LOCUMs rates 2024

[JacobMcCandles]

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Why not have someone help with the kids? It’s nice to have someone make the lunch while I play dolls with them. It’s nice to have someone pick up their toys while I put them down for a nap. It’s nice to have someone watch their sleep monitors while I walk the dog and my wife works out. It’s nice to have someone get the bottles ready while I read to the older ones.

You should try it. Imagine a life with no mundane activities and pure quality time. Yes, I miss some quality time but that is unavoidable in life.

Maybe I'm just confused with your verbiage because when I hear of hiring someone to help with kids I don't think of someone making lunch or cleaning. I agree with the other poster, my wife would kill me if I worked that much, and she'd be right to. You can get quality time with your kids by also having them help you make lunch, help clean up, etc. I'd say having 160 hours less a month at home gives a pretty good shot at quality time with the kids.

 

[hoot504]

Who needs options trading when you have this work ethic?

What is your secret to sustain this? Some people are just built differently.

I feel kind of weird glomming on to this to declare myself as one of these people, but I am, and I do think it's something about my world view and outlook that allows this. I worked 200+ hours/month for the better part of a year uninterrupted, don't think I've ever done less than 150, and currently avg 180+/month. Not quite Porfirio numbers but in the ballpark. Some of my colleagues look at me like I'm crazy. It's usually the more complainy types that look at me askance when I tell them my hours.

Thing is this is easy for me. At this moment we still get paid quite well and as said above, mine for gold while there's gold to be mined. I grew up solidly middle class (lower middle class if anything) and think that the novelty of making as much as you can working these sorts of hours just hasn't worn off. When I see the countless threads on here whining about the state of EM (I see all of these problems too, and they are real) I think about the people absolutely slaving away in finance and tech, probably working more hours than I worked in residency, and for a much less guaranteed outcome (though higher theoretical ceiling). We don't have it that bad. Actually we have it quite well.

 

[Porfirio]

I feel kind of weird glomming on to this to declare myself as one of these people, but I am, and I do think it's something about my world view and outlook that allows this. I worked 200+ hours/month for the better part of a year uninterrupted, don't think I've ever done less than 150, and currently avg 180+/month. Not quite Porfirio numbers but in the ballpark. Some of my colleagues look at me like I'm crazy. It's usually the more complainy types that look at me askance when I tell them my hours.

Thing is this is easy for me. At this moment we still get paid quite well and as said above, mine for gold while there's gold to be mined. I grew up solidly middle class (lower middle class if anything) and think that the novelty of making as much as you can working these sorts of hours just hasn't worn off. When I see the countless threads on here whining about the state of EM (I see all of these problems too, and they are real) I think about the people absolutely slaving away in finance and tech, probably working more hours than I worked in residency, and for a much less guaranteed outcome (though higher theoretical ceiling). We don't have it that bad. Actually we have it quite well.

Dude I know pulls 300-340 hrs a month. Been doing that for 13+ years. He calls me weaksauce.

Only needs 4.5 hrs of sleep. His stories of pay/bonuses are legendary from 6-13 years ago.

 

[gruemd]

Where u guys getting 285/hr full time? I have to do locums in the boonies on the side because my full time gig pays a crummy 230/hr. Can barely afford my mortgage on 230/hr. Chicago blows for work but the city is worth it.

I'll say that that rate takes into account 401k (69k contribution last year), HSA (8300), bonuses, health insurance premiums, etc., so that's an "all-in" rate. Shockingly low hourly rate for EM on paper, but all the other stuff brings it to the ~280 range for 2024. Looking for new people too, if you're interested! Within driving distance to Chicago, we visit 3-4 times a year, I'm a big fan of the city...minus the Cubs, because I grew up in a Cardinals household.

 

[emergentmd]

Why not have someone help with the kids? It’s nice to have someone make the lunch while I play dolls with them. It’s nice to have someone pick up their toys while I put them down for a nap. It’s nice to have someone watch their sleep monitors while I walk the dog and my wife works out. It’s nice to have someone get the bottles ready while I read to the older ones.

You should try it. Imagine a life with no mundane activities and pure quality time. Yes, I miss some quality time but that is unavoidable in life.

Man, Kudos to you. Whatever works for you, the wife, and kids. I know married cardiologist who is never home with their kids. I know married surgeons who has their one kid picked up by a nanny after school. I know a SAHM married to an anesthesiologist who complains all the time b/c he doesn't help. I know a director at one of the Big 3 accounting firm who has a SAHM who hates her life and kids don't like him much b/c he is never home.

Your wife sounds like mine and she would let me essentially do anything. She is a SAHM b/c she finds a purpose/enjoyment being home with the kids. But Bro, you are more of man than me. I prob maxed out at 150hrs/month during my full time gig days and maybe 90 hrs/month doing locums traveling (2 hr drive) but was making 400/hr. I did have a 3 hr locums opportunity about 7 yrs ago that was offering essentially unlimited hours making about 500-700/hr but after a few shift, it just took too much of my soul. Yes, I am a weaksauce but have much respect for you and some of the docs who did lots of hours prob making close to $1/yr.

I am an easy sleeper and can sleep almost anywhere/anytime but Locums was just brutal. Now if I could find something where I live paying me 500-700/hr back in the day, I would have definitely maxed it out big time maybe even 200hrs/month.

 

[Porfirio]

Man, Kudos to you. Whatever works for you, the wife, and kids. I know married cardiologist who is never home with their kids. I know married surgeons who has their one kid picked up by a nanny after school. I know a SAHM married to an anesthesiologist who complains all the time b/c he doesn't help. I know a director at one of the Big 3 accounting firm who has a SAHM who hates her life and kids don't like him much b/c he is never home.

Your wife sounds like mine and she would let me essentially do anything. She is a SAHM b/c she finds a purpose/enjoyment being home with the kids. But Bro, you are more of man than me. I prob maxed out at 150hrs/month during my full time gig days and maybe 90 hrs/month doing locums traveling (2 hr drive) but was making 400/hr. I did have a 3 hr locums opportunity about 7 yrs ago that was offering essentially unlimited hours making about 500-700/hr but after a few shift, it just took too much of my soul. Yes, I am a weaksauce but have much respect for you and some of the docs who did lots of hours prob making close to $1/yr.

I am an easy sleeper and can sleep almost anywhere/anytime but Locums was just brutal. Now if I could find something where I live paying me 500-700/hr back in the day, I would have definitely maxed it out big time maybe even 200hrs/month.

My wife and I had a conversation before I started all this about what we wanted out of life and for our children. My wife’s very high priorities for the future are college educations for our kids paid for by us, very nice weddings for each of our children, and a comfortable lifestyle that will continue to grow in an economic kind of way. We initially rented an apartment while in residency then moved to renting a house and now we have a middle to upper middle class home that we own. Eventually, we will move to a larger house that will be much more than what we have now. She is very happy with the way things are now because she and my kids see me everyday.

We sit down and talk about budgeting and economic direction together every year. Every 5 years we project out 5 years in the future to see where we are headed. Both her and I realized my first year of attendinghood that a traditional 120 hrs a month would not work for our family’s goals in life. Additionally, my wife was very taken aback that I would be working less than 40 hrs a week (160 hrs a month) which is traditional in the labor force. She said she wanted a man who works to demonstrate to our kids what work looks like. But she is also a strong traditional woman, so…

 

[Brigade4Radiant]

What state can you work 226 hours and be in your bed every night? Kudos to you one thing about EM for all the suck the more you work the more money you make which is not true in a lot of fields

 

[WhatJobDoIPick]

My wife and I had a conversation before I started all this about what we wanted out of life and for our children. My wife’s very high priorities for the future are college educations for our kids paid for by us, very nice weddings for each of our children, and a comfortable lifestyle that will continue to grow in an economic kind of way. We initially rented an apartment while in residency then moved to renting a house and now we have a middle to upper middle class home that we own. Eventually, we will move to a larger house that will be much more than what we have now. She is very happy with the way things are now because she and my kids see me everyday.

We sit down and talk about budgeting and economic direction together every year. Every 5 years we project out 5 years in the future to see where we are headed. Both her and I realized my first year of attendinghood that a traditional 120 hrs a month would not work for our family’s goals in life. Additionally, my wife was very taken aback that I would be working less than 40 hrs a week (160 hrs a month) which is traditional in the labor force. She said she wanted a man who works to demonstrate to our kids what work looks like. But she is also a strong traditional woman, so…

1) very commendable work ethic

2) I hope you have a prenup

 

[JacobMcCandles]

My wife and I had a conversation before I started all this about what we wanted out of life and for our children. My wife’s very high priorities for the future are college educations for our kids paid for by us, very nice weddings for each of our children, and a comfortable lifestyle that will continue to grow in an economic kind of way. We initially rented an apartment while in residency then moved to renting a house and now we have a middle to upper middle class home that we own. Eventually, we will move to a larger house that will be much more than what we have now. She is very happy with the way things are now because she and my kids see me everyday.

We sit down and talk about budgeting and economic direction together every year. Every 5 years we project out 5 years in the future to see where we are headed. Both her and I realized my first year of attendinghood that a traditional 120 hrs a month would not work for our family’s goals in life. Additionally, my wife was very taken aback that I would be working less than 40 hrs a week (160 hrs a month) which is traditional in the labor force. She said she wanted a man who works to demonstrate to our kids what work looks like. But she is also a strong traditional woman, so…

At least to me, the more you expand on your situation the less it makes sense. Maybe your wife just enjoys the baby sitter, higher income, and you being away from the home during waking hours?

 

[emergentmd]

I find what @Porfirio says is reasonable. His locums job is in the same city so say its 12 hr shifts so 19 shifts a month. When I did locums, there were full timers doing 22x12 hr shifts. TBH, I could do this but could not perform at my A game. It would be my B/C game where I just see the sick, take it easy otherwise letting the healthy wait.

My wife and I had the same conversation before we had kids. She was full time nurse just turning 30, offered the department RN manager and we decided our goal was for her to be home with the kids. She sacrificed her career and the person who eventually got the job eventually became the CNO of the system. She chose a career as a SHM rather than a nurse/management and she would tell you this was the best decision for her, the kids, and our family. This allowed and she allowed me to do essentially do what I want and take risks knowing I was doing it for the family while having one parent home all the time. If not for her sacrifice and supportive wife, I would not have been able to completely quit my 500K hospital job and move to an unknown venture.

 

[Porfirio]

At least to me, the more you expand on your situation the less it makes sense. Maybe your wife just enjoys the baby sitter, higher income, and you being away from the home during waking hours?

Some people… always skeptical, always in disbelief. You could show them irrefutable proof and they would still deny. Why?

 

[JacobMcCandles]

Some people… always skeptical, always in disbelief. You could show them irrefutable proof and they would still deny. Why?

Because some of the dots and reasoning don’t make any sense? But again, it’s not my life and if it works for you and your family then more power to you.

 

[hoot504]

Because some of the dots and reasoning don’t make any sense? But again, it’s not my life and if it works for you and your family then more power to you.

Neutral observer. You sound like you’re trying to tear the guy down a little.

Don’t think you understand the complexities of their relationship and economic reality from a couple forum posts.

 

[JacobMcCandles]

Neutral observer. You sound like you’re trying to tear the guy down a little.

Don’t think you understand the complexities of their relationship and economic reality from a couple forum posts.

You're right, I don't. Not trying to tear the guy down but I'll add that there's more to life than work and money and that working half those hours is more than plenty for someone to reach very reasonable financial goals (dream financial goals by 95% of America).

Most here understand that 240 hours/month in an ED is neither healthy nor sustainable. Something will eventually give.

 

[hoot504]

You're right, I don't. Not trying to tear the guy down but I'll add that there's more to life than work and money and that working half those hours is more than plenty for someone to reach very reasonable financial goals (dream financial goals by 95% of America).

Most here understand that 240 hours/month in an ED is neither healthy nor sustainable. Something will eventually give.

How do you define healthy or sustainable? I agree that 240/month is probably too much for most, as given typical ER scheduling rhythms and how a lot of shifts bleed over into the next day, that's essentially zero days off. However, if you have the support system in place (or young flying solo and don't have any other responsibilities) I think you can certainly do it.

In my opinion 120/month is almost equally extreme. I'm 37. Peak accumulation years. I love my days off but don't need 18 of them a month. The fact that I worked my balls off since residency and already have a metric ****-ton of money put away brings me a lot of peace of mind. I actually feel like I could basically coast the rest of my career and be fine. If I'd never done more than 120/month I would be in a significantly different financial situation.

 

[emergentmd]

220hrs/month comes out to about 50 hrs/wk or 4-5 dys/wk at 12hr shifts.

If I pushed hard at max effort with 3pph, then this would be almost impossible. If I did 1.5-1.8ppd, then it would not be that difficult.

I did locums at a uber sick trauma hell hole and had some full timers doing 22 shifts x 12 hrs per month who were in their 50-60's. Definitely possible but they had my ultra respect. Those guys were pulling well over 1M/yr. If I were single without responsibility, I would take on a job like this. Make $1M, save 500k/yr, after 5 years should have 3M in the bank. Then do whatever I want at 35.

 

[JacobMcCandles]

How do you define healthy or sustainable? I agree that 240/month is probably too much for most, as given typical ER scheduling rhythms and how a lot of shifts bleed over into the next day, that's essentially zero days off. However, if you have the support system in place (or young flying solo and don't have any other responsibilities) I think you can certainly do it.

In my opinion 120/month is almost equally extreme. I'm 37. Peak accumulation years. I love my days off but don't need 18 of them a month. The fact that I worked my balls off since residency and already have a metric ****-ton of money put away brings me a lot of peace of mind. I actually feel like I could basically coast the rest of my career and be fine. If I'd never done more than 120/month I would be in a significantly different financial situation.

Too much for most? There’s a reason that there’s probably only a handful of EM docs that work >200 hours/month for years and years after residency. I, personally, don’t know one doc who has even did that for one month after residency. There’s a reason the average EM doc probably works in the 130-140ish hours/month range. If I worked 240 hours a month I wouldn’t have the time I wanted to do the things I want for myself like work out, prepare the foods I want, etc. I certainly wouldn’t get to spend the time I wanted with my family that I wanted. And, lastly, I’d be a huge grump when I did get to spend time with them. Also, my wife would probably divorce me and I wouldn’t blame her if I were willingly working that much in EM for years and years.

 

[JacobMcCandles]

I did locums at a uber sick trauma hell hole and had some full timers doing 22 shifts x 12 hrs per month who were in their 50-60's. Definitely possible but they had my ultra respect. Those guys were pulling well over 1M/yr. If I were single without responsibility, I would take on a job like this. Make $1M, save 500k/yr, after 5 years should have 3M in the bank. Then do whatever I want at 35.

Medicine is much different now than it was back then. Hell, it’s even much different now than it was pre-COVID. The patients have gotten significantly worse and sicker. It’s kind of like baseball where only a handful of pitchers pitch greater than 200 innings in a season but it used to be incredibly common decades ago. Respectfully, didn’t you say you’re going down to 2 shifts/month at a FSED? There’s a difference in currently doing it and saying you’d do it.

 

[hoot504]

Too much for most? There’s a reason that there’s probably only a handful of EM docs that work >200 hours/month for years and years after residency. I, personally, don’t know one doc who has even did that for one month after residency. There’s a reason the average EM doc probably works in the 130-140ish hours/month range. If I worked 240 hours a month I wouldn’t have the time I wanted to do the things I want for myself like work out, prepare the foods I want, etc. I certainly wouldn’t get to spend the time I wanted with my family that I wanted. And, lastly, I’d be a huge grump when I did get to spend time with them. Also, my wife would probably divorce me and I wouldn’t blame her if I were willingly working that much in EM for years and years.

You’ve come across a few just in this thread. I don’t believe it’s nearly as rare as you think it is.

Doesn’t mean you have to follow suit. Your post does sound kind of alarmist though. What applies to you may not apply to others, and vice versa.

 

[hoot504]

Medicine is much different now than it was back then. Hell, it’s even much different now than it was pre-COVID. The patients have gotten significantly worse and sicker. It’s kind of like baseball where only a handful of pitchers pitch greater than 200 innings in a season but it used to be incredibly common decades ago. Respectfully, didn’t you say you’re going down to 2 shifts/month at a FSED? There’s a difference in currently doing it and saying you’d do it.

I disagree. COVID may have changed our perception of a few things but “worse and sicker” I’m not buying.

 

[JacobMcCandles]

I disagree. COVID may have changed our perception of a few things but “worse and sicker” I’m not buying.

It’s certainly subjective but the patients are much more demanding. As far as sicker, it’s been a pretty common trajectory considering the advances in medicine and the fact we can keep more and more people “living” that would have already been dead if they were living decades ago.

 

[hoot504]

we can keep more and more people “living” that would have already been dead if they were living decades ago.

Can't argue with you there brother.

 

[emergentmd]

Respectfully, didn’t you say you’re going down to 2 shifts/month at a FSED? There’s a difference in currently doing it and saying you’d do it.

I would have done 200hrs coming out of residency for 5 years if I was making 1M/yr. If my 28 year old newly minted single attending without any anchors had connections for a locums gig averaging $400+/hr, why not. I was doing 200+hrs/month in residency so it would just be a high paying fellowship. Put away 500K/yr for 5 years, and at 33 could decide what I wanted in life. It really is not a terrible option.

But now at 50 and not needing the money? Heck no, my health and good years are slowly disappearing with time much more valuable than money

 

[Pinner Doc]

Why not have someone help with the kids? It’s nice to have someone make the lunch while I play dolls with them. It’s nice to have someone pick up their toys while I put them down for a nap. It’s nice to have someone watch their sleep monitors while I walk the dog and my wife works out. It’s nice to have someone get the bottles ready while I read to the older ones.

You should try it. Imagine a life with no mundane activities and pure quality time. Yes, I miss some quality time but that is unavoidable in life.

Yeah but then there’s someone else in my house.

 

[JacobMcCandles]

I would have done 200hrs coming out of residency for 5 years if I was making 1M/yr. If my 28 year old newly minted single attending without any anchors had connections for a locums gig averaging $400+/hr, why not. I was doing 200+hrs/month in residency so it would just be a high paying fellowship. Put away 500K/yr for 5 years, and at 33 could decide what I wanted in life. It really is not a terrible option.

But now at 50 and not needing the money? Heck no, my health and good years are slowly disappearing with time much more valuable than money

Not a terrible option but I don’t think it’s an option someone should count on coming out of residency. The chance a $400/hr locums gig continues on in the current environment in a reasonable place for years is very slim.

I wholeheartedly agree on making hay while the sun shines. I followed the same path. I think every graduating resident should work more (but less than residency) once they get out and taper down. It’s much easier to do that than work the minimum straight out of residency and then having to increase your hours for whatever reason.

 

[EctopicFetus]

Not all EM jobs are the same. Due to some scheduling items I worked 8 days in a row.. All day shifts.. I left that run of shifts and thought.. i could literally work 6 on 1 off for eternity if I had day shifts. That being said I avg like 80-100 clinical hours a month now.. post residency for 6 years I averaged about 160 hours (all nights). Things change.

I make a very good hourly rate top 1% so no need to work more clinical hours. I have been doing this a while and saved and invested well.. it’s optional at this point but i keep working.

 

[Janders]

220hr? Rough.

But like everyone says, different hours are different. Do 1.7-1.8pph, modest acuity, short commute, minimal overnights b/c of nocturnists in a mostly friendly work environment and you can do A LOT of hours. I’ve done 12 hour overnights where I see 4-6 patients the entire shift. The number of THESE I could do is largely limited by boredom. Thankfully I like video games and reading.

Work 30-50% overnight hours with a random rotating schedule, see 2.5+ pph with vast boarding, unpleasant specialists, 50% of the nurses you need… I mean we can all DO 220hr of THAT a month, but most of us have the wisdom to avoid it.

I think I’ve only worked 220 clinical hours one month in the past decade, but I was also playing chief of EM at my shop, and VP of the medical staff, and it was during a covid winter wave so things were weird and I had a lot of non-clinical work duties added on. Family (young kids) went away for 2.5 weeks over the winter holiday and I was like screw it, I’ll work every day. I think I strung like 11 overnights between 4 hospitals (the moonlighting ones offering mega bonus rates), plus I did a ton of shifts prior to the holidays. 21-22 shifts in December IIRC, then like 19-20 in January, mix of 9, 10 and 12s.

And it was fine. Because I had a house to myself. There was no social activity going on. I worked. I slept. I woke up. I worked out hard. I did some chores and did something fun for a hour or two then I drove to work. Rinse. Repeat. I was on a mission, war-time footing, the economics of this job looked VERY tenuous and figured might as well make some money.

But I have a hard time imagining working 22 x 10hr shifts a month long term, while enjoying my family, any of my hobbies, and any of the other things we live for…. YMMV but my diminishing returns are more and more apparent 🙂

 

[emergentmd]

Just got an email for $370/hr night with 50K sign on bonus in west Tx. Yeah, not the most desirable but 300+/hr is not difficult right now

 

[Apollyon]

Just got an email for $370/hr night with 50K sign on bonus in west Tx. Yeah, not the most desirable but 300+/hr is not difficult right now

That's just nuts, what I bolded. A sign on bonus for locums?

 

[emergentmd]

That's just nuts, what I bolded. A sign on bonus for locums?

I assume it would be full time and not locums. Those are full, time rates. The locums rates must be uber high for them to get that desperate. I haven't seen a sign on bonus for a while unless the rate was USACS level

Everyone on this site keeps saying EM is doomed but there are plenty of high paying jobs. Even in Austin, where it was almost impossible to get into the market 10 years ago, I get flooded with emails all the time. I was even offered my old Dept chair job which used to be a coveted job but looks like they are getting desperate to find a warm body.

 

[WhatJobDoIPick]

Who's joining me on the overnight tonight for less money than we made ten years ago?!

 

[Pinner Doc]

Who's joining me on the overnight tonight for less money than we made ten years ago?!

Me!

 

[miacomet]

I assume it would be full time and not locums. Those are full, time rates. The locums rates must be uber high for them to get that desperate. I haven't seen a sign on bonus for a while unless the rate was USACS level

Everyone on this site keeps saying EM is doomed but there are plenty of high paying jobs. Even in Austin, where it was almost impossible to get into the market 10 years ago, I get flooded with emails all the time. I was even offered my old Dept chair job which used to be a coveted job but looks like they are getting desperate to find a warm body.

I think more and more people are leaving the field younger. It's just a hard job. EM docs used to almost never do fellowships that took them out of the ER, but plenty are going straight to palli, ICU etc.

 

[emergentmd]

I think more and more people are leaving the field younger. It's just a hard job. EM docs used to almost never do fellowships that took them out of the ER, but plenty are going straight to palli, ICU etc.

I agree. When I first started the doc ran the ship and was respected by a well staffed ER. My last shift, the doc became just a cog to follow predetermined metric with less respect from a poorly staffed inexperienced staff.

 

[EctopicFetus]

I am fortunate. My pay has gone up and down but generally trended up. 2024 was my best year ever.. I feel decent 2025 will be better. I’m working on a home run type project.. who knows.. maybe it hits.. maybe ill be babe Ruth when I get my chance to hit.. maybe ill be Mario Mendoza..

The key is to keep getting up to bat if you want to make some real dough.

 

[Mount Asclepius]

My pay in 2024 was highest ever as well and has gradually crept upwards year-over-year other than one brief down year during the pandemic (we probably should have more aggressively taken out a higher PPP loan than we did, but there were unknowns specifically possible future forgiveness). Much of that individual increase though is gained experience with speed, efficiency and billing knowledge that I didn’t have years ago.

Pay also hasn’t kept up with inflation. It’s difficult as an owner/partner to fight for any sort of adjustment for inflation in that regard as the costs of fixed expenses like malpractice and health insurance keep rising, payers continue to fight and downcode claims, and on top of that there is the constant threat of Medicare revising payment. We’ve had to capitalize on every area of billing that we can (i.e. EKGs, US, observation, etc). The only avenue available is to work with the hospital system to subsidize increased costs with time. Not an easy endeavor. We could hire an army of NPPs, but still have the luxury of staying a physician and partner predominant group. Despite everything pay has still gotten marginally better.

It’s hard to keep stepping up to the plate, but doing so regularly early on, and as long as you can, allows for the financial independence to keep playing because you enjoy the teammates and the game, instead of due to needing a paycheck.

I work slightly more than most (around 130-160ish hours/month depending on the month), but certainly don’t pull 200+ hours/month like I occasionally did right out of residency. For most people it’s very difficult to sustainably work that amount and not burn out earlier than you otherwise would have. Relationships do suffer as time spent together is the most important aspect to building bonds.

I’ve always felt Locums is difficult in that regard as you sacrifice more than is easy to quantity on paper. The rates also don’t seem to be as good as 10 years ago. Sure you can find some paying $300-400/hour for who knows how much of a meat grinder of a job. It’s not the $500-1,000/hour though that I remember hearing about.

I’ll continue beating my broken drum and argue that finding a well oiled SDG with opportunity in a decent enough location is the way to go. It will give you financial independence and more options than the alternative.

 

[alpinism]

I've started to pick up some of these high paying locums shifts recently mostly across the midwest at rural community hospitals.

The market is surprisingly strong at the moment and its not too hard to find 300/hr+ for 1+ PPH shops and 400/hr+ for 2+ PPH shops.

Pluses and minuses but most sites are well staffed and resourced compared with city hospitals constantly overflowing with hallway beds.

Met quite a few people that commute from coastal cites even Hawaii/Australia/New Zealand and do 2 weeks a month for 600K salaries.

The whole thing is crazy since literally the exact same jobs in cities now offer 50% less for 50% more work but that just goes to show how the massive number of new residencies has saturated most cities and people currently have to accept 150/hr rates to do shifts at NYC/LA hospitals.

 

[EctopicFetus]

I've started to pick up some of these high paying locums shifts recently mostly across the midwest at rural community hospitals.

The market is surprisingly strong at the moment and its not too hard to find 300/hr+ for 1+ PPH shops and 400/hr+ for 2+ PPH shops.

Pluses and minuses but most sites are well staffed and resourced compared with city hospitals constantly overflowing with hallway beds.

Met quite a few people that commute from coastal cites even Hawaii/Australia/New Zealand and do 2 weeks a month for 600K salaries.

The whole thing is crazy since literally the exact same jobs in cities now offer 50% less for 50% more work but that just goes to show how the massive number of new residencies has saturated most cities and people currently have to accept 150/hr rates to do shifts at NYC/LA hospitals.

And it is gonna get worse and worse.. 3k new grads coming in 2025.. Keep in mind there are only so many ICU fellowships out there. The other thing is at least by me the ICU jobs are pretty full though most of the IM/CCM guys want to do clinic / pulm cause thats where the $$ is.. Sleep also..

 

[ERMudPhud]

200+/pt is insanely good. You making more than the full timers?

Hard to say. Most of the docs I met were also locums of one sort or another. Also, I probably saw more like 2.5/hr. It's kind of how I'm wired. If there are patients to see I tend to just see them.

 

[miacomet]

It also goes to show how illiterate people are to do that. They’ll burn out. Here in Chicago the hospitals have massive turn over. One of the local hospitals, not even in the city proper is paying $175/hour for 2 pph. Only an absolute ***** would take that gig.

Why would anyone do that ever?

Edit: There are shops I would take that salary or lower. But they would involve days, 1 pph, super low acuity, free lunch, collegial environment, and not a medmal hellhole.

No EM job in Chicago meets a single one of those criteria.

 

[finalpsychyear]

I went to residency and became pretty good friends with several EM during pgy 1 year. None were married and most did not get hitched till at or around 35-36. EM was kicking butt i believe back then. however only 3 out of the 8 cared to be working more than 1 FTE and this idea of FIRE had been coming along. Flash forward almost 10 years and those who worked then, sub 40 yo now, are closer to 0.5 FTE TODAY and already at or near their FIRE numbers and there is def regret among the others who made less and tended to overspend and get the doctor house, cars, YOLO mentality etc and 1 has health issues so they struggle to work even 1 FTE.

If your single and want to retire or be in a postion to cut back early, those first 10 years of attendinghood how much you gross, save, and invest are mathematically CRITICALLY the most important in your entire career. This wont be as easy for those married and with kids but for everyone else your future self will pay you mad homage for doing this. Good luck. Now if you want to work late into 50s-60s then be my guest but that should be purely for fun and not need.

 

[WhatJobDoIPick]

I went to residency and became pretty good friends with several EM during pgy 1 year. None were married and most did not get hitched till at or around 35-36. EM was kicking butt i believe back then. however only 3 out of the 8 cared to be working more than 1 FTE and this idea of FIRE had been coming along. Flash forward almost 10 years and those who worked then, sub 40 yo now, are closer to 0.5 FTE TODAY and already at or near their FIRE numbers and there is def regret among the others who made less and tended to overspend and get the doctor house, cars, YOLO mentality etc and 1 has health issues so they struggle to work even 1 FTE.

If your single and want to retire or be in a postion to cut back early, those first 10 years of attendinghood how much you gross, save, and invest are mathematically CRITICALLY the most important in your entire career. This wont be as easy for those married and with kids but for everyone else your future self will pay you mad homage for doing this. Good luck. Now if you want to work late into 50s-60s then be my guest but that should be purely for fun and not need.

I think there's a middle ground to be threaded. You don't have to work 160+ hrs / month as a fresh attending just as you don't need to buy a Porsche and 5k sqft house.

 

[emergentmd]

It also goes to show how illiterate people are to do that. They’ll burn out. Here in Chicago the hospitals have massive turn over. One of the local hospitals, not even in the city proper is paying $175/hour for 2 pph. Only an absolute ***** would take that gig.

Those who do this and complain, I have zero sympathy.

 

[Brigade4Radiant]

Doesn't Illinois have awful malpractice as well. I know it can be hard if you have a spouse and she wants to be close to family to raise kids it isn't easy. Especially if she was grinding with the kids when you didn't make much in residency

 

[TooMuchResearch]

I think there's a middle ground to be threaded. You don't have to work 160+ hrs / month as a fresh attending just as you don't need to buy a Porsche and 5k sqft house.

What if I just live in the Porsche?

This is a joke as I am married with children and pets.

 

[Apollyon]

What if I just live in the Porsche?

This is a joke as I am married with children and pets.

That was someone WCI said - "As an EM doc, can i afford a Lamborghini?" and his response "Yes, if you live in it!"

 

[hoot504]

What if I just live in the Porsche?

This is a joke as I am married with children and pets.

No need for hotel when off to locums gigs

 

[DocEspana]

For (good) reasons I can't be too specific about, I love my current locums job I do to allow me to knock out 60-80 hours a month but I'll possibly only be doing it for 4-6 months more because they will probably succeed in getting new blood longterm at the site. It was 300/hr for a mixture of empty rural critical access hospital and busy but appropriately staffed high acuity trauma center. So neither was particularly hard. I'm sure when the current contract is up the company will offer to ship me somewhere else at a similar price point, but I'm curious what the market is looking like broadly.

What companies are offering good compensation for reasonable sites? I really like the current company a lot, just doing my due diligence and checking what the market looks like. In the past I had been sent to some absolute horror shows for only slightly more than what I make at my major city slave labor camp (Miami) I drive to as a my full time job. I talk with a few recruiters for years now and occasionally work with them (integrity, weatherby, and atlas, if youre curious) but theyre mostly upfront that while pay is rising, its mostly rising at really ****ty sites that people arent excited to work at and the good places that just need staffing arent paying good $$ yet.

Is this an accurate assessment? Are there good places out there paying decent and/or companies that seem to get better contracts than others? Otherwise I'll just continue with my current company wherever they send me since its a set rate of 300/hr and their sites are always pretty decent.

 

[Porfirio]

$80-$100+ per hr pay difference the Locum pay makes sense. Otherwise pick up an extra local shift or two. Not worth travel/time.

Crap hospitals have crap metrics thus get crap doc productivity while docs practice med mal exposure defense. You will not fix the crap ER. It is a crap job. They will not fire you from a crap job.

And if you do get fired - there are 5-8 other crap jobs in most large cities. You can get another one in a few months. Just have back up plan options in background (PRN locations). I promise there are plenty of docs who want a day off from their crap job and would give you the shift.

 

[EctopicFetus]

Hard for me to understand the logic of locums if you have kids. If you consider what you are getting paid when you factor in time away it is trashy. I would consider low volume driveable locums for 275/hr and i would either want to work a 72 hour shift or do a reverse 24 followed by a morning 12 and then go home. To at least squeeze out 36 hours in 48 plus a 2-3 hour drive. I could probably get a bunch of other work done in the meantime.