Dear locums/PRN docs

[bougiecric]

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I get it. I've worked at multiple hospital before, and may do so again in the future. I don't begrudge you for the path you've chose.

That said, please don't frequently request shift swaps from the FT docs to accommodate your complicated schedule. Especially if you're trying to switch shifts to pick up bonuses at more lucrative sites. Part of the benefit in being FT is that I know my schedule, and it's not my responsibility to upend my life at the last minute to help you work at other places. If you want a more predictable schedule, you are welcome to work FT at our site.

I am going to continue to ignore or decline you're unreasonable trades. Sorry.

 

[RustedFox]

Our region (CMG) just made a ruling with the schedulers that "the local docs come first" in response to widespread outcry against the travelers getting what they want when they want it.

 

[Porfirio]

Why are you FT?

 

[Pinner Doc]

Our region (CMG) just made a ruling with the schedulers that "the local docs come first" in response to widespread outcry against the travelers getting what they want when they want it.

We would do that, but we’d never fill shifts. And so it goes.

 

[Porfirio]

I just don’t understand why people think “I will be full time for Team/SCP/Envision/pick your Physician Owned Group” when really you are full time at Me, LLC.

 

[EctopicFetus]

I just don’t understand why people think “I will be full time for Team/SCP/Envision/pick your Physician Owned Group” when really you are full time at Me, LLC.

IM full time for my group.. why wouldnt I be.. Also, as mentioned on here depending on the desperation the locums docs can get what they want. I have never worked locums but ill entertain discussion with the recruiters.. First I push the price, then I make the most absurd requests I can come up with. Some will just say.. No nights, no weekends etc. I tell them I am only interested in day shifts Monday - Thursday.

If the need for locums is low then they can fill what the Ft docs want. .if the need is enough they will push around the FT docs cause they know or think they can.

I also dont begrudge the guys asking you for a swap. I equally think it is fine to tell them no.

 

[hoot504]

Booooring.

Wouldn't it be more fun to talk about how garbage most of them are?

 

[EctopicFetus]

Booooring.

Wouldn't it be more fun to talk about how garbage most of them are?

Not gonna lie.. thats also true.. but thats a different question.

I do have a question. If the site you work at is so bad that it requires constant locums docs isnt that proof of need to pay more and if thats true then why dont the FT docs there demand more money.

Im not talking about a spot that once every 5 years needs some Locums doc for 3-6 months.

 

[alpinism]

You know the all of the reason(s).

Dr. (insert name) loves their current life as a resident of (insert home town) and does not want to leave because of (insert list of excuses) and therefore has to work at (insert malignant hospital) and will not upset leadership at (insert corporate group) and works for below average pay.

 

[hoot504]

Not gonna lie.. thats also true.. but thats a different question.

I do have a question. If the site you work at is so bad that it requires constant locums docs isnt that proof of need to pay more and if thats true then why dont the FT docs there demand more money.

Im not talking about a spot that once every 5 years needs some Locums doc for 3-6 months.

This just happened to us. We got a change in pay structure that ended up being a raise for anyone seeing 1.5+pph. Personally It was about a 15% raise for me. I think I've talked to you before Ectopic and you know where I work. It's not a bad gig and in a major metro but we just can't keep fully staffed, and have to continuously rotate locums docs in. Last year the bosses actually had some trouble hiring the numbers they wanted => raise for us.

 

[TooMuchResearch]

I just don’t understand why people think “I will be full time for Team/SCP/Envision/pick your Physician Owned Group” when really you are full time at Me, LLC.

Because I'm paid well and know my sites, all nurses, etc. there is some locums work I could do within a 90 minute drive from home for maybe 20% more pay with a worse EMR and sucks enough that they've been locums dependent for 1+ years.

 

[Porfirio]

Because I'm paid well and know my sites, all nurses, etc. there is some locums work I could do within a 90 minute drive from home for maybe 20% more pay with a worse EMR and sucks enough that they've been locums dependent for 1+ years.

You should play this a different way.

Help the locum site out for 2-3 shifts for the 20% rate for 2 months. Pull back and say “call me when you need me.” They will call with more.

Once the Locum site grows a dependence on you, you will have a predictable schedule. You can pull back from your FT site and create even more demand for yourself.

Predictability is the goal for CMGs. Chaos is their bane and your gain.

No harm in trying. But that’s just my thoughts. I have sat next to docs like you for years. This year I made $200,000 more than them for the same job.

 

[EMdoc235]

Anyone doing locums ever get paid late? The company I work for is consistently late 1-2 weeks with payments, citing things like "the hospital hasn't paid us yet." It's stressful and infuriating. Hospital seems to be doing fine financially. After this month I won't be working for them anymore.

 

[JacobMcCandles]

Anyone doing locums ever get paid late? The company I work for is consistently late 1-2 weeks with payments, citing things like "the hospital hasn't paid us yet." It's stressful and infuriating. Hospital seems to be doing fine financially. After this month I won't be working for them anymore.

The hospital paying them should have nothing to do with them paying you on time. Your contract is with them and not the hospital.

 

[hoot504]

Anyone doing locums ever get paid late? The company I work for is consistently late 1-2 weeks with payments, citing things like "the hospital hasn't paid us yet." It's stressful and infuriating. Hospital seems to be doing fine financially. After this month I won't be working for them anymore.

No. Leave. Immediately.

You think line workers at a factory with a high school diploma get paid late? They don't. So why the **** would you be ok with it? This only exists if people (us) allow it to by working for them.

 

[EctopicFetus]

Look at NES and APP and the companies who did locums with APP.

Find the right SDG and locums wont make sense. The top end for SDGs is much better than locums. Yes you wont make $1k/hr which can happen in locums. But my job is so steady and consistent it is boring from a financial perspective. I show up to work, say hi to the same people, know the consultants which makes life easy and honestly I get it when locums pays more. If I could make 20% more I would look. Most of the locums near here are far below my hourly.

One of the highly unattractive things about locums is having to deal with recruiters etc. it’s a time suck that isnt compensated. In general there is also travel. It is unpaid and it’s not like they are sending you to great cities. I see the beauty if you have a “normal” EM job. I would suggest if it is an option to find the unicorn. They exist.. the path is now painful but they arent screwing you financially. My first job out of residency I was making 1/4 to 1/3 of the partners for 2 years. This pushed folks to do nights since there was a night differential.

 

[ERMudPhud]

Anyone doing locums ever get paid late? The company I work for is consistently late 1-2 weeks with payments, citing things like "the hospital hasn't paid us yet." It's stressful and infuriating. Hospital seems to be doing fine financially. After this month I won't be working for them anymore.

Who is that? Just so I can avoid them

I get texts every day asking if I'm available for locums. I always say, "Sure for the right price". Most of the time my right price makes them go away. Every so often I get a good gig out of it. I give them one week a month and tell them to cram as many shifts as they can into that week but don't give me any days off. Current gig crams 6 12's into that week. If they don't want me that week I go back to hiking, paddling, skiing. Doesn't bother me a bit. If they want me I go work it. I've never asked anyone to trade with me. If I give them a week I"ll be there unless I end up hospitalized.

 

[emergentmd]

How hard is it to just say no?

On the flip side, I would have no problems switching with a full timer but only if I kept my bonus.

 

[NYEMMED]

Our region (CMG) just made a ruling with the schedulers that "the local docs come first" in response to widespread outcry against the travelers getting what they want when they want it.

I did locums, and converted to a full time gig when I found a place I liked.

In general if I am flying to work at your shop for 5 days straight, away from my family. I’m choosing when I come.

 

[RustedFox]

I did locums, and converted to a full time gig when I found a place I liked.

In general if I am flying to work at your shop for 5 days straight, away from my family. I’m choosing when I come.

I hear you, but you can choose when you come -after- the full-timers have their schedules made.

 

[emergentmd]

If I am getting bonuses, I never expect to get first pick. I just wait until the bonus increases which ends up being shifts that are not covered.

 

[Porfirio]

I am not sure why we blame Locums or feel pity for Full Timers.

The people (CMG) who have the bag of money and control of the schedule only care about keeping the ever-increasing flow of the money coming to them.

They want the available, most cheapest widget.

CMG FTers need to wake up because this $200-$250 per hour pay is bullsh-t. That’s $140-$200 per hour pay in 2019.

 

[JacobMcCandles]

CMG FTers need to wake up because this $200-$250 per hour pay is bullsh-t. That’s $140-$200 per hour pay in 2019.

Look at the Medicare $/RVU since then.

 

[Porfirio]

Look at the Medicare $/RVU since then.

Honestly, I put no stock in the RVU crap. The hospital which is making a ton off facility fee payments will subsidize the physician cost. HCA is already doing this and still making $4-$6 billion yearly profit (projected 2025).

 

[dozitgetchahi]

No. Leave. Immediately.

You think line workers at a factory with a high school diploma get paid late? They don't. So why the **** would you be ok with it? This only exists if people (us) allow it to by working for them.

It also hints at serious financial problems with the locums company.

Whenever I’ve heard of physician groups/PPs/etc not making payroll on time, it’s usually very bad news. I used to work for a PP that started missing payroll shortly after I left. They imploded shortly thereafter.

 

[JacobMcCandles]

Honestly, I put no stock in the RVU crap. The hospital which is making a ton off facility fee payments will subsidize the physician cost. HCA is already doing this and still making $4-$6 billion yearly profit (projected 2025).

Why would you put zero stock in it? It’s the very foundation for what physician’s are reimbursed on, whether you like it or not. Medicare sets their rate and then most times contracts are based on a percent of Medicare. Hospitals don’t love to subsidize their ED. Most CMG presentations will center around them not having to subsidize their ED and most hospitals don’t want to have to get involved. HCA is much more than a CMG running an ED. Tying ED physician reimbursement to inflation from 2019, while may seem like a reasonable stance on the surface, shows an incredible lack of insight with any depth. While I hate CMGs, your anger shouldn’t be with them in this regard, it should be with your congressional representatives.

 

[Porfirio]

Why would you put zero stock in it? It’s the very foundation for what physician’s are reimbursed on, whether you like it or not. Medicare sets their rate and then most times contracts are based on a percent of Medicare. Hospitals don’t love to subsidize their ED. Most CMG presentations will center around them not having to subsidize their ED and most hospitals don’t want to have to get involved. HCA is much more than a CMG running an ED. Tying ED physician reimbursement to inflation from 2019, while may seem like a reasonable stance on the surface, shows an incredible lack of insight with any depth. While I hate CMGs, your anger shouldn’t be with them in this regard, it should be with your congressional representatives.

Honestly man, I kind of just ignore your posts. Not worth it, sorry. Just move on.

 

[JacobMcCandles]

Honestly man, I kind of just ignore your posts. Not worth it, sorry. Just move on.

If you want to ignore the financial fundamentals behind EM pay that is definitely your choice but to say it's the fault of EM physicians who take jobs for what the market around them dictates is shortsighted at best. People take jobs for all kinds of reasons and many don't revolve around money. Honestly, CMGs likely rely on those people who are bound to certain geographic regions for one reason or another. Our collections per patient haven't kept up with inflation despite trying to optimize billing and insurance contracts so our pay also hasn't kept up with inflation since 2019. That doesn't mean I feel like I'm entitled to higher pay. I understand there are a lot of moving parts that determine what I ultimately make.

 

[AlmostAnMD]

If you want to ignore the financial fundamentals behind EM pay that is definitely your choice but to say it's the fault of EM physicians who take jobs for what the market around them dictates is shortsighted at best. People take jobs for all kinds of reasons and many don't revolve around money. Honestly, CMGs likely rely on those people who are bound to certain geographic regions for one reason or another. Our collections per patient haven't kept up with inflation despite trying to optimize billing and insurance contracts so our pay also hasn't kept up with inflation since 2019. That doesn't mean I feel like I'm entitled to higher pay. I understand there are a lot of moving parts that determine what I ultimately make.

Yup

I was geographically tied since my wife works in a highly specialized field only around in a few places in the whole country. So I could either drive 90 minutes one way to escape the CMG monopoly or just deal with the malignancy.

In the end I chose option 3 and gtfo

Not gonna miss that 160/hr seeing 4 pph with insane acuity and horrible murderous nurses. Or manslaughter? Whatever the one is where they can't help but kill out of ignorance

 

[Porfirio]

If you want to ignore the financial fundamentals behind EM pay that is definitely your choice but to say it's the fault of EM physicians who take jobs for what the market around them dictates is shortsighted at best. People take jobs for all kinds of reasons and many don't revolve around money. Honestly, CMGs likely rely on those people who are bound to certain geographic regions for one reason or another. Our collections per patient haven't kept up with inflation despite trying to optimize billing and insurance contracts so our pay also hasn't kept up with inflation since 2019. That doesn't mean I feel like I'm entitled to higher pay. I understand there are a lot of moving parts that determine what I ultimately make.

Ok here goes.

We are talking about CMG contracts with locums/PRNs and FT docs. These are unstable contracts that would be money losers for CMGs. Most of them are subsidized by the hospital or under the terms “cost plus.” Meaning who cares about Medicare RVU reimbursement.

(Side note- Medicare RVU reimbursement has fluctuated with political whims since 1992, look at the data and you will find ups and downs, all while physician yearly compensation has only gone up. You could argue other factors -ie raise of midlevel use. But this is all beside the topic/point.)

If the CMGs were losing money on a contract, they would just drop it and tell the hospital “see you later, and good luck finding another CMG pimp with doc hoes.” It is simple business.

Most of these sites pay god awful FT rates ($200-$250, $140-$200 pre-inflationary equivalent) with no pay increase in sight because the CMGs just abuse the FTers and subsidize Locum/PRN docs with hospital funds.

It just amazes me that FTers still sit next to me making significantly less than me and still have to overcome the inflation mountain of 2020-2025.

 

[JacobMcCandles]

Ok here goes.

We are talking about CMG contracts with locums/PRNs and FT docs. These are unstable contracts that would be money losers for CMGs. Most of them are subsidized by the hospital or under the terms “cost plus.” Meaning who cares about Medicare RVU reimbursement.

(Side note- Medicare RVU reimbursement has fluctuated with political whims since 1992, look at the data and you will find ups and downs, all while physician yearly compensation has only gone up. You could argue other factors -ie raise of midlevel use. But this is all beside the topic/point.)

If the CMGs were losing money on a contract, they would just drop it and tell the hospital “see you later, and good luck finding another CMG pimp with doc hoes.” It is simple business.

Most of these sites pay god awful FT rates ($200-$250, $140-$200 pre-inflationary equivalent) with no pay increase in sight because the CMGs just abuse the FTers and subsidize Locum/PRN docs with hospital funds.

It just amazes me that FTers still sit next to me making significantly less than me and still have to overcome the inflation mountain of 2020-2025.

CMGs will take on bad contracts at the expense of potentially gaining much more profitable contracts. They'll take on a money losing contract with the hope that they'll get other facilities under the hospital system's umbrella. This happens all the time with large multi-state hospital systems. They also know that the c-suite they deal with (and bail out) in these hospitals are trying to move up into bigger positions within that hospital system or potentially others. They'll try to throw as many hooks into that pond to cultivate these relationships knowing they have the chance to pay off later.

As mentioned before, most EM docs (and most people in life) just don't have the willpower to fight tooth and nail to maximize their pay. I'd be surprised if hospitals are outright subsidizing the CMGs for PRN/locums as that isn't how hospital subsidies typically work. Usually it's a set amount and it's the CMGs job to make sure the ED is staffed. It'd be an unusual arrangement for the CMG to tell the hospital "hey, I need $5k to fill this shift on Monday" and the hospital cuts them a check. But, I can guarantee I'm not involved in those discussions at the hospital you work at so maybe it is an unusual arrangement. Most people are happy to have some kind of stability and typically get that at the expense of higher compensation so I understand why a lot of people are ok with the situation you describe.

 

[EctopicFetus]

Why would you put zero stock in it? It’s the very foundation for what physician’s are reimbursed on, whether you like it or not. Medicare sets their rate and then most times contracts are based on a percent of Medicare. Hospitals don’t love to subsidize their ED. Most CMG presentations will center around them not having to subsidize their ED and most hospitals don’t want to have to get involved. HCA is much more than a CMG running an ED. Tying ED physician reimbursement to inflation from 2019, while may seem like a reasonable stance on the surface, shows an incredible lack of insight with any depth. While I hate CMGs, your anger shouldn’t be with them in this regard, it should be with your congressional representatives.

Nah sorry man.. this is a total fallacy. EM pay is up since 2019 even if the conversion factor is down. EM pay is straight supply / demand. Its why trash bins like USACS can pay crap in Chicago, Denver, Charlotte (before they lost those contracts), hawaii etc.

Its not that the people in Denver are poorer than the people in Mississippi (where the pay is often almost 2x Charlotte and Denver). Its supply/Demand for hospital employment and for CMGs.

 

[JacobMcCandles]

Nah sorry man.. this is a total fallacy. EM pay is up since 2019 even if the conversion factor is down. EM pay is straight supply / demand. Its why trash bins like USACS can pay crap in Chicago, Denver, Charlotte (before they lost those contracts), hawaii etc.

Its not that the people in Denver are poorer than the people in Mississippi (where the pay is often almost 2x Charlotte and Denver). Its supply/Demand for hospital employment and for CMGs.

What part of my post is total fallacy?

Reimbursement and compensation are two different things, though related, but it's tough to tease them out in this conversation as it gets very nuanced. I don't believe I said that EM pay has gone down. EM pay hasn't kept up with inflation but that's probably pretty common among a lot of industries over the last 6 years. Average EM pay has gone up (mine, too, although it's a bit tougher to compare) but most people have been working much harder for that dollar.

EM is not straight supply/demand (if it were that simple, wouldn't pay be going down with the drastic increase in the supply side of new grads recently?) and it is much more complicated than that although we know that supply and demand plays a part. It's why compensation is lower than in many 'desirable' areas. I don't believe anything in any of my posts on this subject is a total fallacy. It's a market with a bunch of moving parts.

 

[emergentmd]

Not gonna miss that 160/hr seeing 4 pph with insane acuity and horrible murderous nurses. Or manslaughter? Whatever the one is where they can't help but kill out of ignorance

Man, That is some serious geographic leash you and your partners were on. 160/hr at 4pph? That is horrid

 

[EMdoc235]

Man, That is some serious geographic leash you and your partners were on. 160/hr at 4pph? That is horrid

I don’t think I’d ever work in those conditions. There’s almost always a rural site a couple hours away that pays far more with lower volumes and lower acuity.

 

[emergentmd]

I don’t think I’d ever work in those conditions. There’s almost always a rural site a couple hours away that pays far more with lower volumes and lower acuity.

Some do not want to drive an hour away but those numbers are abusive. APCs in our area ERs are making 120/hr seeing the simple stuff without all of the headaches.

 

[AlmostAnMD]

Man, That is some serious geographic leash you and your partners were on. 160/hr at 4pph? That is horrid

Yeah and it's really weird but for some reason turnover is really high. Again, I'm no longer in EM, which is the only way I could stay sane in this region.

I don’t think I’d ever work in those conditions. There’s almost always a rural site a couple hours away that pays far more with lower volumes and lower acuity.

For a single guy that's fine. Married with kids driving 90 minutes one way to work every day is a great way to never see your family.

Like I said, I got out of this trash entirely and it's just a memory now.