Locum questions , for a novice Locum

[xtina0]

So I am going to leave my W2 job which has absolutely no benefits and start per diem.

I have been in contact with a Locum agency and just wanted an idea of how this works as I am new to this.

Am I tied to this agency for the length of my contract with a specific hospital? Is there a way to leave the Locum agency at some point and negotiate directly with the hospital?

What rates do you all think are reasonable for NYC?
The rate listed was $275/hr which I was happy with , I tried to negotiate but they quickly shut me down and I didn't counter because the rate was reasonable.

The Locum agency offers malpractice? is the malpractice coverage they offer good enough if there were to be a major adverse event.

Should I trust the Locum company? I am a little confused how they work- so they get a flat rate for my hire or is it an hourly compensation to them too? And once I am presented to a hospital am I not allowed to directly contact the hospital?

Any Locum advice is appreciated

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[dabears505]

You can't directly talk to the hospital after the company has introduced you. You need tail from your w2 job. You don't need malpractice from locums typically as they provide coverage.

 

[xtina0]

You can't directly talk to the hospital after the company has introduced you. You need tail from your w2 job. You don't need malpractice from locums typically as they provide coverage.

my w2 was occurrence. so the malpractice Locums provide is good enough?

 

[GassYous]

no benefits??

 

[xtina0]

no benefits??

yes I was just painting the picture of why im switching - other than paying for my malpractice, they don't pay for anything

 

[GravelRider]

My understanding is that you essentially sign a non-compete with the locums agency. Once you work at a hospital via that agency, you cannot work at that specific hospital for either another agency or yourself for a period of time after the assignment finishes.

Edit: $275/hr seems to be fair and the going rate for locums in nyc as far as I’m aware. I would make sure they covering travel and lodging. If you don’t need lodging, you might be able to squeeze a few more dollars out of them.

 

[caligas]

How does one know malpractice coverage is good quality?

Do you need a lawyer to review each contract?

 

[pgg]

If you eventually decide to go full time via direct employment at a place where a locums co placed you, there's a payout to the locums co. It'll be in your contract. Usually a fee something in the range of $20-30K. You can pay it or the hospital can pay it but the money comes from somewhere (i.e. you) in the end.

 

[xtina0]

My understanding is that you essentially sign a non-compete with the locums agency. Once you work at a hospital via that agency, you cannot work at that specific hospital for either another agency or yourself for a period of time after the assignment finishes.

Edit: $275/hr seems to be fair and the going rate for locums in nyc as far as I’m aware. I would make sure they covering travel and lodging. If you don’t need lodging, you might be able to squeeze a few more dollars out of them.

Thank you, that answers my question. So interesting the way these Locum agencies work- wish I did more homework before I started chatting with them

 

[Drwine]

I was going to make a new post. "Do we really need a locums agency in this market?" I am retiring in June from full time practice of over 30 years. My plan is to reach out to my network with weeks that I am available to work and meet my new mantra "Call me anything but late for dinner."

I know what agencies charge and what they pay so I can make it a win-win situation for both of us. Given the current shortage of anesthesiologists I am comfortable that I can wind my career down to complete retirement in this fashion. Worse comes to worse I can sign up with an agency but in the near term I doubt that I will need to go that route. I am sure the biggest problem will be willing to stand fast and not make it a full time job. I am willing to be flexible and make my more extended time off during periods of lower demand. I will work most of the summer and travel during the fall. I will help out during school breaks while planning several weeks of travel in January until the President's Week school break. You get the picture.

My initial plan is only to take assignments where I can easily commute from my home. I had contemplated travel but the pandemic changed that.

 

[MirrorTodd]

Side question: how does one get locums without going through an agency?

 

[Arch Guillotti]

Side question: how does one get locums without going through an agency?

Word of mouth probably.

 

[Twiggidy]

Side question: how does one get locums without going through an agency?

Yep. Friends and word of mouth....which is a good bring back to the other thread asking if you should give full notice when leaving a practice. Here's a good reason why the answer is yes. If you want to help per diem, if you're on good terms, it's a good way to avoid a locums agency

 

[pasgasser2]

Hope it's okay for me to piggyback off of this thread but maybe others getting started on locums may have this question too-

Can I have more than one agency present me to the same hospital? I've been told before that I should work with multiple locum agencies because each will give you different rates. It sounds like they need my CV first before they can present me and get my targeted hourly rates. Do I end up just sending my CV to multiple locum agencies?

Also, if I am presented to the hospital but do not take the locums job...am I still on the hook for the non-complete/buy-out clause? The current hospital i want to locums at is also hiring direct so if I can't get my desired hourly rates via locums I may consider just becoming an employee

 

[GASMAN]

Just tag on this, can one request the assignment excludes certain types of cases?

 

[Aether2000]

If locums can be at a quality surgery center or centers, then your life will be much easier than at hospitals. I do both, but much prefer the simplicity of surgery centers with GI/ortho total joints/spine/ENT/plastics rather than hospitals with megatrauma cases. I left my full time practice at a hospital and one of my partners joined me. We split one full time job at a surgery center (roughly 2-3 months on then 2-3 months off) and travel or work pickup locums jobs with the 6 months we have scheduled off each year. We formed a LLC to maximize our retirement benefits and other benefits, and run all our funds through that. The lifestyle is markedly improved.

 

[chocomorsel]

Hope it's okay for me to piggyback off of this thread but maybe others getting started on locums may have this question too-

Can I have more than one agency present me to the same hospital? I've been told before that I should work with multiple locum agencies because each will give you different rates. It sounds like they need my CV first before they can present me and get my targeted hourly rates. Do I end up just sending my CV to multiple locum agencies?

Also, if I am presented to the hospital but do not take the locums job...am I still on the hook for the non-complete/buy-out clause? The current hospital i want to locums at is also hiring direct so if I can't get my desired hourly rates via locums I may consider just becoming an employee

If you want to be an employee don’t go thru a locums agency first. The hospital will have to pay them a finders fee that comes from somewhere (you) as mentioned above.
The agency that presents you first gets to get the contract should you accept it. They don’t duke it out at the same hospital as I suspect no one has time for that. If you don’t like the job, don’t take it. But don’t do this too often as the agencies will get annoyed. By the time you agree to be presented you need to know you want the job.

 

[Ashers]

Side question: how does one get locums without going through an agency?

I know a few places in different states that are hiring locums without agencies. Often they then ask if you have any desire to work there permanently. I have not had such a desire, and going through an agency was a better deal for me with the 3 jobs. Jobs in AZ, MT, and WI.

Just tag on this, can one request the assignment excludes certain types of cases?

Yes. You say it, so it's in your info when you get presented. I tell people upfront what I won't do. I won't look at jobs that require OB, and I reinforce I won't do OB if there is OB anywhere on site. Due to my jobs the last several years, I haven't done thoracic and cranis, so I didn't want to start doing them in a new system.

 

[pasgasser2]

If you want to be an employee don’t go thru a locums agency first. The hospital will have to pay them a finders fee that comes from somewhere (you) as mentioned above.
The agency that presents you first gets to get the contract should you accept it. They don’t duke it out at the same hospital as I suspect no one has time for that. If you don’t like the job, don’t take it. But don’t do this too often as the agencies will get annoyed. By the time you agree to be presented you need to know you want the job.

How would I find out which agency is willing to offer me the best rate if only one agency is allowed to present me to the hospital? I thought the general mantra was to get in touch with multiple agencies and see which one is willing to offer the best locum rates for an assignment?

 

[narcotics999]

How would I find out which agency is willing to offer me the best rate if only one agency is allowed to present me to the hospital? I thought the general mantra was to get in touch with multiple agencies and see which one is willing to offer the best locum rates for an assignment?

Set a rate you are willing to accept. The agency will always say it is too high, we have never offered such a high rate....

Don't back off, but make sure your rate is reasonable.

Right now the going rate is around 275-325. You can get more or less depending on the geographic areas, working conditions, supervision or not.

 

[chocomorsel]

How would I find out which agency is willing to offer me the best rate if only one agency is allowed to present me to the hospital? I thought the general mantra was to get in touch with multiple agencies and see which one is willing to offer the best locum rates for an assignment?

Well yes. You agree on a rate before you get presented. Pick 100 agencies but only the first one who presents gets dibs.

 

[minwoo]

Well yes. You agree on a rate before you get presented. Pick 100 agencies but only the first one who presents gets dibs.

Can a locum agency agree on a rate before presentation? I'm being told by an agency that the hospital is one that approves the rate after the physician is presented. But I understand that whatever the rate the hospital approves, the agency will take significant portion of that and then agree (or disagree) to the rate that I ultimately get paid. It seems likely that agencies will have varying flexibilities in how much they're going to skim to allow a more desirable or undesirable rate to the locums. Thanks for all the helpful info btw, really trying to understand the ins and outs of this before sending over my CV.

 

[chocomorsel]

Can a locum agency agree on a rate before presentation? I'm being told by an agency that the hospital is one that approves the rate after the physician is presented. But I understand that whatever the rate the hospital approves, the agency will take significant portion of that and then agree (or disagree) to the rate that I ultimately get paid. It seems likely that agencies will have varying flexibilities in how much they're going to skim to allow a more desirable or undesirable rate to the locums. Thanks for all the helpful info btw, really trying to understand the ins and outs of this before sending over my CV.

They are lying. Tell the minimum that you will take otherwise don't waste your time. The know their margins. The rate is agreed on by you and them. And when you have ironed out all that, then yeah, have them present. If they can't do it, move on. There are more than 100 agencies out there.
I have been doing this long enough that I have a minimum and move on when that is not met. If you are new, then maybe you won't get it but I bet you can. The few locums companies that know me, know my work ethic, that I do a good job and am always asked back and know I don't play around when it comes to my money. I started off in 2017 back when with $240 an hour and that was a good rate back then, but only if you did 10 hour days and the OT kicked in. I do remember posting that on here and was not believed by some. LOL. Now it's more like $300 as demand is high.

 

[MirrorTodd]

Can a locum agency agree on a rate before presentation? I'm being told by an agency that the hospital is one that approves the rate after the physician is presented. But I understand that whatever the rate the hospital approves, the agency will take significant portion of that and then agree (or disagree) to the rate that I ultimately get paid. It seems likely that agencies will have varying flexibilities in how much they're going to skim to allow a more desirable or undesirable rate to the locums. Thanks for all the helpful info btw, really trying to understand the ins and outs of this before sending over my CV.

Ya that "rate" seems to be all bull**** unless there is something I am missing. I have been speaking with one locums company who quoted me a rate for a job as $245/hr, then somehow that rate dropped to $240/hr because they would have to bill differently because I'm a military physician, despite the fact that I would be performing off duty employment.
I also just spoke with another locums company who asked me what I was looking for. I told them ideally somewhere in the $275-$300 range. They told me that they would have to check with the hospital to see if my rate would be approved. This tells me that this company gets a certain piece of the pie, no matter what the rate is. Long story short, the locums company isn't looking to do you any favors by taking a smaller cut to give you a better rate.

 

[abolt18]

What are people's thoughts on doing weekend coverage for locums? What can you expect for beeper call? Any guaranteed minimum hours? Sounds like hourly rate is in the ~300 range for when you're actually working.

This next year I won't have a lot of weekdays available (going back to do CT fellowship), but I will have a lot of weekends available and am likely going to try to arrange some sort of weekend locums at hospitals within a couple hours' drive if possible.

 

[GassYous]

What are people's thoughts on doing weekend coverage for locums? What can you expect for beeper call? Any guaranteed minimum hours? Sounds like hourly rate is in the ~300 range for when you're actually working.

This next year I won't have a lot of weekdays available (going back to do CT fellowship), but I will have a lot of weekends available and am likely going to try to arrange some sort of weekend locums at hospitals within a couple hours' drive if possible.

attending -> fellowship?

 

[abolt18]

attending -> fellowship?

Accurate. Have saved a bunch of money to supplement my living during fellowship a bit, but for the right price, wouldn't mind making a little extra cash on a few weekends. Gotta fund those backdoor Roth IRAs!

 

[BobLoblaw78]

Dealing with the hiring side of locums, I have noticed a couple of things. The locums company will raise their rates each time they come back to you until you cry uncle. Getting multiple locums and talking to them reveals that they pay the locum providers different amounts. ie- they will try to stick the hospital with the provider that they are paying the least. Thus, they are taking a bigger piece of the pie while sticking you with the worst locums that you will accept.

 

[chocomorsel]

Dealing with the hiring side of locums, I have noticed a couple of things. The locums company will raise their rates each time they come back to you until you cry uncle. Getting multiple locums and talking to them reveals that they pay the locum providers different amounts. ie- they will try to stick the hospital with the provider that they are paying the least. Thus, they are taking a bigger piece of the pie while sticking you with the worst locums that you will accept.

Why don’t you guys hire your own docs then. Instead of going thru an agency.

 

[BobLoblaw78]

That was to fill a spot while waiting on new hire to come and was in a bad spot. Haven't used locums company since then and now know enough people doing it that I shouldn't need to.

If you're doing locums, I wouldn't understate the value of trying to build relationships and get to a point where you bypass the agency. If someone you know can't fill the spot, someone they know probably can.

 

[anbuitachi]

has anyone ever negotiated non compete? like the length of time. how long are people seeing ? 1 or 2 years?

 

[chocomorsel]

has anyone ever negotiated non compete? like the length of time. how long are people seeing ? 1 or 2 years?

2 years is the norm