So what changes with time that EM becomes so deplorable?

[TooMuchResearch]

Bird, that was a great post.

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[EvoDevo]

Man, this thread encapsulates so much of the disillusionment that I've experienced over the past two years. It's been depressing to realize that the specialty is exactly as @Birdstrike describes. And it won't change, ever. The only way out is either fellowship, death, or doing something that's not really medically related. I'm working on my own exit plan (five years) and hope to be able to work EM in the future when and how I want, for fun.

In the meantime, I've become one of those guys: Hired gun locums, working for no one group but many. The pay is absolutely great and the schedulers ask me what I want, not what I'll take. There certainly is more risk, but so what? F--- it! I can always cave and go back to working for The Man, but right now I love being able to be an asset to a hospital, see varied pathology, and know that when a suit tries to pull the BS that Bird describes...I can literally "peace out." F-- the suits and CMGs: I'm a great doc, I bring value to the ERs that I work in, but none are worth my marriage or health, and this way I get more time with the family.

I know some of you have vocally eviscerated locums docs, and truthfully many suck. But many don't and I've met some amazingly skilled EPs who are taking control of their lives...

 

[Birdstrike]

Man, this thread encapsulates so much of the disillusionment that I've experienced over the past two years. It's been depressing to realize that the specialty is exactly as @Birdstrike describes. And it won't change, ever. The only way out is either fellowship, death, or doing something that's not really medically related. I'm working on my own exit plan (five years) and hope to be able to work EM in the future when and how I want, for fun.

In the meantime, I've become one of those guys: Hired gun locums, working for no one group but many. The pay is absolutely great and the schedulers ask me what I want, not what I'll take. There certainly is more risk, but so what? F--- it! I can always cave and go back to working for The Man, but right now I love being able to be an asset to a hospital, see varied pathology, and know that when a suit tries to pull the BS that Bird describes...I can literally "peace out." F-- the suits and CMGs: I'm a great doc, I bring value to the ERs that I work in, but none are worth my marriage or health, and this way I get more time with the family.

I know some of you have vocally eviscerated locums docs, and truthfully many suck. But many don't and I've met some amazingly skilled EPs who are taking control of their lives...

Amen, brutha. Take control. And thank you, for the hard work you do.

 

[GeneralVeers]

Man, this thread encapsulates so much of the disillusionment that I've experienced over the past two years. It's been depressing to realize that the specialty is exactly as @Birdstrike describes. And it won't change, ever. The only way out is either fellowship, death, or doing something that's not really medically related. I'm working on my own exit plan (five years) and hope to be able to work EM in the future when and how I want, for fun.

In the meantime, I've become one of those guys: Hired gun locums, working for no one group but many. The pay is absolutely great and the schedulers ask me what I want, not what I'll take. There certainly is more risk, but so what? F--- it! I can always cave and go back to working for The Man, but right now I love being able to be an asset to a hospital, see varied pathology, and know that when a suit tries to pull the BS that Bird describes...I can literally "peace out." F-- the suits and CMGs: I'm a great doc, I bring value to the ERs that I work in, but none are worth my marriage or health, and this way I get more time with the family.

I know some of you have vocally eviscerated locums docs, and truthfully many suck. But many don't and I've met some amazingly skilled EPs who are taking control of their lives...

I did exactly what you did and it has changed my life. 5+ years out at the same CMG job I didn't know what I wanted to do, and the continual salary decreases, increased patient load, and regulations made me dread going into work every day.

Now as a full-time self-employed locums, I work where I want, when I want, for as many shifts as I want. I just got back from a 2 week vacation in the South Pacific. Having complete control over your own schedule is the most liberating thing you can get in this profession. If I work at a site that I don't like, or a site which goes downhill, guess what? I leave, and take my skills elsewhere. With proper research, I am consistently able to find sites that I enjoy working at, with a reasonable workload (~ 2 pts/hour), and with salary at 95-99% of what the profession as a whole is making.

True I am away from home and it can be stressful. Two of my informal work partners have young children, and still manage the locums lifestyle. Yes they are away from home, but with making more money they have been able to cut down on their work hours by 30% which means they have more days off, and more useful time with family.

The other thing that most people don't think about are airline and hotel points. If you properly manage these, it can be equivalent to $10,000 in tax-free benefits. If spent on the right awards (like Emirates First Class) you can can get $100,000 of nearly-free international First Class travel. Best of all you have the free time to use them!

 

[gman33]

Any people have luck doing Locums, but without so much travel?
I can see some of the benefits, but being away from home for weeks at a clip would not sit so well with my wife.

 

[EctopicFetus]

I think if I ever left the SDG life locums would be the next best. I think it is a tough road with the travel but I think grinding it out with the CMG sucks worse. I have really been looking at my financials and if my great SDG gig would ever go away I think the locums or another SDG is the way to go.

I did moonlighting for a CMG when I first started out, I only worked when they were desperate and made a lot of money. I think thats the key.

For you guys doing Locums are those gigs pretty steady for a period of time or are you constantly negotiating your rate?

When I worked for the CMG they would call and say..

CMG "hey EF, we really need some coverage this Friday are you free?"
Me: "luckily I am. What are you guy gonna pay?"
CMG" UH... we have no extra money in the pool"
Me: "Oh with the drive I need X, if you guys can do that I will work, otherwise I just cant. I have some plans I would need to switch. I need to firm up those plans asap so let me know in the next 2 hours".
CMG 2 hours later "uh ok, we can do your X".

Are the locums jobs the same way or is it like for 6 months I will give you 3 shifts a month at X/hr?

 

[Groove]

I worked for Weatherby for a couple years during residency and would fly out once or twice a month depending on how many shifts I could spare. I honestly had a pretty good experience with them but you def have to do some hard nosed negotiating. I had a work colleague at my last job who did 100% locums and worked whenever he wanted, wherever he wanted, and lived on a boat sailing the Bahamas when he was off on his down time. One of the most competent ED docs and genuinely HAPPY individuals I've met in awhile. I was most envious. That kind of arrangement is probably great for single docs who don't mind traveling/exploring. Gman, I think you'd have to probably have a pretty understanding wife. In my case, I was going through a divorce so I was happy to be away!

They accidentally sent me an email where it was a correspondence between the locums company and the client and there was some nasty emails back and forth negotiating rates for a group of docs (me included) who were being hired for the gig. It seemed like they were pocketing at least $50/hr on top of the locums pay from what I remember.

 

[GeneralVeers]

I worked for Weatherby for a couple years during residency and would fly out once or twice a month depending on how many shifts I could spare. I honestly had a pretty good experience with them but you def have to do some hard nosed negotiating. I had a work colleague at my last job who did 100% locums and worked whenever he wanted, wherever he wanted, and lived on a boat sailing the Bahamas when he was off on his down time. One of the most competent ED docs and genuinely HAPPY individuals I've met in awhile. I was most envious. That kind of arrangement is probably great for single docs who don't mind traveling/exploring. Gman, I think you'd have to probably have a pretty understanding wife. In my case, I was going through a divorce so I was happy to be away!

They accidentally sent me an email where it was a correspondence between the locums company and the client and there was some nasty emails back and forth negotiating rates for a group of docs (me included) who were being hired for the gig. It seemed like they were pocketing at least $50/hr on top of the locums pay from what I remember.

Generally the locums company pockets between 15-30% of the amount the hospital is paying. I do not work with locums companies, but negotiate directly with the hospital recruiters and cut out the middle man. It's win-win, as I get more money, and the hospital saves money too. It does take a bit more work and research, but $25-$50/hour more is definitely worth it.

 

[GeneralVeers]

I think if I ever left the SDG life locums would be the next best. I think it is a tough road with the travel but I think grinding it out with the CMG sucks worse. I have really been looking at my financials and if my great SDG gig would ever go away I think the locums or another SDG is the way to go.

I did moonlighting for a CMG when I first started out, I only worked when they were desperate and made a lot of money. I think thats the key.

For you guys doing Locums are those gigs pretty steady for a period of time or are you constantly negotiating your rate?

When I worked for the CMG they would call and say..

CMG "hey EF, we really need some coverage this Friday are you free?"
Me: "luckily I am. What are you guy gonna pay?"
CMG" UH... we have no extra money in the pool"
Me: "Oh with the drive I need X, if you guys can do that I will work, otherwise I just cant. I have some plans I would need to switch. I need to firm up those plans asap so let me know in the next 2 hours".
CMG 2 hours later "uh ok, we can do your X".

Are the locums jobs the same way or is it like for 6 months I will give you 3 shifts a month at X/hr?

Everything is negotiable. In general you agree to do X number of shifts per month at X rate. If they call me up last minute to work extra shifts, then there needs to be a hefty bonus attached. I know one doctor who charges time-and-a-half every time they want him to work with less than 2 weeks notice.

This is a great way to defeat the CMGs. As a locums they are generally losing money on you at the site, but they need you in order to keep the contract and "market share". If all ED docs became locums, we could destroy the tyranny of CMGs and take back our profession!

 

[EvoDevo]

Amen, brutha. Take control. And thank you, for the hard work you do.

Thanks Bird. I am taking control. But you should see the incredulous stares of my former colleagues. Can't understand why I would leave the crap job....

 

[EvoDevo]

I did exactly what you did and it has changed my life. 5+ years out at the same CMG job I didn't know what I wanted to do, and the continual salary decreases, increased patient load, and regulations made me dread going into work every day.

Now as a full-time self-employed locums, I work where I want, when I want, for as many shifts as I want. I just got back from a 2 week vacation in the South Pacific. Having complete control over your own schedule is the most liberating thing you can get in this profession. If I work at a site that I don't like, or a site which goes downhill, guess what? I leave, and take my skills elsewhere. With proper research, I am consistently able to find sites that I enjoy working at, with a reasonable workload (~ 2 pts/hour), and with salary at 95-99% of what the profession as a whole is making.

True I am away from home and it can be stressful. Two of my informal work partners have young children, and still manage the locums lifestyle. Yes they are away from home, but with making more money they have been able to cut down on their work hours by 30% which means they have more days off, and more useful time with family.

The other thing that most people don't think about are airline and hotel points. If you properly manage these, it can be equivalent to $10,000 in tax-free benefits. If spent on the right awards (like Emirates First Class) you can can get $100,000 of nearly-free international First Class travel. Best of all you have the free time to use them!

Love this post.

Being away from home does suck...I'm lucky in that The Wife is fully supportive of the new arrangement. While it's tough on her while I'm gone, she loves:

* the very nice income increase
* the fact that I am only gone for very defined blocks of time (and sometimes she comes with!)
* that I am a much better father/husband when I'm home because I'm not being whipsawed by a ******ed NIGHT - NIGHT - NIGHT - ("Day Off My A--") - DAY - OFF - DAY - DAY - EVENING schedule.
* the fact that we can say, "Evo will work these days and only these days" and if you need last minute coverage, They Gots to PAY. No more being subject to guilt for "letting down the team."

 

[Birdstrike]

Thanks Bird. I am taking control. But you should see the incredulous stares of my former colleagues. Can't understand why I would leave the crap job....

Let me guess, half think you're crazy, and the other half are jealous?

 

[EvoDevo]

Let me guess, half think you're crazy, and the other half are jealous?

Exactly