work, do you fly in the same day or night before. When do you leave? Fly out right after shift? Of course it depends of when shift ends, but do you do same day travel? a 5 day trip feels much shorter than a 7 day one...

 

[VentJockey]

A friend of mine does this in addition to his regular job. He flies clear across the country and makes in one week the same amount as he makes the rest of the month in his regular salary. He is very happy with the situation.

 

[GeneralVeers]

When you guys travel to work, do you fly in the same day or night before. When do you leave? Fly out right after shift? Of course it depends of when shift ends, but do you do same day travel? a 5 day trip feels much shorter than a 7 day one...

It depends on several factors:

1. Flights. I usually take the latest flights that will get me there on the evening before my shift. I usually book the first flight out after my last shift, which in some cases on a night shift is only 2-3 hours after I'm done.
2. Flight schedules if they line up
3. What I have to do the next day. If I can sleep when I get home, then I usually take the earliest flight and don't worry about sleeping. If I need to be productive, then I'll sleep a bit at the hotel and book a later flight.

 

[EMDoc0411]

I like to fly in the day of. I do a reverse schedule. I start with the night shift then transition through the various shifts until the last day I do the early day shift. I then fly home that evening. This maximizes the time that I am there and I can get home sooner.

 

[GeneralVeers]

I like to fly in the day of. I do a reverse schedule. I start with the night shift then transition through the various shifts until the last day I do the early day shift. I then fly home that evening. This maximizes the time that I am there and I can get home sooner.

I find that too tough on night shifts because it often means going 24 hours without sleep. If I left home in the morning, I could arrive in my job city at 2 PM. By the time I got to the hotel and settled it would be after 3 PM, and then to work at 6 or 7 PM would mean getting very little or no sleep at all.

 

[WilcoWorld]

It depends on several factors:

1. Flights. I usually take the latest flights that will get me there on the evening before my shift. I usually book the first flight out after my last shift, which in some cases on a night shift is only 2-3 hours after I'm done.
2. Flight schedules if they line up
3. What I have to do the next day. If I can sleep when I get home, then I usually take the earliest flight and don't worry about sleeping. If I need to be productive, then I'll sleep a bit at the hotel and book a later flight.

I like to fly in the day of. I do a reverse schedule. I start with the night shift then transition through the various shifts until the last day I do the early day shift. I then fly home that evening. This maximizes the time that I am there and I can get home sooner.

I'm happy that you've found a set up that works for you, but these schedules sound like torture to me.

 

[GeneralVeers]

I'm happy that you've found a set up that works for you, but these schedules sound like torture to me.

Some days it can feel like torture. Does doubling your salary make it worth that? Also if I want to take an entire month of for a vacation I can, as I get to make my own schedule.

 

[BJJVP]

I'm happy that you've found a set up that works for you, but these schedules sound like torture to me.

I guess it is torture, but not any more than the usual EM schedule. At least to me, it's just a different pattern of torture. I found that unless I have a huge chunk of time off, I never fully recovered from the traditional EM schedule. But believe me, the only thing that keeps me going on the last day of working that month is knowing I have a large chunk of time off coming to me.

 

[WilcoWorld]

Like I said, I'm glad that you found something that works for you. I like my job set up (as much as one can like a job), but I'm sure there are aspects of what I do that would make other docs run for the hills.

 

[emergentmd]

How much would it take for you to do a few shifts each month at a per diem place 6 hrs from your home? Of course you'd have to spend a few nights there. Hotels are covered. 10 hr shifts.

I am interested in pure hourly rates as well as a comparison to your current hourly rate. Or any other metric you may think up.

Thx

6hrs? If your are flying it doesn't matter much if its 2 hrs vs 3hrs fly time. What would matter more is if there is a direct flight and how easy it would be to schedule a flight. Alot of variable but this is what I do

Place is 3 hrs drive away. There are 7-10 direct flights each day so about every 90 minutes. My contract rate is 1.8x my current hr pay at home base, 2.3x my per shift rate (read longer shifts here). Even with this rate, it is not worth it to me but is to alot of my partners. I would only do a shift if its a minimum of 3x my home base hrly rate and I have NOTHING to do. If I have to miss an event, have to work after/before my home base shift, I would expect to have 4x my base pay minimum. I turn down 3x my home base pay on a weekly basis. I am sure many will think I make this up, but it takes me 2 dys to cover a shift. day before travel, work am shift, travel home at night. So I lose 2 dys, don't see my family for 2 dys, live in a hotel. That is worth atleast 3x my hourly base pay. If I have to sacrifice something, then it goes up to 4x my hourly base pay. My Min to do a shift is $500/hr if I have no functions at home. And all cost of travel is covered.

I also do locums with a 1 hr drive. I will give them a hometown discount b/c I do not waste any extra time traveling other than the 1 hr drive. My kids have no clue that I am even out of town. But even with the hometown discount, I require $450/hr if I have nothing to do. If I have to sacrifice, then It has to be $550/hr. A BIG sacrifice, and my min is $650/hr.

 

[Apollyon]

6hrs? If your are flying it doesn't matter much if its 2 hrs vs 3hrs fly time. What would matter more is if there is a direct flight and how easy it would be to schedule a flight. Alot of variable but this is what I do

Place is 3 hrs drive away. There are 7-10 direct flights each day so about every 90 minutes. My contract rate is 1.8x my current hr pay at home base, 2.3x my per shift rate (read longer shifts here). Even with this rate, it is not worth it to me but is to alot of my partners. I would only do a shift if its a minimum of 3x my home base hrly rate and I have NOTHING to do. If I have to miss an event, have to work after/before my home base shift, I would expect to have 4x my base pay minimum. I turn down 3x my home base pay on a weekly basis. I am sure many will think I make this up, but it takes me 2 dys to cover a shift. day before travel, work am shift, travel home at night. So I lose 2 dys, don't see my family for 2 dys, live in a hotel. That is worth atleast 3x my hourly base pay. If I have to sacrifice something, then it goes up to 4x my hourly base pay. My Min to do a shift is $500/hr if I have no functions at home. And all cost of travel is covered.

I also do locums with a 1 hr drive. I will give them a hometown discount b/c I do not waste any extra time traveling other than the 1 hr drive. My kids have no clue that I am even out of town. But even with the hometown discount, I require $450/hr if I have nothing to do. If I have to sacrifice, then It has to be $550/hr. A BIG sacrifice, and my min is $650/hr.

And this occurs on a consistent, predictable basis? Those numbers are WAY high (99th percentile for $650/hr, I believe), and I would not put faith in an administration that is in "crisis" management as a day to day operating mode. (As in, "proactive" - learn new practices constantly, "reactive" - situation occurs which, when addressed, changes the way going forward, "crisis" - things happen, it is addressed, but the primary process is not changed.) If, in January, Dr. Emerg tells me on 28 Jan that, in Feb, he can do 24 hours at $450, 12 hrs at $550, and 8 hrs at $650, then, on Feb 26, he can do March hours of 16 at $450, 16 of $550, and 8 of $650, I'm going to start to see a pattern. And, whomever it is who is scheduling (or who gives them the budget with which to schedule), they are either going to have to do better, or do something else (as in, they're out). On a parallel, while you are raking it in, aren't they actively recruiting? $350/hr for 120 hrs is $500K/year. I don't care how much of a ****hole that is - 5 or 8 years of that, and, with prudent management, someone can look at retiring. It seems crazy that you are regularly turning down 3X your base, and, as I say, QUITE a surprise that it is consistent and predictable.

 

[emergentmd]

And this occurs on a consistent, predictable basis? Those numbers are WAY high (99th percentile for $650/hr, I believe), and I would not put faith in an administration that is in "crisis" management as a day to day operating mode. (As in, "proactive" - learn new practices constantly, "reactive" - situation occurs which, when addressed, changes the way going forward, "crisis" - things happen, it is addressed, but the primary process is not changed.) If, in January, Dr. Emerg tells me on 28 Jan that, in Feb, he can do 24 hours at $450, 12 hrs at $550, and 8 hrs at $650, then, on Feb 26, he can do March hours of 16 at $450, 16 of $550, and 8 of $650, I'm going to start to see a pattern. And, whomever it is who is scheduling (or who gives them the budget with which to schedule), they are either going to have to do better, or do something else (as in, they're out). On a parallel, while you are raking it in, aren't they actively recruiting? $350/hr for 120 hrs is $500K/year. I don't care how much of a ****hole that is - 5 or 8 years of that, and, with prudent management, someone can look at retiring. It seems crazy that you are regularly turning down 3X your base, and, as I say, QUITE a surprise that it is consistent and predictable.

I am absolutely not saying that I can pick up a a $600/hr shift any time I want. If I was just doing Locums, I can tell you with certainty that I can pick up a $400/hr shift 25 days of the month, $500/hr shift 10 dys of the month, and $600/hr shift prob 5 times a month. You have to be flexible.

And you are right, these places are actively hiring but they CAN NOT hire at much higher rate than what they have been giving out. They are stuck in a tough situation. They may have 6 docs that are full time making $250/hr. If they were going to hire at $350/hr, then these 6 docs are either going to expect the same rate or leave. Plus every doc that leaves opens up 15 more uncovered shifts and I can tell you they leave all of the time.

But eventually they will get everything staffed well but there are 10 more hospitals that will have shortages that needs coverage.

I currently have 10 days in June offered at a rate of $475/hr and 30 shifts in July at $400/hr.

To your 500k/yr point, its readily available. I pull in close to 400k with benefits working 120hr/mo. So 500k without benefits is not much given that I have to travel. But if I were single and had no location commitments, I could easily make 700K working 15-12hr shifts a month.

 

[barnacle]

Do most of you set up your locums on your own or arrange it through a locums company? Any companies you recommend? Any you recommend to avoid?