Locum Tenens and sign on bonuses

[Evaduarte]

Hi, all!

Do sign-on bonuses and loan repayment bonuses exist when hired out of residency with Locum Tenens agencies?

Alternatively, is it common for hospitals to offer sign on bonuses if you are hired as an independent contractor rather than as an employee of the hospital?

Thank you!

---

Members don't see this ad.

 

[bravotwozero]

The latter is not common.

Locum Tenens agencies can sometimes offer permanent positions, which can offer sign on bonuses.

Hope that helps.

 

[gutonc]

Your "bonuses" as locums are in the form of getting paid 20-50% more than you would as an employed/regular doc in the group.

 

[southerndoc]

Everytime I get a call from a locums company and quote them my rate, they cease to call me.

 

[GeneralVeers]

Everytime I get a call from a locums company and quote them my rate, they cease to call me.

I laugh at some of the rates. How they get suckers to take these jobs mystifies me.

 

[chocomorsel]

Everytime I get a call from a locums company and quote them my rate, they cease to call me.

Good for you. They love to lowball.

 

[chocomorsel]

I laugh at some of the rates. How they get suckers to take these jobs mystifies me.

Fresh grads. People with red marks in their file. Pure ignorance.

 

[Groove]

Traditional locums do not generally pay sign on bonuses. Exceptions would be if you were negotiating 6 months to a year at a desperate location and some sort of longer term contractual agreement with the locums company but those types of situations are fairly rare.

CMG, HEM (hospital employee model), and SDG can all pay sign on bonuses. The biggest are usually with the larger CMGs who have higher liquidity and can more readily procure assets for hiring purposes. SDGs usually pay the smallest, in my limited experience, because the sign on is usually coming out of the group's pocket. Hospitals can be zero or somewhere in between.

That being said, I've noticed a drop in large sign on bonuses post COVID this year so if you're graduating soon, I wouldn't get my hopes up. It's a bad year to be entering EM.

Agree with the others that locums rates are pretty bad compared to a few years ago. I haven't encountered any that are higher than local market rates.

 

[chocomorsel]

Traditional locums do not generally pay sign on bonuses. Exceptions would be if you were negotiating 6 months to a year at a desperate location and some sort of longer term contractual agreement with the locums company but those types of situations are fairly rare.

CMG, HEM (hospital employee model), and SDG can all pay sign on bonuses. The biggest are usually with the larger CMGs who have higher liquidity and can more readily procure assets for hiring purposes. SDGs usually pay the smallest, in my limited experience, because the sign on is usually coming out of the group's pocket. Hospitals can be zero or somewhere in between.

That being said, I've noticed a drop in large sign on bonuses post COVID this year so if you're graduating soon, I wouldn't get my hopes up. It's a bad year to be entering EM.

Agree with the others that locums rates are pretty bad compared to a few years ago. I haven't encountered any that are higher than local market rates.

I have noticed a few contracts working in the Covid ICUs that are typically looking for either board certified ER docs or ICU docs. No other base specialty seems to fit the bill unless there is an ICU fellowship as well.
ER seems to be given a preference in this regard if one wants to work in some of the Covid units. Makes no sense to me, but I guess ER guys must be running the show on some of those contracts.
Just FYI for anyone interested in ICU work to cover the bills.

 

[Groove]

I have noticed a few contracts working in the Covid ICUs that are typically looking for either board certified ER docs or ICU docs. No other base specialty seems to fit the bill unless there is an ICU fellowship as well.
ER seems to be given a preference in this regard if one wants to work in some of the Covid units. Makes no sense to me, but I guess ER guys must be running the show on some of those contracts.
Just FYI for anyone interested in ICU work to cover the bills.

Weird, I wouldn't know the first thing about running a COVID ICU. I haven't rounded on ICU patients since residency. I mean, sure there's some crossover...but not really. They must be pretty desperate.

 

[chocomorsel]

Weird, I wouldn't know the first thing about running a COVID ICU. I haven't rounded on ICU patients since residency. I mean, sure there's some crossover...but not really. They must be pretty desperate.

Had a big debate about this one with one of my ER friends who defended the practice. Really believes ER docs with just their base training and better surgical and debatably better echo skills (depends on where one trained really) makes them better to run an ICU out of residency than a surgeon or an anesthesiologist.
I was amazed.
But it is what it is and an option for relatively “starving” ED docs who aren’t afraid of Covid ICU work.

 

[EM Junkie]

Weird, I wouldn't know the first thing about running a COVID ICU. I haven't rounded on ICU patients since residency. I mean, sure there's some crossover...but not really. They must be pretty desperate.

At the shops I’ve heard about this practice in Houston (all HCA), you’re not “running the ICU” so much as you’re a procedure monkey. Not a bad deal if you’re into procedures.

 

[chocomorsel]

At the shops I’ve heard about this practice in Houston (all HCA), you’re not “running the ICU” so much as you’re a procedure monkey. Not a bad deal if you’re into procedures.

Really? I thought they were looking for ICU docs. So who’s seeing the patients and coming up with the plans if not the ED docs staffing the Unit? Do they have an extra ICU doc besides the ED doc?

 

[EM Junkie]

Really? I thought they were looking for ICU docs. So who’s seeing the patients and coming up with the plans if not the ED docs staffing the Unit? Do they have an extra ICU doc besides the ED doc?

Yep still staffed by ICU doc and ICU mid levels

 

[chocomorsel]

Yep still staffed by ICU doc and ICU mid levels

Oh. Well. This is interesting. Because they don’t advertise it like that. When I was trying to go to NY in the spring I literally was turned down for the ICU because I wasn’t and ER doc or ICU certified yet. Literally was trying to argue to an idiot recruiter as to why an EM doc without a fellowship doesn’t have better qualifications than an ICU trained doc and their EM program director insisted I wasn’t qualified for ICU work.
It was so odd. Anyway went with another company who didn’t care about me being an anesthesiologist as long as I did an ICU fellowship.
But what you are saying makes so much more sense now.

 

[Jabbed]

At the shops I’ve heard about this practice in Houston (all HCA), you’re not “running the ICU” so much as you’re a procedure monkey. Not a bad deal if you’re into procedures.

Odd. Any idea what the pay is like?

 

[namethatsmell]

Everytime I get a call from a locums company and quote them my rate, they cease to call me.

I answer them even when I'm not looking for more work just so I can do this.

I figure if there's enough of us doing this it might cause a rising tide to lift all ships.

Or at the very least, it's fun to hear how they reply.

 

[GeneralVeers]

I answer them even when I'm not looking for more work just so I can do this.

I figure if there's enough of us doing this it might cause a rising tide to lift all ships.

Or at the very least, it's fun to hear how they reply.

I love the shock in their voice: "$350/hour?? *GASP* If you can find that job good luck! Our $130/hour is VERY competitive for the middle-of-nowhere Alabama!"

 

[bravotwozero]

Traditional locums do not generally pay sign on bonuses. Exceptions would be if you were negotiating 6 months to a year at a desperate location and some sort of longer term contractual agreement with the locums company but those types of situations are fairly rare.

CMG, HEM (hospital employee model), and SDG can all pay sign on bonuses. The biggest are usually with the larger CMGs who have higher liquidity and can more readily procure assets for hiring purposes. SDGs usually pay the smallest, in my limited experience, because the sign on is usually coming out of the group's pocket. Hospitals can be zero or somewhere in between.

That being said, I've noticed a drop in large sign on bonuses post COVID this year so if you're graduating soon, I wouldn't get my hopes up. It's a bad year to be entering EM.

Agree with the others that locums rates are pretty bad compared to a few years ago. I haven't encountered any that are higher than local market rates.

I still managed to see one offer (middle of nowhere in the midwest) that had a $120k sign on bonus. Biggest sign on i've ever seen.

 

[chocomorsel]

I can't believe you wouldn't want to say goodbye to your family for 6 days, get on a series of planes and wear a m**k for 10 hours, stay at a low rate Best Western, work yourself to exhaustion at a grimy understaffed hell-hole, and spend 10 hours flying back with 3 connections all while wearing your m**k, to make the same amount of money you could have made doing an extra shift or two at your primary site. You monster. What kind of doctor are you. Clearly you don't understand the market or care about people.

Signed,
Typical aggressive locums recruiter

Agree on the Flying and these days agree on the Hotel thing although I have never stayed at a Best Western. The service in these Hotels these days sucks.

What I love about Locums is the freedom to work when I want and take off when I want. That’s difficult to do in a group setting where I am forced to take call or suffer a huge pay cut if I don’t.

But I know you all don’t do call so it’s a non issue. I am getting tired of the traveling aspect though.

 

[Fox800]

I'm doing full-time locums at one site only for the next year. Pay is good, but I did not take in to account the value of my days off spent in airports. I initially tried to help out and make some $$ by working extra shifts, and was punished by extra trips to and from this isolated city. Now I'm scaling back my shifts per month so I only make 1 or 2 trips.

Not sure it's worth the extra pay. I'd take a $25/hr pay cut to sleep in my own bed at night. Problem is I'd have to live in a place I'm probably not thrilled about.

 

[bravotwozero]

Here's another thought/idea for anyone struggling to find jobs: If you can't find anything locally and locums work has dwindled (which is what everyone seems to be saying), see if you can get a good full/part time position within reasonable flying/driving distance, and have their scheduler do block shifts. Pay for your own travel/lodging, and come back home when your block of shifts is over. If the hourly rate is high enough, paying for your own travel and lodging might be worth it, especially now since flights and hotels are cheap. If you're 1099, all of that ought be a write off as well.

 

[Fox800]

Here's another thought/idea for anyone struggling to find jobs: If you can't find anything locally and locums work has dwindled (which is what everyone seems to be saying), see if you can get a good full/part time position within reasonable flying/driving distance, and have their scheduler do block shifts. Pay for your own travel/lodging, and come back home when your block of shifts is over. If the hourly rate is high enough, paying for your own travel and lodging might be worth it, especially now since flights and hotels are cheap. If you're 1099, all of that ought be a write off as well.

Yep. Probably need to take about $15-20 off the top of the hourly rate, depending on the place. I'm racking up about $1750-2500 per week of shifts including airfare, hotel, rental car, gas, and Ubers. Hotels are pricier than usual in this area. Work pays for it, though.

You need to be sure it works out in your favor.

 

[namethatsmell]

Here's another thought/idea for anyone struggling to find jobs: If you can't find anything locally and locums work has dwindled (which is what everyone seems to be saying), see if you can get a good full/part time position within reasonable flying/driving distance, and have their scheduler do block shifts. Pay for your own travel/lodging, and come back home when your block of shifts is over. If the hourly rate is high enough, paying for your own travel and lodging might be worth it, especially now since flights and hotels are cheap. If you're 1099, all of that ought be a write off as well.

This can be a great strategy. Look for shops 1-2 hours drive outside a major metro. If you find one with a solid rate and they're willing to block your shifts...then they're probably trying to avoid going down the more expensive locums route and you've likely identified a group that will also be willing to re-imburse for milage and a hotel.

 

[namethatsmell]

I love the shock in their voice: "$350/hour?? *GASP* If you can find that job good luck! Our $130/hour is VERY competitive for the middle-of-nowhere Alabama!"

Ha, totally.

I once had one laugh at my rate for a crap gig in bumble Missouri. I replied that my rate for him just went up another $100/hr. It sounded like the air on his end had just been sucked out of the room. A few weeks later my buddy took what I think was the same job he was pitching for the rate I initially offered. It's all smoke and mirrors with them. Mind as well have fun.

 

[Lexdiamondz]

Had a big debate about this one with one of my ER friends who defended the practice. Really believes ER docs with just their base training and better surgical and debatably better echo skills (depends on where one trained really) makes them better to run an ICU out of residency than a surgeon or an anesthesiologist.
I was amazed.
But it is what it is and an option for relatively “starving” ED docs who aren’t afraid of Covid ICU work.

In many of the public hospitals the COVID ICUs were run by a mix of anesthesiologists, ER guys and surgeons. The ER guys mostly did rapid response type stuff and took admissions and were pretty good at that, but pretty **** at longitudinal care.

Didn't really matter in the end though - whether ICU, EM, Gas or Surg trained care many of the patients died anyway.

 

[chocomorsel]

In many of the public hospitals the COVID ICUs were run by a mix of anesthesiologists, ER guys and surgeons. The ER guys mostly did rapid response type stuff and took admissions and were pretty good at that, but pretty **** at longitudinal care.

Didn't really matter in the end though - whether ICU, EM, Gas or Surg trained care many of the patients died anyway.

Agreed. That’s why I don’t understand why they would discriminate quite frankly.

 

[southerndoc]

Just received a message through LinkedIn to staff the Georgia World Congress Center, which has been turned into a makeshift hospital for stepdown patients. They offered $120/hour. WTH?!? Travel nurses through the state agency are getting paid that much! They want a 40-60 hour/week commitment.

 

[turkeyjerky]

Just received a message through LinkedIn to staff the Georgia World Congress Center, which has been turned into a makeshift hospital for stepdown patients. They offered $120/hour. WTH?!? Travel nurses through the state agency are getting paid that much! They want a 40-60 hour/week commitment.

Yeah, that's been pretty much the standard for these types of jobs ever since the summer. Other than some of the initial offers for NYC and Detroit last spring (most of which fell through) nearly everything has been insultingly low. They know there are a whole lot of desperate docs out there.

 

[southerndoc]

Yeah, that's been pretty much the standard for these types of jobs ever since the summer. Other than some of the initial offers for NYC and Detroit last spring (most of which fell through) nearly everything has been insultingly low. They know there are a whole lot of desperate docs out there.

Can't believe it's already gotten to the point of paying the same rate as they pay nurses.

 

[Groove]

Can't believe it's already gotten to the point of paying the same rate as they pay nurses.

Meanwhile, we have local nurses who have left to take travel nursing jobs in TX paying 10K/wk. 10K! That’s more than what I make!

 

[KGflyboy]

I never had luck with locums companies. They used to call me constantly and offer low rates in the mid to upper $100s.

I made what I feel were reasonable counter offers based on my current full time compensation. I would require 25% to 50% more than my regular pay in order to do locums work. If the job was within my home state and required traveling only a few hours by car, I requested $300. If it required longer travel, air travel, rental cars, and other expenses like that I wanted $350 + travel expenses.

Why would I leave my family for days at a time to work in crappy places and learn new EMRs living in crappy hotels for the same or less pay than I could earn at home?

The recruiters always thought I was sooo lucky to have a full time job paying more than what they could offer. Now I never get calls from recruiters. I guess they find enough people willing to take their low-ball offers.

 

[chocomorsel]

Just received a message through LinkedIn to staff the Georgia World Congress Center, which has been turned into a makeshift hospital for stepdown patients. They offered $120/hour. WTH?!? Travel nurses through the state agency are getting paid that much! They want a 40-60 hour/week commitment.

Hope you sent this back.🤣😂🤪😜

 

[GeneralVeers]

Locums is dead. I don't even waste my time looking at their offers anymore. It's sad and depressing how far rates have fallen, especially in TX

 

[Fox800]

Locums is dead. I don't even waste my time looking at their offers anymore. It's sad and depressing how far rates have fallen, especially in TX

What, you don't want $150/hr to work in rural west Texas, and round admitted patients while you're at it?

I have gotten emails offering $80-90/hour in TX. They're obviously looking for a PA/NP, but wouldn't mind if some idiot physician took the bait.

 

[GeneralVeers]

What, you don't want $150/hr to work in rural west Texas, and round admitted patients while you're at it?

I have gotten emails offering $80-90/hour in TX. They're obviously looking for a PA/NP, but wouldn't mind if some idiot physician took the bait.

Exactly. I'd say that we could fix this if dumb physicians stopped taking these jobs, but with the job shortage that's unlikely.