Internal locums rates

Started by cowbydoc
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My point is what keeps a group from disintegrating if it employs multiple locums earning 50% more per hour? Sure, there are some people that have overspent and live paycheck to paycheck but that’s not describing the majority of docs. When our group was a PP we never hired locums for this reason. We were concerned it would create a wildfire we couldn’t control.
 
cowbydoc said:
My point is what keeps a group from disintegrating if it employs multiple locums earning 50% more per hour? Sure, there are some people that have overspent and live paycheck to paycheck but that’s not describing the majority of docs. When our group was a PP we never hired locums for this reason. We were concerned it would create a wildfire we couldn’t control.
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True private practice groups don’t use locums doc like that.

Always follow the money trail. True private practice groups will pay locums docs to do the bare minimum work 7-3 m-Friday to save on costs.

You answered your own question about “when our group was PP we never hired locums for this reason”
 
cowbydoc said:
My point is what keeps a group from disintegrating if it employs multiple locums earning 50% more per hour? Sure, there are some people that have overspent and live paycheck to paycheck but that’s not describing the majority of docs. When our group was a PP we never hired locums for this reason. We were concerned it would create a wildfire we couldn’t control.
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We actually pay our locums about 15% less than our permanent full time people. They also miss out on some money from the hospital system. In exchange they work only when they want and never take call.
 
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nimbus said:
We actually pay our locums about 15% less than our permanent full time people. They also miss out on some money from the hospital system. In exchange they work only when they want and never take call.
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You guys are like my sisters place who pays their perm full time partners up to $550/hr to work and pays their w2 employee docs $400/hr and the 1099 locums docs $350/hr. The locums docs and employees docs only work 7-3 if it’s extra work. The partners take all the lucrative calls. Now the only reason the partners can make that much extra is because that’s exactly subsidy the hospitals is paying them to cover the calls extra.

The exact same rate locums third party company gets as well

That’s the way it should be.
 
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aneftp said:
You guys are like my sisters place who pays their perm full time partners up to $550/hr to work and pays their w2 employee docs $400/hr and the 1099 locums docs $350/hr. The locums docs and employees docs only work 7-3 if it’s extra work. The partners take all the lucrative calls. Now the only reason the partners can make that much extra is because that’s exactly subsidy the hospitals is paying them to cover the calls extra.

The exact same rate locums third party company gets as well

That’s the way it should be.
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At those rates no locums should be needed…..
 
dannyboy1 said:
At those rates no locums should be needed…..
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Correct. But sometimes partners don’t want to work and employees don’t want to work especially on a Friday. Thus some locums will come in.

What’s shady how third parties come in an offer $300//hr 1099 locums when they get the same $550/hr rate as my sister practice from the hospital. So then try to squeeze another $50/hr profit off locums docs. (But in locums company defense) they have to cover travel and lodging that can add another $200/day to the locums bill.

My sister place covers malpractice but no travel and lodging for 1099 locums but they are in major metropolitan top 5-6 areas so all docs doing locums live within a 30 mile radius.
 
This is the way it should be- pay your full time docs the same rate you would pay an agency for extra time. Has anyone ever been in a situation where the locums docs are getting 1.5-2x the full time rate and had to force the administration’s hand to up the rate? I can’t imagine working around locums making bank is great for department morale or stability.
 
aneftp said:
You guys are like my sisters place who pays their perm full time partners up to $550/hr to work and pays their w2 employee docs $400/hr and the 1099 locums docs $350/hr. The locums docs and employees docs only work 7-3 if it’s extra work. The partners take all the lucrative calls. Now the only reason the partners can make that much extra is because that’s exactly subsidy the hospitals is paying them to cover the calls extra.

The exact same rate locums third party company gets as well

That’s the way it should be.
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Do they really pay their full timers this rate BY THE HOUR or is this an overtime rate!! Can’t imagine it’s a regular hourly rate. That would be about 1M per year for 40 hours a week no call assuming 8 weeks PTO. market is good, it’s not that good…/
 
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dannyboy1 said:
Do they really pay their full timers this rate BY THE HOUR or is this an overtime rate!! Can’t imagine it’s a regular hourly rate. That would be about 1M per year for 40 hours a week no call assuming 8 weeks PTO. market is good, it’s not that good…/
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Again. Follow the money trail. I keep telling u guys this. Be a socialist democrat. Think like a socialist democrat like Harris.

If u like and will vote for Kamela Harris. U will like locums pay.

ITS ALWAYS EASY WHEN YOU ARE SPENDING OTHER PEOPLE’s MONEY.

The overtime rate is given at the hospital that is PAYING THE PRIVATE GROUP EXTRA MONEY to cover.

Think about it. If it’s YOUR MONEY. If it’s the GROUP MONEY. They will be tight about it and send u home at 3pm if employee or 1099 contract

But covering another place on the OTHER’s guy money. It’s easy to bill and rape them.
 
aneftp said:
Again. Follow the money trail. I keep telling u guys this. Be a socialist democrat. Think like a socialist democrat like Harris.

If u like and will vote for Kamela Harris. U will like locums pay.

ITS ALWAYS EASY WHEN YOU ARE SPENDING OTHER PEOPLE’s MONEY.

The overtime rate is given at the hospital that is PAYING THE PRIVATE GROUP EXTRA MONEY to cover.

Think about it. If it’s YOUR MONEY. If it’s the GROUP MONEY. They will be tight about it and send u home at 3pm if employee or 1099 contract

But covering another place on the OTHER’s guy money. It’s easy to bill and rape them.
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I can’t tell if this is the most or least enlightening post I have ever read.
 
aneftp said:
True private practice groups don’t use locums doc like that.

Always follow the money trail. True private practice groups will pay locums docs to do the bare minimum work 7-3 m-Friday to save on costs.

You answered your own question about “when our group was PP we never hired locums for this reason”
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This is exactly how our private practice operates. We don’t use locums per se, but we have part time workers who generally work easy day shifts. They are paid less than partners for the same shift. But they don’t deal with the business side of things, just clock in and clock out, and we don’t abuse them with tough rooms.
 
In the mid Atlantic at least 3 AMCs have new comp packages, salary based and not RVU based. Even for partners. I think because everyone knows the “private stock”/partner status is worthless - won’t be another round of buy outs.
 
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USAP for one - rolling it out now/next few months (see gaswork ads "new compensation plan!"
Others I'm not at liberty to say since told in private...but basically it's not a great time for a lot of friends who are "Partners" in those entities, stuck with worthless AMCbucks.
 
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arsene19 said:
In the mid Atlantic at least 3 AMCs have new comp packages, salary based and not RVU based. Even for partners. I think because everyone knows the “private stock”/partner status is worthless - won’t be another round of buy outs.
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I know the package but I I ain’t gonna to post it either. The mid Atlantic buyout deals in 2015/2016 Weren’t that great to began with. Those guys regretted it

As with mednax. The early sellouts made out much better than the later sell outs.

Same with usap.

Following the same exact story. Mednax (American anesthesiology) and usap essentially mirror itself

Except mednax stock was public already since it’s a more diverse company. But it’s been suffering a long time in stock. Notice MD (mednax stock) peaked in 2015

Guess when usap was born…end of 2014.
 
Maverikk said:
It's easy to find if you ask around, it's not being advertised because you can still get new grads who think 550 and lots of call and unreimbursed time in the hospital is great, which it is after residency until you get burned out. I have a friend looking, mostly metro areas, if someone has experience and knows the market the time to negotiate for a full time w2 is now.
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So this is basically the new AMC comp models - look at gaswork. Except it is 500k (maybe including the value of the match and healthcare benefits? I hope not). Which sounds AWESOME when you're a CA3 making 80k. Then in 3 years time, you're a partner. If you're really sharp, you get to be on governance...and tackle issues like what to do with the aging or debilitated partner, or the declining payor mix, or how to convince the hospital you need a higher stipend. Most of these uncompensated meetings will happen between 5-10pm.

Or, you can go work for $300+ an hour and make your own schedule. But this has no community/guarantee of hours/requires a lot of confidence in both clinical and business skills.

Most people go for the former, and wonder if/when they should ever make the jump to the latter.
 
The former would be better to start out as a new grad probably in a PP group rather than an AMC if you can find one. Having the community and support is invaluable when you get into sticky situations, also learning how to be a responsible physician, communicate, how to run a board, learning how to tell a good/bad nurse/surgeon/tech/process takes being in a similar set up for a bit...you don't learn those, and you're not asked to, doing locums. The problem is it's way under the hourly market rate. It won't take new grads long to realize this, a lot shorter than hospitals and AMCs
 
Maverikk said:
The former would be better to start out as a new grad probably in a PP group rather than an AMC if you can find one. Having the community and support is invaluable when you get into sticky situations, also learning how to be a responsible physician, communicate, how to run a board, learning how to tell a good/bad nurse/surgeon/tech/process takes being in a similar set up for a bit...you don't learn those, and you're not asked to, doing locums. The problem is it's way under the hourly market rate. It won't take new grads long to realize this, a lot shorter than hospitals and AMCs
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True Private practice partnership days are over in 95% of the major metro areas

When people are trolling a Minnesota private practice gig (on the other jobs forums)! And Minnesota has always been a very high paying job private practice location (and fair)

It’s a huge sign the private practice business is in big trouble.

Inflation and the market conditions have caught up to the vast majority of private practices even the fair practices that aren’t predatory. A 700-800k for private practice gigs working 45-48 hrs and 10 weeks off were the gigs to be at. Unfortunately the times have change. You are giving up what amounts to 500k in income in a a 2 year partnership at minimum.

So if you are making 350/400k w2 x 2 years as you partnership track person

Partners make 750k.

Vs AMC paying you 500k/10 weeks for pure 40 hr week

What is the break rate gen point assuming no pay raises?

500k x 5 years equals 2.5 million
400k x 2 years equals 800k
Partner 750k 3 years equals 2.2 million.

So your break even will roughly 4.5 years.

That’s a long time to break even.
 
aneftp said:
True Private practice partnership days are over in 95% of the major metro areas

When people are trolling a Minnesota private practice gig (on the other jobs forums)! And Minnesota has always been a very high paying job private practice location (and fair)

It’s a huge sign the private practice business is in big trouble.

Inflation and the market conditions have caught up to the vast majority of private practices even the fair practices that aren’t predatory. A 700-800k for private practice gigs working 45-48 hrs and 10 weeks off were the gigs to be at. Unfortunately the times have change. You are giving up what amounts to 500k in income in a a 2 year partnership at minimum.

So if you are making 350/400k w2 x 2 years as you partnership track person

Partners make 750k.

Vs AMC paying you 500k/10 weeks for pure 40 hr week

What is the break rate gen point assuming no pay raises?

500k x 5 years equals 2.5 million
400k x 2 years equals 800k
Partner 750k 3 years equals 2.2 million.

So your break even will roughly 4.5 years.

That’s a long time to break even.
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Not if your career is thirty years
 
Maverikk said:
The former would be better to start out as a new grad probably in a PP group rather than an AMC if you can find one. Having the community and support is invaluable when you get into sticky situations, also learning how to be a responsible physician, communicate, how to run a board, learning how to tell a good/bad nurse/surgeon/tech/process takes being in a similar set up for a bit...you don't learn those, and you're not asked to, doing locums. The problem is it's way under the hourly market rate. It won't take new grads long to realize this, a lot shorter than hospitals and AMCs
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Most just go to Kaiser and call it good enough.

500s, reasonable hours, good life balance.

With average comp >500, and other intangibles (covid changing work life balance equation?) I am seeing far far fewer “where can I grind out 60+ hr weeks” people. Most new grads want the salary, to work, and to leave and live life.

I applaud them
 
GassYous said:
Not if your career is thirty years
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Again. You are thinking of the old days.

If the private group falls apart in 5 years. You will be losing income.
My brothers true private practice place fell apart after 35 years in existence. He was the president.

My sister place been around for similar 35 years is struggling as well.

My residency friend abandon her practice (her practice disbanded 2 years ago) and she was the president of her practice.

We don’t know how long a practice will last these days.
 
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aneftp said:
Again. You are thinking of the old days.

If the private group falls apart in 5 years. You will be losing income.
My brothers true private practice place fell apart after 35 years in existence. He was the president.

My sister place been around for similar 35 years is struggling as well.

My residency friend abandon her practice (her practice disbanded 2 years ago) and she was the president of her practice.

We don’t know how long a practice will last these days.
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Things is, specifically for Minnesota, almost all the hospitals, 10+, are staffed by private groups. So the odds of a group imploding in <5 years is extremely unlikely.

Tolerating the weather is another thing. But most people that work here are from here and have family here so they want/need to be here which makes doing a partnership track worth it for the long haul.
 
crash2500 said:
Things is, specifically for Minnesota, almost all the hospitals, 10+, are staffed by private groups. So the odds of a group imploding in <5 years is extremely unlikely.

Tolerating the weather is another thing. But most people that work here are from here and have family here so they want/need to be here which makes doing a partnership track worth it for the long haul.
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Correct. Some regions are more isolated from management or hospitals employment.

Physicans are employed 80% of the time nationwide.

Minnesota maybe 30%
 
Shimmy8 said:
Not a chance in hell I’d sign up for any sort of partner track in this day and age UNLESS there’s no real financial hit the first couple years.
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How about they tell u a 10% hit the first two years then you become a “partner”

You get equal shares of class “A” group shares

The original partners get class “B” group shares worth 2x as much as class A group shares.
 
aneftp said:
How about they tell u a 10% hit the first two years then you become a “partner”

You get equal shares of class “A” group shares

The original partners get class “B” group shares worth 2x as much as class A group shares.
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It would be unwise to take a partnership track job where the pay/workload ratio is worse than other similar jobs in a market. It is unnecessarily risky. I would also say if partners are doing shenanigans with shares like that, the culture of the practice is not worth “buying” into.
 
Yeah almost all the MDs &lt;10 yrs out from residency are well educated from WCI etc. They’re planning on working 20 then next career. Locums 1099 makes it super easy to Barista FIRE once empty nest, if you haven’t hit Fat FIRE and can walk away entirely if you want to.

A rare few have fallen into the big house/cars/private school thing…most have 1 or 2 out of those 3 and have intentionally planned to be work optional by 50.

Most of my fellow 45+ colleagues are 0.5 FTE no call, and working on their artwork/golf/travels
 
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arsene19 said:
Yeah almost all the MDs &lt;10 yrs out from residency are well educated from WCI etc. They’re planning on working 20 then next career. Locums 1099 makes it super easy to Barista FIRE once empty nest, if you haven’t hit Fat FIRE and can walk away entirely if you want to.

Most of my fellow 45+ colleagues are 0.5 FTE no call, and working on their artwork/golf/travels
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They must not have kids if the are 45 or kids when they were younger.

My friends with 2-8 million buyout worked well past the 3-5 year required buyout period into their early 50s before cutting Back but they were men

The women tend to cut back much sooner
 
aneftp said:
They must not have kids if the are [emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]]] or kids when they were younger.

My friends with 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million buyout worked well past the 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year required buyout period into their early [emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]s before cutting Back but they were men

The women tend to cut back much sooner
Click to expand...

Hope he invested some of it. Otherwise, he’s on the losing end after taking a pay cut and working past [emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]]] years.
 
arsene19 said:
Nope plenty of 45+ with kids. Wanted to retire in time to enjoy their MS and HS years.

YMMV!
Click to expand...
Well congrats. Their magic number and cost of living must be lower than my colleagues. They are in their mid to late 50s

Net worth excluding paid off homes
In the 10 digit (I know 15-20 million sounds a lot) to 99% of the public. But they still chug along working
Their kids long grown in med school and residency or working as attending.
 
Haha NW 10 digit = billionaires and still working. That’s awesome! They must like work! Love the passion.

My cohort is only 10 mil NW max, more like 5 mil and part time (not counting their RE). Good index investing and saving. Work is fun, but even more fun when optional.

Kudos to your billionaire 10 digit club!!
 
Last edited:
arsene19 said:
Haha NW 10 digit = billionaires and still working. That’s awesome! They must like work! Love the passion.

My cohort is only 10 mil NW max, more like 5 mil and part time (not counting their RE). Good index investing and saving. Work is fun, but even more fun when optional.

Kudos to your billionaire 10 digit club!!
Click to expand...
Sorry my bad. I meant 8 digit. 15-20 million. I did write that.
 
aneftp said:
Their kids long grown in med school and residency or working as attending.
Click to expand...


If someone in their 50s has a kid who’s an attending, they must have had kids when they were very young. I work with a 53yo ENT who has a 4yo and another one the way.
 
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aneftp said:
Some of my classmates got married age 21/22. Started having kids age 23/25. So two kids by the time they were 4th years.
Click to expand...
My 1st kid was born when I was 24 and in my senior year of college. 3rd kid was born 4 years later between 3rd and 4th year of med school. I had a lot of classmates with kids(very nontrad heavy school) and many on a very similar timeline to mine.

So I definitely could have some kids working as practicing physicians when I'm in my 50s.
 
abolt18 said:
My 1st kid was born when I was 24 and in my senior year of college. 3rd kid was born 4 years later between 3rd and 4th year of med school. I had a lot of classmates with kids(very nontrad heavy school) and many on a very similar timeline to mine.

So I definitely could have some kids working as practicing physicians when I'm in my 50s.
Click to expand...

Probably depends on where you went to school. I went to med school in Manhattan where it’s not practical to have kids and family as a medical student. The people who did likely chose to go to medical school somewhere else. None of my classmates were even married. One woman had a cat. Some people had a fish tank or a hamster.
 
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