Ring, Ring, Ring...Hello?

[Old_Mil]

"Dr. X?"

"Yes?"

"I'm Y, a fast talking used car salesman type with a New York accent and Florida area code calling you about a position that just opened up in rural state in the central time zone. I'm not sure if you're familiar with this, but it's a really tragic situation. A resident who was going to join the practice went on vacation with his fiancee to Spain and died hiking."

"Uh huh...where is it?"

"Our contract with our client prevents me from telling you exactly where it is, but I can tell you other things about the practice. It's about an hour south of Farmville."

"Ok, and is it with a local group or a CMG?"

"It's with a group."

"A local group?"

"A major medical group. I don't know if you're familar with Envision, TeamHealth, Schumacher."

"Yes, I am. No thanks."

The story he was referencing above was this one:

"A Florida doctor fell to his death last week while vacationing with his fiancée in Ibiza, Spain, according to the Staten Island Advance. Dr. Daniel Sirovich "slipped and fell 82 feet" off a cliff during a romantic getaway to the Mediterranean island. The accident reportedly took place last Wednesday when Sirovich and 28-year-old Kristi Kelly stopped to take a photo overlooking the beach. Sirovich, 34, was just 10 days from moving to Boston for a new job at an intensive-care trauma unit,"
LINK

A tragic story to be sure, but one that has absolutely nothing to do with the ER job with chronic turnover he was trying to fill south of Farmville.

A reminder to all our graduating residents: recruiters who cold call and aren't hospital employees lie like rugs. They will tell you absolutely anything and everything to get you to take a job. Ones who are hospital employees and who are trying to get you to join a hospital practice as an employee are usually better, but even then trust but verify. The one who recruited me to my current gig was a hospital employee and was good. The one who recruited me to my first job out of residency (the one I quit after two months) was nice, but understated the practice volume by ~ 20%.

Talk to your attendings. Look on practicelink.com for jobs in the areas you are interested in going to. Remember, the pecking order of EM jobs is local group > hospital employee > CMG > HCA. The only time you should be working with a third party recruiter is if they call you about a W2 or local group job not advertised on practicelink that doesn't involve working with a CMG. You shouldn't choose to work for a CMG if you can avoid it, but if you can't, you should be working directly with them.

Good luck. You'll need it.

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[Groove]

I've still got an old email that the practice manager for an SDG accidentally sent me when I was a resident applying for my first moonlighting gig (Through Weatherby). It had a string of emails between various recruiters haggling over prices for a variety of docs along with me who I guess had applied. I wish I could post it. Well, hell...let me cut and paste a few snippets:

Everybody is fine with the exception of the on e $170 guy. You have one that was coming in lower so I would assume your margins are greater. If you can rob from Peter to pay Paul we will get your $170 guy plugged in at tomorrow’s meeting so you can book them all now.

Thanks

The other one is billed at 150 an hour so same margin. Doc wants 2 more so I bill 20 more. No real science behind it or extra pay day for me. I do everything by the book.

I will tell <name removed> he is a no go at $170

<name removed> is fine.

I do not understand your language. What is 2 more? He’s not great. Tell him $10 more and work with me. I know how it works. You’re good; young, brash, cocky and know how to deliver………...but not better than me. Now I do the training.

I meant 20 more. Who trained you? I know you are good, and you know the business. Cmon, help us out here. Let’s get this thing rolling. Truly, we are not making a lot on this deal. I am trying to help out. Ok, this doctor at $170 and lets put these dates in the books.

I have to send you another contract for <name removed>. Give me 15 minutes.

I have a fiduciary responsibility to our EM billing client. I can't go above 160. Really.

So Dr. Groove wants $110 and you have to pay him that. I will charge you $40 an hour on the brokerage deal. ( contract coming soon.) That’s puts us at $150 right where we want to be. Just please be sure the hospital can credential a resident.

These staffing firm recruiters who call you on the phone and act all professional are snakes in the grass and are routinely back stabbing and robbing you behind the scenes with their finder fees and tacking on $40-$60/hr on your negotiated rates that go straight to them.

Yeah, yeah....I know. $110/hr, but hey... I was desperate and naive back then and truly didn't know what I was worth. I doubt they would have hired me if I had asked for higher and I was just happy to be making some extra money. To think I worked at that rate for my last 2 years of residency!

 

[Apollyon]

@Old_Mil mil I thought you were in Canada, out of medicine, but still making EM level dollars?

 

[GonnaBeADoc2222]

Man I love ******g with these people and asking for 700/hr for their ridiculous "opportunities" in rural bum**** with zero resources, or even Wi-Fi.

 

[Old_Mil]

@Old_Mil mil I thought you were in Canada, out of medicine, but still making EM level dollars?

Medicine is my side hustle now. Working part time there. Working full time @ my other job. Got back into medicine primarily to keep my license current and be in a position to quarterback family through the system if needed. Other job works out to paying 78 an hour more than EM. A 150% linear increase in income since I got involved in it 3 years ago. No, it isn’t Amway...just to pass along what sort of opportunities there are outside of health care. The top grossing guy here makes more than all non ROAD specialities.

 

[Apollyon]

Medicine is my side hustle now. Working part time there. Working full time @ my other job. Got back into medicine primarily to keep my license current and be in a position to quarterback family through the system if needed. Other job works out to paying 78 an hour more than EM. A 150% linear increase in income since I got involved in it 3 years ago. No, it isn’t Amway...just to pass along what sort of opportunities there are outside of health care. The top grossing guy here makes more than all non ROAD specialities.

Still in Canuckistan, though?

 

[VA Hopeful Dr]

I've still got an old email that the practice manager for an SDG accidentally sent me when I was a resident applying for my first moonlighting gig (Through Weatherby). It had a string of emails between various recruiters haggling over prices for a variety of docs along with me who I guess had applied. I wish I could post it. Well, hell...let me cut and paste a few snippets:













These staffing firm recruiters who call you on the phone and act all professional are snakes in the grass and are routinely back stabbing and robbing you behind the scenes with their finder fees and tacking on $40-$60/hr on your negotiated rates that go straight to them.

Yeah, yeah....I know. $110/hr, but hey... I was desperate and naive back then and truly didn't know what I was worth. I doubt they would have hired me if I had asked for higher and I was just happy to be making some extra money. To think I worked at that rate for my last 2 years of residency!

One of my sister's roommates worked as a recruiter for a few months. He quit because, in his words, he just felt disgusted with himself at the end of the day.

 

[Apollyon]

One of my sister's roommates worked as a recruiter for a few months. He quit because, in his words, he just felt disgusted with himself at the end of the day.

I flirted a bit with Weatherby, several (well, now, many) years ago. Part of what turned me off was what seemed to be a constant turnover of "consultants". The galling lack of consistency was, well, galling.

 

[Tenk]

Disgusting

 

[deleted836128]

Oh, God. I hate these calls. At least from a PA standpoint, the offers are insulting because they offer less per hour in a less desirable location as an independent contractor...?! When I can make literally 50.00 more per hour as an employee in my current hospital WITH benefits. “How would you like to live in Antarctica for eight weeks and provide solo coverage as a PA in the ER out there? There’s no physician on site but we have a dermatologist in Florida that you can consult by phone if you have questions. Yes, we pay 50.00 per hour less than you make now but... we will cover your flight here? Oh, we will cover your Antarctica DEA license too!” It’s like, why are you calling me? I always tell them in a nice way while simultaneously hinting that the offer is insulting. Weatherby, All Star, Medestar. I once got one FOR MY OWN ER which is nuts because do the hiring and we weren’t hiring at the time. What is this nonsense...

 

[TooMuchResearch]

Why even do it in a nice way? Just tell them the offer is insulting and not to call back unless the rate is at minimum $xxx (whatever number would make you consider it).

Oh, God. I hate these calls. At least from a PA standpoint, the offers are insulting because they offer less per hour in a less desirable location as an independent contractor...?! When I can make literally 50.00 more per hour as an employee in my current hospital WITH benefits. “How would you like to live in Antarctica for eight weeks and provide solo coverage as a PA in the ER out there? There’s no physician on site but we have a dermatologist in Florida that you can consult by phone if you have questions. Yes, we pay 50.00 per hour less than you make now but... we will cover your flight here? Oh, we will cover your Antarctica DEA license too!” It’s like, why are you calling me? I always tell them in a nice way while simultaneously hinting that the offer is insulting. Weatherby, All Star, Medestar. I once got one FOR MY OWN ER which is nuts because do the hiring and we weren’t hiring at the time. What is this nonsense...

 

[MechEDoc]

Medicine is my side hustle now. Working part time there. Working full time @ my other job. Got back into medicine primarily to keep my license current and be in a position to quarterback family through the system if needed. Other job works out to paying 78 an hour more than EM. A 150% linear increase in income since I got involved in it 3 years ago. No, it isn’t Amway...just to pass along what sort of opportunities there are outside of health care. The top grossing guy here makes more than all non ROAD specialities.

Ok, what are you doing outside of medicine as your main hustle?

 

[citymd1234]

Once got an email from a recruiter for a position, but somehow wires got crossed and a thread planning her bachelorette party ended part of the email. I told her about it and her response was totally incoherent. Not to mention I got 3 more emails about jobs that also detailed plans of her party. Blocked the email address and reported it to the staffing company.

These guys are total clowns.

 

[Shufflin]

Medicine is my side hustle now. Working part time there. Working full time @ my other job. Got back into medicine primarily to keep my license current and be in a position to quarterback family through the system if needed. Other job works out to paying 78 an hour more than EM. A 150% linear increase in income since I got involved in it 3 years ago. No, it isn’t Amway...just to pass along what sort of opportunities there are outside of health care. The top grossing guy here makes more than all non ROAD specialities.

Consulting firm?

 

[DarkHorizon]

I’m Ortho Trauma, these types of offers are pretty common. What’s ironic is that I have found, more than once, hospitals paying more to have some random Locums guy cover call, than paying one of their own guys (a known entity) to take call. They always try to strong arm their own guys into covering extra call for free. When we all refuse, they go to the locums guys.... when you bring it up in the meetings, they usually have some unbelievable answers to justify this.....

e.g.... one of the hospitals in my system lost one of their surgeons and is now using locums to help with call. I found out about it and offered to cover call there and fix all the bad trauma, instead of shipping it to the mothership. Didn’t get much of a response, other than, “we can credential you there and you can take call and generate more wRVUs” but no mentions of call pay. Unbelievable.

 

[The Knife & Gun Club]

I’m Ortho Trauma, these types of offers are pretty common. What’s ironic is that I have found, more than once, hospitals paying more to have some random Locums guy cover call, than paying one of their own guys (a known entity) to take call. They always try to strong arm their own guys into covering extra call for free. When we all refuse, they go to the locums guys.... when you bring it up in the meetings, they usually have some unbelievable answers to justify this.....

e.g.... one of the hospitals in my system lost one of their surgeons and is now using locums to help with call. I found out about it and offered to cover call there and fix all the bad trauma, instead of shipping it to the mothership. Didn’t get much of a response, other than, “we can credential you there and you can take call and generate more wRVUs” but no mentions of call pay. Unbelievable.

Curious what you ortho guys typically get offered for locums rates?

I have an ortho peds buddy who recently got offered $1000/hour. As a broke med student rates like that made me wanna cry.

 

[Listen2Savage]

Curious what you ortho guys typically get offered for locums rates?

I have an ortho peds buddy who recently got offered $1000/hour. As a broke med student rates like that made me wanna cry.

400 × 275

 

[DarkHorizon]

I’m Ortho Trauma, these types of offers are pretty common. What’s ironic is that I have found, more than once, hospitals paying more to have some random Locums guy cover call, than paying one of their own guys (a known entity) to take call. They always try to strong arm their own guys into covering extra call for free. When we all refuse, they go to the locums guys.... when you bring it up in the meetings, they usually have some unbelievable answers to justify this.....

Curious what you ortho guys typically get offered for locums rates?

I have an ortho peds buddy who recently got offered $1000/hour. As a broke med student rates like that made me wanna cry.

$1000/ hour to do what?

Most places would pay for call for ortho trauma, cases are on top, usually goes like $1500/24 hours per call and if you have to come in to do a case, another $250/ hour or so. Some places will pay higher but there will be no hourly rate.

The highest offer I got was at a busy level 1 trauma center with $4000/24 hours to take call with no additional incentive, with no residents or midlevel help. I said no because that’s borderline suicidal.

 

[rokshana]

I’m Ortho Trauma, these types of offers are pretty common. What’s ironic is that I have found, more than once, hospitals paying more to have some random Locums guy cover call, than paying one of their own guys (a known entity) to take call. They always try to strong arm their own guys into covering extra call for free. When we all refuse, they go to the locums guys.... when you bring it up in the meetings, they usually have some unbelievable answers to justify this.....

e.g.... one of the hospitals in my system lost one of their surgeons and is now using locums to help with call. I found out about it and offered to cover call there and fix all the bad trauma, instead of shipping it to the mothership. Didn’t get much of a response, other than, “we can credential you there and you can take call and generate more wRVUs” but no mentions of call pay. Unbelievable.

You should tell the locums company that you are available!

 

[Groove]

All this reminds me of one of my old gigs where the CMG lost the contract and the hospital wanted to hire us all as hospital employees but the contract was crap and they had this bizarre malpractice clause without tail. We spend months trying to negotiate with the hospital but they kept ignoring us. Fast forward, about 95% of us quit when it becomes apparent that we were making no headway. What do they end up doing? Going with Weatherby for $400+/hr locums to staff the ED for the following 2 years while they tried to recruit docs. If they had simply taken some time to negotiate and concede a few minor things, I'd probably still be there. C-suite can make some idiotic decisions.

The funny part is that me and a buddy tried to get Weatherby to hire us to work there shortly thereafter but when the hospital found out it was us, they declined as they were still pissed off that we hadn't signed their contract. I heard that was Weatherby's largest contract during those two years. There's no telling how much money they made off a string of very poor hospital administrative decisions.

 

[The Knife & Gun Club]

$1000/ hour to do what?

Most places would pay for call for ortho trauma, cases are on top, usually goes like $1500/24 hours per call and if you have to come in to do a case, another $250/ hour or so. Some places will pay higher but there will be no hourly rate.

The highest offer I got was at a busy level 1 trauma center with $4000/24 hours to take call with no additional incentive, with no residents or midlevel help. I said no because that’s borderline suicidal.

It was coverage for a hospital that had just had some kind of shenanigans with their ortho group, who’d walked out. Wish I knew the specifics about what kind of operative and call responsibilities it entailed. But as he said the hospital was well known for the wrong reasons and “I wouldn’t touch that mess for 500,000 a week”

And yes you’re right it wasn’t hourly coverage because that’s not really a thing for y’all - it was $50,000 per week for what worked out to be about 40ish hrs.

 

[Apollyon]

The highest offer I got was at a busy level 1 trauma center with $4000/24 hours to take call with no additional incentive, with no residents or midlevel help. I said no because that’s borderline suicidal.

That's *****ic - $167/hr, flat? That's not a "no", that's a "Hell NO"!

 

[Groove]

That's *****ic - $167/hr, flat? That's not a "no", that's a "Hell NO"!

Well, keep in mind that's flat hourly just to be on call. He gets paid that just to twiddle his thumbs watching "Naked and Afraid" on Discovery. However, at a busy level 1, he/she most assuredly would get called in for a surgical case or three, in which case he gets paid an extra $250/hr to be in the hospital. That's $417/hr for the hours that he's in the hospital. Not too shabby.

That would be akin to us being paid to be "on call" during high volume months. We could be at home getting paid $167/hr but if we got called in for 2-6 hours to decompress the ED, we get another $250/hr on top of that.

 

[Apollyon]

Well, keep in mind that's flat hourly just to be on call. He gets paid that just to twiddle his thumbs watching "Naked and Afraid" on Discovery. However, at a busy level 1, he/she most assuredly would get called in for a surgical case or three, in which case he gets paid an extra $250/hr to be in the hospital. That's $417/hr for the hours that he's in the hospital. Not too shabby.

That would be akin to us being paid to be "on call" during high volume months. We could be at home getting paid $167/hr but if we got called in for 2-6 hours to decompress the ED, we get another $250/hr on top of that.

That looks like the $1500 job. The way I read it was $4k flat, getting your ass kicked, no extra for OR. Hard pass.

 

[Groove]

That looks like the $1500 job. The way I read it was $4k flat, getting your ass kicked, no extra for OR. Hard pass.

Oh yeah, you're right...I didn't notice he said "no additional incentive" for the 4K job which I guess would negate the hourly rate. That does sound pretty bad.

 

[DarkHorizon]

Yup 4K straight, no hourly incentive, no residents to do your consults or mid levels for scut. That can get real heavy at a busy place in a hurry.

 

[GonnaBeADoc2222]

Yup 4K straight, no hourly incentive, no residents to do your consults or mid levels for scut. That can get real heavy at a busy place in a hurry.

That's a terrible rate. Good on you not accepting that nonsense.

 

[Apollyon]

Yup 4K straight, no hourly incentive, no residents to do your consults or mid levels for scut. That can get real heavy at a busy place in a hurry.

Did this happen to be in San Diego? At ACEP, when it was in Vegas, there were some guys there that worked at a level 1 without any residents. I didn't even know that that was a thing.

 

[DarkHorizon]

Did this happen to be in San Diego? At ACEP, when it was in Vegas, there were some guys there that worked at a level 1 without any residents. I didn't even know that that was a thing.

Mid sized town Midwest, with an ER residency and a Gen Surg residency but no ortho residency. I’m sure most can infer.

 

[VA Hopeful Dr]

Did this happen to be in San Diego? At ACEP, when it was in Vegas, there were some guys there that worked at a level 1 without any residents. I didn't even know that that was a thing.

Spartanburg is like that, you lived nearby awhile back. Or did you mean no residents of any kind, not just EM residents?

 

[GeneralVeers]

Just saw a locums offer for $275/hr in San Jose. Pretty good for CA. I wonder what's wrong with the hospital?

 

[thegenius]

Just saw a locums offer for $275/hr in San Jose. Pretty good for CA. I wonder what's wrong with the hospital?

I just got a text from VISTA about a locums in San Jose as well. The text didn't quote me the rate, but it's probably the same place that you saw. $275/hr is probably average in the region, in Northern California. I have a feeling though it probably isn't a good site. Probably wouldn't be worth it. It's too far of a drive for me anyway. I would call them if it were $350 or $400/hr though.

 

[SeasideDoc]

TeamHealth acquired two ED (and hospitalist) contracts (Good Samaritan Hospital and Regional Medical Center) in San Jose as of October.

 

[thegenius]

TeamHealth acquired two ED (and hospitalist) contracts (Good Samaritan Hospital and Regional Medical Center) in San Jose as of October.

Boooo