Locums and Direct Contract w/ Hospitals

[Sleepnmd]

Fairly new to locums work and discovering that many locums and recruitment agencies utilize questionable tactics including, not only low balling the anesthesiologist, but presenting the MD to hospitals with the intention of “owning” the Dr. by taking the Dr. off the market from other locums agencies for that particular hospital. I was even bullied by one agency in one instance: they claimed a particular hospital had a need, then presented me, once I agreed they said the hospital didn’t have the need anymore, and then told me that I couldn’t apply through other agencies to ANY hospital that agency works with (even though I never signed any agreement with this agency). It seems that if the agencies are taking a massive cut of the money and trying at the same time to “own” the doc, do docs sometimes directly contract with hospitals instead of being taken advantage of by a middleman? Wondering if anyone has insight into how to directly contract with hospitals and how to protect oneself from predatory locums agencies.

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[AppTrail]

name and shame, what agency?

 

[aneftp]

Again these are newbie posts about locums. U guys simply don’t under how the locums contracts work.

1. Find out who exactly owns the exclusive anesthesia contract

If facility is hospital owned and anesthesia is hospital run in house w2. Than you will have a better chance with directly contracting out.

So do you know who owns the anesthesia contracts? Before making these statements.

The big guys amc want to wall off locums contracts and favor their own wholy owned 1099 subsidies like envoy and dy staffing. So if envision and team health have the contract. They will want to double dip with their 1099 divisions rather than let u move in

 

[IVdoc]

I've been doing locums for a short time and here is my evaluation. The locums agencies will post ads to collect CVs just to say they have all these doctors in their candidate pool. Notice all those Gaswork ads that say: "Please send CV for immediate consideration", because they want to have your info. This makes the hospitals more eager to work with locums agencies that have access to available locums doctors. The locums agencies keep posts of locums jobs active even if that locums job has closed. They want to bait you into contacting them because: 1) they have your attention 2) you are dumb and gave them your CV thinking they will get you that locums job opportunities 3) they now know your phone # and email and will hammer call and email you non-stop because they have to feed themselves and their families. They don't get paid until they deliver a locums doctor to the hospital's door 4) They "presented" your credentials/CV to the hospital and tell the hospitals that you are with their agency whether you signed a document or not. Once you are "presented" you are locked out of going to other agencies to present you for higher rates and some will lock you out of being presented for an entire hospital system. It's a horrible system that tries to trap locums doctors. I've tried to contact hospital recruiters on my own and offer my locums services, cutting out the middleman, and they either ignore my emails or email me that they work with agencies for locums. Hospital admin want to waste money and deal with locums agencies, go figure. IT's a shady business with these locums agencies

 

[aneftp]

To add. There is a local hospital near me that is in house w2 model hospitals run anesthesia. They will let u contract directly. But u gotta pay for ur own overhead travel malpractice etc. after expenses he told me he was only averaging $360/hr which isn’t great. But u can negotiate directly

Many locums docs have their own locums companies.

As for the run of the mill locums companies. The best way they get contracts is to offer available dates

As a sole provider doc trying to get a contract. You need to offer something. Are you willing to give them 24/7 coverage for months at a time? That the main advantage of bigger locums companies. They will come in and say. We have 5 docs who can cover 3 fte locums 1099 slots for u for x amount of months. That’s how you get business and grow

But if you are Joe single member LLC locums doc “hey I can offer 2 weeks at a time”. That’s a harder sell to the hospital who needs more coverage

 

[Drwine]

Networking is important if you want to not work with agencies. I spent 35 years locally and know a lot of people in my geographic area. I can reach out with my available dates and have them pen me in before they fill in with agencies.

 

[Sleepnmd]

I've been doing locums for a short time and here is my evaluation. The locums agencies will post ads to collect CVs just to say they have all these doctors in their candidate pool. Notice all those Gaswork ads that say: "Please send CV for immediate consideration", because they want to have your info. This makes the hospitals more eager to work with locums agencies that have access to available locums doctors. The locums agencies keep posts of locums jobs active even if that locums job has closed. They want to bait you into contacting them because: 1) they have your attention 2) you are dumb and gave them your CV thinking they will get you that locums job opportunities 3) they now know your phone # and email and will hammer call and email you non-stop because they have to feed themselves and their families. They don't get paid until they deliver a locums doctor to the hospital's door 4) They "presented" your credentials/CV to the hospital and tell the hospitals that you are with their agency whether you signed a document or not. Once you are "presented" you are locked out of going to other agencies to present you for higher rates and some will lock you out of being presented for an entire hospital system. It's a horrible system that tries to trap locums doctors. I've tried to contact hospital recruiters on my own and offer my locums services, cutting out the middleman, and they either ignore my emails or email me that they work with agencies for locums. Hospital admin want to waste money and deal with locums agencies, go figure. IT's a shady business with these locums agencies

That’s exactly been my experience. I’m finding that these VMSs bring a whole new level of shadiness to this because they farm you out to a bunch of places without even getting your permission.

 

[mmag]

What's to keep someone from creating a virtual persona with a plausible CV to send to locums to sus out whether a job is real or not? Can't the catfishing go both ways?

 

[IVdoc]

That would be funny to catfish them! If you look on Gasworks there are a couple of recruiters from AMN that post a locums requests job for every state with the urgent request to email your CV immediately to them as if this locums job in every state is going to be gone by tomorrow. These locums agencies will also provide trickery by using words like "our exclusive client or our premier client (the hospital)" as if they are the only locums agency that that hospital works with. It did fool me once when I accepted an "exclusive" locums job with an agency who claimed to be "exclusive" with the hospital, only to find that there were plenty of other locums docs from other agencies and so the locums agency I signed with was not so exclusive as they claimed in their ad. I've also read reviews of these locums agencies from disillusioned recruiters on Glassdoor who claim that they have to cold call doctors 70-100 calls/day to meet their daily quotas. Most of these recruiters have no idea what you do as a doctor, there are some agencies that post the credentials of their "healthcare recruiters" as prior work with car sales or Geico insurance sales. There may be some career healthcare recruiters, but most are fresh college grads who are doing telemarketing as their first job as they can't find a job in their industry. They just read an ad that is on some job board that their agency pays access to have and are clueless about anything clinical. Once they catfish you, they expect you to arrange all the dates that you will work while they take 30-40% cut off what they hospital is paying per day. You have been warned

 

[nimbus]

That would be funny to catfish them! If you look on Gasworks there are a couple of recruiters from AMN that post a locums requests job for every state with the urgent request to email your CV immediately to them as if this locums job in every state is going to be gone by tomorrow. These locums agencies will also provide trickery by using words like "our exclusive client or our premier client (the hospital)" as if they are the only locums agency that that hospital works with. It did fool me once when I accepted an "exclusive" locums job with an agency who claimed to be "exclusive" with the hospital, only to find that there were plenty of other locums docs from other agencies and so the locums agency I signed with was not so exclusive as they claimed in their ad. I've also read reviews of these locums agencies from disillusioned recruiters on Glassdoor who claim that they have to cold call doctors 70-100 calls/day to meet their daily quotas. Most of these recruiters have no idea what you do as a doctor, there are some agencies that post the credentials of their "healthcare recruiters" as prior work with car sales or Geico insurance sales. There may be some career healthcare recruiters, but most are fresh college grads who are doing telemarketing as their first job as they can't find a job in their industry. They just read an ad that is on some job board that their agency pays access to have and are clueless about anything clinical. Once they catfish you, they expect you to arrange all the dates that you will work while they take 30-40% cut off what they hospital is paying per day. You have been warned

Indeed. I’ve googled some of the recruiters who have contacted me and their LinkedIn pops up. Often it is their first job out of college.

 

[Sleepnmd]

Has anyone tried doing an end run around the recruiters and contacting hospitals or surgery centers directly? Thereby cutting out the middleman? If so, I wonder how you accomplished this. I know some hospitals prefer to work through an agency in getting locums docs which makes no sense but it’s more expensive for the hospital.

 

[abolt18]

Has anyone tried doing an end run around the recruiters and contacting hospitals or surgery centers directly? Thereby cutting out the middleman? If so, I wonder how you accomplished this. I know some hospitals prefer to work through an agency in getting locums docs which makes no sense but it’s more expensive for the hospital.

I did try this with one hospital and it was fruitless. N=1

 

[Leinie]

I did try this with one hospital and it was fruitless. N=1

I've tried a few time with no success. We're at N=2 now....

 

[Lecithin5]

Has anyone tried doing an end run around the recruiters and contacting hospitals or surgery centers directly? Thereby cutting out the middleman? If so, I wonder how you accomplished this. I know some hospitals prefer to work through an agency in getting locums docs which makes no sense but it’s more expensive for the hospital.

I don’t know this for a fact, but I suspect recruiters would ask the hospitals that they are not to be undercut…

 

[psychbender]

My first two introductions to locums were direct contacts. One was an anesthesiologist calling the OR front desk to get in touch with anyone interested in doing locums for him (one of these rural one doc places where he's paid boatload for 365 coverage). The other was a local hospital where a colleague contacted the private group and hammered out a direct deal. He wouldn't share the contacts until he left, then I slid in. Partners would call me when they wanted coverage.

I tried to do it myself at another local hospital there, but despite them being desperate for work (half the moderate-sized academic department all left the same year), the hospital recruiter said they only deal with agencies, and the agency only wanted long-term commitments, rather than the weekend here and there that I could offer at the time.

 

[aneftp]

My first two introductions to locums were direct contacts. One was an anesthesiologist calling the OR front desk to get in touch with anyone interested in doing locums for him (one of these rural one doc places where he's paid boatload for 365 coverage). The other was a local hospital where a colleague contacted the private group and hammered out a direct deal. He wouldn't share the contacts until he left, then I slid in. Partners would call me when they wanted coverage.

I tried to do it myself at another local hospital there, but despite them being desperate for work (half the moderate-sized academic department all left the same year), the hospital recruiter said they only deal with agencies, and the agency only wanted long-term commitments, rather than the weekend here and there that I could offer at the time.

This is all correct.

Hospitals want bodies and they want 24/7 coverage. Can you the lone wolf provide that coverage? That's the Locums companies sales pitches. They sell the hospital admin they can provide the equivalent of 2-3 FTE Locums bodies. The single anesthesiologist who only offers sporadic coverage like weekends is at a significant disadvantage in terms of negotiations.

The agency presents a list of 30 docs on their roster who can supply coverage for the hospital .

Smaller private practices are so much easier to contact directly but they are getting so far and few in between.

Some big hospitals will love for you to do direct but the caveat is you need to carry your own malpractice. And they don't budge on their Locums direct rate ($350/hour) for direct Locums 1099 with mega hospital system for me. Plus I provide my own malpractice insurance. I looked at the contract they sent me. This is practice where the hospital runs the w2 anesthesia department. I'm like this is not good. I asked for $420/hr the wouldn't budge. Because them paying me $350/hr plus my overhead of my own malpractice. My effective rate is like $300/hr and at that point, what's the point?

That's exactly what happened to this doc, he got his own contract direct with the hospital and he averages $356/hr after expenses. And his hours are guaranteed. So he's paying for his own malpractice and not getting that great of a deal to go direct.

 

[caligas]

Let’s say I see a locums job I like on gaswork or whatever and I’m ready to send CV to agency. What about including a little disclaimer, like “ I am providing my CV for informational purpose of only, I retain the right to negotiate with any party for this or any other position”

 

[IVdoc]

There was a previous thread on SDN anesthesia which a poster said that some locums agencies will "name clear" you even on inquiry. Seems like once they have your CV they broadcast it to every hospital and claim you as their bitch and that you are with their agency. What a screwed up system. Why hasn't any locums doctor gotten a lawyer involved to shake up this BS noncompete that locums agency industry have cooked up?

 

[aneftp]

There was a previous thread on SDN anesthesia which a poster said that some locums agencies will "name clear" you even on inquiry. Seems like once they have your CV they broadcast it to every hospital and claim you as their bitch and that you are with their agency. What a screwed up system. Why hasn't any locums doctor gotten a lawyer involved to shake up this BS noncompete that locums agency industry have cooked up?

Incorrect. U have to give them permission to discuss/present your cv to the hospital.

So what happens if they present ur name (u discuss ur rate with them before) say $350-400/hr

They present u. They (the hospital) or even if you declined it. Than that’s where you get into trouble.

 

[AppTrail]

This is all correct.

Hospitals want bodies and they want 24/7 coverage. Can you the lone wolf provide that coverage? That's the Locums companies sales pitches. They sell the hospital admin they can provide the equivalent of 2-3 FTE Locums bodies. The single anesthesiologist who only offers sporadic coverage like weekends is at a significant disadvantage in terms of negotiations.

The agency presents a list of 30 docs on their roster who can supply coverage for the hospital .

Smaller private practices are so much easier to contact directly but they are getting so far and few in between.

Some big hospitals will love for you to do direct but the caveat is you need to carry your own malpractice. And they don't budge on their Locums direct rate ($350/hour) for direct Locums 1099 with mega hospital system for me. Plus I provide my own malpractice insurance. I looked at the contract they sent me. This is practice where the hospital runs the w2 anesthesia department. I'm like this is not good. I asked for $420/hr the wouldn't budge. Because them paying me $350/hr plus my overhead of my own malpractice. My effective rate is like $300/hr and at that point, what's the point?

That's exactly what happened to this doc, he got his own contract direct with the hospital and he averages $356/hr after expenses. And his hours are guaranteed. So he's paying for his own malpractice and not getting that great of a deal to go direct.

How much is your own yearly malpractice?

 

[aneftp]

How much is your own yearly malpractice?

A lot…25-30k occurrence. I carried my own malpractice for 10 years.

That’s why it’s not worth it for me anymore.

You can pay claims made and it’s cheaper

 

[staple]

I successfully navigated a direct locums contract with two different hospitals…

Made significantly more than the recruiter was offering. Malpractice was easy and lodging plus travel was negotiated into the deal.

 

[aneftp]

I successfully navigated a direct locums contract with two different hospitals…

Made significantly more than the recruiter was offering. Malpractice was easy and lodging plus travel was negotiated into the deal.

Did amc have the contract? Or was it directly w2 hospital employed? Or private group?

 

[staple]

Did amc have the contract? Or was it directly w2 hospital employed? Or private group?

One contract from a while ago was with a private practice group who was in a difficult staffing situation, so all negotiations went through their group.

More recently, I’ve negotiated directly with the hospital since they employed their anesthesia department. I reached out to the physician recruiter at the hospital and negotiated all terms. They had multiple locum agencies that they worked with as well, but were more than willing to negotiate with me as well.

 

[aneftp]

One contract from a while ago was with a private practice group who was in a difficult staffing situation, so all negotiations went through their group.

More recently, I’ve negotiated directly with the hospital since they employed their anesthesia department. I reached out to the physician recruiter at the hospital and negotiated all terms. They had multiple locum agencies that they worked with as well, but were more than willing to negotiate with me as well.

Yes. That’s the easiest way to do direct locums. (When hospital has its own in house w2 anesthesia)

Once an amc is involved with the exclusive anesthesia contract. They tend to double dip with their side 1099 envoy, dy staffing companies and lock out locum companies or direct competition.

 

[narcotics999]

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One contract from a while ago was with a private practice group who was in a difficult staffing situation, so all negotiations went through their group.

More recently, I’ve negotiated directly with the hospital since they employed their anesthesia department. I reached out to the physician recruiter at the hospital and negotiated all terms. They had multiple locum agencies that they worked with as well, but were more than willing to negotiate with me as well.

Hospital gets you occurrence-based malpractice?

 

[PainInTheAnes]

Has anyone tried doing an end run around the recruiters and contacting hospitals or surgery centers directly? Thereby cutting out the middleman? If so, I wonder how you accomplished this. I know some hospitals prefer to work through an agency in getting locums docs which makes no sense but it’s more expensive for the hospital.

I did this once and they told me “go work with XYZ agency, they are our exclusive provider of locums docs”.

Turns out that was a lie, there are several companies contracting to them, and I get calls from other Locums agencies about the same hospital.

I have no idea what motivates the hospitals or the groups to contract out to Locums agencies this way, and then lie about it after the fact. When you factor in the cut that they take it’s gotta be 25% or more so they’re pushing 550+ to staff on an hourly basis.

This is why you keep multiple contracts going at once. You can’t trust people who make these sorts of decisions any more than you can trust a senior partner at a private practice saying “our group is so fair and profitable, just give us 1 million dollars over 3 years and you’ll see!”