If you're willing to sell your soul for 3 years, what're the possibilities?

[Ambogeo]

Say you had three years to work your butt off as an internal medicine doctor. No kids, no family. Maybe one day off in a week, two max.

You get 8 hours of sleep in the night, but work for the rest of the time you're up.

So what's the best way to make the most amount of money in that say 15 hours a day of work?

Locum jobs seem good, but are they stable? As in, can you get them week after week if you're willing to travel anywhere in the country?

Even night shifts and holiday shifts are fine.

So which way would make you the highest hourly pay and how much is that number?

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[Promethean]

Say you had three years to work your butt off as an internal medicine doctor. No kids, no family. Maybe one day off in a week, two max.

You get 8 hours of sleep in the night, but work for the rest of the time you're up.

So what's the best way to make the most amount of money in that say 15 hours a day of work?

Locum jobs seem good, but are they stable? As in, can you get them week after week if you're willing to travel anywhere in the country?

Even night shifts and holiday shifts are fine.

So which way would make you the highest hourly pay and how much is that number?

@cabinbuilder has given me reason to believe that someone working their tush off doing FM locums can see $300k out of it, and I don't think that involves working 365 days a year. I believe she takes off some time to see her family.

What I know from travel nursing is that there are a number of companies that are really good to work with and that will keep you as busy as you dare to be. To maximize your opportunities, you would want to have licenses in a few high need states.

You negotiate your terms. You can/should specify in your contract a minimum number of hours of work that you will be paid for, so that you don't get somewhere, find out that the need wasn't as great as you were given to believe, and be stuck sitting around not being paid. Again, what I know about is OR nursing, but the contract basics are kinda the same.

So, for travel nursing, a standard contract may be guaranteed 48 hours of pay, with hours above 40 paid at time and a half, for between 4 and 26 weeks. Additional overtime may be available. I've seen some contracts that were for 60 guaranteed hours, so either six 10 hour days or five 12s, or some other variation, but those are less common. Lodging and a vehicle may be included, or there may be a housing / travel stipend. Basically everything is negotiable, from hourly wage to hours to schedule to benefits to housing to perks. Everything. You pick what points really matter to you and which you can compromise on, and shop around for opportunities that come closest to your needs.

I think you will burn right out if you try to work 14 hour days, 6 days a week, 52 weeks a year x 3 years. It isn't absolutely impossible, but it would be absolutely miserable. But if you aim for 13 week assignments, you can take a couple weeks off in between each and still be sitting mighty pretty on income.

Be sure to consider the cost of a good accountant into your expenses, and plan on staying ahead of your taxes. Underpaying them can get very expensive when you have to catch up on them on the back end, especially if you are getting paid via 1099s and not as an employee.

 

[Promethean]

This appears to be a decent and comprehensive guide.

http://www.medpagetoday.com/KevinMD/41085

A little searching will yield much more info.

As for rates... A full time job is around 2000 hours per year of straight time, at 40 hours a week.

If you want to gross 300k, you need to arrange to be paid $150/hr for the equivalent of 2000 hours per year. Remember that isn't take home. That is before taxes, expenses, etc. Adjust expectations accordingly depending on how much you want to work, and how much you expect to get paid.

To take your proposed scenario to its unrealistic extreme:
If you did go all out and worked 14 hour days at $150/hr x 6 days a week, you could hit $300k in just 24 wks of work, assuming no overtime for extended hours. If you did manage to work basically every week, you might be able to more than double that.

 

[cabinbuilder]

Say you had three years to work your butt off as an internal medicine doctor. No kids, no family. Maybe one day off in a week, two max.

You get 8 hours of sleep in the night, but work for the rest of the time you're up.

So what's the best way to make the most amount of money in that say 15 hours a day of work?

Locum jobs seem good, but are they stable? As in, can you get them week after week if you're willing to travel anywhere in the country?

Even night shifts and holiday shifts are fine.

So which way would make you the highest hourly pay and how much is that number?

Locum jobs are VERY stable. I have done 9 month assignments and multiple locations. Usually the minimum is 3 months. Some jobs are sporadic holiday/weekend/vacation coverage. All depends on the need and the budget of the site.

 

[cabinbuilder]

"Be sure to consider the cost of a good accountant into your expenses, and plan on staying ahead of your taxes. Underpaying them can get very expensive when you have to catch up on them on the back end, especially if you are getting paid via 1099s and not as an employee."

Take this statement to heart. I got hit hard last year by paying both Oregon state income tax AND federal income tax and had to come up with $75,000 to cover both. Big OUCH.

 

[Ambogeo]

Wow! Thank you for all the advise and helpful answers.

If you don't mind me asking, what's the average hourly rate people make with locums?

And how much of this hourly rate do you keep (after malpractice, taxes, etc.)

And stay and transport is paid by the hospital in locums correct?

"Be sure to consider the cost of a good accountant into your expenses, and plan on staying ahead of your taxes. Underpaying them can get very expensive when you have to catch up on them on the back end, especially if you are getting paid via 1099s and not as an employee."

Take this statement to heart. I got hit hard last year by paying both Oregon state income tax AND federal income tax and had to come up with $75,000 to cover both. Big OUCH.

 

[cabinbuilder]

Wow! Thank you for all the advise and helpful answers.

If you don't mind me asking, what's the average hourly rate people make with locums?

And how much of this hourly rate do you keep (after malpractice, taxes, etc.)

And stay and transport is paid by the hospital in locums correct?

All locums jobs are different for sure. The lowest I made was $80 hr but that was a super long term assignment with all housing/rental care/ airline tickets paid for. The most I have made was $165 hr doing holiday coverage in urgent care. Pure hospitalist makes more of course. ER makes more. Just depends on the contract. I generally average $95/hr for 3-4 month urgent care/FM jobs.

Malpractice is covered by the locums company. You will have to figure out your taxes with what you ultimately keep

Be wary of working locums in states with state income tax. It doesn't matter where you live, if you work in a state that has state income tax they will tax YOUR ENTIRE YEARLY EARNINGS even if you only worked there part of the year. Be wary of this and be sure you talk to your accountant about that. Oregon is notorious for raking you.

 

[ThoracicGuy]

All locums jobs are different for sure. The lowest I made was $80 hr but that was a super long term assignment with all housing/rental care/ airline tickets paid for. The most I have made was $165 hr doing holiday coverage in urgent care. Pure hospitalist makes more of course. ER makes more. Just depends on the contract. I generally average $95/hr for 3-4 month urgent care/FM jobs.

Malpractice is covered by the locums company. You will have to figure out your taxes with what you ultimately keep

Be wary of working locums in states with state income tax. It doesn't matter where you live, if you work in a state that has state income tax they will tax YOUR ENTIRE YEARLY EARNINGS even if you only worked there part of the year. Be wary of this and be sure you talk to your accountant about that. Oregon is notorious for raking you.

When I did some 1099 work, I paid each respective state taxes on work done in that state. For places that I called my residence, I did pay taxes on all yearly income, though I did get a credit to taxes paid to other states.

Was Oregon considered your state of residence? With temporary jobs like that, couldn't you choose to live in a no income tax state as your base to minimize taxes?

 

[cabinbuilder]

When I did some 1099 work, I paid each respective state taxes on work done in that state. For places that I called my residence, I did pay taxes on all yearly income, though I did get a credit to taxes paid to other states.

Was Oregon considered your state of residence? With temporary jobs like that, couldn't you choose to live in a no income tax state as your base to minimize taxes?

When you look at the tax code for Oregon, they don't care that you don't live there. If you work there, they tax your yearly income. Believe me, I checked.



Part-year and nonresident:

 

[ThoracicGuy]

When you look at the tax code for Oregon, they don't care that you don't live there. If you work there, they tax your yearly income. Believe me, I checked.

That's ridiculous... That's one state I will never do locum in...

 

[cabinbuilder]

That's ridiculous... That's one state I will never do locum in...

Yep, that's the reason I don't work there anymore either.

 

[Mman]

That's ridiculous... That's one state I will never do locum in...

do any states care where you live? I know professional athletes have to file a state tax return in every state they play a game in because those states all consider the share of income from that game to be earned in and taxable in the state.

 

[PistolPete]

Be wary of working locums in states with state income tax. It doesn't matter where you live, if you work in a state that has state income tax they will tax YOUR ENTIRE YEARLY EARNINGS even if you only worked there part of the year. Be wary of this and be sure you talk to your accountant about that. Oregon is notorious for raking you.

I don't understand this. Do you mean they extrapolate your tax that is withheld, assuming that you will work there an entire year? In other words, if I work in Oregon for only 3 months, will they withhold a years worth of taxes, assuming I'll work there for a full 12 months?

 

[mvenus929]

I don't understand this. Do you mean they extrapolate your tax that is withheld, assuming that you will work there an entire year? In other words, if I work in Oregon for only 3 months, will they withhold a years worth of taxes, assuming I'll work there for a full 12 months?

Given that most of the time, they are being paid as 1099, I don't think the state withholds anything at all, but when you file taxes, you are responsible for income taxes for the entire year, even if you only worked for 3 months. And if you don't have that earmarked out, well...Or at least that's what the above posts seem to be implying.

 

[dpmd]

Oregon tax pub indicates they only tax Oregon sources of income for nonresidents but in order to be a nonresident you have to have another permanent home so perhaps that was the issue (or the accountant made an error which I have had happen before for me). Also possible is that the locums company was Oregon based in which case it would be considered Oregon source income.

 

[cabinbuilder]

I don't understand this. Do you mean they extrapolate your tax that is withheld, assuming that you will work there an entire year? In other words, if I work in Oregon for only 3 months, will they withhold a years worth of taxes, assuming I'll work there for a full 12 months?

Locums paychecks don't get taxes taken out. However, your accountant is bound to disclose your yearly wages. So..... I'm just talking the state of Oregon. Oregon tax laws for state income tax will bill you based on your yearly income regardless of the time actually worked in Oregon. I know this because it happened to me 2 years in a row.

 

[cabinbuilder]

Oregon tax pub indicates they only tax Oregon sources of income for nonresidents but in order to be a nonresident you have to have another permanent home so perhaps that was the issue (or the accountant made an error which I have had happen before for me). Also possible is that the locums company was Oregon based in which case it would be considered Oregon source income.

My locums company was based in Utah but the locums site I worked at was in Oregon so it was considered an Oregon source of income.

 

[dpmd]

My locums company was based in Utah but the locums site I worked at was in Oregon so it was considered an Oregon source of income.

Well yeah, but it sounded like you were saying you earned income at other sites outside of Oregon but still paid taxes to Oregon for it.

 

[cabinbuilder]

Well yeah, but it sounded like you were saying you earned income at other sites outside of Oregon but still paid taxes to Oregon for it.

I did. I worked 5 months in Wyoming but since I also worked in Oregon, the Oregon law based my state income tax on my total income, not just what I made in Oregon.

 

[dpmd]

I did. I worked 5 months in Wyoming but since I also worked in Oregon, the Oregon law based my state income tax on my total income, not just what I made in Oregon.

Did you work the other 7 mths that in Oregon? If so you would have been considered an Oregon resident so then they tax all your income from any source. However there is a specific clause for people how have a permanent home in another state and are just in Oregon for a temporary reason (which you would think locums would qualify as) and then you should only have paid taxes on your Oregon source income. If you didn't keep a permanent home somewhere else though then you would have been considered an Oregon resident.

 

[cabinbuilder]

Did you work the other 7 mths that in Oregon? If so you would have been considered an Oregon resident so then they tax all your income from any source. However there is a specific clause for people how have a permanent home in another state and are just in Oregon for a temporary reason (which you would think locums would qualify as) and then you should only have paid taxes on your Oregon source income. If you didn't keep a permanent home somewhere else though then you would have been considered an Oregon resident.

Water under the bridge. Just went by what the accountants told me.

 

[dpmd]

Water under the bridge. Just went by what the accountants told me.

They aren't always right so it is always good to know how to find out for yourself. Like I said, I have had accountants deal with pay earned in one area when having a permanent residence elsewhere incorrectly before.

 

[jacksparrow82]

Say you had three years to work your butt off as an internal medicine doctor. No kids, no family. Maybe one day off in a week, two max.

You get 8 hours of sleep in the night, but work for the rest of the time you're up.

So what's the best way to make the most amount of money in that say 15 hours a day of work?

Locum jobs seem good, but are they stable? As in, can you get them week after week if you're willing to travel anywhere in the country?

Even night shifts and holiday shifts are fine.

So which way would make you the highest hourly pay and how much is that number?

I've been doing this for the last 10 months or so now. I decided I wanted to pay off as much of my student loans as possible and start saving more aggressively for retirement. So, I started picking up extra shifts within my group (I work as a hospitalist). We have an optional "cross coverage" shift that is 6pm to Midnight. It pays 135/hr and consists mostly of answering the cross coverage pager and occasionally doing an admission or two. I also cover a pulm rehab program very occasionally (only pays like 75/hr, but doesn't involve any clinical work, just sit there in case of an emergency). In addition to these extra jobs, I also picked up extra patients on my rounding days, made sure to hit all my quality measures each quarter so I ended up with productivity and quality bonuses. I raked in a lot of extra money this year. I think my gross salary this year is up over $70k more than years past. It feels great though because I managed to pay down a ton of debt. I have one more loan to pay off with high interest rate and then I'm dialing back down to a normal amount of hours. I'm working a 6-midnight shift right now (in addition to rounding today). Doing the same tomorrow.
A girl I work with used to do locum work in a middle of nowhere town Kentucky that paid $2100/shift. I don't know the details, but she said she made a lot of money working for them. It was tough though because you have to get a hotel room and stay for the week (they pay travel expenses of course). So, bottom line is, there's tons of money out there to be made if you're willing to sacrifice the time. If you're young and have loans to pay or just want to boost your salary, go for it. Just be careful to practice good medicine and avoid errors. Don't over do it or you'll set yourself up for a lawsuit.

 

[Smart Money MD]

Many of the previous commenters mentioned locums in a rural area, which is probably one of the more sure bets to make bank in a short amount of time. You can also be more likely to maximize any pretax contributions too since you'd be working on a 1099 or in a self-employed status.

Another option would be simply to find a Hospitalist position with a group who is short of doctors. You can crank up your additional shifts and almost double your take if you want to live in the hospital. Likewise, you can also have a full-time Hospitalist position with options to moonlight at local urgent care facilities or even another hospital if you choose.