Downshifting on the road to retirement...

Started by Groove
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Depending on if it is HOPD or Private. Single block like 3-4 dys straight? 3-4 is pushing it because you feel like a prisoner and if your first night is bad, makes for a bad next 3 dys. 2 is doable.

HOPD is typically harder with your noncompliant more complicated medicare/medicaid population.

Private - Lots depend on the location. If you are on the border, all bets are off b/c u may get lots of non paying, complicated pts. If you are in the city/suburb, all depends on location. If you are on the ourskirts, small city typically its pretty calm at nights where you can get 4-6 hrs+ sleep. If you are near downtown, you are getting the 3am nightclub/bar scene plus homeless populations who thinks everyone is awake at 3am.

If you are looking to do 3-4 dys straight, I would pick private in small city/suburb away from downtown. There will be nights where no one shows up after 1pm. I work in much busier sites and I will get 2 hrs straight 25% of the time, 4-6 60%, and 6+ 15%

Plus lots depend on the pay. For 15ppd and you are just 1099, I would expect 225+/hr because they are making lots of $$$ off from your 15ppd.
 
emergentmd said:
We all change as we get older. What is imp when you are single early 30s is not the same when you have a few kids in your 40s or have an empty nest in your 50's.

I worked in busy hospital EM for 17 years and found something better as my life changed did not mean EM was not for me. It did it for 17+ years at a high level and enjoyed every minute of it. I could have done it for another 17 years but if there are better options why not pivot?

Very odd take.
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Came here to say the very same thing.

I was in it for 17 years, and then I left.

I changed. But the job did, too.
 
Anybody work for a CMG and always notice like 2-3 people on the schedule (PRN or FTE) that seem to always have preferential shifts? No nights? No weekends? Something similar? I've ALWAYS noticed these dudes. One was PRN and used to take up 6-8 of our day shifts and he told me he worked nights for another hospital system in town and once I got privileges in that system, dude works zero nights there. Another one early in my career couldn't work nights because of a heart attack (chain smoker, early 50s.) Another one got pregnant and found some data on overnights contributing to miscarriage risk or something like that. (Is that even real? I'm not even saying I minded that one!) I've just always seemed to notice these people. I'm not talking about SDG partners. I'm not even talking about CMG admin who seem to always have preferential shifts (d/t "meetings", etc..) It seems to always be PRN peeps.

I wanna be one of those peeps. How do you go about pulling it off? The CMG brass always says they don't do preferential contracts but I've literally ALWAYS seen it. What gives?
 
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If you are PRN I don't see why you would work less desirable shifts. I do nights at my main place and do PRN at other EDs I will only pick up what suits my main schedule. For fulltime yeah I see that as well you have to balance that with nocturnist or pay for some differential for nights. You have to be okay with working like one shift a month at times though.
 
Groove said:
Anybody work for a CMG and always notice like 2-3 people on the schedule (PRN or FTE) that seem to always have preferential shifts? No nights? No weekends? Something similar? I've ALWAYS noticed these dudes. One was PRN and used to take up 6-8 of our day shifts and he told me he worked nights for another hospital system in town and once I got privileges in that system, dude works zero nights there. Another one early in my career couldn't work nights because of a heart attack (chain smoker, early 50s.) Another one got pregnant and found some data on overnights contributing to miscarriage risk or something like that. (Is that even real? I'm not even saying I minded that one!) I've just always seemed to notice these people. I'm not talking about SDG partners. I'm not even talking about CMG admin who seem to always have preferential shifts (d/t "meetings", etc..) It seems to always be PRN peeps.

I wanna be one of those peeps. How do you go about pulling it off? The CMG brass always says they don't do preferential contracts but I've literally ALWAYS seen it. What gives?
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All the time here. All my career.

It's that the primary hospital system is starved for docs so that these interlopers get preference because "they can only work *those* shifts". Rather than saying "no" and giving the FT staff priority, they just wanna fill those shifts in any way possible.

We had a big meeting about this awhile back. I don't think it actually changed anything.

FWIW: I'm "part-time guaranteed" between 3 hospital systems within HCA. I don't always get my picks, and when I don't, I also don't throw a tantrum and just pick politely from what's available. Sometimes, months are so naked on the coverage map that I take almost full time hours. Granted, I work nights only and have no kids, so there's that.
 
emergentmd said:
If they are desperate, they will make exceptions. Places that makes exceptions typically are not places I would want to work. Fairness means alot.
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Completely agree. If your place consistently has a high need for PRN docs, it likely isn't a great place to work in general, which in turn gives leverage to the PRN docs to refuse anything except cush shifts.

The closest we came to that at my shop was when I was in fellowship and I didn't have to work any nights, but all my shifts were either Saturday or Sunday. Still came out relatively fair for everyone in the end.

The only other time you could dictate your schedule was as a nocturnist, which also seemed a fair trade.
 
I totally see where you guys are coming from but in my particular city...we have absolutely never been found not wanting for EM docs. It's what I call a "second tier" city which is what I usually recommend residents move to upon graduation where you can have access to amenities, a reasonable sized airport, but nobody necessarily wants to move there so you can benefit form market dynamics. We simply have never had enough EM docs and PRN docs have "ruled the roost" ever since I've been here. It's a matter of knowing the market, knowing your worth, etc.. and willing to bluff when you know you are cheaper as a local doc than the multitude of locums docs being flown in every month.

Most docs rotate between hospital systems with sign ons, PRN princess contracts or newly grad docs signing on for regular. Trust me, I would never propose to do something like that in a regular city. BUT....I'm not in a regular city. So, why not? I've done my time. There isn't an SDG within a 90 mile radius of me. CMGs are the only ones willing to come here. They are all corrupt and they are all negotiable...after they tell you they aren't. We've all seen it.

I'm starting to feel like I'm getting a second wind. Maybe 8 shifts/mo somewhere lower acuity and stable pay and do the tele-UC on the side as "future proofing" and insurance for worst case scenarios. I think 5-6 more years.

AI tells me that shift number/mo is less important at this point with the portfolio side doing most of the heavy lifting through compounding and is insisting that I give the tele-UC 6-12 months due to the future proofing and ability to do that longer term with greater flexibility.
 
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It didn't/doesn't even need to be a busy city anymore IMO. I see cold calls for big cities in Texas and I am sure if I offered to work shifts/mo at rate then they would be happy to slot me for whatever 6 shifts I wanted. Not sure why anyone would do this because you are better off just doing locums but I have no idea the current locums market.
 
locums market in TX is on fire currently. Speaking from personal experience here as I've just started to dabble in locums work.
 
can get anywhere from $300 (low) to $400/hr. Not including bonuses for last minute shifts etc. But recruiters are non stop calling/texting/emailing me.
 
I am one of the PRN guys. You have to be willing to walk away. The shops suck, so the shifts are hard but the money is grrrrrrrrreat.

The future for all CMG full timers needs to be CMG PRNers. Just walk away and offer to be PRN there because you are taking another full time job somewhere else. Once you are PRN start eating shifts you want for whatever good bonus there is. Keep dropping the full time job to turn it PRN. Once you have plenty of PRN opportunities, you no longer need the full time job. This can take some time to set up.
 
Not a bad strategy unless you need good benefits. Most of those gigs are 1099 so won't offer health insurance.
 
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Porfirio said:
I am one of the PRN guys. You have to be willing to walk away. The shops suck, so the shifts are hard but the money is grrrrrrrrreat.

The future for all CMG full timers needs to be CMG PRNers. Just walk away and offer to be PRN there because you are taking another full time job somewhere else. Once you are PRN start eating shifts you want for whatever good bonus there is. Keep dropping the full time job to turn it PRN. Once you have plenty of PRN opportunities, you no longer need the full time job. This can take some time to set up.
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Can you expand on how your negotiation goes? Do you offer X number of hours and then what stipulations are you requesting? No nights? X hourly pay? Do they go through the effort of interviewing you first and then negotiating further or are you stipulating everyone pre-interview and once everything is in place...agreeing to interview and or onboarding, etc..?
 
I did locums for about a year and I am sure the full timers must have been pissed. I have no idea, short of wanting security, why anyone would stay when there are locums at the site.

Full timers - attend meetings, holidays/weekends, deal with metrics, respond to emails, be nice to the staff, make $275/hr, could not make their schedule. For this they got insurance/benefits and guaranteed 15 shifts.

Locums - no meetings, no metrics, no emails, $275/hr plus typical 2 k bonus = $441/hr, pick whatever shift I want. No benefits, no guaranteed shifts. Sometimes 2k becomes 5k.

I could make the same as the full timers working 8 shifts/mo.
 
emergentmd said:
I did locums for about a year and I am sure the full timers must have been pissed.
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Yep. Locums should be a temporary answer to surges or unexpected absences. Not unreasonable to keep a couple around for 2 shifts a month an insurance.

But a place where multiple locums routinely get full shift choice is a place I don’t want to be FT at.

It’s just supply / demand economics. I did locums where the initial deal was I picked the shifts, and pay was solid. That was fine. Then it got more of i could give 6-7 available shifts and get maybe 3-4 of them. No issue. No nights. No weekends.

Then it slowly became “we need you to pull an overnight if you want to stay” and “you need to do 1 weekend shift a month to stay”

And for a bit, for the price, and the drive, and the familiarity it was worth it. Then it wasn’t (for me). But that’s OK, it actually meant they were getting enough FT staff that cared about their own schedules that locums eating the weekday daytime shifts wasn’t popular anymore. Good for them.

Granted when I left they came calling with sweetheart shifts a couple months later as they couldn’t fill their schedules. So I went back for a little bit until it was no longer mutually beneficial.
 
Groove said:
Can you expand on how your negotiation goes? Do you offer X number of hours and then what stipulations are you requesting? No nights? X hourly pay? Do they go through the effort of interviewing you first and then negotiating further or are you stipulating everyone pre-interview and once everything is in place...agreeing to interview and or onboarding, etc..?
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Negotiation is simple:

I have privileges to work there and they have no one to work. I give them the days I can work and tell them my bonus number to get me there. I tell them no nights. They schedule me however they want.

Remember these are rough shops so they have no chance to get fully staffed because of how bad they are.

The hardest part is getting privileges. That you have to work your way in. Either starting FT then leaving or contacting the CMG to find out if they want PRN docs.
 
Porfirio said:
Negotiation is simple:

I have privileges to work there and they have no one to work. I give them the days I can work and tell them my bonus number to get me there. I tell them no nights. They schedule me however they want.

Remember these are rough shops so they have no chance to get fully staffed because of how bad they are.

The hardest part is getting privileges. That you have to work your way in. Either starting FT then leaving or contacting the CMG to find out if they want PRN docs.
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Negotiating is easy when you actually have a worth in mind. Know what you want to work for. What you ACTUALLY are happy to work for. I tell recruiters my PRN rate starts at $500/hr. No one has taken me up on that, but that’s my negotiation.
 
bravotwozero said:
can get anywhere from $300 (low) to $400/hr. Not including bonuses for last minute shifts etc. But recruiters are non stop calling/texting/emailing me.
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There is a EM job posting in my hospital website... small town (or city) in the southeast.

Salary
Highly competitive compensation that averages well above $300/hr, sign-on bonus for those that qualify, and some of the nation’s best physicians working beside you!

I thought that was the going rate for EM almost everywhere except big cities in CA/NY/FL etc...
 
Splenda88 said:
There is a EM job posting in my hospital website... small town (or city) in the southeast.

Salary
Highly competitive compensation that averages well above $300/hr, sign-on bonus for those that qualify, and some of the nation’s best physicians working beside you!

I thought that was the going rate for EM almost everywhere except big cities in CA/NY/FL etc...
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It’s not. I work in a mid-size (not popular) city and rates at CMGs/hospital systems are mid $200s anywhere you could reasonably drive to.
 
Guys/gals

I just signed a contract to work for another hospital system. I am having second thought now. How do I go about it if I don't want to work for that place anymore before receiving the sign on bonus?
 
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Splenda88 said:
Guys/gals

I just signed a contract to work for for another hospital system. I am having second thought now. How do I go about it if I don't want to work for that place anymore before receiving the sign on bonus?
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What’s your contract say, broseph?

I had a similar situation two years ago when I had a contract in hand to pick up PRN shifts before realizing how much I would hate working more and backed out.
 
Splenda88 said:
Guys/gals

I just signed a contract to work for another hospital system. I am having second thought now. How do I go about it if I don't want to work for that place anymore before receiving the sign on bonus?
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You just tell them. Most contracts technically require it in writing I think. I've done this twice actually. One was after signing on but still within the 90 day resignation window. Short, albeit uncomfortable call. Short of it was the dude verbally agreed on a 10k signing bonus so I could move across the country and I was a broke ass graduating resident. I asked him about it and he reneged. My home town CMG offered me 50K sign on which was 3 hours away. He was pissed and I felt bad but I don't now. Second time was....actually, I guess that was the only time. I've committed to X number of shifts though and then gone down a few months later but that's not really a big deal IMO. Oh...second time doesn't really count because they lost the contract at the hospital.

It's hard to burn bridges in this specialty, especially if you work in a short staffed city but if you full on renege after signing the contract and starting the onboarding process then I'd plan on never needing to work for them again for at least 5 years or until your memory fades a bit. You can always just offer to continue onboarding as a PRN doc but I wouldn't do that unless you really intend to pick up shifts. I think it's less important if it's a big CMG. You're just a number to them and they'll gladly feed you back through the meat grinder in a few years if you show back up. I'd feel bad about it if was a traditional SDG that had wine and dined me, hired me and then I backed out.
 
Groove said:
You just tell them. Most contracts technically require it in writing I think. I've done this twice actually. One was after signing on but still within the 90 day resignation window. Short, albeit uncomfortable call. Short of it was the dude verbally agreed on a 10k signing bonus so I could move across the country and I was a broke ass graduating resident. I asked him about it and he reneged. My home town CMG offered me 50K sign on which was 3 hours away. He was pissed and I felt bad but I don't now. Second time was....actually, I guess that was the only time. I've committed to X number of shifts though and then gone down a few months later but that's not really a big deal IMO. Oh...second time doesn't really count because they lost the contract at the hospital.

It's hard to burn bridges in this specialty, especially if you work in a short staffed city but if you full on renege after signing the contract and starting the onboarding process then I'd plan on never needing to work for them again for at least 5 years or until your memory fades a bit. You can always just offer to continue onboarding as a PRN doc but I wouldn't do that unless you really intend to pick up shifts. I think it's less important if it's a big CMG. You're just a number to them and they'll gladly feed you back through the meat grinder in a few years if you show back up. I'd feel bad about it if was a traditional SDG that had wine and dined me, hired me and then I backed out.
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Do not ever feel bad about backing out of a contract with a CMG or hospital.

Just remember what they did to us during covid. We are nothing to them.
 
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skougess said:
What’s your contract say, broseph?

I had a similar situation two years ago when I had a contract in hand to pick up PRN shifts before realizing how much I would hate working more and backed out.
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I probably will look into it. I am not in the mood to read 50 pages.
 
Groove said:
You just tell them. Most contracts technically require it in writing I think. I've done this twice actually. One was after signing on but still within the 90 day resignation window. Short, albeit uncomfortable call. Short of it was the dude verbally agreed on a 10k signing bonus so I could move across the country and I was a broke ass graduating resident. I asked him about it and he reneged. My home town CMG offered me 50K sign on which was 3 hours away. He was pissed and I felt bad but I don't now. Second time was....actually, I guess that was the only time. I've committed to X number of shifts though and then gone down a few months later but that's not really a big deal IMO. Oh...second time doesn't really count because they lost the contract at the hospital.

It's hard to burn bridges in this specialty, especially if you work in a short staffed city but if you full on renege after signing the contract and starting the onboarding process then I'd plan on never needing to work for them again for at least 5 years or until your memory fades a bit. You can always just offer to continue onboarding as a PRN doc but I wouldn't do that unless you really intend to pick up shifts. I think it's less important if it's a big CMG. You're just a number to them and they'll gladly feed you back through the meat grinder in a few years if you show back up. I'd feel bad about it if was a traditional SDG that had wine and dined me, hired me and then I backed out.
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I did the onboarding already. I have 3-4 days to decide before they process that 25k sign-on.
 
Splenda88 said:
I did the onboarding already. I have 3-4 days to decide before they process that 25k sign-on.
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Hmmm. That's close. Another reason why I don't do sign ons anymore. 25K is nothing. That's like 15K after taxes. Maximum flexibility to jet when/if something infinitely better comes around is worth the price of being able to pivot. Of course, I suppose you can always pay it back. I'd say if you have cold feet, just tell them now. Otherwise, what's one year?

That being said, this would be the first time I've heard of someone going all the way through onboarding and being days away from the bonus landing in your account to getting cold feet. I'm assuming you are way past the resignation/termination clause stipulations? If so, and it was me...I'd probably just work the year. Actually, I'd be tempted to tell them I'm cancelling the 25K sign on (assuming they are requiring FTE hours) and am requesting 20 or 40 hours less than FTE. That way you aren't quitting and leaving them high/dry and can still test it out but you are retaining maximum flexibility and can pick up or maintain PRN at other sites. Easily quit/pivot in a few months if you end up hating it while saving face because you never took the sign on and therefore aren't obligated to the full year.
 
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Groove said:
Hmmm. That's close. Another reason why I don't do sign ons anymore. 25K is nothing. That's like 15K after taxes. Maximum flexibility to jet when/if something infinitely better comes around is worth the price of being able to pivot. Of course, I suppose you can always pay it back. I'd say if you have cold feet, just tell them now. Otherwise, what's one year?

That being said, this would be the first time I've heard of someone going all the way through onboarding and being days away from the bonus landing in your account to getting cold feet. I'm assuming you are way past the resignation/termination clause stipulations? If so, and it was me...I'd probably just work the year. Actually, I'd be tempted to tell them I'm cancelling the 25K sign on (assuming they are requiring FTE hours) and am requesting 20 or 40 hours less than FTE. That way you aren't quitting and leaving them high/dry and can still test it out but you are retaining maximum flexibility and can pick up or maintain PRN at other sites. Easily quit/pivot in a few months if you end up hating it while saving face because you never took the sign on and therefore aren't obligated to the full year.
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Working the year? It's a 2-year contract and I would have to move.
 
Splenda88 said:
Working the year? It's a 2-year contract and I would have to move.
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You signed a 2y contract for only 25K? That's crazy man. It includes a move? Get out now if you don't want to move. Just burn the bridge, especially if this is not local and you intend on staying where you are.

0.5 shifts/mo for 2 years is 120 hours for a 10h shift. That's like 33K. Doing a sign on for less than 50-75K over 2 years is completely not worth it and doing sign ons in general after you have paid off your loans is never a good idea. You lose every ounce of leveraging power. You can never complain about the schedule or anything else for that matter and expect anyone to do anything about it because they have you by the balls. The one time I did that I negotiated for a pro rata clause that would vest me on the sign on after a year as I moved closer to the 2yr mark so I wouldn't have to worry about paying all that back 3 months from my 2yr if I quit. Again, that was in my education loan pay back days. Never again after I paid that off.
 
Groove said:
Feed it through AI.
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Man, I am a chatgpt convert. I put almost everything through Chat then verify if it is really important. Just put my first FF draft through Chat yesterday and have another draft this thursday. Lets see if it helps with FF.
 
emergentmd said:
Man, I am a chatgpt convert. I put almost everything through Chat then verify if it is really important. Just put my first FF draft through Chat yesterday and have another draft this thursday. Lets see if it helps with FF.
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Same, I have it analyze all sorts of legal and financial stuff. Obviously, you have to perform due diligence but damn does it save me a 300/hr consulting fee that I would have paid 10 or 20 years ago.
 
Bittersteel said:
Dude you need to work on impulse control.
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I am usually a very levelheaded individual. I just was not happy with my place because I have not had a raise for 3 years. But after doing a real cost benefit analysis, I realize financially it won't be a good thing.

Same salary and better benefits and better working conditions, but higher COL
 
Splenda88 said:
I did the onboarding already. I have 3-4 days to decide before they process that 25k sign-on.
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I’d let them know ASAP. If you’re not on the schedule then they’ll likely just let bygones be bygones no matter what your contract says. Whether it’s a CMG or SDG wouldn’t really play into how I handled it. You don’t want to burn unnecessary bridges and the people who would be suffering are your fellow docs.
 
JacobMcCandles said:
I’d let them know ASAP. If you’re not on the schedule then they’ll likely just let bygones be bygones no matter what your contract says. Whether it’s a CMG or SDG wouldn’t really play into how I handled it. You don’t want to burn unnecessary bridges and the people who would be suffering are your fellow docs.
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I am an IM hospitalist. It's not a group. I will be working for the hospital.
 
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Groove said:
Feed it through AI.
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To experiment with this I recently fed a renters insurance contract (for my daughter's college rental) through AI (Claude, I think) and I have to say it gave really good analysis and suggestions. It stated that most of the coverages were in the standard range but the medical liability was on the low end. I asked for an increase and got it for a negligible premium increase.

I wasn't about to pay a lawyer for a tiny policy like this (only $16/month). And I wouldn't yet rely on AI exclusively for more important contracts. But I tell you this: Any such legal analysis of the printed word I pay a lawyer for, I'll be testing their review next to AI's free review as a competition.
 
emergentmd said:
Man, I am a chatgpt convert. I put almost everything through Chat then verify if it is really important. Just put my first FF draft through Chat yesterday and have another draft this thursday. Let’s see if it helps with FF.
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I gotta say, watching some of you guys outsource all of your decision making to AI sounds really depressing.

Enjoy the fantasy draft yourself. It’s literally a hobby. Figure out if you like your career yourself, a computer can’t actually feel or empathize with you. Read your legal documents yourself. Be actually informed rather than spoon fed from a hallucinating machine.

As much as it was a bit over the top when he posted it, to quote @RustedFox , “be a man”.
 
Birdstrike said:
To experiment with this I recently fed a renters insurance contract (for my daughter's college rental) through AI (Claude, I think) and I have to say it gave really good analysis and suggestions. It stated that most of the coverages were in the standard range but the medical liability was on the low end. I asked for an increase and got it for a negligible premium increase.

I wasn't about to pay a lawyer for a tiny policy like this (only $16/month). And I wouldn't yet rely on AI exclusively for more important contracts. But I tell you this: Any such legal analysis of the printed word I pay a lawyer for, I'll be testing their review next to AI's free review as a competition.
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Yeah, I've been doing this for the past year or so. It's always done a good job with the legal writing and analysis but in the beginning it hallucinated when referencing other cases in the literature, etc.. which made things confusing. Most of that has gone away. Current LLMs are extremely good at legal analysis and writing. I feed through all my telemedicine and new contracts to get its opinion. Way cheaper and faster than paying $300 for a consultation visit with a local attorney.

It's also really good at medical legal defense attestations in your medical notes. I spent an entire afternoon having it comprise different attestations for a variety of presentations with a goal of minimizing probabilistic outcome of lawsuit, etc..
 
skougess said:
I gotta say, watching some of you guys outsource all of your decision making to AI sounds really depressing.

Enjoy the fantasy draft yourself. It’s literally a hobby. Figure out if you like your career yourself, a computer can’t actually feel or empathize with you. Read your legal documents yourself. Be actually informed rather than spoon fed from a hallucinating machine.

As much as it was a bit over the top when he posted it, to quote @RustedFox , “be a man”.
Click to expand...
I think ‘trust but verify’ is a good happy medium here
 
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