Locums Rate

[cerev]

I am looking into a locums gig for a few months when I might be between jobs, and I was hoping that those familiar with locums work can give me some advice (I've never done it myself). The back-story is that there is a small rural hospital near where I have a second home where it would be nice to spend the summer, but not necessarily a place I want to work full-time. They have postings available for both full-time and locums work and I want to use the information from the full-time gig to maximize the locums pay. This is all based on advertised rates, and I have not contacted the group yet. Here is the info:

Advertised full-time 1099 pay is about $13,500 per week worked and covers insurance with tail, q4 call with no post-call day off. Advertised locums pay is $1500 a day 7-3:30, so $7500 a week.

So basically an extra $6000 a week to cover call. On an average week that would have 5/4 weekday calls and 1/4 of a weekend (or 5 weekday calls a 4 week (28 day) month and 2 weekend 24 hour shifts). What is the best way to structure this to maximize pay? Specific questions:

1) Best way to structure deal? Flat rate for weekday and weekend call vs. cost to carry pager + hourly night/weekend rate
2) For both above (flat rate vs pager + hourly rate), what are reasonable rates?
3) My initial plan: Negotiate $1800 for 7-3:30 ($9000 a week), $1000 to carry pager on weekday (average $1250 a week), $2000 pager call per weekend 24 hours shift ($1000/wk), $300/h after 3:30 or on weekend. This works out to $14,250 for 50 hours a week in the hospital with a fair amount of pager call. Floor would be $11,250 a week for 40 hr week. Reasonable? Unreasonable? Where should I tweak? How to maximize?

Thanks in advance.

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[deleted697535]

Small rural hospital 14k a week for 50 hours... Wtf!?! Shooting fish in a barrel mate

 

[ryanjmy]

My only advice would be to try to negotiate without a locums company. They pay you about 60% of what they charge. So if the advertised rate is $1500/day they are charging $2500. The only real service they provide is your malpractice insurance.

 

[aneftp]

My only advice would be to try to negotiate without a locums company. They pay you about 60% of what they charge. So if the advertised rate is $1500/day they are charging $2500. The only real service they provide is your malpractice insurance.

Not usually. It’s generally 20% what locums company charges.

I know this cause I know the recruiting managers for one of the locums companies.

It’s all negotiable though. Sometimes it’s even less than 20% if it’s a longer term deal. Revenue stream matters with longer term deals.

 

[chocomorsel]

How big is the hospital and how busy? If it’s rural and sleepy it could totally be easy money and 13,5 is a very good rate considering you may work 30 hours.
I personally don’t see how they even afford that. But then again, I am not a great negotiator.

 

[Mman]

Small rural hospital 14k a week for 50 hours... Wtf!?! Shooting fish in a barrel mate

that's a fairly normal rate for small rural hospitals

 

[deleted697535]

Thats about 4 times what a UK trained anesthetist makes after 9 or 10 years of residency...

 

[neutro]

Not usually. It’s generally 20% what locums company charges.

I know this cause I know the recruiting managers for one of the locums companies.

And you believe the recruiting manager of a locums company?

Locums companies have an 80% turnover rate with their staff. These are just sales people whose sole purpose is to earn money off your back without providing any real service. They screw both the physician and the hospital. But because they are so wisdespread in this game, hospitals cannot compete with them in terms of advertising.

MUCH better to negotiate directly with the hospital if you can and ask for pay and schedule you want - its better for long term also to make contacts. Not everything is about money. Its about the type of cases, schedule, how much help available from CRNAs...etc. Those are some real factors to consider besides just a set $ amount and you will never know it unless you either show up first day to work, or talk to the chairman directly (which the locums companies with discourage).

Thanks.

 

[pgg]

Advertised locums pay is $1500 a day 7-3:30, so $7500 a week.

Under $200/hr is at the bottom end of what I would expect as a generalist. Some really locums saturated areas are as low as $170/hr. (Military hospital towns are a good example because there are so many of us looking for part time moonlighting gigs.)

For a rural job $200-250/hr is more reasonable.

That said, $180/hr to sit your own room doing low risk gen surg and ortho, arriving at and leaving the hospital while the sun's shining, isn't necessarily a bad deal. Supervising, train wreck patients, working late, covering call, etc needs a better rate.

Anesthesia services can be a loss leader for a hospital because the ORs and supporting services need us, and the big picture earns boatloads of money, so don't believe for a second that they can't "afford" it. Of course they'll lowball people while handwringing over how poor the place is. It's what they do. Demand more. Or work somewhere else. They need you. You don't need them.

Thats about 4 times what a UK trained anesthetist makes after 9 or 10 years of residency...

What's the ratio of student loan balances between US and UK anesthesiologists?

 

[anbuitachi]

Thats about 4 times what a UK trained anesthetist makes after 9 or 10 years of residency...

what UK anesthetist goes thru 9-10 years of residency?

 

[deleted697535]

what UK anesthetist goes thru 9-10 years of residency?

Everyone basically. 2 years fy1,2. 5sat years. 1 or 2 fellowship.
Some less, some more...

Uk loan ratio is prob 4 or 5 times less too, but thats a one off cost which you guys seem to clear in 2 years?

 

[okayplayer]

Everyone basically. 2 years fy1,2. 5sat years. 1 or 2 fellowship.
Some less, some more...

Uk loan ratio is prob 4 or 5 times less too, but thats a one off cost which you guys seem to clear in 2 years?

I wish. Hasn’t been my experience.

 

[anbuitachi]

Everyone basically. 2 years fy1,2. 5sat years. 1 or 2 fellowship.
Some less, some more...

Uk loan ratio is prob 4 or 5 times less too, but thats a one off cost which you guys seem to clear in 2 years?

so everyone is minimum 34 when they get their first job? 21 + 4 yr med school + 9 year residency? Somehow this doesn't fit the description i got from other UK anesthetists. I have heard that residency is easier in UK cause you guys work less.

It's not even about debt, its about total paid for education. I did med school a whil ago so it was cheaper, so it was 55k x 4 years for med school, with 6-6.8% interest rate, on top of college loans, which was 45k x 4 years.

 

[Postictal Raiden]

so everyone is minimum 34 when they get their first job? 21 + 4 yr med school + 9 year residency? Somehow this doesn't fit the description i got from other UK anesthetists. I have heard that residency is easier in UK cause you guys work less.

It's not even about debt, its about total paid for education. I did med school a whil ago so it was cheaper, so it was 55k x 4 years for med school, with 6-6.8% interest rate, on top of college loans, which was 45k x 4 years.

Comparing Anesthesiology Residency Training Structure and Requirements in Seven Different Countries on Three Continents

 

[deleted697535]

Youngest ive ever heard of was 29. Average would be 32-34.
I cant really comment unbiased on residency here vs there...

 

[ryanjmy]

Not usually. It’s generally 20% what locums company charges.

I know this cause I know the recruiting managers for one of the locums companies.

It’s all negotiable though. Sometimes it’s even less than 20% if it’s a longer term deal. Revenue stream matters with longer term deals.

I had a locums guy accidentally send me what they were charging instead of what I’d be making. It was exactly 60%. I have no idea if this is typical but it does happen. It’s a lucrative business designed to prey on us and hospitals.

 

[cerev]

Under $200/hr is at the bottom end of what I would expect as a generalist. Some really locums saturated areas are as low as $170/hr. (Military hospital towns are a good example because there are so many of us looking for part time moonlighting gigs.)

For a rural job $200-250/hr is more reasonable.

That said, $180/hr to sit your own room doing low risk gen surg and ortho, arriving at and leaving the hospital while the sun's shining, isn't necessarily a bad deal. Supervising, train wreck patients, working late, covering call, etc needs a better rate.

Anesthesia services can be a loss leader for a hospital because the ORs and supporting services need us, and the big picture earns boatloads of money, so don't believe for a second that they can't "afford" it. Of course they'll lowball people while handwringing over how poor the place is. It's what they do. Demand more. Or work somewhere else. They need you. You don't need them.




What's the ratio of student loan balances between US and UK anesthesiologists?

Thanks pgg. If the hourly rate is say $200 during the day, what is a reasonable ask for nights and weekends? $300? More/less? Also, what is normal compensation for carrying a pager?

 

[anbuitachi]

I had a locums guy accidentally send me what they were charging instead of what I’d be making. It was exactly 60%. I have no idea if this is typical but it does happen. It’s a lucrative business designed to prey on us and hospitals.

are hospitals against directing hiring ppl for locums vs going thru company?

 

[anbuitachi]

Comparing Anesthesiology Residency Training Structure and Requirements in Seven Different Countries on Three Continents

any data on post COLLEGE education? med school varies so much in different countries, i have no idea what med school even means in some places. but its still an interesting read. UK avg work week is 48 hours.. insane. it's pretty much just a regular job. Denmark limited you to 37 hours... I can see how someone may spend many years in residency in some countries because its treated just as a regular job.

but honestly i think it is one reasonable solution to fixing 1 part of the toxic culture in our healthcare system. reduce med school tuition to affordable levels like in other countries. increase residency duration, but decrease hours. treat them like human beings, and perhaps more people will be willing to enter medicine w/o feeling like they were dehumanized and treated like slaves tied down by their debts with no way out. i imagine it would help with the mental health epidemic in our doctors. i think residency is so hated because its grueling, your life outside of medicine disappears, and you have no way out because of your 300k debt thats constantly rising. i think if we adopt the European method, docs would end up happier.

also just looked it up but common to have UK med school start after HS, not college. Another way to save an additional 6 figures in debt by skipping college!

 

[Hoya11]

Thanks pgg. If the hourly rate is say $200 during the day, what is a reasonable ask for nights and weekends? $300? More/less? Also, what is normal compensation for carrying a pager?

What is a reasonable hourly rate for someone with benefits, but who works by the hour.. this person is committed to finishing the day at a surgical center which ends at a variable time from 3-6... benefits include the usual med/dent/life/malpractice/retirement... what do you all think is a reasonable hourly rate? 150 too low?

 

[cerev]

What is a reasonable hourly rate for someone with benefits, but who works by the hour.. this person is committed to finishing the day at a surgical center which ends at a variable time from 3-6... benefits include the usual med/dent/life/malpractice/retirement... what do you all think is a reasonable hourly rate? 150 too low?

In my old job, all benefits (health/vision/dental insurance, malpractice, employer's portion of social security, retirement, parking, meeting stipend, etc.) all added up to about approximately 1/6 of my total compensation. At that rate, $150/hr + benefits is approximately equal to $180/hr w/o benefits. While I know this doesn't scale linearly, I would pass at $150/hr + benefits.

 

[pgg]

Thanks pgg. If the hourly rate is say $200 during the day, what is a reasonable ask for nights and weekends? $300? More/less? Also, what is normal compensation for carrying a pager?

All of this is just my opinion, and as such it's going to be saturated with bias from my experience and the regions I've worked (largely rural).

A reasonable home pager call rate for a weeknight is 1x your hourly rate whether you get called or not. If called in, you should additionally get paid the regular rate +20% or so, with a minimum callback of 2 hours. So if the regular day rate is $200/hr, to cover nights there (pager call 5 PM to 7 AM) I'd be looking for a fee of $240 or $250, plus $240-250/hour if you come in, with a 2 hour minimum. This is all predicated on an overnight call-in being an unusual event. The primary intent is to pay you to be available, and only rarely to pay you to work.

If you're routinely working 6 or 8 or 12 hours when it's dark outside, that's not really "call", that's an overnight/graveyard shift and I personally wouldn't even consider abusing myself that way for less than $300/hr, and maybe not even then.

For a scheduled Saturday or Sunday day shift (same hours as a weekday) I've never been paid a premium over weekday pay. Daylight hours = daylight hours.

The 20% premium for OT is a very ballpark figure that has matched most of the contracts I've had. However, at present my OT rate is just 8% more than my base rate. I'm OK with that because I was able to demand a high base rate because I'm TEE boarded and credentialed to do cardiac cases.

At my current locums job, my weekend rate is the weekday rate for an 8 hour minimum (whether I work or not) plus overtime at the OT hourly rate.

I used to cover Fri 4 PM to Monday 7 AM at a rural hospital for a flat rate of $4500. This was actually 2nd call Fri, 1st call Sat, and 2nd call Sun. A typical weekend would be a few hours Fri night closing down the ORs, then about 10 hours in the hospital on Saturday, and none on Sunday. That was a very popular call shift, and people got in line for it, so they were probably overpaying. The key there was that the partners hated working weekends, and were willing to pay generously for weekend coverage so they'd never ever have to risk taking a shift themselves.

I just signed up at a new place for a weekend pager call deal for about 1/3 that ($1400) but the expectation is that I'll very rarely be called in. If I am, there is additional hourly OT pay. That strikes me as reasonable for what amounts to being tethered to a 20 minute radius of the hospital, in sobriety, for the weekend.


The above is just my own experience over the last ~10 years of on and off moonlighting to supplement my Navy day job's case load and income. It's notable that I had long stretches where I did zero locums work because there wasn't anything I liked available close to me and I didn't feel like traveling, or because I just didn't want to fill my vacation with more work. I have left jobs where the work environment was poor (my personal record is quitting after 4 days). I think that as a locums, getting good rates, and working in a good environment, is very dependent upon your ability and willingness to turn down an offer or leave. I've found that I can be fairly picky and set fairly high rates for myself ... if I'm willing to be unemployed for a while.

 

[pgg]

What is a reasonable hourly rate for someone with benefits, but who works by the hour.. this person is committed to finishing the day at a surgical center which ends at a variable time from 3-6... benefits include the usual med/dent/life/malpractice/retirement... what do you all think is a reasonable hourly rate? 150 too low?

A ~50 hour/week ASC kind of job, M-F 7-5 on average? Given 10 weeks vacation, 42 x 50 x 150 = $315K ... add $54K retirement and the other benefits and the package is pushing $400K W-2. That sounds pretty good for a mommy-track job.

Of course, it's probably 4:1 supervision at an ASC, so I'd be miserable doing it.

 

[cerev]

All of this is just my opinion, and as such it's going to be saturated with bias from my experience and the regions I've worked (largely rural).

A reasonable home pager call rate for a weeknight is 1x your hourly rate whether you get called or not. If called in, you should additionally get paid the regular rate +20% or so, with a minimum callback of 2 hours. So if the regular day rate is $200/hr, to cover nights there (pager call 5 PM to 7 AM) I'd be looking for a fee of $240 or $250, plus $240-250/hour if you come in, with a 2 hour minimum. This is all predicated on an overnight call-in being an unusual event. The primary intent is to pay you to be available, and only rarely to pay you to work.

If you're routinely working 6 or 8 or 12 hours when it's dark outside, that's not really "call", that's an overnight/graveyard shift and I personally wouldn't even consider abusing myself that way for less than $300/hr, and maybe not even then.

For a scheduled Saturday or Sunday day shift (same hours as a weekday) I've never been paid a premium over weekday pay. Daylight hours = daylight hours.

The 20% premium for OT is a very ballpark figure that has matched most of the contracts I've had. However, at present my OT rate is just 8% more than my base rate. I'm OK with that because I was able to demand a high base rate because I'm TEE boarded and credentialed to do cardiac cases.

At my current locums job, my weekend rate is the weekday rate for an 8 hour minimum (whether I work or not) plus overtime at the OT hourly rate.

I used to cover Fri 4 PM to Monday 7 AM at a rural hospital for a flat rate of $4500. This was actually 2nd call Fri, 1st call Sat, and 2nd call Sun. A typical weekend would be a few hours Fri night closing down the ORs, then about 10 hours in the hospital on Saturday, and none on Sunday. That was a very popular call shift, and people got in line for it, so they were probably overpaying. The key there was that the partners hated working weekends, and were willing to pay generously for weekend coverage so they'd never ever have to risk taking a shift themselves.

I just signed up at a new place for a weekend pager call deal for about 1/3 that ($1400) but the expectation is that I'll very rarely be called in. If I am, there is additional hourly OT pay. That strikes me as reasonable for what amounts to being tethered to a 20 minute radius of the hospital, in sobriety, for the weekend.


The above is just my own experience over the last ~10 years of on and off moonlighting to supplement my Navy day job's case load and income. It's notable that I had long stretches where I did zero locums work because there wasn't anything I liked available close to me and I didn't feel like traveling, or because I just didn't want to fill my vacation with more work. I have left jobs where the work environment was poor (my personal record is quitting after 4 days). I think that as a locums, getting good rates, and working in a good environment, is very dependent upon your ability and willingness to turn down an offer or leave. I've found that I can be fairly picky and set fairly high rates for myself ... if I'm willing to be unemployed for a while.

Thanks pgg, this is very helpful.

Just to be clear: when you take weekday PM call, you are getting paid your hourly rate a a 20% premium regardless as to wether or not you are working the entire time (for instance: $200/hr weekday->$240/hr weeknight * 14 hours = $3,360?). This sounds like an amazingly good deal to me, especially if you don't plan on getting called back in, but perhaps I am missing something.

Also, quick question as to how these deals are normally structured. My impression was that they are frequently (but not always) paid as a base for a weekday shift (say $1600 for 7 to 3:30) + compensation to cover the pager (that is, to be available but not necessarily in the hospital squeezing the bag) + hourly for any time spent in the hospital after hours. This seems to align with what you are saying, with some small caveats. I ask as I cross-posted this in the whitecoatinvestor.com forums and several people suggested that such a plan is overly complicated and it would be better to be paid a flat rate (e.g. $14k/wk regardless of the hours worked). What has your experience been?

 

[pgg]

Thanks pgg, this is very helpful.

Just to be clear: when you take weekday PM call, you are getting paid your hourly rate a a 20% premium regardless as to wether or not you are working the entire time (for instance: $200/hr weekday->$240/hr weeknight * 14 hours = $3,360?). This sounds like an amazingly good deal to me, especially if you don't plan on getting called back in, but perhaps I am missing something.

No, for a PM call it would be $240 to hold the pager overnight, 5 PM to 7 AM. If you're called at 11 to do an appy and you leave at 1, you'd be paid another $480 for those two hours of work. Total $720 for the night. But most nights you're not called, and you get the $240.

Also, quick question as to how these deals are normally structured. My impression was that they are frequently (but not always) paid as a base for a weekday shift (say $1600 for 7 to 3:30) + compensation to cover the pager (that is, to be available but not necessarily in the hospital squeezing the bag) + hourly for any time spent in the hospital after hours. This seems to align with what you are saying, with some small caveats. I ask as I cross-posted this in the whitecoatinvestor.com forums and several people suggested that such a plan is overly complicated and it would be better to be paid a flat rate (e.g. $14k/wk regardless of the hours worked). What has your experience been?

The risk with flat rates is you might get worked like a dog, and not get paid extra for it.

There's nothing wrong with a flat rate of $X for M-F 7 - 3 PM ... plus hourly OT. There's something wrong with a flat rate of $X for M-F where you're expecting to work 7-3 but end up staying until 6 PM on four days and 10 PM the other day. Because someone called in sick that week, and you're there to get the work done for a flat rate.

The key to any fair scheme is having an idea how many hours you're going to work, on average, and what kind of hours they are, and then deciding what it's worth to you.

I prefer the unambiguous language of a daily minimum rate plus OT. The OT rate dissuades them from arbitrarily making you stay late, and it makes it worth your while when they do.

There's nothing complicated about
- we'll pay you $1600 to work from 7-3 (guaranteed 8 hour minimum, if we send you home at 9 you get $1600)
- if you stay past 3 we'll pay you $240/hour
- if you're on pager call at night we'll pay you $240/hour
- if you get called in we'll pay you $240/hour with a 2 hour minimum
We're doctors and we're good at math. No one is confused by this. It's transparent. It's fair. Everybody knows exactly what's up.

You won't get hosed by coming in at 7 and getting told at 9 they don't need you for the day, go home with your $400.

You won't get hosed by coming in at 7, expecting to leave at 3, and getting stuck there until 6 every day when you were expecting 8 hour days for your flat rate.

You won't get hosed by working a lot of hours when it's dark outside for a flat rate you negotiated when they told you "ah, cases at night are unusual" ...

Locums jobs are hourly gigs at their core. You're not a partner and you're not going to be a partner. You're trading time for money without any of the distractions and duties of committees, hospital politics, schedule writing, cat herding, and complaint answering. You're better off knowing exactly how much every hour you work is worth. If it's not written down in detail someone will take advantage of you.

 

[cerev]

No, for a PM call it would be $240 to hold the pager overnight, 5 PM to 7 AM. If you're called at 11 to do an appy and you leave at 1, you'd be paid another $480 for those two hours of work. Total $720 for the night. But most nights you're not called, and you get the $240.




The risk with flat rates is you might get worked like a dog, and not get paid extra for it.

There's nothing wrong with a flat rate of $X for M-F 7 - 3 PM ... plus hourly OT. There's something wrong with a flat rate of $X for M-F where you're expecting to work 7-3 but end up staying until 6 PM on four days and 10 PM the other day. Because someone called in sick that week, and you're there to get the work done for a flat rate.

The key to any fair scheme is having an idea how many hours you're going to work, on average, and what kind of hours they are, and then deciding what it's worth to you.

I prefer the unambiguous language of a daily minimum rate plus OT. The OT rate dissuades them from arbitrarily making you stay late, and it makes it worth your while when they do.

There's nothing complicated about
- we'll pay you $1600 to work from 7-3 (guaranteed 8 hour minimum, if we send you home at 9 you get $1600)
- if you stay past 3 we'll pay you $240/hour
- if you're on pager call at night we'll pay you $240/hour
- if you get called in we'll pay you $240/hour with a 2 hour minimum
We're doctors and we're good at math. No one is confused by this. It's transparent. It's fair. Everybody knows exactly what's up.

You won't get hosed by coming in at 7 and getting told at 9 they don't need you for the day, go home with your $400.

You won't get hosed by coming in at 7, expecting to leave at 3, and getting stuck there until 6 every day when you were expecting 8 hour days for your flat rate.

You won't get hosed by working a lot of hours when it's dark outside for a flat rate you negotiated when they told you "ah, cases at night are unusual" ...

Locums jobs are hourly gigs at their core. You're not a partner and you're not going to be a partner. You're trading time for money without any of the distractions and duties of committees, hospital politics, schedule writing, cat herding, and complaint answering. You're better off knowing exactly how much every hour you work is worth. If it's not written down in detail someone will take advantage of you.

Thanks again pgg. That was my sentiment in the WCI thread, but I got a fair amount of pushback suggesting that it was too complicated, difficult to track, and likely to breed animosity. It is good to hear from an anesthesiologist who has done this (I don't know how many of those responding were anesthesiologists and familiar with the nuances of how we work).

 

[ProRealDoc]

Under $200/hr is at the bottom end of what I would expect as a generalist. Some really locums saturated areas are as low as $170/hr. (Military hospital towns are a good example because there are so many of us looking for part time moonlighting gigs.)

For a rural job $200-250/hr is more reasonable.

That said, $180/hr to sit your own room doing low risk gen surg and ortho, arriving at and leaving the hospital while the sun's shining, isn't necessarily a bad deal. Supervising, train wreck patients, working late, covering call, etc needs a better rate.

Anesthesia services can be a loss leader for a hospital because the ORs and supporting services need us, and the big picture earns boatloads of money, so don't believe for a second that they can't "afford" it. Of course they'll lowball people while handwringing over how poor the place is. It's what they do. Demand more. Or work somewhere else. They need you. You don't need them.

What would your hourly rate be for covering CT cases exclusively?

 

[pgg]

What would your hourly rate be for covering CT cases exclusively?

That's tough to find in my experience, most places have wanted me to cover general cases too. I have found exactly one place that wanted me for CT only

$250/h with 8h minimum
$270/h OT
$270 for 5 PM - 6 AM weeknight pager call, plus OT if called in for a takeback or something from the ER (rare)
Weekend call coverage is prorated weeknight rate for however many hours covered so a 24 would be 270 x 24/13 = 500

I think that's fair. Been looking for a job like that for over a year and finally found a place where their needs intersected my wants. I couldn't cast a very wide net (geographically) being tied to my day job.

Edited for math

 

[aneftp]

I’ve done flat rate at medium size hospital Beeper call. Usually average 5-8 hours of physical work.

My break even point is around 10 hours work a day. I will cover both weekend days so 48 hour call. My rate is $2600 per 24 hour call. Last time I worked 4 hours on a Sunday. And 10 hours on Saturday.

The time before I got hosed. I worked about 16 hours on Saturday. Turned around and worked another 10 hours Sunday. So 26 hours worked for $5200.

I have option of carrying beeper for $800/24 hours also and $200/hr.

That’s why I say about 10 hours is my break even working hours. But they pay me from 7am-7am calls. Calls are usually 8am though.

I don’t haggle a lot. Cause i know the place. They are familiar with me. It’s overall easy work. It’s driving distance for me. I don’t really need hotel but they pay for my hotel. Easy points to collect with hotel. Not my full time job. Make around 20-25k extra income for the year.

There is trauma one hospital in town offering $4000/flat rate. But it’s busy.

It really depends on how desperate the facility is also. And how much regular work u want.

 

[anes121508]

All of this is just my opinion, and as such it's going to be saturated with bias from my experience and the regions I've worked (largely rural).

A reasonable home pager call rate for a weeknight is 1x your hourly rate whether you get called or not. If called in, you should additionally get paid the regular rate +20% or so, with a minimum callback of 2 hours. So if the regular day rate is $200/hr, to cover nights there (pager call 5 PM to 7 AM) I'd be looking for a fee of $240 or $250, plus $240-250/hour if you come in, with a 2 hour minimum. This is all predicated on an overnight call-in being an unusual event. The primary intent is to pay you to be available, and only rarely to pay you to work.

If you're routinely working 6 or 8 or 12 hours when it's dark outside, that's not really "call", that's an overnight/graveyard shift and I personally wouldn't even consider abusing myself that way for less than $300/hr, and maybe not even then.

For a scheduled Saturday or Sunday day shift (same hours as a weekday) I've never been paid a premium over weekday pay. Daylight hours = daylight hours.

The 20% premium for OT is a very ballpark figure that has matched most of the contracts I've had. However, at present my OT rate is just 8% more than my base rate. I'm OK with that because I was able to demand a high base rate because I'm TEE boarded and credentialed to do cardiac cases.

At my current locums job, my weekend rate is the weekday rate for an 8 hour minimum (whether I work or not) plus overtime at the OT hourly rate.

I used to cover Fri 4 PM to Monday 7 AM at a rural hospital for a flat rate of $4500. This was actually 2nd call Fri, 1st call Sat, and 2nd call Sun. A typical weekend would be a few hours Fri night closing down the ORs, then about 10 hours in the hospital on Saturday, and none on Sunday. That was a very popular call shift, and people got in line for it, so they were probably overpaying. The key there was that the partners hated working weekends, and were willing to pay generously for weekend coverage so they'd never ever have to risk taking a shift themselves.

I just signed up at a new place for a weekend pager call deal for about 1/3 that ($1400) but the expectation is that I'll very rarely be called in. If I am, there is additional hourly OT pay. That strikes me as reasonable for what amounts to being tethered to a 20 minute radius of the hospital, in sobriety, for the weekend.


The above is just my own experience over the last ~10 years of on and off moonlighting to supplement my Navy day job's case load and income. It's notable that I had long stretches where I did zero locums work because there wasn't anything I liked available close to me and I didn't feel like traveling, or because I just didn't want to fill my vacation with more work. I have left jobs where the work environment was poor (my personal record is quitting after 4 days). I think that as a locums, getting good rates, and working in a good environment, is very dependent upon your ability and willingness to turn down an offer or leave. I've found that I can be fairly picky and set fairly high rates for myself ... if I'm willing to be unemployed for a while.

I have been following your posts for quite some time now and appreciate your honest and unfiltered experiences/advice/pearls.

This is a great example of what we should be sharing with each other. The more knowledge you all share, the less likely the young guys will take stupid low ball offers. Call it union mentality, but whatever...we should all be more blunt about this stuff and spread the word on what is stupid to accept and what’s a good deal. It’ll help us and not the ***** who accidentally sent the email revealing that he was taking 60% off the top as a finders fee.

I think some of you more experienced guys should write a bible type thing that explains the business of anesthesia and all the factors to consider and what goes into wether or not you take an amc gig or locums gig.

 

[anes121508]

No, for a PM call it would be $240 to hold the pager overnight, 5 PM to 7 AM. If you're called at 11 to do an appy and you leave at 1, you'd be paid another $480 for those two hours of work. Total $720 for the night. But most nights you're not called, and you get the $240.




The risk with flat rates is you might get worked like a dog, and not get paid extra for it.

There's nothing wrong with a flat rate of $X for M-F 7 - 3 PM ... plus hourly OT. There's something wrong with a flat rate of $X for M-F where you're expecting to work 7-3 but end up staying until 6 PM on four days and 10 PM the other day. Because someone called in sick that week, and you're there to get the work done for a flat rate.

The key to any fair scheme is having an idea how many hours you're going to work, on average, and what kind of hours they are, and then deciding what it's worth to you.

I prefer the unambiguous language of a daily minimum rate plus OT. The OT rate dissuades them from arbitrarily making you stay late, and it makes it worth your while when they do.

There's nothing complicated about
- we'll pay you $1600 to work from 7-3 (guaranteed 8 hour minimum, if we send you home at 9 you get $1600)
- if you stay past 3 we'll pay you $240/hour
- if you're on pager call at night we'll pay you $240/hour
- if you get called in we'll pay you $240/hour with a 2 hour minimum
We're doctors and we're good at math. No one is confused by this. It's transparent. It's fair. Everybody knows exactly what's up.

You won't get hosed by coming in at 7 and getting told at 9 they don't need you for the day, go home with your $400.

You won't get hosed by coming in at 7, expecting to leave at 3, and getting stuck there until 6 every day when you were expecting 8 hour days for your flat rate.

You won't get hosed by working a lot of hours when it's dark outside for a flat rate you negotiated when they told you "ah, cases at night are unusual" ...

Locums jobs are hourly gigs at their core. You're not a partner and you're not going to be a partner. You're trading time for money without any of the distractions and duties of committees, hospital politics, schedule writing, cat herding, and complaint answering. You're better off knowing exactly how much every hour you work is worth. If it's not written down in detail someone will take advantage of you.

Do you think a job with AMC deserves same approach?

 

[anes121508]

Thanks again pgg. That was my sentiment in the WCI thread, but I got a fair amount of pushback suggesting that it was too complicated, difficult to track, and likely to breed animosity. It is good to hear from an anesthesiologist who has done this (I don't know how many of those responding were anesthesiologists and familiar with the nuances of how we work).

That’s bs ...difficult to track and animosity my a**. Surprised to hear that’s what’s on WCI thread. I’m a huge fan of WCI. Bet some of the folks on here could do gues posts on WCI. I’d love to see some of you senior guys/gals on this forum do a guest post on business of anesthesia and your opinions and suggestions. it’d be a service to us all.

 

[deleted50478]

Do you think a job with AMC deserves same approach?

Absolutely

 

[kidthor]

pgg - to be sure, are those rates to you as a 1099 and you cover your own malpractice, parking, etc, or is this via an agency/hospital that covers that for you?

 

[pgg]

pgg - to be sure, are those rates to you as a 1099 and you cover your own malpractice, parking, etc, or is this via an agency/hospital that covers that for you?

1099

They cover malpractice + tail.

I've never in my life paid for parking at a hospital. They give me a badge and it opens the lot or garage.

 

[deleted592694]

Must be nice to never in your life to have paid for parking at a hospital; this will be the case at my upcoming gig but during residency and currently in fellowship, parking anywhere close to the hospital costs/costed ~ $100-150 per month, and arriving anytime after 6:10 in a very snow heavy city ensured you would never get a covered spot in the garage.

My parking while moonlighting has been free.

1099

I've never in my life paid for parking at a hospital. They give me a badge and it opens the lot or garage.

 

[pgg]

That's lame.

I think a friend of mine who did a peds fellowship at CHOP had to pay for parking.

 

[AdmiralChz]

That's lame.

I think a friend of mine who did a peds fellowship at CHOP had to pay for parking.

My parking during fellowship was insane - like more than $300 a month. It was directly adjacent but still sucked. Several of my co-fellows lived within walking distance to avoid that.

Also had to pay in residency, wasn’t exactly free either but probably half of what I paid above and it was a long haul to the ORs from there.