Locums Market Temp Check
Started by Coffee PRN
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
Is the hourly rate better to work with a 3rd party locums agency instead of the arm of the PE group? Is it more financially favorable to accept locums work from Echo (Sound Anes), Bridgecare (Napa), Envoy (Envision), D&Y (Team Health) or go with an outside locums agency? When I spoke with one of these arms of the PE group at the hospital, the recruiter for the arm said they prioritized the arm locums agency before the outside agencies, she said to "save the hospital money". Which I doubt that is the case as someone on this forum has previously put out the idea that they are trying to "double dip" for payment. I've also read the Echo and other locums arms will string you along and drop you before the 30 days where they can cancel because they found cheaper labor. Anyone work with other agencies such as Odessey, 360 Anesthesia, etc? It sucks that hospitals don't want to contract direct and get milked for 40-60% extra billing charge from these middle men
It all depends how open the bids are for locums contracts.
Some places have open bidding. U can access the open bidding via a 50k cash entry system as a locums company (not as individual).
Some places have closed bidding processes.
Advertisement - Members don't see this ad
livinlavidalocums
Full Member
I don’t have experience with any of the ones you named.
I have had bad experiences with locumtenes. I have found comphealth advertised rates to be 25-50/hr less than others.
Also the actual recruiter makes a big difference.
In my 4 years doing locums I have learned the following
1) smaller physician owned locums companies will typically have lower overhead and may be more competitive. For example physician owned locums company will pay you 400/hr and charge hospital 460/hr but bigger agency will pay you the same but charge hospital 500/hr
2)bigger hospital groups and anesthesia groups may not work with smaller locums agencies so you will have to use one of the bigger ones. Find a good recruiter with one of them and use him/her for the bigger groups and stick to physician owned smaller ones with smaller groups
3) going direct with group or hospitals theoretically will be cheaper but I have found the rates to be less than locums agencies. Additionally I have heard of docs not getting paid. They will have a tough time not paying dealing with Locums agencies and law firm/lawyers behind them
4)get imlc if you are willing to go to multiple states for locums work
this forum and sharing info especially via pm can be very helpful. If we all demand 400/hr they will have to pay that. If we inform a colleague rate is 450 for that area we can prevent locums agency from ripping off an uniformed colleague getting 350/hr.
Sometimes third party makes more financial sense. I have found that to be the case in other areas as well.
Sometimes hotels or airlines will not match or beat a 3rd party rate. It makes no financial sense but thats how it goes sometimes
I have dealt with the major players and smaller mom & pop operations in terms of locums agencies. In terms of the larger companies, you can reasonably be sure that you will get paid fairly and on-time. My experience with the smaller operations is that they demand that you won't get paid unless they get paid first. I had an experience with one company last year where they withheld payment to me for over a month. It took a lot of calls to get them to pay up. They still reach out to me with offers much higher than the other agencies (425-450/hr) but I don't know if I want to have to go through that again. Plus, I heard they sometimes won't pay you the full amount according to what I've read on the web.
Stay away from some of the major players who have terrible reputations (AMN healthcare, Staffcare and Locumtenens). I can't vouch for the locum arms of the AMC's like Sound, Envision, etc. but I don't like that they could hang you out to dry if something goes wrong and they need to scapegoat you. The financial interest of the AMC would always come first. An independent agency would likely defend you better since they are on the hook for malpractice and also be liable for placing you there.
cittykat
Full Member
$600/hr for pedi hearts in flyover country. Kind of surprised there is a program in Peoria.
Is NY one of those states (like PA) where they actively audit locums docs to see if they have filed their NYS income tax return?
Audits are random. U roll the dice just like how hospital admin rolls the dice with low staffing at trauma centers at night
Great rate, the malpractice environment in Illinois is...😒
cittykat
Full Member
Pipeline looks bad and is getting worse. Even CHOP is short.
If a young trainee has the skills and fortitude for this niche, they’ll be able to name their price.
Last edited:
Always found it funny how pediatric cardiac anesthesiologist have agreed to work for the same pay as general anesthesiologist. You Should be making so much more for the time it took to get there and the stress of the job. And don’t talk to me about insurance reimbursements blah blah. Hospitals should be bending over backwards for you with stipends. You think pediatric cardiac surgeons accept any offer that gets throw there way?
cittykat
Full Member
For decades they’ve been convinced to do it for the love of the game 😂. But that’s been changing recently. Few years ago one of our experienced pediatric cardiac guys got recruited to the Bay Area to help start a new program and he was offered what was an eye popping amount at that time.
Yeah. It’s crazy. My close friend of 25 years is boarded in both. Two fellowships. The partners always left him in the most complex cases solo for hours for the same pay. He did it for so many years. There are stars and there are rock stars. Peds cardiac finally gets what they deserve. It’s too bad he’s aging out. But the young docs absolutely should know their worth.
Sorry that's not how it works at all. Agency can be in Iran, there's still a box for which state each portion of income was earned filed by the employer(agency in this case). This needs to be accurate, it's the whole principle behind the jock tax. Sure if it's under 10k, nobody cares but if you're doing six figure locums this will not slip through the cracks. But please go ahead and try and report back.
Advertisement - Members don't see this ad
State of GA gets a report from the employer in GA of all their payments tied to SSNs. Super easy to flag SSNs that did not file a return in GA. Whether it's enforced or not is a whole different story. State of HI definitely does aggressively though.
It’s not enforced by the Jacksonvile based docs I know who moonlight in Georgia 1099. Maybe one day they will get caught.
We are talking 500-700k 1099 income generated in Georgia since Jacksonvile pay is so bad for 1099.
Peds people are weird. They're not wired like normal people.
Not many places have a peds cardiac program so there is that going against them. Only one per state barely so if negotiations go south; gotta leave the state. That is why salaries are on the low side seemingly
Rules of supply and demand. Only so many jobs in “desirable” locations.
So while demand overall may be higher, not everyone is willing to move to places like South Dakota or Wisconsin. And once they are there, it can be difficult to leave for family reasons.
On the flip side, for hospitals in those highly desirable spots, they can pay less because of higher supply of potential employees.
livinlavidalocums
Full Member
thx. got my answer. So if locums agency checks that income came from Hawaii then Hawaii will know without having to audit.
livinlavidalocums
Full Member
All blue states will want every penny. Once I got my Cali license ftb of ca wanted to tax me for 2-3 years plus penalty. Such a pain proving I didn’t live or work in CA. They weren’t convinced I Just got licensed so I can move to Ca eventually. Sent them my other state tax return until they backed off.
CA taxes you for everything. Bottles cans bags phone cable gas sales income property. But I do love the weather.
Don’t you live in California? Anything that ties you to that state even electricity bill.
As for California medical license. I have had one for 22 years. The trick I learn even though I haven’t been back in 17 years is
1. “Retire” the license for $25. Do it for 4 yeas (2 renewals). Avoid the $1200 renewal fee
Than 2. Reactivate it to active status (u have up to 4 years and 364 days) and send in ur cme documents with the re activation process. It’s quick. Less than 1-2 weeks to Reactivate whenever they get ur paperwork.
And retire it again for $25 when the next cycle starts.
livinlavidalocums
Full Member
I did move back to Cali 10 years ago but got licensed prior to moving back. If I ever move out of CA then I will use that trick
Yeah just know they're aggressive about chasing down tax evaders. I know a college NCAA player who didn't file for their 1 away game played in Hawaii (NIL era) and they got fined heavily along with paying the tax.
I don’t understand the college football player. They aren’t being paid per game like a pro athlete. It is more like an endorsement deal. I know an NBA player that domiciled in Dallas in an apartment but he played in CA for his endorsements to run through Texas for tax reasons.
Not sure they will. You are not an employee. You are a 1099. National locums company with places all over. The locums company may not even know the breakdown of where you worked.
Locums is 1099. Not an employee. Might make a difference if they are reporting. I’m not sure. Maybe someone from a locums company can shed some light….
l
But than again they pay 1099 crnas bogus tax free housing for years who are local and that’s clearly illegal. Max is 12 months to pay tax free housing regardless where u live per irs rules Becuase if u are given more than 12 months tax free housing u are clearly “living” full time in a certain location.
“
Under IRS Publication 463, any work assignment expected to last—or that actually lasts—longer than one year is legally considered indefinite, not temporary. Because of this, you generally lose the ability to write off travel and housing expenses or receive them tax-free. [1, 2]
The specific IRS rules regarding this setup include the following critical details:
companies like edgeford/flex health don’t report out of Florida 1099 income.
But than again they pay 1099 crnas bogus tax free housing for years who are local and that’s clearly illegal. Max is 12 months to pay tax free housing regardless where u live per irs rules Becuase if u are given more than 12 months tax free housing u are clearly “living” full time in a certain location.
“
Under IRS Publication 463, any work assignment expected to last—or that actually lasts—longer than one year is legally considered indefinite, not temporary. Because of this, you generally lose the ability to write off travel and housing expenses or receive them tax-free. [1, 2]
The specific IRS rules regarding this setup include the following critical details:
- The 1-Year Rule: The IRS assumes that if you work at a single location for more than 12 months, that location has become your new "tax home". Once a location becomes your tax home, housing stipends are no longer considered "away from home"
Housing stipends not the same as reimbursement of travel. Hotel, rental car, air fare, etc.. Which most locum companies do instead of stipend.
Locum places that offer set stipends also potentially run afoul of whether that is truly tax deductible reimbursement vs taxable income. Irrespective of thr 1 year IRS rule
Advertisement - Members don't see this ad
They did this to me. Had my license as a resident in another state. I think I had to send them my 1040. Was completely ridiculous.
The "collectives" payments are a per game agreement for some university programs. This incentivizes and fights against the opt-out of the bowl games
This thread is going the wrong direction so feel free to PM for answers. But you're taking the word "employee" too literally. Sure it's not W2 and rather 1099 income but on the tax forms it doesn't matter. Let's say Agency 1 receives 1.5 mil from HI hospital 1. They have that in their revenue breakdown. They then declare 1.35 was an expense in the form of compensation to employees. There is a box after that saying state taxes withheld or not for each depending on their status and how much they made etc. There is a breakdown of which employees along with other expenses in a later form with the EIN/SSN of each different payees. This will be submitted to the feds and state of HI. State of HI will likely not ignore anything over $100k. The guys who did a week or two of an assignment will probably be fine. You are essentially hoping the agency doesn't file HI state taxes which won't happen.
livinlavidalocums
Full Member
For California, only reason was having a california state medical license. There was not any property or income in California the two years California claimed I owe state taxes. So for California the trigger seems to be having a state license.
I Have not been to Hawaii (except for vacation) so not sure how they operate there.
…
Any movement on solo/hands on locums gigs?
Aside from solely summer vacation coverage or major holiday coverage in a remote small town?
I Have not been to Hawaii (except for vacation) so not sure how they operate there.
…
Any movement on solo/hands on locums gigs?
Aside from solely summer vacation coverage or major holiday coverage in a remote small town?
Straighten out? How did u make the 50k tax bill disappear.
If u live in a state income tax state is usually not as big of a deal to pay state income taxes in places where u work. Say leave in Maryland (9% state and county taxes) pay California state income taxes (9-11%) . Get credited back to Maryland. Not a full 1:1 credit but close enough
I did not live in Colorado nor work in Colorado. The locums company(integrity locums) was headquartered in Denver.
Oh got it.
livinlavidalocums
Full Member
blue states will want to tax you for everything. California is definitely this way. Hawaii and Colorado apparently also.
How do you see open biddings? My understanding was that these locums agencies work with a vendor management system that hospitals use, like mls for realtors. It’s a steep price (~20k) to get access.
Every situation is unique. I know PP groups I had friends in I offered to go direct with. The agencies paid more because the hospital was paying for it bc the group didn’t have coverage and it wasn’t in their contract.
@livinlavidalocums
What are some physician owned locums agencies? Seems like that would be the easiest to work with.
Yes, doesn’t matter where your locums agency is located or where your llc is located. It’s the location of the income generated. Different states are slower/faster for tracking you down but eventually they probably will. Found this out the hard way when I first started doing locums: nothing on my taxes or paperwork said the (high tax) state I was doing locums in. Locums company where my paycheck came from and my llc both in lower income states. 2 years (!) later got hit with a big bill plus fines…learning lesson. I got an accountant. I’m used to
Yes. It’s more than 20k. A lot more to get into the VMS. But open bidding doesn’t guarantee anything thing. It’s pretty fierce competition.
As for physician owned companies. They face the same hurdles as even bigger companies. Some hospitals or even amc don’t award contracts out to them. It’s just business. Everyone says it’s easy till it’s not easy. The locums business I’m talking about
I think everyone wants to hit a home run with locums contracts.
1. Easy work load
2. Good pay
3. Flexible hours
Just perfect.
But I like to quote Spocks’s aka Leonard Nimoy’s last tweet before he died a couple of days later.
"A life is like a garden. Perfect moments can be had, but not preserved, except in memory."
That same quote definitely applies to the locums world!
1. Easy work load
2. Good pay
3. Flexible hours
Just perfect.
But I like to quote Spocks’s aka Leonard Nimoy’s last tweet before he died a couple of days later.
"A life is like a garden. Perfect moments can be had, but not preserved, except in memory."
That same quote definitely applies to the locums world!
livinlavidalocums
Full Member
I know two docs that have their own locums companies Pm me if u want to know more. Aneftp may know some as well if u want to pm him also.
A lot of these hospitals use a VMS (vendor management system) where the locums agencies pay a high fee (not exactly sure how much) to place a bid for the locums doc to work at the hospital. From what I read it's a system where the lowest bid will probably get the assignment; meaning that the lowest rate for the doctor. A lot of these locums agencies ask you to send them your CV so that they can claim your NPI and claim you work with them even if you were just inquiring. The agenicies put your info in the VMS and put a bid on your head. If you don't get the assignment, you still were "presented" and locked out of working with that hospital system for 1-2 years. Even if the agencies say no noncompete with you, they already signed noncompetes with the hospitals. Plus most of these VMS are owned by the big locums agencies even though they claim vendor neutrality.
Also why are so many locums agencies and anesthesia management companies owned by CRNAs? It seems like these CRNAs are very business minded while the W2 anesthesiologists are just working for the man/woman/hospital collecting a check while the CRNA owners are reaping handsome fees being the owners.
Also why are so many locums agencies and anesthesia management companies owned by CRNAs? It seems like these CRNAs are very business minded while the W2 anesthesiologists are just working for the man/woman/hospital collecting a check while the CRNA owners are reaping handsome fees being the owners.
Every tom dkck Harry owns these locums companies. Not just crnas. Lady was just a gloried secretary with associates degree made off like a bandit driving Ferrari and netting 20 plus million a year forming her own DEI preferred company to ger preferred contract especially accelerated during the Biden era) with state owned university global contracts. A great starting point to grow ur business.
So there are a lot of business savvy people. And there are docs who own their own companies I deal with.
So there are a lot of business savvy people. And there are docs who own their own companies I deal with.
Advertisement - Members don't see this ad
cittykat
Full Member
Like this guy who is a CRNA but has multiple DEI certs.
Company - Wander Staffing
wanderstaffing.com
Arch Guillotti
Senior Member
Staff member
Administrator
Volunteer Staff
Lifetime Donor
20+ Year Member
When you throw out fake inflammatory narratives it makes you all the less believable if that is even possible.
Associate degree from Palm beach state in 2012 ….. unlike you who think I make up stuff. I tell the truth. There is no glory I take in telling the truth.
More power to them for taking advantage of programs to gain contracts. A lot of people always gotta get inside access to get ahead in life. And yes it’s not just under represented minorities with DEI programs.
I don’t inflam when I speak the truth. I push buttons but the truth is the truth. And white people like Trump cheat also. I’m always fair and balance. Dude doesn’t get ahead in life being a c minus student without help. He got a lot of help.
Give a link to the business
Look up flex health solutions/now edgeford. Look who runs it. Look who the front person is…and now the husband is “helping” her run it
This is a story as old as DEI has been around.
Using minority women as a front person for a company to get contracts. Not the first nor last one to do it. It’s just not the locums business.
My crna friend (African American) woman who’s former military been telling how this is the angle people use to get contracts. I wouldn’t expose all this unless people are educating me.
