What's going on in the world of locums?

[miacomet]

Getting more calls for locums lately, what's up with the locums market in terms of availability, regional markets, and hourly rates?

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[bravotwozero]

I’m getting the same. Part of it is because the holidays are coming up, and with a lot of the full timers taking vacations etc there’s always a need for locums docs to fill in holiday shifts.

Texas, Iowa and Michigan are hot spots from what I can gather.

 

[EctopicFetus]

Lots of calls offers of little pay though. Are people getting offered 300+? Serious Q for the locums crowd if you aren’t getting $300+ then whats the point.

 

[bravotwozero]

I’ve seen maybe 1-2 offers north of 300. Most were in the 250-280 range, with some low volume lowballs at 220.

 

[miacomet]

Lots of calls offers of little pay though. Are people getting offered 300+? Serious Q for the locums crowd if you aren’t getting $300+ then whats the point.

Agreed, most have been 260-280; I agree it's pointless unless they are offering a really sweet schedule and the Ritz. Which they are most definitely not.

 

[NYEMMED]

Agreed, most have been 260-280; I agree it's pointless unless they are offering a really sweet schedule and the Ritz. Which they are most definitely not.

For $260-280, I want a mid day shift say 9a-6p only, no nights or weekends, at a well running site.

You want me to help out your site with numerous issues? $350+ days and 450+ nights

 

[NYEMMED]

On a locums side as well…

My buddy from residency took an insurance job for 2 years. Would he have a chance at re-entering clinical with a locums gig?

 

[emergentmd]

I have partners who do locums at a place that pays 375/hr plus only do shifts when they offer 2K+/12hr shifts.

Still way underpaid. I wouldn't do this for 1k/hr now but my younger self jumped at this place when they paid me 650/hr

 

[forchinet121]

I have partners who do locums at a place that pays 375/hr plus only do shifts when they offer 2K+/12hr shifts.

Still way underpaid. I wouldn't do this for 1k/hr now but my younger self jumped at this place when they paid me 650/hr

Bro are you trolling or serious? You are making more than 1k per hour and you used to make 650/hr a while ago? Like what lol..anything over 300/hr is very good I’ve never heard of 650/hr in my life let alone 1k unless there’s some very strange circumstances going on

 

[HemorrhagicShock]

On a locums side as well…

My buddy from residency took an insurance job for 2 years. Would he have a chance at re-entering clinical with a locums gig?

I'm interested in any experiences with this question as well. Is re-entering after 2 years even possible??

 

[emergentmd]

Bro are you trolling or serious? You are making more than 1k per hour and you used to make 650/hr a while ago? Like what lol..anything over 300/hr is very good I’ve never heard of 650/hr in my life let alone 1k unless there’s some very strange circumstances going on

Very Serious, not sure why you think I would troll. My old locums pay was 475-900/hr depending on need. One old locums called me wanting help and my old partners are making 650/hr on most bonused shifts.

I never said I made $1k/hr, actually I I think my max for any previous locums was 900/hr when they were uber desperate. I said I would not go back and do my old locums gig for 1k/hr just b/c I have better options.

If I told you what I really made, you prob would not believe me but being an owner/partner is a pretty sweet deal but similar to everything in life, it could quickly change

 

[wareagle726]

Very Serious, not sure why you think I would troll. My old locums pay was 475-900/hr depending on need. One old locums called me wanting help and my old partners are making 650/hr on most bonused shifts.

I never said I made $1k/hr, actually I I think my max for any previous locums was 900/hr when they were uber desperate. I said I would not go back and do my old locums gig for 1k/hr just b/c I have better options.

If I told you what I really made, you prob would not believe me but being an owner/partner is a pretty sweet deal but similar to everything in life, it could quickly change

I've done something so wrong in my life lol

 

[forchinet121]

Very Serious, not sure why you think I would troll. My old locums pay was 475-900/hr depending on need. One old locums called me wanting help and my old partners are making 650/hr on most bonused shifts.

I never said I made $1k/hr, actually I I think my max for any previous locums was 900/hr when they were uber desperate. I said I would not go back and do my old locums gig for 1k/hr just b/c I have better options.

If I told you what I really made, you prob would not believe me but being an owner/partner is a pretty sweet deal but similar to everything in life, it could quickly change

I would believe you if you’re serious I just wasn’t sure..how much do you make now?

 

[emergentmd]

I would believe you if you’re serious I just wasn’t sure..how much do you make now?

Not gonna say but most is owning the facility charges. Like every business, the owners makes the money. Hard to make much when you are punching the clock and paying taxes. Look for passive income where money comes in when you are at home relaxing.

 

[Rekt]

I've done something so wrong in my life lol

I would believe you if you’re serious I just wasn’t sure..how much do you make now?

Important to note even then that money was extremely atypical. Those rates were only when you kept telling places no until the very last second. Also if something bad happens to a contract and they need coverage, etc. Or if you're one of the bastards that picked up summa shifts. Rates are nothing like that now as noted above. Also, he's not even an ED doc anymore and just is a FSED owner.

 

[miacomet]

Important to note even then that money was extremely atypical. Those rates were only when you kept telling places no until the very last second. Also if something bad happens to a contract and they need coverage, etc. Or if you're one of the bastards that picked up summa shifts. Rates are nothing like that now as noted above. Also, he's not even an ED doc anymore and just is a FSED owner.

Good for him....

 

[forchinet121]

Not gonna say but most is owning the facility charges. Like every business, the owners makes the money. Hard to make much when you are punching the clock and paying taxes. Look for passive income where money comes in when you are at home relaxing.

Why bring up how much you make then say you don’t want to say..

 

[emergentmd]

Why bring up how much you make then say you don’t want to say..

What a FSER partner makes is irrelevant. I never said how much I made. I just said how much I made doing locums and how much my partners are making doing locums currently at my old site.

The topic of this thread is about Locums bouncing back and from what I see, it is bouncing back. Maybe not to their hay days but I seem to be getting daily emails/calls.

But I can tell you for fact that docs at my old locums base rate is 325-375/hr by contract and they are getting 1.5-2x rates for coverage. Sure not all shifts are like this, but there is a slew of nights that require this bonus.

 

[emergentmd]

Also, he's not even an ED doc anymore and just is a FSED owner.

I still cover a full time shifts but you are right, I do not work in the hospital. I still think this makes me an ED doc.

 

[forchinet121]

What a FSER partner makes is irrelevant. I never said how much I made. I just said how much I made doing locums and how much my partners are making doing locums currently at my old site.

The topic of this thread is about Locums bouncing back and from what I see, it is bouncing back. Maybe not to their hay days but I seem to be getting daily emails/calls.

But I can tell you for fact that docs at my old locums base rate is 325-375/hr by contract and they are getting 1.5-2x rates for coverage. Sure not all shifts are like this, but there is a slew of nights that require this bonus.

What does an FSER partner make? Why is that such a secret? If you make 5 mil a year good for you..there are 16 year old YouTubers making double, just curious that’s all no judgement

 

[Mount Asclepius]

Why bring up how much you make then say you don’t want to say..

Texan bravado.

 

[emergentmd]

Texan bravado.

This always amuses me. No one knows me and I get nothing out of just being open/honest. I could be your next door neighbor. The amount I make as a business owner is irrelevant to Locums, and I can not hold a candle to Mr Beast. I never said how much I make or my ego gets nothing out of having an anonymous name.

I am just being honest of what I see which is more than many people I know who keeps everything a secret because they don't want people going on their turf. People who know me have no idea what I make unless they ask as my self worth have little to do with what I make.

I speak the honest truth just to give docs options and its up to them if its worth the risks. Nothing wrong with punching the clock for $200/hr until you retire likely rich. But there are better ways if you are willing to take risks. I have failed many times and happy to describe the mistakes I have esp with the stock market and funding start ups.

 

[emergentmd]

What does an FSER partner make? Why is that such a secret? If you make 5 mil a year good for you..there are 16 year old YouTubers making double, just curious that’s all no judgement

How much you make as a partner depends on how much equity you have at each site. Successful sites should cash flow 5+M/yr but the time/risks are more than many docs willing to take. My equity across all of my sites would be equivalent to about 1/4 of a site.

 

[EctopicFetus]

How much you make as a partner depends on how much equity you have at each site. Successful sites should cash flow 5+M/yr but the time/risks are more than many docs willing to take. My equity across all of my sites would be equivalent to about 1/4 of a site.

I have long preached the SDG life. As I learned more and more about it what I came to realize is that within SDGs there is a crazy schism.

I know SDGs making $5-600/hr+. A regular ED with a regular payer mix has the SDG docs making $300+/hr.

As emergent said things can change fast. the highest paid SDG I know recently got the barbed wire dildo due to the NSA. Now seeing 50% more patients at a 20% cut in pay. Now that being said they are making good money still but that job got much worse literally overnight.

A really well run SDG can make $500/hr plus for all partners if you use MLPs well (urgent care type cases only) and have a system that is efficient.

The issue is with the RN staffing issues this is near impossible. The paradigm many of us live in is some crazy belief that you cant collect more than 150 or 200 per patient. This is pure nonsense.

I had an argument with someone and they swore the max per patient was x (i dont recall the number) and I said dude.. ill open up my old groups financials and show you right now. He didnt believe me and thought I was bluffing. Files opened and dude tucked his tail. Dont believe you are as limited as people who dont know tell you they are.

 

[xaelia]

Bro are you trolling or serious? You are making more than 1k per hour and you used to make 650/hr a while ago? Like what lol..anything over 300/hr is very good I’ve never heard of 650/hr in my life let alone 1k unless there’s some very strange circumstances going on

Bro he's not fabricating this at all.

When I was faculty back in Houston, local sites desperate for docs were paying $600+/hr for docs.

I recall old posts about sites in MS for $800+/hr for docs.

This is a decade ago, now.

 

[EctopicFetus]

Bro he's not fabricating this at all.

When I was faculty back in Houston, local sites desperate for docs were paying $600+/hr for docs.

I recall old posts about sites in MS for $800+/hr for docs.

This is a decade ago, now.

Had a buddy of mine in phoenix get $1k/hr. He had a crazy good year and made over $1m that year. he averaged something like 525/hr for the year. Yes he worked a lot but it was fairly low volume.

 

[forchinet121]

How much you make as a partner depends on how much equity you have at each site. Successful sites should cash flow 5+M/yr but the time/risks are more than many docs willing to take. My equity across all of my sites would be equivalent to about 1/4 of a site.

So you make about 1.3M per year? That’s excellent good for you man

 

[ScepticSkeksis]

I've seen a few 300/hr jobs in secondary cities in TX. Also LA has a few, but I suspect they might be hellholes.

Definitely nowhere what I heard docs were making years ago. I certainly couldn't even dream of $650/hr at this point!

 

[emergentmd]

He had a crazy good year and made over $1m that year.

Good old days. I remember looking at open schedules and If I picked up 15x12hr shifts a month would have hit 1M but I probably would have quit medicine after a few years and defending countless lawsuits.

I have an old friend that still does crazy Locums and prob gets close to 1M but he flies all over the place, working in the dearth of society.

 

[emergentmd]

As emergent said things can change fast. the highest paid SDG I know recently got the barbed wire dildo due to the NSA. Now seeing 50% more patients at a 20% cut in pay. Now that being said they are making good money still but that job got much worse literally overnight.

A really well run SDG can make $500/hr plus for all partners if you use MLPs well (urgent care type cases only) and have a system that is efficient.

15 Yrs ago during the golden days of EM, we had a pretty good payer mix. I think it was around 66/33 commercial/(medicare/medicaid/uninsured).
Commercial netted about $250/pp. The rest prob about $100/pp if lucky. So about $175/pp, our SDG brought in about $300/hr for each doc @ 2pph. The environment/city was great to work in so I considered it a unicorn gig. The only way to reach that number now would be to have a slew of MLPs working given the downward insurance pressure.

NSA has really screwed the pooch even more and it is still hard to quantify given delayed payments. But in the past 5 years of EM, I would say professional/facility payments have gone down 33%. If our old SDG was still alive, I would guess each pt professional reimbursements prob now brings in about $125pp which essentially makes SDG nonviable.

 

[Mount Asclepius]

This always amuses me. No one knows me and I get nothing out of just being open/honest. I could be your next door neighbor. The amount I make as a business owner is irrelevant to Locums, and I can not hold a candle to Mr Beast. I never said how much I make or my ego gets nothing out of having an anonymous name.

I am just being honest of what I see which is more than many people I know who keeps everything a secret because they don't want people going on their turf. People who know me have no idea what I make unless they ask as my self worth have little to do with what I make.

I speak the honest truth just to give docs options and its up to them if its worth the risks. Nothing wrong with punching the clock for $200/hr until you retire likely rich. But there are better ways if you are willing to take risks. I have failed many times and happy to describe the mistakes I have esp with the stock market and funding start ups.

I think you somewhat miss the point. You may not be entirely wrong. It's that your tone is very Texan and can come across as mildly abrasive to people from other parts of the country. Admittedly, people from other regions can also come across poorly in different ways. It's just that there is a certain bravado that seems unique to some people from Texas having been involved with interviewing medical students from Texas applying for residency and Texan physicians applying for pre-partnership positions.

You have valuable insight based upon your business experience. You have also been financially successful. I do sense veins of humbleness, gratitude and contentment in your comments which are values that I can relate to. I commend you on your achievements. You've also been fortunate with your timing. Even if it isn't your intent you occasionally come across as flaunting your success to others, quasi-questioning others who don't achieve the same success, and are vague with some details whilst portraying transparency, which is not received well.

 

[Mount Asclepius]

15 Yrs ago during the golden days of EM, we had a pretty good payer mix. I think it was around 66/33 commercial/(medicare/medicaid/uninsured).
Commercial netted about $250/pp. The rest prob about $100/pp if lucky. So about $175/pp, our SDG brought in about $300/hr for each doc @ 2pph. The environment/city was great to work in so I considered it a unicorn gig. The only way to reach that number now would be to have a slew of MLPs working given the downward insurance pressure.

NSA has really screwed the pooch even more and it is still hard to quantify given delayed payments. But in the past 5 years of EM, I would say professional/facility payments have gone down 33%. If our old SDG was still alive, I would guess each pt professional reimbursements prob now brings in about $125pp which essentially makes SDG nonviable.

I don't agree with your last statement. Our SDG is alive and well. We receive payment that is greater than $125/patient and greater than $300/hour. We don't even have a great payer mix. SDGs are currently very viable and I'd argue a better, more stable answer than Locums going forward particularly given the projected surplus of EPs in the future.

 

[WorkNoteEmergency]

I’m getting way more locums emails/texts but haven’t answered any (yet). Last locums to work in my shop (Virginia) were getting paid $225/hr which is about average for everyone else. There is only one independent group I can think of in a 150 mile radius of my hospital.

 

[emergentmd]

Even if it isn't your intent you occasionally come across as flaunting your success to others, quasi-questioning others who don't achieve the same success, and are vague with some details whilst portraying transparency, which is not received well.

Message boards tend to result in short/concise messages and I get it can come across as abrupt or even flaunting. Never my intent but I do try to be direct as much as possible. Again, its a message board and I don't believe their is a need to filter my message to exude humility. I do this in the real world b/c you can never talk to the avg person and say anything about success/wealth when you are a doctor making 10x more than the avg person. We all know this happens and many docs comes across as arrogant just b/c people already have this preconception.

We receive payment that is greater than $125/patient and greater than $300/hour

This is great and I would say to keep this train going as long as possible. I just have not had this experience and I am sure there is a large regional difference. I just looked at our Avg professional fees for our 90% insured FSER and it comes around 130pp but we definitely are majority level 3/4.

 

[beebermd]

back when I was a partner with my FSED group, I had ownership at a couple of sites. My best site (20-30 pts/24hr) with 6% ownership paid 10-15k/month without ever working a shift. My monthly work was 8 24s at the FSED and 5 12s at the traditional ED @ 250/hr. Was making a little over a 1mil a year.

 

[emergentmd]

back when I was a partner with my FSED group, I had ownership at a couple of sites. My best site (20-30 pts/24hr) with 6% ownership paid 10-15k/month without ever working a shift. My monthly work was 8 24s at the FSED and 5 12s at the traditional ED @ 250/hr. Was making a little over a 1mil a year.

Great Job. It sounds like you are not doing this anymore, just curious what happened? That monthly income for 6% seems low with that volume.

Nothing wrong with making 150K/yr doing nothing.

 

[GonnaBeADoc2222]

I think you somewhat miss the point. You may not be entirely wrong. It's that your tone is very Texan and can come across as mildly abrasive to people from other parts of the country. Admittedly, people from other regions can also come across poorly in different ways. It's just that there is a certain bravado that seems unique to some people from Texas having been involved with interviewing medical students from Texas applying for residency and Texan physicians applying for pre-partnership positions.

You have valuable insight based upon your business experience. You have also been financially successful. I do sense veins of humbleness, gratitude and contentment in your comments which are values that I can relate to. I commend you on your achievements. You've also been fortunate with your timing. Even if it isn't your intent you occasionally come across as flaunting your success to others, quasi-questioning others who don't achieve the same success, and are vague with some details whilst portraying transparency, which is not received well.

It's the standard "I'll tell you about all the money I make, but won't give you concrete advice on how to do the same" attitude that is prevalent on SDN and WCI forums.

 

[Brigade4Radiant]

It's the standard "I'll tell you about all the money I make, but won't give you concrete advice on how to do the same" attitude that is prevalent on SDN and WCI forums.

Yeah but they should charge for that though seriously.

 

[xaelia]

It's the standard "I'll tell you about all the money I make, but won't give you concrete advice on how to do the same" attitude that is prevalent on SDN and WCI forums.

It's prevalent in all industries – it's a manifestation of survivorship bias.

See: crypto, the prosperity gospel, etc. for other examples of idolatry.

 

[emergentmd]

It's the standard "I'll tell you about all the money I make, but won't give you concrete advice on how to do the same" attitude that is prevalent on SDN and WCI forums.

I think I try my best to be open esp with real estate investing as there is nothing proprietary. I can't really talk in open forum about trade secrets/open books as this not only affects me but all my partners. I do try to give insight on other EM work options including FSERs esp when its open knowledge. I think you would do the same with trade secrets.

 

[emergentmd]

Yeah but they should charge for that though seriously.

I don't know about charging but no successful business would open their books/trade secrets, otherwise they would not be successful anymore.

I mean, my knowledge of the FSER industry is vast not because someone opened their books. It was due to many years of trial/error/mistakes/lost income/stress before I figured it out.

I mean, I could probably tell someone how to make a FSER successful but then I would just be hurting myself/partners. It would be financial suicide.

 

[gudog]

On a locums side as well…

My buddy from residency took an insurance job for 2 years. Would he have a chance at re-entering clinical with a locums gig?

from perspective of someone (me) who's been on a credentials committee for 20+ years, no way without proving current clinical knowledge
ie - will need to find one of those re-entry programs and get some current clinical experience
I know they exist for ortho, GYN, maybe others, don't know about ER

 

[GonnaBeADoc2222]

from perspective of someone (me) who's been on a credentials committee for 20+ years, no way without proving current clinical knowledge
ie - will need to find one of those re-entry programs and get some current clinical experience
I know they exist for ortho, GYN, maybe others, don't know about ER

Why can a nurse get an NP "for later" and get credentialed no problem, but a board-certified physician has to go through this rigamarole?

 

[inspirationmd]

from perspective of someone (me) who's been on a credentials committee for 20+ years, no way without proving current clinical knowledge
ie - will need to find one of those re-entry programs and get some current clinical experience
I know they exist for ortho, GYN, maybe others, don't know about ER

Speaking, generally, you are correct, but this is not always 100% true. It really also depends on how desperate the Locums is. One of my residency classmates hates emergency medicine and went out doing Suboxone and urgent care for a while before deciding that she had to go back. By that point she had been out of the ED clinically for several years plus she had done extra time away after having her second child. They had me write a letter attesting to her clinical abilities in residency and that I believed based on my clinical experience with her that she would acclimate quickly back to the environment. It may be a little bit different though since she was still doing something clinical with urgent care and basically addiction medicine as opposed to just being with the insurance company. I think they had her double covered for a couple shifts and then said “you’re good”.

I will say this is definitely the exact scenario of why you should be doing at least a little bit of clinical EM work if you think that you may go back as an even remote possibility. Even with a subspecialty picking up a PRN gig is a good idea.

 

[inspirationmd]

Of course she didn’t really learn her lesson since she grandfathered into the Addiction Medicine boards and swears she is never going back. Now works as an inpatient physician at an addiction rehab as their Medical director. She hasn’t done EM in almost another year now.

 

[TooMuchResearch]

I don't know about charging but no successful business would open their books/trade secrets, otherwise they would not be successful anymore.

I mean, my knowledge of the FSER industry is vast not because someone opened their books. It was due to many years of trial/error/mistakes/lost income/stress before I figured it out.

I mean, I could probably tell someone how to make a FSER successful but then I would just be hurting myself/partners. It would be financial suicide.

Just tell me how to do it in my state, which is many, many states away from you.

 

[emergentmd]

Just tell me how to do it in my state, which is many, many states away from you.

Start by changing the laws. Only a few even allows it b/c the hospitals own the monopoly on emergency care.

 

[gudog]

Why can a nurse get an NP "for later" and get credentialed no problem, but a board-certified physician has to go through this rigamarole?

I fight this every meeting, is truly annoying - we have NP's around my place that specialty hop every 1-2 years

 

[miacomet]

How long does it take until one would have reentry problems? A year? Two?

 

[RustedFox]

How long does it take until one would have reentry problems? A year? Two?

One year.
I flamed out in 2020.
It took knowing people who know people and a very understanding director for me to come back.