Locums: The Big Canary in the Emergency Medicine Coalmine

[EctopicFetus]

I think I posted a locums email chain awhile back where I could see the recruiters haggling with the hospital/group client and if memory serves, it was roughly $40/hr on top of most of the physician fees. Of course, this was 8 or 9 years ago. When you factor in malpractice costs, travel costs, business expenses, etc.. I doubt their profit margin is as massive as one might think.

Another time, they were paying the docs around $300/hr but I know for a fact the hospital was billed at $400/hr. That's the largest profit that I've been aware of personally.

Weatherby for both of those.

A group I knew paid a flat 24% to a cmg to do all practice admin. Thats a huge number but covered everything but med mal.

The numbers are pretty easy. If a CMG isn't making $50/hr they arent too keen to keep the contract. Even crappy sites require $1m profit. As I said their public filings (I think it was TH) showed profit margin of 28%.

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[chocomorsel]

Also, your math is way off here.

The average monthly number of clinical hours that I think most people would say is healthy would be probably about 120-130. 140 is pushing it. Go above 140 and you are seriously risking burnout.

I'll even assume 140 hrs for this calculation:

140 hrs/month * 231 dollars/hour * 12 months = $386,400.

And with TH, this figure is quite possibly paid as a 1099, increasing your tax burden, and with paltry, if any, benefits.

Ok, this is like 35 hours a week. Is this an ER thing? Most docs are working more than 35 hours a week.
Is burnout bad in EM due to all the swinging of schedules? Or other things?

 

[Frazier]

Ok, this is like 35 hours a week. Is this an ER thing? Most docs are working more than 35 hours a week.
Is burnout bad in EM due to all the swinging of schedules? Or other things?

It is, in its quintessential form, a high intensity work environment teeming with mixed acuity, uncertainty, violence/abuse, and constant interruptions.

It is 35 hours in EM similar to a olympic sprinter running maybe 2 miles per day total versus the marathon runner's 10 miles.

It doesnt make it easier -- it is just... different.

 

[GeneralVeers]

Ok, this is like 35 hours a week. Is this an ER thing? Most docs are working more than 35 hours a week.
Is burnout bad in EM due to all the swinging of schedules? Or other things?

The fast pace does contribute to burn out, but the main sources are patient satisfaction and administration. Because we are contract employees, and replaceable, admin can pile on all sorts of aribitrary metrics and rules on us. Sepsis guidlines are one of the big offenders. Patient satisfaction simply ruins the job for most of us.