Locums Market Temp Check

[PainInTheAnes]

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Correct. I like to be in urban places 10-15 from Apple Store with access to gig fiber service. I can’t stand the boonies. Where phone service barely works or 5-10 min from the beach.

Most of the consistent money is all rural areas areas but sometimes rural is only 30-45 min from major city suburbs.

I love the boonies. Patients less demanding, generally more respect and better teamwork. Pros and cons!

 

[PainInTheAnes]

yeah. Lots of docs on the 1099 trail in Florida. My friend only being offered $325hr 1099 at hca

I guess that’s ok. But it’s 1.5 hrs away from his house. So unless there is calls or tons of hours involved. It’s not worth it.

Time and distance for work

Another locums doc only has 4 shifts next month so he’s scrambling.

So if you are 100% 1099. U gotta keep ur foot in the door at multiple places. Plus it helps to not have 2 baby mommas and 5 kids and 3 different homes to pay for …. I’m just trolling my friend he got too many expenses.

Even 325 is workable if you can get hours.

I think availability of hours is the litmus test of the locums market. Places that are nervous for coverage will throw 10s and 12s guaranteed. Places with more consistency will throw 8s. The needs of these places are different.

A marginally higher number is great, but the multiplier is the most importsnt part.

 

[NicholasPavona]

Why do you say that

Because it's true?

 

[Ashers]

All I know is Milwaukee and Wisconsin. Is always looking. Must be crap show there.

They're short, but the hospitals are not willing to work with people who want flexible schedules or flexibility in cases. It doesn't seem like it's changed too much in the last few years aside from Vituity taking over the Ascension anesthesiologists and Aurora basically using Ark for most locums (if only them now).

 

[aneftp]

They're short, but the hospitals are not willing to work with people who want flexible schedules or flexibility in cases. It doesn't seem like it's changed too much in the last few years aside from Vituity taking over the Ascension anesthesiologists and Aurora basically using Ark for most locums (if only them now).

I’m telling everyone
40 hrs a week
20 weeks off
500-550k

Some type of night float system like 5p-10p beeper. That does
The trick

Or 6 (24) hr calls in 2 week period , 26 weeks off 500k

Or let cardiac docs do 7-3 plus beeper plus 26 weeks off.

My buddy who’s in management and familiar with Wisconsin (from management) view point is if they do those schedules than they gotta find people to work the regular days

I told them that’s where the older docs will fill the void 0.5 fte days. Older docs don’t want 1.0fte but will gladly take 0.5fte

U gotta be creative if stuff isn’t working.

Or just pay everyone 700k/10 weeks off/40 hrs

 

[SRYSPAC]

They're short, but the hospitals are not willing to work with people who want flexible schedules or flexibility in cases. It doesn't seem like it's changed too much in the last few years aside from Vituity taking over the Ascension anesthesiologists and Aurora basically using Ark for most locums (if only them now).

Oh well, sorry admin.

 

[james775]

On an unrelated note, why is credentialing for Locums like pulling teeth? Absolute insane amount of forms and hoops to jump through. That’s with the Locums company doing heavy lifting.

 

[aneftp]

like clockwork. Locums heat check summertime ramping up.

So just be organized and pick and choose. But most people with school age kids want summer time off.

 

[AppTrail]

yeah. Lots of docs on the 1099 trail in Florida. My friend only being offered $325hr 1099 at hca

I guess that’s ok. But it’s 1.5 hrs away from his house. So unless there is calls or tons of hours involved. It’s not worth it.

Time and distance for work

Another locums doc only has 4 shifts next month so he’s scrambling.

So if you are 100% 1099. U gotta keep ur foot in the door at multiple places. Plus it helps to not have 2 baby mommas and 5 kids and 3 different homes to pay for …. I’m just trolling my friend he got too many expenses.

I've been seeing a few of these 17 weeks on, 35 weeks off gigs popping up. If you are 100% locums, I think this is a good hedge against work slowing down. Obviously depends on the pay and workload, but recently I saw 17 weeks, 12hr shifts x7 days (around 1400 hours a year)...can't remember if its 1099 or W2. But these jobs are getting gobbled off fast.

 

[aneftp]

I've been seeing a few of these 17 weeks on, 35 weeks off gigs popping up. If you are 100% locums, I think this is a good hedge against work slowing down. Obviously depends on the pay and workload, but recently I saw 17 weeks, 12hr shifts x7 days (around 1400 hours a year)...can't remember if its 1099 or W2. But these jobs are getting gobbled off fast.

Definitely.

13 weeks off almost becoming the norm.

Places in Florida still pay 450k-500k/8 weeks off (someone post about northern Virginian paying that as well and they thought it was a good job) it’s really having to be available for work 42-44 weeks out of the year. It’s too much of a commitment these days.

The 12 hour shifts x 7 days (17 weeks) is only good for nights. That’s why people are gobbling them up. Usually pays 500k

I wouldn’t want 84 hrs of DAYTIME work for 7 days in a row. That’s brutal. 7a-7p especially Trauma centers where u are running around.

Than the night float doc comes in at 7p-7a (for 17 weeks) and gets to sleep 50% of the time especially on weekends. That’s why everyone younger docs wants those jobs. So they can work elsewhere.

Heck I’m not even young any more. My plan at my new gig is to work 7-3p side gig 1099 or even a w2 prn job I got lined up (super close by just in case I get stuck with overnight case, than roll into beeper call from home 5p-7a at full time w2 job with 20 weeks off when I’m nights float.

I can squeeze 10-15k each week more 1099 income the week I’m doing nights (10 weeks night float)

Plus l leave the 20 weeks wide open to do real 1099 work elsewhere

 

[AppTrail]

Definitely.

13 weeks off almost becoming the norm.

Places in Florida still pay 450k-500k/8 weeks off (someone post about northern Virginian paying that as well and they thought it was a good job) it’s really having to be available for work 42-44 weeks out of the year. It’s too much of a commitment these days.

The 12 hour shifts x 7 days (17 weeks) is only good for nights. That’s why people are gobbling them up. Usually pays 500k

I wouldn’t want 84 hrs of DAYTIME work for 7 days in a row. That’s brutal. 7a-7p especially Trauma centers where u are running around.

Than the night float doc comes in at 7p-7a (for 17 weeks) and gets to sleep 50% of the time especially on weekends. That’s why everyone younger docs wants those jobs. So they can work elsewhere.

Heck I’m not even young any more. My plan at my new gig is to work 7-3p side gig 1099 or even a w2 prn job I got lined up (super close by just in case I get stuck with overnight case, than roll into beeper call from home 5p-7a at full time w2 job with 20 weeks off when I’m nights float.

I can squeeze 10-15k each week more 1099 income the week I’m doing nights (10 weeks night float)

Plus l leave the 20 weeks wide open to do real 1099 work elsewhere

The trend that I’m noticing and this may be what it has been for a while now but:
-Hospital in middle of nowhere, typically 4 ORs +/- OB. One doc on at a time. 3 docs in rotation so 2 docs always off. Assuming very light call back overnight.

If hospital has OB and/or gets night cases, then either CRNA in house does OB with MD backup. Or 3 doc rotation plus 2 night float docs. Hospitals/agencies know this is how they get people to come to rural areas, docs get minimum 26weeks off, everyone wins

 

[pgg]

I've been seeing a few of these 17 weeks on, 35 weeks off gigs popping up. If you are 100% locums, I think this is a good hedge against work slowing down. Obviously depends on the pay and workload, but recently I saw 17 weeks, 12hr shifts x7 days (around 1400 hours a year)...can't remember if its 1099 or W2. But these jobs are getting gobbled off fast.

7 AM - 7 PM for 7 days is a miserable, miserable week unless it's actually a leisurely 7 AM - 3 PM with some pager time taking it to 7 PM.

84 hours is no joke. Even worse if some of those weeks are a night float 7 PM - 7 AM gig.

And then if you spend a significant portion of the "off" weeks doing locums ... recipe for burnout. 1400 hours from your 7x12 gig plus another 1000-1500 on the locums side starts pushing 3000 hours/year which is no way to live. Lots of money, sure. But you're earning it.

5-10 years ago people were grinding hard like that to make $600-700K.

Maybe the more sensible plan these days is to make your $600-700K working 45 per week and sleeping in your own bed. When the alternative is killing yourself to scratch another $300K (taxed at the top marginal rate) I really don't understand the mindset. Spend a little less, live a lot better (and longer).

 

[RedandBlack7]

7 AM - 7 PM for 7 days is a miserable, miserable week unless it's actually a leisurely 7 AM - 3 PM with some pager time taking it to 7 PM.

84 hours is no joke. Even worse if some of those weeks are a night float 7 PM - 7 AM gig.

And then if you spend a significant portion of the "off" weeks doing locums ... recipe for burnout. 1400 hours from your 7x12 gig plus another 1000-1500 on the locums side starts pushing 3000 hours/year which is no way to live. Lots of money, sure. But you're earning it.

5-10 years ago people were grinding hard like that to make $600-700K.

Maybe the more sensible plan these days is to make your $600-700K working 45 per week and sleeping in your own bed. When the alternative is killing yourself to scratch another $300K (taxed at the top marginal rate) I really don't understand the mindset. Spend a little less, live a lot better (and longer).

Depends on the jobs. Some of these night float jobs are from home so it’s not 84 hours in house working.

Some locums jobs are not super demanding either. Just supervision not that strenuous.

 

[pgg]

Depends on the jobs. Some of these night float jobs are from home so it’s not 84 hours in house working.

Some locums jobs are not super demanding either. Just supervision not that strenuous.

Yeah obviously the devil's in the details and intensity, I made a point of mentioning that, but

1) you're kidding yourself if you think pushing 3000 hours per year isn't a grind no matter how it's arranged

2) "just supervision" is riskier and more demanding than solo work, unless you're one of those **** dinosaurs who "supervises" from the lounge or just signs charts as a liability sponge

 

[AppTrail]

7 AM - 7 PM for 7 days is a miserable, miserable week unless it's actually a leisurely 7 AM - 3 PM with some pager time taking it to 7 PM.

84 hours is no joke. Even worse if some of those weeks are a night float 7 PM - 7 AM gig.

And then if you spend a significant portion of the "off" weeks doing locums ... recipe for burnout. 1400 hours from your 7x12 gig plus another 1000-1500 on the locums side starts pushing 3000 hours/year which is no way to live. Lots of money, sure. But you're earning it.

5-10 years ago people were grinding hard like that to make $600-700K.

Maybe the more sensible plan these days is to make your $600-700K working 45 per week and sleeping in your own bed. When the alternative is killing yourself to scratch another $300K (taxed at the top marginal rate) I really don't understand the mindset. Spend a little less, live a lot better (and longer).

don't get me wrong, the pay would have to make sense...something like a 17-week on, 35week off W2 gig would still need to pay at least 500k (maybe a little less if it it's a super slow hospital where you're done by 1pm everyday and are on pager the rest of the day).

That's still hitting locums-type hourly pay as a W2. Plus benefits and a guaranteed full time job as a base if locums temporarily dries up. Obviously no job is guaranteed beyond the typical 90-120day termination clause and you may be fighting for prime weeks off.

 

[aneftp]

don't get me wrong, the pay would have to make sense...something like a 17-week on, 35week off W2 gig would still need to pay at least 500k (maybe a little less if it it's a super slow hospital where you're done by 1pm everyday and are on pager the rest of the day).

That's still hitting locums-type hourly pay as a W2. Plus benefits and a guaranteed full time job as a base if locums temporarily dries up. Obviously no job is guaranteed beyond the typical 90-120day termination clause and you may be fighting for prime weeks off.

Most of the jobs with 20 plus weeks off these days that get gobbled up quickly pay around 500k (give or take). Plus the hours are roughly 40 hours a week the weeks you work. Even when you include the beeper hours. Beeper hours is where docs really undervalue their time and worth.
The job I'm gonna to take over my 30 weeks off job (30 weeks off off which entails solo OB coverage for 72 hours weekends) every 5 weeks...OB volume is doubled the last 4 months due to competing hospital closing down. Which is one of my reasons. Went from 1 delivery a day, maybe 2 to having 3-4 deliveries a day. Yesterday had 6 including 2 c/s. That's not high volume OB but high enough where its getting taxing to cover multiple days in a row, especially calling in crna for the OR cases as well. CRNAs can help in weekday daytime, but it's just doc only at night and weekends for ob.

So the new job is 20 weeks, working 7-12p/1pm (till lunches get done), next day 7-5p, and alternate for 2 weeks. That's around 40 hours with no calls.

One night beeper 5pm-7am (cases usually done around 9-10pm), go home and sleep. do it for 7 days, with 7 days off.

So the devil is always in the details like PGG says.

No one is taking the 7a-7p level 1 daytime job (7 days a week job) with 26 weeks off because you are really working the equivalent of 2 weeks anyways (84 hours) heavy case load. But the 4 docs that split the 7p-7a night float trauma job is a way better deal. They do this for 2 weeks and split it with 26 weeks off. for 500K.

So that's the catch-22 hospitals and management companies face. How to evenly divide up the work load because the night float is by far the better deal.

 

[RedandBlack7]

Yeah obviously the devil's in the details and intensity, I made a point of mentioning that, but

1) you're kidding yourself if you think pushing 3000 hours per year isn't a grind no matter how it's arranged

2) "just supervision" is riskier and more demanding than solo work, unless you're one of those **** dinosaurs who "supervises" from the lounge or just signs charts as a liability sponge

If you are preopping the patient, doing the lines and blocks, helping with induction and monitoring vitals on epic throughout for 2-3 rooms, it still allots for down time

 

[aneftp]

There is national amc with their own 1099 wholly own subsidiary trying to offer $300/hr 1099 in a facility they have exclusive contract

But hospital is paying 100% locums costs. So independent smaller locums companies are offering $350/hr for the same hospital

That’s how shady the locums 1099 business is.

So hospitals willing to pay global $500/hr per locums doc. And the wholly own subsidiary of the large amc who already has the contract is trying to pocket $200/hr while the smaller locums company is pocketing $150/hr

 

[Dawkter]

In the past the benefits at larger institutions used to make up for the salary difference with locums. This made locums appealing to physicians who were covered by their spouses with health insurance etc.

In the current market going 1099 (tax advantage) + paying for your own health insurance seems to make a lot of sense while still offering far more flexibility than that of a hospital/academic institution employee. This is an appealing way to work especially for Gen Z.

 

[dizzy21]

In the past the benefits at larger institutions used to make up for the salary difference with locums. This made locums appealing to physicians who were covered by their spouses with health insurance etc.

In the current market going 1099 (tax advantage) + paying for your own health insurance seems to make a lot of sense while still offering far more flexibility than that of a hospital/academic institution employee.

I put away over 200k pretax using cash balance plans and solo 401k contributions. Along with business deductions even if I had to purchase my own health insurance It’s very difficult to beat the favorable tax treatment of a business owner in the current market. If the locums market were to tank for some reason employment would become more attractive.

For now I will make hay.

 

[aneftp]

In the past the benefits at larger institutions used to make up for the salary difference with locums. This made locums appealing to physicians who were covered by their spouses with health insurance etc.

In the current market going 1099 (tax advantage) + paying for your own health insurance seems to make a lot of sense while still offering far more flexibility than that of a hospital/academic institution employee. This is an appealing way to work especially for Gen Z.

Yes. But it depends on job market.
Locums much harder to do in bigger cities especially around 2014-2018 as amc buyout peaked in 2017 with KKR purchase of Envison.

Academics jobs still good for those who want tons of flexibility with child care.

What’s great for everyone these days is they have choices. Choice to go x place as locums or full time.
X choice to make a ton. X choice to even do w2 work as part time.

 

[aneftp]

I put away over 200k pretax using cash balance plans and solo 401k contributions. Along with business deductions even if I had to purchase my own health insurance It’s very difficult to beat the favorable tax treatment of a business owner in the current market. If the locums market were to tank for some reason employment would become more attractive.

For now I will make hay.

As long as you are making hay, paying 30k plus in healthcare premiums for a family of 4-5 is not a big deal.

Self employed is great.

 

[CubsDynasty]

Or better yet find the full time, local job that allows you to choose 1099 or W2, a lot more of that nowadays