No incentive to be full-time ED doc? What to do

[OfTheTrenches]

---

Members don't see this ad.

Currently work at a high acuity, busy, understaffed facility full time (120 hrs) 1099. PRN make about $50/hr more than the full time docs and usually get offered bonus if any extra shifts worked. Recently PRN has been bumped up to about $100/hr more than full timers for guaranteed hours committed each month (~60-80).

Recently they have started to hire locums for about $75/hr more than full time docs.

Night docs recently have been offered a sign on bonus on top of making $50/hr more than full time day docs.
New grads this summer will have new sign on bonus that we current full time docs never had.

What would do in this situation? Quit/go PRN and a couple different local hospitals? only stay and ask about retention bonus? Stay full time and do minimal work on shift while adding prn shifts elsewhere?

Seems like no incentive/undervalued to be full-time. Other people have similar issues in their ED?

 

[RustedFox]

Someone find the "First time?" meme and post it for me.

 

[JacobMcCandles]

1.) Have backup plan for another job.
2.) Ask for a “market adjustment” based on what they’re paying.
3.) If they say no then decide what you want to do: continue on where you’re at and get underpaid for your loyalty or move on.

 

[emergentmd]

I was one of those locums who made twice as much as the full timers who got to pick shifts I wanted who was less efficient. I always wondered why anyone would stay full time when they knew I was getting 2x rate?

Look for a new job around the area which I am sure there are plenty. I would give them notice to go part time/locums at whatever everyone is getting. They will not give you a locums rate contract. They may give you a new hire full time bonus.

Either way, place looks difficult to staff and you have leverage. I would use it.

Locums prob get more bonus for shifts that is not covered. Those were the good old days.

 

[Groove]

These situations are always a little dance and it's more art than algorithm. Much depends on the local market, supply/demand, etc.. The pros of FTE are guaranteed hours regardless of the supply/demand. The downside is that you aren't compensated to the degree that local PRN/locums might be but then again...you are guaranteed hours where they are not. If you are in an area that seems to always be in demand, then your chances of doing PRN longer term are good as long as you don't mind the risk of losing hours to a class of starving new grads that start saturating your area. After all, employers and schedulers do NOT prefer PRN/part timers and would much rather staff the schedule with FTE.

Either way you skin it, it's really damn tough to burn bridges in this field so there's no harm in negotiating. If you want to play it safe...you could scale back your FTE hours to a minimum and pick up extra PRN each month for the bonus pay if that's an option. If they hire a slew of new grads after ACEP then you have a better chance of negotiating back your lost hours than by negotiating a lost FTE spot in the group. This option would probably be preferred if you have lots of roots planted in your city/area.

Permanent PRN players who try to balance this game long term tend to always find themselves in feast or famine situations. The best markets for that strategy are less desirable cities that are always in need. I happen to live in one of those but I have lots of roots where the stability of my job and proximity to home are more desirable to me than the stress of worrying about whether I'm going to be able to work X number of shifts each month but that's a personal decision. It tends to get stressful during those ebbs and flows of local need, where bonus pay is staggered for empty shifts and while you wait for the bonus pay to go up, all the extra shifts get nabbed on first offer by hungry, starving new grads with ER salary loans.

 

[Porfirio]

Go PRN everywhere within 1-1.5 hrs driving distance around you. There is no down side.

 

[EctopicFetus]

Currently work at a high acuity, busy, understaffed facility full time (120 hrs) 1099. PRN make about $50/hr more than the full time docs and usually get offered bonus if any extra shifts worked. Recently PRN has been bumped up to about $100/hr more than full timers for guaranteed hours committed each month (~60-80).

Recently they have started to hire locums for about $75/hr more than full time docs.

Night docs recently have been offered a sign on bonus on top of making $50/hr more than full time day docs.
New grads this summer will have new sign on bonus that we current full time docs never had.

What would do in this situation? Quit/go PRN and a couple different local hospitals? only stay and ask about retention bonus? Stay full time and do minimal work on shift while adding prn shifts elsewhere?

Seems like no incentive/undervalued to be full-time. Other people have similar issues in their ED?

This is the stupidity of so many hospitals. As others mentioned I would leave and go PRN. It would be wise of them to block you from working for a period of time but seemingly there must be other jobs around you that will pay better as well. Go there and you can always come back.

I also would suggest going to your boss/ decision maker after you start looking for other jobs and say you are looking and you want to be paid like everyone else and don't want to work to a committed job making much less than others.

 

[JacobMcCandles]

Go PRN everywhere within 1-1.5 hrs driving distance around you. There is no down side.

There is a downside and we saw that during COVID. A lot of PRN docs found themselves with no hours. What are the chances something like that happens again? Probably low but most places are trying to staff up with full-timers and cut PRN. You’ll likely always be able to find hours but it may not be as much or which hours you’d like.

 

[EctopicFetus]

There is a downside and we saw that during COVID. A lot of PRN docs found themselves with no hours. What are the chances something like that happens again? Probably low but most places are trying to staff up with full-timers and cut PRN. You’ll likely always be able to find hours but it may not be as much or which hours you’d like.

Long term the glut of docs will screw you.. short term you are fine.

 

[Porfirio]

Likelihood of a huge drop in ER volume like COVID? Very low if not basically 0%.

Short term 3-5 years? That is a risk worth taking. For me, that is $405,000-$675,000 over 3-5 years extra over full timers. Plus, I have no full time headaches and get Thanksgiving/Christmas off every year.

Yep, you keep being full time.

 

[emergentmd]

Man, the good old days when I did locums at 2x rate. It was truly the best of both worlds other than the travel. If I could find one in my home town, it would have been a no brainer

1. No holidays unless I chose to do it at 3-4 rate
2. No nights
3. No weekends
4. No admin, meetings, metrics.

I remember not ever checking my email. Full timers would ask me about the new directives from the top, and I just shrugged my shoulders. Why do I care if I meet metrics. What are they going to do to me?

 

[OfTheTrenches]

[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]]]][emoji[emoji[emoji6]][emoji[emoji6]]]" data-quote="Groove" data-source="post: 0" class="bbCodeBlock bbCodeBlock--expandable bbCodeBlock--quote js-expandWatch">

These situations are always a little dance and it's more art than algorithm. Much depends on the local market, supply/demand, etc.. The pros of FTE are guaranteed hours regardless of the supply/demand. The downside is that you aren't compensated to the degree that local PRN/locums might be but then again...you are guaranteed hours where they are not. If you are in an area that seems to always be in demand, then your chances of doing PRN longer term are good as long as you don't mind the risk of losing hours to a class of starving new grads that start saturating your area. After all, employers and schedulers do NOT prefer PRN/part timers and would much rather staff the schedule with FTE.

Either way you skin it, it's really damn tough to burn bridges in this field so there's no harm in negotiating. If you want to play it safe...you could scale back your FTE hours to a minimum and pick up extra PRN each month for the bonus pay if that's an option. If they hire a slew of new grads after ACEP then you have a better chance of negotiating back your lost hours than by negotiating a lost FTE spot in the group. This option would probably be preferred if you have lots of roots planted in your city/area.

Permanent PRN players who try to balance this game long term tend to always find themselves in feast or famine situations. The best markets for that strategy are less desirable cities that are always in need. I happen to live in one of those but I have lots of roots where the stability of my job and proximity to home are more desirable to me than the stress of worrying about whether I'm going to be able to work X number of shifts each month but that's a personal decision. It tends to get stressful during those ebbs and flows of local need, where bonus pay is staggered for empty shifts and while you wait for the bonus pay to go up, all the extra shifts get nabbed on first offer by hungry, starving new grads with ER salary loans.

Yeah the permanent PRN players don’t bother me.

It’s the fact that they get offered extra bonus for extra shifts, tend to get scheduled mostly/all morning and day shifts at the more desired facilities in the system.

 

[EctopicFetus]

I think you get a lot of the pros and cons here. One other one is that you are often going to the crappiest sites. That being said the higher the rate the aim is to get you off the schedule ASAP. Understand, they dont care about quality unless you generate a ton of complaints. I also agree that if you go the PRN route negotiate as hard as possible. You can always accept less later on. It will be very market dependent. If you are in a desirable place (Austin, many parts of Florida, Chicago, etc) and dont want to travel your luck will be minimal. If you want to go to Iowa, and other flyover type jobs then go for it. I think on FB someone posted a job in New Mexico that is full time and everyone just flys in for over 300/hr and it looked simple.

If you are gonna go PRN/Locums no reason to take under 300 if you are willing to travel. The issue is needing a ton of medical licenses and keeping up with them. If you can find a lucrative long term gig thats the way. If you cant I would suggest what I tell young docs.. Work the minimum at your FT gig and then pick up the $$$ sites when bonuses and pay make sense. This is threading the needle for young docs who need a salary guarantee but also want to maximize income.

 

[slchino]

This is happening at my shop too. Large cmg, a lot of recent turn over. I’m pgy8, I got thrown into a pgy 1 nocturnist schedule and see all these locums get the day shift and get paid 125$/hr extra. I told the scheduler and it’s better but not much. I’m giving it another month and if I get shafted. I’ll leave too. I agree the per diems get treated better imho. All day shifts no weekends

It’s Rediculous how some groups treat their full timers. Or maybe it’s they don’t like me and it’s their way of saying such.

 

[Porfirio]

This is happening at my shop too. Large cmg, a lot of recent turn over. I’m pgy8, I got thrown into a pgy 1 nocturnist schedule and see all these locums get the day shift and get paid 125$/hr extra. I told the scheduler and it’s better but not much. I’m giving it another month and if I get shafted. I’ll leave too. I agree the per diems get treated better imho. All day shifts no weekends

It’s Rediculous how some groups treat their full timers. Or maybe it’s they don’t like me and it’s their way of saying such.

It’s not about liking you. It’s about business. Their business is filling blanks on a schedule sheet.

 

[OfTheTrenches]

[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]][emoji[emoji[emoji6]][emoji[emoji6]]][emoji[emoji[emoji6]][emoji[emoji6]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]]" data-quote="Porfirio" data-source="post: 0" class="bbCodeBlock bbCodeBlock--expandable bbCodeBlock--quote js-expandWatch">

It’s not about liking you. It’s about business. Their business is filling blanks on a schedule sheet.

Yeah I get that they don’t want to publish an open schedule. All they have to do is send an email to full timers about open shifts for bonus before publishing the schedule. They won’t do that they ask prn for shift coverage for extra money. Meanwhile the full timers are working hardest shifts/locations for less pay.

 

[AlmostAnMD]

It’s not about liking you. It’s about business. Their business is filling blanks on a schedule sheet.

This isnt always true

A guy at my old shop complained about some parts of his schedule (in his defense he did have a ****ty recurring issue that felt fair to raise) and they retaliated by giving him nights every 4-5 shifts for a few months.

I think it was a move meant to bring the rest of us in line about complaining. That was his assessment anyway, which looking back was probably correct.

Was one of the first flags I encountered the group was corrupt.

 

[TooMuchResearch]

This isnt always true

A guy at my old shop complained about some parts of his schedule (in his defense he did have a ****ty recurring issue that felt fair to raise) and they retaliated by giving him nights every 4-5 shifts for a few months.

I think it was a move meant to bring the rest of us in line about complaining. That was his assessment anyway, which looking back was probably correct.

Was one of the first flags I encountered the group was corrupt.

Wow, I've noticed we do the opposite. We've had a few people more or less get a full 1-2 year reprieve from our busiest places when they get burned out.

 

[Rekt]

Same thing at my hospital. Very busy high acuity. Locums make 70-100 more per hour, see half or even 1/3 the volume, don’t pick up kids or anybody pregnant, zero proficiency in any actual emergent procedures, essentially only seeing 20-40 year chest pains and abdominal pains. Completely useless and the reason other specialties hate EM docs.

 

[AlmostAnMD]

Wow, I've noticed we do the opposite. We've had a few people more or less get a full 1-2 year reprieve from our busiest places when they get burned out.

That's awesome. My old shop definitely didn't gaf about burnout. 10 docs leave a year, hire 10 docs. Problem solved.

Obviously you're the winner here, nice group