Possible to make ends meet as a surgeon by only picking up call?

[Brahnold Bloodaxe]

At some point in my career I'd like to have the ability to regularly take extended time off, such as working one month and then taking the next one off, several times a year. Obviously, this is not possible in a traditional surgery practice where you need to maintain a referral base and follow up post surgery for up to 90 days, but what about not having a full time job at all and just picking up call as often as possible?

Is this feasible?

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[Smurfette]

At some point in my career I'd like to have the ability to regularly take extended time off, such as working one month and then taking the next one off, several times a year. Obviously, this is not possible in a traditional surgery practice where you need to maintain a referral base and follow up post surgery for up to 90 days, but what about not having a full time job at all and just picking up call as often as possible?

Is this feasible?

Look into locums tenens.

You can work as a locums and fill in at places without enough manpower to fill holes in the call schedule themselves. This could mean taking call for just weekends, or for 1-2 weeks at a time, or doing longer term assignments depending on the situation. You can also accept or decline jobs based on what you need. The caveat is that some of these jobs are available for a reason, and you could end up working in a difficult environment.

You can work either for an agency (who will manage everything but take a cut of what the hospital is paying) or independently (potentially higher payday but you pay your own malpractice, licenses, health insurance, etc.). Try searching for threads on locums for more info.

 

[vhawk]

I've done a little bit of locums during fellowship as a moonlighting opportunity and so I've learned a bit about how the process works, the pluses and minuses, etc. I'm certainly not an expert but I feel I've got some insight into your question.

I think it is certainly possible to make a living doing what you describe, and it obviously is because there are many people doing exactly that. As smurfette said, there are different types of locums jobs, from more consistent part time jobs to more random grab a shift here and there kind of things. Most of these jobs are available through one of the dozen or so Locums companies out there, which are basically like temp firms, they collect a bunch of doctors in various specialties, then hospitals come to them when they need coverage and they coordinate. Working through these firms was nice for me since it meant I didnt have to do any work for licensing, credentialing, scheduling, pay, anything. It was basically like "Can you work this date? Ok, show up, and we will write you a check." These are usually paid hourly, or some version of "$X for the first Y hours, then $Z/hr for every hour after that," but there are lots of variations. As with anything like this, MAKE SURE YOU READ the contracts and the fine print and know exactly what you are getting into. It is important for you to know what kind and how much malpractice they are providing (or if you have to provide your own), things like that.

The downside of firms like this is that obviously they take a pretty huge cut, and they operate in kind of a sleazy way. Its like working for a used car salesman. They dont care about the patients, they dont care about the hospitals, they dont care about the doctors. They care about filling as many shifts as they can. And any given hospital may give the bid for their open shifts to like 5 different locums firms, so they are very competitive and aggressive with each other. Its a little unseemly.

I think it is possible for you to do this independently, and if you were seriously thinking about doing it for a living, permanently, I would strongly recommend looking into that option. Its definitely a lot more work but I think the pay would be markedly better as well.

In terms of how much you can make and how lifestyle friendly, a lot of it is going to depend on how flexible you are and what you want. If you are willing to fly anywhere in the country on relatively short notice and cover whatever shifts people have, you can actually make quite a bit of money doing this. Its hard on you if you have a family or crave stability but as I've done it over the last year or so I can definitely see how a certain type of person/personality would be able to enjoy it.

 

[Brahnold Bloodaxe]

I've done a little bit of locums during fellowship as a moonlighting opportunity and so I've learned a bit about how the process works, the pluses and minuses, etc. I'm certainly not an expert but I feel I've got some insight into your question.

I think it is certainly possible to make a living doing what you describe, and it obviously is because there are many people doing exactly that. As smurfette said, there are different types of locums jobs, from more consistent part time jobs to more random grab a shift here and there kind of things. Most of these jobs are available through one of the dozen or so Locums companies out there, which are basically like temp firms, they collect a bunch of doctors in various specialties, then hospitals come to them when they need coverage and they coordinate. Working through these firms was nice for me since it meant I didnt have to do any work for licensing, credentialing, scheduling, pay, anything. It was basically like "Can you work this date? Ok, show up, and we will write you a check." These are usually paid hourly, or some version of "$X for the first Y hours, then $Z/hr for every hour after that," but there are lots of variations. As with anything like this, MAKE SURE YOU READ the contracts and the fine print and know exactly what you are getting into. It is important for you to know what kind and how much malpractice they are providing (or if you have to provide your own), things like that.

The downside of firms like this is that obviously they take a pretty huge cut, and they operate in kind of a sleazy way. Its like working for a used car salesman. They dont care about the patients, they dont care about the hospitals, they dont care about the doctors. They care about filling as many shifts as they can. And any given hospital may give the bid for their open shifts to like 5 different locums firms, so they are very competitive and aggressive with each other. Its a little unseemly.

I think it is possible for you to do this independently, and if you were seriously thinking about doing it for a living, permanently, I would strongly recommend looking into that option. Its definitely a lot more work but I think the pay would be markedly better as well.

In terms of how much you can make and how lifestyle friendly, a lot of it is going to depend on how flexible you are and what you want. If you are willing to fly anywhere in the country on relatively short notice and cover whatever shifts people have, you can actually make quite a bit of money doing this. Its hard on you if you have a family or crave stability but as I've done it over the last year or so I can definitely see how a certain type of person/personality would be able to enjoy it.

Very good rundown. Assuming I'd have total flexibility to travel in search of the highest rates and work every day of the month during the month I'm "on," would it be feasible to hit $350k+ working 6 months of the year?

 

[vhawk]

Hmmm....if you are working not just every "day" of the month you are on but 24 hrs a day, or at least close to that, then yes, I think that would be possible. Thats not as terrible as it sounds as many of those hours "on" could be spent sitting in a hotel watching TV and waiting for pages which, depending on how busy the hospital is, may never come. IOW working 30 days straight, 24 hrs/day, isnt as daunting as it would be in residency, and isnt necessarily inhumane or horrible (though obviously you could get unlucky.) Many of these jobs dont have you running a clinic or seeing postops, you are basically just covering an ED and emergency issues plus whatever inpatient census, so its not that labor intensive.

I would say that your $ amount is probably pretty close to the max you could make in a 6 month on/6month off scenario and you would likely make less.

 

[ConfusedChemist]

Very good rundown. Assuming I'd have total flexibility to travel in search of the highest rates and work every day of the month during the month I'm "on," would it be feasible to hit $350k+ working 6 months of the year?

Sometimes, it's important to take a step back and re-read to assess the absurdity of a statement.

This might have one of those times Also, I'd suggest emerg.

 

[bannie22]

Tell us how it goes. Thats a very interesting, risky, and also wild way of practicing.

Or perhaps it is just more common than I was ever exposed to

 

[Brahnold Bloodaxe]

Hmmm....if you are working not just every "day" of the month you are on but 24 hrs a day, or at least close to that, then yes, I think that would be possible. Thats not as terrible as it sounds as many of those hours "on" could be spent sitting in a hotel watching TV and waiting for pages which, depending on how busy the hospital is, may never come. IOW working 30 days straight, 24 hrs/day, isnt as daunting as it would be in residency, and isnt necessarily inhumane or horrible (though obviously you could get unlucky.) Many of these jobs dont have you running a clinic or seeing postops, you are basically just covering an ED and emergency issues plus whatever inpatient census, so its not that labor intensive.

I would say that your $ amount is probably pretty close to the max you could make in a 6 month on/6month off scenario and you would likely make less.

That's interesting..you can easily make $2k in a 10 hour shift in EM, so I was expecting a surgeon willing to travel anywhere to maximize rates to be able to make roughly that much, as well. One major point I'm confused about: when you sign on to take call, say for $1000 a night, is it common to pocket the professional fee as well if you get called in to operate? I would personally feel shortchanged if I ended up operating on 3 patients overnight for a measly $1k while the hospital kept not just the facility fee but my professional fee as well!

 

[vhawk]

In my experience no but I don't have enough to say what is "common."

EM is working a lot harder for that 10 hr shift than "surgeon covering the ed and floor calls overnight" is so I'm not surprised the pay is a little less. I'm sure, as I said, if I were willing to shop around the country and for other types of jobs I could have done better but I was pretty happy with 2k/12hr shift plus reimbursement for travel.

A more consistent job where you are seeing patients in clinic booking and doing cases and doing followup probably pays more but I didn't look at any jobs like that. I just wanted weekends and nights

 

[Brahnold Bloodaxe]

Gotcha. I think surgeons should be more insistent on always keeping the professional fee. The way I see it, you pay me a flat $X fee because you need a surgeon on call or else the hospital shuts down. For that $X I carry the pager and agree to get out of bed when it rings. If you call me over and ask me to perform a midnight operation that nets the hospital an $8000 facility fee you better not try to keep my $1500 professional fee on top of that! The flat fee is what you pay me to carry the pager whether I come in or not, if I come in and operate I want my rightful share of the billing as well.

 

[ACSurgeon]

Very good rundown. Assuming I'd have total flexibility to travel in search of the highest rates and work every day of the month during the month I'm "on," would it be feasible to hit $350k+ working 6 months of the year?

Hmmm....if you are working not just every "day" of the month you are on but 24 hrs a day, or at least close to that, then yes, I think that would be possible. Thats not as terrible as it sounds as many of those hours "on" could be spent sitting in a hotel watching TV and waiting for pages which, depending on how busy the hospital is, may never come. IOW working 30 days straight, 24 hrs/day, isnt as daunting as it would be in residency, and isnt necessarily inhumane or horrible (though obviously you could get unlucky.) Many of these jobs dont have you running a clinic or seeing postops, you are basically just covering an ED and emergency issues plus whatever inpatient census, so its not that labor intensive.

I would say that your $ amount is probably pretty close to the max you could make in a 6 month on/6month off scenario and you would likely make less.

Sometimes, it's important to take a step back and re-read to assess the absurdity of a statement.

This might have one of those times Also, I'd suggest emerg.

Acute care surgery jobs require that you cover 25% of the call and pay 400K/year. The few jobs I interviewed at varied from 24/7 call for an entire week (fewer weeks) to working week on/week off with some breaks during the week. Some jobs require back up call in addition to the 25% primary call. These jobs were not locums and were in a city of 600k people (i.e. not a rural location desperate for a surgeon).

So, possible to make 350k working half the year, but maybe not month on/month off...

 

[bannie22]

what about doing a fellowship and doing plastics or neuro or ent or urology or ortho?

 

[ThoracicGuy]

what about doing a fellowship and doing plastics or neuro or ent or urology or ortho?

I wouldn't expect a pre-podiatrist to know, but you can't do a fellowship after general surgery to do neurosurgery, ent, urology, or ortho.

 

[balaguru]

EmCare has jobs that fit your criteria and is currently hiring in various locations throughout the US. Disclosure: I work for EmCare.

 

[dmal]

If you go through a locums company, they pay you a flat/hourly fee (maybe 150-200/hr) with an extra daily fee to carry the pager ~ 1500$. I don't think you can bill for your own cases or office visits if you're going through a company. If you contract directly through a hospital you may be able to negotiate a deal where you bill for the cases you do on top of your hourly/daily rates.

As for making 350k, for 6 months of locums work, I don't see how its possible. I can see someone making that much if they're doing 12 months of locums...

 

[dmal]

EmCare has jobs that fit your criteria and is currently hiring in various locations throughout the US. Disclosure: I work for EmCare.

Doesn't EmCare require Trauma/Critic care fellowship? I met someone who works for EmCare in TX a few years ago and she also recommended to check them out, but when I went to their site, all the jobs were asking for Trauma/critic care fellowships- and only in TX and FL.

 

[balaguru]

Doesn't EmCare require Trauma/Critic care fellowship? I met someone who works for EmCare in TX a few years ago and she also recommended to check them out, but when I went to their site, all the jobs were asking for Trauma/critic care fellowships- and only in TX and FL.

Many of the surgeons are not fellowship trained. I am nearly certain the trauma director of our busiest level 1 facility has no fellowship training. Many of the directors are not fellowship trained. I am not fellowship trained. With that said they are probably listing a preference for fellowship training to make hiring and assignments simpler and discourage less committed surgeons from applying. The last flyer mentioned open positions in CA, FL, IN, TX and NH.

The idea of billing for your professional fees for trauma/acs services sounds great in theory but in practice isn't always the best advice. First you have to decide if you are going to be in network or out of network. If "in network" then you will need to credential with payors. If you are hopping around the country this is not a trivial task. Next you need to figure out if you are going to do billing on your own or pay someone else to do it. 6% of collections is close to the going rate. Then you will likely need to hassle your biller on a regular basis to collect as you monitor your accounts receivable. If you have negotiated billing for your professional fees you daily rate will likely be lower such that when you consider only your daily rate you may not be making as much as you would like. This will create uncertainty and likely some anxiety regarding hitting targets for yourself when you look at your call schedule. There is something to be said for the situation in which you can look at your schedule and know exactly how much you will make based on the number of shifts that you have been assigned and to be free of the headaches of billing and collections makes that situation even better.