What's Going on in Elk County, PA? Crazy High Locum Rates

[Mman]

The OP's assertion is that it's impossible to get that amount of pay. That 5k is absurd. I'm showing that it's not. If you're desperate enough to require locums, you can afford to pay more than what is being billed for anesthesia charges.

while it is possible, that does not mean all locums jobs pay that much and there is a lot of regional variation in terms of what pay you can expect.

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[nimbus]

locums pays the lowest possible cost required to find coverage whether or not the collections cover it.

Of course. But you are saying hospitals can pay less than what the anesthesia practice actually collects. That is no longer true.

 

[GravelRider]

I think they exist but they aren't made public because 1) why would I advertise my awesome locums gig so others can snatch it my potential income 2) the people offering it would get flooded with people kicking the tires on their gig or get a handful of poor anesthesiologist trying to cash in.

A lucrative locums position doesn't need to advertise to the world and if they do need to advertise to the world, it's because it's located somewhere even despite the money it's difficult to recruit. Elk County is 2.5hrs from Pittsburg....and I'm not even getting super excited about Pittsburgh

It makes no sense for a hospital paying way above average locums rates to not post the job everywhere they can. Wouldn’t they want people knocking down the door for the job so they can drive down the rates? If I was a hospital, I would be advertising all over the place for those high paying jobs.

Those high rate jobs are either in terrible locations or are just exhausting work.

 

[Twiggidy]

It makes no sense for a hospital paying way above average locums rates to not post the job everywhere they can. Wouldn’t they want people knocking down the door for the job so they can drive down the rates? If I was a hospital, I would be advertising all over the place for those high paying jobs.

Those high rate jobs are either in terrible locations or are just exhausting work.

My counter argument is that many high rate locums aren't through a hospital but through a practice that contracts with a hospital. These places probably have a shortlist of mercenaries (or they pay the rate to their own folks who are on vacation, ie internal locums) that they use to fill gaps in coverage. For example, my personal gig doesn't need to advertise when we need help and the same goes for a handful of places around me. We have our mercenaries or workhorses that are our go-to. The hospitals/practices putting up the bat signal for high locums rates are the places that have difficulty getting anesthesiologists period, or as you say, maybe they want to get a big crop of people on the list only to undercut them later and probably create a cycle.

 

[chocomorsel]

I agree. I still do not believe that those 6-10K for 24hr calls exist. I maintain that people are making stuff up. For 6-10K 24hr in-house calls, I would get a license in a new state and be Q2 with post call off for a week straight every month, no questions asked.

Realistically, I think people are inflation the numbers for internet points and/or there are other financial considerations in play that get them to the claimed numbers.

I have been a locums for five years and before that was out west. Let me tell you 8-10k calls exist. The OB group was pulling this **** each 24z

@sevoflurane please educate this young padawan on what you used to make in Indiana and what your group pays now?
She clearly is incredulous because “pearls clutched”. She’s never seen it. Lol

 

[chocomorsel]

I think they exist but they aren't made public because 1) why would I advertise my awesome locums gig so others can snatch it my potential income 2) the people offering it would get flooded with people kicking the tires on their gig or get a handful of poor anesthesiologist trying to cash in.

A lucrative locums position doesn't need to advertise to the world and if they do need to advertise to the world, it's because it's located somewhere even despite the money it's difficult to recruit. Elk County is 2.5hrs from Pittsburg....and I'm not even getting super excited about Pittsburgh

You don’t need the city when you are tied to the chain that much. You just possibly need the airport.

 

[chocomorsel]

There is a hospital currently recruiting locums, $450/hr for generalists and $500/hr for cardiac. The unit value there is in the mid 30s. The anesthesia collections from that practice doesn’t even come close to covering those locums rates. The hospital is paying almost twice what that practice actually generates.

Damn. Wish I had a California license. I would pay them taxes.

 

[chocomorsel]

Why don’t you go over to the private forum @Zekchar and see eve rates posted there.

 

[ERRES2288]

As a reference point. Midwest academics. 5.5k 24 in house weekend. Busy level 1 with OB. People take it but seems low to me

 

[GassYous]

while it is possible, that does not mean all locums jobs pay that much and there is a lot of regional variation in terms of what pay you can expect.

I'm not saying that all locums pay that much or that you can always get that unit value or case load. The op said that he does not believe that you can get 6-10k for 24 hours. That 5k for 24 hours is very high. Both assertions are untrue. I just gave a basic analysis with md only or only cases to show that it is not only within the realm of possibility but definitely attainable just from anesthesia billing.

 

[Twiggidy]

I'm not saying that all locums pay that much or that you can always get that unit value or case load. The op said that he does not believe that you can get 6-10k for 24 hours. That 5k for 24 hours is very high. Both assertions are untrue. I just gave a basic analysis with md only or only cases to show that it is not only within the realm of possibility but definitely attainable just from anesthesia billing.

Yep. Two hearts, a busy OB shifts (3-4 long blocks running plus a couple sections), and a good unit value can easily have you at 10k. Rough 24 hrs possible to bill that much.

 

[Mman]

Of course. But you are saying hospitals can pay less than what the anesthesia practice actually collects. That is no longer true.

not true? It happens all the time. Isn't that what people talk about with AMCs unendingly here? Everyone at all those jobs is getting paid less than the business collects on their behalf. Locums shifts get filled for whatever the lowest price someone is willing to work for.

 

[chocomorsel]

not true? It happens all the time. Isn't that what people talk about with AMCs unendingly here? Everyone at all those jobs is getting paid less than the business collects on their behalf. Locums shifts get filled for whatever the lowest price someone is willing to work for.

And some of those lowest prices are quite high these days.
It’s all we are saying.

I was making $244 an hour five years ago at my highest counting OT pay. And three years ago it was the basic $200 but with lots of OT at $300 an hour.

Now it’s $325-350 per hour plus at least $375 in OT.

Things have changed especially for those willing to travel.

 

[nimbus]

not true? It happens all the time. Isn't that what people talk about with AMCs unendingly here? Everyone at all those jobs is getting paid less than the business collects on their behalf. Locums shifts get filled for whatever the lowest price someone is willing to work for.

It depends on the payor mix. If an AMC can get very high commercial rates and has a good payor mix, they may be able to recruit without a hospital stipend and even skim some money off the top. In this market, if your median unit is under $50, you need hospital stipends in order to offer competitive compensation and recruit.

 

[Mman]

In this market, if your median unit is under $50, you need hospital stipends in order to offer competitive compensation and recruit.

$50/unit does fantastic in an ACT model

 

[Southpaw]

It depends on the payor mix. If an AMC can get very high commercial rates and has a good payor mix, they may be able to recruit without a hospital stipend and even skim some money off the top. In this market, if your median unit is under $50, you need hospital stipends in order to offer competitive compensation and recruit.

$50? This seems quite a dramatic change. Just a few years ago I feel like everything I heard out of CA was $30-40 a unit.

I really can’t fathom any private practice hospital based anesthesiologist getting > $50/unit. Regardless of location. It doesn’t matter how good your commercial rate is, there’s not enough commercial volume. Medicare/Medicaid/self pay is at least 40% of volume in ANY hospital, and generally speaking it’s upwards of 50% or more.

If the cost of living in your area has made you dependent on a $50/unit, then my opinion is that sadly your MD only private practice days are numbered. Because hospitals aren’t beholden to the MD only model. They won’t stipend you forever to support it. They don’t care - they just want the ORs running.

ACT at $50/unit is doing extremely well. Just being honest. And I say that with great remorse as I strongly believe MD only should be the gold standard for any anesthesia practice.

 

[nimbus]

$50? This seems quite a dramatic change. Just a few years ago I feel like everything I heard out of CA was $30-40 a unit.

I really can’t fathom any private practice hospital based anesthesiologist getting > $50/unit. Regardless of location. It doesn’t matter how good your commercial rate is, there’s not enough commercial volume. Medicare/Medicaid/self pay is at least 40% of volume in ANY hospital, and generally speaking it’s upwards of 50% or more.

If the cost of living in your area has made you dependent on a $50/unit, then my opinion is that sadly your MD only private practice days are numbered. Because hospitals aren’t beholden to the MD only model. They won’t stipend you forever to support it. They don’t care - they just want the ORs running.

ACT at $50/unit is doing extremely well. Just being honest. And I say that with great remorse as I strongly believe MD only should be the gold standard for any anesthesia practice.

If a modest house costs $1-2mil, new grads and even CRNAs cannot be recruited without decent pay. That’s the current reality. Old doctors who moved to the area years and decades ago have been subsidizing hospitals by accepting low pay for years. They could do that because they have a much lower COL than new arrivals. But those doctors are getting old and retiring. New arrivals can’t afford to do that even if they wanted to. Things have changed. It’s time to pay the piper.

My buddy’s long suffering group had a unit value in the low 30s for years. They recently became hospital employees with a guaranteed unit value close to $50 and multiple stipends. Sure anesthesia will be a money loser for the hospital but the alternative was to shut down rooms.

 

[Zekchar]

If a modest house costs $1-2mil, new grads and even CRNAs cannot be recruited without decent pay. That’s the current reality. Old doctors who moved to the area years and decades ago have been subsidizing hospitals by accepting low pay for years. They could because they have a much lower COL than new arrivals. But those doctors are getting old and retiring. New arrivals can’t afford to do that even if they wanted to. Things have changed. It’s time to pay the piper.

Very very true. This will be more and more magnified as time goes on. I couldn't afford my current house (8 years out of fellowship) at its current price. The cap for physician loans is 1M. Desirable locations will have increased difficulty recruiting because a new grad wishes to move to an area, plant their roots, and buy a house. This will get even more magnified in less desirable areas since the price of an anesthesiologist has gone up. Hospitals will have to operate at a loss when it comes to anesthesia staffing and hope to make that up in ortho, IR, NORA, etc volume. Its either pay anesthesia or lose all the other services.

Anesthesia will be the Costco hot dog. Sold at a loss but gets people in the door to buy their other junk.

 

[aneftp]

What is new grads standard of living? My first job was a very high cost of living area in a top 5-7 major metro area in the north. I purchased a house less than 2x my income at the time ($220-250k) where the average cost of a house where the older attending all started at 1 million. It was 20 miles out.

Most had 1.5-2 million dollar homes. (This was at height of the 2005 housing bubble). Their commute was 7-8 miles and 20 min to the hospital. Mine was 20 miles out and 40-50 minutes in.

 

[mja75]

The anesthesia Gravy Train is back! Im so happy for my OR colleagues. I’ve heard $500/hour quoted a few times already. Amazing.

 

[ERRES2288]

Incredible..and I’m over here working for my measly 450k a year

 

[coffeebythelake]

Very very true. This will be more and more magnified as time goes on. I couldn't afford my current house (8 years out of fellowship) at its current price. The cap for physician loans is 1M. Desirable locations will have increased difficulty recruiting because a new grad wishes to move to an area, plant their roots, and buy a house. This will get even more magnified in less desirable areas since the price of an anesthesiologist has gone up. Hospitals will have to operate at a loss when it comes to anesthesia staffing and hope to make that up in ortho, IR, NORA, etc volume. Its either pay anesthesia or lose all the other services.

Anesthesia will be the Costco hot dog. Sold at a loss but gets people in the door to buy their other junk.

i think the elephant in the room is WHY medicare reimburses anesthesia so poorly
so much worse than any other field

 

[nimbus]

i think the elephant in the room is WHY medicare reimburses anesthesia so poorly
so much worse than any other field

Blame it on 1992 RBRVS. Anesthesia and EM got screwed.

 

[GassYous]

i think the elephant in the room is WHY medicare reimburses anesthesia so poorly
so much worse than any other field

And why they keep planning for 10% cuts when they should be giving 10% increases

 

[Status Sciaticus]

The anesthesia Gravy Train is back! Im so happy for my OR colleagues. I’ve heard $500/hour quoted a few times already. Amazing.

where do you see 500/hr?

 

[Dr. Rude]

And why they keep planning for 10% cuts when they should be giving 10% increases

Because the payers (including Medicare) would ideally like to write one check to a health care system and let them work out how to divide the pie to provide care to the community. That is what they are trying to move towards.