Locums vs Telehealth Psych for Geographic Mobility?

[LeJoker]

Hi all,

I'm a psychiatrist 1.5 years out of residency. I've worked most of that for a telehealth co because I'm not rooted in one place (single, no kids, moved around a lot for school etc) and in fact still am trying to find where I'd like to settle down geographically. I'm considering continuing telehealth given that it gives me mobility (at least within USA), but have also thought a lot about locums as another means of seeing different places while working. I do miss the in-person medical environment and the social elements of that.

So my question is:
1) Financially, does locums really seem to out perform (or at least match) non-locums jobs? How advantageous/disadventageous is the 1099 situtation of having to set up my own health insurance and other benefits?
2) If you've done locums, has there been any major advantages or disadvantages that are worth thinking about?
3) International locums seems especially exciting. Any tips on how to find this? Global Medical seems to have scant opportunities for psych abroad.

Thanks all!

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[When is graduation again?]

1) Not sure what your telehealth company is, but I'd guess yes for most of them. Telehealth companies tend to pay for productivity decent to low wages for productivity, which provides a lot of things you can't control for. I'm in a Southern, relatively cheap state, and I've seen locums inpatient jobs pay out about 235 per hour for 7 on 7 off work (12 hour days). Income is higher, but you'll have to get your own benefits. I use my wife's federal benefits, so not an issue for me, while getting the tax benefits of being 1099.

2) Main advantages are freedom, flexibility, and pay. Even though you sign a contract for x amount of time, you can typically leave earlier with 1 months notice. Disadvantages are a lot of the jobs have terrible support or are undesirable. In my area, there are a ton of locums gigs for state hospitals, ACT teams, and inpatient gigs in less desirable cities.

3) Can't answer this as I have no experience.

 

[FlowRate]

It seems like your primary goal is to continue trying out new places to figure out where you want to live, with secondary goal of doing locums if locums will meet the travel need and have other advantages like pay or IRL camaraderie.

I've never done locums but, as WhenGrad mentioned, typically the word is that locums assignments are for particularly hard to fill and undesirable jobs/locations/both.

Seems like a lot of potential pitfalls, to me. Unsolicited questions: When do you want to decide you're going to settle somewhere? What's stopping you now? Leaning toward anything in particular?

 

[2025DandW]

I have never done telehealth, but I have done locums for years. Most of those years I also had a W2 job. I was able to save a ton between my 457B, 401k and Sep account, switched to Solo 401k after leaving my W2 job. I guess I have been lucky. I have always worked within 30 minutes to 1 hour of a nice major city. Most of my time has been spent in highly sought after cities. The pay is higher than W2. I expect to be paid between $250-350/hour depending on the job. In comparison to a W2, I could do better at my state hospital with a pension, even at the higher hourly rate. State hospitals aren’t for everyone, but my state pays a good wage for 4 days a week, less than 8 hours a day. The additional day could be spent doing locums or moonlighting within the state system. One could potentially take off 48 weekdays a year. Call was not required, but it was available at a low hourly rate, less than $100/hour. I mostly did call for other hospital systems. There was a quite generous pension. When I add up what I could get paid for working 36 hours a week, so ignoring locums, and the value of the pension, it is more than what I make as highly paid locums. It is maybe 7-8% more. You are typically told to add 30% to a W2 salary to determine the minimum you should be paid for locums. I am ignoring taxes in the above examples because trying to compare apples to oranges is difficult. As a W2, I could reduce my taxable income by 8% due to the pension, the maximum allowed for the 457B and the same maximum for the 401k. As a 1099, my solo 401k maximum is 86% of my W2 numbers. Now, as a locum, you could open a defined benefit plan and tuck away quite a bit of money. You can do an s-corp. You can write off your housing, but you have to have a tax home somewhere else, and car along with taking a per diem as long as you don’t stay in one place for over a year. Most locums positions actually pay for housing and a car, flights, DEA and licenses, so you can’t write them off. Moving around can be fun, but it can also quickly get old. Some states, CA and NY come to mind, have very strict rules about residency, so you may have to limit your time in state if you want to avoid becoming a resident. For most people starting out, this is not a big deal, but it can be quite expense once you accumulate a significant number of assets. You do have to worry about health insurance. Many people use the ACA, but it might not be cheap. Some people also get their own disability insurance because as a 1099 you won’t be covered by the facilities workmen’s compensation. Some locums contracts have noncompetes, but some W2 contracts also have them. You can write off supplies, home office, psychiatry related memberships, licenses including DEA, CME, phone to extent used for work, etc. However, you have to pay employee and employer SS and medicare, but you get to write-off 50% of the employer portion. I love the freedom of locums. I also love the ability to ignore the politics of the organization.