Direction of Locums Rates

[dannyboy1]

Have you tried doing this? Because that is a silly statement. The only negotiation you'll have is when you arrive and the job prospect appears tangible. When they're you're best-est new friend. And that's when you'll get a flag planted at a number well behind the line if you're not careful. Then a year later when you ask for what, another 10k 20k they'll grimace and give it to you (while still skimming your pro fees and netting 3M).

That laughter in the boardroom? They aren't laughing with you bro.

You'll need to aggressively negotiate up front and if they need you, they'll do it grudgingly.. but it might take MONTHS.. particularly if they have to send it up to the mothership. Strongly consider working locums first.. once you're there, and if you're good, they'll be incentivized to retain you, obviously.

Thats how it works with big bad corporate. Smaller corporate? They'll decide fairly quickly if they can meet your requirement - or not. They love the "A" candidate but aren't willing to compromise on pay (#youknow) or 1099 status? Bye bye and good luck. While "radoncs" are soon to be a dime a dozen.. quality still matters in smaller locations where referral patterns survive because of interpersonal skillz. Eventually, even corporate understands..

You misunderstand. The only way to negotiate higher anesthesia reimbursement is for the hospital who employs the anesthesiologist to negotiate higher fees with insurance. Does this matter to the individual employed doc. Probably not a whole lot. Maybe if there is more money flowing in to the department then the administrator in charge of anesthesia is under less pressure to lower costs??….

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[sirspamalot]

You misunderstand. The only way to negotiate higher anesthesia reimbursement is for the hospital who employs the anesthesiologist to negotiate higher fees with insurance. Does this matter to the individual employed doc. Probably not a whole lot. Maybe if there is more money flowing in to the department then the administrator in charge of anesthesia is under less pressure to lower costs??….

The theory of hopium and trickle down. Survey says?

Nah, I'll go with FYPM instead.

 

[doctalaughs]

and you are shortsighted. Next you will tell me an airplane is a car with wings... you cannot possibly involve drug companies or device manufacturers in this discussion they do not share in the overall hospital reimbursement pattern.

If you would like to contribute as everyone should why not join a political action committee with AMA and indeed lobby for higher reimbursement rates for physicians. Asking hospitals for money is like going to the bank asking to increase your account by transferring money from your neighbors account.

The money all comes from the same place- patient premiums and taxes.

This whole healthcare system is broken and massively wasteful. Physician “waste” by demanding a high rate for services based on demand is dwarfed by other forms of waste in the system.

If you want to arbitrarily wall-off the discussion to hospital finance the end point is no different— physicians should get paid what their services can fetch in a free market, and that is absolutely is not going to be the main factor in making/breaking this system. Demanding “less pay” for the “good of the system” is not going to change the outcome

 

[sirspamalot]

Demanding “less pay” for the “good of the system” is not going to change the outcome

The system and c-team only care about what they are graded on, and they are graded on.. dollars. Quality is a nice cherry on top.

And that folks is why doctors are laughed at by the CFO's. Not mine though. I got'm to buy me a 2200$ chair that my ass/back really, really appreciate. We had some excess slop in the system that needed allocating. I was happy to help.

I know, you readers are my fans, I just can't help myself sometimes..

 

[GravelRider]

I like it all great point of exactly what is happening... I have a few of these wonderful docs myself who want their malpractice paid, their ass wiped and rate increase as it gets later in the day. What do I know I want out of this profession.

I’m pretty sure you are either in hospital admin or carry a clipboard on a daily basis. I hope I’m right because it’s interesting to see your perspective. You seem threatened by docs asking to get paid what they are worth. I would gladly forgo the complimentary ass wipe for an extra $50/hr. However, if ass wipes are part of my compensation package, I expect my cheeks to be extra clean.

 

[sirspamalot]

I’m pretty sure you are either in hospital admin or carry a clipboard on a daily basis. I hope I’m right because it’s interesting to see your perspective. You seem threatened by docs asking to get paid what they are worth. I would gladly forgo the complimentary ass wipe for an extra $50/hr. However, if ass wipes are part of my compensation package, I expect my cheeks to be extra clean.

 

[lotsapain]

I’m pretty sure you are either in hospital admin or carry a clipboard on a daily basis. I hope I’m right because it’s interesting to see your perspective. You seem threatened by docs asking to get paid what they are worth. I would gladly forgo the complimentary ass wipe for an extra $50/hr. However, if ass wipes are part of my compensation package, I expect my cheeks to be extra clean.

and I am pretty sure you are mildly ******ed... continue bleeding the system and you won't be driving your lambo very soon. You want to get paid more work better and more then ask for more money. Providers who want to sit and do nothing at night by covering one CRNA who does the work for them don't warrant higher rates. If you provide phenomenal care and have low rates of complications then you should get paid more indeed, similar criteria should be in place for surgeons... anyhow this bores me.... read a few books get educated understand the flow... come back.. .

 

[dannyboy1]

and I am pretty sure you are mildly ******ed... continue bleeding the system and you won't be driving your lambo very soon. You want to get paid more work better and more then ask for more money. Providers who want to sit and do nothing at night by covering one CRNA who does the work for them don't warrant higher rates. If you provide phenomenal care and have low rates of complications then you should get paid more indeed, similar criteria should be in place for surgeons... anyhow this bores me.... read a few books get educated understand the flow... come back.. .

Nobody cares about the “quality” of our care. So long as there aren’t catastrophic complications…
We get paid to keep the OR open.

 

[lotsapain]

Nobody cares about the “quality” of our care. So long as there aren’t catastrophic complications…
We get paid to keep the OR open.

I think that is an over-generalization, I can bring some recent examples but do not want to reveal proprietary information.
You are correct crappy hospitals/systems that are short sighed do not a number do. Unfortunately based on your comment
you are seeing the East Coast approach to the situation which is indeed bleak...

 

[dannyboy1]

I think that is an over-generalization, I can bring some recent examples but do not want to reveal proprietary information.
You are correct crappy hospitals/systems that are short sighed do not a number do. Unfortunately based on your comment
you are seeing the East Coast approach to the situation which is indeed bleak...

Sure, we have self reported “quality” check lists. You can imagine how accurate that is. How is it done in your neck of the woods. Genuinely curious.

 

[doctalaughs]

and I am pretty sure you are mildly ******ed... continue bleeding the system and you won't be driving your lambo very soon.

Are you suggesting when the healthcare system implodes, the government and hospital systems are going to come seize the money/property that doctors earned from charging what they could for their services? Lol.

As I said before, if the health care system does implode it will have been 99% administrator, medial, insurance and pharmacy/device companies faults (not to mention stupid laws, regulations and med-mal system). All the more reason for doctors to put money away when they are able for the bleak future.

 

[MirrorTodd]

I think that is an over-generalization, I can bring some recent examples but do not want to reveal proprietary information.
You are correct crappy hospitals/systems that are short sighed do not a number do. Unfortunately based on your comment
you are seeing the East Coast approach to the situation which is indeed bleak...

I'm curious to hear what you think the going rate should be then. Care to tell us what a solo anesthesiologist 1099 should make hourly? How about for supervision of crna's? What should the hourly rate be? How about for supervising AA's? I currently am paid $250/hr for solo 1099 work in my current location. I didn't negotiate at all, I just took what was offered. Am I being underpaid, overpaid, or is this accurate?

 

[sirspamalot]

I'm curious to hear what you think the going rate should be then. Care to tell us what a solo anesthesiologist 1099 should make hourly? How about for supervision of crna's? What should the hourly rate be? How about for supervising AA's? I currently am paid $250/hr for solo 1099 work in my current location. I didn't negotiate at all, I just took what was offered. Am I being underpaid, overpaid, or is this accurate?

Lol you getting robbed. To keep people alive under anesthesia as an MD why are you taking less than 350/hr..

 

[MirrorTodd]

Lol you getting robbed. To keep people alive under anesthesia as an MD why are you taking less than 350/hr..

The Army is paying me $94/hr. So that's why I took an extra job paying $250

 

[sirspamalot]

Plumbers run 200$/hr. Electricians the same. Your lawyer of any pedigree and experience? 500/hr.

Why don't we demand and only accept higher pay? I seriously think some MD's feel simply that..

 

[MirrorTodd]

Plumbers run 200$/hr. Electricians the same. Your lawyer of any pedigree and experience? 500/hr.

Why don't we demand and only accept higher pay? I seriously think some MD's feel simply that..

Some of us need a job now and are limited by what the Army allows as excess work. The sum is fair to me. Talk to me in 3 years (or even next year when I decide to renegotiate) when I am out of the Army and can have a wider range for finding a job and I will be more willing to negotiate.

 

[GravelRider]

and I am pretty sure you are mildly ******ed... continue bleeding the system and you won't be driving your lambo very soon. You want to get paid more work better and more then ask for more money. Providers who want to sit and do nothing at night by covering one CRNA who does the work for them don't warrant higher rates. If you provide phenomenal care and have low rates of complications then you should get paid more indeed, similar criteria should be in place for surgeons... anyhow this bores me.... read a few books get educated understand the flow... come back.. .

I drive a Toyota…an old one. I may be mildly retahded, but you’re the one wiping my ass, so who wins there?

 

[sirspamalot]

I drive a Toyota…an old one. I may be mildly retahded, but you’re the one wiping my ass, so who wins there?

 

[lotsapain]

Plumbers run 200$/hr. Electricians the same. Your lawyer of any pedigree and experience? 500/hr.

Why don't we demand and only accept higher pay? I seriously think some MD's feel simply that..

They charge these rates because they can, ie you do not have a choice but to pay it if your bathroom is leaking... unfortunately hospitals do have a choice now.... CRNAs... and yes we did it to ourselves and yes I think fare rate for a decent anesthesiologist is likely around $400+.... and yes hospitals need to learn how to extract revenue better and stop playing money games..... hopefully this can last until I retire if not we are all f**** and will go back to Clinton era where salaries are 100k I am sure someone in the govt will find a way to cut everything to nill..... but for that money I expect people to show up and not turn into pumpkins at 3pm sighting endless doctor appointments, wife being in labor... car needing repair, kids needing to be fed etc

 

[Gasworks]

They charge these rates because they can, ie you do not have a choice but to pay it if your bathroom is leaking... unfortunately hospitals do have a choice now.... CRNAs... and yes we did it to ourselves and yes I think fare rate for a decent anesthesiologist is likely around $400+.... and yes hospitals need to learn how to extract revenue better and stop playing money games..... hopefully this can last until I retire if not we are all f**** and will go back to Clinton era where salaries are 100k I am sure someone in the govt will find a way to cut everything to nill..... but for that money I expect people to show up and not turn into pumpkins at 3pm sighting endless doctor appointments, wife being in labor... car needing repair, kids needing to be fed etc

the only firewall here is the liability issue. Most surgeons / GI / OB docs are not willing to be the only doc on record especially in the hospital setting. They are usually happy to do so in their own little 1 room ASC but are absolutely unwilling to do so in an environment with sicker patients and no control of staff. Hospital near me tried this a couple of years ago.. unable to hire competent docs, tried to stretch their 1 full time doc with 8:1 ratio which caused a mass exodus of surgeons. A bunch of us got in there on the rebound and killed it with $400 locums rates for a solid 6 months while they reassured the surgeons that things have returned to normal.

Nobody I work with thinks this is going to last forever but if I can squeeze 10 years income into the next 5 years then I’m good with whatever mess comes as a result of all this instability.

 

[anbuitachi]

inflation was 7% last year and 7% this year. that means if you didnt have a 15% raise, you got a pay cut.

 

[DrNut]

the only firewall here is the liability issue. Most surgeons / GI / OB docs are not willing to be the only doc on record especially in the hospital setting. They are usually happy to do so in their own little 1 room ASC but are absolutely unwilling to do so in an environment with sicker patients and no control of staff. Hospital near me tried this a couple of years ago.. unable to hire competent docs, tried to stretch their 1 full time doc with 8:1 ratio which caused a mass exodus of surgeons. A bunch of us got in there on the rebound and killed it with $400 locums rates for a solid 6 months while they reassured the surgeons that things have returned to normal.

Nobody I work with thinks this is going to last forever but if I can squeeze 10 years income into the next 5 years then I’m good with whatever mess comes as a result of all this instability.

I agree that surgeons do not want that liability of supervising CRNAs. They do not want that responsibility in the hospital, ASC, nor clinic. The plastic surgery clinic I work in the afternoon pays anesthesiologists $3500 for availability in the afternoon. The owner of the clinic tried to change to a CRNA model and needed their surgeons to update their ACLS (who then learned that they would be responsible and liable for any anesthesia issues) but there was a huge push back by surgeons to do so. They threatened to do their cases at the hospital ASC. These are surgeons who share the facility fees who were willing to leave. Good luck trying to get non incentivized surgeons to take on that responsibility.

 

[Southpaw]

I agree that surgeons do not want that liability of supervising CRNAs. They do not want that responsibility in the hospital, ASC, nor clinic. The plastic surgery clinic I work in the afternoon pays anesthesiologists $3500 for availability in the afternoon. The owner of the clinic tried to change to a CRNA model and needed their surgeons to update their ACLS (who then learned that they would be responsible and liable for any anesthesia issues) but there was a huge push back by surgeons to do so. They threatened to do their cases at the hospital ASC. These are surgeons who share the facility fees who were willing to leave. Good luck trying to get non incentivized surgeons to take on that responsibility.

location dependent. in my area plastics/GI do CRNA only in their office but anesthesiologists supervise in the hospital. I'm not sure the surgeons/proceduralists care much one way or the other. they seem to just want to get their work done and go home.

 

[lotsapain]

inflation was 7% last year and 7% this year. that means if you didnt have a 15% raise, you got a pay cut.

Inflation does not compound, I am not sure what kind of math this is you are doing but according to it in 4.5 years you will reach 100% increase.

 

[lotsapain]

location dependent. in my area plastics/GI do CRNA only in their office but anesthesiologists supervise in the hospital. I'm not sure the surgeons/proceduralists care much one way or the other. they seem to just want to get their work done and go home.

Yes more and more states have this type of setup and indeed surgeons have to get their stuff done... in some states CRNAs do not need any supervision.

 

[lotsapain]

the only firewall here is the liability issue. Most surgeons / GI / OB docs are not willing to be the only doc on record especially in the hospital setting. They are usually happy to do so in their own little 1 room ASC but are absolutely unwilling to do so in an environment with sicker patients and no control of staff. Hospital near me tried this a couple of years ago.. unable to hire competent docs, tried to stretch their 1 full time doc with 8:1 ratio which caused a mass exodus of surgeons. A bunch of us got in there on the rebound and killed it with $400 locums rates for a solid 6 months while they reassured the surgeons that things have returned to normal.

Nobody I work with thinks this is going to last forever but if I can squeeze 10 years income into the next 5 years then I’m good with whatever mess comes as a result of all this instability.

If you are able to control your expanses and live with the increased salary today like you lived yesterday then you can put something away... most people just spend the increase....

 

[repititionition]

Inflation does not compound, I am not sure what kind of math this is you are doing but according to it in 4.5 years you will reach 100% increase.

bro you need to

 

[lotsapain]

bro you need to

I am not your "bro" asswipe

 

[MirrorTodd]

I am not your "bro" asswipe

I'm not your "asswipe" friend.

 

[Arch Guillotti]

Closing. Off the rails.