Locums heating up?

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emergentmd

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My old locums contacts that dried up right before Covid started have been ramping up with calls/emails for the past 6 months. This past month, I have gotten called/emails almost every other day for Locums coverage.

Is there suddenly a shortage of docs, ER docs leaving the hospitals, or what? Places I used to Locums with are super short and offering regular bonuses again. Even my old full time gig that was always easy to staff is having a hard time finding coverage and taking on PRN docs which never happened before.

I am just curious what is causing the sudden need for coverage.
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Yeah, same thing happening to me. Did something happen in the 'market' for ER Docs?
 
emergentmd said:
My old locums contacts that dried up right before Covid started have been ramping up with calls/emails for the past 6 months. This past month, I have gotten called/emails almost every other day for Locums coverage.

Is there suddenly a shortage of docs, ER docs leaving the hospitals, or what? Places I used to Locums with are super short and offering regular bonuses again. Even my old full time gig that was always easy to staff is having a hard time finding coverage and taking on PRN docs which never happened before.

I am just curious what is causing the sudden need for coverage.
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The local HCA near me has been an absolute dumpster fire for the last few months, with the regional medical director emailing us for the next month, at the end of the preceding month, saying there are 35+ open shifts. Bonuses for all. They did hire some new docs, so less available shifts this month.

But yes, I'm seeing open shifts at a number of places, not just HCA. I think it's a combination of physician burnout, and nursing shortages accelerating it even more.

This isn't going to last, in case anyone forgot about the ever increasing surplus of EPs. That said, the job is tough, and the amount of burnout could keep the turnover high to create some sort of steady state with the job market, in a very grim, service industry/McJobs kind of way.
 
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I don't see how people don't understand this is expected correction from not hiring through COVID and people returning to the ED with their complete nonsense. Within the next 2-3 cycles of THREE THOUSAND residents graduating each year, it won't be long before everything is dried up.
 
I've gotten more calls / emails lately. Honestly, I'm not working for less than 1,000 / hr in your ****hole ED.

At my home site, morale is low, and the beatings continue. Castrated CME, frozen raises, continual "do more with less" attitude. People are unwilling to pick up extra, because the incentive bonus sucks. As a result, when people are out with COVID, etc. there are schedule holes which admin can't seem to figure out the reason why people don't want to fill them (clue: they want more money).
 
GonnaBeADoc2222 said:
I've gotten more calls / emails lately. Honestly, I'm not working for less than 1,000 / hr in your ****hole ED.

At my home site, morale is low, and the beatings continue. Castrated CME, frozen raises, continual "do more with less" attitude. People are unwilling to pick up extra, because the incentive bonus sucks. As a result, when people are out with COVID, etc. there are schedule holes which admin can't seem to figure out the reason why people don't want to fill them (clue: they want more money).
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The hourly rate where I'm currently doing per diem is fairly low considering the volume BUT when there is a call out, they offer $450/hr and surprise-surprise it gets filled super quickly. SDG
 
I brought this up b/c met a guy who worked at a Locums gig I did years ago that was paying $325/hr plus double pay bonus so $650/hr. He is telling me most docs now just are prn, do min shifts, and just pick up shifts. New docs they bring on go PRN or leave after 6 months.

This place was literally the worse ER I ever worked and this is saying alot. I don't think I would do it for $1k/hr right now.
 
Rekt said:
I don't see how people don't understand this is expected correction from not hiring through COVID and people returning to the ED with their complete nonsense. Within the next 2-3 cycles of THREE THOUSAND residents graduating each year, it won't be long before everything is dried up.
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Yeah, anyone who doesn't realize that whatever rebound currently present is temporary is a *****. It's good to hear that places are offering shift bonuses again though. Seems like there was a year or so where I was only seeing laughably low rates.
 
turkeyjerky said:
Yeah, anyone who doesn't realize that whatever rebound currently present is temporary is a *****. It's good to hear that places are offering shift bonuses again though. Seems like there was a year or so where I was only seeing laughably low rates.
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Dead cat bounce.
 
A lot of older docs are bowing out, just not worth it anymore, they've sold their practices to Envision, sick of the corporate metrics.

Combine that with increased volumes, lots of viral URI BS and noone can get in with a PCP/specialist, and you have an increased demand and smaller supply. I think the supply will pick up fast over the next decade with the upcoming surplus.

If you're a new grade or transitioning to a new assignment, you should work the absolute min (0.5 FTE or less) and then leave 1-2 weeks in your schedule to pick up shifts or do locums at another site. I know a guy out of residency who signed up for 20 ten hour shifts/mo with a site uner TeamHealth. He's a *****. His hourly rate is $195/hr. I'm at $310 being locums. Ridiculous.

You must always...know your worth!
 
I never understand why docs sign up for more than 120/month. It sucks when you are committed to a place, expected to do more, expected to pick up extra shift, expected to keep the waiting room empty, expected to be on committees, expected to meet all the metrics, expected to buddy up to the staff, expected to do weekends/holidays for base, expected to do nights just to look at the locum guy come in making 2x what you make without ever reading a CMG email/attend meeting/meet metrics.

I made more working 5 shifts than some made doing 12 without dealing with all the bull crap. I remember the director pounding on metrics and I just shrugged.
 
I'm definitely getting more locums calls/texts/emails but they all remain at paltry rates ~225/hr. My highest paying shifts are actually within my hospital system an hour away. They have regular PRN shifts for 400-500/hr but only a few per month and you have to snap them up quickly. There is poor staffing at this particular site, so there's usually a handful of shifts/mo for that rate.
 
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The problem with my site is that so many docs have such extravagant lifestyles that they are terrified to negotiate / go PRN / collectively hold out for larger shift bonuses. 3+ kids w ridiculous hobbies, private schools, huge houses in VHCOL areas, Teslas, supporting adult children who have their own spoiled kids, etc etc. Unfortunately for me I work in a state with a **** EM market and am stuck here for familial reasons.
 
I've definitely gotten more locums offers this summer but the overwhelming majority are for crappy pay.

There's very few places currently offering 250/hr+ rates which doesn't make it worth the hassle in my opinion.
 
The thng is...i don't really need the money.

I have one child that I am saving up fot a state school college education for.

I take really nice but reasonable vacations.

Loans are paid off.

Why would I work extra for less than 1k/hr when I can paddleboard, workout, play with my kid, etc etc
 
yeah the gym thing is super important for me, i've turned into a full time gym rat, and I love it. That's why I won't pickup more than 2 of these shifts per month, with bonuses
 
bravotwozero said:
yeah the gym thing is super important for me, i've turned into a full time gym rat, and I love it. That's why I won't pickup more than 2 of these shifts per month, with bonuses
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Bro? Bro.

Today is push day. See you at the gym.
 
I'm getting 500/hr offers but that's like for super last-minute coverage. There's really no incentive anymore for an EM doc to sign up for a full-time job. Unless that job pays $350/hr and it's in a super competitive location.

Your biggest leverage as an EM doc is your ability to walk. Once you're tethered to a job/location, there goes your leverage.
 
Kryptocoin said:
I'm getting 500/hr offers but that's like for super last-minute coverage. There's really no incentive anymore for an EM doc to sign up for a full-time job. Unless that job pays $350/hr and it's in a super competitive location.

Your biggest leverage as an EM doc is your ability to walk. Once you're tethered to a job/location, there goes your leverage.
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This is the truth. I guess if you are starting out and need guaranteed $225/hr to pay debt then makes sense. But otherwise I would do part time and pick up FSER/Locums/urgent care.
 
emergentmd said:
This is the truth. I guess if you are starting out and need guaranteed $225/hr to pay debt then makes sense. But otherwise I would do part time and pick up FSER/Locums/urgent care.
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Back in the days of SDG, when loyalty and seniority meant something, I can see why sticking it out for the long haul made sense. Due process, better staffing model, good pay and benefits, and respect... are all essential hallmarks of keeping employees happy. Until I find a job that offer ALL of that, I'm gonna stick with PT at multiple sites. I even get to pick my own hours.

My last job was offering a $50k sign-on bonus for a full-time 3-year contract. No takers yet. Maybe the market is getting smarter.
 
17k/yr divided by 400K income is 4%. Or put it another way, that is working 3 decent locums shifts. Hard no to that.
 
I think the current locums surge is transient and I'd be reticent to forego a FT job to gamble on scalping unfilled shifts. These things were transient 10 years ago and we didn't even have the anticipated surplus of ED docs. Locally, we had a greater metro area firefighter team that got paid top dollar, then experienced an influx of docs to the area and the CMG disbanded the firefighters. Lately we've seen an increased need with more and more open shifts coming available for 1.5-2.5 PRN hourly rates (local docs like myself taking advantage..) but it will definitely go away again with time especially with the impending job market saturation.

The problem with relying on PRN is that it's always feast or famine and all it takes is a month out of work to obliterate any gains over a FTE job. FTE jobs give you security. If there's regular availability for PRN multiple rate shifts then you could gamble and negotiate for 100-120h FTE and scalp the rest. The only problem is that once the PRN dries up (and it will), it can be difficult to find extra hours locally unless you find 1-2 colleagues who would prefer to work less than 120h monthly but can't contract for that, and there's generally always one or two of those in every group.

Speaking as an ex scheduler, nobody likes to rely on PRN docs to fill shifts on a regular basis as they have no real skin in the game and are sporadic with their availability. Most groups are going to want to minimize PRN as much as possible to guarantee reliable coverage and minimize malpractice costs, etc..
 
Fully agree with the gist of the group, something of a dead cat bounce or at least just a return of semi-normal needs in some places. In my region locums never fully died, but the super premium shifts dried up and it was hard to find a LOT of work for good money (say >$250/hr). The work is coming back a bit, but in the places you expect for the reasons you expect… retirement, burnout, people realizing 16/shifts a month forever is BS and moving down to 10-12.

I agree this is likely transient for the next handful of years at most until the incredible crops of new residents destroy this need.
 
GonnaBeADoc2222 said:
The problem with my site is that so many docs have such extravagant lifestyles that they are terrified to negotiate / go PRN / collectively hold out for larger shift bonuses. 3+ kids w ridiculous hobbies, private schools, huge houses in VHCOL areas, Teslas, supporting adult children who have their own spoiled kids, etc etc. Unfortunately for me I work in a state with a **** EM market and am stuck here for familial reasons.
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This is the rub. People who have financially been wise can work for less. Plenty of people live a lifestyle that requires 350-400k in income. When that’s the case you’ll work for crappy pay. Also the new grads will be loading up on the sub $200/hr work. Like the above post. 20 shifts a month. They will work 2200 hours a year and destroy the pay. For them that’s 400k a year and that’s all they care about. It’s game over my friends. I have said it before. By 2026 it will be a total wasteland. Pay will drop in many places to $160/hr and like roaches we will be climbing over one another for that money.
I’ve planned accordingly And you should too.
 
EctopicFetus said:
This is the rub. People who have financially been wise can work for less. Plenty of people live a lifestyle that requires 350-400k in income. When that’s the case you’ll work for crappy pay. Also the new grads will be loading up on the sub $200/hr work. Like the above post. 20 shifts a month. They will work 2200 hours a year and destroy the pay. For them that’s 400k a year and that’s all they care about. It’s game over my friends. I have said it before. By 2026 it will be a total wasteland. Pay will drop in many places to $160/hr and like roaches we will be climbing over one another for that money.
I’ve planned accordingly And you should too.
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Let’s push this out to 2028 or 2030 can we? Thanks!
 
Janders said:
Let’s push this out to 2028 or 2030 can we? Thanks!
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Lol. Or never would be ideal. Issue is if we have 10k too many epbs by 2030 the jobs not in the middle of nowhere will be full in practice sooner. I’m calling 2026. Keep in mind getting a job in a us city right now is already tough.
 
The trick to PT/PRN is to be credentialed at sites that always have need. A lot of CMGs have sites that are difficult to staff. These tend to be an hour or so from a major airport/city. CMGs would rather pay you the extra $$ and than some locum company.

I've been PT/PRN for last 4yrs making >300/hr on average. I don't see myself ever going back to FT unless it's a unicorn job.
 
EctopicFetus said:
This is the rub. People who have financially been wise can work for less. Plenty of people live a lifestyle that requires 350-400k in income. When that’s the case you’ll work for crappy pay. Also the new grads will be loading up on the sub $200/hr work. Like the above post. 20 shifts a month. They will work 2200 hours a year and destroy the pay. For them that’s 400k a year and that’s all they care about. It’s game over my friends. I have said it before. By 2026 it will be a total wasteland. Pay will drop in many places to $160/hr and like roaches we will be climbing over one another for that money.
I’ve planned accordingly And you should too.
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All medical students interested in EM, residents currently in EM, and newly minted EM attendings should read this.

Then read it again.

I think it's an extremely accurate prediction of the market forces at play.
 
EctopicFetus said:
This is the rub. People who have financially been wise can work for less. Plenty of people live a lifestyle that requires 350-400k in income. When that’s the case you’ll work for crappy pay. Also the new grads will be loading up on the sub $200/hr work. Like the above post. 20 shifts a month. They will work 2200 hours a year and destroy the pay. For them that’s 400k a year and that’s all they care about. It’s game over my friends. I have said it before. By 2026 it will be a total wasteland. Pay will drop in many places to $160/hr and like roaches we will be climbing over one another for that money.
I’ve planned accordingly And you should too.
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Recent grads, take heed of the bolded. Grab prn work now and kill your loans so you're not trapped when the roof caves in on EM. Do not take a rate <250/hr (or 350/hr if the site sucks).
 
What’s with all the locums on this thread? Why not just work for a good SDG and get your $225-300/hr plus 20-30% end of year bonus, plus job security, guaranteed hours, ownership in your practice and the chance to improve things you don’t like, and less commute time?

Sure- there is no such thing as perfect job security in EM….but it can be a reasonable bet. And likely a better one than hoping the locums rates stay high and that you aren’t working in a dumpster fire that burns you out real quick?
 
Mbekweni said:
What’s with all the locums on this thread? Why not just work for a good SDG and get your $225-300/hr plus 20-30% end of year bonus, plus job security, guaranteed hours, ownership in your practice and the chance to improve things you don’t like, and less commute time?

Sure- there is no such thing as perfect job security in EM….but it can be a reasonable bet. And likely a better one than hoping the locums rates stay high and that you aren’t working in a dumpster fire that burns you out real quick?
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Because those jobs are vanishingly rare.
Because those jobs are often predatory, with unclear circumstances regarding "partnership requirements".
Because those jobs often have their contracts turn into vapor.
Because those jobs may not be anywhere near where you want to live.


Seriously, I interviewed at the "good SDG" in my region. It was clear :20-30 minutes in that I was being lied to.
I've said this on here before.
 
EctopicFetus said:
This is the rub. People who have financially been wise can work for less. Plenty of people live a lifestyle that requires 350-400k in income. When that’s the case you’ll work for crappy pay. Also the new grads will be loading up on the sub $200/hr work. Like the above post. 20 shifts a month. They will work 2200 hours a year and destroy the pay. For them that’s 400k a year and that’s all they care about. It’s game over my friends. I have said it before. By 2026 it will be a total wasteland. Pay will drop in many places to $160/hr and like roaches we will be climbing over one another for that money.
I’ve planned accordingly And you should too.
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Totally agree. I drove an hour to fill a shift today for 400/hr and relieved an ABEM nocturnist who took a FTE job at this single coverage remote shop during COVID for bad pay because there was paucity of jobs a year ago. She didn’t care… needed to earn X dollars and has been slugging it away at this shop since. Seems very well trained. I couldn’t help but remember how rare it was for this particular site to get ABEM EM docs for any dollar amount 10 years ago when I was PRN there…
 
Groove said:
I think the current locums surge is transient and I'd be reticent to forego a FT job to gamble on scalping unfilled shifts. These things were transient 10 years ago and we didn't even have the anticipated surplus of ED docs. Locally, we had a greater metro area firefighter team that got paid top dollar, then experienced an influx of docs to the area and the CMG disbanded the firefighters. Lately we've seen an increased need with more and more open shifts coming available for 1.5-2.5 PRN hourly rates (local docs like myself taking advantage..) but it will definitely go away again with time especially with the impending job market saturation.

The problem with relying on PRN is that it's always feast or famine and all it takes is a month out of work to obliterate any gains over a FTE job. FTE jobs give you security. If there's regular availability for PRN multiple rate shifts then you could gamble and negotiate for 100-120h FTE and scalp the rest. The only problem is that once the PRN dries up (and it will), it can be difficult to find extra hours locally unless you find 1-2 colleagues who would prefer to work less than 120h monthly but can't contract for that, and there's generally always one or two of those in every group.

Speaking as an ex scheduler, nobody likes to rely on PRN docs to fill shifts on a regular basis as they have no real skin in the game and are sporadic with their availability. Most groups are going to want to minimize PRN as much as possible to guarantee reliable coverage and minimize malpractice costs, etc..
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People in this thread have it backwards. The first thing to go is going to be locums. Let's be realistic. Most physicians are silver spoon type and couldn't imagine slugging life away in some fly over state. Most residents I knew would do anything to go home to their costal city or major city. The future of new grads is snapping up locums in bumble**** Mississippi while they live in Denver or whatever.

Right now a stable FTE SDG or employed gig at 120-130s/hr a month, then picking up PRN, not taking less than 250/hr is the smartest play. Essentially my plan. I'm scheduled for about 130hrs but picking up 4 extra shifts a month >300hr. Destroying my loans asap.
 
Rekt said:
People in this thread have it backwards. The first thing to go is going to be locums. Let's be realistic. Most physicians are silver spoon type and couldn't imagine slugging life away in some fly over state. Most residents I knew would do anything to go home to their costal city or major city. The future of new grads is snapping up locums in bumble**** Mississippi while they live in Denver or whatever.

Right now a stable FTE SDG or employed gig at 120-130s/hr a month, then picking up PRN, not taking less than 250/hr is the smartest play. Essentially my plan. I'm scheduled for about 130hrs but picking up 4 extra shifts a month >300hr. Destroying my loans asap.
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Yep, most of our new grad hires are contracting for 120h and really have no interest in working any more than that. We're getting paid around $260/hr but I have a feeling they would have done it for 200/hr in a heart beat for the convenience. I'm contracted for 140 but picked up enough PRN multiples this month for 170. I'd like to be doing 150 or less but I know from experience that the PRN stuff will dry up soon enough. I just don't want to be stuck at 120h with difficulty getting more hours without having to fly out of town. Although I could pull more as a full time PRN in this area given current need, I can't imagine a more stressful environment worrying if I'll get enough shifts the next month knowing how CMGs plot to get rid of their PRN docs.

I'm really confused with the current locums surge...especially in my area. The only thing I can come up with is the current hospital systems push for ABEM docs in their EDs. That may buy us all some time before salaries plummet and we start feeling the market saturation. I think the IM/FM guys are in a state of paranoia as of late, at least in the metro areas. They are really pushing for ABPS equivalence to ABEM and trying to sell it to local hospital systems as equivalent board certification.
 
Mbekweni said:
What’s with all the locums on this thread? Why not just work for a good SDG and get your $225-300/hr plus 20-30% end of year bonus, plus job security, guaranteed hours, ownership in your practice and the chance to improve things you don’t like, and less commute time?

Sure- there is no such thing as perfect job security in EM….but it can be a reasonable bet. And likely a better one than hoping the locums rates stay high and that you aren’t working in a dumpster fire that burns you out real quick?
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Ah yes the obligatory "just join an SDG" post.
 
I’ve known of several good SDGs over the years in pretty decent locations that are fairly frequently hiring to replace retiring EPs or those leaving for good reasons. I think some of you were just burned once by a predatory SDG or are perhaps geographically limited. Not saying they are super easy to find or available everywhere, but they are out there and a substantially better option in my opinion than the alternative.
 
Mount Asclepius said:
I’ve known of several good SDGs over the years in pretty decent locations that are fairly frequently hiring to replace retiring EPs or those leaving for good reasons. I think some of you were just burned once by a predatory SDG or are perhaps geographically limited. Not saying they are super easy to find or available everywhere, but they are out there and a substantially better option in my opinion than the alternative.
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No one's debating this.

I know of one SDG in my area. An hour away. Work 1600 hrs of sweat equity for non guaranteed partnership after 2.5 yrs. Why would I do this when I can work less hours for more pay now?
 
GonnaBeADoc2222 said:
No one's debating this.

I know of one SDG in my area. An hour away. Work 1600 hrs of sweat equity for non guaranteed partnership after 2.5 yrs. Why would I do this when I can work less hours for more pay now?
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Certainly within the confines of your hour geographical limitation that may be the case. That’s your choice and may be the best decision for you.

However, you can still find SDGs in small to moderate sized cities across the country with 1.5-3 year partnership tracts working reasonable hours/month (100-140) and almost essentially guaranteed partnership assuming you don’t screw it up. The end reward can be $300-400/hour working at a decent job.

I do think the landscape of EM is going to change dramatically over the next 5-10 years. Past success doesn’t guarantee future returns. Now more than ever though signing on for a potentially long term stable job matters when SDGs will be able to increasingly be selective when hiring. Our application list keeps growing with time.

Making a little extra now at the expense of the future may be nearsighted. I recognize that there certainly is the potential to lose out with sweat equity if not making partner. Partner pay though can rival and even beat locums pay. Trying to shoot for a ‘stable’ SDG with long term better income potential is worth the risk over the short term gains of an uncertain locums market and the constant downward pressure on CMG employed positions.
 
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There's also EM docs who don't even know what a real SDG is. I see it all the time on EM doc jobs. They say they're an SDG then it gets clarified they're actually employed by the hospital or a single physician or two holds the entire contract. I've met several recent grads who didn't know what an SDG was or really even what a CMG is. Sad.
 
As an aside, if there are any ABEM docs in the Houston/BCS area who would like to pick up prn shifts at a highly functional FSER (no EMS traffic, no medicare, no medicaid, 90%+ insured) with above avg EM pay without any overlord/metrics, DM me. Never a commitment, pick up a shift if you like. We have some older docs that would like to slow down and we try to be very selective. Just 1099 prn shifts, Occurance made med mal, great EMR.
 
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GatorCHOMPions said:
The hourly rate where I'm currently doing per diem is fairly low considering the volume BUT when there is a call out, they offer $450/hr and surprise-surprise it gets filled super quickly. SDG
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Was cold called today and quoted that rate. He said he couldn't go above $200 unless it was a last minute shift.

ER docs need to stand strong and refuse to work for less than $350/hr for locums.
 
Mount Asclepius said:
Certainly within the confines of your hour geographical limitation that may be the case. That’s your choice and may be the best decision for you.

However, you can still find SDGs in small to moderate sized cities across the country with 1.5-3 year partnership tracts working reasonable hours/month (100-140) and almost essentially guaranteed partnership assuming you don’t screw it up. The end reward can be $300-400/hour working at a decent job.

I do think the landscape of EM is going to change dramatically over the next 5-10 years. Past success doesn’t guarantee future returns. Now more than ever though signing on for a potentially long term stable job matters when SDGs will be able to increasingly be selective when hiring. Our application list keeps growing with time.

Making a little extra now at the expense of the future may be nearsighted. I recognize that there certainly is the potential to lose out with sweat equity if not making partner. Partner pay though can rival and even beat locums pay. Trying to shoot for a ‘stable’ SDG with long term better income potential is worth the risk over the short term gains of an uncertain locums market and the constant downward pressure on CMG employed positions.
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The number of "stable" groups gobbled up by PE...is ever growing. Nothing is sure.
 
miacomet said:
The number of "stable" groups gobbled up by PE...is ever growing. Nothing is sure.
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Hence ‘stable’ and the quotes. Our group has survived for several decades, has received several awards from community and hospital over the years, and with recent market analysis by the hospital coming out very favorable for us despite us being quite profitable. Also know of several other SDGs that have been ‘stable’ for a really long time. Just because some, or even a lot, go under, doesn’t mean it happens for all.
 
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