Direction of Locums Rates

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Asking admin for a subsidy to subsidize locums? Has anyone actually ever done this?
AMC's that take a contract can (and have) agreed to specific staffing models with the understanding that hospitals cover the locums/overages during the transition (which per the agreement can be a year or even two). After this time the AMC is solely responsible for the staff. Meanwhile, the hospital directs these funds from their temporary staffing (vs permanent staffing) budget so it doesn't appear as a fixed cost.

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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?!
I said basically that exact thing (I used different specialties) to a crna in residency. She had no answer for me. I then added, "I will never be an MDA. My degree and license say MD."

But ironically, I'm chatting on reddit with someone complaining about crnas and they keep using MDA. 🤦
 
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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.
I’m confused can you clarify what you are? You seem to be an MD but you’re also hiring other MDs so you’re a worker but also a recruiter?
 
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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.
That does not sound like the job he or she is describing. These are little hospitals thar don’t typically have you running around all day and night. I have had a job like this in a 99 bed hospital and it was quite easy actually. And plenty of ACT practices work this way.
So if you want that 600 an hour for this job you will be assed out. $350-400 an hour works though IMO.
 
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I’m confused can you clarify what you are? You seem to be an MD but you’re also hiring other MDs so you’re a worker but also a recruiter?
It is quite weird. I think he or she is the chairman of the department of a small hospital. An employee but the one in charge who helps with hiring and recruiting. One who sounds like they sold out to an AMC a while back due to how he/she is helping get rid of docs. And the use of the terms MDAs and Providers.
I could be wrong, but that is my hunch.

Edit: Not a W2 and staffing multiple hospitals and a Physician. A locums company owner who happens to be a doc? I didn’t know FL worked anything like Texas with docs going to multiple hospitals. So confused.
 
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I’m glad to hear of these hospital systems cutting superfluous admin… hoping others follow suit. If you aren’t a doctor or nurse or other provider involved in some aspect of patient care get out… you’re not wanted and too expensive because you don’t do 💩
 
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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.
I agree. It’s all about either overall compensation or total hours worked or type of calls involved.

I don’t sleep at all on call at my current job. That’s why I give most of it
AMC's that take a contract can (and have) agreed to specific staffing models with the understanding that hospitals cover the locums/overages during the transition (which per the agreement can be a year or even two). After this time the AMC is solely responsible for the staff. Meanwhile, the hospital directs these funds from their temporary staffing (vs permanent staffing) budget so it doesn't appear as a fixed cost.
MBA degree people call that playing 4D chess.

Hospital kicked out small private group cause they didn’t want to keep paying the small group 3 million in subsidy including ob payor mix 90% Medicaid.

1/3 the docs left. 1/2 the crna’s led. So on paper the hospital said they weren’t paying. Any subsidy. First year the “recruitment budget to cover locums” was 4 million. Since it was city/county subsidized hospital. Everything public knowledge. Hospital admin brag they didn’t have to private subsidy for anesthesia and “expanded coverage”. Second year locums cost in recruitment budget was 5 million.

So much for a cost savings. But marketing wise for hospital press releases. It all sounded good how much the admin was saving tax payers.
 
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I agree. It’s all about either overall compensation or total hours worked or type of calls involved.

I don’t sleep at all on call at my current job. That’s why I give most of it

MBA degree people call that playing 4D chess.

Hospital kicked out small private group cause they didn’t want to keep paying the small group 3 million in subsidy including ob payor mix 90% Medicaid.

1/3 the docs left. 1/2 the crna’s led. So on paper the hospital said they weren’t paying. Any subsidy. First year the “recruitment budget to cover locums” was 4 million. Since it was city/county subsidized hospital. Everything public knowledge. Hospital admin brag they didn’t have to private subsidy for anesthesia and “expanded coverage”. Second year locums cost in recruitment budget was 5 million.

So much for a cost savings. But marketing wise for hospital press releases. It all sounded good how much the admin was saving tax payers.

Robbing Peter to pay Paul. Same pot of money, only shrinking. Accounting magic….
 
That does not sound like the job he or she is describing. These are little hospitals thar don’t typically have you running around all day and night. I have had a job like this in a 99 bed hospital and it was quite easy actually. And plenty of ACT practices work this way.
So if you want that 600 an hour for this job you will be assed out. $350-400 an hour works though IMO.

Oh I meant i would want 600/yr for a job like this not 600/hour
 
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I’m glad to hear of these hospital systems cutting superfluous admin… hoping others follow suit. If you aren’t a doctor or nurse or other provider involved in some aspect of patient care get out… you’re not wanted and too expensive because you don’t do 💩


We had 4 nurses in our operating room who were very good circulators. But now they joined the dark side and sit in their offices all day. When things get tight and we need help in the ORs, they still remain in their office. I hope they find their way back into the operating rooms.
 
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I agree. It’s all about either overall compensation or total hours worked or type of calls involved.

I don’t sleep at all on call at my current job. That’s why I give most of it

MBA degree people call that playing 4D chess.

Hospital kicked out small private group cause they didn’t want to keep paying the small group 3 million in subsidy including ob payor mix 90% Medicaid.

1/3 the docs left. 1/2 the crna’s led. So on paper the hospital said they weren’t paying. Any subsidy. First year the “recruitment budget to cover locums” was 4 million. Since it was city/county subsidized hospital. Everything public knowledge. Hospital admin brag they didn’t have to private subsidy for anesthesia and “expanded coverage”. Second year locums cost in recruitment budget was 5 million.

So much for a cost savings. But marketing wise for hospital press releases. It all sounded good how much the admin was saving tax payers.
These stories are beyond frustrating. The most frustrating part is they don’t face consequences for their actions.
 
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Oh I meant i would want 600/yr for a job like this not 600/hour
$300/hr locums (low side these days) x 45 hours x 44 weeks. That’s almost 600k with no calls and no weekends and basically leaving 3-4pm every day.

So why join a practice with calls and weekend responsibilities for 600k?

I’ve run the numbers. AMC HAD TO INCREASE the pay to 500k (as the average) with full calls/weekends and it’s not really working

Full time calls people need to make at least 700k these days if u want them to work 50-60 hours.

Or decrease the hours to 40-45 and make pay 450-500k with no calls.

The in between job for 500-600k w2 with full calls and more hours isn’t gonna to cut it these days.

People want lifestyle (no calls/limited weekend days) and decent pay (450k)

Or they want to make a lot more (700k and up)

The in between full time job is very tricky to fill these days.
 
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I agree. It’s all about either overall compensation or total hours worked or type of calls involved.

I don’t sleep at all on call at my current job. That’s why I give most of it

MBA degree people call that playing 4D chess.

Hospital kicked out small private group cause they didn’t want to keep paying the small group 3 million in subsidy including ob payor mix 90% Medicaid.

1/3 the docs left. 1/2 the crna’s led. So on paper the hospital said they weren’t paying. Any subsidy. First year the “recruitment budget to cover locums” was 4 million. Since it was city/county subsidized hospital. Everything public knowledge. Hospital admin brag they didn’t have to private subsidy for anesthesia and “expanded coverage”. Second year locums cost in recruitment budget was 5 million.

So much for a cost savings. But marketing wise for hospital press releases. It all sounded good how much the admin was saving tax payers.


Every anesthesia group to hospitals right now, “You can pay now to keep us or pay much more later to replace us.”

Same thing happened with nurses. And our stipends are nothing compared to neurosurgery and ortho trauma.
 
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$300/hr locums (low side these days) x 45 hours x 44 weeks. That’s almost 600k with no calls and no weekends and basically leaving 3-4pm every day.

So why join a practice with calls and weekend responsibilities for 600k?

I’ve run the numbers. AMC HAD TO INCREASE the pay to 500k (as the average) with full calls/weekends and it’s not really working

Full time calls people need to make at least 700k these days if u want them to work 50-60 hours.

Or decrease the hours to 40-45 and make pay 450-500k with no calls.

The in between job for 500-600k w2 with full calls and more hours isn’t gonna to cut it these days.

People want lifestyle (no calls/limited weekend days) and decent pay (450k)

Or they want to make a lot more (700k and up)

The in between full time job is very tricky to fill these days.

Agreed I chose more lifestyle oriented job with easy days, minimal call for 450k. Other options in town were partnerships where partners weee working much harder for 500ish. They are having trouble filling these jobs with even 1 year partnership track.
 
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It certainly feels like rates are still going up as many you of you have stated. I'm seeing a M-F locums near Chicago at $360/hr and one in a big college town at $375/hr.
 
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Can you work 60 hours locums and make 1M per year? Is that sustainable?
 
Every anesthesia group to hospitals right now, “You can pay now to keep us or pay much more later to replace us.”

Same thing happened with nurses. And our stipends are nothing compared to neurosurgery and ortho trauma.
Yeah neuro and ortho get crazy stipends to mostly sit around at home on call. Hell even this HBS surgeon I know would be put up at the Ritz (the actual Ritz) when he was on call.

Yet where I work we don’t even have a call room with a bed…
 
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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.
Ok but explain this- how can hospitals be hurting seeing the facility fees they collect for some surgeries?! Like $100k for ecmo cannula toon. C’mon.
 
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Ok but explain this- how can hospitals be hurting seeing the facility fees they collect for some surgeries?! Like $100k for ecmo cannula toon. C’mon.
Those hospitals seem to all be small centers that don’t do the tertiary type cases that generate those fees. Hard to survive if you’re not cranking outpatient knees or electrophysiology procedures
 
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Can you work 60 hours locums and make 1M per year? Is that sustainable?
Some people love living out of a hotel and don't mind being at a new place often.

I had fun with it for a while. And then it got old.

Everything is harder at short term locums jobs. Finding places in the hospital. EMR quirks. Is the epi in drawer 2 on the left side or was that the other place? Which PACU nurse is dumb and dangerous? Which surgeon is so bad his patients should all get a second IV and a type & screen? The locals aren't real motivated to help you out (mentorship from senior partners matters a lot early in a career, and the value of a good partner who gives a **** about you can't be overstated).

What else? Agency scheduled flights with layovers when direct options exist. Sometimes they'll do business class, sometimes they refuse. Time away from family. Hobbies and other interests have to be adapted to road life, or postponed. Jet lag. Days of your life wasted in planes, airports, car rental shops. Obstacles to good diet and exercise.

All that is totally separate from the 1099/no-benefits issue.

How much do you really want to torture yourself for a few extra $? Try it and see. Maybe you'll like it.

The ordinary PP job with benefits at a place 15 minutes from your house and family and all your stuff, albeit for $100K less, isn't so bad. There's a point when enough money is simply enough, and living like a normal human is kind of nice, even if no one tells the IRS how happy you are.
 
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Some people love living out of a hotel and don't mind being at a new place often.

I had fun with it for a while. And then it got old.

Everything is harder at short term locums jobs. Finding places in the hospital. EMR quirks. Is the epi in drawer 2 on the left side or was that the other place? Which PACU nurse is dumb and dangerous? Which surgeon is so bad his patients should all get a second IV and a type & screen? The locals aren't real motivated to help you out (mentorship from senior partners matters a lot early in a career, and the value of a good partner who gives a **** about you can't be overstated).

What else? Agency scheduled flights with layovers when direct options exist. Sometimes they'll do business class, sometimes they refuse. Time away from family. Hobbies and other interests have to be adapted to road life, or postponed. Jet lag. Days of your life wasted in planes, airports, car rental shops. Obstacles to good diet and exercise.

All that is totally separate from the 1099/no-benefits issue.

How much do you really want to torture yourself for a few extra $? Try it and see. Maybe you'll like it.

The ordinary PP job with benefits at a place 15 minutes from your house and family and all your stuff, albeit for $100K less, isn't so bad. There's a point when enough money is simply enough, and living like a normal human is kind of nice, even if no one tells the IRS how happy you are.
Also everything over 600k is taxed like 40 percent so is it worth it to make more to lose almost half of every dollar?
 
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Not if you have a PLLC and pay yourself a salary. That 600k 1099!is not what you pay yourself. Gotta have an accountant hook you up.
Let’s say you make 1 mil in the year 1099, you’re saying there’s a way that above 6 or 700k you won’t get taxed at 37 percent? Even if you pay yourself a salary and do all the maneuvers
 
Talk to an accountant who does this on a regular. Lots of expense ar you can write off, Office supplies, phone, trips r/t work but to destination places, plane tickets, cars. You can bring that down I bet with the right maneuvers. I am not an accountant and the wrong person to act but I have been 1099 before and my taxes have been below normal compared to W2 percentages.
But you also gotta weigh in what benefits you get as a W2 employee or someone in a 1099 partnership.
 
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Love these lying recruiters. My buddy who’s currently at making $350/hr locums and $325/hr in New York

He wanted to go to Florida for the winter. Recruiter tried to low ball him at $250/hr and then said they re upped it to $265/hr and being generous. What’s so funny is I know people who are at $325/hr at the same hospital. Now he got them up to $300-hr

All a game. They the recruiters and companies are like mortgage brokers. A $25/50/hr difference in locums pays means another another $200-500 a day in the locums companies pockets.

And you are the one doing the physical work.
 
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Recruiters are super underhanded. They’ll low ball you and say you’re asking over market rate… then mark you up 20% for every hour you work. Rape and pillage imho
 
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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?
I see them only going up then leveling off. I've been doing full time locums for 3 years. When I started rates were $220-$250. Now rates are $300-$500 depending on your negotiation skills, value proposition, and location.

Honestly I been able to triple my previous Private W2 salary, do zero call, have every weekend off, and still take off 12 weeks. This has been a banner year.
 
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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 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.
You definately have a nice job. I will say that on the 1099 side, I'd argue that you actually stand to KEEP more of your money amd reduce you tax bill significantly depending on your business structure, business deductions, and your retirement accounts. I have every weekend off, do zero call, and made in the high $800s this year. I took off 12 weeks. Between my 401k and Cash balance plans, I was able to save $183,000 in retirement accounts, deduct business expenses, and reduce my taxable wages to lower than I paid working a W2 job. It all depends. You make great points tho.
 
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I see them only going up then leveling off. I've been doing full time locums for 3 years. When I started rates were $220-$250. Now rates are $300-$500 depending on your negotiation skills, value proposition, and location.

Honestly I been able to triple my previous Private W2 salary, do zero call, have every weekend off, and still take off 12 weeks. This has been a banner year.
Very nice! How many hours per week do you work? And do you have to travel all over? How does that affect time with family and kids?
 
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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.
You're right. But honestly, that is the nature of entrepreneurship. Everyone is in it to get paid. Surely you don't expect for locums companies and recruiters to field all the jobs, do all your paperwork, arrange all your travel, pay for all your travel, licensure, amd credentialing and not get a cut? Nobody is in this for charity. Honeslty I do not care what anyone else makes as long as Im being compensated appropriately based on the job amd location. The larger issue I see is physicians concerning themselves with other people's pockets and not taking the time to adequately negotiate based on their own value proposition. In this game you absolutely can NEVER just take the rate they say. Unless of course you are desperate.
 
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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?
That makes sense but it all comes down to supply and demand. In non-popular locations, it is hard to retain and recruit talent. Therefore, hospitals rely on full time locums to fill the gap so they can continue to generate revenue for their business.
 
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.

These numbers are very real. If I didn't want much time off, I could have easily generated over 1 million this year without even doing call.
 
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Also everything over 600k is taxed like 40 percent so is it worth it to make more to lose almost half of every dollar?
No true. Depending on your business structure , retirement plan setup, amd business deductions, I'd argue that most full time locums keep more of their money and actually pay less tax that you do as W2.
 
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Very nice! How many hours per week do you work? And do you have to travel all over? How does that affect time with family and kids?
I work 45-50 hrs/week M-F. I don't "travel all over". I am married and my wife is supportive. I fly home every weekend and take off 12 weeks/year. We make it work. We are interested in financial independence. I plan on only working 26 weeks/year by the time I'm 50.
 
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I work 45-50 hrs/week M-F. I don't "travel all over". I am married and my wife is supportive. I fly home every weekend and take off 12 weeks/year. We make it work. We are interested in financial independence. I plan on only working 26 weeks/year by the time I'm 50.
How long do your contracts usually run at a single hospital before having to move on? Also, what business structure do you recommend (s-corp?)
 
How long do your contracts usually run at a single hospital before having to move on? Also, what business structure do you recommend (s-corp?)
Contract length depends on the institutional need amd what else I have going on. The beauty of doing locums and working independently is you determine your availability which for most will surround family obligations, events, and revenue goals.

Personally I take the S-corp election, as it saves me on employment taxes, but there are compliance pieces to consider. The structure you choose should be based on your individual situation.
 
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I work 45-50 hrs/week M-F. I don't "travel all over". I am married and my wife is supportive. I fly home every weekend and take off 12 weeks/year. We make it work. We are interested in financial independence. I plan on only working 26 weeks/year by the time I'm 50.
That sounds amazing.

How do you like locums compared to your presumably prior employed life? Any big downsides in the locums route? Also it sounds like you think it’ll continue to get even hotter for the near term?
 
Let’s say you make 1 mil in the year 1099, you’re saying there’s a way that above 6 or 700k you won’t get taxed at 37 percent? Even if you pay yourself a salary and do all the maneuvers
At $1 million per year it gets difficult to not pay some serious taxes. You can only deduct so much as an Anesthesiologist:

1. Business deductions $60,000
2. Auto deduction $125,000 (tesla at 100% deduction)
3. Retirement at $185,000

These come right off the top then you must pay taxes on the rest. One year I got my business deductions up to $95,000 and it's possible to push retirement over $200,000 per year depending on your age.
 
At $1 million per year it gets difficult to not pay some serious taxes. You can only deduct so much as an Anesthesiologist:

1. Business deductions $60,000
2. Auto deduction $125,000 (tesla at 100% deduction)
3. Retirement at $185,000

These come right off the top then you must pay taxes on the rest. One year I got my business deductions up to $95,000 and it's possible to push retirement over $200,000 per year depending on your age.
Is there a limit for auto deductions cause I've been eyeing a Cayenne GTS EV Hybrid?
 
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New Braunfels TX $300-$310 advertised, 3 sites 10 miles of each other, 5x8's or 4x10's, no neuro, hearts. New Braunfels is actually a nice little town.
 
I work 45-50 hrs/week M-F. I don't "travel all over". I am married and my wife is supportive. I fly home every weekend and take off 12 weeks/year. We make it work. We are interested in financial independence. I plan on only working 26 weeks/year by the time I'm 50.
Shoot, that's close to $450/hr, I don't know about you but I just went from six to midnight.
 
How does one get this much into retirement?
401k Employee contribution: $20500
401k Employer contribution: $12000
Cash Balance Plan: $152,500

As a 1099, you can set up and independently managed Cash Balance Plan that is maintained by firm for compliance.
 
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That sounds amazing.

How do you like locums compared to your presumably prior employed life? Any big downsides in the locums route? Also it sounds like you think it’ll continue to get even hotter for the near term?
I tell everyone that locums is not for everyone. The primary reason I quit my last job is to fully control my schedule, take full advantage of the tax code as a business owner, and never work another holiday in my life lol.

To be successful with locums you need to understand the game, hiring trends, the likelihood of assignment cancelation, ect. You need to be flexible with location and you need to understand how to negotiate based on your value proposition. It goes without saying, you need to be good at your job and ok with things changing. You need to be ok with the idea that there is risk involved in doing locums (risk of cancelation amd no paycheck) ect.

The largest downside is being away from home and ensuring financial compliance.
 
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I’ve never seen an admin get fired… they get moved around or they blame “greedy locums anesthesiologists”

Yes that is indeed the case and yes Locums Anesthesiologists are greedy... I am laughing at this conversation, only 3-4 years back $160 an hour was an amazing rate to have suddenly everyone knows what they "should be paid"... as far as 19k per OR per day that's highly overestimated only top tier facilities with 60/40 mix get that.....
 
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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?

In order to do that two things have to happen:
1. Hospitals must negotiate with insurance companies to get decent per unit rates and that is tough because
2. Hospitals need people with experience in negotiating with insurance companies and they are very hard to find even for big institutions
3. Insurances do not negotiate with small entities, why should they as smaller entities cannot demand anything too few patients to gain
hence its a take it or leave it situation. Large entities that see tens to hundred thousand patients are worth negotiating with and even
then see point #2

Hospitals would love to hire people directly but that involves knowing how to do such a thing. I have seen it done by smaller
entities who then understood they cannot pay the salaries they offer - entire department jumps ship to the next big thing.....

GREED is the source of all evil on both sides its very simple. I humble suggest to people on this thread to come
down... don't demand rates you will just make it worse for yourself and the next guy.... solution is a modified
Doctors "union" ... organization if you will. ASA should just create a singular staffing company that any hospital in the country can
reach out to where all rates are the same and what you make is determined by:

1. Hours worked
2. Extra points accumulated for taking calls, doing many cases (ie fast paced endo) willing to do
high risk cases - peds, cardiac, cath lab.

This is rudimentary stuff and there are systems that have figured all this out.... happy staff = low turn over money is made FAIRLY.....

What do I know all millennials on here will cry they need to work 30 hours and make a million dollars just because they are entitled...
 
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