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slurpy15

I have some questions about the economics of locums companies-

Does anyone know how much of a premium companies charge hospitals over the physician fee? Is it 50%? 100%
Do they bill hospitals separately for licenses, room, and board or is it rolled into a general fee?

Do hospitals prefer to use locums companies because of some perceived benefit (prescreening, help with credentialing, paid medmal) or do they use them simply because it's the most efficacious way to find a doc last minute?

Please feel free to cross-post this under other specialties.

Thanks so much for this info!!
 

GeneralVeers

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Typically it's 30-50% of the physician fee, so if they are paying you $200, then they are collecting $260-$300/hr for your services plus travel expenses.

Hospitals do not prefer locums agencies, but sometimes they are the only option if they cannot hire directly, or their contracted CMG can't provide enough coverage.

I stay away from locums companies and negotiate my own salary with hospitals/groups. They prefer doing that because it saves them money versus paying the markup for a locums company. Additionally they locums companies usually have non-compete clauses that prevent you from working for that hospital/group if they no longer contract with that hospital.
 
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FMtoEM

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Typically it's 30-50% of the physician fee, so if they are paying you $200, then they are collecting $260-$300/hr for your services plus travel expenses.

Hospitals do not prefer locums agencies, but sometimes they are the only option if they cannot hire directly, or their contracted CMG can't provide enough coverage.

I stay away from locums companies and negotiate my own salary with hospitals/groups. They prefer doing that because it saves them money versus paying the markup for a locums company. Additionally they locums companies usually have non-compete clauses that prevent you from working for that hospital/group if they no longer contract with that hospital.

In doing so you pay your own malpractice. How difficult is it to set up your own malpractive? So far my malpractice is paid by CMG and the locums staffing company.
 
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deleted109597

In doing so you pay your own malpractice. How difficult is it to set up your own malpractive? So far my malpractice is paid by CMG and the locums staffing company.
Depends on where you live. There are plenty of self malpractice firms out there geared towards this. In Texas, people in our facility were able to keep the ~$20/hr the CMG was taking out of our pay. Policies maxed out at roughly $10K/year, well below the $20-30K the CMG was taking.
 

Cheese Whiz

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Not correct. I always negotiate for hospital or CMG employer to provide insurance.
How about travel expenses (flights, hotels, cars)? Have you found these expenses covered and set up by the CMG or do you make your own bookings and pay out of pocket? If out of pocket, what types of salary adjustment do you negotiate? Also what are the tax length of time limits for write offs as an independent contractor (can you work for same group for over 6 months, a year, etc before it's no longer "tenens " by IRS)
 

GeneralVeers

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How about travel expenses (flights, hotels, cars)? Have you found these expenses covered and set up by the CMG or do you make your own bookings and pay out of pocket? If out of pocket, what types of salary adjustment do you negotiate? Also what are the tax length of time limits for write offs as an independent contractor (can you work for same group for over 6 months, a year, etc before it's no longer "tenens " by IRS)

I always make them pay travel. Sometimes they book it for me, other times I pay out of pocket and they reimburse.

There is no time limit for being independent contractor. It purely has to do with your written contract with the employer.
 

neurochica

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Agree, its about 40% mark up. I call the hospital directly and negotiate a higher rate...saves them money and I increase my pay.
 

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How do you find hospitals that need a locums person if not going through a locums company? I can understand if they're in your area or you if know someone there you might hear about opportunities, but cold calling random hospitals all over the place seems pretty inefficient.
 
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Alvarez13

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How do you find hospitals that need a locums person if not going through a locums company? I can understand if they're in your area or you if know someone there you might hear about opportunities, but cold calling random hospitals all over the place seems pretty inefficient.

I'm starting to consider locums as well. Should I just start calling and asking to speak with a director, physician recruiter, some other staffing person?
 
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deleted109597

Don't fool yourselves. Even EmCare, TeamHealth, Schumacher, and USACs are all using locums companies when their assassin/ambassador/special forces/whatever can't cover the void.
So you have to know the area, or someone on the ground where these shops are. Then you simply get credentialled, and when they're short they text/call/email incessantly.
And you just ask what the bonuses are. If they're not paying, then say no thank you. If you want to ask for money, they might blacklist you, but I haven't met anyone who has had this happen, especially at shops that needy.
 
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emergentmd

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Don't fool yourselves. Even EmCare, TeamHealth, Schumacher, and USACs are all using locums companies when their assassin/ambassador/special forces/whatever can't cover the void.
So you have to know the area, or someone on the ground where these shops are. Then you simply get credentialled, and when they're short they text/call/email incessantly.
And you just ask what the bonuses are. If they're not paying, then say no thank you. If you want to ask for money, they might blacklist you, but I haven't met anyone who has had this happen, especially at shops that needy.

I get txt messages all the time for coverage. I love it. Ignore it for a few dys, and if they keep asking for the same day to be covered, you will start to figure out what they will pay.
 

The White Coat Investor

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If the service provided to you by the locums company is not worth the price, then don't use them. Go direct. Likewise, if it isn't worth it to the hospital, they won't use the locums company. But there are plenty of docs and hospitals out there who feel it is worth it or locums companies wouldn't exist. Yes, a significant percentage of what the hospital pays goes toward the costs of the services the company provides (including the physician salary) and the profit for the company. I don't know the percentage but I wouldn't be surprised to learn the doctor got 50% of what the hospital was paying. But keep in mind, even if there were no locums company you would still have travel, credentialing, malpractice etc expenses that have to come out of that same pile of money from the hospital.
 
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deleted109597

But keep in mind, even if there were no locums company you would still have travel, credentialing, malpractice etc expenses that have to come out of that same pile of money from the hospital.
Absolutely. Although the elephant in the room is that malpractice (in some places) is nowhere near what the locums/CMG charges you. I've seen $20-30 an hour charged for malpractice taken out of your check (but you're taxed on it of course). With zero claims in 5 years, mine costs less than $3/hr on the open market. You just have to see if your contract lets you. And then you simply tell the agency/site "I've got my own, how much will you give me back for the malpractice you're not paying?"
 
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shookwell

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Locums companies can be great. I work locums on the side but I have a regular job so I don't need the locums if it doesn't work for me. I only take locums jobs if they can credential me in less than 2 weeks and pay enough to make it worth my time. I don't actually care about how long it takes to credential, but if you only take places that can credential you quickly, you find places that are pretty desperate for coverage and you can negotiate your rates way up. I don't mind working in places where I have to work hard and see lots of patients, but I ask for a lot more money. I also never commit to taking X number of shifts or to work for a certain amount of time.

This way, I end up taking shifts that pay significantly more than average, and then after the first month, when they try to negotiate me down to near the "usual" rates, I just say no. If they still need coverage they call me back with higher rates or I just tell them the rate I will work at and refuse to negotiate down at all.

This ends up getting me less shifts overall, but I end up with a much higher rate than I am offered first. Since I'm not relying on the locums for my salary and use it just as bonus income, I'm willing to take less hours but get a higher rate per hour.
 
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