Locums rates going up

[gbwillner]

Methinks the job market is definitely improving.

Locums rates have often been described as a barometer of the market, and we have often talked about how bad rates have been suggesting desperation for work. I remember getting Locums offers for $1200-1400 per day about 4-5 years ago and being told this was pretty high, that usually it was $900-1000 per day.

I just got an unsolicited request for Locums work in Pennsylvania for $1600 per day plus $200/hr OT plus all expenses and credentialing. Just wondering if the rest of you are seeing similar things.

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[KeratinPearls]

Methinks the job market is definitely improving.

Locums rates have often been described as a barometer of the market, and we have often talked about how bad rates have been suggesting desperation for work. I remember getting Locums offers for $1200-1400 per day about 4-5 years ago and being told this was pretty high, that usually it was $900-1000 per day.

I just got an unsolicited request for Locums work in Pennsylvania for $1600 per day plus $200/hr OT plus all expenses and credentialing. Just wondering if the rest of you are seeing similar things.

I saw a 1 month locums gig for $30,000 for the month. So I think so but that’s a n=1. If anyone wants to know where, I charge $10,000.

 

[cmz]

A few months ago locums rates were around $2-2.2K with CompHealth.

 

[WEBB PINKERTON]

I would hope so. There is a shortage for EVERY profession right now. I think the number of posts on this website with job in the title is down as well, which is an important metric.

 

[gbwillner]

A few months ago locums rates were around $2-2.2K with CompHealth.

This is what you would pay the agency, correct?

 

[pathslides]

$2000+ and all the expenses very common now. That is how much the pathologist is being given from locum company.

Plus most these locums also say possibility of perm position.

Path is best. Fun job. Easy money.

 

[cmz]

This is what you would pay the agency, correct?

Yep.

 

[LADoc00]

As the per diem rate marches up there will be hospital contracts that simply become not worth doing. We are seeing the unraveling of the entire field in slow motion in a sense.

Think of this: A 200 bed hospital has enough work, around 7000 surgicals/year to support 2 FT pathologists. In a bygone era, MAYBE one pathologist could suck it up for a few days at max, but the small group relied on locums to have any time off.

Given all the conferences now, ROSE, frozens and the increasing complexity of EMR systems on top of hospitals massively reducing support staff in the lab, it now takes 1-2 days of overlap with the 2 FT pathologists to lock on a locums provider. This is on top of the massive paperwork filed ahead of time.

Lets say each partner takes 6 weeks of vacation which is standard.

At $3000 per diem and ramp up of 2 days per week to orient the new locums provider, you are taking over a quarter of a million to cover just vacations for 2 people.

Hire a third body you say? I would say total costs of a new mid career pathologist are now pushing 450-500K (benefits, payroll taxes etc).

At levels much above this the entire proposition becomes untenable as a business so we are really at only the beginning of this downward cycle and at my best estimate the field is already at a breaking point.

The issues facing the field that are the most pressing:
1.) Skyrocketing staffing costs, which I still think will move up another 40-50% from here.
2.) Massively increased practice complexity including a significant increase in non-revenue generating time required for things like multi-disciplinary conferences and ROSE
3.) Sea change in terms of gender balance with the corresponding movement towards lifestyle and away from the grind. This cannot be overestimated.
4.) Ramping hospital pressures to reduce medical director costs
5.) Centralization of AP and CP within larger hospital systems
6.) Full speed exiting of the longest term and most experienced staff that were capable of very high volume workflows

 

[cmz]

The issues facing the field that are the most pressing:
1.) Skyrocketing staffing costs, which I still think will move up another 40-50% from here.
2.) Massively increased practice complexity including a significant increase in non-revenue generating time required for things like multi-disciplinary conferences and ROSE
3.) Sea change in terms of gender balance with the corresponding movement towards lifestyle and away from the grind. This cannot be overestimated.
4.) Ramping hospital pressures to reduce medical director costs
5.) Centralization of AP and CP within larger hospital systems
6.) Full speed exiting of the longest term and most experienced staff that were capable of very high volume workflows

Everything you're saying is 100% true. Our group is literally one step ahead of the curve but it seems like we're fighting against a stacked house and it's become cumbersome to keep proper pace with what you're describing above. Geography is important. In my area, it seems that the corporate goons haven't figured things out either. The HCA hospital that my group departed from is still trying to hire a pathologist and a PA (also trying to weave in telepathology so they don't need to have a warm body present in the office every day) and they are also trying to plug a huge hole in the neighboring city that is 60 miles away. I think geography will protect things for a bit, but eventually I think they will win out. What will happen is the new hires covering the area will be asked to do a mountain of work and be in two places at once. I expect there to be a lot of turnover, but that isn't anyone's problem but the folks they hire. Corporate always seems to win.

 

[Alteran]

Corporate always seems to win.

Yes, to a point. I present this regarding one of the largest corporate structures that seems to have no respect for its workforce:

Amazon ‘could run out of people to hire in US by 2024’: report

Amazon is sounding the alarm over an internal memo which estimates that the retail giant could run out of people to hire and man their US-based warehouses within the next 18 months, according to a …

nypost.com

There are still a finite number of pathologist bodies in a dwindling pool of desirable candidates, both in practice and in the pipeline. These large conglomerates are eventually going to face the same problem if the turnover is quick enough.

 

[wholeheartedly]

 

[LADoc00]

Younger academic physicians will never make even a fraction of what older generations in academics did. Combined with inflation at these levels, they will be solid middle class households along with teachers, policemen and firefighters their entire lives.

Of course they are paid like blue collar workers but expected to work at investment banking level of hours....I will take a hard pass thanks.

 

[octopusprime]

Younger academic physicians will never make even a fraction of what older generations in academics did. Combined with inflation at these levels, they will be solid middle class households along with teachers, policemen and firefighters their entire lives.

Of course they are paid like blue collar workers but expected to work at investment banking level of hours....I will take a hard pass thanks.

entry level engineer-type positions at Google pay $150k-$200k...as a college grad...at age 22.
entry level academic pathology positions at Anywhere U. pay $150k-$200k...as a newly boarded pathologist...at age 32...after losing 10 years of similar compensation/retirement saving and being saddled with at least $200k-$300k of student loan debt.

 

[Alteran]

entry level engineer-type positions at Google pay $150k-$200k...as a college grad...at age 22.
entry level academic pathology positions at Anywhere U. pay $150k-$200k...as a newly boarded pathologist...at age 32...after losing 10 years of similar compensation/retirement saving and being saddled with at least $200k-$300k of student loan debt.

I heard software engineers with expertise in AI get recruited in the 7 figure range at Google.

 

[KeratinPearls]

entry level engineer-type positions at Google pay $150k-$200k...as a college grad...at age 22.
entry level academic pathology positions at Anywhere U. pay $150k-$200k...as a newly boarded pathologist...at age 32...after losing 10 years of similar compensation/retirement saving and being saddled with at least $200k-$300k of student loan debt.

That’s assuming you are smart enough to be hired by these companies and that you actually like comp sci, math or whatever major these companies look for.

 

[octopusprime]

if you're smart/dedicated/stubborn enough to get to entry level academic pathology, i'm fairly certain those persons could handle entry level at google.

 

[Mad Jack]

if you're smart/dedicated/stubborn enough to get to entry level academic pathology, i'm fairly certain those persons could handle entry level at google.

Smart yes, but creativity is what is needed to succeed in tech. You also have to beat out tens of thousands of others for those Google jobs, while our paths are much more linear and concrete

 

[LADoc00]

Lots of folks in tech make stupid amounts of money.

But things to consider:
1.) Their income is almost always pure W-2, meaning they are paying full tilt income taxes on the entire nut
2.) The portion of their compensation from stock options is now significantly depressed, even to the point of them being underwater on the options now. This is very very important because people who exercise their options pay taxes on gains when they receive the stock, not when they sell it. So they may have actually lost a massive amount of real and paper wealth this year.
3.) They can go from hero to zero very quick now. Some very talented people might get picked up, but the current tech situation is more grim than even the dot com sell off in 2000.

Me making 7 figures is nothing like what a Google engineer making 7 figs is as I can do very complex tax planning as a shareholder owner of a private corporation to make sure the bulk of that wealth ends up in my hands and not Uncle Joe's hands.

 

[octopusprime]

They are linear and concrete because that's what the career trajectory requires, not because everyone that does path (or medine) is incapable of doing something nonlinear or off the beaten path.

stable & academically inclined people are prone to succeed. All I'm saying is there are ample opportunities for steady jobs that pay $150-$200k that are MUCH easier and shorter hauls than 9-10 yrs of med school & residency, google was just an example cuz everyone knows google.

 

[LADoc00]

Yah of course the opportunity cost of being a physician in the US is insane. Which is why all the folks dropping out completely from healthcare is so fascinating of a situation.

I have no less than 6 female colleagues basically ghost out well before retirement.

 

[Spikebd]

Yah of course the opportunity cost of being a physician in the US is insane. Which is why all the folks dropping out completely from healthcare is so fascinating of a situation.

I have no less than 6 female colleagues basically ghost out well before retirement.

I’ve seen many males bail the past year, too. Good pathologists, great even. Most had 10+ years if they wanted.

 

[KeratinPearls]

I’ve seen many males bail the past year, too. Good pathologists, great even. Most had 10+ years if they wanted.

Yah of course the opportunity cost of being a physician in the US is insane. Which is why all the folks dropping out completely from healthcare is so fascinating of a situation.

I have no less than 6 female colleagues basically ghost out well before retirement.

Why are they retiring?

 

[LADoc00]

They arent retiring per se in my experience, they are doing a few different things:
1.) Claiming permanent disability and collecting an untaxed monthly payment for life. This can really vary when you got your policy though. One MD I know gets $50,000 each month TAX FREE for life. That is totally insane. He immediately quit, moved and lives on his yacht mostly. Neurosurgeon too. The other MDs I know are getting between 10-15K tax free a month. The tax free nature of disability cannot be overstated especially in California because the government sees you are a "zero income" household meaning you can get all these benefits they are throwing to poor people on top of that.

2.) Leaving to biopharma jobs

3.) Complete career change, becoming a small business owner (small hotel, b and b, laundry mats and convenience stores etc)

4.) Quitting and doing locums very part time.

5.) Relocating with their assets abroad.

TONS of MDs are sitting on the sidelines basically saying I will work for X amount and not a dollar less, which I fully respect. Smart folks have probably saved enough to cover their mortgage and expenses for a year+. (My back of the napkin math last night tells I can "cover living expenses" for 34 years with my current cash on hand)

 

[mike-sheree]

I’ve seen many males bail the past year, too. Good pathologists, great even. Most had 10+ years if they wanted.

I was one of them; a great one that is.

 

[mike-sheree]

34x your annual living expenses of “ under a mattress cash- on- hand“ is more than enough to annually meet your living expenses when invested even quite conservatively and taking 3-4% annually without EVER running out of money with >95% certainty. Time to retire.

 

[Zarniwoop]

I'd like to find my retirement story.... Too much writer's block though - and not enough cash on hand.

 

[LADoc00]

34x your annual living expenses of “ under a mattress cash- on- hand“ is more than enough to annually meet your living expenses when invested even quite conservatively and taking 3-4% annually without EVER running out of money with >95% certainty. Time to retire.

Huh exactly what my attorney/former college roommate said last night...I told him I was like dwarf from Lord of the Rings, I cant leave money on the table. Character flaw I am working to overcome.

 

[shikimate]

This permanent disability thing is a great gimmick but kinda getting out of hand with so many claiming psychiatric issues. I remember in residency a few years back our resident's union (in Canada) had to raise the premium substantially because so many were claiming psychiatric issues they ran short on cash.
I'd love to do transition in the 5 years to locum in summer and teach at carib school from Jan-May lol. If anyone here has a lead on how to get a position at carib school link me up TIA.

 

[mike-sheree]

Just look up several of the lesser favorable med schools in the carib, pick one, go on vacay there and call the school or drop in and introduce yourself. Assuming you are U.S. boarded ap/cp they will go out of their way to accommodate you IF you are serious.
I encountered this in Saba over a period of years. Met one of the old retired Scottish doctors who was a “ founder” down there in the “ inn too deep” bar. This was in 1993. It was Dr. John Buchannan, R.I.P. I donated some books and kitsch but never worked there. Been there 9 times since and they are now one of the more”prestigious “ carib schools.

 

[Rosai]

Lots of folks in tech make stupid amounts of money.

But things to consider:
1.) Their income is almost always pure W-2, meaning they are paying full tilt income taxes on the entire nut
2.) The portion of their compensation from stock options is now significantly depressed, even to the point of them being underwater on the options now. This is very very important because people who exercise their options pay taxes on gains when they receive the stock, not when they sell it. So they may have actually lost a massive amount of real and paper wealth this year.
3.) They can go from hero to zero very quick now. Some very talented people might get picked up, but the current tech situation is more grim than even the dot com sell off in 2000.

Me making 7 figures is nothing like what a Google engineer making 7 figs is as I can do very complex tax planning as a shareholder owner of a private corporation to make sure the bulk of that wealth ends up in my hands and not Uncle Joe's hands.

Whats the best way to learn about complex tax planning and owning a private corporation? Any book you read or did you just figure it out as you went. thx

 

[mike-sheree]

You must first learn to really understand financial statements. A good accounting book or “ the portable MBA” can be useful. And DEFINITELY leave any complex tax planning to the experts. You just need to be fluent interpretating all the numbers, seeing red flags, obvious manipulations, etc.
Just be comfy reading and speaking their “ language”.

 

[Med Director New England]

Whats the best way to learn about complex tax planning and owning a private corporation? Any book you read or did you just figure it out as you went. thx

By hiring lawyers and CPAs..

 

[LADoc00]

Whats the best way to learn about complex tax planning and owning a private corporation? Any book you read or did you just figure it out as you went. thx

I spent 2.5 years when I started private practice in night school. Took tax law, contract law, human resource management, accounting, financial planning and commodities trading. Wished I stayed and took options trading and hedging strategies but they were cancelled due to budget cuts at the time.

I am not at all exaggerating when I say my first 3-5 years in private practice were longer hours than my internship, 80+ hrs/week easy.

 

[gbwillner]

Whats the best way to learn about complex tax planning and owning a private corporation? Any book you read or did you just figure it out as you went. thx

First talk to an accountant to get a general overview.