Locums Market Temp Check

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Don’t forget it’s also this time of year… there’s less people looking for jobs now. There are a few off cycle experienced people. Locums will be hot until the next round of new grads enters the market next summer.
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pgg said:
That's what I hear and it's consistent with what I've seen. Though I'm not in the locums game any more.


I've kept my credentials active at a place where I was doing PRN W-2 moonlighting a few years ago. Small community hospital, coastal NC. I haven't worked there since 2022 but their per diem rates have crept up gradually. Think they're in the neighborhood of $325/hr now but the pager call stipend isn't bad and call is super light. Their full time employees make substantially less than that.

Yesterday I got locums email for coverage there. Out of curiosity I asked the spammer what they were paying - $350/hr.

That hospital system has been really reluctant to increase their rates. It appears they, like so many administrators, are acting like this market is temporary and are happy to overpay for locums while they slow bleed permanent staff.
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Is the locums 1099? $325 w2 might be better after the 7.65% medicare/social security tax savings (coincidentally ~$25/hr for the first $170,000) assuming they cover medmal.
 
amyl said:
Don’t forget it’s also this time of year… there’s less people looking for jobs now. There are a few off cycle experienced people. Locums will be hot until the next round of new grads enters the market next summer.
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This hasn’t been my experience. There’s some shuffling every year in July but legitimately there’s always more retirements than entries and new entries don’t like to work as much as the old guard
 
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etherengineer said:
Is the locums 1099? $325 w2 might be better after the 7.65% medicare/social security tax savings (coincidentally ~$25/hr for the first $170,000) assuming they cover medmal.
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It is 1099 of course but the issue at hand is that the hospital is paying FAR more than 350 to the locums co, if the physician gets 350.

It speaks to the insane reality that hospitals still think that this market is temporary, and will happily pay a locums comoany $600/hr to avoid paying their own employees $400/hr.
 
aneftp said:
38k this week for my friend in Texas for 5 days. Light call. The homeboys are raking in 100k every 10 days in Memphis for almost a year. (they are their own agency, no third party locums agency) that’s how much agencies take off the top if u let them instead of keeping it for urself. 10k a day is standard. 12k a day is becoming the standard soon.
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Gah, I’m doing it wrong.
 
dizzy21 said:
Gah, I’m doing it wrong.
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Maybe?

I bet you're doing just fine by any objective and sane standard.

Those guys are making bank now, but it's a **** life being a locums in Memphis.

There's something to be said for earning "enough" (whatever that number is for you), living where you want to live, and not working in a place that's ****ed up six different ways.
 
pgg said:
Maybe?

I bet you're doing just fine by any objective and sane standard.

Those guys are making bank now, but it's a **** life being a locums in Memphis.

There's something to be said for earning "enough" (whatever that number is for you), living where you want to live, and not working in a place that's ****ed up six different ways.
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Thanks, was about to start calling up random Memphis hospitals that I found on google maps lol!
 
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Reactions: pgg
aneftp said:
38k this week for my friend in Texas for 5 days. Light call. The homeboys are raking in 100k every 10 days in Memphis for almost a year. (they are their own agency, no third party locums agency) that’s how much agencies take off the top if u let them instead of keeping it for urself. 10k a day is standard. 12k a day is becoming the standard soon.
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If this is real and they are open to more people, I would do it.
 
pgg said:
It is 1099 of course but the issue at hand is that the hospital is paying FAR more than 350 to the locums co, if the physician gets 350.

It speaks to the insane reality that hospitals still think that this market is temporary, and will happily pay a locums comoany $600/hr to avoid paying their own employees $400/hr.
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Anesthesia companies actually understand this. But have a hard time convincing hospitals and surgery centers to raise the salary.

The anesthesia revenue collections no longer can sustain anesthesia private practices. My brother practice just dissolved also out west. And he’s was the president of the practice for the last 10-15 years.

He’s actually make a lot more with the hospital paying him 1099 without the headaches off the blended unit system

What hospitals/management are afraid of (in their minds is to be ahead of the game with salary. They are very reluctant to lead the market in anesthesia salary
 
The thing about locums is it’s like dealing with mortgage brokers.

Place just imploded on the west coast of Florida.
I’m sure some people got the same text.

One small company tried to come in at $285/hr. I told them I know crnas who will work for that rate. I’m completely trolling them.

Than another another comes in at $325/hr. I told them I know crnas in New York who can work for those rates.

Just games these days.

I did get one company up to $395/hr. But I don’t want it. No calls available. No worth the drive for me to drive 2 plus hours

Sure they will find snowbirds willing to take $350-hr just because it the nice time of the year weather wise coming up end of October but they will go as low as some suckers will take. And work load is pretty rough there.

I compare workload and pay and travel distance. I put it all in my calculations. If I can’t be home within. 45 min -1 hr. It may not be worth it to me.
 
aneftp said:
What hospitals/management are afraid of (in their minds is to be ahead of the game with salary. They are very reluctant to lead the market in anesthesia salary
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Someday some hospital will realize that leading the market in physician salary will attract and retain top talent, and the increased productivity and quality, and the fewer complications and lower turnover will drive efficiency, growth, and profit.

In the coming era of bundled payments, one OR screwup that results in someone spending a month or two in the ICU getting fabulously expensive care for zero additional payments (not to mention the lawsuit), is going to cost more than the top talent they chased away or could've recruited, had they simply decided to lead the market.
 
pgg said:
Someday some hospital will realize that leading the market in physician salary will attract and retain top talent, and the increased productivity and quality, and the fewer complications and lower turnover will drive efficiency, growth, and profit.

In the coming era of bundled payments, one OR screwup that results in someone spending a month or two in the ICU getting fabulously expensive care for zero additional payments (not to mention the lawsuit), is going to cost more than the top talent they chased away or could've recruited, had they simply decided to lead the market.
Click to expand...

Malpractice cost is a different pot of $$$. Administrators will say it is out of their control. However, they do a great job on physician salary KPI.
 
pgg said:
Someday some hospital will realize that leading the market in physician salary will attract and retain top talent, and the increased productivity and quality, and the fewer complications and lower turnover will drive efficiency, growth, and profit.

In the coming era of bundled payments, one OR screwup that results in someone spending a month or two in the ICU getting fabulously expensive care for zero additional payments (not to mention the lawsuit), is going to cost more than the top talent they chased away or could've recruited, had they simply decided to lead the market.
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I still think the bundled payment thing being a money loser for hospitals is a myth.

Ever wonder why it seems like ICUs are always full?

It’s because hospitals want them full. Full hospital, full revenue, full profit potential.

Go to any academic center in the country and the story is the same. “We’re on diversion, ICU is too full, hospital is too full, oh man guys it’s so full here! And we need to clear it out only to *wink wink* keep it open for all those new patients that need care!”

All for these academic centers to find the money to build multi billion dollar add on towers in the most expensive real estate in their cities. Too broke to pay docs though!
 
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narcotics999 said:
Malpractice cost is a different pot of $$$. Administrators will say it is out of their control. However, they do a great job on physician salary KPI.
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Most big anesthesia companies or even big hospitals systems these days just self insure themselves. It’s far cheaper (barring mega lawsuit) to be self insured for these big companies

So the cost of physician malpractice is actually much lower than hospitals will tell you.
 
pgg said:
Someday some hospital will realize that leading the market in physician salary will attract and retain top talent, and the increased productivity and quality, and the fewer complications and lower turnover will drive efficiency, growth, and profit.

In the coming era of bundled payments, one OR screwup that results in someone spending a month or two in the ICU getting fabulously expensive care for zero additional payments (not to mention the lawsuit), is going to cost more than the top talent they chased away or could've recruited, had they simply decided to lead the market.
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Good luck convincing administration that one particular tube jockey will actually be better at preventing badness than another. Define “better”. We are all licensed, most of us are board certified. Complications happen. It is simply looked at as the cause of doing business….
 
aneftp said:
Most big anesthesia companies or even big hospitals systems these days just self insure themselves. It’s far cheaper (barring mega lawsuit) to be self insured for these big companies

So the cost of physician malpractice is actually much lower than hospitals will tell you.
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Yup. Everyone is self insured these days. It actually shouldn’t cost a penny to add an additional doc.
 
PainInTheAnes said:
I still think the bundled payment thing being a money loser for hospitals is a myth.

Ever wonder why it seems like ICUs are always full?

It’s because hospitals want them full. Full hospital, full revenue, full profit potential.

Go to any academic center in the country and the story is the same. “We’re on diversion, ICU is too full, hospital is too full, oh man guys it’s so full here! And we need to clear it out only to *wink wink* keep it open for all those new patients that need care!”

All for these academic centers to find the money to build multi billion dollar add on towers in the most expensive real estate in their cities. Too broke to pay docs though!
Click to expand...
ICUs are profitable when they're full of post surgical patients who get shuffled out just in time for another surgical patient.

The vent-riding complication with dead kidneys on CRRT getting a trach and PEG on POD 38, not so much.
 
PainInTheAnes said:
I still think the bundled payment thing being a money loser for hospitals is a myth.

Ever wonder why it seems like ICUs are always full?

It’s because hospitals want them full. Full hospital, full revenue, full profit potential.

Go to any academic center in the country and the story is the same. “We’re on diversion, ICU is too full, hospital is too full, oh man guys it’s so full here! And we need to clear it out only to *wink wink* keep it open for all those new patients that need care!”

All for these academic centers to find the money to build multi billion dollar add on towers in the most expensive real estate in their cities. Too broke to pay docs though!
Click to expand...
There is a lot of non clinical dead weight in true academics. But that’s the way the system is setup to advance the next generation of doctors.

Better than try to have hca trying to educate the future doctors in their residency programs
 
Easy to hear about 350 1099 from a Locum company. Which group is paying 450 total. Then Have to go direct to group and cut out middleman. But preexisting relationship is key. Medmal occurrence based they sub you in
 
arsene19 said:
Easy to hear about 350 1099 from a Locum company. Which group is paying 450 total. Then Have to go direct to group and cut out middleman. But preexisting relationship is key. Medmal occurrence based they sub you in
Click to expand...
U can buy daily medmal for $175/day

Just fyi for those concern with medmal
 
aneftp said:
There is a lot of non clinical dead weight in true academics. But that’s the way the system is setup to advance the next generation of doctors.

Better than try to have hca trying to educate the future doctors in their residency programs
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My sibling recently started at an academic place and pretty much always has a resident or crna with her doing the procedure or setting up the room though she wants to do the procedures herself to stay sharp. However, her days are 7a to 4-5p with 2 calls a month 6 wks off. She will easily be in the 550-600 range w2 not counting a 14% 401a match. Not sure year 1 is the best time for a fresh grad to be doing locums so i've backed off pressuring her to think about it even though a friend of hers is pulling 900 1099 but he runs around quite a bit she feels like she's already getting more than she expected in pay so its a hard convince. If i was making that salary day 1 post residency not sure i'd be as interested either to be fair.
 
finalpsychyear said:
My sibling recently started at an academic place and pretty much always has a resident or crna with her doing the procedure or setting up the room though she wants to do the procedures herself to stay sharp. However, her days are 7a to 4-5p with 2 calls a month 6 wks off. She will easily be in the 550-600 range w2 not counting a 14% 401a match. Not sure year 1 is the best time for a fresh grad to be doing locums so i've backed off pressuring her to think about it even though a friend of hers is pulling 900 1099 but he runs around quite a bit she feels like she's already getting more than she expected in pay so its a hard convince. If i was making that salary day 1 post residency not sure i'd be as interested either to be fair.
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Academic centers require the cycle of life (new blood to do the clinical work)

Just be thankful it’s 2024 and now 2014. Salaries are up even in academic center.

She’s new grad so doesn’t know any better working 5 days a week with 6 weeks off

Academic centers rely on some new grads who don’t know workload. So any workload from residency is better to them
 
aneftp said:
Academic centers require the cycle of life (new blood to do the clinical work)

Just be thankful it’s 2024 and now 2014. Salaries are up even in academic center.

She’s new grad so doesn’t know any better working 5 days a week with 6 weeks off

Academic centers rely on some new grads who don’t know workload. So any workload from residency is better to them
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Low call burden is key in academics. New graduates can’t resist the allure of 1-2 calls per month at minimum. Their mindset is that they can work 5 days a week forever if there’s no call and high predictability.

The money is in taking advantage of unpredictability with low hit rates. Roll the dice a ton of times for a few dollars each knowing that the true hit rate (up all night, caught in a bad situation alone with no backup, or working post call when exhausted) is pretty low and tolerating that risk.

New grads like low risk. Low risk means low patient loads and low call burden with people you’ve already known in your home program. I love it because it takes people who would otherwise be hungry to work and silos them off in comfort.
 
arsene19 said:
It’s a great time to be an anesthesiologist. Truly.
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Makes up the lost decade of 2010-2020 for many of us.

1994-2000 were also lean years for many anesthesiologists as well. Now
Those were truly lean years with pay in the low 100s in many big cities.
 
Shimmy8 said:
Who you using for medmal? Trying to maybe get some 1099 work that will be sporadic shifts but may pay well.
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Malpractice can be state specific

Daily insurance for malpractice in Florida we can use
www.nwanesthesia.com

Nationwide Anesthesia

Choose Nationwide Anesthesia Services, Inc. for professional anesthesiology placements and seamless credentialing services.
www.nwanesthesia.com www.nwanesthesia.com

They offer it daily. Usually the company will reimburse u the $175 a day u are working.

Don’t offer to insure ur self in this market unless it a guaranteed 6-12 month deal u know u are gonna to generate at least 400k per 6 months because it will eat into ur own net profit margin. Paying the daily rate will cost you $35k a year long term.
 
pgg said:
Someday some hospital will realize that leading the market in physician salary will attract and retain top talent, and the increased productivity and quality, and the fewer complications and lower turnover will drive efficiency, growth, and profit.

In the coming era of bundled payments, one OR screwup that results in someone spending a month or two in the ICU getting fabulously expensive care for zero additional payments (not to mention the lawsuit), is going to cost more than the top talent they chased away or could've recruited, had they simply decided to lead the market.
Click to expand...
I don’t know that admins ever have the attitude of trying to lead the market with salaries as that would would, at least in their view, lead to hyperinflation.
 
aneftp said:
Malpractice can be state specific

Daily insurance for malpractice in Florida we can use
www.nwanesthesia.com

Nationwide Anesthesia

Choose Nationwide Anesthesia Services, Inc. for professional anesthesiology placements and seamless credentialing services.
www.nwanesthesia.com www.nwanesthesia.com

They offer it daily. Usually the company will reimburse u the $175 a day u are working.

Don’t offer to insure ur self in this market unless it a guaranteed 6-12 month deal u know u are gonna to generate at least 400k per 6 months because it will eat into ur own net profit margin. Paying the daily rate will cost you $35k a year long term.
Click to expand...
This is a staffing agency for locums/PRN, their site states:

"As an independent contractor, you will be responsible for your own malpractice coverage. We recommend obtaining a malpractice policy with limits of at least $1 million per occurrence/$3 million aggregate.

For those of you who plan to work in the state of Virginia, you will need a policy with limits of at least $2,600,000 per occurrence/$7,800,000 aggregate.

For information about CRNA coverage through AANA, contact AANA Insurance Services at 800–343–1368.

When you are on assignment with Nationwide Anesthesia Services, if you do not have your own policy, we can provide malpractice coverage through our agency for a fee based on hours worked, with an 8–hour minimum per day. Keep in mind, though, that if you work as a locum tenens more than 26 weeks per year, it will be more cost–effective for you to purchase your own policy."

I don't see an option for daily malpractice in FL other locations? Confused.
 
caligas said:
I don’t know that admins ever have the attitude of trying to lead the market with salaries as that would would, at least in their view, lead to hyperinflation.
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Me and this other doc agreed 18 months ago in order to recruit crnas especially the young ones to give them 100k sign on bonus over 3 years. That’s a big enough number to get the newer grads who owe money. The upper admin said no. They didn’t want to set a precedent.

Guess what? 18 months later now they are gonna to give 75k sign on bonus for 2 years! That’s $37.5k each year. More expensive than the 33k a year we told them to do.

Now have a couple of new grads who took the bait.

Now these 100k crna sign on bonus are a dime a dozen. (For 3 years). 18 months too late. Wasting more and more money on locums each day

On the doc side. I told them if they weren’t gonna to pay docs more. Than the docs need more time off. It’s very simple. Time and money. That’s what they comes down to. They are down 4 anesthesiologists in 2 months already.

No one listens. I see it. I’m sure others see it. That’s why I pushed for these massive time off. 20 plus weeks off.

A 4 doc model for 600k with 13 weeks off can easily become a 5 doc model with 20 weeks off and 500k each

What’s the cost? 4 x 600k is 2.4 million.
5 docs x 500k h equals 2.5 million.

There is almost no cost difference to admin with this model. But you spread the burden of work so it’s much easier with one extra doc.

Those docs who want to work more can easily find more locums work to make up that 100k difference.

There is a job in Georgia that’s currently setup this way. 4 docs/600k. They are short 2 docs so locums docs are all getting $400/hr.

Think about the cost of having 2 full time locums docs. Vs going to the 5 doc model. Each locums docs will cost you a min 1 million easily.
 
SRYSPAC said:
This is a staffing agency for locums/PRN, their site states:

"As an independent contractor, you will be responsible for your own malpractice coverage. We recommend obtaining a malpractice policy with limits of at least $1 million per occurrence/$3 million aggregate.

For those of you who plan to work in the state of Virginia, you will need a policy with limits of at least $2,600,000 per occurrence/$7,800,000 aggregate.

For information about CRNA coverage through AANA, contact AANA Insurance Services at 800–343–1368.

When you are on assignment with Nationwide Anesthesia Services, if you do not have your own policy, we can provide malpractice coverage through our agency for a fee based on hours worked, with an 8–hour minimum per day. Keep in mind, though, that if you work as a locum tenens more than 26 weeks per year, it will be more cost–effective for you to purchase your own policy."

I don't see an option for daily malpractice in FL other locations? Confused.
Click to expand...
Call them. That’s what my friend uses when he works at a surgery center in Florida. The agency than reimburse him for the cost of the malpractice.
 
aneftp said:
Malpractice can be state specific

Daily insurance for malpractice in Florida we can use
www.nwanesthesia.com

Nationwide Anesthesia

Choose Nationwide Anesthesia Services, Inc. for professional anesthesiology placements and seamless credentialing services.
www.nwanesthesia.com www.nwanesthesia.com

They offer it daily. Usually the company will reimburse u the $175 a day u are working.

Don’t offer to insure ur self in this market unless it a guaranteed 6-12 month deal u know u are gonna to generate at least 400k per 6 months because it will eat into ur own net profit margin. Paying the daily rate will cost you $35k a year long term.
Click to expand...


Dang. I don’t make nearly as much as locums but I pay $200/mo for malpractice insurance.
 
pgg said:
Someday some hospital will realize that leading the market in physician salary will attract and retain top talent, and the increased productivity and quality, and the fewer complications and lower turnover will drive efficiency, growth, and profit.
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First off I hear this all the time -“ we don’t want to set the market.” I’ve heard it mostly with the local crna market as the crnas don’t have the significant restrictive covenant that doctors do here… thus crnas are free to move to the highest bidder. They hope to just wait until the other practice is full and hire whatever is left over. (🙄 and 👎)
Second you are assuming that hospitals, admin and AMCs, want top talent. I don’t think they do. I think they want good enough doctors that play nice with everyone else and aren’t savvy enough to ask too many questions or play the market forces in their favor
 
narcotics999 said:
Malpractice is always deductible. If you are bold enough, deduct twice. Once compensated by agency or hospitals, 2nd time from your 1099, lol
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Hmmm… please explain that better. I clearly understand your “2nd time” example, but how do you deduct the “compensated by agency?”
 
centdoc said:
Hmmm… please explain that better. I clearly understand your “2nd time” example, but how do you deduct the “compensated by agency?”
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Like hotels for travel The agency pays me for the hotel (tax free). I pay for it on my credit card.

Double dipping.

So the agency (if you negotiate ) will reimburse you for daily malpractice and you can deduct on your business side
 
amyl said:
First off I hear this all the time -“ we don’t want to set the market.” I’ve heard it mostly with the local crna market as the crnas don’t have the significant restrictive covenant that doctors do here… thus crnas are free to move to the highest bidder. They hope to just wait until the other practice is full and hire whatever is left over. (🙄 and 👎)
Second you are assuming that hospitals, admin and AMCs, want top talent. I don’t think they do. I think they want good enough doctors that play nice with everyone else and aren’t savvy enough to ask too many questions or play the market forces in their favor
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I agree; or you can have a hospital that won't accept new grad AA's/CRNA's at a busy tertiary center, yet offer $0 vs the $100K signing bonuses that other places are offering in the area, and also be below market in terms of PTO, then relying on locums.

On top of that, have docs go into rooms at 3/5 PM because they are short anesthetists.

Pay the loyal, full time folks more and not rely on mercenaries? Strange concept...

🤔
 
I just saw on Gaswork a blooper from one of the locums agencies. It listed a job and as "Rate: $400/hr (Bill Rate) $300/hr (Pay Rate)" So the leeching from the locums agencies from the physicians real. Why do they get $100/hr for doing nothing? I pretty much do all my credentialing paperwork, book all my travel and hotels. Is there a website where we can get access to these locums jobs without the middle clowns?
 
IVdoc said:
I just saw on Gaswork a blooper from one of the locums agencies. It listed a job and as "Rate: $400/hr (Bill Rate) $300/hr (Pay Rate)" So the leeching from the locums agencies from the physicians real. Why do they get $100/hr for doing nothing? I pretty much do all my credentialing paperwork, book all my travel and hotels. Is there a website where we can get access to these locums jobs without the middle clowns?
Click to expand...
Couple of reasons
1: cost of doing business. Like why does chipotle cost me $14 for a steak burrito delivery when the normal price is $11. That’s a 30% markup on price. PLUS delivery fee ($3). So literally a 60% markup for a $11 burrito
2. Some locums docs hate to shop around and provide their own malpractice. Just look at the posters on these message boards asking me about daily malpractice or even shopping around for locums job

Some locums docs act like princes and princesses acting like a job should be handed to them on a silver platter.

That’s why
 
Places blow up every day It may be ascension. I dunno. That’s what I mean these locations are a dime a dozen

“Hello! This is Emily with AMN Healthcare. I am reaching out to ask if you are open to locums in Wisconsin. We just had 7 positions open up, 4 in Milwaukee! No call; $425/hr; WI license; Monday-Friday shifts 8s and 10s. Let me know if you are interested i would love to talk more!”

Milwaukee isn’t a bad city. Fly in fly out if u have a week or two to spare Figure 50 hours is easy $21k ish. No calls
 
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