What hospitals pay locums compared

[chocomorsel]

Whoa, hold on.

If a surgeon says he or she is not equipped to handle an appendectomy in their PP outpt clinic, would you be disappointed in the surgical profession? Not equipped isn't the same as can't handle. They need a hospital's OR with a surgical team composed of anesthesiologist, scrub nurse, techs, clean up crew & extensive hospital post-op care from IM, ICU etc if anything goes wrong. Actually, the hospital and entire team needs the surgeon, for the $$$$$.

Psychiatrists can handle psychotic disorders, however insurance won't pay for our version of an OR and surgical team.

The next line after the part above you quoted me was “why aren’t you able to handle the severely ill outside of the social work aspect?”
I got the answer. It seems to be the SW and the lack of payment stemming from that.

Fair. Understood.

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[chocomorsel]

Except he’s right - even accounting for those factors that not all practices are set up to treat pts with significant psychopathology, many psychiatrists don’t want to treat the mentally ill. This has been the case since at least the middle part of the 20th century.

So if these psychiatrists don’t want to treat the mentally ill, who do they want to treat?

And I understand about the social aspects etc. You guys should get paid for that.

A better comparison would be Hearts. Most anesthesiologists and surgeons don’t do hearts. But that’s a surgery that requires complex monitoring, procedures and extra training.
In a well supported severe schizophrenic or bipolar, what extra training or procedures are involved in psych? Besides time?

 

[dl2dp2]

Except he’s right - even accounting for those factors that not all practices are set up to treat pts with significant psychopathology, many psychiatrists don’t want to treat the mentally ill. This has been the case since at least the middle part of the 20th century.

Many anesthesiologists don't want to be in the OR and prefer interventional pain, even though they could just take Medicaid patients all day and do the most high-risk surgeries constantly, and even if they choose to do that they'd still get more $ per hour than your average psych locuming at a hospital treating SMIs.

Many surgeons only do outpatient breast surgeries, even though they could do complicated colectomies on Medicaid patients all day.

Many medical students decide to become dermatologists and not treat the medically ill, even though they could all become primary care physicians serving those who can't afford their services.

If you want to treat people who are SMI, do locum at a hospital. Isn't that the point of this thread?

If you want to change any of this, you need to change the way incentives are structured. This is not a provider problem. Complete BS argument to blame it on providers.

 

[MisterKitty]

Reading this thread really makes me want to switch out of psych residency for something more lucrative. Feel like I’m on the way to the poor house

 

[chocomorsel]

Reading this thread really makes me want to switch out of psych residency for something more lucrative. Feel like I’m on the way to the poor house

How come? You can apparently do cash only and charge $300-500 an hour and have no problem filling up even with insured patients.

Or do locums and make at least $200 an hour. Or do PP and take only the good payors and not bother with highly sick patients. You will not be poor. If you join a large group you have more negotiating power.

Do you guys ever joking large multi specialty groups by chance?

 

[chocomorsel]

On a different topic, why are so many of you referring to yourselves as “providers?”

 

[Sushirolls]

How come? You can apparently do cash only and charge $300-500 an hour and have no problem filling up even with insured patients.

Or do locums and make at least $200 an hour. Or do PP and take only the good payors and not bother with highly sick patients. You will not be poor. If you join a large group you have more negotiating power.

Do you guys ever joking large multi specialty groups by chance?

Large multispeciality groups neglect Psychiatry typically, similar to health systems / hospitals.
Some see the value of Psychiatry and hire them, but even in my local area the few they did hire, are all full and closed to new patients, and now the group is referring out the psych needs.
Large multispeciality groups have a large chunk of CMS (medicare/medicaid) and the nuances of psychiatry billing, the practices potentially can fill quickly with this population and they lose money on the psych department - not always.

 

[nexus73]

I feel half trolled by this anesthesiologist.

 

[Candidate2017]

Except he’s right - even accounting for those factors that not all practices are set up to treat pts with significant psychopathology, many psychiatrists don’t want to treat the mentally ill. This has been the case since at least the middle part of the 20th century.

False.

Many psychiatrists enjoy variety and work across different severity, settings and clinics. Dealing with the same type of patient gets draining. Whether day after day of anxious housewives, or schizophrenics who think it's ok to go off their meds "because I'm better", or suidical 20 y.o. borderline girls, or saying no to substance seekers. I mean, I just saw a patient in the hospital who happened to be covered in feces and scabies. It broke up the day. But no way would anyone accept them in an PP outpt clinic. Medicaid's $45 reimbursement isn't going to cover clean up costs, exterminators, or lost revenue from patients in the waiting room who are scared away. Let alone pay for a couple of security guards. And have you seen an ADHD 9 y.o. completely destroy a nice office? Even violent psychotics cause less damage.

Others enjoy working only with a higher functioning population. That's ok. This is no different from orthopods who derive plenty of money and satisfaction helping elite athletes regain elite level function vs orthopods who prefer to hammer knees into Medicare grannies for marginal improvements in function.

 

[Shufflin]

Reading this thread really makes me want to switch out of psych residency for something more lucrative. Feel like I’m on the way to the poor house

If you look carefully and get a little lucky, you can have what's considered a high income-to-work hours ratio for a medical field.

 

[adiradirim]

A better comparison would be Hearts. Most anesthesiologists and surgeons don’t do hearts. But that’s a surgery that requires complex monitoring, procedures and extra training.
In a well supported severe schizophrenic or bipolar, what extra training or procedures are involved in psych? Besides time?

For the psychiatrist, there is no extra training involved. A residency trained psychiatrist should be knowledgeable enough to provide medication recommendations for these patients. The only procedures involved would be long acting injectable medication administration - which can be done by the psychiatrist. However, you would need to keep the medication in office which is another issue itself.

You need to remember that a lot of people with schizophrenia live very different lives from us. They are homeless or in housing. They have no car. Sometimes no cell phones or internet access and would have to go to a library to access internet. They have no job and are usually get monthly checks. This is not to mention if drug use, physical abuse, prostitution, or anything else is also in play.

The other resources everyone is mentioning is mostly Case Management which involves a worker that will drive to the patient's house, check on them, help out with any life things - like getting an ID, setting up a bank account, figuring out bus routes. turning their electricity/water back on, whatever issues come up. They also will pick the patient up and bring them to the appointment and drive them back home. Having nursing available is nice too with injections, drug screens, etc, but most private psychiatry offices do not have enough volume to need nursing. You'd have to pay this person a decent salary which cuts into your income.

Also, to care for these patients adequately, you would likely need an office in the inner city where all these patients live. They would need to be able to access your office by walking or bus routes since most do not drive. This is where most community mental health agencies are. Depending on the area, this could be especially costly or have safety issues with crime in the area. I've had my co-residents who have had their cars broken into while working in these offices during the day.

Now, there are plenty of patients with schizophrenia who are functional enough that they don't need all that. They have secure housing, plenty of money, and family members (spouses or kids) that help them take meds, get to their appointments, stay sober, stay safe, and go to therapy. These patients would be fine to come see you in a solo private office.

 

[MisterKitty]

If you look carefully and get a little lucky, you can have what's considered a high income-to-work hours ratio for a medical field.

Sounds a lot like buying scratch off lotto tickets at a gas station

 

[chocomorsel]

For the psychiatrist, there is no extra training involved. A residency trained psychiatrist should be knowledgeable enough to provide medication recommendations for these patients. The only procedures involved would be long acting injectable medication administration - which can be done by the psychiatrist. However, you would need to keep the medication in office which is another issue itself.

You need to remember that a lot of people with schizophrenia live very different lives from us. They are homeless or in housing. They have no car. Sometimes no cell phones or internet access and would have to go to a library to access internet. They have no job and are usually get monthly checks. This is not to mention if drug use, physical abuse, prostitution, or anything else is also in play.

The other resources everyone is mentioning is mostly Case Management which involves a worker that will drive to the patient's house, check on them, help out with any life things - like getting an ID, setting up a bank account, figuring out bus routes. turning their electricity/water back on, whatever issues come up. They also will pick the patient up and bring them to the appointment and drive them back home. Having nursing available is nice too with injections, drug screens, etc, but most private psychiatry offices do not have enough volume to need nursing. You'd have to pay this person a decent salary which cuts into your income.

Also, to care for these patients adequately, you would likely need an office in the inner city where all these patients live. They would need to be able to access your office by walking or bus routes since most do not drive. This is where most community mental health agencies are. Depending on the area, this could be especially costly or have safety issues with crime in the area. I've had my co-residents who have had their cars broken into while working in these offices during the day.

Now, there are plenty of patients with schizophrenia who are functional enough that they don't need all that. They have secure housing, plenty of money, and family members (spouses or kids) that help them take meds, get to their appointments, stay sober, stay safe, and go to therapy. These patients would be fine to come see you in a solo private office.

Thanks for the detailed response.
I don’t think you need to have an office in the inner city though. They are every where as you say.

 

[calvnandhobbs68]

Thanks for the detailed response.
I don’t think you need to have an office in the inner city though. They are every where as you say.

What you think isn’t necessarily what’s correct. I’m assuming you’ve never worked in a community mental health agency. Most of us have.

 

[JSizzles]

If you are concerned about cost or accessibility-I’ve heard that cash medical care in Tijuana is cheaper. I would assume this is also the case for psychiatric care. You might be able to utilize telepsych. I would google “muy bueno psychiatry Tijuana”

 

[chocomorsel]

What you think isn’t necessarily what’s correct. I’m assuming you’ve never worked in a community mental health agency. Most of us have.

It's not just about what I think. It's the reality and what your colleague also stated below. Mental illness does not affect just poor people in the inner city alone. It affects everyone even the middle and rich people in suburbia.

Also, to care for these patients adequately, you would likely need an office in the inner city where all these patients live. They would need to be able to access your office by walking or bus routes since most do not drive. This is where most community mental health agencies are. Depending on the area, this could be especially costly or have safety issues with crime in the area. I've had my co-residents who have had their cars broken into while working in these offices during the day.

Now, there are plenty of patients with schizophrenia who are functional enough that they don't need all that. They have secure housing, plenty of money, and family members (spouses or kids) that help them take meds, get to their appointments, stay sober, stay safe, and go to therapy. These patients would be fine to come see you in a solo private office.

 

[michaelrack]

Mental illness does affect everyone but it is (in general ) more likely to occur in the poor. It can also make a person poor, through job loss etc.

 

[chocomorsel]

Mental illness does affect everyone but it is (in general ) more likely to occur in the poor. It can also make a person poor, through job loss etc.

Statistically? Mental illness like Bipolar, Schizophrenia, depression, Shizoaffective etc. Mood and Psychotic disorders.
I am not talking about substance abuse.
It is more likely to affect the poor? If so, why?

 

[jbomba]

Statistically? Mental illness like Bipolar, Schizophrenia, depression, Shizoaffective etc. Mood and Psychotic disorders.
I am not talking about substance abuse.
It is more likely to affect the poor? If so, why?

Adverse childhood experiences are seen much more commonly in lower SES. ACE are a fairly significant risk factor for later developing schizophrenia, depression. I'm not certain about bipolar.

 

[Username2015]

Sounds a lot like buying scratch off lotto tickets at a gas station

There are plenty of routes in psychiatry to have a great earning to time or effort ratio. You don’t have to be lucky. You just have to do what anybody does and interview with different employers.

 

[Candidate2017]

To get back on topic, what is a reasonable amount to be paid for weekend inpt coverage? 15 beds, covering call Fri PM to Mon AM, round on Sat and Sun.

 

[dl2dp2]

To get back on topic, what is a reasonable amount to be paid for weekend inpt coverage? 15 beds, covering call Fri PM to Mon AM, round on Sat and Sun.

If you are fully in house to also cover various other services, I would say 60 hours at $200 per hour at a minimum would be about $12000. Something like that would be reasonable, pure 1099. There are ones out there that pay more, especially if you are also expected to cover ER consults.

 

[DocMom1]

In neurology, I have seen locums gigs for >$500/hour.

 

[jbomba]

If you are fully in house to also cover various other services, I would say 60 hours at $200 per hour at a minimum would be about $12000. Something like that would be reasonable, pure 1099. There are ones out there that pay more, especially if you are also expected to cover ER consults.

There are weekend only gigs result available that pay 12k a weekend? One could do these once or twice a month?

 

[michaelrack]

To get back on topic, what is a reasonable amount to be paid for weekend inpt coverage? 15 beds, covering call Fri PM to Mon AM, round on Sat and Sun.

$3000 to $5000, depending on if the doc has to pay his own malpractice, do physical exams, degree of medical support, responsibilities outside of the unit (ER coverage), etc.

 

[dl2dp2]

There are weekend only gigs result available that pay 12k a weekend? One could do these once or twice a month?

Maybe, maybe not. Typically locum hospitals hire a bunch of people so you might not get one or two weekends a month at a particular facility.

If you are willing to travel, sure. Plenty of people work two weekends a year and add another 150-200k on top of their salary.

 

[reca]

Maybe, maybe not. Typically locum hospitals hire a bunch of people so you might not get one or two weekends a month at a particular facility.

If you are willing to travel, sure. Plenty of people work two weekends a year and add another 150-200k on top of their salary.

I assume this is two weekends a month. If not.....sign me up for the 75k/weekend shifts.

 

[jbomba]

Maybe, maybe not. Typically locum hospitals hire a bunch of people so you might not get one or two weekends a month at a particular facility.

If you are willing to travel, sure. Plenty of people work two weekends a year and add another 150-200k on top of their salary.

Yeah that's kind of what I was getting at but didn't say. Traveling once a month for a weekend doesn't seem bad at all, even with a family.

 

[dl2dp2]

I assume this is two weekends a month. If not.....sign me up for the 75k/weekend shifts.

Yeah that's kind of what I was getting at but didn't say. Traveling once a month for a weekend doesn't seem bad at all, even with a family.

IMO, having done this, there are better ways to make money than weekend overnight shifts at an inpatient psych ward. But yes this is a viable option.

 

[Psychresy]

IMO, having done this, there are better ways to make money than weekend overnight shifts at an inpatient psych ward. But yes this is a viable option.

What are these other ways? 12k a weekend sounds tough to beat.

 

[psychacad]

If you are fully in house to also cover various other services, I would say 60 hours at $200 per hour at a minimum would be about $12000. Something like that would be reasonable, pure 1099. There are ones out there that pay more, especially if you are also expected to cover ER consults.

How do you go about to find these positions?

I'm in the northeast (nyc, willing to travel) and haven't found a place yet with full weekend coverage (something like q3/4 weeks).

 

[Ahamis]

In neurology, I have seen locums gigs for >$500/hour.

That would be higher than the neurosurgeon hour... it doesn’t make sense.

 

[dl2dp2]

I'm in the northeast (nyc, willing to travel) and haven't found a place yet with full weekend coverage (something like q3/4 weeks).

There's not ONE place that would do this. I would start by calling a recruiter, who usually have a Rolodex. Typically it's a hodgepodge. Some places have 12-hour shifts. Some places have 24-hour shifts. Some places offer entire weekends, but only once every 2 months. You puzzle it together. You can't expect that things are just handed to you... There are A LOT of state hospitals around also that need locum coverage. This is really not hard. If you can't "find a place" I don't know what's wrong--do you have a red flag on your resume? I literally get Emails/calls daily about locums.

 

[psychacad]

There's not ONE place that would do this. I would start by calling a recruiter, who usually have a Rolodex. Typically it's a hodgepodge. Some places have 12-hour shifts. Some places have 24-hour shifts. Some places offer entire weekends, but only once every 2 months. You puzzle it together. You can't expect that things are just handed to you... There are A LOT of state hospitals around also that need locum coverage. This is really not hard. If you can't "find a place" I don't know what's wrong--do you have a red flag on your resume? I literally get Emails/calls daily about locums.

I get spammed by tons of locum offers, but then get radio silence when I mention weekend coverage. It seems that most contracting hospitals don't go for locums companies for something like qmonth weekend coverage. NYC hospitals don't pay those rates (max I found was $180) and the ones I spoke with also kind of shy off from weekend coverage. Do I just need to contact random places that are further away?

 

[mojetter]

I get spammed by tons of locum offers, but then get radio silence when I mention weekend coverage. It seems that most contracting hospitals don't go for locums companies for something like qmonth weekend coverage. NYC hospitals don't pay those rates (max I found was $180) and the ones I spoke with also kind of shy off from weekend coverage. Do I just need to contact random places that are further away?

The weekend inpatient coverage is hard to find and low pay because so many people want to do it, its free of admin/meetings, discharges (most places) and continuity of care for difficult patients...they can say "talk to your doctor on Monday"

Thats been my experience....im on this weekend and its a cakewalk compared to M-F

 

[jbomba]

The weekend inpatient coverage is hard to find and low pay because so many people want to do it, its free of admin/meetings, discharges (most places) and continuity of care for difficult patients...they can say "talk to your doctor on Monday"

Thats been my experience....im on this weekend and its a cakewalk compared to M-F

It's odd there are so many completely different experiences on this forum.

 

[mojetter]

It's odd there are so many completely different experiences on this forum.

Yeah I think its regional too... Ive been doing locums for 4 years in Maryland, GA, and Florida

Places that have lots of employed contracts tend to rope the employed physicians into mandatory weekends with no extra pay (ie HCA and UHS) but even they fall short on staffing and need people, places with severe shortages have no choice lately they get lots of locums to stay running

 

[Candidate2017]

$3000 to $5000, depending on if the doc has to pay his own malpractice, do physical exams, degree of medical support, responsibilities outside of the unit (ER coverage), etc.

Standalone psych hospital, probably limited or no medical support, no physical exams, no ED or other responsibilities, call is pager-only Fri PM to Mon AM (includes accepting new admissions), Sat and Sun rounding on 15 pts. Malpractice is provided, I believe. They are offering toward the lower end of that range. I don't have any proof but I think they can do closer to $5k.

 

[jbomba]

Yeah I think its regional too... Ive been doing locums for 4 years in Maryland, GA, and Florida

Places that have lots of employed contracts tend to rope the employed physicians into mandatory weekends with no extra pay (ie HCA and UHS) but even they fall short on staffing and need people, places with severe shortages have no choice lately they get lots of locums to stay running

Gotcha. I guess things would change though if the provider was willing to fly anywhere to work. I imagine recruiters would have a lot more they could offer you.

 

[michaelrack]

Standalone psych hospital, probably limited or no medical support, no physical exams, no ED or other responsibilities, call is pager-only Fri PM to Mon AM (includes accepting new admissions), Sat and Sun rounding on 15 pts. Malpractice is provided, I believe. They are offering toward the lower end of that range. I don't have any proof but I think they can do closer to $5k.

ask for 4,000

 

[psychacad]

It's odd there are so many completely different experiences on this forum.

Lesson: take everything you read here with a few grains of salt.

 

[dl2dp2]

Standalone psych hospital, probably limited or no medical support, no physical exams, no ED or other responsibilities, call is pager-only Fri PM to Mon AM (includes accepting new admissions), Sat and Sun rounding on 15 pts. Malpractice is provided, I believe. They are offering toward the lower end of that range. I don't have any proof but I think they can do closer to $5k.

Really... they can get MDs for 3-5k per weekend? Yuck.

 

[Psychresy]

Really... they can get MDs for 3-5k per weekend? Yuck.

Are you seeing these bigger rates you mentioned earlier in this thread through locums recruiters or are these more word of mouth harder to find opportunities?

 

[dl2dp2]

Are you seeing these bigger rates you mentioned earlier in this thread through locums recruiters or are these more word of mouth harder to find opportunities?

I think it's hard to get entire weekends but 200 should be standard for 24 hours. I would start with recruiters, then call hospitals/personal connections. I've had experiences with both. Typically the order of things is you start working somewhere full time then you pick up shifts at the hospitals affiliated to it.

 

[chocomorsel]

When I cold called psych hospitals directly, one of them told me they paid Staff Care $240 an hour (can't remember exactly what they paid the doc, might have been $180 an hour).

Somehow when I tried finding work on my own without the help of an agency, the hourly rates I was quoted were usually abysmal (HCA offered me $126 an hour for weekend inpatient work). I am not sure why it is such an inefficient system that relies so much on middlemen.

There are sites (nomad health, lucidity direct) that are supposed to cut out the agencies, but they have very few listings.

Don't worry. Nomad has turned completely into a Nursing recruiting website.
Guess that's where the money is. Surprise surprise.
And they are now making $150 an hour or so.

 

[dl2dp2]

Are you seeing these bigger rates you mentioned earlier in this thread through locums recruiters or are these more word of mouth harder to find opportunities?

If you are still interested, I recently got a locum offer of $240 an hour at a state hospital near NYC for board certified. Up to 36 hours a week. PM me if you want the recruiter. Major academic medical centers in NYC are paying $200.