I’m transitioning out of a full-time on-call hospital anesthesiologist position and looking to go full time with locums. I haven’t had much success on gasworks and with the recruiters that are out there. I should say I’m focused mostly on trying to find PRN work at the moment because there are no locums jobs locally. I have even been searching for temporary positions nationally, but have not come up with anything. Perhaps I’m missing something. I would be anxious to hear other people‘s experience and advice/tips on how to break into the locums and PRN market.
Ins and Outs of Locums Search
- Thread starter Sleepnmd
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Join a big agency. That will be your best bet
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And bro you may have missed the boat on the great locum train. I used to locum pre covid before everyone was a locum and now I can't get assignments in the boonies anymore because the shifts are all taken. Too many full time locum docs now.
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I’ve had the best luck with personal contacts. I also work for prior employers. I hate talking with recruiters and getting ****ty rates. Most posts on the boards are old and just fishing for your information. Reach out and keep up with colleagues as they move onward in life.
The market is definitely changing in many parts of the country. Tons of competition
That’s why I urge people to hedge their bets especially those with kids to try to find hybrid w2 jobs with 20-26 weeks off.
Most of the locums docs I know have real w2 jobs (like me) and add 1099 locums on top of it.
My Florida work colleague 6 month 2 weeks assignment each month just got canceled in New York with 30 days notice. So he’s scrambling to find other locums work
One of my lucrative 1099 Florida gigs said they didn’t need me except for spring break which I declined since I’m going skiing in park city with the kids for their break. So they may not need me till April now.
I’ll probably back fill a few days here and there on my time off. But I have privileges at 7 different hospitals and 3 surgery centers so i have a rotation of 1099 work I can tap into. That is the key. Get credentials at many places.
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Unpopular take but I think the market is cooling.
Interesting. Makes a lot of sense to be a W2 for at least half the year. What seems challenging is breaking into the locums system, i.e. finding those 1099 jobs that are out there-either locally or around the country (I’m pretty much willing to travel anywhere for a short stint as I have little kids)-so would it be through just cold calling surgery centers or network like crazy by just calling everyone you know in the field? I obviously don’t have connections in random states, though I did recently apply for the IMLC. Like I said, I’m spending inordinate amounts of time with recruiters and paperwork and it’s basically getting me nowhere. Thanks for all the helpful info!
I’d just stay locally or as close to home as you can. 90% of docs should be able to find some 1099 gig within a 2-3 hr drive (assuming you live in a somewhat large metro area).
Just get ur foot in the door. Sometimes it helps to make connections and have some one vouch for you. My crna friends got me into another locums gig. Just word of mouth. I always pay it forward as well
Just be patient. Jobs go in cycles and many places fill up this time or year and it starts to re open open during peak vacation week demands. Spring break. Easter break and summer break.
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Nope. Been doing fulltime locums for 13+ years and have heard this time and time again.
Fulltime locums sounds great on paper but is not easy.
Need multiple licenses in states with alot of locum needs, couple of DEAs. Agency, directly with national companies.... lots of work out there.
Been offered hybrid 26 weeks W2 jobs but if they make it 1099, I will strongly consider it.
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The holidays are filled up months in advance. Right now I have locums contracts until December, 2025. You got to have multiple licenses, DEAs, be willing to work in the boonies and be ok sitting out until. the right job comes along. I have a rotation of 3 different hospitals, in 3 different states with 3 different agencies. Always 3 to make sure if one fills up with a perm or hospital need changes, I have other options lined up.
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Some agencies are trying to get exclusive contracts with hospitals so those jobs are not posted anywhere. Need to already be credentialed with them to know which sites these are.
These days I’m always less than 60 minutes from major international airports with non stop flights to Europe South America and Asia
You don’t absolutely need to work in the boonies.
But you are correct if you want really stable locums income you need to plan way in advance and willing to travel to different places
I prefer my home bed and still be around my kids. That’s really why most of my friends do the hybrid jobs with lots of weeks off. If I didn’t have kids. I would just jet set around the country like I did for most parts of 2007/2008. I racked up 100k miles on united airlines during the time east coast to west coast primarily.
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Is it rare to have been doing full time locums at only one hospital for more than a year?
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I don't think its rare especially if it's in a super undesirable area and hard to recruit FTE
If your rate is low and the facility grows attached to you. You can keep milking it.
This doc works for $275/hr/300 1099 plus Hotel and travel since mid 2022 at one facility I’m at. I’m $350/375 (same locums company!).
So they are perfectly fine with him working (4) 10s and he’s fine with it also. Super easy workload. 1:2 maybe 1:3 max coverage. I’ve covered 1:1 twice a week there eyeballs. About as easy a locums job you can have. So he’s ok making around 500k 1099. No calls no weekends with 8 weeks off and 3 day weekends every week.
This is a major big city also with international airport 15 min away.
He’s older. Kids are adults. Nice gig to ride until they tell him to leave.
They actually gave him notice to leave this month finally (back in November 60 days notice) but changed their mind. So he’s good till at least end of June this year. A whopping 3 years.
My residency class back way back 2 decades plus had 1099 gig for a crazy 7 years! It was a state hospital I was telling him dude. U should have been w2 with all the retirement benefits and year 8 was vested in state pension. Under the old plan.
Bridgecare is their 1099 division. My buddy works on /off for them in upstate New York for the past 3 plus years
Just a reminder that bridgecare is napa and they will do things to benefit napa. They are trying to get enough locums at each site working under bridgecare so they an "control costs."
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How bad is NAPA as a W2
I’m just familiar with Napa in mid Atlantic and Napa in New York
The guys make close to 700k w2. And the savvy ones game the system to make the 1099 docs work hard in daytime and they take over the calls and work
So they don’t work super hard.
It’s all about maximizing 1099 docs to off load your workload as w2 doc plus maximize ur w2 extra pay incentives while “short staff”
It takes two to tango. Help the 1099 docs make the money. And help urself as w2 to maximize ur work load and income as well
I’m sorry that sounds sleazy and unethical.
At the end of the day, someone is footing the bill. There’s no such thing as free lunch.
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I’m not sure how it’s unethical, it’s just business. The hospital and insurance companies are all making money off your backs anyways. Why do it for free?
It’s double dipping and scheming to increase shift time. It’s sleazy.
Insurance company (or hospital or whoever is paying) is irrelevant.
Hospital is making a ton of money. Know your worth
Just remember under the ACA (which the hospitals help write). Their facility fees have GONE UP while doctor reimbursement have GONE DOWN.
Straight anesthesia reimbursement (with no subsidy) no longer compensates 80% of anesthesia practices throughout the country.
Hospitals can always shut down the ORs if they don’t want to pay. Literally. I’ve been waiting and waiting like almost a stare down at hospital I offered my services for 50k a week for 24/7 coverage (no ob). Slow small hospital 55 min from my house so I can sleep in my own bed. 60 min response time
It’s a game. Do you know what the hospital finally did?? They decided to shut down the ORs after a certain time and divert cases (if needed for real surgery) so they wouldn’t have to pay me the 50k a week (or my friends)
I actually applauded them for doing that. Some administrators had the balls to shut down the ORs. I’m sure they didn’t have nursing or tech staffing either. But for once the hospital administration is smarter than me.
I’ve been telling these administrators just to shut down ORs for the night at smaller places (some mid Atlantic hospitals do it also). Transfer the emergency patients after hours to sister hospitals more full service.
This saves hospital systems millions. Don’t have to pay ancillary staff money like ER docs radiology docs or anesthesia docs. Don’t have to depend on nursing or scrub techs either.
It’s the right thing to do.
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If you work in any hospital in the USA, you are already complicit in the huge wealth transfer scheme that is the us health care system. You do realize that the profit they make is magnitudes larger than the anesthesia fee right ?
Again, that’s irrelevant to try to game the system at an individual level.
Don’t get the complicity part. Please explain, how is labor complicit by itself?
Complicit in what? If you strongly feel and think the corporation you work for is conducting fraud, speak up and perhaps initiate litigation? Fraud is for courts to decide.
I find purposely colluding with another physician to game the system to make more money and increase shift time when it need not be, as corrupt behavior.
If you are having to justify it by bringing in the “well they do it too” argument, then I don’t have anything further to add.
Again, I fail to see relevance here at an Individual conduct level.
Those are all symptoms of a broken healthcare system. We know that.
Still doesn’t address why, at an individual level, you feel that it’s ok to collude with a full time physician on fixed salary - and they should be taking over the cases and doing their work, but aren’t. That is what their contract says. And 1 hour overtime becomes 5. Multiply that by 3 times a week on overage where overtime should not have been paid. Over 1 year that’s 200-250k.
Great way to help a broken system. Keep pillaging. 👍
Can’t expect hospitals to be accountable if the physicians and staff aren’t accountable themselves.
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Over the past 3 decades, many of the smallest hospitals in our community shut down completely. Saves even more money.
Broken systems start at the top. Remember that
Who lets surgeons book elective trach cases at 9pm at local community hospitals with no trauma.
Who makes those decisions ?
Think. And no. It’s not the surgeon fault. It comes from the top level. And this is what costs the system money. That administration is the one who needs to be accountable for allowing it. They are the ones who say let the docs decide. It’s all rhetoric because they are afraid to say no for fear the surgeon will take their business elsewhere if private doctor.
One of the flip side. If surgeon were hospital employee. They will do the bare minimum once their 2-3 year guarantee contract with built in rvu incentives expires. Again up to hospital administrators to pay surgeons more.
So it needs to start from the top level.
Two of the hospitals I cover ob volume is less than 700 deliveries a year. One has crna covering ob at night. One has doc covering ob at night.
Just a massive waste of money. You pay for ob nursing staff to sit around at night as well. All to keep services open for the community. And one of the hospital is a for profit big hospital chain. Makes zero sense. I know why they do it. To capture market share. The non profit is really acting like the for profit hospital chain as well
There are other more full service hospitals that can absorb the ob patients 30 min away as well.
Ok man.
It’s up to you. You can justify it as much as you want with “they do it too/they waste money too/they’re ripping off patients too - so it makes it ok” reasons, but I’m not convinced.
It’s your call but it’s only a matter of time until someone catches you.
If I was the chairman of this practice, I would take a look at surgery end, pacu entry and anesthesia end times and see what’s going on. Numbers and times will tell the whole story.
It’s up to you. You can justify it as much as you want with “they do it too/they waste money too/they’re ripping off patients too - so it makes it ok” reasons, but I’m not convinced.
It’s your call but it’s only a matter of time until someone catches you.
If I was the chairman of this practice, I would take a look at surgery end, pacu entry and anesthesia end times and see what’s going on. Numbers and times will tell the whole story.
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I have done 9 assignments with them in 4 different states.
- there is a lot of penny pinching more than other groups. They will fight you tooth and nail for any OT and even travel reimbursements. Their rates are always less- and when they do pay market rates it is because hospital admin threatened them by yanking their contract if they did not get staffing up.
I would much rather be out of work than work for them. Last time I worked with them was 2021.
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Im not sure why you feel sorry for AMCs. I know it’s location dependent but the one I work with will float people to other hospitals/ASCs depending on needs. So hospital pays AMC to staff 10 locations or a certain number of anesthetists/docs… then the AMC floats a couple people to one of their other sites so now AMC is collecting money from hospital for staffing thats not actually there. That’s free money for the AMC while increasing the workload for those who are now short-staffed. They’re double dipping and collecting the subsidy.
they can see when people clock in/out and can see the schedule. If they have problems with how a place is using 1099s then they can change it. But they’re probably also want to keep full time people happy.
lol I could care less for AMCs. I was just pointing out that it’s not worth (to me) scheming and up charging time.
I think people should be paid for their work and I believe in production model. But I don’t agree with greedy behavior.
I think people should be paid for their work and I believe in production model. But I don’t agree with greedy behavior.
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Dude the whole world is driven by greed. You think anesthesia practices are driving up costs for the patient? The costs have already been driven up beforehand! Now because of supply and demand, the hospitals have to actually pay us what they would have kept for themselves and their nonprofit status. Everyone from the bottom workers to the upper brass wants their “fair share” of the piece of the pie. At least we contribute something tangible. Not all the players in this can say that.
Most major metro areas have 3-4 main hospitals within a 30 mile radius. I forgot the the Medicare transfer rules. So many layers of complexity but if it’s the same hospital system the hospitals should probably eat the cost to transfer and shut down low volume hospital after 7pm Or cases.
Hmmm, so you’re saying it’s ok to up charge time?
I don’t up charge unless it’s extreme desperation like the center will need to close down. Mind you many places cut staffing razor thin
As for up charging. Doctors charges pail in comparison to facility fees to the patient and insurance company. Do you have a problem with the surgeon getting $500. The anesthesia company gets $1400 I think. The hospitals getting 21k in actual payments for a 90 min foot procedure. Not super charges. The actual payment. A smaller hospital without negotiating powers gets half of that. That my friend is an upgrade by the hospital because they have the negotiating upper hand over the insurance.
Again not my personal world. By some of my locums buddy’s on the trail have a saying “make them pay”. The are fantastic anesthesia docs. I call Them the Gang of Four. They are doing the same thing the hospital does to the insurance companies. Charging as much as they can.
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I have to ask if you worked during Covid.
It’s so odd to see someone complain about costs and pillaging after the insane ordeal and graft that the Covid shutdown of the healthcare system caused.
What’s left now are remnants of a system that used to hide its waste and corruption. Like the trump admin, it all used to happen in the shadows but now that the light of day is on hospital finances, everyone has no stomach for it.
I didn’t want this from our profession, but now that it’s this way the solution is to try to plan an exit or to cut back substantially when possible. This is a game for pool sharks and con men now, not noble helpful people like go to med school
AMC need to take a 20-30% cut. They aren’t paying you ur maket value.
If we all went hourly model (which is the fairest compensation for anesthesia along with some extra pay for those who do nights or higher risk cases). That would be the best way to compensate someone. Leave early. Dont get paid. Very simple
Have to work more. Get paid more.
That’s why I mentioned over and over again the true market pay for a 40 hr anesthesia doctor with 10 weeks off is 700k
No need to scheme when you pay people market rate.
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You keep mentioning the 700k, 40hr/week, 10weeks off is the market rate yet these jobs are very rare. Are you saying this is what it is or what it should be? None of the jobs in my state come close to this. It may be because everyone in my metro area, at least, seems satisfied with their pay and they don’t want to ruffle any feathers. They are way too soft despite my encouragement and showing them salary data from various sources.
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Hes referring to base + benefits + matching. Total package
If you don’t change your model. You become a dinosaur. People think I’m old here. I’m old but not super old (age 50). I see staffing problems and how to correct them the last several years. Either pay people money or give them more time off.
Time and money. It’s been said so many times.
That’s why u gotta compress the schedule and go to the 6-7 (24 hr) (some models even better with falls 3pm more trauma calls) call model 2 weeks on. 2 weeks off for 500k. That’s roughly 40 hr spread over 4 weeks but u do it over a 12 day period. I literally have 3 guys who fly down Sunday night. Work Monday Wednesday Friday Sunday Tuesday Thursday for the “full time” job Fly back home to their home state Friday morning
Don’t be like blockbuster video and get complacent with the old work schedule. Be like Netflix and keep reinventing yourself first by making going anway from mail order dvd/blu ray rentals to streaming to owing their in house shows. Than reinvent themselves again doing live streaming sports.
Hospital staffing models need to reinvent themselves if it’s not working.
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Speaking of non-profit status, Indiana is floating a bill that will yank non-profit status of a hospital if it charges more than 200% of Medicare. I think that’s a great start.
Lol. That pads the private insurance profit margins
These lawmakers are just stupid. Seriously.
If the law was tied to insurers decreasing premiums in coordination with lower payments to hospitals. Than that would make sense and thus the patients get lower premiums
This is equivalent of the Colorado United healthcare anesthesia monopoly lawsuit. United healthcare got tired of paying usap more money. But they just pad their profits
This is why Americans and lawmakers are stupid.
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Administration isn’t stupid. They could micromanage the situation and risk losing both the locums and full time MDs. They understand in this market it’s best to look the other way. If they can send an RN or an MD home and not pay them on a slow day they would and do. Don’t worry, the minute they think you cost more than you are worth you will be gone.
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