Economics of outrageous Locum Tenens hourly rates

[rekrul]

I've been lurking around the EM forum for a while and I sometimes come across threads discussing $300/hr locum tenens contracts in unpopular areas such as rural Texas and parts of the Southeast (Louisiana, Mississippi, etc.) I'm just trying to wrap my head around how such rates are possible, and whether they're at all sustainable. I'll be starting medical school this year, and while insane money isn't my main motivation into looking at EM, it is the fuel of idle daydreams ! With that said, I'm attempting to analyze what drives these hourly rates in an effort to get a feel for whether they may still be around 7 odd years from now when I'm an attending.

With that said, here are the things I'm struggling to fully understand. I get that places in undesirable locations are forced to pay more to attract physicians, and furthermore that locums assignment pay even more on top of that due to urgent need during transition periods etc. But how can the patient bases in these out-in-the-boondocks locations support such lavish hourly rates? It's not like Mississippi and rural Texas are meccas of economic activity and the accompanying premium insurance that comes with it. Are hospitals offering these rates simply because they must staff their ERs during temporary periods while looking for permanent doctors even at the cost of losing money in the interim? Or are they actually still making money and this is possible because these areas have uncommonly generous reimbursement rates compared to places where an EM doc would struggle to pull in $180 on the best day?

From my perspective as someone who has struggled to literally eat growing up, these temporary, highly lucrative contracts seem too good to be true. I would be willing to fly even unto the ends of the earth for a 3 month contract working 20, 10hr shifts a month at
$300/hr. I don't care how brutal the work may be, you'd pocket $100,000+ even after tax, insurance etc for 3 months of work and could go chill in some foreign country for a couple months spending your loot before coming back for another X month contract. I can't imagine that there aren't enough young, single EM guys out there to jump all over these opportunities and drive down the rates. I can only hope these things are still around when I'm ready to join the party.

I realize that nobody has a crystal ball, but does anyone have a hunch regarding the sustainability of such gigs being there years into the future? In my own mind, I think that if high locum rates are driven primarily by high reimbursements, then they won't be there in a few years. If, however, they primarily reflect the difficulty of finding people at short notice to work in unpopular areas, then they have a better chance of persisting, since people will always be moving around and at any given time there will be hospitals trying to tide over until they can find someone to agree to settle down in Piedmont or whatever...

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[Birdstrike]

It's "fish stories."

Ever gone fishing with a group of guys? Yeah. They all caught bigger fish than you, that you couldn't believe, didn't they?

These are rates hospitals will pay in times of desperation to get short term staff coverage in desperate times of need, in underserved EDs. In other words, "We have no choice but to throw 3-4 times our normal wage at a doctor to get staff coverage, or the ER, and therefore the whole hospital, shuts down and we lose hundreds of thousand of dollars."

I wouldn't spend too much time daydreaming about it, as such rates don't last very long, because once a hospital in dire straits hires permanent docs, those teaser rates go away. There is a thing called a "firefighter" job, were people fly around going to these places to make higher wages, but from what I've seen, to actually find these places you've got to work through a staffing company who's going to take a large cut. Otherwise, you can't just randomly one day, fly to some hospital in Alaska to work 2 days, then Peurto Rico for three days if you don't have a license in either place, or hospital privileges in either place.

Also, such locations frequently are horrible to work or live at, and it is precisely for this reason that they can't get doctors.

So, yes you can make more more money working a desperate locations, but the sustained "too good to be true" wages, in all likelihood are too good to be true, for the vast majority of people, the vast majority of their career's shifts.

If you go into EM, or any other field, your going to make around the speciality average, +/- 20-30%, which is still pretty darned good. Inevitably, someone is going to chime in with some claim of $900/hr in Texas or $1,000,000 per year, that no one else can believe. My advice is not to get too daydreamie about the far ends of the spectrum, or anything that seems too good to be true, because it probably is.

 

[gman33]

starting med school this year = 7-8 years from this being a factor

don't waste any mental energy thinking about this now

 

[RustedFox]

It's "fish stories."

Ever gone fishing with a group of guys? Yeah. They all caught bigger fish than you, that you couldn't believe, didn't they?

These are rates hospitals will pay in times of desperation to get short term staff coverage in desperate times of need, in underserved EDs. In other words, "We have no choice but to throw 3-4 times our normal wage at a doctor to get staff coverage, or the ER, and therefore the whole hospital, shuts down and we lose hundreds of thousand of dollars."

I wouldn't spend too much time daydreaming about it, as such rates don't last very long, because once a hospital in dire straits hires permanent docs, those teaser rates go away. There is a thing called a "firefighter" job, were people fly around going to these places to make higher wages, but from what I've seen, to actually find these places you've got to work through a staffing company who's going to take a large cut. Otherwise, you can't just randomly one day, fly to some hospital in Alaska to work 2 days, then Peurto Rico for three days if you don't have a license in either place, or hospital privileges in either place.

Also, such locations frequently are horrible to work or live at, and it is precisely for this reason that they can't get doctors.

So, yes you can make more more money working a desperate locations, but the sustained "too good to be true" wages, in all likelihood are too good to be true, for the vast majority of people, the vast majority of their career's shifts.

If you go into EM, or any other field, your going to make around the speciality average, +/- 20-30%, which is still pretty darned good. Inevitably, someone is going to chime in with some claim of $900/hr in Texas or $1,000,000 per year, that no one else can believe. My advice no to get too daydreamie about the far ends of the spectrum, or anything that seems too good to be true, because it probably is.

Ahhh, this is abooout to get goood.

 

[The White Coat Investor]

I've been lurking around the EM forum for a while and I sometimes come across threads discussing $300/hr locum tenens contracts in unpopular areas such as rural Texas and parts of the Southeast (Louisiana, Mississippi, etc.) I'm just trying to wrap my head around how such rates are possible, and whether they're at all sustainable. I'll be starting medical school this year, and while insane money isn't my main motivation into looking at EM, it is the fuel of idle daydreams ! With that said, I'm attempting to analyze what drives these hourly rates in an effort to get a feel for whether they may still be around 7 odd years from now when I'm an attending.

With that said, here are the things I'm struggling to fully understand. I get that places in undesirable locations are forced to pay more to attract physicians, and furthermore that locums assignment pay even more on top of that due to urgent need during transition periods etc. But how can the patient bases in these out-in-the-boondocks locations support such lavish hourly rates? It's not like Mississippi and rural Texas are meccas of economic activity and the accompanying premium insurance that comes with it. Are hospitals offering these rates simply because they must staff their ERs during temporary periods while looking for permanent doctors even at the cost of losing money in the interim? Or are they actually still making money and this is possible because these areas have uncommonly generous reimbursement rates compared to places where an EM doc would struggle to pull in $180 on the best day?

From my perspective as someone who has struggled to literally eat growing up, these temporary, highly lucrative contracts seem too good to be true. I would be willing to fly even unto the ends of the earth for a 3 month contract working 20, 10hr shifts a month at
$300/hr. I don't care how brutal the work may be, you'd pocket $100,000+ even after tax, insurance etc for 3 months of work and could go chill in some foreign country for a couple months spending your loot before coming back for another X month contract. I can't imagine that there aren't enough young, single EM guys out there to jump all over these opportunities and drive down the rates. I can only hope these things are still around when I'm ready to join the party.

I realize that nobody has a crystal ball, but does anyone have a hunch regarding the sustainability of such gigs being there years into the future? In my own mind, I think that if high locum rates are driven primarily by high reimbursements, then they won't be there in a few years. If, however, they primarily reflect the difficulty of finding people at short notice to work in unpopular areas, then they have a better chance of persisting, since people will always be moving around and at any given time there will be hospitals trying to tide over until they can find someone to agree to settle down in Piedmont or whatever...

First of all, $300 isn't some ridiculous amount. We don't average that, but we had months where we made that this last year, and we see less than 1.5 an hour on average. So I hardly find it surprising that a desperate locums job would offer that.

I have seen a shift or several shifts offered at $4-500 an hour by desperate locums folks. I think it would be pretty hard to line that up for anything resembling long term.

And I'm not willing to go work in a terrible job in another state for a mere $300 an hour, especially if it required 20 ten hour shifts. You can have all those you like.

Try to remember your roots and grow into your income as slowly as you can. It happens faster than you think.

 

[Birdstrike]

.

 

[rekrul]

@ Birdstrike

Thanks for your detailed response. In particular with regards to this bit:

I wouldn't spend too much time daydreaming about it, as such rates don't last very long, because once a hospital in dire straits hires permanent docs, those teaser rates go away. There is a thing called a "firefighter" job, were people fly around going to these places to make higher wages, but from what I've seen, to actually find these places you've got to work through a staffing company who's going to take a large cut.......

Also, such locations frequently are horrible to work or live at, and it is precisely for this reason that they can't get doctors.

So, yes you can make more more money working a desperate locations, but the sustained "too good to be true" wages, in all likelihood are too good to be true, for the vast majority of people, the vast majority of their career's shifts.

That is of course to be expected. They're paying you above and beyond what the average doc can expect to make, and in return you're going to absorb pain. Is that a great way to live life for the long term? Of course not. But there is such a big emphasis on the issue of medical school debt that the mere existence of such gigs, unpleasant though they may be, is encouraging.

Of what consequence is 250k of student loans if one can pay it off with a mere ~100 "firefighter" shifts? You don't wanna be killing yourself at 50 with long stretches of shifts at remote sites, but I see nothing wrong with using a couple of years in your early 30's to pay off your debt, save some $$$, and use the flexibility of contract work to travel around for extended periods while doing it. From the perspective of a young guy with no family, isn't working 20 shifts straight at "firefighter" rates in Mississippi and then taking 20 days in Thailand better than spending 40 days in a "regular" job somewhere typical like suburban Boston at much lower rates and with at most a few days of continuous free time at a stretch?

Assuming those firefighter gigs exist, they seem quite perfect for someone starting out!

@White Coat Investor
That's great! I'm glad to hear that people are doing well, in contrast to a lot of doom and gloom we usually hear. (With the disclaimer that from a long-term macroeconomic standpoint I'm a doom and gloomer myself. Eh.)

 

[Birdstrike]

Ahhh, this is abooout to get goood.

Lol

 

[SoCuteMD]

Of what consequence is 250k of student loans if one can pay it off with a mere ~100 "firefighter" shifts? You don't wanna be killing yourself at 50 with long stretches of shifts at remote sites, but I see nothing wrong with using a couple of years in your early 30's to pay off your debt, save some $$$, and use the flexibility of contract work to travel around for extended periods while doing it. From the perspective of a young guy with no family, isn't working 20 shifts straight at "firefighter" rates in Mississippi and then taking 20 days in Thailand better than spending 40 days in a "regular" job somewhere typical like suburban Boston at much lower rates and with at most a few days of continuous free time at a stretch?

First of all, that 250k balloons during residency even if you pay some of the interest. At 7% interest, 250k becomes 350k before you are even done training.

Second, do not mistake making 250k for taking home 250k. By the time you have paid your taxes, you probably have somewhere in the range of 60% of that left. And don't forget your retirement contributions. And your health insurance. And your disability insurance.

Third, there's a reason these places have to pay a lot (and $300/hr really isn't a lot). They are usually understaffed. You may not have much (any?) specialty backup and it may be in a terrible medicolegal environment.

When a bunch of attending tell you that there's a lot more to the story, trust that there's a lot more to the story.

 

[Birdstrike]

@ Birdstrike

Thanks for your detailed response. In particular with regards to this bit:

I wouldn't spend too much time daydreaming about it, as such rates don't last very long, because once a hospital in dire straits hires permanent docs, those teaser rates go away. There is a thing called a "firefighter" job, were people fly around going to these places to make higher wages, but from what I've seen, to actually find these places you've got to work through a staffing company who's going to take a large cut.......

Also, such locations frequently are horrible to work or live at, and it is precisely for this reason that they can't get doctors.

So, yes you can make more more money working a desperate locations, but the sustained "too good to be true" wages, in all likelihood are too good to be true, for the vast majority of people, the vast majority of their career's shifts.

That is of course to be expected. They're paying you above and beyond what the average doc can expect to make, and in return you're going to absorb pain. Is that a great way to live life for the long term? Of course not. But there is such a big emphasis on the issue of medical school debt that the mere existence of such gigs, unpleasant though they may be, is encouraging.

Of what consequence is 250k of student loans if one can pay it off with a mere ~100 "firefighter" shifts? You don't wanna be killing yourself at 50 with long stretches of shifts at remote sites, but I see nothing wrong with using a couple of years in your early 30's to pay off your debt, save some $$$, and use the flexibility of contract work to travel around for extended periods while doing it. From the perspective of a young guy with no family, isn't working 20 shifts straight at "firefighter" rates in Mississippi and then taking 20 days in Thailand better than spending 40 days in a "regular" job somewhere typical like suburban Boston at much lower rates and with at most a few days of continuous free time at a stretch?

Assuming those firefighter gigs exist, they seem quite perfect for someone starting out!

In that context, yes, it's good. But don't listen to me. My opinion is just one.

 

[rekrul]

First of all, that 250k balloons during residency even if you pay some of the interest. At 7% interest, 250k becomes 350k before you are even done training.

Second, do not mistake making 250k for taking home 250k. By the time you have paid your taxes, you probably have somewhere in the range of 60% of that left. And don't forget your retirement contributions. And your health insurance. And your disability insurance.

Third, there's a reason these places have to pay a lot (and $300/hr really isn't a lot). They are usually understaffed. You may not have much (any?) specialty backup and it may be in a terrible medicolegal environment.

When a bunch of attending tell you that there's a lot more to the story, trust that there's a lot more to the story.

Good points. In this hypothetical example I meant 250k as the amount that you're saddled with on the day you become an attending, although I'm sure people who've done the private undergrad/private med school circuit can easily exceed that. Still, $300/hr to me is a lot! I'm not about to pretend I know anything about the intensity of the ER. It may very well be absolutely brutal to the point where after a couple of back to back shifts you don't wanna wake up the next day for the third in a row regardless of the money. I'll defer to the attendings and residents on that point.

But $300 is a lot if you're not from money:

• work a ten hour shift, buy yourself rent in a decent downtown apartment and food/entertainment for a month.
• work 20 such shifts, buy yourself a BMW 4 series, cash.
• work 200 such shifts, make what a typical corporate drone makes in ~6 years.

Sorry, I had to indulge in a little mental masturbation. Going back to my Ramen now

 

[SoCuteMD]

Good points. In this hypothetical example I meant 250k as the amount that you're saddled with on the day you become an attending, although I'm sure people who've done the private undergrad/private med school circuit can easily exceed that. Still, $300/hr to me is a lot! I'm not about to pretend I know anything about the intensity of the ER. It may very well be absolutely brutal to the point where after a couple of back to back shifts you don't wanna wake up the next day for the third in a row regardless of the money. I'll defer to the attendings and residents on that point.

But $300 is a lot if you're not from money:

• work a ten hour shift, buy yourself rent in a decent downtown apartment and food/entertainment for a month.
• work 20 such shifts, buy yourself a BMW 4 series, cash.
• work 200 such shifts, make what a typical corporate drone makes in ~6 years.

Sorry, I had to indulge in a little mental masturbation. Going back to my Ramen now

You're missing the point. Work a 10 hour shift, gross 3000, take home 1800. I don't know what downtown you are living in, but around here that will not cover food, entertainment AND rent unless you are living in a hole. Your math is off.

 

[GeneralVeers]

I'm writing this as I sit on a beach at a resort in therror Maldives. How do I pay for this you may ask? I am a recipient of these "outrageous" and "too good to be true" rates. I've been doing it for nearly two years now. I work 12 shifts per month and make twice as much as I used to make in a CMG full time.

The economics aren't as clear as they are made out to be here. A good example is the huge contract between HCA and EmCare. EmCare may lose money paying these exhorbitant rates at one HCA hospital, but in return HCA gives them very lucrative contracts elsewhere. If they failed to provide adequate staffinget at one site then they risk losing the entire deal.

Excuse me while I finish my Mai Tai.

 

[iish]

I'm writing this as I sit on a beach at a resort in therror Maldives. How do I pay for this you may ask? I am a recipient of these "outrageous" and "too good to be true" rates. I've been doing it for nearly two years now. I work 12 shifts per month and make twice as much as I used to make in a CMG full time.

The economics aren't as clear as they are made out to be here. A good example is the huge contract between HCA and EmCare. EmCare may lose money paying these exhorbitant rates at one HCA hospital, but in return HCA gives them very lucrative contracts elsewhere. If they failed to provide adequate staffinget at one site then they risk losing the entire deal.

Excuse me while I finish my Mai Tai.

Why are you reading SDN from a beach in the Maldives?

 

[xaelia]

Why are you reading SDN from a beach in the Maldives?

SDN is all he has to fill his sad, lonely, empty soul ....

It's a tragic tale, all too common in these parts.

 

[Birdstrike]

Why are you reading SDN from a beach in the Maldives?

He can't live without us, man. We're his umbilical cord.

 

[Birdstrike]

I'm writing this as I sit on a beach at a resort in therror Maldives. How do I pay for this you may ask? I am a recipient of these "outrageous" and "too good to be true" rates. I've been doing it for nearly two years now. I work 12 shifts per month and make twice as much as I used to make in a CMG full time.

The economics aren't as clear as they are made out to be here. A good example is the huge contract between HCA and EmCare. EmCare may lose money paying these exhorbitant rates at one HCA hospital, but in return HCA gives them very lucrative contracts elsewhere. If they failed to provide adequate staffinget at one site then they risk losing the entire deal.

Excuse me while I finish my Mai Tai.

Any sightings of the great White Whale Moby?

Are the pool-boys leprechauns serving pots of gold, free of charge?

Did Jerry Garcia pop up outta rainbows and jam acoustic Uncle Johns Band with you, too?

Either way, enjoy the hell out of yourself...

 

[rekrul]

I'm writing this as I sit on a beach at a resort in therror Maldives. How do I pay for this you may ask? I am a recipient of these "outrageous" and "too good to be true" rates. I've been doing it for nearly two years now. I work 12 shifts per month and make twice as much as I used to make in a CMG full time.

The economics aren't as clear as they are made out to be here. A good example is the huge contract between HCA and EmCare. EmCare may lose money paying these exhorbitant rates at one HCA hospital, but in return HCA gives them very lucrative contracts elsewhere. If they failed to provide adequate staffinget at one site then they risk losing the entire deal.

Excuse me while I finish my Mai Tai.

Nice!

This is a data point supporting the theory that "frictional under-supply" of ER docs is driving these rates rather than reimbursement differentials between regions. The question then becomes, how fast is the supply of EM boarded docs increasing? Since EM is a relatively new specialty, I'd imagine the bulk of practicing ER docs is at the beginning and middle portion of their careers rather than the end. In that case, each year the X number of graduating residents is basically an X net increase in the total supply.

Is anyone here familiar with the trend in residency spots? Is EM embarking on a heedless expansion of the sort that ruined pathology?

 

[shoal]

Nice!

This is a data point supporting the theory that "frictional under-supply" of ER docs is driving these rates rather than reimbursement differentials between regions. The question then becomes, how fast is the supply of EM boarded docs increasing? Since EM is a relatively new specialty, I'd imagine the bulk of practicing ER docs is at the beginning and middle portion of their careers rather than the end. In that case, each year the X number of graduating residents is basically an X net increase in the total supply.

Is anyone here familiar with the trend in residency spots? Is EM embarking on a heedless expansion of the sort that ruined pathology?

Yes. The number of residency positions in em is increasing, the number of midlevels are increasing. As for comparison to path, i am unsure and there have been numerous threads on sdn regarding this. It certainly has me concerned as a soon to be attending in july. I heed wci advice and plan on living small, pay my loans and pay my retirement.

Sent from my LG-D801 using Tapatalk

 

[Chip N Sawbones]

You're missing the point. Work a 10 hour shift, gross 3000, take home 1800. I don't know what downtown you are living in, but around here that will not cover food, entertainment AND rent unless you are living in a hole. Your math is off.

Well, to be technical if he were to only work one shift a month for the entire year he'd only be making 36,000 a year and would still be in the second lowest tax bracket. Depending on state taxes he'd be able to take home something like 30,000 of that, or 2,500 a month. In New Orleans where I live that would be quite reasonable for food, entertainment and non-hole rent. I know one shift a month isn't really a viable work schedule, certainly not with student loan payments, but it is kind of nice to know that in theory someone could work one day a month, goof off for the other 29 and still get by just fine.

 

[emergentmd]

No way to predict the future. Never pick a field when you are a med student b/c of finances. Todays EM could be tomorrows Pathology.

Speaking of now, there are many options to do well financially. I can only speak for the south but

300/hr is not difficult to find. Sure these places are not well staffed and specialists may be lax. It may sound scary but its really no biggie.

Locums are plenitful. You can work 10 dys a month and make 500K/yr. I know people who work 15/month for 3 months and take 3 months off for a long vacation.

As I am married with kids, my choices to do locums is less. I still try to do 1-2 shifts a month and make as much in 1 shift as i do in 3 shift at my current job. If things stay good with locums, i see myself going full locums in 3-5 yrs when kids are older. I can make my own schedule, work when I want. take all holidays off. Work only mornings if I want. I realize that I have to deal with the uncertainty of not having a secure job but hopefully in 3-5 yrs, My home will be paid off and have 1-2 Mil in retirement. travels would suck but i would work 4-8 dys a month which is bearable. I have my foot in the door so even if they stop paying such high rates, my contract is still signed.

If i just left residency and had nothing to hold me down to one place, i would do locums. Work really hard for 1-2 yrs. Save up/pay off loans. Then do 10dys/month and travel around the world.

 

[SoCuteMD]

Well, to be technical if he were to only work one shift a month for the entire year he'd only be making 36,000 a year and would still be in the second lowest tax bracket. Depending on state taxes he'd be able to take home something like 30,000 of that, or 2,500 a month. In New Orleans where I live that would be quite reasonable for food, entertainment and non-hole rent. I know one shift a month isn't really a viable work schedule, certainly not with student loan payments, but it is kind of nice to know that in theory someone could work one day a month, goof off for the other 29 and still get by just fine.

You are forgetting state tax, FICA (which is at a higher rate if you are self employed). After all that is said and done, you'd be lucky to have 2400 left to pay rent, food, car, auto insurance, health insurance and then any entertainment expenses (according to PaycheckCity.com - for a single adult with only 1 deduction, take home would be about 2350 not accounting for the higher FICA). If you're going to throw out unrealistic numbers (no one will hire you for one shift a month, by the way) at least try to do some due diligence on the numbers you are throwing out.

 

[GeneralVeers]

I definitely miss this forum a lot! I was even able to get just enough internet at at the far ends of the Earth to read this thread and post. Currently I'm sitting in Abu Dhabi on my way to London.

My lifestyle has definitely improved since doing locum tenans full time. Whereas I used to work 18-20 shifts per month before, I now work 12, and with the bump in hourly still make more money. I also make my own schedule and work when I want and how often I want.

Fellow Emergency Physicians, join me and break our shackles of CMG bondage! They've decided to commoditize us, so we should return the favor. Yes we're commodities, and the going rate is $300/hour, not the $150/hour they used to pay me after deducting "administrative fees". Make them compete for our warm bodies to fill their Sh*tty contracts! Hell, there's no reason we can't make it $500/hour if we are smart.

 

[Birdstrike]

I definitely miss this forum a lot! I was even able to get just enough internet at at the far ends of the Earth to read this thread and post. Currently I'm sitting in Abu Dhabi on my way to London.

My lifestyle has definitely improved since doing locum tenans full time. Whereas I used to work 18-20 shifts per month before, I now work 12, and with the bump in hourly still make more money. I also make my own schedule and work when I want and how often I want.

Fellow Emergency Physicians, join me and break our shackles of CMG bondage! They've decided to commoditize us, so we should return the favor. Yes we're commodities, and the going rate is $300/hour, not the $150/hour they used to pay me after deducting "administrative fees". Make them compete for our warm bodies to fill their Sh*tty contracts! Hell, there's no reason we can't make it $500/hour if we are smart.

Great post. Good to hear you're taking charge of your career and practice life. No one else should be able to control you. If you let them, they will.

Travel safe.

 

[Postictal Raiden]

No way to predict the future. Never pick a field when you are a med student b/c of finances. Todays EM could be tomorrows Pathology.

Speaking of now, there are many options to do well financially. I can only speak for the south but

300/hr is not difficult to find. Sure these places are not well staffed and specialists may be lax. It may sound scary but its really no biggie.

Locums are plenitful. You can work 10 dys a month and make 500K/yr. I know people who work 15/month for 3 months and take 3 months off for a long vacation.

As I am married with kids, my choices to do locums is less. I still try to do 1-2 shifts a month and make as much in 1 shift as i do in 3 shift at my current job. If things stay good with locums, i see myself going full locums in 3-5 yrs when kids are older. I can make my own schedule, work when I want. take all holidays off. Work only mornings if I want. I realize that I have to deal with the uncertainty of not having a secure job but hopefully in 3-5 yrs, My home will be paid off and have 1-2 Mil in retirement. travels would suck but i would work 4-8 dys a month which is bearable. I have my foot in the door so even if they stop paying such high rates, my contract is still signed.

If i just left residency and had nothing to hold me down to one place, i would do locums. Work really hard for 1-2 yrs. Save up/pay off loans. Then do 10dys/month and travel around the world.

Is this even possible? I'm genuinely interested in knowing the answer.

 

[emergentmd]

Is it possible for EM to be like pathology? Why Not. We could and are trending the way anesth is doing. There could be 1 MD to 4 Mid levels.

They could just use Family practice docs with Trauma course as standard of care in the ED. Who knows.

ALL I know is I make alot in my main job and will start to pick up high dollar shifts when i am needed.

 

[Birdstrike]

Is this even possible? I'm genuinely interested in knowing the answer.

Possible, but doubtful since EM is still in shortage mode. Pathology doesn't have EMTALA which is job security for EPs in the sense that there's too many patients to see 24/7/365. I think the days of standing around, not being able to find patients or work in EM are far off. Of all the things to worry about, I wouldn't worry about this one happening in the near future. It's only theoretical right now. You don't go from a shortage of BC/BE EPs one day, to a complete collapse of the job market the next.

When the daily harassment by recruiters ends, which is daily phone calls and emails regarding EDs that are short looking for coverage, I'll be the first to post here.

As someone not afraid to drop a post with plenty of doom and gloom if needed, I just don't see it (widespread unemployment amongst BC/BE EPs) personally. The more likely problem is that you'll have too many patients, more job offers than you need, and more shifts than you want or need.

 

[Plectron]

I would love to talk to someone about doing locums. Anyone interested in talking, please PM me, I don't want to hijack the thread.

 

[SoyMilk]

I definitely miss this forum a lot! I was even able to get just enough internet at at the far ends of the Earth to read this thread and post. Currently I'm sitting in Abu Dhabi on my way to London.

My lifestyle has definitely improved since doing locum tenans full time. Whereas I used to work 18-20 shifts per month before, I now work 12, and with the bump in hourly still make more money. I also make my own schedule and work when I want and how often I want.

Fellow Emergency Physicians, join me and break our shackles of CMG bondage! They've decided to commoditize us, so we should return the favor. Yes we're commodities, and the going rate is $300/hour, not the $150/hour they used to pay me after deducting "administrative fees". Make them compete for our warm bodies to fill their Sh*tty contracts! Hell, there's no reason we can't make it $500/hour if we are smart.

All it would take is a union. A single national all-powerful EP union. Just imaging the bargaining power of something like this...

 

[GeneralVeers]

I'm against unions, but in general if we stood up for our individual rights, and individually didn't allow the government and CMGS to push around and pay us less than what we're worth, we would have more power.

 

[link2swim06]

All it would take is a union. A single national all-powerful EP union. Just imaging the bargaining power of something like this...

If only there was a national organization that represented us. Cough, ACEP.

Waiting they support CMGs....

 

[NinerNiner999]

If only there was a national organization that represented us. Cough, ACEP.

Waiting they support CMGs....

If we unionized, and EP's refused to work, wouldn't that lead to an influx of FP and IM doctors covering EDs and devalue our specialty?

CMG's have proliferated in the regular retention of so called "Mercenaries" who only work at higher rates. They hold out for calls because of short staff, poor coverage, or holidays, and cash in on handsome hourly rates. I have a friend who was recently paid $800 per hour to cover a single shift. That is not hyperbole.

As more and more people do this, and as metrics and satisfaction continue to require more physician coverage, compounded with the effect of increased volume growth, our current model is not sustainable. Take heed.

 

[weasel23]

As more and more people do this, and as metrics and satisfaction continue to require more physician coverage, compounded with the effect of increased volume growth, our current model is not sustainable. Take heed.

How do you see it changing? Asking as a medical student.

 

[Arcan57]

How do you see it changing? Asking as a medical student.

ACT-style with more midlevels than docs. Get the midlevels to be rock solid on their patient satisfaction (since they'll be seeing most of the discharged/surveyed patients) and have a low threshold for kicking the case up to the doc and you can hold onto a contract at a profit while paying enough above market rate to the docs that you don't have to pay confiscatory shift bonuses.

 

[RustedFox]

CMG's have proliferated in the regular retention of so called "Mercenaries" who only work at higher rates. They hold out for calls because of short staff, poor coverage, or holidays, and cash in on handsome hourly rates. I have a friend who was recently paid $800 per hour to cover a single shift. That is not hyperbole.

As more and more people do this, and as metrics and satisfaction continue to require more physician coverage, compounded with the effect of increased volume growth, our current model is not sustainable. Take heed.

I too, know of a guy that got paid 800/hour for one eight hour shift. The shop is so crazy, that afterwards he said to me; "Bud, I'll never do that again."

I've hit 450/hour, but never more than that.

 

[emergentmd]

I hope this EP shortage gravy train keeps going for another 5 yrs. I have a full time job and young kids so picking up these shifts that comes last minute is difficult. But in 5 yrs when I go full locums, I can pick all these extra short shifts up.

During Dec, there were 20 shifts at my moonlighting job that offered me 500/hr x 12 hrs. If I didn't have a full time job, I would have picked up all 20 of those days raking in 120k. I only could pick up 2 shifts and got paid 14k b/c one shift paid me 650 per hr.

There were a few shifts right around christmas that offered me 975/hr but that is about the highest I ever seen.

It feels good for me to have the CMGs over a barrel and rake in the dough.

 

[SoyMilk]

I hope this EP shortage gravy train keeps going for another 5 yrs. I have a full time job and young kids so picking up these shifts that comes last minute is difficult. But in 5 yrs when I go full locums, I can pick all these extra short shifts up.

During Dec, there were 20 shifts at my moonlighting job that offered me 500/hr x 12 hrs. If I didn't have a full time job, I would have picked up all 20 of those days raking in 120k. I only could pick up 2 shifts and got paid 14k b/c one shift paid me 650 per hr.

There were a few shifts right around christmas that offered me 975/hr but that is about the highest I ever seen.

It feels good for me to have the CMGs over a barrel and rake in the dough.

I get it it's nice to brag. Still, I don't think any of this engenders positivity from anyone (colleagues / patients / etc) nor does it promote our interests.

 

[Apollyon]

I get it it's nice to brag. Still, I don't think any of this engenders positivity from anyone (colleagues / patients / etc) nor does it promote our interests.

"I don't brag, but I like to boast" - Kid Rock.

If you are still a med student, those glasses color what you say. I, as a weathered attending, applaud his post. If patients are coming here to comment, that's not their thing. I mean, we can't stop them, but this is simple economics, and, statistically, very, VERY few of them have EVER undertaken ANY economics instruction. It totally promotes our interests.

 

[richnathan]

Hey EM intern here with a couple questions. First, are higher salaries for locum available mainly in Texas, and Mississippi, or are they available in various parts of the country. Secondly, is it recommended to get a full-time gig at one location right out of residency to ease the transition to attendinghood, or would it be reasonable to start locums full time right away. PMs welcome! Thanks!

 

[Birdstrike]

Get the highest wage you can

 

[emergentmd]

I get it it's nice to brag. Still, I don't think any of this engenders positivity from anyone (colleagues / patients / etc) nor does it promote our interests.

Not bragging or even boasting. I am not sure why EM docs thinks its so taboo to state what many EM docs are aware of. I would say any EM doc that works in a big EM group have friends that moonlight and know what they make. It doesn't take a rocket scientist to figure out that if I made 275/hr at my main job and my partner is traveling to another city to pick up extra shifts, that he must be making atleast 350+/hr.

I also don't see why it is so bad to know that EM docs can make alot of money. Many specialists make way more than we do. So what we have the abilities to make alot?

Anyhow, I will go back to my hole and try not to offend

 

[emergentmd]

Get the highest wage you can

I second this. I held out for 6 months to get my contract. They finally had to cave in.

 

[Postictal Raiden]

I hope this EP shortage gravy train keeps going for another 5 yrs. I have a full time job and young kids so picking up these shifts that comes last minute is difficult. But in 5 yrs when I go full locums, I can pick all these extra short shifts up.

During Dec, there were 20 shifts at my moonlighting job that offered me 500/hr x 12 hrs. If I didn't have a full time job, I would have picked up all 20 of those days raking in 120k. I only could pick up 2 shifts and got paid 14k b/c one shift paid me 650 per hr.

There were a few shifts right around christmas that offered me 975/hr but that is about the highest I ever seen.

It feels good for me to have the CMGs over a barrel and rake in the dough.

I hope this job is available in 6 years. I'd do the 20 shifts/month for an entire year and have all my debt paid off.

 

[Hooper]

How do you actually go about doing Locums? Do you just sign with a staffing company (like Emcare or teamhealth) and just have them offer you jobs? What type of jobs are we talking? Like a month here and there at different hospitals all over the country. Or a couple of shifts at the same hospitals every month in the state you live in because you need to be licensed in that state? Forgive my ignorance.

I'm a second year resident and thinking about doing Locums after residency as I am single and have no family (and prefer it that way for now). Do you think it's a good idea for a fresh grad? I plan on moving to south Florida after residency as well

 

[GeneralVeers]

How do you actually go about doing Locums? Do you just sign with a staffing company (like Emcare or teamhealth) and just have them offer you jobs? What type of jobs are we talking? Like a month here and there at different hospitals all over the country. Or a couple of shifts at the same hospitals every month in the state you live in because you need to be licensed in that state? Forgive my ignorance.

There are two common approaches I've seen people use:

1. Sign up with a locums agencies who place you at various sites around the country for which they have contracts. You can usually decide which jobs to take and which to decline. This approach has the benefit of you not having to do much work yourself, other than show up for your shifts. The downside is your rate may be lower (the locums company takes ~30% off the top), and you can't work at that site or often geographic area if the locums company loses a contract due to non-compete clauses.

2. Find your own jobs. Scan the job listings and look for high-paying jobs. It usually doesn't take too much effort to figure out which hospital is the one mentioned in the job listing. AT that point I go directly to the hospital recruiter, or CMG staff who are in charge and work with them directly. The benefit is that you can sometimes negotiate a higher rate than what the locums listed, and you are free from any non-compete clauses. The downside is that you have to do a lot of the research yourself, and may have to book your own travel.

 

[Mad Jack]

300/hr in a locums 1099 position is before the 40% you have to save for taxes. Post-tax, that leaves you with $180/hr, with no health insurance or other benefits.

Can you find a locums that pays $300/hr? Sure. Will you come out ahead versus an employed position at $175/hr? Barely, if at all.

 

[GeneralVeers]

300/hr in a locums 1099 position is before the 40% you have to save for taxes. Post-tax, that leaves you with $180/hr, with no health insurance or other benefits.

Can you find a locums that pays $300/hr? Sure. Will you come out ahead versus an employed position at $175/hr? Barely, if at all.

Employed position at $180/hour would still have to pay 40% taxes, I know because I did that for 5 years. Actually my marginal tax rate comes out to about 27% after deductions.

At $300/hour, my benefits are worth about $41/hour. Subtract 30% for income tax and that leaves $181/hr net.

AT $180/hour employed, your employee benefits contribution would be about $20/hour (401K). That leaves $160/hour. Subtract 30% and you have $112/hour.

That means you have a net of about $700 per shift at the $300/hour locums job versus employed. Having worked for a CMG for 5 years, and doing locums for 2 years, I can tell you that these numbers are accurate.

 

[RustedFox]

I hope this job is available in 6 years. I'd do the 20 shifts/month for an entire year and have all my debt paid off.

You say this now. I said it "then" as well.

Its not do-able. The gulf from senior resident to attending is wide and deep.

 

[GeneralVeers]

You say this now. I said it "then" as well.

Its not do-able. The gulf from senior resident to attending is wide and deep.

I agree about the shifts. I never do 20/month. I'm perfectly happy with 12, and a max of 15 shifts per month. That gives me a lot of free time off.

 

[Mad Jack]

Employed position at $180/hour would still have to pay 40% taxes, I know because I did that for 5 years. Actually my marginal tax rate comes out to about 27% after deductions.

At $300/hour, my benefits are worth about $41/hour. Subtract 30% for income tax and that leaves $181/hr net.

AT $180/hour employed, your employee benefits contribution would be about $20/hour (401K). That leaves $160/hour. Subtract 30% and you have $112/hour.

That means you have a net of about $700 per shift at the $300/hour locums job versus employed. Having worked for a CMG for 5 years, and doing locums for 2 years, I can tell you that these numbers are accurate.

All assumptions below occur above the 125k bracket to neglect social security:

Maxing out your 403b at $180/hr only costs about $8.41/hr. Insurance costs are negligible (my last employer I paid about $42 biweekly for health, dental, and parking). Most of your earnings will fall in the 33% tax bracket, plus 2.9% for Medicare, netting $110/hr. $300/hr in 1099 status will cost you 0.08814% of income per check to max your SEP-IRA at 55k/year, 1% for health insurance, and 35.9% of post-deduction earnings, netting you a total of $192.24/hr with substantially higher retirement savings (55k versus 17.5k) and likely better health insurance. Contractor wins by a wide margin, you're totally right. I forgot to factor in the way SS doesn't really matter after a certain income bracket (which still isn't enough to close the gap).