Questions regarding being per diem vs full time

[desi0chick]

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Final year ER resident year confused about the concept about working "per diem" and how taxes work moving forwards if I were to work in different states. The area I'm looking for full time ER hospital positions are pretty much non-existent right now except urgent cares. If I were to sign full time urgent care in NY but per diem shifts in CT or NJ, would I be screwed by paying taxes in multiple states?

 

[southerndoc]

Depends on the state. Those states are usually tax heavy, so possibly.

 

[thegenius]

All depends on how you are paid, W2 or 1099. You can be per diem or full time and be 1099 OR W2, for instance.

There are several state and federal labor laws if you are a W2 employee.
If you are a 1099 you basically get what you calculate as your pay. You have to pay all the taxes.

1099 is easy. I've been doing it for 7 years. I pay quarterly taxes to state and fed. My calculations are pretty accurate as I'm always within +/- $2,000 for a refund at tax time (either I pay a little or get a little back).

 

[sylvanthus]

Per diem 10-99 is great in general, huge tax perks, lots of writeoffs, works awesome in conjunction with a w-2 position.

But be wary of some of the downsides, for instance, I got a needlestick putting in a central line on a contracted post polio patient. I got it though, boomshakalaka.

However, I had the usual blood testing done and paperwork filled out. But neither the hospital, not teamhealth would cover the cost. Nor the state. Ended up paying 1k out of pocket since I was noones employee… Total horsepuckey.

 

[thegenius]

Did someone see you needlestick yourself? I've stuck myself a few times and have never reported it. Doesn't seem worth the hassle.

 

[sylvanthus]

Ya unfortunately. Ahh well live and learn.

 

[Apollyon]

Ya unfortunately. Ahh well live and learn.

Back in 1972, iirc, a mob guy got shot twice. While sitting on the floor, back to the wall, police get there, and, what does he say? "Nobody shot me."

 

[EctopicFetus]

The 1099 vs W2 thing is interesting. Maybe outside the scope of this discussion but you lose a ton of protection as a 1099. IN a world with fewer and fewer W2 options I would simply say think of being a 1099 like asking a plumber to come to your house. You can “fire” them at a moments notice because it is more akin to really telling them not to come back. Do the same to your employee and there are a ton of protections. I think Ideally from a tax perspective do 1099 and W2. As far as filing taxes in multiple states thats what CPAs are for. A lot of this has to do with state laws but as mentioned taxes in the NY,NJ, CT area are gonna be sky high

 

[Angry Birds]

I am per-diem and W2.

 

[EctopicFetus]

I am per-diem and W2.

Working for 2 different tax ids? This is an ideal situation imo for 98% of em docs.

 

[thegenius]

I had an S-Corp and W2 at one point and was paying more in taxes / bookkeeping than being just a plain old 1099.

I was happy to switch back to 1099 + W2. Maybe my tax profile takes advantage of this more than others.

I guess the name of the game is you should get a tax projection by a CPA to determine what’s best for you.

 

[GeneralVeers]

I'm W2 and 1099. It's the best of both worlds. The W2 employer pays their part of my employment tax (about $6/hr for the year) and HSA helps me max out the $7200 contribution. I use my 1099 to finish out my 401K, and deduct everything related to being a doctor.

 

[sylvanthus]

Not sure how many people have looked into this, but if you live in a community property state (9 states Inthink qualify). you can do a qualified joint venture with your spouse in your LLC, pay them a proportion of your income so long as they “materially psrticipate” in the llc, and they can have their own solo 401k.

I would have gone this route if my ED hours didnt dry up.

 

[EctopicFetus]

Not sure how many people have looked into this, but if you live in a community property state (9 states Inthink qualify). you can do a qualified joint venture with your spouse in your LLC, pay them a proportion of your income so long as they “materially psrticipate” in the llc, and they can have their own solo 401k.

I would have gone this route if my ED hours didnt dry up.

Yes but you have to consider and offset social security for said spouse.

 

[MechEDoc]

Per diem 10-99 is great in general, huge tax perks, lots of writeoffs, works awesome in conjunction with a w-2 position.

But be wary of some of the downsides, for instance, I got a needlestick putting in a central line on a contracted post polio patient. I got it though, boomshakalaka.

However, I had the usual blood testing done and paperwork filled out. But neither the hospital, not teamhealth would cover the cost. Nor the state. Ended up paying 1k out of pocket since I was noones employee… Total horsepuckey.

Same. Putting in a central line with a crappy kit. Made a mistake, got a needle stick on a active IV drug user. Paid for PEP myself, about $3k.

Was the kit crappy and risk could be mitigated? Yes! Will anything change? Nope. Could I have avoided the mistake? Sure. Was it likely multifactorial? You bet. Plenty of blame to go around, however nothing will change.

 

[RustedFox]

Same. Putting in a central line with a crappy kit. Made a mistake, got a needle stick on a active IV drug user. Paid for PEP myself, about $3k.

Was the kit crappy and risk could be mitigated? Yes! Will anything change? Nope. Could I have avoided the mistake? Sure. Was it likely multifactorial? You bet. Plenty of blame to go around, however nothing will change.

This kind of thing trips me out. I take my time with lines; especially suturing them in.
A sterile pair of forceps (needle pickups) needs to be included in each kit. Why it's not, I will never know.

 

[MechEDoc]

This kind of thing trips me out. I take my time with lines; especially suturing them in.
A sterile pair of forceps (needle pickups) needs to be included in each kit. Why it's not, I will never know.

I agree re needle pickups. I was using a straight hand sewing needle and poked myself. I now also grab a suture kit and curved suture needle and use that to secure the central line.

 

[GeneralVeers]

I agree re needle pickups. I was using a straight hand sewing needle and poked myself. I now also grab a suture kit and curved suture needle and use that to secure the central line.

Never understood the straight needle thing. I forgot how to do one hand tie 10 years ago.

 

[Cinclus]

Never understood the straight needle thing. I forgot how to do one hand tie 10 years ago.

Oh, thank gawd. I thought I was the only one, hahahaha. All of my hospitals' kits have always included pickups, fortunately. I don't mess with those straight needle daggers.

 

[RustedFox]

Oh, thank gawd. I thought I was the only one, hahahaha. All of my hospitals' kits have always included pickups, fortunately. I don't mess with those straight needle daggers.

Yeah, if that's what I get when I open the kit, I bend it into a fishhook with the needle drivers before I do anything else.

Dumb. Dumb. Dumb.
Whoever designed central line kits did it all wrong. Straight-needle dagger, 3+ feet of guidewire when you need maybe 18 inches, maximum, lots of **** that I don't even look at, let alone know what its used for...

 

[thegenius]

I agree re needle pickups. I was using a straight hand sewing needle and poked myself. I now also grab a suture kit and curved suture needle and use that to secure the central line.

Those straight needles are STUPID. At least the kits we used have curved needles and needle drivers. I don't think we need forceps but I can understand why they are desired.