Locums; kick ass or lick butt?

Discussion in 'Anesthesiology' started by Pooh & Annie, Aug 7, 2006.

  1. Pooh & Annie

    Pooh & Annie Member
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    Locums to me had always seemed like a crappy way to go. You end up places where you don't know anybody, getting all the lamest cases. And if you have a family already, forget it.
    But I'm starting to get the idea that for someone fresh out of residency hoping to bank some good cash and work a lot of crappy hours early, it could be the perfect choice. Is this true? Does the freelance aspect make dealing with taxes a pain that's not worth the trouble? Or can you find a guy pretty easily to take care of the numbers while you rake in the hours and hopefully, the dough?
     
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  3. supahfresh

    supahfresh un paradis du gangster
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    yeah, i want to hear about some locums stories.
     
  4. The_Sensei

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    Got a buddy working in the Washington, DC area making $1500/8 hour shift and lots of OT at the rate of $225/hr. He loves it.......single guy, though.
     
  5. norgeringerike

    norgeringerike Junior Member
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    I am also interested to hear an answer from the more senior members of this forum. I once attended a lecture by a chairman of an anesthesia department. It was basically career advice for the CA-3's. His opinion was that locums was bad if you are planning on applying for a competetive job in the future because the partners may question the applicants ability to stay in once place and hold a long term job down. Any agreements or disagreements on this??
     
  6. medstudent99

    medstudent99 Member
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    locum tenems sounds like so much fun, i am definitly interested in that...hawaii! asia! sounds awesome...if ur not married i mean ur only young once.
     
  7. soon2bdoc2003

    soon2bdoc2003 Senior Member
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    My sentiments exactly. I think I am definitely set on doing a year or 2 of locums before settling down. For now I am investing in a handful of licenses so i can spend some time in a place before making a long term commitment. I mean just take a good look at your academic department and decide if want to work with a bunch like that for the next 5+ years. All I need now is a ferrari dealership that will let me buy a car with 0 down payment and a set of that nice ferrari fitted luggage.
     
  8. Laryngospasm

    Laryngospasm Trench Dog
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    That wont be a problem, theyll just charge you 10% on the remaining 250K$ that you can get an f430 for :p
     
  9. dhb

    dhb Member
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    Seems like those locums are traveling and making to much dough to post on this forum :laugh:
    i'd like to here about their experience too...
     
  10. militarymd

    militarymd SDN Angel
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    For you newbies....this may sound like a lot of money, but it is not. Any good job pays this and MORE.

    The ONLY benefit in LTs....is the opportunity to travel....unfortunately, what most people don't tell you is that most places you go are crappy.

    From my Navy experience...the Navy tells you to join up and see the world....what they don't tell you is that over 70% of the world is covered with salt water.
     
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  11. The_Sensei

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    Problem is there aren't that many GOOD jobs; much more prevalent are the locums gigs where you're makin' this kind of cash....
     
  12. ketamine

    ketamine Junior Member
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    The_Sensei is right; “ Problem is there aren't that many GOOD jobs; much more prevalent are the locums gigs where you're makin' this kind of cash....”

    $1500 a day is 375K per year without taking any call or working more than 8 hours per day. In at 0700 out at 1500.

    With decent jobs hard to find. You will not be able to match that kind of income unless you get awarded the anesthesia contract. Yes some anesthesia management company liar will promise that kind of income, “partnership income from day one” but will be paid thru the imaginary bonus plan. I.E. work for 6 month to a year at 150K per year and be fired for demanding to be paid your bonus.
    OR You could slave away (80 hour per week at 150K) for two to five years to make partner, then be fired just before you make partner to be replaced by a new graduate or learn that the group is loosing money and partner make little or nothing.

    Yes working locum has problems. I have talked to a number of employers who have looked at the dozen plus location that I have worked and said they don’t hire locums doctors since they are too unstable. I attribute that to employers desire to employ for New graduates or MDA the will not stick up for their rights, who will work 24/7 for very low wages for the lie that they will make partner or get a non existent bonus.
    With locums you know what you will get paid you work 12 hour you get 12 hours of pay two week later not a lie about a bonus at the end of the year. I have been never lied to by locums agencies about my pay or worked call or extra hours for nothing something that has happened regularly at every permanent job I have had.
     
  13. militarymd

    militarymd SDN Angel
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    Take away the costs of benefits and vacation, that great paying LT job salary just dropped to 250,000.....

    Add in the fact that the LT guy is the butt boy that gets all the crap and none of the benefits of working at a hospital....the "value" of that 250,000 just dropped some more.
     
  14. Laryngospasm

    Laryngospasm Trench Dog
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    I agree after vacation and weekend days I will only work about 200 days a year. I get malpractice, health, dental, 40k in a retirement plan, vested immediately, cme time etc. My salary is much higher than it would be at that locums salary. And did anybody mention that with the AMT one of the only deductions that we are guaranteed is the home mortgage interest deduction? So you will still likely end up buying a home somewhere for a tax shelter, might as well be where you go home to at night. Hate to be paying for a 400-500K home and going back to a hotel or a apartment at night.
     
  15. ketamine

    ketamine Junior Member
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    Originally Posted by militarymd
    Take away the costs of benefits and vacation, that great paying LT job salary just dropped to 250,000.....

    250K + benefits equals 375K, sound like a lie an anesthesia management company liar would say to you after working for a year without getting the imaginary bonus payment.
    Exclusive of retirement and malpractice, even the best anesthesia group’s benefits plan is only worth 10K max. Malpractice is almost uniformly paid by the locums agency while the majority of contracts and offers I have seen for permeant employment attempt to dump the tail on you or force you to get your next employer to cover the cost of a tail.
    Your 40k retirement is most likely a lie; I have seen several contracts where if you read the language carefully you will see the retirement money is far from guaranteed. I have talked to a dozen or more different anesthesiologist in several different groups who told me how their employers stole their retirement money. Until that money is in an account that only you and your banker or broker control it is just another empty promise. Something as lucrative as Retirement money is just too much for the anesthesia management company liars to pass up.
    Yes locums do not get paid vacation but if you take all of the call time and the hours after 1500 you are forced to work most permanent jobs quickly adds up. So if you get 8 weeks vacation but work 60 hrs per week you are actual working the equivalent of 66 weeks per year 44 * 1.5 = 66wks. So as a locum to make the same 375K working the same 60 per week you would need only to work 36 weeks and could take the remaining 16 week off.
    Locums get paid 1099 income so if you are wise enough to form a corporation and pretend to reside in a no state income tax state i.e. (NH,TN,FL,TX,ND,WY, WA,NV,AK) you can take advantage of the tax laws that are more favorable to businesses and create a benefits plan that is far better than what you will find anywhere else. You can structure you income and benefits to avoid the AMT. Without the risk of being tied to an expensive house, I do not own a house and have not rented an apartment for over two years. I seldom drive my own car, Why was money on unnecessary things that the locums agency will provide.
     
  16. militarymd

    militarymd SDN Angel
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    Ket,

    You sound like one bitter fella who is not able to find a good job..when they are all around to be found...Why is that?
     
  17. Laryngospasm

    Laryngospasm Trench Dog
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    Its a lot more than 250k, a lot more than 8 weeks vacation, the retirement is in the contract, and I like having a house to come home to ;)
     
  18. johankriek

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    because it sounds like he doesnt wanna be chumped..

    only a "chump" would take a job that doesnt specify the exact hours worked... and the exact amount of calls taken.. If more calls taken means more money... YOu have to understand something.. somebody is making money on you.. if its not the insurance company it is the anesthesia group hiring you.. if its not the anesthesia group its the hospital.. I sleep much much better at night as an independent contractor.. Its tough to stomach the whole 3 years to partnership thing.. very tough... Never get into an arrangement like this. MOreover, when the crnas make an arrangement.. anything over 40 hours... they get paid overtime like 120 dollars an hour.. so why shouldnt you demand more money for anything over 40 hours..

    it sounds like ketamine was trying to emphasize.. you make whatever you work... period..as a locum if you work one thousand hours a week.. you get paid for one thousand hours a week. hard to be taken for a sucka . if you get into a groups situtation as their employee.... they will make you do all this stuff stay til 6p m daily.. take weekend call.. and you are not making anything extra.. that is ridiculous..

    there are a lot of jobs out there... but they are BS jobs.. believe me....
     
  19. Laryngospasm

    Laryngospasm Trench Dog
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    So you believe that all jobs that are not LT are BS? My job is by the hour, you get paid for what you work for your information, is that BS? If my group wanted to screw me and give me every saturday call for a year then I would just make 3 times every other group member.
     
  20. UTSouthwestern

    UTSouthwestern 1K Member
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    Fortunately, the reality is that there ARE a lot of good groups out there AND locums can be both profitable and enjoyable in the right circumstances and to the right people.

    You have choices.

    Are there groups that abuse associates? Yes. Are there ****aay locums jobs? Yes. Whichever situation you get into, you need to be sure that you are getting treated fairly and that you are comfortable with the particular work and locale you are signing up for.

    Several of my friends are working locums currently and they have all had a 50/50 experience with the locations (old equipment, old drugs, VERY slow surgeons) and reimbursement (anywhere from 17-52K/month). The case types? Don't even begin to ask about it. At the same time, they enjoyed travelling to locales they would have never considered living in (New Mexico, Nebraska, North Dakota, Washington state, etc.) and they've taken several months off at a time. One is now a part time professional poker player.

    At the same time, I and several of my classmates have joined groups and none of us has complained about being abused by the work load or call schedule. Two and three year partnership tracks are the theme for us but the money has been almost as good as the locums guys and the partnership money will be better. We're all settled with families and homes so this works for us better than travelling for locums. The one distinct advantage I think we enjoy over our locums classmates is the fact that we have each picked groups that cover cases that we like to cover.

    Bottom line once again is that you have choices.
     
  21. militarymd

    militarymd SDN Angel
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    I 'm a owner of a group...I hire folks...no one is complaining....and I'm willing to bet all the folks who work for me make more than you and have more time off than you...wanna compare notes via PM?
     
  22. johankriek

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    no i dont believe that all jobs that are not locum tenens is bs. just most of them.. I believe if you dont get paid for everything you do.. it is bs.. In other words, if you accept a salary from a group... for lets say 200k.... and they dont specify the amount of time or cases you do for that 200k .. than thats a crap job.. It might be at the hospital that you want.. but you are being taken for a ride... They will make you take 5 calls one month 7 calls the next 8 the next.... with no rhyme or reason.. make you stay til 6 or7.. all in the name of taking it for the team... thats BS.... you are not a resident anymore.. you are an attending and demand to be paid what you are worth... this will get old.. you will be resentful and it will show.. and you will never make partner... you(laryngospasm) are in a hourly situation.. nobody can hurt you... if you work a thousand hours.. you get paid for a thousand hours.. period.. I am in a fee for service situation out west.. whatever i do i get paid for it.. I dont have 6 guys who are senior to me making bread off of my hard labor.. to the tune of like 2-300K per year.. wake up.. talk to people... the crnas negotiate that every hour after 40 hours they get over time.... im sorry if i hurt peoples feelings..
     
  23. ketamine

    ketamine Junior Member
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    “I believe if you don’t get paid for everything you do.. it is BS..” – johankriek


    Good jobs are hard to find. Look at gaswork or talk to any recruiter and 80% of the jobs you hear about are B.S. where you are going to get screwed. Good jobs where you work for straight hourly income or get to bill for your own cases are rare. Most jobs force you to take call and work late for little or no extra compensation.

    All I want to is to get paid fairly for the work I do. I do not care weather it is Locums or Permanent. If you take call or stay late you should be rewarded, with additional pay in your next pay check and not just in the form of and empty promise of partnership or the promise of an imaginary bonus in 12 months. With locums that is not an issue but with every permanent job I have had that is a radical Idea whose mere mention could get me fired or placed on the non partner tract.

    The other problem I have with permeant jobs is the problem of deferred compensation is ripe for abuse. The employers of Anesthesiologists know that it cost about 100K to sue someone so they fee free to steal 100K per employee with little fear of reprisal.

    You could have negotiated the best contract in the world but when your employer decides to steal your imaginary bonus and your 40K/ per year retirement plan you will have very little chance of getting any of it back. The most I have ever been owed by a locums agency at any given time is a month’s pay.

    Locums contract are relatively straight forward a page or two at most not 20 plus pages that I routinely see for permeant employment. The longer the contract the more difficult it will be to enforce and the more ways and employer can avoid paying you the money you deserve.
     
  24. militarymd

    militarymd SDN Angel
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    Dudes,


    ket and joh.....what's going on here? Seems most people are happy with their jobs....I'm an employer....all my people are happy and not going anywhere.

    The rest of the attendings on here are happy with their situation....and then we have the 2 of you....

    Bitter....been screwed....expecting to get screwed.....

    What's up?

    Tell us more about yourselves.
     
  25. militarymd

    militarymd SDN Angel
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    Getting paid by the hour is not getting paid for your work.

    Physicians in general do not earn an hourly wage. We generate revenue by billing patients, insurance companies, and other 3rd parties.

    Sooo, we only generate money/revenue when we actually do clinical work as defined by cpt/rvu/icd codes or whatever.

    As an anesthesiologist, if you are getting paid on an hourly basis...meaning essentially like a nurse.....based on attendance...what it means is that someone is MAKING money off your back.

    Ask yourself this...where is the money coming from per hour of attendance? Insurance company? Hospital? patients' bank accounts? It doesn't matter.

    Where ever the revenue is coming from, the LT company is taking a cut before paying you...otherwise the LT company cannot exist.

    So, working as an LT with the LT company as the middle man.....by definition, you are getting SCREWED.....it 's just that you are getting screwed in a way that you don't recognize....by a businessmen who know nothing about your skills and training....and not other anesthesiologists.

    I guess I would rather be screwed by businessmen and not by my peers.
     
  26. johankriek

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    I am complete fee for service.. I do not get paid hourly. I am certain most phycicians would opt this route.. I agree with you when you say we are paid by insurance companies.. But thats not where it ends.. If my few hospitals want me to stay "in house" its gonna cost them extra. not the insurance company.

    You get screwed less when working hourly because you negotiated a fair rate.. and wil be paid as long as you are there working.. time is money.. if you work a thousand hours you get paid a thousand hours.. They cannot hurt you.. the more you work the more you get paid...... believe me. out there working for these groups.. resentment can b uild pretty fast.. if you find that you are working for these money greedy (insert choice word here).
    My first job i got out in less than 3 months when they put me on call an unfair amount of times.. more weekends then most.. I exercised my 6 week clause... then i locummed for 2 years.. then i came out here...... locumming was one of the most rewarding experiences for me.. and the loocums company did make money off of you.. maybe 3 hundred dollars.. that i could live with.. not being an employee of some group who is going to make money off of you..
     
  27. johankriek

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    I am happy with my job.. I am. but I know whats out there. plus.. i know at least 10 docs who are not happy with their situation and i always tell them to come by me and do what i do..

    how did YOU become an employer? are you just the boss.. are you a hospital employee???
     
  28. militarymd

    militarymd SDN Angel
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    I was offered and accepted part ownership of an anesthesia group...which contracts with a hospital to provide physcian anesthesia services. I'm an owner of the corporation..which employs physicians, including myself..to provide anesthesia services.

    We are not employed by the hospital.....We actually approached the hospital to employ us (higher more stable ..ie not case dependent guaranteed salary), but the hospital declined.

    We bill patients and other payors for our services.
     
  29. johankriek

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    how were you offered part ownership of a group? are you part owner or own the group??/
     
  30. militarymd

    militarymd SDN Angel
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    It was in the contract.

    and part owner.
     
  31. johankriek

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    not many people get offered part owner of a group right off the bat
     
  32. militarymd

    militarymd SDN Angel
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    It wasn't right off the bat....it was 30 days...I've shortened it......The new people I'm recruiting now are offered ownership in 7 days....

    However, in the next year or so...we'll probably lengthen the time period, but pay and vacation and call will always be the same.

    My/our philosophy is we bring you on only if we want you to be an owner....If a person is not offered ownership within 30 days, that person will likely be let go as soon as a suitable replacement is identified.

    Group jobs are fine....you just have to read the contract.....and research your potential partners.....
     
  33. johankriek

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    well then you have a fair group really.... ownership in 7 days.. nice... thats the way it should be really..
     
  34. militarymd

    militarymd SDN Angel
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    i agree...I think a lot of groups out there are out to screw people.....BUT...

    sometimes it is VERY hard to find the right people you want to be partners........the dynamics of how a new person interacts with the rest of the group can sometime be unpredictable...and won't be an issue until a few months into the relationship...hence the need for prolonged "partnership" tracks.


    I'm sticking with folks with similar backgrounds...

    1) ex-military
    2) bigots
    3) anti-AA gunners
    4) likes liquor
    5) likes fast cars/bikes
    6) shoots guns
    7) hard working.
    8) chauvinist pigs
     
  35. bronchospasm

    bronchospasm Junior Member
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    Hi All

    I have a job offer and need you guy's opinion. Let me know what you think.
    Here it is

    Independent contractor -- 1099
    Pay own health, malpractice, disability, retirement
    $ 1300 for 0700 -- 1500 hrs
    $ 225 for every hour after 1500 hrs
    $ 250 for weeday call
    $ 800 for weekend call (2 hour guarantee)
    7 weeks vacation allowed but no pay if you dont work
    No termination clause in contract with hospital

    Basicaly make 320 - 330 K without any overtime. Overtime make $225 and hour after 1500 hrs whether you are on call or not.

    Thank you
     
  36. jetproppilot

    jetproppilot Turboprop Driver
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    HAHAHAHAHHAHAHAHAHAHAHAHAHAHAHA

    OK, before the ^&ck-you-Mil posts start, realize Chi is smarter than all of us and has posted this somewhat tongue-in-cheek.

    That being said, I routinely order my margaritas with an extra shot of Don Julio, with some Cointreau swirled on top. On the rocks, of course. With salt.

    Uhhh, Sir, bring me another, please. Yeah, this one isn't gone. But it'll be in a minute.

    I've driven a Hayabusa at 150 mph on I-49.

    If someone breaks into my house and gets past my 110 pound Great Pyrreneese, they're gonna be staring down the barrel of my .45 Glock. Complete with the red-dot on said-intruder's-dome.

    I can outwork any of you dudes out there, and I can place an epidural/IJ/subclavian/axillary block/fem-sci/A-line/SWAN faster than Dr Tinker/Miller.

    But I ain't a bigot.

    Nope, not ex-military.

    The AA thing, well, I think its a crock.

    Not a chauvinist. More women in my group than men (although all the MDs are XY). I live in an estrogen world. Not so bad. Just gotta know how to handle it.

    Whatcha think, Hung? Am I worthy? :laugh:
     
  37. militarymd

    militarymd SDN Angel
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    Close enough.:thumbup:
     
  38. militarymd

    militarymd SDN Angel
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    That means you get no notice.....otherwise..not too bad.
     
  39. Locumsreview

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    I did locums anesthesia for 2 years, fulltime, did numerous assmts in numerous states, WA, CO, NC, CA, PA. I really had a good time doing it. The biggest drag about it got to be the airports, TSA is really irritating. I had mostly good experiences, with a few bad ones. As a result, i started a website, locumsreview.com where providers of all types can post reviews of hospitals and agencies. There is so much locum tenens work out there now that we shouldn't have to go to crappy hospitals.

    Most of the agencies I worked with were good. Daniel and Yeager was the best, though their people have real deep Southern accents, and sometimes have a hard time understanding them. My biggest issue was with the hospitals. I did a great assignment in Tacoma, WA. I would have joined the group if my wife wasn't still in fellowship. Hospitals need locums for different reasons. The people in Tacoma need locums because the hospital admin screwed them and a bunch of their people left. The hospital and area were great. Other places need locums because the area sucks. I went to Porterville, CA which is a nasty town, probably the meth capital of the world. The hospital was OK and the staff were very nice, but I would never want to settle down there, and clearly, nobody else did either. So, they needed locums.

    As far as money, locums is paying about $1200 for 8 hours now, with 175 hr overtime and you get money for carrying the beeper. I made about $360,000 in 2005 doing full time locums, though I did not do much call. I only took about 4 weekends of call the whole year and none during the week. I took about 3 weeks vacation. You can make way more than that if you do overtime. I did an assignment the next year where I had to do in house OB call and they paid me $175/hr for 24 hrs. I put in mabye 3 epidurals during that time and slept and surfed the internet the rest of the time. Not too shabby.
     

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