Dear locums/PRN docs

[bravotwozero]

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That is so, so so sad. I would never invest in HCA, it's like breaking into my friend's house that works at one of those places and stealing his money

HCA employees can buy shares in HCA at discounted prices.

 

[RustedFox]

HCA employees can buy shares in HCA at discounted prices.

that's a load-bearing "employees" there, bro.

 

[EMdoc235]

Anyone else noticing that the locum market sucks right now? I live in a big city and nothing new within 2 hours. Pretty sure my current close by gig will dry up by summer. Only options are 4 hours away. Back in 2023 there were 4 sites at least near me offering $325/hour+.

Talked to a recruiter today about something just over 2 hours away and pay was $280/hour and people were signing up. My full time job pays that smh.

 

[RustedFox]

Anyone else noticing that the locum market sucks right now? I live in a big city and nothing new within 2 hours. Pretty sure my current close by gig will dry up by summer. Only options are 4 hours away. Back in 2023 there were 4 sites at least near me offering $325/hour+.

Talked to a recruiter today about something just over 2 hours away and pay was $280/hour and people were signing up. My full time job pays that smh.

I get emails with offers at 315-325 for sites all around me for low volume FSEDs where you sleep at night.

I get better by negotiating directly with my CMG as a bro.

 

[EMdoc235]

I get emails with offers at 315-325 for sites all around me for low volume FSEDs where you sleep at night.

I get better by negotiating directly with my CMG as a bro.

Maybe I should move to Florida. Weather is better too. Midwest doesn’t pay well in the big cities. People in Detroit are working for half what you quoted.

 

[EctopicFetus]

Maybe I should move to Florida. Weather is better too. Midwest doesn’t pay well in the big cities. People in Detroit are working for half what you quoted.

Yikes. Plus state income taxes, weather and Detroit. Sorry homies.

 

[RustedFox]

Maybe I should move to Florida. Weather is better too. Midwest doesn’t pay well in the big cities. People in Detroit are working for half what you quoted.

Everything is wet here. I walk out of a shift and my entire car is wet. I drive with the wipers on all the way home and it's not raining.
I hate it.

 

[EMdoc235]

Yikes. Plus state income taxes, weather and Detroit. Sorry homies.

Luckily I don’t live in Detroit and it’s better here, but property and income taxes are rough. Plus I’m starting to get tired of the cold weather. A swamp doesn’t sound bad.

 

[WhatJobDoIPick]

Anyone else noticing that the locum market sucks right now? I live in a big city and nothing new within 2 hours. Pretty sure my current close by gig will dry up by summer. Only options are 4 hours away. Back in 2023 there were 4 sites at least near me offering $325/hour+.

Talked to a recruiter today about something just over 2 hours away and pay was $280/hour and people were signing up. My full time job pays that smh.

Rates I see are atrocious. Equal to or nominally higher than what you make on the partner track of my group.

I'm sure there's room for negotiation, but honestly you could pay me 600/hr and it wouldn't be worth it to me.

 

[JacobMcCandles]

The locums man giveth and the locums man taketh away. Doing locums probably shouldn’t be a part of anyone’s long term plan.

 

[AlmostAnMD]

The locums man giveth and the locums man taketh away. Doing locums probably shouldn’t be a part of anyone’s long term plan.

If you've got no kids, no spouse, no geographic ties it's probably ideal

I know a guy that just lives permanent bachelor mode and dgaf

I know someone else with all of those things who only saw $$$$$ in his eyeballs ala cartoon characters and quit after a year.

Family

Locums

pick one

 

[JacobMcCandles]

If you've got no kids, no spouse, no geographic ties it's probably ideal

I know a guy that just lives permanent bachelor mode and dgaf

I know someone else with all of those things who only saw $$$$$ in his eyeballs ala cartoon characters and quit after a year.

Family

Locums

pick one

Even when I was single I was always a big proponent of sleeping in my own bed. Obviously, everyone is different but I'd prefer steady hours and then I can travel where I want and not have to worry about prolonged periods of time away from home or working while on "vacation".

 

[Porfirio]

Locums is tough because you have a middleman who has to get his too. Inflation goes up, they have to get more too. Hospitals (for profits) are preparing for more uninsured patients because of the Obamacare issues. Lots of downward pressure this year. Hospital profits are the last thing to always go down.

 

[AlmostAnMD]

Locums is tough because you have a middleman who has to get his too. Inflation goes up, they have to get more too. Hospitals (for profits) are preparing for more uninsured patients because of the Obamacare issues. Lots of downward pressure this year. Hospital profits are the last thing to always go down.

Insurance is the last profit to go down, not hospitals

When medicaid cuts hit medicaid payors will definite deny enough coverage to make up for the cuts and pass that onto hospitals/docs. They don't plan on taking a cut. They won't say it out loud, but I guarantee they want the same profit margins with less money

Spent the last year building a moat around our system for this very reason. 2028 is going to rock hospitals harder than they realize, 30% loss from Medicaid is a conservative estimate. And I wouldn't poopoo their dollars....as a secondary payor and by sheer volume this is not an unsubstantial revenue loss.

 

[EctopicFetus]

For the locums proponents (I am not one) how much time do you spend negotiating, emails, planning etc. Seems like an uncalculated “cost” of the job, plus the time lost to travel sucks. I cant wrap my head around doing it. Even for an extra $50/hr meh.. not sleeping in my bed, being in some crappy town (often) just the lost hours of my life seem not to make it worthwhile. I put my requests online and boom i get my schedule. Seems much simpler, i see my kids, i sleep in my bed, i go to restaurants i know and like, i work with nurses i know (some I like and some i dont). I do well $$ wise but i think if i had a typical job at what point would i do locums. I cant come up with the answer. Plus when the $ drops i guess you just dont work? Seems like the market is decelerating pretty slowly now but thats about to change IMO. I called it in 2022. I said we would see things slow by 2026/2027 and then it would accelerate into a complete mess.

It’s the advice i give residents. Keep in mind even if you dont believe the ACEP workforce data 2 major issues come out of there.

1) even if docs are quitting younger we have more and more young docs. 2) that also means your career wont be long 3) they didnt take into account the opening of even more residencies in those studies and thats happened. The number of spots is growing and the number of positions needed hasnt at all. Now more places are looking to the noctor only model.

Im in the back half of my career so it matters less to me but is this a matter of being an ostrich with your head in the sand? A plan to maximize money and get out like others apparently have? My personal experience with people i know is women are leaving EM, men not so much. Maybe some other shoe drops but it appears in my small world that the new grads want to work fewer hours, will work more years and the ability to find a semi functional job is dramatically falling. People are working either bad jobs or are in a good group but it is requiring them to travel for a few years before they hit the read money pot which has its own set of issues.

back in the day when things were simpler it seemed like a new grads came out and sprinted like crazy for a few years and then settled into their comfort zone for work. Now it seems like they just start at the comfort zone, plug along for a bit and then???? Idk.. we will see.

 

[EctopicFetus]

Insurance is the last profit to go down, not hospitals

When medicaid cuts hit medicaid payors will definite deny enough coverage to make up for the cuts and pass that onto hospitals/docs. They don't plan on taking a cut. They won't say it out loud, but I guarantee they want the same profit margins with less money

Spent the last year building a moat around our system for this very reason. 2028 is going to rock hospitals harder than they realize, 30% loss from Medicaid is a conservative estimate. And I wouldn't poopoo their dollars....as a secondary payor and by sheer volume this is not an unsubstantial revenue loss.

Issue here is at some point doctors wont work. I am not saying we are close to that number but there are more than a few docs in various specialities who work due to the golden handcuffs. Hospitals can add MLPs to help keep wages up but in the end something is gonna have to give. Cut the pay of EM low enough and you’ll have a major need thereby driving rates up again. It’s how it all works.

 

[AlmostAnMD]

Issue here is at some point doctors wont work. I am not saying we are close to that number but there are more than a few docs in various specialities who work due to the golden handcuffs. Hospitals can add MLPs to help keep wages up but in the end something is gonna have to give. Cut the pay of EM low enough and you’ll have a major need thereby driving rates up again. It’s how it all works.

Maybe

I still hold the pessimistic view hospitals in general will be okay with staffing EDs with midlevels or with bare minimum docs in purely supervisory/nominal roles.

If I've learned anything on the money side, it's that it's money first, everything else second.

I desperately want to be wrong

 

[WhatJobDoIPick]

For the locums proponents (I am not one) how much time do you spend negotiating, emails, planning etc. Seems like an uncalculated “cost” of the job, plus the time lost to travel sucks. I cant wrap my head around doing it. Even for an extra $50/hr meh.. not sleeping in my bed, being in some crappy town (often) just the lost hours of my life seem not to make it worthwhile. I put my requests online and boom i get my schedule. Seems much simpler, i see my kids, i sleep in my bed, i go to restaurants i know and like, i work with nurses i know (some I like and some i dont). I do well $$ wise but i think if i had a typical job at what point would i do locums. I cant come up with the answer. Plus when the $ drops i guess you just dont work? Seems like the market is decelerating pretty slowly now but thats about to change IMO. I called it in 2022. I said we would see things slow by 2026/2027 and then it would accelerate into a complete mess.

It’s the advice i give residents. Keep in mind even if you dont believe the ACEP workforce data 2 major issues come out of there.

1) even if docs are quitting younger we have more and more young docs. 2) that also means your career wont be long 3) they didnt take into account the opening of even more residencies in those studies and thats happened. The number of spots is growing and the number of positions needed hasnt at all. Now more places are looking to the noctor only model.

Im in the back half of my career so it matters less to me but is this a matter of being an ostrich with your head in the sand? A plan to maximize money and get out like others apparently have? My personal experience with people i know is women are leaving EM, men not so much. Maybe some other shoe drops but it appears in my small world that the new grads want to work fewer hours, will work more years and the ability to find a semi functional job is dramatically falling. People are working either bad jobs or are in a good group but it is requiring them to travel for a few years before they hit the read money pot which has its own set of issues.

back in the day when things were simpler it seemed like a new grads came out and sprinted like crazy for a few years and then settled into their comfort zone for work. Now it seems like they just start at the comfort zone, plug along for a bit and then???? Idk.. we will see.

I agree that I think there's a huge financial reckoning coming for medicine. Beyond federal level Medicare and Medicaid cuts, my state loves to suck off private insurance and underfund Medicaid.

You have to be very misguided to go into medicine now, unless the education is free / cheap / funded for you, and absolutely insane to go into EM today.