LOCUMs rates 2024

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Most locums rates I see advertised are between $280-350 / hr 1099.

I think that rate is trash, not worth the travel and lack of support to work in a dump.
 
always.chillin said:
Doesn’t Kaiser pay at least 200 full time?
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I work at a northern california kaiser and we pay $235/hr day shift, $295/hr on weekends, and $345/hr for nights. It's a great gig. Just in Fresno which is a hard for some people. We have 3 regular locums docs who travel from far away and work few nights in a row and then fly back home
 
In the Boston area I’m aware of frequent opportunities for 275-295 / hr gigs at places close to the city. This is for any given shift, vaguely reasonable 2024 work environments.
 
anyone heard of any critical access or remote shops paying 400+ an hour? seems like 350 is highest im seeing anywhere
 
If people would refuse to accept locums rates for anything less than $400-450/hr, the locums companies would be forced to pay the higher rate to get their staffing. The locums are charging more because the company gets a pretty decent cut of the pie (30-50%).
 
southerndoc said:
If people would refuse to accept locums rates for anything less than $400-450/hr, the locums companies would be forced to pay the higher rate to get their staffing. The locums are charging more because the company gets a pretty decent cut of the pie (30-50%).
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It's really annoying when I hear about EM docs accepting less than this for locums or for spot coverage at their shops.

Have some self respect.

The freaking dock workers were offered 50% more pay and they REFUSED it.
 
mihirtak said:
anyone heard of any critical access or remote shops paying 400+ an hour? seems like 350 is highest im seeing anywhere
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Where did you find a critical access place with 350? Is it higher volume?
 
About $300/hr. No nights for me. That's why I do locums.
 
PB2464 said:
About $300/hr. No nights for me. That's why I do locums.
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What do you define as a night?
Yeah, I tried this. All they wanted was nights, so I'm out soon, but I'm sad.
I've been quoted $220 to $325 an hour with a minimal night differential. Juice just isn't worth the squeeze with how hard this specialty has become.
 
miacomet said:
What do you define as a night?
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I thought about this for a moment. One one side are the purists, who day "it's only a night shift if you are relieved by the day shift". The other end is someone who might say, "if I go outside after the shift and it's dark, it's a night shift!" (even if you worked the day, and it's 7pm).
 
Apollyon said:
I thought about this for a moment. One one side are the purists, who day "it's only a night shift if you are relieved by the day shift". The other end is someone who might say, "if I go outside after the shift and it's dark, it's a night shift!" (even if you worked the day, and it's 7pm).
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I would say any shift that ends at 1:01 am or later.
 
miacomet said:
What do you define as a night?
Yeah, I tried this. All they wanted was nights, so I'm out soon, but I'm sad.
I've been quoted $220 to $325 an hour with a minimal night differential. Juice just isn't worth the squeeze with how hard this specialty has become.
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Any time spent after 1 am or so. It doesn't alter my sleep schedule really, which is my main concern. Getting tired at the same time every night and waking with the sun is unbelievable. Well worth it. And hopefully I can stay alive longer for my wife.

Depending on your area, you might have to do some travel to make it work. I believe the travel outweighs night shifts. Not everyone will.
 
WhatJobDoIPick said:
It's really annoying when I hear about EM docs accepting less than this for locums or for spot coverage at their shops.

Have some self respect.

The freaking dock workers were offered 50% more pay and they REFUSED it.
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The locums companies aren’t pocketing the entire margin though. Malpractice, admin costs, commission for the rep, etc etc add up. That’s why it’s so rare to get a 400/hr rate even if the hospital is ok paying the locums company 500/hr. Google says they have a 5% profit margin after all is said and done.

Not to say people should accept crap rates. Always negotiate up. The advertised pay is always going to have wiggle room. But there’s a reason 450/hr is unicorn pay and it’s not just because docs don’t negotiate.

One question I have never found an answer for is why hospitals are so reluctant to directly hire locums. I know that they sometimes will but anecdotally it seems rare. For an EM doc who doesn’t need an office and is just another warm body to have on shift, it doesn’t make sense that these locums companies offer a ton beyond setting up malpractice insurance, yet health systems don’t want to directly contract with docs.
 
larpleston said:
One question I have never found an answer for is why hospitals are so reluctant to directly hire locums. I know that they sometimes will but anecdotally it seems rare. For an EM doc who doesn’t need an office and is just another warm body to have on shift, it doesn’t make sense that these locums companies offer a ton beyond setting up malpractice insurance, yet health systems don’t want to directly contract with docs.
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Because then they need to hire somebody (or make alienate somebody by adding this onto their tasks) to coordinate everything and then deal with any issues that pop up. It's much, much easier to write a check knowing that somebody will be there.
 
JacobMcCandles said:
Because then they need to hire somebody (or make alienate somebody by adding this onto their tasks) to coordinate everything and then deal with any issues that pop up. It's much, much easier to write a check knowing that somebody will be there.
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EM is showing up to shifts, seeing patients, and going home. Your explanation makes sense for a locums outpatient GI doc, or a surgeon for instance, but the marginal administrative burden for another ER doc on staff who can pick up some shifts here and there is incredibly low. What issues is the hospital punting to the locums agency other than malpractice and maybe payroll since they can just pay the company instead of the doc directly? The hospital is responsible for credentialing, training, any issues that arise in shift, etc, regardless of whether there’s an locum agency involved. And medmal and a somewhat simpler payroll doesn’t seem worth the extra cost of a staffing agency, so there must be some hospital admin reason that is not as immediately obvious.
 
What's the longest you guys have seen locums in hospitals? I'm in a large city. The inner city hospitals and nearby suburban hospitals seem to intermittently need locums for a few months then eventually find suckers to do the job for pennies. But, if you go just over an hour outside the city, the locums seem to persist for quite a while. My current site has probably 25%+ of shifts covered by locums and I'm really liking it.
 
fresyes123 said:
Not true at least at my shop. We'll take anything
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By the looks of your name, I'd assume you're at the Fresno Kaiser, and I'm not surprised.

I did some gigs in the Central Valley with Vituity, and while the money was reasonable, never again. Just a tragic place to live and be.

That said... how much are you all paying for pool docs?
 
always.chillin said:
What's the longest you guys have seen locums in hospitals? I'm in a large city. The inner city hospitals and nearby suburban hospitals seem to intermittently need locums for a few months then eventually find suckers to do the job for pennies. But, if you go just over an hour outside the city, the locums seem to persist for quite a while. My current site has probably 25%+ of shifts covered by locums and I'm really liking it.
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You like it? We’ve had to fire so many.

Unfortunately we have had to deal with a myriad of locums. About 75% have a pathologic personality disorder and/or are straight up dangerous at treating patients. The next 15% are barely passable and incredibly slow. 10% are tolerable at best.
 
Rekt said:
You like it? We’ve had to fire so many.

Unfortunately we have had to deal with a myriad of locums. About 75% have a pathologic personality disorder and/or are straight up dangerous at treating patients. The next 15% are barely passable and incredibly slow. 10% are tolerable at best.
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All the sites I’ve worked so far are pretty normal places. The distance is probably what deters people. I’m thankful for the sites paying me what they do, and I try to do a good job and always have had good relationships with everyone. Some of the sites send me metrics, and I’ve noticed I’m on par if not faster than the full timers. It’s really too bad, because if all these sites would just start paying everyone $300/hour full time, we wouldn’t need locums as much and people would be more motivated to work hard.
 
My interactions with locums docs is they are bad docs and have major personality issues and do it as an end of career / burned all the bridges type folks. No one worth keeping around. My interactions have been limited but all negative. Literally all.. 100%.. Again N is small.

As mentioned hospitals use locums because they need them for the continued work. I am sure if the hospital does this it would ruin their rep. I also wouldn’t be shocked if there is something in their locums agreement that prevents this.
 
larpleston said:
EM is showing up to shifts, seeing patients, and going home. Your explanation makes sense for a locums outpatient GI doc, or a surgeon for instance, but the marginal administrative burden for another ER doc on staff who can pick up some shifts here and there is incredibly low. What issues is the hospital punting to the locums agency other than malpractice and maybe payroll since they can just pay the company instead of the doc directly? The hospital is responsible for credentialing, training, any issues that arise in shift, etc, regardless of whether there’s an locum agency involved. And medmal and a somewhat simpler payroll doesn’t seem worth the extra cost of a staffing agency, so there must be some hospital admin reason that is not as immediately obvious.
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Depending on how many places you've worked, credentialing can be a huge pain. I punt absolutely everything to the staffing agencies. Some try to make me track down procedure logs. Nope.

always.chillin said:
What's the longest you guys have seen locums in hospitals? I'm in a large city. The inner city hospitals and nearby suburban hospitals seem to intermittently need locums for a few months then eventually find suckers to do the job for pennies. But, if you go just over an hour outside the city, the locums seem to persist for quite a while. My current site has probably 25%+ of shifts covered by locums and I'm really liking it.
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6 months to over a year. Accrue enough places at one time and you never have to worry about it.

Most of the doctors knocking locums are the ones too afraid to take the risk or they can't. You need to be somewhat frugal or more financially independent in case shifts dry up 1-2 months (I have not personally experienced that yet). Once you make 30-50% more and can create your own schedule, there is no going back.

Whenever I hear about someone signing a contract I cringe and think...sucker.
 
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PB2464 said:
Depending on how many places you've worked, credentialing can be a huge pain. I punt absolutely everything to the staffing agencies. Some try to make me track down procedure logs. Nope.



6 months to over a year. Accrue enough places at one time and you never have to worry about it.

Most of the doctors knocking locums are the ones too afraid to take the risk or they can't. You need to be somewhat frugal or more financially independent in case shifts dry up 1-2 months (I have not personally experienced that yet). Once you make 30-50% more and can create your own schedule, there is no going back.

Whenever I hear about someone signing a contract I cringe and think...sucker.
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I havent seen the rates all that high. Around me, baseline jobs paying 230 -240 are offering locums under 300. There are normal jobs around me that you can get close to that. The few SDGs near me make more than that.

My issue with locums is once you factor in travel time / time away from family the pay doesnt seem to make as much sense but maybe thats just what is around me. I’m not looking to get licensed in 10 other states. I have a buddy who is based in the SW and travels all over creation, Maine, Kentucky western AZ and is getting $$300-330/hr.. just doesnt make a ton of sense.
 
PB2464 said:
Depending on how many places you've worked, credentialing can be a huge pain. I punt absolutely everything to the staffing agencies. Some try to make me track down procedure logs. Nope.



6 months to over a year. Accrue enough places at one time and you never have to worry about it.

Most of the doctors knocking locums are the ones too afraid to take the risk or they can't. You need to be somewhat frugal or more financially independent in case shifts dry up 1-2 months (I have not personally experienced that yet). Once you make 30-50% more and can create your own schedule, there is no going back.

Whenever I hear about someone signing a contract I cringe and think...sucker.
Click to expand...

I’m not sure if locums is paying >30% more. Unless you go to really undesirable jobs that are dumpster fire locations, then maybe they might pay that.

In a 2 hour radius to where i live, the highest locums rate I’ve seen is around 325/hr seeing 2-2.5 pph. Most w2 shops pay 230-250/hr plus benefits. When you start including the value of the benefits especially the 1/2 ficaa taxes, 401k match, cme, health insurance etc then the difference is maybe 50/hr for working at disaster shops.
 
EctopicFetus said:
I havent seen the rates all that high. Around me, baseline jobs paying 230 -240 are offering locums under 300. There are normal jobs around me that you can get close to that. The few SDGs near me make more than that.

My issue with locums is once you factor in travel time / time away from family the pay doesnt seem to make as much sense but maybe thats just what is around me. I’m not looking to get licensed in 10 other states. I have a buddy who is based in
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Isn't $300 about 30% more than $230?

I'm working way less than everyone else for more pay and I don't travel that far. Region has a lot to do with it. The fact that I'm able to drive and do this tells me that it's more of a risk taking thing by the doc around me since they could easily do the same. Most just don't know it. I get questions all the time.
 
always.chillin said:
All the sites I’ve worked so far are pretty normal places. The distance is probably what deters people. I’m thankful for the sites paying me what they do, and I try to do a good job and always have had good relationships with everyone. Some of the sites send me metrics, and I’ve noticed I’m on par if not faster than the full timers. It’s really too bad, because if all these sites would just start paying everyone $300/hour full time, we wouldn’t need locums as much and people would be more motivated to work hard.
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What are you making as the locums guy? How much more than the full timers
 
cyanide12345678 said:
I’m not sure if locums is paying >30% more. Unless you go to really undesirable jobs that are dumpster fire locations, then maybe they might pay that.

In a 2 hour radius to where i live, the highest locums rate I’ve seen is around 325/hr seeing 2-2.5 pph. Most w2 shops pay 230-250/hr plus benefits. When you start including the value of the benefits especially the 1/2 ficaa taxes, 401k match, cme, health insurance etc then the difference is maybe 50/hr for working at disaster shops.
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I'm actually making almost 50% more at one place. Let's not forget the bonus on top of that every now and then.

Also, I would never want to be W2.
 
PB2464 said:
Isn't $300 about 30% more than $230?

I'm working way less than everyone else for more pay and I don't travel that far. Region has a lot to do with it. The fact that I'm able to drive and do this tells me that it's more of a risk taking thing by the doc around me since they could easily do the same. Most just don't know it. I get questions all the time.
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Well…. It’s actually not.

I’ll explain. I get $238/hr (recent increase by university system).

I also got paid a retention bonus for 3 years which is worth about $15/hr.

We also get quarterly quality bonuses (use the sepsis order set etc) which is another 20k/year if you meet those - so about $13/hr.

Then i get about 15k in 401k match. 5k cme. And since im w2, my employer pays 1/2 my social security and Medicare taxes which is roughly another 15k.

So my 1099 equivalent income is probably around 280/hr without even considering the medical benefits, And i don’t even work at a dumpster fire and get to sleep in my bed every night.
 
cyanide12345678 said:
Well…. It’s actually not.

I’ll explain. I get $238/hr (recent increase by university system).

I also got paid a retention bonus for 3 years which is worth about $15/hr.

We also get quarterly quality bonuses (use the sepsis order set etc) which is another 20k/year if you meet those - so about $13/hr.

Then i get about 15k in 401k match. 5k cme. And since im w2, my employer pays 1/2 my social security and Medicare taxes which is roughly another 15k.

So my 1099 equivalent income is probably around 280/hr without even considering the medical benefits, And i don’t even work at a dumpster fire and get to sleep in my bed every night.
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And you're missing out on the tax benefits of NOT being 1099.

I'm not a fan of trying to increase my theoretical earnings through bonuses, RVU, using order sets (you're joking right?), CME, etc. That's more of a brain drain for me, but to each his own.

It doesn't matter how how you spin it. You're not sleeping in your bed every night because you're working at night. I'm not. Also I don't work a single holiday. Barely weekends. If you want theoretical earnings/expenses subtract some of your pay for more medical expenses down the road.
 
I will also add that I don't care what they say a job pays. I will negotiate over every offering and almost always successful. A lot depends on initial rate. I have walked away several times. I can't believe it when people take the first offer.
 
PB2464 said:
It doesn't matter how how you spin it. You're not sleeping in your bed every night because you're working at night. I'm not. Also I don't work a single holiday. Barely weekends. If you want theoretical earnings/expenses subtract some of your pay for more medical expenses down the road.
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Now that’s true. I don’t sleep every night in my bed because of night shift and i do work quite a few weekends. I think my quality of life will definitely be better if i had a stable schedule and no weekends.

But as far as the exact financial numbers go - as someone who was an S corp before, i think a degree of 1099 benefits is wiped out by the increase in tax burden of ficaa taxes.

The biggest 1099 benefit is the ability to do a defined benefit plan, the second biggest is having a solo 401k up to 62-63k limit (or whatever the limit is these days). Most people who are 1099 rarely use a defined benefit plan. And the actual benefit of deducting expenses is not as great when you’re an ER doc - there’s only so much you can arguably deduct. Maybe a car, mileage sure - the expenses usually aren’t as much.

But on the other hand, when you really start crunching numbers on the w2 side - access to a hsa, and a 457 often leads to very similar tax related benefits.

The reality is - the best way to do things is to have both - i have a prn 1099 gig. I get to deduct my expenses, get a 401k with an employer match, then get access to a 457, and on top have a solo 401k where i can max the employer contribution. So all in all - i personally have 80k of tax sheltered investment space including HSA for myself and 50-60k for my 1099 wife.

So honestly…i do both, but im also not willing to jump ship from my w2 as locums likely will start to dry up in 3 ish years as supply demand imbalance begins to show.
 
HemorrhagicShock said:
By the looks of your name, I'd assume you're at the Fresno Kaiser, and I'm not surprised.

I did some gigs in the Central Valley with Vituity, and while the money was reasonable, never again. Just a tragic place to live and be.

That said... how much are you all paying for pool docs?
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$235/hr day shift, $295/hr on weekends, and $345/hr for nights
Yeah Fresno Kaiser. It's not like the other hospitals in town - trauma center is crazy and academic, the two vituity sites you get worked to the bone. I have no idea why so many people don't want to work here. It feels like a unicorn gig. A few pool docs figured it out and have been flying in, working strings of shifts, and then going home for a few years now. They're all good. One guy even works 22+ shifts pool every month by doing a bunch of doubles and then flying home
 
fresyes123 said:
$235/hr day shift, $295/hr on weekends, and $345/hr for nights
Yeah Fresno Kaiser. It's not like the other hospitals in town - trauma center is crazy and academic, the two vituity sites you get worked to the bone. I have no idea why so many people don't want to work here. It feels like a unicorn gig. A few pool docs figured it out and have been flying in, working strings of shifts, and then going home for a few years now. They're all good. One guy even works 22+ shifts pool every month by doing a bunch of doubles and then flying home
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Fresno is that bad, Kaiser EM is very idiosyncratic, and ultimately losing high-acuity high-volume skill due to atrophy

That's why I never considered it.
 
EctopicFetus said:
I havent seen the rates all that high. Around me, baseline jobs paying 230 -240 are offering locums under 300. There are normal jobs around me that you can get close to that. The few SDGs near me make more than that.

My issue with locums is once you factor in travel time / time away from family the pay doesnt seem to make as much sense but maybe thats just what is around me. I’m not looking to get licensed in 10 other states. I have a buddy who is based in the SW and travels all over creation, Maine, Kentucky western AZ and is getting $$300-330/hr.. just doesnt make a ton of sense.
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What is anticipated job market growth?
I would assume with all the boomers aging and more sh$$ getting rammed down ED throats that there will be more jobs available to support increase in residency expansion or at least blunts some of the effects.
 
My situation is a little unique as a number of colleagues were/are working with what amounts to a local/regional locums agency that basically tried to get full time known solid docs that live locally to serve as a locums pool for sites that either need seasonal or intermediate / long term help that are within driving distance.

It’s a good concept. The quality of locums docs I worked alongside were solid (I’ve also worked side by side with the classic shady type). It allows people to have their standard core w2 gig but get a couple 1099 shifts on the side for tax benefits, extra money, variety.

The pay was always solid/ good, rarely amazing.

I enjoyed it both for the obvious financial reasons, but also bc the variety in practice location/style was refreshing. As the two sites I enjoyed the most finally filled with full timers and I got more and more busy with admin stuff at my core site, I’ve backed off… but I like the model.
 
HemorrhagicShock said:
Fresno is that bad, Kaiser EM is very idiosyncratic, and ultimately losing high-acuity high-volume skill due to atrophy

That's why I never considered it.
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But wouldn't that be a perfect setup for locums? $300/hr to see 15 low-moderate acuity patients in a shift? I'm not sure why everyone feels that seeing 32 critical care patients in 8 hours is the only way to be happy in EM. You can still get that somewhere else the rest of the month, no? Different strokes, I guess
 
fresyes123 said:
$235/hr day shift, $295/hr on weekends, and $345/hr for nights
Yeah Fresno Kaiser. It's not like the other hospitals in town - trauma center is crazy and academic, the two vituity sites you get worked to the bone. I have no idea why so many people don't want to work here. It feels like a unicorn gig. A few pool docs figured it out and have been flying in, working strings of shifts, and then going home for a few years now. They're all good. One guy even works 22+ shifts pool every month by doing a bunch of doubles and then flying home
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That's actually a nice night shift differential. I always think wow what a complete joke to only offer $10/hr, which is often what I see from CMGs if anything at all.
"Hey you don't have to see as many people" is what the claim, totally ignoring other factors.
 
PB2464 said:
I will also add that I don't care what they say a job pays. I will negotiate over every offering and almost always successful. A lot depends on initial rate. I have walked away several times. I can't believe it when people take the first offer.
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Again, I wonder how much of this is location dependent. It seems to be working out great for you. I’m happy about that. The future for EM as a whole is uncertain. I have found my unicorn.. it’s great. I get few will attain what I have. So I come at it from a “standard” job model.

Some jobs are negotiable. Some are not. My SDG when we hire new people there is 0 room to negotiate.. Then again we have at least 2 people interview for every spot we have. This year 100% of our offers were accepted. Last year i think it was over 90%.
 
johhnybgood said:
What is anticipated job market growth?
I would assume with all the boomers aging and more sh$$ getting rammed down ED throats that there will be more jobs available to support increase in residency expansion or at least blunts some of the effects.
Click to expand...
counter point.. Everyone is pushing people away. Across the country EM volumes per EDBA has been stagnant for 5-6 years. I don’t believe we have hit the pre covid numbers. Now we see hospitals closing. The big one in atlanta, a bunch of rural ones as well.

ED volumes are flat and I imagine if they grow it will be anemic. Hospital at home and new setups to keep NH patients in their NH will also remove some of our volume.

In theory we would have growth in ED volume but I think in reality it isnt happening. The best thing would be opening up FSEDs/microhspitals but that will be region specific. When Texas pay was insane it was during that period of FSED expansion in Texas. The push will be to keep people out of the hospital /ED that will continue.
 
EctopicFetus said:
Some jobs are negotiable. Some are not. My SDG when we hire new people there is 0 room to negotiate.. Then again we have at least 2 people interview for every spot we have. This year 100% of our offers were accepted. Last year i think it was over 90%.
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Why is your job having that many people leave?
 
EctopicFetus said:
My interactions with locums docs is they are bad docs and have major personality issues and do it as an end of career / burned all the bridges type folks. No one worth keeping around. My interactions have been limited but all negative. Literally all.. 100%.. Again N is small.
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That may have been true in the past but not in the present. Several docs like me have been forced into locums because we chose to live in desirable cities, but the pay is trash. Why get paid $175/hr when you can drive 1.5-2hrs out of town and earn double?

Also, even though I'm classified as a "locum" by the hospitals, I don't actually work for any 3rd party locums agency. They are trash and should be avoided. The last time I worked for a 3rd-party agency was ten years ago. I can't imagine how bad they are now. I negotiate directly with the hospital or CMG that staffs the hospital. This is how you get the best pay and best protection.

Three months into any job, I usually get offered a full-time job, but I always decline. I enjoy my freedom.
 
Apollyon said:
Why is your job having that many people leave?
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Ahh.. no one left.. we expanded, took a CMG contract and added coverage at 2 of our sites.. And our hospital system opened a new facility in March so instead of being overstaffed for 9 months we decided to be short staffed for 3 months.
 
Kryptocoin said:
That may have been true in the past but not in the present. Several docs like me have been forced into locums because we chose to live in desirable cities, but the pay is trash. Why get paid $175/hr when you can drive 1.5-2hrs out of town and earn double?

Also, even though I'm classified as a "locum" by the hospitals, I don't actually work for any 3rd party locums agency. They are trash and should be avoided. The last time I worked for a 3rd-party agency was ten years ago. I can't imagine how bad they are now. I negotiate directly with the hospital or CMG that staffs the hospital. This is how you get the best pay and best protection.

Three months into any job, I usually get offered a full-time job, but I always decline. I enjoy my freedom.
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I’m talking about those who come from the 3rd parties.. thats my only experience.
 
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