Dear locums/PRN docs

[Mount Asclepius]

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There is a huge middle ground for EM that is often overlooked. It’s small to medium sized cities. Pay in large cities can sometimes be terrible. Rural areas are unattractive for most to live in and no one wants to constantly travel. There also isn’t a large enough population of high acuity patients to equate to decent billing without subsidy. In small to medium sized cities, you can still find amenities, great jobs and great pay even in very desirable states. These positions may become saturated in the next 5-10 years, but for now I would grab one up if I was a new grad.

 

[NYEMMED]

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

Trust me, I’ve now been on both sides.
I get the FT side as well with not wanting the left overs, the impact of scheduling, retention etc.

But self scheduling on your preference is one of the benefits of locums life. Again, if I am not seeing my family for 5 days to a week , and you are, I’m coming when I want, or I’m not coming at all.

I have sympathy for both

 

[EctopicFetus]

There is a huge middle ground for EM that is often overlooked. It’s small to medium sized cities. Pay in large cities can sometimes be terrible. Rural areas are unattractive for most to live in and no one wants to constantly travel. There also isn’t a large enough population of high acuity patients to equate to decent billing without subsidy. In small to medium sized cities, you can still find amenities, great jobs and great pay even in very desirable states. These positions may become saturated in the next 5-10 years, but for now I would grab one up if I was a new grad.

Can you give an idea of what cities you are referring to? Dont have to name your city but curious what you mean here.

 

[EctopicFetus]

Trust me, I’ve now been on both sides.
I get the FT side as well with not wanting the left overs, the impact of scheduling, retention etc.

But self scheduling on your preference is one of the benefits of locums life. Again, if I am not seeing my family for 5 days to a week , and you are, I’m coming when I want, or I’m not coming at all.

I have sympathy for both

This is sort of funny to me as a non locums person and someone who only when I was moonlighting did I ever work with locums people directly.

Sure you are away from your family but you make more (often much more) and yet you want to stick it to the FT docs.

I think like many of these issues. It comes down to how desperate the site is and what the FT docs will take. I cant imagine being stuck with a craptastic schedule so some locums person can have what they want especially knowing they would be outearning me.

Some EM docs I have met are loyal to a crazy fault and dont understand that this is a business. The hospital and your CMG employer have no loyalty to you.

I do agree that I see the other side but it seems to me that unless very temporary it is a disaster waiting to happen.

 

[Mount Asclepius]

Can you give an idea of what cities you are referring to? Dont have to name your city but curious what you mean here.

I thought it was fairly self explanatory so maybe I don’t understand your question. Technically the definition would be ~50-500k people, but I think the more desirable cities with decent jobs are in the 100k-1M range (still not large cities). You can find $500k+ FT SDG jobs in desirable states in cities of this size.

 

[EctopicFetus]

I thought it was fairly self explanatory so maybe I don’t understand your question. Technically the definition would be ~50-500k people, but I think the more desirable cities with decent jobs are in the 100k-1M range (still not large cities). You can find $500k+ FT SDG jobs in desirable states in cities of this size.

Name the cities..

 

[alpinism]

Just move, no point in working with that. So many other options right now. I know so many docs flying out of the city to work (same for Colorado).

Ohh I travel and work in the midwest for 300/hr rate for shifts.

But there are plenty of docs who are willing to pick up those shifts.

 

[alpinism]

It will be interesting to see what happens with the new annual 100K H1B fees.

Assuming there's no exception for docs it will affect lots of IMG heavy programs.

 

[alpinism]

NYC alone has over 1,000 H1B attending physicians.

Distribution of Physicians With H-1B Visas By State and Sponsoring Employer - PMC

This study describes the number of H-1B visa physician applications and active care H-1B visa applications physicians by state and employer in 2016.

pmc.ncbi.nlm.nih.gov

 

[EctopicFetus]

Real question do we care? Seemingly will make this more US focused and may result in lesser qualified docs cause hard to imagine anyone is dropping 100k to hire a resident when they can have another one for free.

 

[EMdoc235]

Real question do we care? Seemingly will make this more US focused and may result in lesser qualified docs cause hard to imagine anyone is dropping 100k to hire a resident when they can have another one for free.

Better job security for US docs. Opponents to the new rule are saying more mid level use but I still prefer mid levels to hiring foreign docs who will do a 400k job for 200k. And I don’t think midlevels would replace docs where they would be required.

 

[hoot504]

Better job security for US docs. Opponents to the new rule are saying more mid level use but I still prefer mid levels to hiring foreign docs who will do a 400k job for 200k. And I don’t think midlevels would replace docs where they would be required.

Politics aside I find it humorous that this EO comes out and there's immediately a thread hypothesizing the multiple ways it plays out for EM docs, all bad mind you.

Perpetual doom and gloom here.

 

[JacobMcCandles]

Politics aside I find it humorous that this EO comes out and there's immediately a thread hypothesizing the multiple ways it plays out for EM docs, all bad mind you.

Perpetual doom and gloom here.

Yesterday: there’s too many ED docs.

Today: there’s going to be less ED docs.