Locums as a new grad

[Jlaws67]

I'm a CA3 at a big well known midwest program, and after a bunch of emails I've found the place I'd like to work most probably isnt hiring this year. I'm thinking hypothetically that I could work locums until someone retires or quits. Im wondering if anyone has experience working locums after graduation, and if so where should i even start looking. Would other groups look at this as a red flag if I wanted to settle somewhere after? What kind of money could someone doing this actually expect to make if they were willing to put in the hours and take little vacation? Thanks in advance!

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[Hoya11]

I'm a CA3 at a big well known midwest program, and after a bunch of emails I've found the place I'd like to work most probably isnt hiring this year. I'm thinking hypothetically that I could work locums until someone retires or quits. Im wondering if anyone has experience working locums after graduation, and if so where should i even start looking. Would other groups look at this as a red flag if I wanted to settle somewhere after? What kind of money could someone doing this actually expect to make if they were willing to put in the hours and take little vacation? Thanks in advance!

I wouldn't be so committed to the one group.

Move on to some other group in your desired area. Or move areas.

They arent hiring you now, they are probably not going to be hiring you after letting your skills fade working in some eye or GI center.

You can expect 175-200/hr locums. Why would you want to work locums at this stage? Locums is for keeping other options open or partial retirement..

I would get out there and take a full time staff position somewhere with good cases

 

[Arch Guillotti]

I wouldn't be so committed to the one group.

Move on to some other group in your desired area. Or move areas.

They arent hiring you now, they are probably not going to be hiring you after letting your skills fade working in some eye or GI center.

You can expect 175-200/hr locums. Why would you want to work locums at this stage? Locums is for keeping other options open or partial retirement..

I would get out there and take a full time staff position somewhere with good cases

Agree. Don’t hang your hat on a single job. You may be the greatest thing since since sliced bread but you never know what a group is going to do.

 

[deleted171991]

+1. If they really wanted you that badly, they would have told you so, and signed some form of contract with you for 2019.

You are a cog. Get used to the idea. Go with your best current offer. Stop dreaming. You need to pass your boards and develop a career.

 

[C4C]

I wouldn't be afraid to do locums.

Until you look around a little, you have no idea how limited your experience is. With locums, you can see a different gig each week. If you are smart, you'll pick up a new trick at each one. You will also be shocked at how much bad medicine is being practiced, and how lazy and dangerous many anesthesiologists are. Peeking beyond the walls of the ivory towers before you negotiate your first contract is likely to help you negotiate in your own best interests.

I would tell the group that you want to join that you are disappointed that there aren't any present openings, that you would agree to get privileges at the hospital and be available for vacation/prn coverage, and that in the meantime you will be getting real world experience by working at high intensity locums jobs. Only jackasses would begrudge you that career move.

Can you stay on (even only two weeks/month) at your training facility? That would allow you to "see the world/spread your wings," and you wouldn't have to tell a soul about your locums, unless you wanted to. After all, it's not like there'd be any gaps in your employment. Sticking around a training center even in a limited capacity while you are studying for your boards is probably an advisable strategy.

 

[pgg]

One of the problems with doing locums right out of residency is you won't have any colleagues who are invested in your success, who will care to mentor you. You'll be working with people who view you as a plug to fill a hole in the schedule, and a suspect plug at that. You're not going to get case assignments with any thought toward your development needs, the way a good group will bring a new member along.

You'll be safe when you finish residency. That's not the same as being safe, efficient, and good. The learning curve remains steep for a while. As with all things in life, things are harder when you're alone.

 

[DeadSpace]

One of the problems with doing locums right out of residency is you won't have any colleagues who are invested in your success, who will care to mentor you. You'll be working with people who view you as a plug to fill a hole in the schedule, and a suspect plug at that. You're not going to get case assignments with any thought toward your development needs, the way a good group will bring a new member along.

You'll be safe when you finish residency. That's not the same as being safe, efficient, and good. The learning curve remains steep for a while. As with all things in life, things are harder when you're alone.

I had considered locums after residency just to get a chance to travel but I had mentor tell me a similar thing. As many years as I've put into this and as many cases as I've done I thought I'd be fine to be out on my own right away but apparently, there will be more to learn!

 

[BLADEMDA]

I'm a CA3 at a big well known midwest program, and after a bunch of emails I've found the place I'd like to work most probably isnt hiring this year. I'm thinking hypothetically that I could work locums until someone retires or quits. Im wondering if anyone has experience working locums after graduation, and if so where should i even start looking. Would other groups look at this as a red flag if I wanted to settle somewhere after? What kind of money could someone doing this actually expect to make if they were willing to put in the hours and take little vacation? Thanks in advance!

How about an AMC for 1-2 years then go get your dream job? Or, a Fellowship followed by your dream job? Honestly, I don't think locums is a good idea for a new grad for the reasons mentioned in the previous posts. I'd rather see you take that $300k-$325K AMC job for a year or two while still searching for something much better.

 

[C4C]

If you think you need to be mentored, I would not go with an AMC.

My experience is not meant to be universal, but once USAP took over, my group stopped caring about new hires. We used to treat new hires as potential partners, and we were invested. Our spouses got to know their spouses. We told them about schools and neighborhoods. We were careful in scheduling to keep them from working with known trouble makers. We wanted the recruit to succeed, because hiring is a pain.

Now that my old group is a wholly-owned subsidiary of USAP, hiring is a corporate concern. They use a recruiter, and all decisions are made at the corporate level. Corporate tells them when a new body is going to join the rotation, and the new body is plugged in. If it works, great. If it doesn't, another warm body is ordered from HQ. Rinse and repeat.

 

[IMGASMD]

If you think you need to be mentored, I would not go with an AMC. ...
Rinse and repeat.

At first I read it as “rise” and repeat. Like you’ve just found another warm body (barely dead) then start them on the job.
Reading too much into things these days.

 

[Jlaws67]

Appreciate all the advice, I guess I underestimated how important decent mentorship is coming out as a fresh grad.

 

[vector2]

Starting a new job is like the typical film depiction of going to prison. You need to make friends, you need to know when to keep moving and keep your head down, you need to know when to pick a fight with a bully in the yard, you need to know when you can eat, sleep, and use the bathroom, but most importantly, you always need to be watching your a$$.

 

[deleted162650]

Starting a new job is like the typical film depiction of going to prison. You need to make friends, you need to know when to keep moving and keep your head down, you need to know when to pick a fight with a bully in the yard, you need to know when you can eat, sleep, and use the bathroom, but most importantly, you always need to be watching your a$$.

Agree. When I first started at my current gig I killed a podiatrist just to send a message.

 

[anbuitachi]

Agree. When I first started at my current gig I killed a podiatrist just to send a message.

What why did you murder a podiatrist?

 

[Jlaws67]

Agree. When I first started at my current gig I killed a podiatrist just to send a message.

So I guess it's not time to get rid of the Mac blade I fashioned into a shank yet either then

 

[dchz]

What why did you murder a podiatrist?

To get his feet wet?

 

[Modanq]

Anyone work at Locums during fellowship? What kind of rates and cases did you all cover. Thinking of covering weekend locums limiting myself to solo MD only, no CRNA coverage obviously, and cases like ortho, gen surg, basic gyn cases. Make some cash flow.

 

[chocomorsel]

Anyone work at Locums during fellowship? What kind of rates and cases did you all cover. Thinking of covering weekend locums limiting myself to solo MD only, no CRNA coverage obviously, and cases like ortho, gen surg, basic gyn cases. Make some cash flow.

Hard to find weekend work as an anesthesiologist.

 

[2Fast2Des]

If you think you need to be mentored, I would not go with an AMC.

My experience is not meant to be universal, but once USAP took over, my group stopped caring about new hires. We used to treat new hires as potential partners, and we were invested. Our spouses got to know their spouses. We told them about schools and neighborhoods. We were careful in scheduling to keep them from working with known trouble makers. We wanted the recruit to succeed, because hiring is a pain.

Now that my old group is a wholly-owned subsidiary of USAP, hiring is a corporate concern. They use a recruiter, and all decisions are made at the corporate level. Corporate tells them when a new body is going to join the rotation, and the new body is plugged in. If it works, great. If it doesn't, another warm body is ordered from HQ. Rinse and repeat.

If hiring is such a pain, then how does HQ find a steady stream of humans with pulses? Or are they just throwing quality out the window?

 

[deleted162650]

So I guess it's not time to get rid of the Mac blade I fashioned into a shank yet either then

I used a stylet but sure, whatever works.

 

[Man o War]

I wouldn't be afraid to do locums.

Until you look around a little, you have no idea how limited your experience is. With locums, you can see a different gig each week. If you are smart, you'll pick up a new trick at each one. You will also be shocked at how much bad medicine is being practiced, and how lazy and dangerous many anesthesiologists are. Peeking beyond the walls of the ivory towers before you negotiate your first contract is likely to help you negotiate in your own best interests.

I would tell the group that you want to join that you are disappointed that there aren't any present openings, that you would agree to get privileges at the hospital and be available for vacation/prn coverage, and that in the meantime you will be getting real world experience by working at high intensity locums jobs. Only jackasses would begrudge you that career move.

Can you stay on (even only two weeks/month) at your training facility? That would allow you to "see the world/spread your wings," and you wouldn't have to tell a soul about your locums, unless you wanted to. After all, it's not like there'd be any gaps in your employment. Sticking around a training center even in a limited capacity while you are studying for your boards is probably an advisable strategy.

I have actually found the CRNAs to be scary and dangerous on the locums trail, not the anesthesiologists. To the point that I will never, ever take a locums position supervising again.
Most of the anesthesiologists are just running around playing firefighter praying they don’t get sued. That life is not for me.
OP: would highly recommend NOT taking supervision locums gigs. Do your own cases. It’s a jungle out there otherwise.

 

[pgg]

I used a stylet but sure, whatever works.

I have been assured that only the weak used stylets.

 

[deleted162650]

I have been assured that only the weak used stylets.

For intubating yes, you are 100% correct.

Stylets are however approved for shank use.

Weak is fashioning a shank out of something that already has “blade” in the name.

 

[deleted162650]

To get his feet wet?

What you did there - I see it.

 

[Twiggidy]

Me on retirement day (or fill in the blank post call day)

 

[AdmiralChz]

Anyone work at Locums during fellowship? What kind of rates and cases did you all cover. Thinking of covering weekend locums limiting myself to solo MD only, no CRNA coverage obviously, and cases like ortho, gen surg, basic gyn cases. Make some cash flow.

I did moonlighting in a local, almost rural ER. It was a good gig that some of the fellows passed down to each other over the years.

My fellowship was pretty busy, though, and we had (some) internal moonlighting opportunities so very few did work on the side. A fellow last year did locums during each of his/her vacation weeks, but I am sure my wife would have killed me with the TEE probe if I did that.

 

[aneftp]

Let’s do the current math. Even at $200/hr

$200/hr x 40 hours a week x 46 weeks That’s $377k (no benefits)

Most private practice jobs are 350-450k these days. With added benefit of post call days off/early days off. So your “average time” is around 50 hours worked even including calls.

So locums isn’t great unless u are getting tons of overtime plus if u take calls. U gotta work the next day to get paid. That totally defeats purpose of call. Cause u are better just working days rather than have to work post call to get paid.

Locums works for some people. (Time off/calling ur own shots when you want to work)

Just gotta do the math

 

[Twiggidy]

Let’s do the current math. Even at $200/hr

$200/hr x 40 hours a week x 46 weeks That’s $377k (no benefits)

Most private practice jobs are 350-450k these days. With added benefit of post call days off/early days off. So your “average time” is around 50 hours worked even including calls.

So locums isn’t great unless u are getting tons of overtime plus if u take calls. U gotta work the next day to get paid. That totally defeats purpose of call. Cause u are better just working days rather than have to work post call to get paid.

Locums works for some people. (Time off/calling ur own shots when you want to work)

Just gotta do the math

Also, spouse with more lucrative job/career

 

[gasdoc77]

Let’s do the current math. Even at $200/hr

$200/hr x 40 hours a week x 46 weeks That’s $377k (no benefits)

Most private practice jobs are 350-450k these days. With added benefit of post call days off/early days off. So your “average time” is around 50 hours worked even including calls.

So locums isn’t great unless u are getting tons of overtime plus if u take calls. U gotta work the next day to get paid. That totally defeats purpose of call. Cause u are better just working days rather than have to work post call to get paid.

Locums works for some people. (Time off/calling ur own shots when you want to work)

Just gotta do the math

When I do the math, I value my hours from 6-3 much differently than later/weekend hours, which are at least 1.5-2x. If being part of a group means the 50 hours are suddenly less predictable with half falling on “peak hours”, the pay better reflect that. $200/hrx25x46 plus $400/hrx25x46. Total package value better come close to 690k 1099 or they can pay me the locums rates on my terms.

 

[IMGASMD]

When I do the math, I value my hours from 6-3 much differently than later/weekend hours, which are at least 1.5-2x. If being part of a group means the 50 hours are suddenly less predictable with half falling on “peak hours”, the pay better reflect that. $200/hrx25x46 plus $400/hrx25x46. Total package value better come close to 690k 1099 or they can pay me the locums rates on my terms.

I’ve never thought of it this way. But so true!

I had recently looked at a job that’s either “no call” or “call taking”. Calls essential is taking 2 weekends calls a month. Friday or Saturday, “maybe” once in a while a Sunday call. For additional 30 a year. They made it sound like, it’s very chill, not really many cases. When I asked how come no need for people taking weekday calls. They just said, oh those are already covered. It didn’t feel right and I end up passed on the job.

Most keen observers probably already know what’s going on, and maybe some of you are running the same system.

Just now after @gasdoc77 pointed that time should be compensated differently tied everything together for me.

 

[Twiggidy]

I’ve never thought of it this way. But so true!

I had recently looked at a job that’s either “no call” or “call taking”. Calls essential is taking 2 weekends calls a month. Friday or Saturday, “maybe” once in a while a Sunday call. For additional 30 a year. They made it sound like, it’s very chill, not really many cases. When I asked how come no need for people taking weekday calls. They just said, oh those are already covered. It didn’t feel right and I end up passed on the job.

Most keen observers probably already know what’s going on, and maybe some of you are running the same system.

Just now after @gasdoc77 pointed that time should be compensated differently tied everything together for me.

Well, that, and who the heck wants to work on the weekend? *gets on soapbox* Sometimes you can make the worst parts of the job (nights, weekends, holidays) some of the most highly compensated and it's still hard to get them covered. Why? Quality of life. We're in the age of "millenials". We want our nights off and our weekends free or at the very least "home call". I guarantee you there will be a day will it will be very hard to get a physician to spend the night in a hospital.People are will to take less money to have a better quality of life If the nurses want to claim they "can do anything an MD can do" well let them stay in house. *jumps off soapbox*

 

[IMGASMD]

Well, that, and who the heck wants to work on the weekend? *gets on soapbox* Sometimes you can make the worst parts of the job (nights, weekends, holidays) some of the most highly compensated and it's still hard to get them covered. Why? Quality of life. We're in the age of "millenials". We want our nights off and our weekends free or at the very least "home call". I guarantee you there will be a day will it will be very hard to get a physician to spend the night in a hospital.People are will to take less money to have a better quality of life If the nurses want to claim they "can do anything an MD can do" well let them stay in house. *jumps off soapbox*

I agree. Here is what “my” take, with everything that’s going on.
There are fewer “partnership” tract jobs out there, especially in most bigger cities. There is no rainbow at end of x years; it’s not like at end of all these hours I put in, I will get a pot of gold. I start working for/with an AMC at 350, in 10 years, I will get what? 450 if I am lucky. I am just a cog, I am easily replaceable with a new grad. Sure I can acquire new skills and do more work, but I will never make stupid amount of money like the generation before me. However, the partners in these established practices who already sold and got their big payout is expecting me to work hard, take calls for peanuts, and throw a fit when I say no. Or they (old partner/AMC) sell everything as “equal” for call and/or compensation. I say, I haven’t seen one yet. Either the cases would be different, someone would manipulate the schedule or some kind of pay-for-call scheme going on.

Then there’s the quality of life aspect of this discussion. I’ve been guilt into work extra, I’ve seen people been called lazy. I’ve heard, you get pay to stay, why won’t you? Because I don’t want to!

To make this whole discussion even more messy, let’s bring CRNA into this discussion. They certainly get more “rights” than residents, sometimes (junior/occasionally senior) attendings. “My contract says I am only working 7-3.” “Oh I haven’t had my morning breaks yet.” “I don’t take weekend calls.” “I worked all day, you have residents overnight, call them first.” WTF!


Because partnership and medicine as you know, no longer exist. Is it so hard to understand. We (physicians) allowed this to happen.
/big F ING RANT

#dropmike

 

[gasdoc77]

I’ve never thought of it this way. But so true!

I had recently looked at a job that’s either “no call” or “call taking”. Calls essential is taking 2 weekends calls a month. Friday or Saturday, “maybe” once in a while a Sunday call. For additional 30 a year. They made it sound like, it’s very chill, not really many cases. When I asked how come no need for people taking weekday calls. They just said, oh those are already covered. It didn’t feel right and I end up passed on the job.

Most keen observers probably already know what’s going on, and maybe some of you are running the same system.

Just now after @gasdoc77 pointed that time should be compensated differently tied everything together for me.

The myth that all hours are of equal value is BS that is perpetuated by AMC’s and the weaklings that sold out their practices. They want you to invest sweat equity in something that no longer has any value. Let them talk with their wallets and not lip service.

“The greatest trick the devil pulled was convincing the world he didn’t exist (and that all hours are equal so you’re just being a lazy millennial )”

 

[BLADEMDA]

Most locums gigs include an incentive pay for weekends and Friday night through Monday morning. This amount varies based on whether Level 1 or 2 facility. Typically, it can be $600 extra for a friday night up to $2500 for a Saturday 24 call at a level 1 facility plus the $200/$225 per hour compensation rate.

Now, when you look for a fulltime gig ask yourself how many Friday-Monday (0700) shifts you will be expected to do per year. Then, include a reasonable differential for those shifts. At that same time, don't forget to include the number of weeks worked per year and the average number of hours per week.

There are AMC jobs out there where the pay is "only" $25-$35K lower than if you were a 1099 but had to pay for health insurance. I am no fan of AMCs but the numbers don't lie.

If everyone held the line to these "numbers" the AMC would have to pay a fair wage or simply pay the MDs as a 1099 and those who want the extra shifts/weekends with the differential can do them.

 

[aneftp]

When I do the math, I value my hours from 6-3 much differently than later/weekend hours, which are at least 1.5-2x. If being part of a group means the 50 hours are suddenly less predictable with half falling on “peak hours”, the pay better reflect that. $200/hrx25x46 plus $400/hrx25x46. Total package value better come close to 690k 1099 or they can pay me the locums rates on my terms.

And you just made the reason why not do do locums. Cause if locums demands those terms. It’s better just to cut them home at 3pm

I’m willing to bet even at better pay mix hospitals (60% commercial). Cases after regular 3pm hours “add on cases” by surgeons or gi docs are more than likely to be Medicaid or Medicare patients. And we all know how poorly they pay. So why pay a locums $300-400 an hour when you are most likely gonna to lose money on that locums. Just send them home

 

[IMGASMD]

Most locums gigs include an incentive pay for weekends and Friday night through Monday morning. This amount varies based on whether Level 1 or 2 facility. Typically, it can be $600 extra for a friday night up to $2500 for a Saturday 24 call at a level 1 facility plus the $200/$225 per hour compensation rate.

Now, when you look for a fulltime gig ask yourself how many Friday-Monday (0700) shifts you will be expected to do per year. Then, include a reasonable differential for those shifts. At that same time, don't forget to include the number of weeks worked per year and the average number of hours per week.

There are AMC jobs out there where the pay is "only" $25-$35K lower than if you were a 1099 but had to pay for health insurance. I am no fan of AMCs but the numbers don't lie.

If everyone held the line to these "numbers" the AMC would have to pay a fair wage or simply pay the MDs as a 1099 and those who want the extra shifts/weekends with the differential can do them.

Are you saying 24 hr Saturday call is 200*24 + 2500? Or 2500 for call + 200 * hour worked? I would think later, or most people would be hopping on Saturday calls.

How do you “assess” what the hourly rate should be? When looking for a full time gig? Take the market rate?

Thanks.

 

[skypilot]

I have actually found the CRNAs to be scary and dangerous on the locums trail, not the anesthesiologists. To the point that I will never, ever take a locums position supervising again.
Most of the anesthesiologists are just running around playing firefighter praying they don’t get sued. That life is not for me.
OP: would highly recommend NOT taking supervision locums gigs. Do your own cases. It’s a jungle out there otherwise.

I have a question about this. I have never worked as a locums. Is it possible or likely that they would take you into an ACT practice as a locums and allow you to do your own cases? Or would it have to be an MD only practice for it to be easy to pick up locums, and do your own cases without having to supervise. In other words, is there enough demand that I can say "hey I will work no prob, but I want to do my own cases." And they will likely offer me a contract?

 

[chocomorsel]

I have a question about this. I have never worked as a locums. Is it possible or likely that they would take you into an ACT practice as a locums and allow you to do your own cases? Or would it have to be an MD only practice for it to be easy to pick up locums, and do your own cases without having to supervise. In other words, is there enough demand that I can say "hey I will work no prob, but I want to do my own cases." And they will likely offer me a contract?

I did just that. But it was in academics so they didn’t want me to teach which was fine with me as I hate academics.
But in most places, if you are doing locums, you are gonna do what they normally do. If they only supervise, that’s what you do and vise versa. If they do both, then you do as well. Can’t go into an ACT and not expect to supervise because you are there to keep the wheels of the OR turning, not to be a hindrance to that.

 

[Man o War]

I have a question about this. I have never worked as a locums. Is it possible or likely that they would take you into an ACT practice as a locums and allow you to do your own cases? Or would it have to be an MD only practice for it to be easy to pick up locums, and do your own cases without having to supervise. In other words, is there enough demand that I can say "hey I will work no prob, but I want to do my own cases." And they will likely offer me a contract?

I’ve had it happen both ways. Locums has always been an add on to my full time job, so I tell them what my requirements are and they either give it to me or I don’t come. The majority have agreed to my terms because they really needed someone. You always have more flexibility dealing directly with the hospital than a recruiter too, so if you can find a place that has a regular need it’s nice. They know what you will/won’t do and what your price is, so nobody’s time is wasted.
My motto is always, it doesn’t hurt to ask.

 

[anes121508]

If you think you need to be mentored, I would not go with an AMC.

My experience is not meant to be universal, but once USAP took over, my group stopped caring about new hires. We used to treat new hires as potential partners, and we were invested. Our spouses got to know their spouses. We told them about schools and neighborhoods. We were careful in scheduling to keep them from working with known trouble makers. We wanted the recruit to succeed, because hiring is a pain.

Now that my old group is a wholly-owned subsidiary of USAP, hiring is a corporate concern. They use a recruiter, and all decisions are made at the corporate level. Corporate tells them when a new body is going to join the rotation, and the new body is plugged in. If it works, great. If it doesn't, another warm body is ordered from HQ. Rinse and repeat.

That’s sad man. I looked at a job with Usap and liked the people there. Thought Usap was one of the better ones. Went with team health instead of private group (with quite a bit of hesitation) because I followed the cardiac case numbers. I’m only a year out, but our group has vetoed potential new hires. I think it speaks to different agreements between private groups and the amcs at the time of buyouts. Someone in here once told me “not all buyouts are equal, everything is negotiable”

 

[anes121508]

The myth that all hours are of equal value is BS that is perpetuated by AMC’s and the weaklings that sold out their practices. They want you to invest sweat equity in something that no longer has any value. Let them talk with their wallets and not lip service.

“The greatest trick the devil pulled was convincing the world he didn’t exist (and that all hours are equal so you’re just being a lazy millennial )”

A dollar/hr rate goes for weekend call and vacation weeks....those that have been around the block look to sell, especially to the new guy..... ....I bet you can imagine what our weekend call or vacation rate looks like

 

[BLADEMDA]

Are you saying 24 hr Saturday call is 200*24 + 2500? Or 2500 for call + 200 * hour worked? I would think later, or most people would be hopping on Saturday calls.

How do you “assess” what the hourly rate should be? When looking for a full time gig? Take the market rate?

Thanks.

For "in house" call at a Level 1 or Level 2 center there is an hourly base rate plus weekend incentive. For example, at a level 1 center the incentive could be $2,000 plus $225 x 24 hours. The incentive pay is the differential for the weekends and this number varies depending on the day. A Friday night may only be worth $600 for the shift plus the usual rate. Or, Sunday could be $1500 plus the base rate of $225 x 24.

My point is that at busy facilities locums do get a shift differential and you can factor that into your AMC job based on the number of weekend calls (if in house).