Locums

[otis86]

if you are terminated from a locum assignment, does that affect your future ability to get locums positions?

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[pgg]

That's vague. Need more information -

Why were you terminated?
Was there adverse credentialing action?

 

[Coffee PRN]

if you are terminated from a locum assignment, does that affect your future ability to get locums positions?

Unless you were stealing drugs or had your Willie where you weren’t supposed to, no.

 

[NICMAN]

Future hospitals will ask each previous job if there were any adverse actions, conditions placed, restrictions, or limitations on your medical staff membership or clinical privileges. They will also ask the chair to rate you “poor” “fair” “good” or “superior” in a number of areas pertaining to your clinical judgement, knowledge, interpersonal skills, and professionalism. If you have a “Fair” rating in any of those then you should be prepared to clarify.

 

[otis86]

No credentialing action taken. It was working with some real a hole surgeons that I did not like working with

 

[pgg]

If you're as persistently vague when applying for new locums jobs as you are here, you might have trouble.

Oh who am I kidding, locums will hire any warm body these days. If you're not currently in police custody because of the incident you're probably fine.

 

[otis86]

Sorry for the vagueness. I refused to work with some surgeons and from wat I’ve been told so far they did not want to work with me. The Anesthesia chair, being a yes-sir surgeon guy, thought easier to get another anesthesiologist than me, since locums are so easily replaceable.

 

[aneftp]

If you're as persistently vague when applying for new locums jobs as you are here, you might have trouble.

Oh who am I kidding, locums will hire any warm body these days. If you're not currently in police custody because of the incident you're probably fine.

Desperate places will hire anyone. Has a place low ball me for Florida $300/hr.

Ain’t no one reasonable gonna to take it cause it’s more than 90 min from the big 4 cities. Not worth the drive for anyone these days cause they were offering calls either. Triple whammy for me
1. No calls
2. Low pay
3, bad location

But I know the chief there. They were reluctant to take this bad locums doc. But had no choice. He’s not a danger. But just bad. They finally ran out of places to put him so gave him his 30 day notice. Became more of liability.

 

[pgg]

Sorry for the vagueness. I refused to work with some surgeons and from wat I’ve been told so far they did not want to work with me. The Anesthesia chair, being a yes-sir surgeon guy, thought easier to get another anesthesiologist than me, since locums are so easily replaceable.

Don't sweat it.

 

[aneftp]

Sorry for the vagueness. I refused to work with some surgeons and from wat I’ve been told so far they did not want to work with me. The Anesthesia chair, being a yes-sir surgeon guy, thought easier to get another anesthesiologist than me, since locums are so easily replaceable.

Do what you feel comfortable with. At least you understand the locums game.

As locums you are always first to go if they don’t like u. Not liking you trumps the guy getting paid more

All things being equal. Never get comfortable at any 1099 locums place.

 

[otis86]

Let me explain:

Orthopod wants Spinal for a 5 minute knee manipulation. I tell him MAC would be sufficient and save PACU recovery time.

Recommending an A-line for a VATS/Upper lobectomy but being over run by the Thoracic surgeon.

Vasculopath patient with no veins and infiltrated IV and me being blamed for holding up the case bcz of no IV access.

 

[Hoya11]

Let me explain:

Orthopod wants Spinal for a 5 minute knee manipulation. I tell him MAC would be sufficient and save PACU recovery time.

Recommending an A-line for a VATS/Upper lobectomy but being over run by the Thoracic surgeon.

Vasculopath patient with no veins and infiltrated IV and me being blamed for holding up the case bcz of no IV access.

there's a reason no one wants to work there, probably not worth your stress, its not you

 

[dabears505]

Ate you still credentialed there? I woodland even mention anything of your still are. So many locums are credentialed at like 6-10 places because the job ended. You can just say the needed ended. They might have knowledge that the needed had actually not ended, in which case they will likely figure out that you were disliked and let go.

 

[otis86]

Yes still credentialed there. I wasn’t even given a 30 day notice, just told last week.

 

[Bryan O’Blivion]

Well, there’s probably 40 other jobs waiting for you.

 

[aneftp]

Yes still credentialed there. I wasn’t even given a 30 day notice, just told last week.

That’s sucks. Hope u are credentialed elsewhere and not sitting around with no income for a month. Hope u got some compensation.

I’m always getting emails for last minute coverage at multiple places I’m credential at. Someone is always out sick/family emergencies etc. I could probably scramble for 20-30k in 1099 income each month leaving my schedule blank every month as last minute fill in these days in a 2 hr radius from my house.

 

[NicholasPavona]

That’s sucks. Hope u are credentialed elsewhere and not sitting around with no income for a month. Hope u got some compensation.

I’m always getting emails for last minute coverage at multiple places I’m credential at. Someone is always out sick/family emergencies etc. I could probably scramble for 20-30k in 1099 income each month leaving my schedule blank every month as last minute fill in these days in a 2 hr radius from my house.

Well ain't you just the cat's ass, brah?

 

[aneftp]

Well ain't you just the cat's ass, brah?

U gotta be credential at multiple places. If you are full time locums. Or else you risk going without income for 1 plus month. Which is fine with some people

Don’t be a one trick pony.

 

[NicholasPavona]

U gotta be credential at multiple places. If you are full time locums. Or else you risk going without income for 1 plus month. Which is fine with some people

Don’t be a one trick pony.

I respect your game dude.

 

[dannyboy1]

Let me explain:

Orthopod wants Spinal for a 5 minute knee manipulation. I tell him MAC would be sufficient and save PACU recovery time.

Recommending an A-line for a VATS/Upper lobectomy but being over run by the Thoracic surgeon.

Vasculopath patient with no veins and infiltrated IV and me being blamed for holding up the case bcz of no IV access.

Gonna play some devils advocate here. As a locums you are a guest and need to be on your best behavior
1. Why do you care about PACU times? If orthopod wants a spinal, just give him one. At least run it by one of the regulars to see what is the deal with this surgeon
2. Unless the patient has a bad EF or valvulopathy you certainly don’t need an art line for every VATS. with a slick surgeon can be a no big deal, hour long case.
3. No IVs suck. Sometimes it helps to invite the surgical team to help look. At least they can’t blame you anymore. Also, don’t screw around for half an hour. If it’s not there, put in a CVL. I see a lot of wasting time and inadequate IV access because the doc just didn’t put in a CVL (usually haven’t done so in a while and are uncomfortable)

Don’t mean to be hard on you but you managed to piss off 3 separate surgeons and be let go in a time of extreme anesthesia shortage. It could be the problem is staring at you in the mirror…

 

[dabears505]

Gonna play some devils advocate here. As a locums you are a guest and need to be on your best behavior
1. Why do you care about PACU times? If orthopod wants a spinal, just give him one. At least run it by one of the regulars to see what is the deal with this surgeon
2. Unless the patient has a bad EF or valvulopathy you certainly don’t need an art line for every VATS. with a slick surgeon can be a no big deal, hour long case.
3. No IVs suck. Sometimes it helps to invite the surgical team to help look. At least they can’t blame you anymore. Also, don’t screw around for half an hour. If it’s not there, put in a CVL. I see a lot of wasting time and inadequate IV access because the doc just didn’t put in a CVL (usually haven’t done so in a while and are uncomfortable)

Don’t mean to be hard on you but you managed to piss off 3 separate surgeons and be let go in a time of extreme anesthesia shortage. It could be the problem is staring at you in the mirror…

Damn. Laying down harsh reality

 

[Arch Guillotti]

Let me explain:

Orthopod wants Spinal for a 5 minute knee manipulation. I tell him MAC would be sufficient and save PACU recovery time.

Recommending an A-line for a VATS/Upper lobectomy but being over run by the Thoracic surgeon.

Vasculopath patient with no veins and infiltrated IV and me being blamed for holding up the case bcz of no IV access.

1.) Tell him sure and then spend half an hour farting around.

2.) Ask around. May not be a big deal.

3.) Send them back upstairs until they have suitable access. Blame primary team.

 

[crash2500]

Gonna play some devils advocate here. As a locums you are a guest and need to be on your best behavior
1. Why do you care about PACU times? If orthopod wants a spinal, just give him one. At least run it by one of the regulars to see what is the deal with this surgeon
2. Unless the patient has a bad EF or valvulopathy you certainly don’t need an art line for every VATS. with a slick surgeon can be a no big deal, hour long case.
3. No IVs suck. Sometimes it helps to invite the surgical team to help look. At least they can’t blame you anymore. Also, don’t screw around for half an hour. If it’s not there, put in a CVL. I see a lot of wasting time and inadequate IV access because the doc just didn’t put in a CVL (usually haven’t done so in a while and are uncomfortable)

Don’t mean to be hard on you but you managed to piss off 3 separate surgeons and be let go in a time of extreme anesthesia shortage. It could be the problem is staring at you in the mirror…

Sorry this is just unreasonable.

It's his license. If you'd honestly do a spinal for a knee manipulation because the surgeon said so, that's some weak sauce right there. I mean gimme a break.

Also, you know nothing about the vats case. It's his license. Your advice is a recipe for high liability and a workplace that sucks to work at.

This is just another example of you eating one of our own and siding with what is likely a terrible culture and work environment. This is exactly why anesthesiologists get over run all over the country because of other docs willing to compromise for unreasonable surgeons.

 

[Maverikk]

I think his point was to play devils advocate, I’ve had surgeons at places I worked that I didn’t particularly enjoy. But I’ve never been fired before, you should stand your ground when reasonable and also know what hills are worth dying (getting fired on). I’ve told surgeons I’m not doing a spinal, it’s more how you word it. Usually the patients lumbar anatomy looks really difficult on x-ray and they’re really nervous so it may take awhile. If the surgeons tells the patient to ask for it I say sure… but sometimes after telling them about the putting a needle in their spine and having to stay completely still, and they may remember being awake during their procedure, they often change their mind and want a nice nap.

Not having an Aline for thoracic procedures can be fine, you’ve access to one hand, I’ve done resections that were consistently less than an hour with a surgeon who knew when they needed one and when they didn’t. This is why you ask local partners.

No IV access sucks. I tell them give them a liter and call IV therapy, or central lines after trying more than 3 times for a 20G. I give specific instructions to nursing. Always a risk esp with vascular.

It is his license, after enough time you know how to have your hand on the steering wheel. It’s basically useless to argue with some surgeons who are bull headed about things, there are multiple ways to be in charge of anesthesia, arguing with surgeons isn’t a good one unless they’re making unsafe requests. As a locums it’s twice as useless since they don’t know you

 

[aneftp]

I think his point was to play devils advocate, I’ve had surgeons at places I worked that I didn’t particularly enjoy. But I’ve never been fired before, you should stand your ground when reasonable and also know what hills are worth dying (getting fired on). I’ve told surgeons I’m not doing a spinal, it’s more how you word it. Usually the patients lumbar anatomy looks really difficult on x-ray and they’re really nervous so it may take awhile. If the surgeons tells the patient to ask for it I say sure… but sometimes after telling them about the putting a needle in their spine and having to stay completely still, and they may remember being awake during their procedure, they often change their mind and want a nice nap.

Not having an Aline for thoracic procedures can be fine, you’ve access to one hand, I’ve done resections that were consistently less than an hour with a surgeon who knew when they needed one and when they didn’t. This is why you ask local partners.

No IV access sucks. I tell them give them a liter and call IV therapy, or central lines after trying more than 3 times for a 20G. I give specific instructions to nursing. Always a risk esp with vascular.

It is his license, after enough time you know how to have your hand on the steering wheel. It’s basically useless to argue with some surgeons who are bull headed about things, there are multiple ways to be in charge of anesthesia, arguing with surgeons isn’t a good one unless they’re making unsafe requests. As a locums it’s twice as useless since they don’t know you

A lot has to happen to ask someone to leave with zero notice even as locums

Tempers flare. It happens to the best of us. But as locums u have a shorter lease.

 

[ToKingdomCome]

$300 is a disrespectful rate ? People take this ?

 

[IVdoc]

Most of these sites that have locums anesthesiologists have major issues and that's a reason they need locums because permanent docs don't want to stay once they experience the crappiness of the dept. The chairs of the anesthesia depts are weak, pretty much just figureheads with no real clout, just a "yes-man" to surgeons and hospital administrators, Boomers on the verge of retiring who don't want to rock the boat, don't want change because it may jeopardize their job or don't care about implementing updates to anesthesia. Many of the permanent anesthesiologists are Boomers or new grads or just are collecting-a-paycheck anesthesiologists; they don't speak out because it risks their jobs or they just don't care. Ex: if you want to do spinals or nerve blocks for ortho cases, the dept chair says "No we don't do those here". Ex: CRNAs run the place because the job ads describe their roles in the dept as "Empowered CRNA with Full Scope of Practice", the permanent docs just do preops/PACU sign-outs and sign the charts. So as locums either you walk away from these crappy places or you stay, sign the charts, make your hourly rates while looking for another locums job more in line with your work belief/ethics or you just sign the chart because you need a paycheck. These locums agencies will get rid of you if the surgeons or permanent anesthesiologists complain about you. The locums agencies have no loyalty to you and they are not going to bite the hand that feeds them to defend you even if you are in the right.

 

[aneftp]

$300 is a disrespectful rate ? People take this ?

Every market is different. High demand (more supply) than jobs means lower pay. There is an ASC that's super easy 15 minutes from my house usually done around 1pm (8 hr guarantee) pays $300/hr ($2400 guarantee) solo bread and butter gen/pain/ortho

There is an ASC 1 hr away, also 8 hour gurantee pays $375/hr but busy place 1:3 supervision ortho/gen/gi.

I'm a money *****, but which one sounds better to you?

$375/hr x 8 equals $3000
$300 x 8 equals $2400

Rate adjusted for travel time (2 hours vs 30 minutes round trip). Your time on the road is money. So 90 minutes extra on the road.

The $300/hr easier ASC and closer to home job is the better job. You have to see the entire picture. Many people have their blinders on
when it comes to money.

Money, location, workload. They are play factors into what you are willing to work for.

 

[IVdoc]

It is good advice to get credentialed at multiple sites and be linked to different agencies so that no one has a monopoly on your employment. One locums anesthesiologist I worked with said he didn't have a job for 6 months because he relied on one hospital site that didn't need him after he worked 1 month then he didn't work for 6 months and got another locums job later. Credentialing can take 1-3 months

 

[aneftp]

It is good advice to get credentialed at multiple sites and be linked to different agencies so that no one has a monopoly on your employment. One locums anesthesiologist I worked with said he didn't have a job for 6 months because he relied on one hospital site that didn't need him after he worked 1 month then he didn't work for 6 months and got another locums job later. Credentialing can take 1-3 months

Correct never be a one trick poney. I'm working on credentialing at another location right now. As I'm currently working locums this morning.

It's like being on vacation and planning your next vacation while on a current vacation.

 

[pgg]

Not having an Aline for thoracic procedures can be fine, you’ve access to one hand, I’ve done resections that were consistently less than an hour with a surgeon who knew when they needed one and when they didn’t. This is why you ask local partners.

Agree that not every VATS needs an arterial line.

But an a-line is a 2 or 3 minute procedure with ultrasound about 95% of the time.

Just put one in if you want one. If the surgeon says the patient doesn't need one, say OK and put one in.

It only becomes an issue if you spend 25 minutes doing it while they're waiting on you, and you get blood all over the floor. So don't do that.

 

[SRYSPAC]

Every market is different. High demand (more supply) than jobs means lower pay. There is an ASC that's super easy 15 minutes from my house usually done around 1pm (8 hr guarantee) pays $300/hr ($2400 guarantee) solo bread and butter gen/pain/ortho

There is an ASC 1 hr away, also 8 hour gurantee pays $375/hr but busy place 1:3 supervision ortho/gen/gi.

I'm a money *****, but which one sounds better to you?

$375/hr x 8 equals $3000
$300 x 8 equals $2400

Rate adjusted for travel time (2 hours vs 30 minutes round trip). Your time on the road is money. So 90 minutes extra on the road.

The $300/hr easier ASC and closer to home job is the better job. You have to see the entire picture. Many people have their blinders on
when it comes to money.

Money, location, workload. They are play factors into what you are willing to work for.

Appreciate your insight Aneftp; would you be able to DM regarding private health insurance options for someone considering going locums full time?

 

[cchoukal]

Every market is different. High demand (more supply) than jobs means lower pay. There is an ASC that's super easy 15 minutes from my house usually done around 1pm (8 hr guarantee) pays $300/hr ($2400 guarantee) solo bread and butter gen/pain/ortho

There is an ASC 1 hr away, also 8 hour gurantee pays $375/hr but busy place 1:3 supervision ortho/gen/gi.

I'm a money *****, but which one sounds better to you?

$375/hr x 8 equals $3000
$300 x 8 equals $2400

Rate adjusted for travel time (2 hours vs 30 minutes round trip). Your time on the road is money. So 90 minutes extra on the road.

The $300/hr easier ASC and closer to home job is the better job. You have to see the entire picture. Many people have their blinders on
when it comes to money.

Money, location, workload. They are play factors into what you are willing to work for.

This. I work for $300/hr 5 min from my house in the city. Now that we’re moving to the burbs, driving 30 min back into the city for that rate is a different animal, so I’m on the hunt again for a better rate. But the work is very pleasant so I may still book that place.

 

[aneftp]

In tougher locums market. I’d advise to tag team with other docs and offer equivalent of 1.0 fte Locum coverage. You will get better rates.

That’s why I think it’s best to negotiate 20-30 weeks offf than coordinate attacks on facilities that need longer locums coverage. Have a base w2 pay and build on that.

 

[AppTrail]

In tougher locums market. I’d advise to tag team with other docs and offer equivalent of 1.0 fte Locum coverage. You will get better rates.

That’s why I think it’s best to negotiate 20-30 weeks offf than coordinate attacks on facilities that need longer locums coverage. Have a base w2 pay and build on that.

you mean negotiate 20-30 weeks off at your W2 job?

 

[Dr. Rude]

you mean negotiate 20-30 weeks off at your W2 job?

yeah go about 0.6FTE to keep your health insurance and your foot in the door should the locums life not be for you. Lots of CRNAs do that in my corner of the world. Not so much on the doc side.

 

[aneftp]

you mean negotiate 20-30 weeks off at your W2 job?

Yes

 

[aneftp]

yeah go about 0.6FTE to keep your health insurance and your foot in the door should the locums life not be for you. Lots of CRNAs do that in my corner of the world. Not so much on the doc side.

They are more like 1.0 fte jobs with 20 weeks off and 40 hrs a week. W2 pay is 500k with 20 weeks off and 40 hrs average for reference

 

[Coffee PRN]

They are more like 1.0 fte jobs with 20 weeks off and 40 hrs a week. W2 pay is 500k with 20 weeks off and 40 hrs average for reference

500k with 20 weeks off and 40 hours average comes out to nearly $400/hr…seems high.

 

[aneftp]

500k with 20 weeks off and 40 hours average comes out to nearly $400/hr…seems high.

You are correct. I’m getting 30 weeks off. So my numbers are off. But I’m gonna to take slightly less than 500k

 

[Coffee PRN]

You are correct. I’m getting 30 weeks off. So my numbers are off. But I’m gonna to take slightly less than 500k

So you found a W2 job to pay you $568/hr? Somehow I’m skeptical of that. Unless you are doing creative math and only counting call ins on call in your hours worked.

 

[aneftp]

So you found a W2 job to pay you $568/hr? Somehow I’m skeptical of that. Unless you are doing creative math and only counting call ins on call in your hours worked.

Everyone skeptical of stuff I say. I’m gonna to hit 80k for the week locums as well. I can’t feed a family on 70k anymore for the week. I blasted past 50k for the week where it’s chump change.

Open your eyes folks. Not everyone is working 8-10 hrs a day. Some days are 1-2 hrs. Some days off completely. Yes. Some days are 12-14 hrs. I said average of 40 hrs.

 

[Coffee PRN]

Everyone skeptical of stuff I say. I’m gonna to hit 80k for the week locums as well. I can’t feed a family on 70k anymore for the week. I blasted past 50k for the week where it’s chump change.

Open your eyes folks. Not everyone is working 8-10 hrs a day. Some days are 1-2 hrs. Some days off completely. Yes. Some days are 12-14 hrs. I said average of 40 hrs.

I actually give you the benefit of the doubt for most things you say, but I’m not buying that you made 80k in a week.

 

[aneftp]

I actually give you the benefit of the doubt for most things you say, but I’m not buying that you made 80k in a week.

It’s gotta to happen thanksgiving week.
I already hit 70k

7 x 12k equals 84k

Thanksgiving is 14k alone.

Guys are making 100k in 10 days in Memphis I mentioned.

So to say it’s uncommon is incorrect.

The first I heard about these crazy 58k week was in Midwest last year and I like “how”.

Than I found out a guy made 70k in July week (not Fourth of July either) and it’s an arms race and I decided to match his output.

 

[AppTrail]

It’s gotta to happen thanksgiving week.
I already hit 70k

7 x 12k equals 84k

Thanksgiving is 14k alone.

Guys are making 100k in 10 days in Memphis I mentioned.

So to say it’s uncommon is incorrect.

The first I heard about these crazy 58k week was in Midwest last year and I like “how”.

Than I found out a guy made 70k in July week (not Fourth of July either) and it’s an arms race and I decided to match his output.

wow, you're an animal!

 

[Coffee PRN]

It’s gotta to happen thanksgiving week.
I already hit 70k

7 x 12k equals 84k

Thanksgiving is 14k alone.

Guys are making 100k in 10 days in Memphis I mentioned.

So to say it’s uncommon is incorrect.

The first I heard about these crazy 58k week was in Midwest last year and I like “how”.

Than I found out a guy made 70k in July week (not Fourth of July either) and it’s an arms race and I decided to match his output.

It’s not Thanksgiving yet. $476*7*24=$80,000.

That’s a week of continuous work/hours for a full week at a high rate.

How does your 80k week break down?

 

[aneftp]

It’s not Thanksgiving yet. $476*7*24=$80,000.

That’s a week of continuous work/hours for a full week at a high rate.

How does your 80k week break down?

I learn it from my crnas Also. Everything is guarantee

You guys (and gals) are playing checkers. I’m playing chess.

Hourly rate
Guaranteed daily rate
Call stipend

I keep throwing out hints how to do it. Without giving away the entire formula.

Guys are sleeping at their own home in their own bed with their kids and getting paid. I got a golf course view with the clay tennis courts down the street.

 

[Status Sciaticus]

It’s gotta to happen thanksgiving week.
I already hit 70k

7 x 12k equals 84k

Thanksgiving is 14k alone.

Guys are making 100k in 10 days in Memphis I mentioned.

So to say it’s uncommon is incorrect.

The first I heard about these crazy 58k week was in Midwest last year and I like “how”.

Than I found out a guy made 70k in July week (not Fourth of July either) and it’s an arms race and I decided to match his output.

I learn it from my crnas Also. Everything is guarantee

You guys (and gals) are playing checkers. I’m playing chess.

Hourly rate
Guaranteed daily rate
Call stipend

I keep throwing out hints how to do it. Without giving away the entire formula.

Guys are sleeping at their own home in their own bed with their kids and getting paid. I got a golf course view with the clay tennis courts down the street.

why gatekeep?
I have an hourly rate with a 10 hour guarantee which will get me $4,000 - $5,000. add in overnight home call for $2,000-$3,000.
Even doing that everyday is $8,000. Lets just say 8x7 = $56,000.
Where are you getting the extra 30k/week from?

 

[aneftp]

why gatekeep?
I have an hourly rate with a 10 hour guarantee which will get me $4,000 - $5,000. add in overnight home call for $2,000-$3,000.
Even doing that everyday is $8,000. Lets just say 8x7 = $56,000.
Where are you getting the extra 30k/week from?

Business people negotiate behind the scenes. And don’t put things in public.

Many doctors are not smart negotiating

Time and money. Always remember that when you negotiate.

What is your time worth? Your big error is right in from of what you just posted

I can see it as clear as daylight what you are doing wrong.

 

[Status Sciaticus]

Business people negotiate behind the scenes. And don’t put things in public.

Many doctors are not smart negotiating

Time and money. Always remember that when you negotiate.

What is your time worth? Your big error is right in from of what you just posted

I can see it as clear as daylight what you are doing wrong.

Feel free to PM me if you dont want to publicize it.