What's going on in the world of locums?

[inspirationmd]

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

Agree. Out for a year from the ED and you’ll need luck plus connections to get back in the game. Do 1 shift every other month and you’ll have less pain.

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[CoolDoc1729]

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

1-2 years? I know an NP that finished right around the time covid started that has already done hospitalist, neurosurgery, cardiology and EM. I know another one that works as a hospitalist and moonlights doing pulm, and another that works as hospitalist and moonlights neurology. They are honestly bewildered that I can’t just “go be a hospitalist” 🙄

 

[RustedFox]

1-2 years? I know an NP that finished right around the time covid started that has already done hospitalist, neurosurgery, cardiology and EM. I know another one that works as a hospitalist and moonlights doing pulm, and another that works as hospitalist and moonlights neurology. They are honestly bewildered that I can’t just “go be a hospitalist” 🙄

PLPs don't know what they don't know, which is... a lot.

 

[miacomet]

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

Ugh, that's short

 

[emergentmd]

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

To go back to a big hospital would be difficult after a year unless they are desperate. Seems like most other outlying places would take a warm body right now.

 

[CoolDoc1729]

To go back to a big hospital would be difficult after a year unless they are desperate. Seems like most other outlying places would take a warm body right now.

Which is amazing since no one can get anyone transferred, meaning the docs in the sticks are managing whatever rolls in for a couple days without specialist help .. it’s probably safer to have a rusty doc at a teaching level I than a critical access hospital .. but you are absolutely right

 

[emergentmd]

Which is amazing since no one can get anyone transferred, meaning the docs in the sticks are managing whatever rolls in for a couple days without specialist help .. it’s probably safer to have a rusty doc at a teaching level I than a critical access hospital .. but you are absolutely right

Yea, I think Critical Access hospitals are the worst place right now if they are holding sick pts for days.

 

[miacomet]

Just want to note that a locums company emailed me yesterday- 8 hospitals in upstate NY with apparently endless, ongoing needs for locums. Will accept IM, FP, EM. Offering $260 an hour. Absurd. Teamhealth joints FWIW.

 

[WorkNoteEmergency]

Just want to note that a locums company emailed me yesterday- 8 hospitals in upstate NY with apparently endless, ongoing needs for locums. Will accept IM, FP, EM. Offering $260 an hour. Absurd. Teamhealth joints FWIW.

Curious, are you communicating with this company to get the rate? I get emails all the time but never a pay rate mentioned.

One of the emails I got recently was for a hospital near me that I worked a short time for. They underrepresented the volume in the ad but besides that it's a USACS joint, so I was surprised they looking for locus. I texted a friend and he confirmed they're staffed up and not using locums. I figured this might just be a bait and switch attempt, but kind of shady.

 

[miacomet]

Curious, are you communicating with this company to get the rate? I get emails all the time but never a pay rate mentioned.

One of the emails I got recently was for a hospital near me that I worked a short time for. They underrepresented the volume in the ad but besides that it's a USACS joint, so I was surprised they looking for locus. I texted a friend and he confirmed they're staffed up and not using locums. I figured this might just be a bait and switch attempt, but kind of shady.

Weirdly, the unsolicited email did include the hospital names and locations and rates- all 13 of them. Looks like they will take any warm body.

 

[Kryptocoin]

Weirdly, the unsolicited email did include the hospital names and locations and rates- all 13 of them. Looks like they will take any warm body.

A lot EM docs are now working either PRN or PT. Likely from pandemic burnt out. This is causing a staffing crisis. I'm getting 5+ locums messages or offers a day.

 

[emergentmd]

EM locums took a big hit right before covid hit but now there are openings everywhere including cities that typically are hard to break into..

I get almost daily emails on job/locums offering. I saw one in a decent big city in Texas 275/hr with 40K sign on for 2 yrs. Looks like about 2pph.

I know of 325/hr base jobs plus bonuses for open shifts.

I don't think any new grads will have a hard time getting a job anytime soon.

 

[Kryptocoin]

EM locums took a big hit right before covid hit but now there are openings everywhere including cities that typically are hard to break into..

I get almost daily emails on job/locums offering. I saw one in a decent big city in Texas 275/hr with 40K sign on for 2 yrs. Looks like about 2pph.

I know of 325/hr base jobs plus bonuses for open shifts.

I don't think any new grads will have a hard time getting a job anytime soon.

I'm getting good offers but most are single coverage with busy volumes. It's cheaper to pay us an extra $30+/hr than hire a midlevel or god forbid a physician. This just feeds the burnout cycle.

 

[miacomet]

I can't believe they offered $260. I'm personally insulted.

 

[miacomet]

A lot EM docs are now working either PRN or PT. Likely from pandemic burnt out. This is causing a staffing crisis. I'm getting 5+ locums messages or offers a day.

I think it's also that if you are prn you get fewer admin emails, fewer metrics etc.

 

[emergentmd]

I think it's also that if you are prn you get fewer admin emails, fewer metrics etc.

Locums is better than prn if you can find a place close to home. No metrics, no emails, nothing. Show up, work, go home.

 

[RustedFox]

Locums is better than prn if you can find a place close to home. No metrics, no emails, nothing. Show up, work, go home.

See, this is the way admin should treat us if they're not going to support the department in terms of staffing, input, other needs, and generalized all-around respect. You pay me to do the thing. I do the thing.

 

[miacomet]

Locums is better than prn if you can find a place close to home. No metrics, no emails, nothing. Show up, work, go home.

Absolutely. It's often better even when it's not close to home if you are in the market for hotel/air points along with the no emails

 

[namethatsmell]

Recruiter texted me a few days ago advertising $310/hr+travel/per diem for day shifts. I think I know the shop and it's a literal hellscape. Would take $750/hr to get me to consider.

I almost replied, then I realized at 1k/hr I still wouldn't take it.

A lot has changed since pre-pandemic. Yeah, a buck ain't what it used to be thanks to inflation, but the bigger issue it that the "system" went from minimally-functional pre-covid to now full-on Florida Man level of glorious failure after failure. Increasingly, the juice just ain't worth the squeeze grind.

 

[RustedFox]

Recruiter texted me a few days ago advertising $310/hr+travel/per diem for day shifts. I think I know the shop and it's a literal hellscape. Would take $750/hr to get me to consider.

I almost replied, then I realized at 1k/hr I still wouldn't take it.

A lot has changed since pre-pandemic. Yeah, a buck ain't what it used to be thanks to inflation, but the bigger issue it that the "system" went from minimally-functional pre-covid to now full-on Florida Man level of glorious failure after failure. Increasingly, the juice just ain't worth the squeeze grind.

Florida Man here. Can confirm.

 

[GatorCHOMPions]

I saw a generic ad from USACS advertising firefighters for $250/hour (new grad) and $300/hour (experienced). Anyone else see this and take the bait? Also seeing highest hourly rates advertised in my area in very long time.

 

[xaelia]

Also seeing highest hourly rates advertised in my area in very long time.

... and when those higher rates lure more docs from their full-time jobs, even more places will be short and need locums ... in turn necessitating higher rates ... and then ....

 

[PianoMedic]

I saw a generic ad from USACS advertising firefighters for $250/hour (new grad) and $300/hour (experienced). Anyone else see this and take the bait? Also seeing highest hourly rates advertised in my area in very long time.

Got this in the mail literally today. They also mention a sign on bonus that must be for 7 or 10 years or something else ludicrous. Not going to look into it. Doesn’t seem worth it to me.

 

[miacomet]

Locums is better than prn if you can find a place close to home. No metrics, no emails, nothing. Show up, work, go home.

Oh, I see- if you go through a locums company, you are insulated, as opposed to contracting with a company directly??

 

[emergentmd]

I don't think it matters. Locums sites are desperate and know you likely will not be there too long so they just leave you alone.

 

[miacomet]

I don't think it matters. Locums sites are desperate and know you likely will not be there too long so they just leave you alone.

I get calls and emails all the time for totally crappy places paying $260 an hour. Not desperate enough, I guess!

 

[GonnaBeADoc2222]

I dunno man....these days it would take a lot for me to work an extra shift in a dysfunctional place. Prob $500 / hr? Even that prob not enough, unless they're willing to waive the whole BS credentialing process. Credentialing really is the rate limiting step for me to do any kind of PRN / locums work anywhere else.

 

[Janders]

I dunno man....these days it would take a lot for me to work an extra shift in a dysfunctional place. Prob $500 / hr? Even that prob not enough, unless they're willing to waive the whole BS credentialing process. Credentialing really is the rate limiting step for me to do any kind of PRN / locums work anywhere else.

Personally I found doing locums (really more... per diem work...) 1-2 shifts a month somewhere I could drive to in 30-60min from my house, even if slightly dysfunctional, was fine for my psyche. In a way it was a little refreshing.

I found it refreshing to have a DIFFERENT dysfunction. Like "oh yeah the hospitalists here are persnickity about admissions" but "holy **** the lab here gets stuff done quick, and there is a Popeye's a mile away for my drive home!"

It was a little fun to do different locations / patient populations (free standing rural, large academic referral center, busy community in a different town than normal).

In fact, the shift to entirely hourly pay was fun for these type of adventures, b/c I would just be dumb and friendly and tell the charge I was there to work, see whomever got brought back, tell me what to do and I'm happy. WR has 45 bc they have rooms shut, and you don't want me to put WR orders by policy? OK I'll sit and wait. WR exploding and you want to pay me to play PIT doc with a tech for 4 hours. Sure thing! Other docs don't want to see septicons from nursing homes bc they take a long time? I'll see 5 of those cool. Other docs don't want to work with the PA (whom presents everything to you, and you get to go see their patient yourself, no rush)... I'll chill with the PA! I just did my best impression of a golden retriever, turned off the half of my brain that tries to fix all system problems and improve operational flow, and took good care of every individual they brought to me.

The key was being able to separate from the complex operational issues at some of the hospitals, which in my main job I would have been running in circles trying to fix. Not my role as a per diem. It was almost like taking a working vacation day twice a month! Also the actual MD/PA culture at each of these shops was pretty solid, and people took/gave good signout, etc.

BUT, huge caveat here... these places had at worst mild/moderate dysfunctions. They were not literally melting to the ground with people coding in the WR constantly. During the covid surges where ICU capacity was nil, they had significant ICU boarding problems, but so did every ED in the state/region.

The pay was just on par with my day job, so when these dried up I didn't push hard looking for more... I worked too much the first 2 years of the pandemic.

So if one of these type of things popped up again? Yeah I might do it once a month. Depends on the details. I'm pretty crispy and I'm not really looking for more clinical work, but I could trade one shift at home for one away for variety, etc.

But at this point, you want me to go work in a truly dysfunction hellscape, a medicolegal quagmire of death? The hourly rate I would ask for would be more than double my "normal" rate, probably triple to actually get me to consider. Yeah at least triple...

 

[RustedFox]

WR has 45 bc they have rooms shut, and you don't want me to put WR orders by policy? OK I'll sit and wait. WR exploding and you want to pay me to play PIT doc with a tech for 4 hours. Sure thing! Other docs don't want to see septicons from nursing homes bc they take a long time? I'll see 5 of those cool. Other docs don't want to work with the PA (whom presents everything to you, and you get to go see their patient yourself, no rush)... I'll chill with the PA! I just did my best impression of a golden retriever, turned off the half of my brain that tries to fix all system problems and improve operational flow, and took good care of every individual they brought to me.

 

[Janders]

 

[GonnaBeADoc2222]

Personally I found doing locums (really more... per diem work...) 1-2 shifts a month somewhere I could drive to in 30-60min from my house, even if slightly dysfunctional, was fine for my psyche. In a way it was a little refreshing.

I found it refreshing to have a DIFFERENT dysfunction. Like "oh yeah the hospitalists here are persnickity about admissions" but "holy **** the lab here gets stuff done quick, and there is a Popeye's a mile away for my drive home!"

It was a little fun to do different locations / patient populations (free standing rural, large academic referral center, busy community in a different town than normal).

In fact, the shift to entirely hourly pay was fun for these type of adventures, b/c I would just be dumb and friendly and tell the charge I was there to work, see whomever got brought back, tell me what to do and I'm happy. WR has 45 bc they have rooms shut, and you don't want me to put WR orders by policy? OK I'll sit and wait. WR exploding and you want to pay me to play PIT doc with a tech for 4 hours. Sure thing! Other docs don't want to see septicons from nursing homes bc they take a long time? I'll see 5 of those cool. Other docs don't want to work with the PA (whom presents everything to you, and you get to go see their patient yourself, no rush)... I'll chill with the PA! I just did my best impression of a golden retriever, turned off the half of my brain that tries to fix all system problems and improve operational flow, and took good care of every individual they brought to me.

The key was being able to separate from the complex operational issues at some of the hospitals, which in my main job I would have been running in circles trying to fix. Not my role as a per diem. It was almost like taking a working vacation day twice a month! Also the actual MD/PA culture at each of these shops was pretty solid, and people took/gave good signout, etc.

BUT, huge caveat here... these places had at worst mild/moderate dysfunctions. They were not literally melting to the ground with people coding in the WR constantly. During the covid surges where ICU capacity was nil, they had significant ICU boarding problems, but so did every ED in the state/region.

The pay was just on par with my day job, so when these dried up I didn't push hard looking for more... I worked too much the first 2 years of the pandemic.

So if one of these type of things popped up again? Yeah I might do it once a month. Depends on the details. I'm pretty crispy and I'm not really looking for more clinical work, but I could trade one shift at home for one away for variety, etc.

But at this point, you want me to go work in a truly dysfunction hellscape, a medicolegal quagmire of death? The hourly rate I would ask for would be more than double my "normal" rate, probably triple to actually get me to consider. Yeah at least triple...

I don't try to solve any operational issues at my main job. Two years ago I used to, then I figured out the futility in it and the increased stress it causes. Now i just chill and see who I need to see. It baffles me how some of my colleagues with 20 years of attending experiences still get into the quagmire with some of this non-medical ****.

 

[ScepticSkeksis]

Oh, I see- if you go through a locums company, you are insulated, as opposed to contracting with a company directly??

I think they still track your metrics, but you don't need to be on committees and do other nonsense that full-timers do. Am I right?

 

[miacomet]

I dunno man....these days it would take a lot for me to work an extra shift in a dysfunctional place. Prob $500 / hr? Even that prob not enough, unless they're willing to waive the whole BS credentialing process. Credentialing really is the rate limiting step for me to do any kind of PRN / locums work anywhere else.

I think they still track your metrics, but you don't need to be on committees and do other nonsense that full-timers do. Am I right?

I have never been informed of metrics at a locums gig. They may track them, but they are (theoretically) desperate with a set hourly rate so???

 

[dchristismi]

I am getting emails from recruiters using an email address I used, oh, 14 years ago with my married name from that divorce 14 years ago... about 10 different HCA jobs with 12 hour shifts. "Each locations has different start dates and rates."

Aw hell naw. That's just desperate nonsense, and sounds like an utter nightmare. Florida Man is right. (And I'm not referring to Fox.)

 

[miacomet]

I am getting emails from recruiters using an email address I used, oh, 14 years ago with my married name from that divorce 14 years ago... about 10 different HCA jobs with 12 hour shifts. "Each locations has different start dates and rates."

Aw hell naw. That's just desperate nonsense, and sounds like an utter nightmare. Florida Man is right. (And I'm not referring to Fox.)

??? I would think if they are desperate, that would be better....

 

[dchristismi]

Really, 12 hours shifts at an HCA shop in Florida in any of those towns... half of them have HCA residencies, so I admittedly drew some conclusions. They didn't bother to list pay, and I am certainly not going to ask because any time I start formulating an email, well, I can't tell if I'm playing the role of Ursula or they are. Those poor... unfortunate souls.

 

[Janders]

I don't try to solve any operational issues at my main job. Two years ago I used to, then I figured out the futility in it and the increased stress it causes. Now i just chill and see who I need to see. It baffles me how some of my colleagues with 20 years of attending experiences still get into the quagmire with some of this non-medical ****.

It’s my job at the main gig.
Plus we are classically fee for service open books so it behooves us all to try and fix somethings.
Also I like slamming my head into brick walls for fun, and my idol growing up was Sisyphus.

 

[RustedFox]

I am getting emails from recruiters using an email address I used, oh, 14 years ago with my married name from that divorce 14 years ago... about 10 different HCA jobs with 12 hour shifts. "Each locations has different start dates and rates."

Aw hell naw. That's just desperate nonsense, and sounds like an utter nightmare. Florida Man is right. (And I'm not referring to Fox.)

I got that very same email with those very same words and drew the very same conclusion.

I work at an HCA shop in SW FL, but we have no residents.

 

[thegenius]

septicons

Love it.

Starscream is brought in by medic for a BP of 60/30 and AMS.

 

[NYEMMED]

I quit my main job and I now do full locums

Found a sleepy more rural location paying $325/hour plus lodging/travel. Usually easy at night (I sleep about 5-6 hours) on a 12 hour shift.

Was offered a locums with USACS (never would I ever) 220/hour, supervising 3 midlevels in a high acuity ED.

My response to the recruiter “so the 220/hr is a quarter of the hourly pay right? Because you are describing a $600-800/ hour site….

 

[emergentmd]

I don't try to solve any operational issues at my main job. Two years ago I used to, then I figured out the futility in it and the increased stress it causes. Now i just chill and see who I need to see. It baffles me how some of my colleagues with 20 years of attending experiences still get into the quagmire with some of this non-medical ****.

This was true 20 yrs ago when I started to get into AMD then MD. Typically this is what happens

ER doc or other specialists gets pissed b.c of flow issues
Meetings happens, discussion at MEC
After 6 months of monthly meetings, metrics shows, nothing gets done
ER docs and specialists are worn down and don't care anymore so less complaints
Admin thinks they have fixed the problems b/c no more complaints
Now the ER is just as bad but now everyone has a new "normal" for how the ER should function.

Many times over, the only think Admin cares about if profit and the docs not complaining. They have no idea or care about fixing any issues. They have a great playbook that works every time.

 

[sylvanthus]

... and when those higher rates lure more docs from their full-time jobs, even more places will be short and need locums ... in turn necessitating higher rates ... and then ....

Sweet the nurse technique.

 

[emergentmd]

I have been out of the hospital game for about 5 yrs but CMGs must really be getting desperate.

1. I get almost daily email, txt messages offering jobs constantly AND even with rates which is atypical
2. Got a call from a recruiter I used to work w/ and probably liked me b/c they offered me a medical director years ago, ask me to name my rate. When I told her $1k/hr minimal, she was taken aback and said that was way above what they could offer. I would't even cover those sites for 1k/hr but just testing how desperate they are.
3. A hospital based partner, who works in a top 10 city and almost impossible to break into 10 yrs ago, was sick of how they were screwing with her schedule. She emailed them and gave her notice. She got a quick call from the RMD and begged to stay. When I left 5 yrs ago, they wouldn't even let me stay prn and now they are begging docs to stay.

 

[miacomet]

Sweet the nurse technique.

Exactly this. EM jobs are not offering a reason to stay- unpaid hours, benefits that aren't worth it, micromanagement, metrics, while ACA insurance is easily obtained, locums rates are somewhat higher, and no metrics/micromanagement. Why would anyone stay?

 

[bravotwozero]

This is a bit off topic, but a new locum position I applied for just sprung it on me that I have to do a hair drug test. This is after I've interviewed and already been given the position. This is ridiculous. I'm skeptical of whether I can pass it. Any way of getting around it, or do I just refuse and forfeit the position? Feels a bit awkward too.

If you have doubts about passing it, find another position. Your career is toast if you test positive. Not worth it.

 

[bravotwozero]

If I test positive with them, do they report it to the state/board/DEA?

They may or may not, but you might end up having to disclose this on a licensing renewal application or recredentialling somewhere.

 

[RustedFox]

If I test positive with them, do they report it to the state/board/DEA?

This nonsense agitates the hell out of me both ways.

 

[RustedFox]

I'm more than happy to do a UDS. But a hair test is invasive and narc like behavior. Not to mention my scalp hair is too short, and I don't have enough body hair, so I can't even technically do the test right now. I'd have to probably grow out my pubes or scalp hair.

Sure. UDS-es are flimsy.

Can and should a person be permitted to enjoy recreational substances in the privacy of their private life? Sure. Individual rights and freedoms FTW.

However, that also means that there's a likelihood that you're the irritating stoner that ruins my pinball nights out by being stupefied and smelly.

No. Drinking isn't the same.

 

[Apollyon]

I'm more than happy to do a UDS. But a hair test is invasive and narc like behavior. Not to mention my scalp hair is too short, and I don't have enough body hair, so I can't even technically do the test right now. I'd have to probably grow out my pubes or scalp hair.

I was going to say, shave your head!

 

[BoardingDoc]

Sure. UDS-es are flimsy.

Can and should a person be permitted to enjoy recreational substances in the privacy of their private life? Sure. Individual rights and freedoms FTW.

However, that also means that there's a likelihood that you're the irritating stoner that ruins my pinball nights out by being stupefied and smelly.

No. Drinking isn't the same.

Meh, I think they're similar. The average person who smokes weed isn't going out reeking of weed and acting like an idiot. They're the random person zenning out on their pinball machine next to you, they just happen to have eaten a gummy or hit their vape pen before they came in. The blazed ***** who reeks of weed is no different to me than the utterly s***faced guy who's trying to start a fight while barely standing up straight. They're just different flavors of a**hole.

This isn't so much a defense of smoking weed as it is an endorsement of moderation and not being a douchecanoe.