Direction of Locums Rates

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With the continuing shortage of anesthesiologists/CRNAs in the environment where hospitals are currently facing large deficits and reimbursements are decreasing, how do you see locums rates trending in the near future? Are you noticing rates are continuing to increase, or have they leveled off some?

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With the continuing shortage of anesthesiologists/CRNAs in the environment where hospitals are currently facing large deficits and reimbursements are decreasing, how do you see locums rates trending in the near future? Are you noticing rates are continuing to increase, or have they leveled off some?
Hospitals are too big to fail, as they provide a vital public service as a group. The government will prop them up as long as they need to through subsidy or fudging the numbers. Whatever they have to pay to get anesthesia staff based on supply/demand is what they will pay. With increased Medicaid rolls, the demand is only going up.
 
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I'm looking for locums opportunities in socal and they all seem to be marching upward. Everywhere that's serious in my area (socal) seems to be offering 300/hr for locums 1099 daytime work. Just a few months ago they were all at 250. I'm peds boarded and a locums guy I'm working with told me 350 should be the floor for anywhere looking for peds specifically, whereas this had been 300 a few months ago. So for now things are all going up.
 
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Up is the only direction right now.
Supply is tight. No “anesthesia” no surgery. I am waiting for the day that the crnas prices themselves out.
I’ve heard some agency pays crna @225/hr. Yes agency rate, so they’re charging 300+ for crnas right now. Just few months ago, I would be happy working at 250/hr. Hack two years ago, I’d be over the moon if I get 200.

The great resignation is still in effect, some partners retired, some are planning to go within the next 6 months to a year. Can’t blame them…. Some of them are sort of worried with the market, but hey if you’re dead, can’t spent the money.
 
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Up is the only direction right now.
Supply is tight. No “anesthesia” no surgery. I am waiting for the day that the crnas prices themselves out.
I’ve heard some agency pays crna @225/hr. Yes agency rate, so they’re charging 300+ for crnas right now. Just few months ago, I would be happy working at 250/hr. Hack two years ago, I’d be over the moon if I get 200.

The great resignation is still in effect, some partners retired, some are planning to go within the next 6 months to a year. Can’t blame them…. Some of them are sort of worried with the market, but hey if you’re dead, can’t spent the money.
You are pricing yourself too low. A few months ago $250 and two years ago $200? I was making $275 two summers ago and haven't seen $200 since early 2019 when I had no options. And I am a woman. We aren't known to be great negotiators. Price yourself higher and help yourself and fellow colleagues.
 
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Up. $300 is min. 350-400 is not uncommon. You have to ask.
 
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Locum assignment 2 months ago in California - $300/hr, 10-12 hour guaranteed, $350 for every hour over 10-12. Being reached out to now with $330 base and when I test the waters with $350/hr base, I am getting "only if you commit 2 weeks/month." In other words, YES.
 
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When the facility fees are counted in the tens of thousands or more, dropping a few hundred for the anesthesiologist is nbd
 
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$300 is the bare minimum

$350 is more common these days. Mid west is $400-hr

$450/hr overtime rates.

Look at all the hospital collections for surgery

19k for 90! Min foot surgery hospital collected. Surgeon got measly $500

Anesthesia got $1400

Hospital will need to kick back more if they collecting 19k for foot surgery. (This was the actual collections)

No surgery means they lose that 19k
 
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You are pricing yourself too low. A few months ago $250 and two years ago $200? I was making $275 two summers ago and haven't seen $200 since early 2019 when I had no options. And I am a woman. We aren't known to be great negotiators. Price yourself higher and help yourself and fellow colleagues.

You’re probably right. I think i (we) suffer from afraid to ask too much, since I am not able to just walk away. (The only way to negotiate).
 
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$300 is the bare minimum

$350 is more common these days. Mid west is $400-hr

$450/hr overtime rates.

Look at all the hospital collections for surgery

19k for 90! Min foot surgery hospital collected. Surgeon got measly $500

Anesthesia got $1400

Hospital will need to kick back more if they collecting 19k for foot surgery. (This was the actual collections)

No surgery means they lose that 19k
Lately I’ve been giving a lot of thought to giving up the full time job to do locums. I’d make 2.5x my current hourly rate. When I chatted with a comp health recruiter in August he was trying to convince me $350 is top end and tough to get.

Are you regularly seeing 350 and higher? What’s the supervision ratio?
 
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You’re probably right. I think i (we) suffer from afraid to ask too much, since I am not able to just walk away. (The only way to negotiate).
I asked for a $25/h bump at one hospital, and I was asked if I would work 32/h a week. I said no and found a job that was paying what I was asking for a few miles away. When I've asked if lower paying jobs (in locations where I want to be) are negotiable, I've been told no. :cautious:
 
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I asked for a $25/h bump at one hospital, and I was asked if I would work 32/h a week. I said no and found a job that was paying what I was asking for a few miles away. When I've asked if lower paying jobs (in locations where I want to be) are negotiable, I've been told no. :cautious:
32 hours a week is too much? Or is this a second job?
If the locations you want to be are popular locations then this could possibly be the case. However everything is negotiable. I don’t ask if it is negotiable. I ask what they are offering and then go up from there. I suspect if some other person (likely make) went in there more demanding than you they could possibly get it. But I am also not looking in popular places.
 
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Y’all may want to consider that some of these locums offers may be being put out to make it appear to hospital admin or chief of surgery type people that they are “trying”.
 
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32 hours a week is too much? Or is this a second job?
If the locations you want to be are popular locations then this could possibly be the case. However everything is negotiable. I don’t ask if it is negotiable. I ask what they are offering and then go up from there. I suspect if some other person (likely make) went in there more demanding than you they could possibly get it. But I am also not looking in popular places.
32h/wk is too little. I wanted 40. I knew what they were paying others and asked for that. They said cut your hours.
 
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Y’all may want to consider that some of these locums offers may be being put out to make it appear to hospital admin or chief of surgery type people that they are “trying”.
It’s really supply and demand. If they can’t staff ORs. And ORs get shut down. Admin gets fired quickly. So it’s not about “ trying.” It’s about survival.

Every day one OR cannot run. It’s at min 30k lost revenue for the hospital. Maybe 60k lost revenue. That’s a ton of money.

Sure these can be temp rates the next 6-12 months. The early birds get the best rates as hospital gets desperate. One hospital in Florida was paying $375 when they were super desperate. My buddy locked in those rates but it’s been 12 months. And my bother buddy can only get $325 and they won’t budge.
 
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I asked for a $25/h bump at one hospital, and I was asked if I would work 32/h a week. I said no and found a job that was paying what I was asking for a few miles away. When I've asked if lower paying jobs (in locations where I want to be) are negotiable, I've been told no. :cautious:

They find a way…. All games and numbers. I’ve only looking in more suburbia of big cities, so they can/will be picky.
 
It’s really supply and demand. If they can’t staff ORs. And ORs get shut down. Admin gets fired quickly. So it’s not about “ trying.” It’s about survival.

Every day one OR cannot run. It’s at min 30k lost revenue for the hospital. Maybe 60k lost revenue. That’s a ton of money.

Sure these can be temp rates the next 6-12 months. The early birds get the best rates as hospital gets desperate. One hospital in Florida was paying $375 when they were super desperate. My buddy locked in those rates but it’s been 12 months. And my bother buddy can only get $325 and they won’t budge.
I’ve never seen an admin get fired… they get moved around or they blame “greedy locums anesthesiologists”
 
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I’ve never seen an admin get fired… they get moved around or they blame “greedy locums anesthesiologists”
I’ve never seen an admin fired. Their numbers only grow with new bizarre roles created, and/or they get promoted.

Our old hospital CEO, for example, ran things into the ground financially and then got promoted to be CEO at a fancier hospital. Now the hospital keeps cutting our salaries while that guy undoubtedly got a golden handshake.

I get random emails or see internal webpages announcing Janet, MHA as the new “manager of XYZ” - as these new positions are endlessly created. I’ve also seen celebration and sadness emails thanking Janet when she moves to a new job.

But when a new doctor comes on board or leaves, nobody cares. I had several coworkers just disappear without any explanation or announcement.

This is modern healthcare.
 
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I’ve never seen an admin fired. Their numbers only grow with new bizarre roles created, and/or they get promoted.

Our old hospital CEO, for example, ran things into the ground financially and the got promoted to be CEO at a fancier hospital. Now the hospital keeps cutting our salaries while that guy undoubtedly got a golden handshake.

I get random emails or see internal webpages announcing Janet, MHA as the new “manager of XYZ” - as these new positions are endlessly created. I’ve also seen celebration and sadness emails thanking Janet when she moves to a new job.

But when a new doctor comes on board or leaves, nobody cares. I had several coworkers just disappear without any explanation or announcement.

This is modern healthcare.

Yes! There have been several surgeons that left that I really liked and didn't say a word. No emails or anything. But every time there's a new director of diversity or some other nonsense in some tiny hospital in the middle of nowhere they send an email to the whole system.
 
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Hospital and health systems' dire finances are spurring layoffs—here are 33 examples from 2022​

By Dave MuoioNov 1, 2022 09:00am
Layoff notice, medical equipment, gloves and stethoscope

Updated on Oct. 17 at 11:00 a.m.

The hospital and health system landscape in 2022 is dominated by warnings of major financial losses, often attributed in part to the rising costs of labor.

A nursing shortage and the winter’s omicron surge forced many provider organizations to turn to contract workers demanding rates far beyond those seen prior to the pandemic.

Systems say those prices are stabilizing with each passing month. However, many hospitals’ depleted budgets are now having to contend with economywide wage and supply cost increases at a time when high-profit volumes (such as surgeries) are still recovering from pandemic disruptions.

Reports from Kaufman Hall and Fitch Ratings warn that hospitals’ dire finances and labor supply struggles will at least continue through the end of the year, if not longer.

The result is seemingly contrary to industry trends: a ramp-up of workforce recruitment and retention investments countered by service limitations and layoffs hospitals say are needed to keep the lights on.


Related​


A number of health systems including big names such as Providence are on both ends of that spectrum, trimming down administrative or leadership positions as they work to plug holes among their clinical workforces.

And while several layoffs were the result of full facility closures, several were accompanied by promises to help former employees transition to other unfilled and much-needed roles within the organization.

Read on below for a running roundup of 33 layoff announcements, news reports and regulatory filings from hospitals and health systems during 2022 (and be sure to check out the latest on layoffs hitting biotech and digital health).


Adventist Health said in early August that it had cut 52 positions at its Roseville, California, headquarters within the past month. The 23-hospital system said directors, managers and staffing coordinators were included in the layoffs and that they were welcome to apply to one of 2,000 open positions across the organization.

Albany Medical Center informed staff of a “painful” restructure eliminating 37 positions. The restructure is primarily among management and nonclinical roles, leadership wrote in a Sept. 14 letter (PDF) to staff, and all layoffs will be provided a severance package and career placement assistance. The medical center has seen $66 million in year-to-date operating losses.

Ascension St. Vincent Dunn in Indiana will close on Dec. 16 after parent company Ascension was unable to find a buyer for the critical access hospital and nine other medical practices. The hospital shutdown will come with layoffs for 76 hospital employees as well as 56 workers across the practices, according to a letter to Indiana's Department of Workforce Development. Ascension will be offering severance and outplacement services to those who don't enter another position within the system.

BHSH System said Sept. 9 that it had made the “difficult decision” to cut 400 of its 64,000-person workforce. The organization cited inflation and the end of COVID-19 relief payments as reasons for the cuts while noting it had recruited roughly 10,000 since the top of the year to open roles.

Blessing Health System shut down its 49-bed hospital in Keokuk, Iowa, on Sept. 30. The decision will impact 151 workers, many of whom will be doing on-site work or be placed on administrative leave until the layoffs go into effect on Nov. 4. The hospital had been acquired in March 2021 from UnityPoint Health, whom the system noted had also had troubles running a profit.

Bozeman Health Deaconess trimmed 28 leadership and leadership support staff positions in early August and closed an additional 25 job openings. The 2,400-person system cited pandemic economic strains in a letter to staff.

Bristol Hospital laid off 10 managers, cut 21 job vacancies and saw executives take a voluntary 8% pay cut for the year. The June reductions did not affect any of the Connecticut community hospital’s medical staff or patient services employees and will save $3.9 million. The broader Bristol Health system has roughly 1,750 employees and reported a $13.9 million operating loss for 2021.

Cape Fear Valley Health saw two rounds of layoffs across its locations in October. The North Carolina system's Harnett Healtheliminated 56 positions early in the month, 26 of which were full time. It later informed Cape Fear Valley Healthemployees of 200 position eliminations, 42 of which were currently filled by employees in "non-direct patient care positions." The system's CEO attributed cuts at both locations to "unexpected expenses and revenue challenges" and said outplacement services were being offered to those affected.

Commonwealth Health is closing its First Hospital psychiatric center and other outpatient locations at the end of October and, with it, expects to lay off 245 employees. The system is part of the hospital chain Community Health Systems.

East Carolina University Health is laying off 61 employees following the summer closure of its COVID-19 testing sites. The system said cuts were set to begin Sept. 23 and that those affected would receive support if interested in applying to other open positions.

Garnet Health (PDF) filed a notice with New York that the Nov. 9 closure of five outpatient sites would bring 29 layoffs. The system employs more than 3,300 people and 850 medical staff members across its three hospitals and other facilities.

Lake City Community Hospital told South Carolina 222 of its employees will be impacted by the end-of-year closure of its facility. The hospital and Williamsburg Regional Hospital are both reportedly shutting down and transferring their services to the soon-to-be-completed MUSC Black River Medical Center, which will be located in between the two locations and host new care capabilities.

Memorial Hospital at Gulfport laid off its vice president of system development and chief medical officer in April. The moves were driven by both financial challenges and an interest to return the hospital to an organizational structure preceding the executives’ appointments. The 328-bed facility had no other layoff plans.

Moses Taylor Hospital informed the Pennsylvania Department of Labor and Industry that its upcoming merger with the Regional Hospital of Scranton would result in 29 layoffs. These employees work out of its acute care facility and are expected to be laid off on Dec. 2. Some of the affected employees are represented by SEIU Healthcare Pennsylvania, according to the hospital's letter to the department, and no "bumping rights" are being applied.

Noble Health’s spring furlough of 181 employees across its Audrain Community Hospital and Callaway Community Hospital looks to be permanent as the hospitals’ new owner, Platinum Team Management, has been unable to reopen the facilities. The organization had until Missouri regulators’ Sept. 21 deadline to find investors and reopen the two community hospitals and has recently submitted a request to the state for more time.

NorthBay Health announced a workforce reduction of roughly 7% of its full-time equivalents in July. The news followed retirements and voluntary departures and affected departments across the 2,700-employee system. The hardest hit were senior management positions, which saw a 20% reduction. Those laid off received severance packages and job hunt assistance. The California system had recently announced the temporary closure of one of its two urgent care centers due to staffing issues.

OhioHealth kicked off its largest-ever wave of layoffs in July, sharing plans to cut 637 jobs over the course of months. Of those, 567 worked in information technology roles and will remain on the payroll until Jan. 3. The remainder were from the revenue cycle department and will be officially laid off Nov. 4. OhioHealth said the layoffs weren’t driven by cost savings but that the system intends to hand off both functions to third-party vendors that will improve patient experience and care. OhioHealth employs roughly 30,000 people.

Penn Highlands Connellsville Hospital said in July that a workforce restructuring of 47 roles would come with 27 layoffs and 20 eliminations through retirement and attrition. No bedside clinical nurses were affected by the restructuring. The hospital had joined Penn Highlands Healthcare System on April 1 and saw a $16.5 million loss over the previous five years.

ProMedica disclosed in quarterly earnings roughly 150 layoffs among its nonclinical staff. The Toledo, Ohio-based system has seen a $281 million operating loss during the first half of 2022 and alongside the July layoffs has fired several members of its leadership.

Providence announced a reorganization in July targeting a “leaner” operating model with fewer executives and larger regional divisions. The system—which logged a $714 million operating deficit in 2021 and a $934 million operating loss during the first six months of 2022—did not specify how many leadership roles were eliminated but noted that it will continue aggressively recruiting to fill clinical vacancies.

Regional Hospital of Scranton informed the Pennsylvania Department of Labor and Industry that its upcoming merger with Moses Taylor Hospital would result in 8 layoffs among employees working out of its acute care facility. Some of the affected employees are represented by SEIU Healthcare Pennsylvania, according to the hospital's letter to the department, and no "bumping rights" are being applied.

Sanford Health laid off an undisclosed number of layoffs among leadership and administrative staff. In a letter to employees, CEO Bill Gassen said the decision was made to cut down administrative expenses and that the decision to "streamline our leadership structure and simplify operations" were largely in non-clinical areas and "will not adversely impact patient or resident care in any way." He also noted that the system is currently hiring for over 6,000 positions, "mainly in patient-facing roles."

Shriners Hospital for Children laid off 38 in April and another 20 at the end of September as it prepares to close a facility operating on the University of South Florida’s campus.

Sparrow Health System will be laying off "hundreds" of roles across the organization. A spokesperson told media in late September that the job reductions will primarily target leadership and non-patient care positions, but that some clinic jobs—union nurses included—would be affected in low patient volume areas. The system has lost $90 million across the first six months of 2022.

St. Charles Health System announced 105 layoffs and the elimination of 76 vacant positions in May. The organization’s CEO pointed to expense increases, reduced surgery volumes and relief paybacks that will see St. Charles “likely end 2022 in the red” and said the reductions were necessary “to ensure the long-term financial stability of the health system.” That CEO resigned in the following months and was followed out the door by St. Charles’ executive vice president and chief physician executive, whose roles were eliminated to cut costs.

St. Vincent Charity Medical Center said in a Sept. 14 notice it was transitioning from an acute care hospital to an ambulatory health services center, eliminating 978 positions effective Nov. 15. Nearly half of those were full-time employees with the remainder a mix of part-time and as-needed workers.

Trinity Health shut down its West Springfield, Massachusetts-based Trinity Health at Home, a home care and hospice agency. With the closure came 60 layoffs that were set to go into effect Sept. 5.

Trinity Health Mid-Atlantic closed its Mercy Senior Health Center in West Philadelphia due to rising costs. Fourteen people were laid off, according to a notice with the state, although a spokesperson told the press that the system would work to find homes for those employees elsewhere in the system.

Trinity Health of New England’s Mercy Medical Center said in May that it had laid off 12 of its 380 nurses as well as a number of ancillary staff such as secretaries and interpreters. A spokesperson told the press the downturn was due to pandemic disruption of traditional demand and noted that the hospital was also eliminating other positions that were currently vacant.

UNC Health Rockingham filed a notice in late August that it would lay off 67 of its 749 employees effective Oct. 31 with the end of two vendor contracts for food and environmental services. It plans to switch to a single new vendor, Sodexo, for its next contract and said that all employees would have an opportunity to continue with them.

University Hospitals is cutting 326 vacant roles and laying off 117 administrative employees. The Cleveland-based system said in a release that these job eliminations and other reduction efforts will yield a $100 million decrease in expenses. All employees who were laid off did not provide direct patient care and will receive severance.

Yale New Haven Health laid off 72 junior and senior management employees in September and cut another 83 vacant positions. Those cut were encouraged to apply for other jobs at the seven-hospital system, which employs roughly 30,000 people and expects to lose $300 million by the end of its fiscal year.
 
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I pay $325/hr in FL. I also hire locums crna at $200+ depending on my desperation level. I was paying them 185 for the past year but in the past few months nobody worth hiring would even return my calls at that rate. We cover small community hospitals with laughably light OR schedules and l&d. Bigger groups are walking away since they can’t figure out how to make money at these places leaving the hospital admins desperate. It’s a sad story but I’m making triple what I made working w2.
 
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I pay $325/hr in FL. I also hire locums crna at $200+ depending on my desperation level. I was paying them 185 for the past year but in the past few months nobody worth hiring would even return my calls at that rate. We cover small community hospitals with laughably light OR schedules and l&d. Bigger groups are walking away since they can’t figure out how to make money at these places leaving the hospital admins desperate. It’s a sad story but I’m making triple what I made working w2.
Do you get those rates in Florida to "supervise" 4 CRNAs or to do your own cases? Is there parts of Florida where you can do your own cases?
 
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Lately I’ve been giving a lot of thought to giving up the full time job to do locums. I’d make 2.5x my current hourly rate. When I chatted with a comp health recruiter in August he was trying to convince me $350 is top end and tough to get.

Are you regularly seeing 350 and higher? What’s the supervision ratio?
It all depends on location. The more desirable the location the more people are interested. I’m in flordia. The more inland make America great non desirable areas are paying a ton. The coastal areas are paying less. Miami/south flordia sucks for locums pay. But people will take $250/275/hr to be in Miami cause of the weather especially in winter times.

U gotta do the math. It’s very tricky. I had option of doing pure 1099 and making 650k easy for roughy 45 hours a week no nights no weekends

But I chose w2 with state benefits working 38 hours a week q30 days calls that’s paid extra that I don’t even have to take for roughly 450k plus generous benefits worth around an extra 30k plus paid holidays and lots of off days. I’m literally working approximately 38-39 weeks for that. So that’s equivalent to around $300/hr. Which I’m fine with. I still get to sock away close to 70k in retirement benefits 403b/457b/401a. The hours worked with early days and days off are more important to me these days since I have kids. The locums I know who travel out of state their kids are in college and they probably don’t want to be home with their spouses as empty nesters Lol. It’s true. We all know that.

There are places in Midwest. U can easily hit 900k doing locums. It’s simple math. With a little overtime. 375/400/hr x 50 hours x 44-46 weeks worked.
I’ve never seen an admin get fired… they get moved around or they blame “greedy locums anesthesiologists”
I have seen two admin get fired in California. One in Maryland. Of course hospital admin are like nfl and nba coaches. No matter how bad they are. They will just get recycled to another hospital system due to their “experience “.

So yes in a way. They just move around.

But when ORs get shut down due to inadequate staffing. The blame goes right to the top. Especially at good payor mix hospitals.
 
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But I chose w2 with state benefits working 38 hours a week q30 days calls that’s paid extra that I don’t even have to take for roughly 450k plus generous benefits worth around an extra 30k plus paid holidays and lots of off days. I’m literally working approximately 38-39 weeks for that. So that’s equivalent to around $300/hr. Which I’m fine with. I still get to sock away close to 70k in retirement benefits 403b/457b/401a. The hours worked with early days and days off are more important to me these days since I have kids. The locums I know who travel out of state their kids are in college and they probably don’t want to be home with their spouses as empty nesters Lol. It’s true. We all know that.
That sounds like my dream job!
 
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I pay $325/hr in FL. I also hire locums crna at $200+ depending on my desperation level. I was paying them 185 for the past year but in the past few months nobody worth hiring would even return my calls at that rate. We cover small community hospitals with laughably light OR schedules and l&d. Bigger groups are walking away since they can’t figure out how to make money at these places leaving the hospital admins desperate. It’s a sad story but I’m making triple what I made working w2.
Are you a recruiter? Or a doc? Or both?
 
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Fyi. If locums company is offering $350/hr.

The locums agency is charging the hospital anywhere between $500-550/hr

Everyone is eating at the table

The recruiter will make $50/hr off
The locums company owner nets $100/hr off u

And they will bill the hospital ur hotel/car/travel fees.

There is a ton of money going around. In a weird way. We have to thank CRNAs. Lol. They aren’t dropping their prices. Their prices are paying $200/hr these days. Some crna’s are getting $250/hr in parts of the northeast I know.
 
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With locum rates going up, at some point won't hospitals find it "cheaper" to directly hire and employ anesthesia staff instead of contracting out to private groups and AMCs?
 
With locum rates going up, at some point won't hospitals find it "cheaper" to directly hire and employ anesthesia staff instead of contracting out to private groups and AMCs?
This is the same predicament as travel nursing though and I don't see that going away anytime soon.
 
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With locum rates going up, at some point won't hospitals find it "cheaper" to directly hire and employ anesthesia staff instead of contracting out to private groups and AMCs?

It's not about finding people for cheap. It's about finding people at all.
 
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With locum rates going up, at some point won't hospitals find it "cheaper" to directly hire and employ anesthesia staff instead of contracting out to private groups and AMCs?

Eventually, but the hospitals have tendencies to cheap out on permanent staff. At which point the permanent staff will leave and the churn will continue. Until the market tightens up and demand goes back done, the conditions causing these high locums rates will continue.
 
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Eventually, but the hospitals have tendencies to cheap out on permanent staff. At which point the permanent staff will leave and the churn will continue. Until the market tightens up and demand goes back done, the conditions causing these high locums rates will continue.
This is the sad part, some places the perm staff make literally half of what comparable full time locums make. It’s almost like hospitals want departments to be made of mercenaries or have no cohesion
 
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This is the sad part, some places the perm staff make literally half of what comparable full time locums make. It’s almost like hospitals want departments to be made of mercenaries or have no cohesion
Hospital executives don't care. Everybody's property is nobody's property. You are just a cog. They don't care about the long-term, because their own incentives are short-term. Whatever keeps the machine functioning. "Après moi, le déluge."

Stupid employees care about titles and whatever lies they are told. Smart people care about money in the bank. If my place hired locums at much higher hourly rates, I would find a locum job myself and quit. Unless one is partner, one doesn't owe the business any loyalty. They don't know that word anyway.
 
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Hospital executives don't care. Everybody's property is nobody's property. You are just a cog. They don't care about the long-term, because their own incentives are short-term. Whatever keeps the machine functioning. "Après moi, le déluge."

Stupid employees care about titles and whatever lies they are told. Smart people care about money in the bank. If my place hired locums at much higher hourly rates, I would find a locum job myself and quit. Unless one is partner, one doesn't owe the business any loyalty. They don't know that word anyway.
It’s every hospital, private or academic, that does this.

I can’t figure it out myself. Part of it may be that some demographics don’t care about money as much (older anesthesiologists with money in the bank, or people who have a working spouse who is very successful).

In academics those are overwhelmingly the ones who stay long term that I’ve seen. Lots of trust fund beneficiaries, kept men/women, and older people who want away from the private practice stacking cash life.

Whenever you judge a job against another job, always realize you’re buying something. Even if it has little value to you, someone else may value it highly. That could be collegiality, no call, location, benefits, or cases you like.

You always pay for things you like, or generally get paid for things you hate conversely
 
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Do you get those rates in Florida to "supervise" 4 CRNAs or to do your own cases? Is there parts of Florida where you can do your own cases?
It varies.. but it’s never brutal or abusive. These are small community hospitals that don’t have much volume but require a certain number of bodies to get the mornings going and finish out the afternoon addons. I usually start my days at 1:3 and keep 1 provider until the OR is done in case I need to pop in a labor epidural. We usually only have docs on at night and weekends.
 
It varies.. but it’s never brutal or abusive. These are small community hospitals that don’t have much volume but require a certain number of bodies to get the mornings going and finish out the afternoon addons. I usually start my days at 1:3 and keep 1 provider until the OR is done in case I need to pop in a labor epidural. We usually only have docs on at night and weekends.

Who are these providers you speak of? I suppose MDAs work all the calls, but nurses are 7-3 with over time over 40? I just don’t get it.
 
Who are these providers you speak of? I suppose MDAs work all the calls, but nurses are 7-3 with over time over 40? I just don’t get it.
What I don’t get are docs who never want to take call, never want to be in a room alone and don’t want anything to do with OB but still want to be paid yacht money. If I could find competent hardworking docs with a little flexibility I would gladly get rid of every crna tomorrow.

Just yesterday I had this conversation with someone who wanted guaranteed overnight hours AND a crna on call so he wouldn’t actually have to lift a finger. Please tell me on what fantasy planet you can be paid thousands to generate a few hundred in revenue at best. Non PE owned groups survive on razor thin margins.. not the fat cat billing that envision and team health generate. We actually have a business that has long term goals not “bleed practices dry and sell”.

Taking call is part of the job. Covering OB is part of the job. Providing actual patient care is part of the job. I’d say around 50% of my fellow MDAs don’t understand these 3 simple facts but are the first to cry when a crna steps up to the job they REFUSE for half the pay.

There are a lot of inconvenient truths in anesthesia.. crna encroachment is real and the shortage of MDAs will only make it worse. ASCs that would have never entertained the idea of solo crna are now writing new surgeon / gi / crna collaborative agreements to completely cut anesthesiologists out of the picture. Why? Because supervising a couple of endo rooms while the crna/aa do all of the cases is “slave labor” at $250/hr.

Sorry for the rant.. I spent most of the day yesterday with hospital admin writing new CRNA policy so we can permanently erase another MDA position. I fought tooth and nail to prevent this but the wonderful doc who “knew his worth” wanted the annualized equivalent of $2 million to generate and few thousand in revenue per day. He’s now earning $0 in his hotel room trying to find another gig.

Anyway I’m gonna go start a gallbladder.. on a Saturday.. by myself.. cheers.
 
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Unrelated, but I can't believe some of us have accepted the AANA agenda of referring to ourselves as "MDAs" as to blur the lines and obfuscate the fact that we are physicians who went through medical school and residency to be where we are. It's disappointing, and I refuse to minimize or disparage myself with that language. You all should too.
 
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What I don’t get are docs who never want to take call, never want to be in a room alone and don’t want anything to do with OB but still want to be paid yacht money. If I could find competent hardworking docs with a little flexibility I would gladly get rid of every crna tomorrow.

Just yesterday I had this conversation with someone who wanted guaranteed overnight hours AND a crna on call so he wouldn’t actually have to lift a finger. Please tell me on what fantasy planet you can be paid thousands to generate a few hundred in revenue at best. Non PE owned groups survive on razor thin margins.. not the fat cat billing that envision and team health generate. We actually have a business that has long term goals not “bleed practices dry and sell”.

Taking call is part of the job. Covering OB is part of the job. Providing actual patient care is part of the job. I’d say around 50% of my fellow MDAs don’t understand these 3 simple facts but are the first to cry when a crna steps up to the job they REFUSE for half the pay.

There are a lot of inconvenient truths in anesthesia.. crna encroachment is real and the shortage of MDAs will only make it worse. ASCs that would have never entertained the idea of solo crna are now writing new surgeon / gi / crna collaborative agreements to completely cut anesthesiologists out of the picture. Why? Because supervising a couple of endo rooms while the crna/aa do all of the cases is “slave labor” at $250/hr.

Sorry for the rant.. I spent most of the day yesterday with hospital admin writing new CRNA policy so we can permanently erase another MDA position. I fought tooth and nail to prevent this but the wonderful doc who “knew his worth” wanted the annualized equivalent of $2 million to generate and few thousand in revenue per day. He’s now earning $0 in his hotel room trying to find another gig.

Anyway I’m gonna go start a gallbladder.. on a Saturday.. by myself.. cheers.


A couple of well insured endo rooms should generate $2mil/yr. $250/hr is just not the current locums rate. I’d say no thanks too. After being squeezed by PE for a decade, the doctor is squeezing back. Remember PE also does not lift a finger for the 20-30% of anesthesia revenues they collect. It’s called negotiation and now is the time to do it. The doctor will have no problem finding other work. And why are you helping the bean counters write policies that will hurt you in the end? Also you sound sad about doing your own Saturday morning gallbladder 🤔
 
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A couple of well insured endo rooms should generate $2mil/yr. $250/hr is just not the current locums rate. I’d say no thanks too. After being squeezed by PE for a decade, the doctor is squeezing back. Remember PE also does not lift a finger for the 20-30% of anesthesia revenues they collect. It’s called negotiation and now is the time to do it. The doctor will have no problem finding other work. And why are you helping the bean counters write policies that will hurt you in the end? Also you sound sad about doing your own Saturday morning gallbladder 🤔

Yeah...I have no interest in supervising all day only to be left alone at night. If that means I don't get the job in a low volume community place then so be it. In the setup described I'd rather be the CRNA.
 
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What I don’t get are docs who never want to take call, never want to be in a room alone and don’t want anything to do with OB but still want to be paid yacht money. If I could find competent hardworking docs with a little flexibility I would gladly get rid of every crna tomorrow.

Just yesterday I had this conversation with someone who wanted guaranteed overnight hours AND a crna on call so he wouldn’t actually have to lift a finger. Please tell me on what fantasy planet you can be paid thousands to generate a few hundred in revenue at best. Non PE owned groups survive on razor thin margins.. not the fat cat billing that envision and team health generate. We actually have a business that has long term goals not “bleed practices dry and sell”.

Taking call is part of the job. Covering OB is part of the job. Providing actual patient care is part of the job. I’d say around 50% of my fellow MDAs don’t understand these 3 simple facts but are the first to cry when a crna steps up to the job they REFUSE for half the pay.

There are a lot of inconvenient truths in anesthesia.. crna encroachment is real and the shortage of MDAs will only make it worse. ASCs that would have never entertained the idea of solo crna are now writing new surgeon / gi / crna collaborative agreements to completely cut anesthesiologists out of the picture. Why? Because supervising a couple of endo rooms while the crna/aa do all of the cases is “slave labor” at $250/hr.

Sorry for the rant.. I spent most of the day yesterday with hospital admin writing new CRNA policy so we can permanently erase another MDA position. I fought tooth and nail to prevent this but the wonderful doc who “knew his worth” wanted the annualized equivalent of $2 million to generate and few thousand in revenue per day. He’s now earning $0 in his hotel room trying to find another gig.

Anyway I’m gonna go start a gallbladder.. on a Saturday.. by myself.. cheers.
I sympathize with you, I really do. But the hospitals annihilate whatever we “bill” and pocket it all in the form of facility fees. This is a trend in every specialty and is totally by design.

I think the point of the ACA and Medicaid expansions is to end the private practice billing/collection model to ultimately squeeze insurance companies into bankruptcy or so that they’re not negotiating with practices, but rather the government. Physician practices go out of business and then negotiate their cut of facility fees based on supply/demand for their specialty, and capitalist market forces dictate compensation rather than payor mixes. Everyone agrees that compensation differences based on payor mixes are nonsensical and wildly unfair to patients and doctors in some parts of the country

The way to do that is to increase facility fees while decreasing physician fee billing codes gradually. It’s happening to anesthesia, ED, rad onc, and cardiology. Eventually it’ll happen to surgical sub specialties too.

The facility fees are where the money is going. A lot of doctors who you think are lazy May only realize how much money is sloshing around for an average endoscopy day and want their fair share.
 
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What I don’t get are docs who never want to take call, never want to be in a room alone and don’t want anything to do with OB but still want to be paid yacht money. If I could find competent hardworking docs with a little flexibility I would gladly get rid of every crna tomorrow.

Just yesterday I had this conversation with someone who wanted guaranteed overnight hours AND a crna on call so he wouldn’t actually have to lift a finger. Please tell me on what fantasy planet you can be paid thousands to generate a few hundred in revenue at best. Non PE owned groups survive on razor thin margins.. not the fat cat billing that envision and team health generate. We actually have a business that has long term goals not “bleed practices dry and sell”.

Taking call is part of the job. Covering OB is part of the job. Providing actual patient care is part of the job. I’d say around 50% of my fellow MDAs don’t understand these 3 simple facts but are the first to cry when a crna steps up to the job they REFUSE for half the pay.

There are a lot of inconvenient truths in anesthesia.. crna encroachment is real and the shortage of MDAs will only make it worse. ASCs that would have never entertained the idea of solo crna are now writing new surgeon / gi / crna collaborative agreements to completely cut anesthesiologists out of the picture. Why? Because supervising a couple of endo rooms while the crna/aa do all of the cases is “slave labor” at $250/hr.

Sorry for the rant.. I spent most of the day yesterday with hospital admin writing new CRNA policy so we can permanently erase another MDA position. I fought tooth and nail to prevent this but the wonderful doc who “knew his worth” wanted the annualized equivalent of $2 million to generate and few thousand in revenue per day. He’s now earning $0 in his hotel room trying to find another gig.

Anyway I’m gonna go start a gallbladder.. on a Saturday.. by myself.. cheers.

Keep fighting the good fight sounds like you’re in a challenging spot. Night work and weekend work rarely generates $$ though. The hospital needs to pony it up for anesthesia availability if that’s what they want. MD solo of course is fine but if I’m supervising all day running around like crazy and then solo all night and on weekends I would want 600+ and this is tough to get without a subsidy.
 
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Sorry for the rant.. I spent most of the day yesterday with hospital admin writing new CRNA policy so we can permanently erase another MDA position. I fought tooth and nail to prevent this but the wonderful doc who “knew his worth” wanted the annualized equivalent of $2 million to generate and few thousand in revenue per day. He’s now earning $0 in his hotel room trying to find another gig.

Anyway I’m gonna go start a gallbladder.. on a Saturday.. by myself.. cheers.
1st off.....MDA? (sounds like AMC speak..alt motives?).

2nd- that time would have been better spent advocating to admin to subsidize your locums cost (to whatever extent necessary). Those numbers are little more than a rounding error in their budget. Instead, more deferred comp to the administrators and another L for the specialty.

These are the front lines where ground is either gained or (permanently?) lost. Position statements, etc are seldom more than lip service and virtue signaling.
 
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2nd- that time would have been better spent advocating to admin to subsidize your locums cost (to whatever extent necessary). Those numbers are little more than a rounding error in their budget. Instead, more deferred comp to the administrators and another L for the specialty.

Asking admin for a subsidy to subsidize locums? Has anyone actually ever done this?
 
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I don't see how any private practice can survive with locum rates so high. We had one partner leave for full time locums. He left a >$600k job to make $500/hour. When I can I'll pick up extra shifts at a plastic surgery clinic that starts at noon and closes by 5pm (flat rate for availability is $3500, sometimes there's only two cases and I'm gone when the last patient leaves the facility at 3pm). the shortage is real. and very tempting to just quit my full time job.
 
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I don't see how any private practice can survive with locum rates so high. We had one partner leave for full time locums. He left a >$600k job to make $500/hour. When I can I'll pick up extra shifts at a plastic surgery clinic that starts at noon and closes by 5pm (flat rate for availability is $3500, sometimes there's only two cases and I'm gone when the last patient leaves the facility at 3pm). the shortage is real. and very tempting to just quit my full time job.
What area is this in?
 
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Who are these providers you speak of? I suppose MDAs work all the calls, but nurses are 7-3 with over time over 40? I just don’t get it.

Touched a nerve or two there, didn’t I?
Everyone else picked up what I was trying to say….
1. MDA?! What the fu(k is a MDA? It’s redundant…. Anesthesiologists, like cardiologist, like gastroenterologist, like endocrinologist, is a physician only position. Do we call them MDC? MDG? MDE?!

2. I’d like to be a nurse in this set up. I punch in/out for 40 hrs, no call, no stress…. I will do you a solid, I can even sign my own chart and do my own pre-op. But I demand a morning break (at least 15 mins). Lunch break, and you better believe it, I will start asking when I can get out at 2pm.

I understand the call is part of the work, I will be glad to take calls, when it’s compensated like CRNAs, when I am not a partner (just an “employee”).

We are so reliant on CRNAs, we are already so fu(ked. At the same time we criticize each other, we are afraid to piss off crnas. WTFH!
 
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What area is this in?
BFE midwest. I live in a Big 10 college town. Closes international airport is 3 hours away. Lots of international students so the restaurants are at least decent.
 
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