Locums Question

[callmeanesthesia]

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case time only sounds like a rip off. If you have several cases back to back you don’t get paid for half an hour during turnover every time? If you are called in the middle of the night for a case ‘asap’ and the surgeon doesn’t show up for an hour you are just sitting there off the clock? If you don’t get called in you gave up your weekend for no money? Sounds terrible.

I need to get some more details and see an actual contract but yeah, if it’s for case time only I don’t think I’ll pursue it.

 

[deleted87051]

I need to get some more details and see an actual contract but yeah, if it’s for case time only I don’t think I’ll pursue it.

The most important detail is weekend volume and efficiency. Ask for their numbers. If the OR has busy lineups every weekend it can be worthwhile. If it’s quiet or sporadic, it’s a waste of your time.

 

[k12balla]

Regarding the avg hourly rate, this is not true. Sure, this is what is advertised, but many, many people make more. Your rate is dependent on MANY FACTORS, most of all your ability to negotiate. The need for Anesthesiologist in the locums world is pretty high. The supply of Anesthesiologist willing to do locums is pretty low. The issue comes down to negotiation and leverage regardless of if you use an agency vs doing it alone. I just secured an assignment is a reasonable city at $255/hr with no call through an agency.

I agree with you that some people make more. But I would argue that most make in that range ($180-220/hr) and would be generally content to make $200/hr. Ignorance is bliss. Most people don't take the time to peruse the forums to find out what the going rate is, or understand their leverage and how desperate some of these facilities can be. Physicians who actually do their due diligence when it comes to negotiating, imho, are pretty slim (<10%). We are trained not to talk about money, to be modest/humble, and to not ask for more because we should be doing it out of the goodness of our hearts.

I'm with you though. I don't mind being a mercenary if the price is right. I am well compensated for my time, my schedule is flexible, I have multiple options, and if I don't like a situation, I can easily change scenery. Practicing in California has the advantage of being primarily solo independent practice. Some of these AMCs will have you supervising 10 rooms + OB to earn your per diem. That's for the birds.

 

[cockblockandrun]

You could ask them directly to do locums, but ask for 50% more and 1099. What's the worst that can happen? They say no?

They might only want FTE, but you could always try asking.

DO NOT DO AGENCY LOCUMS.

I will agree and disagree you about this statement.

It all comes down to which locum agency you work with and how transparent they are with you.

Most of the locum agencies are garbage and these recruiters are used car salesmen trying to sell you snakeoil.
You have to realize that the money locum agencies are making off you is NEVER going to be in your pocket and only saves the hospital or the group money. Agencies have to make at a MINIMUM 32% of what you are making but even if you directly contract with the hospital, you are not going to see that 32%. Most of the time it benefits ONLY the hospital and group not you.

I have done full time locums for 8 years now, agency and non-agency and quite honestly its the same in terms of your compensation.

I prefer working with only 2 agencies for these reasons:

1. Med-mal- they cover it, occurence based (but some will be shady about this so ALWAYS get a copy of the malpractice certificate from the agency before starting an assignment. I made the mistake once out of residency where the agency didn't tell me I was going under the group's policy and not theirs). Friends of mine who have had lawsuits say the solid locum agencies have an incredible risk and quality team, access to the top lawyers and support from the agency.

2. And the number one reason i like working with agencies- accountability from the groups. Do you know how many SHADY AF anesthesiology groups and hospitals there are out there? They agree to a contract and terms then decide to back out or not pay you what was agreed. I worked an assignment where they flew me out to Michigan but when I got there the hospital didn't finish credentialing me and I sat in a hotel for a week watching Maury Povich re-runs and still making free money because the locum agency went to bat for me and got the hospital to pay up. You think if I were directly contracted that would have happened? Highly unlikely. I have come to the conclusion that most of anesthesia is run by some unethical and morally awful human beings and working with an agency that has my back is a powerful tool rather than try to go up there to bat by myself.

3. Some agencies give you bonus money for working certain number of hours for them in a year. Nice little perk and usually about an extra $3-4k per year.

So again depends on the agency. I will agree that most agencies are run by even more awful human beings.

Recruiter: "Dr, we have a great opportunity in the Miami area?"
Me: "What hospital?"
Recruiter: "We can't tell you what hospital but its a real hospital"
Me: "Why can't you tell me?"
Recruiter: "Because we don't want you to know"
Me: "Why?"
Recruiter: "Those are the rules"
Me: "So you want me to go to a hospital in the Miami area but you won't tell me which hospital and which city in the Miami area"
Recruiter: "Correct"
Me: "So I spent all of these years of studying and training and I have to blindly get on a plane and go somewhere I don't know"
Recruiter: "Yes. Thats how this works"
Me: "What are the rates?"
Recruiter: 8 hours for $1200
Me: GTFO and NEVER call me again.
Click.

Next day:
Another recruiter, same agency.... "Dr. we have a great opportunity in the Miami area. Want to hear about it?"
Me: Go F yourself and never call me again.

Next week: rinse and repeat.

 

[CubsDynasty]

I will agree and disagree you about this statement.

It all comes down to which locum agency you work with and how transparent they are with you.

Most of the locum agencies are garbage and these recruiters are used car salesmen trying to sell you snakeoil.
You have to realize that the money locum agencies are making off you is NEVER going to be in your pocket and only saves the hospital or the group money. Agencies have to make at a MINIMUM 32% of what you are making but even if you directly contract with the hospital, you are not going to see that 32%. Most of the time it benefits ONLY the hospital and group not you.

I have done full time locums for 8 years now, agency and non-agency and quite honestly its the same in terms of your compensation.

I prefer working with only 2 agencies for these reasons:

1. Med-mal- they cover it, occurence based (but some will be shady about this so ALWAYS get a copy of the malpractice certificate from the agency before starting an assignment. I made the mistake once out of residency where the agency didn't tell me I was going under the group's policy and not theirs). Friends of mine who have had lawsuits say the solid locum agencies have an incredible risk and quality team, access to the top lawyers and support from the agency.

2. And the number one reason i like working with agencies- accountability from the groups. Do you know how many SHADY AF anesthesiology groups and hospitals there are out there? They agree to a contract and terms then decide to back out or not pay you what was agreed. I worked an assignment where they flew me out to Michigan but when I got there the hospital didn't finish credentialing me and I sat in a hotel for a week watching Maury Povich re-runs and still making free money because the locum agency went to bat for me and got the hospital to pay up. You think if I were directly contracted that would have happened? Highly unlikely. I have come to the conclusion that most of anesthesia is run by some unethical and morally awful human beings and working with an agency that has my back is a powerful tool rather than try to go up there to bat by myself.

3. Some agencies give you bonus money for working certain number of hours for them in a year. Nice little perk and usually about an extra $3-4k per year.

So again depends on the agency. I will agree that most agencies are run by even more awful human beings.

Recruiter: "Dr, we have a great opportunity in the Miami area?"
Me: "What hospital?"
Recruiter: "We can't tell you what hospital but its a real hospital"
Me: "Why can't you tell me?"
Recruiter: "Because we don't want you to know"
Me: "Why?"
Recruiter: "Those are the rules"
Me: "So you want me to go to a hospital in the Miami area but you won't tell me which hospital and which city in the Miami area"
Recruiter: "Correct"
Me: "So I spent all of these years of studying and training and I have to blindly get on a plane and go somewhere I don't know"
Recruiter: "Yes. Thats how this works"
Me: "What are the rates?"
Recruiter: 8 hours for $1200
Me: GTFO and NEVER call me again.
Click.

Next day:
Another recruiter, same agency.... "Dr. we have a great opportunity in the Miami area. Want to hear about it?"
Me: Go F yourself and never call me again.

Next week: rinse and repeat.

which 2 agencies?

 

[Zekchar]

So again depends on the agency. I will agree that most agencies are run by even more awful human beings.

Recruiter: "Dr, we have a great opportunity in the Miami area?"
Me: "What hospital?"
Recruiter: "We can't tell you what hospital but its a real hospital"
Me: "Why can't you tell me?"
Recruiter: "Because we don't want you to know"
Me: "Why?"
Recruiter: "Those are the rules"
Me: "So you want me to go to a hospital in the Miami area but you won't tell me which hospital and which city in the Miami area"
Recruiter: "Correct"
Me: "So I spent all of these years of studying and training and I have to blindly get on a plane and go somewhere I don't know"
Recruiter: "Yes. Thats how this works"
Me: "What are the rates?"
Recruiter: 8 hours for $1200
Me: GTFO and NEVER call me again.
Click.

Next day:
Another recruiter, same agency.... "Dr. we have a great opportunity in the Miami area. Want to hear about it?"
Me: Go F yourself and never call me again.

Next week: rinse and repeat.

I completely agree and this has been my experience is well. My recommendations are:

1) Set up an independent "throw-away" email address
2) Sign up for google voice and get a "throw-away" phone number
3) Set the number to "do not disturb"
4) Post on gaswork and doccafe and only give out the throw-away number and email
5) Screen all the replies and offers and have built in responses to the masses of recruiters
6) Over time you weed out the spammers and learn who is actually trying to find you a spot versus who got your number off some master list and is merely adding you to their email blasts every other day
7) Work and talk on the phone exclusively with the "good" recruiters and ignore the others

 

[k12balla]

I completely agree and this has been my experience is well. My recommendations are:

1) Set up an independent "throw-away" email address
2) Sign up for google voice and get a "throw-away" phone number
3) Set the number to "do not disturb"
4) Post on gaswork and doccafe and only give out the throw-away number and email
5) Screen all the replies and offers and have built in responses to the masses of recruiters
6) Over time you weed out the spammers and learn who is actually trying to find you a spot versus who got your number off some master list and is merely adding you to their email blasts every other day
7) Work and talk on the phone exclusively with the "good" recruiters and ignore the others

This guy gets paid!

Most staffing agencies will only release details of the contract location once they have your CV on file. That way you can't undercut them later once they give you the facility name.

 

[cockblockandrun]

This guy gets paid!

Most staffing agencies will only release details of the contract location once they have your CV on file. That way you can't undercut them later once they give you the facility name.

Yeah this is true but this is my view on that:

You have someone with a undergrad SALES degree who worked in car sales or a sales and marketing corporate job telling me over the phone the rules of the game.
NO. We are physicians, years of schooling, training, studying. We are human beings with families, lives and loved ones. I am going to tell you the rules of the game and if you don't like it, go F yourself and if you call me again, I will insult you so terribly over the phone until you either cry or hang up.
Physicians need to wake up and start empowering themselves and not letting others set the rules to the game.
You think LeBron James or Kawhi Leonard went into free agency hoping and begging and letting the teams set the rules? These guys had NBA executives falling all over themselves and flying cross country and meeting them in locations set by Leonard and James. They had the talent and skills needed so they set the rules.

 

[Zekchar]

Yeah this is true but this is my view on that:

You have someone with a undergrad SALES degree who worked in car sales or a sales and marketing corporate job telling me over the phone the rules of the game.
NO. We are physicians, years of schooling, training, studying. We are human beings with families, lives and loved ones. I am going to tell you the rules of the game and if you don't like it, go F yourself and if you call me again, I will insult you so terribly over the phone until you either cry or hang up.
Physicians need to wake up and start empowering themselves and not letting others set the rules to the game.
You think LeBron James or Kawhi Leonard went into free agency hoping and begging and letting the teams set the rules? These guys had NBA executives falling all over themselves and flying cross country and meeting them in locations set by Leonard and James. They had the talent and skills needed so they set the rules.

One caveat. Some places will not work with you directly. You have to remember that bringing you on-board for a hospital is also an expense. They try to make it easier on themselves by hiring middle-men (or women) which are the locum recruiters. This streamlines the process for you and the hospital both and they are used to using recruiters for this precise need.

At the end of the day there is information asymmetry. While you have the skills, you don't have access to a master list of where those skills can be applied. Chances are you also aren't willing to cold-call hospitals and offer up your services. Hence, the use of recruiters for better or for worse. This is less an opinion or a judgement on their value, but more of an honest evaluation of the circumstances out there.

 

[IMGASMD]

While you have the skills, you don't have access to a master list of where those skills can be applied. Chances are you also aren't willing to cold-call hospitals and offer up your services. Hence, the use of recruiters for better or for worse. This is less an opinion or a judgement on their value, but more of an honest evaluation of the circumstances out there.

There was an agency who would basically cold call for me or use their resources to find me a job in my desired location. I think the fee was something like a 1-3k down payment. And 7-10% of first year salary. If I am looking for a next job, I may just give them a try. With something almost impossible and see if they can do it?

Or anyone actually used that kind of service and want to comment?

 

[cockblockandrun]

One caveat. Some places will not work with you directly. You have to remember that bringing you on-board for a hospital is also an expense. They try to make it easier on themselves by hiring middle-men (or women) which are the locum recruiters. This streamlines the process for you and the hospital both and they are used to using recruiters for this precise need.

At the end of the day there is information asymmetry. While you have the skills, you don't have access to a master list of where those skills can be applied. Chances are you also aren't willing to cold-call hospitals and offer up your services. Hence, the use of recruiters for better or for worse. This is less an opinion or a judgement on their value, but more of an honest evaluation of the circumstances out there.

Why not cold-call hospitals and groups? Why not directly contact AMCs (which I have done before)? What can a recruiter do that I can't?

And most of these agencies cold call hospitals and groups anyways.

 

[cockblockandrun]

There was an agency who would basically cold call for me or use their resources to find me a job in my desired location. I think the fee was something like a 1-3k down payment. And 7-10% of first year salary. If I am looking for a next job, I may just give them a try. With something almost impossible and see if they can do it?

Or anyone actually used that kind of service and want to comment?

Don't do it. If you invest some time and do your homework, you can do as good if not better job than these agencies. They are predators looking for lazy physicians to suck and take advantage of.

 

[IMGASMD]

Don't do it. If you invest some time and do your homework, you can do as good if not better job than these agencies. They are predators looking for lazy physicians to suck and take advantage of.

Duly noted.

At the end it’s just time vs money. If I do use this kind of agency I would probably have pretty strict criteria. Ex: MD only, PP, call frequency, vacation length... I do also see the flip side of it, when we get these kind of calls from agencies, “we can help you staff, we have a candidate...” usually it doesn’t even get to the hiring partner, it goes to our admin.....

So would love to hear someone’s story if there is one to tell.

 

[k12balla]

Yeah this is true but this is my view on that:

You have someone with a undergrad SALES degree who worked in car sales or a sales and marketing corporate job telling me over the phone the rules of the game.
NO. We are physicians, years of schooling, training, studying. We are human beings with families, lives and loved ones. I am going to tell you the rules of the game and if you don't like it, go F yourself and if you call me again, I will insult you so terribly over the phone until you either cry or hang up.
Physicians need to wake up and start empowering themselves and not letting others set the rules to the game.
You think LeBron James or Kawhi Leonard went into free agency hoping and begging and letting the teams set the rules? These guys had NBA executives falling all over themselves and flying cross country and meeting them in locations set by Leonard and James. They had the talent and skills needed so they set the rules.

Yes we as physicians are definitely bringing more to the table than the average recruiter, however, they are also providing a valuable service (for some more than others) and we should provide them with a basic level of decency and respect. You catch more flies with honey than you do with vinegar. I think viewing your interaction with them as a negotiation, and understanding your leverage, the facilities, and theirs, will get you much farther and ultimately better compensated. At the end of the day, the hospital needs a position filled, and they are helping to fill that void as are you. We all have our role to play. There's really no need to resort to name calling, they're just trying to do their job. I will say this though, I much prefer to communicate via email/text via recruiters. I would not recommend a phone conversation until you are much further along in the process. It will save the both of you time and energy.

With regards to your free agency analogy: For those who have had the joy of trying to find coverage for a day/week in their own practice, you can relate to just how hard it can be to find a high quality candidate at a moments notice. Most people (*not all) who do locums, do it for a reason. Some just want to work part time, some have personality issues, some have malpractice suits, some can't do certain procedures or cases, some cancel cases right and left etc etc. The point is, if you are a strong provider who is flexible, works well with others, can do blocks, can supervise, can get credentialed quickly, handles paperwork and charting efficiently, etc and you pair that with a facility (team) who is stuck with a bunch of nobodies/locums because the recently deserted AMC over promised, well in that scenario, you can pretty much name your price. Especially once you've covered a few shifts for them, and they see that you are the real deal, and what you're bringing to the table, they will gladly pay your exorbitant locums rate, and prioritize your schedule over everyone elses to keep you coming back. You might not get a hefty signing bonus, guaranteed contracts, or wined and dined, but you can still get treated pretty well and compensated even better for being a superstar in a highly specialized field where most of the other stars already have long term deals with no buy out provisions.

 

[pgg]

At the end it’s just time vs money. If I do use this kind of agency I would probably have pretty strict criteria. Ex: MD only, PP, call frequency, vacation length... I do also see the flip side of it, when we get these kind of calls from agencies, “we can help you staff, we have a candidate...” usually it doesn’t even get to the hiring partner, it goes to our admin.....

This is exactly how I use locums agencies. I'm still active duty military so my requirements are pretty strict
- majority cardiac case load
- ongoing need for a few days to a week per month
- $250+/hour
- willing to travel anywhere in the continental USA

I don't have the time to scour North America to find these jobs by cold calling places. I hope the locums agency makes fat stacks. Their success is my success.

I get nearly endless spam for 4:1 surgicenter and hospital jobs paying $170/hr. Nobody needs a locums agency to find that. Pick up the phone and call the 10 nearest facilities and at least 5 will hire you for that on the spot.

 

[somedumbDO]

Midwest locums rates 225-300$ per hour guaranteed 8 hr shifts. No bs like just paying for OR time +/- malpractice provided. It gets a tad better if you negotiate privately and have own malpractice but not 30% plus better. I would not recommend locums for any new grad, get 5 yrs of expirence first. Locums and your own LLC is probably better than 90% partnership gigs in my area. This disrepency could be local but I highly highly doubt it. Remember dealing with group drama is a real headache. Schedules, meetings, hiring, all that stupid sleeping in the hospital how much is that worth?!?!

 

[StillAwake]

For those of you who are primarily doing locums as their permanent gig and have a family. How do you balance family obligations and the need to potentially travel longer distances from your home?

 

[k12balla]

For those of you who are primarily doing locums as their permanent gig and have a family. How do you balance family obligations and the need to potentially travel longer distances from your home?

Depending on how you schedule it, you can actually end up with more free time, and more importantly more quality time with your family. I have some pretty consistent work in my home town, and am credentialed with many of the groups in the area. I also work out of town for 1-2 weeks at a time every other month for a premium. This allows me to take weeks off at a time, and not necessarily worry about the income I'm missing out on . I also try to not to schedule work on any early dismissal days, holidays, etc. We take 2-3 week long vacations annually with a lot of 3 and 4 day weekends for road trips or just going to the local museum/park when nobody's there. When I am in town, I work 7-3, M-F, no call no weekends. Not everyone will have a similar set up, but the point is that it is possible to balance life and work. I'm pretty satisfied with how things are arranged, and have no qualms working 14 days straight of 12 hour shifts doing your basic lap chole, as long as it means I'll also be getting the next 14 days off with my family, while drinking Mai Tais on a beach watching the sunset.