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deleted1150906
What are some of the highest offers you have seen for neurology ?
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Assuming you mean locums, $3600/day for in-person NCC, 8 hours guaranteed in-hospital and rest on-call from hotel. Tele: $5000/day for a 24-hour continuous shift.
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3k a day around KC area for neurohospitalist work.
Drhappyface
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Saw a post for $375/hr. $5000/24 tele is solid. What's usually rate for telestroke?
Is that tele stroke or tele general neuro ? Can you accept to do 1 24hr shift per month?
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deleted1158258
how long do these contracts run for? Are they reliable long term?
Is this an opportunity still ongoing? I think I know where you are talking about.
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I’ve found that most locums opportunities recently have been pretty disappointing in terms of pay, at least in my opinion. I make more in my day job without leaving my house (do tele) than most of these offers. Where are these $5k/day gigs? How are you all finding tele locums gigs? Very interested
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Most I have seen is about $300-350 per hour.
Most neurology locums though are about $200-250 per hour. You can get more of course if you are able to negotiate directly and cut out the middle man.
Most neurology locums though are about $200-250 per hour. You can get more of course if you are able to negotiate directly and cut out the middle man.
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In the nearby college town (70k population and within 1.5 hr drive from a 5M metro), a Locum opportunity for a mixed inpatient/outpatient work without call is $260/hr or about 2K a shift. As mentioned above, this is less than what I get paid per shift at my permanent job.
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Where is this happening?
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deleted1158258
so you're making over 600k as a neurologist?
I’m not sure how you got to that conclusion, but no.
I do know a few neurologists out there who do make that kind of money though.
Several discussions on that topic have been had in the past, some of which I participated in. You should search the forums.
I do know a few neurologists out there who do make that kind of money though.
Several discussions on that topic have been had in the past, some of which I participated in. You should search the forums.
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Unrelated question but are there neurohospitalist jobs that are week on week off, 7am-7pm, with no home call at night (once you leave the hospital at 7pm- you can sleep peacefully)? Locums or otherwise?
I actually prefer my residency life of no home call (have dedicated night coverage everyday)- but attendings don’t seem to get this luxury.
I actually prefer my residency life of no home call (have dedicated night coverage everyday)- but attendings don’t seem to get this luxury.
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Yes they exist but they are the minority
There are also jobs where you still are covering the nights from home but call is very light. These jobs tend to have either a separate stroke service or telestroke taking the stroke alert calls
There are also jobs where you still are covering the nights from home but call is very light. These jobs tend to have either a separate stroke service or telestroke taking the stroke alert calls
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Don’t forget that there are also plenty of purely outpatient locums opprtunities. You work only Monday to Friday without any call or any weekend obligations. And no inbasket obligations during your off-weeks.
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I’ve always wondered about that. Who takes care of replying to messages or following up on labs/images that you order during your outpatient locum
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The employed/staff neurologists have the responsibility of handling the inbasket/messages of the locums physicians when they are off/gone.
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What’s the pay like for this?
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Yeah, 250ish per hour for outpatient work is the number I got from a couple recruiters that keep calling me
Imo, that’s a low pay and needs to be higher to attract people. Maybe $300 is where I’d start to consider
Imo, that’s a low pay and needs to be higher to attract people. Maybe $300 is where I’d start to consider
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I recently signed on for an ongoing outpatient locums job in my city and only a 20-30 minute commute. It’s decent pay if you were to extrapolate it for working the whole year (Monday to Friday) - working out to $400-500k per year.
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deleted1139416
Is it common for people to chase the super high salaries in rural areas by flying there every couple weeks?
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@HipiMochi--I'm trying! Just starting my neuro-loco journey but very interested in working in rural areas--both if the income is higher and also because that's where my interest lies (I grew up in very rural areas--some of these places have patient's driving for 4-5 hours to see a neurologist--something very cool about being able to help alleviate that). Plus, since I have a family/two young kids I'm leaving behind I'd like to see if some of these places would be willing to let me triage some of the outpatient follow-ups to remote follow-up--I do think rural hospitals might be more flexible about this.
Re: Money--just to throw in my experiences, for my first contract I negotiated 275/hr for outpatient (negotiated up from initial 200/hr). One of my colleagues passed along an opportunity for 300/hr outpatient but doubt I get it (I could only offer a week a month due to prior commitment; I'm not too keen on bailing on an opportunity just b/c a higher rate comes along).
Re: Money--just to throw in my experiences, for my first contract I negotiated 275/hr for outpatient (negotiated up from initial 200/hr). One of my colleagues passed along an opportunity for 300/hr outpatient but doubt I get it (I could only offer a week a month due to prior commitment; I'm not too keen on bailing on an opportunity just b/c a higher rate comes along).
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While I'm at it--there probably would be some benefit to a "team locums" approach--I've heard of some surgical colleagues doing this--either banding up so they can do direct contracting (hospitals are more reluctant to negotiate with soloists vs groups, especially as the former can only provide patchy coverage) versus more easily by group negotiating with locums (at the very least we should be splitting referral fees--better a fellow neuron than Comphealth).
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Are you directly able to negotiate with hospitals rather than going through a locum company/ recruiter?
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You can in at least some situations but you would need to approach the employer/hospital directly right from the get go as opposed to using the locums company to get the postion and then trying to cut the middle man out. Some hospitals rely a lot on locums companies to fill their staffing needs and they won’t want to ruin this relationship.
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deleted1139416
Doesn’t locums also expand your options since these companies contract with multiple hospitals?
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I don't intend to pass myself off as an expert here re: direct vs locums. I have talked with a few admins on the other side (also Directmedstaffing LLC is a great educational resource on this topic).
It's always been a bit of a mystery why hospitals are reluctant to do the obvious and cut out the middleman. It should benefits us both, right?
That said, it seems like direct contracting is either an uphill battle (emailing a lot of places and a lot of convos that go nowhere) or oddly the hospital offers less going direct (and saving them money) vs the locums rate.
What I've heard/thought is that it boils down to:
--It's not the hospital administrator who is paying, so they care less and prioritize convenience. Hospitals know that locums will be expensive and budget for this so the administrator won't get blamed, whereas they probably would catch some heat if they try to save the hospital a few bucks by doing something a bit unconventional (direct contracting) and it falls through.
--Big locums companies offer at least the appearance of legitimacy and stability that a random doc emailing a resume in just can't. For that reason I've been told some systems have it specified in their bylaws that they will only work with a corporation (or they might even specify a few big locums companies for their staffing needs).
--Admin knows they won't be hassled by a bunch of negotiations, credentialling delays etc (or if it is, won't be their problem) as they might if they work working with a direct contractor. Just call a locums company, pay through the nose and all the inconvenience is handled by someone else.
--Even if this is a mis-interpretation of the law, the Stark law makes hospitals reluctant to be seen as overpaying a doctor via direct contracting, whereas shelling out a bunch of money to a locums company won't trigger an audit. In effect, locums companies provide the "service" of a deep pocket to receive cash.
--Hospitals also want to avoid the position of being seen as the physician's employer which would open them up to employment lawsuits etc. With the locums the locums companies handle this risk (side note: lobbying going on right now by the locums companies to draft legislation ensuring that they can continue to treat locums docs as contractors instead of employees).
--As a direct contractor sending out blind emails it is often difficult to get in front of the decision maker. With locums companies the decision maker is reaching out to you. I speculate that some of my emails just get lost in corporate bureaucracy.
TLDR: Direct contracting would be the dream--it's hard to think of a more wasteful use of society's healthcare $$$ than corporate profits for the locums companies, but from what I've heard and am experiencing it is still an uphill battle. Another dysfunction of our healthcare dollars.
It's always been a bit of a mystery why hospitals are reluctant to do the obvious and cut out the middleman. It should benefits us both, right?
That said, it seems like direct contracting is either an uphill battle (emailing a lot of places and a lot of convos that go nowhere) or oddly the hospital offers less going direct (and saving them money) vs the locums rate.
What I've heard/thought is that it boils down to:
--It's not the hospital administrator who is paying, so they care less and prioritize convenience. Hospitals know that locums will be expensive and budget for this so the administrator won't get blamed, whereas they probably would catch some heat if they try to save the hospital a few bucks by doing something a bit unconventional (direct contracting) and it falls through.
--Big locums companies offer at least the appearance of legitimacy and stability that a random doc emailing a resume in just can't. For that reason I've been told some systems have it specified in their bylaws that they will only work with a corporation (or they might even specify a few big locums companies for their staffing needs).
--Admin knows they won't be hassled by a bunch of negotiations, credentialling delays etc (or if it is, won't be their problem) as they might if they work working with a direct contractor. Just call a locums company, pay through the nose and all the inconvenience is handled by someone else.
--Even if this is a mis-interpretation of the law, the Stark law makes hospitals reluctant to be seen as overpaying a doctor via direct contracting, whereas shelling out a bunch of money to a locums company won't trigger an audit. In effect, locums companies provide the "service" of a deep pocket to receive cash.
--Hospitals also want to avoid the position of being seen as the physician's employer which would open them up to employment lawsuits etc. With the locums the locums companies handle this risk (side note: lobbying going on right now by the locums companies to draft legislation ensuring that they can continue to treat locums docs as contractors instead of employees).
--As a direct contractor sending out blind emails it is often difficult to get in front of the decision maker. With locums companies the decision maker is reaching out to you. I speculate that some of my emails just get lost in corporate bureaucracy.
TLDR: Direct contracting would be the dream--it's hard to think of a more wasteful use of society's healthcare $$$ than corporate profits for the locums companies, but from what I've heard and am experiencing it is still an uphill battle. Another dysfunction of our healthcare dollars.
I think another point of "convenience" for hospitals with locums companies is a bigger pool.
Let's say you have a job that needs filling and you get a doc from a locums company and the guy/gal is a nightmare. Well you can get rid of that person easily and replace with someone else who might be a better fit. Similarly it's easier to fill a schedule with docs from a company in particular and be assured of coverage rather than contracting one person solo.
It's pretty uphill. I've had a couple attempts and only one looks fruitful for now...and we haven't talked numbers yet so we'll see if it fails there.
Let's say you have a job that needs filling and you get a doc from a locums company and the guy/gal is a nightmare. Well you can get rid of that person easily and replace with someone else who might be a better fit. Similarly it's easier to fill a schedule with docs from a company in particular and be assured of coverage rather than contracting one person solo.
It's pretty uphill. I've had a couple attempts and only one looks fruitful for now...and we haven't talked numbers yet so we'll see if it fails there.
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locums definitely expands your options if you have flexibility to work in any state/locale. However, some may have a very narrow geographic focus in terms of finding work. Cold emailing/calling your local hospitals to find a per diem or locum-like arrangement is worth trying if you don’t want to settle down yet in a full time employed position. But like others have said, that’s not that easy either because of the politics involved and you could be competing against the more guaranteed inpatient coverage that locums and teleneurology companies can provide without having to btw pay for your malpractice.
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@Telamir: Agreed. I'm finding it very hard to get a place to negotiate with you directly if you are not able to provide comprehensive coverage. If they need to fill a six month block and you can only do 1 week/month then probably not worth it for admin. This is one of the main reasons I'm in favor of a "team locums" approach. In this day and age (especially with how many states are now IMLC) it doesn't seem like that insurmountable an obstacle to get a few neurologists together and offer a comparably deep bench.
Going through locums is a pain. At my current workplace I've pointed out that a good chunk of the stuff I'm doing (hospital follow-ups, a ton of EEG reading) can and should be done just as well remotely. Personally I'd rather use my on-ground time productively seeing patients who need to be seen in-person. I'd also be happy to do it at a major discount remote and they'd be happy to do it--but we are running into the snag that this is now a 3-sided negotiation as the locums company needs their cut. Ultimately I might just try to get my foot in the door and then pass this opportunity along to someone else.
Going through locums is a pain. At my current workplace I've pointed out that a good chunk of the stuff I'm doing (hospital follow-ups, a ton of EEG reading) can and should be done just as well remotely. Personally I'd rather use my on-ground time productively seeing patients who need to be seen in-person. I'd also be happy to do it at a major discount remote and they'd be happy to do it--but we are running into the snag that this is now a 3-sided negotiation as the locums company needs their cut. Ultimately I might just try to get my foot in the door and then pass this opportunity along to someone else.
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By the way--I'm an idiot. It's Flexmedstaff LLC, not direct medstaff LLC. No connection/not shilling. I just really support the guy's message of cutting out the locums company, and he's put out a lot of education on this topic.
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I remember that you were working (I believe) full-time teleneurology at one point? Did it not work out?
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Good memory!
Moving on for a couple of reasons, much of which were initial concerns that I just couldn't figure out a way around.
One of the main ones is that I really enjoy practicing all aspects of neurology--some inpatient, some outpatient, some procedures (EMG/NCS, LP/botox), some EEG. I did an old school clinical neurophys fellowship 50/50 because I thought that would give me the most variety.
It's been harder than expected to arrange that around a telemedicine schedule. Local practice options are very limited; in particular I'm a much less appealing candidate if I can only work 1-2 days every other week. Locums would have been painful with a week on/week off schedule, especially for outpatient (they want 6 month minimum commitments).
Teleneuro was nice in some ways--you can't beat the commute or the chance to sport the "telemed mullet" (fancy up top, party down below). That said I found certain aspects draining--overhead is high so productivity is very important. I tend to be pretty thorough so this often meant looooooong days on my keister.
It can be a little boring--often initial consults will be staffed by someone else which leaves you the job of being an MRI follow-up monkey. Case variety is pretty limited, and often the difficult cases aren't well suited for telemedicine IMO, which is more built for bread and butter TIA follow-up, seizure etc.
Ideally I'd like to talk some of these rural hospitals into letting me do a hybrid on-ground/telemedicine schedule (ideal ideal would be a couple of hospitals, possibly with a few partners--I hate having only one client/boss). I always wanted to do rural medicine and I'm hopeful that they would be flexible.
YMMV. Happy to share my experience if you are going that route.
Moving on for a couple of reasons, much of which were initial concerns that I just couldn't figure out a way around.
One of the main ones is that I really enjoy practicing all aspects of neurology--some inpatient, some outpatient, some procedures (EMG/NCS, LP/botox), some EEG. I did an old school clinical neurophys fellowship 50/50 because I thought that would give me the most variety.
It's been harder than expected to arrange that around a telemedicine schedule. Local practice options are very limited; in particular I'm a much less appealing candidate if I can only work 1-2 days every other week. Locums would have been painful with a week on/week off schedule, especially for outpatient (they want 6 month minimum commitments).
Teleneuro was nice in some ways--you can't beat the commute or the chance to sport the "telemed mullet" (fancy up top, party down below). That said I found certain aspects draining--overhead is high so productivity is very important. I tend to be pretty thorough so this often meant looooooong days on my keister.
It can be a little boring--often initial consults will be staffed by someone else which leaves you the job of being an MRI follow-up monkey. Case variety is pretty limited, and often the difficult cases aren't well suited for telemedicine IMO, which is more built for bread and butter TIA follow-up, seizure etc.
Ideally I'd like to talk some of these rural hospitals into letting me do a hybrid on-ground/telemedicine schedule (ideal ideal would be a couple of hospitals, possibly with a few partners--I hate having only one client/boss). I always wanted to do rural medicine and I'm hopeful that they would be flexible.
YMMV. Happy to share my experience if you are going that route.
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BTW there's a database on Facebook's Physician side gigs of locums and other job rates--- Www.Facebook.com/groups/physiciansidegigs Admittedly not a lot of data points yet, but helpful if everybody contributes
At the point where you're negotiating group locums directly with hospitals, what you're essentially doing is starting a private practice, so while it would be technically better to cut out the middleman you have to be willing to become an entrepreneur. I think its an interesting idea but it'll be a lot of work.
Also, there used to be someone on this forum who did full time locums and posted a lot about doing all the negotiations directly - neurochica I think? Something like that
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Thanks for sharing your experiences, it's nice to get feedback from someone who did it for a while.
I did my share of locums in the past, but honestly, it get harder as you get older. The frequent traveling, living in hotels, learning new EMRs, and constantly re-introducing yourself in new places is much, much easier when you're in your 20s and 30s. When I was doing locums, it tended to be at the same couple of places close to home. That said, some of the aspects you mentioned (lack of variety, following up on tests ordered by previous neurologists, etc.) is probably common to both teleneurology and (at least inpatient) locums neurology. The pressure to see more patients per shift is undoubtedly more of a teleneurology thing, though (again, compared to inpatient locums neurology, where what you get is what you get and is more hospital-dependent).
The idea of neurologists grouping together to offer continuous coverage is intriguing, but as others have pointed out, I wonder if it's not dissimilar from what a lot of the teleneurology companies are doing, and do hospitals and patients prefer in-person neurologists that much over teleneurologists?
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Thank you for the feedback--I think you're kinda right but I kinda disagree too. IDK about a lot of work. Some work perhaps?
IMO there are many ways to skin a cat.
--If going the locums route: At the very least's a point of leverage if there's enough semi-mobile neurologists that you can offer to bring someone else in on an opportunity--we know that bringing someone else in is worth something to the locums companies (or else they wouldn't give you the standard 2k referral bonus). Even if it's only splitting that referral fee or bargaining an extra 10 bucks/hour (100 bucks/day, 500/week), I think it would be worth it to compile an email list/chain/SDN thread/whatever that if you get a genuinely good opportunity (i.e., let's not spam each other) you can kick these things out. Quick and costs only the time to send out an email.
Ultimately locums companies have to realize that it's a better proposition to give up some money on margin to make it back on volume--the Costco model. There are a few recruiters who do this and seem honest/trustworthy, though too many of them seem to think they can charm/"Wolf of Wall Street" their way into making an extra 50-100 bucks/hour off me by talking my rate down. Negotiating as a group also makes it easier to ensure you won't be dropped if you negotiate a high rate (e.g., if I get myself 24k/week but can only do one week a month, and they hire 3 others at for 20k/week, pretty sure my shifts will start to disappear) or otherwise exploited.
Mildly entertaining side note: I used to have entertaining conversations with a Barton recruiter--persistently the worst IMO--who was so condescending about explaining to me how locums worked and why my suggested rates of 250/hr outpatient, 275 inpatient weren't realistic. I'd let him putter on for awhile then mention I currently had more business than I can handle at 275/hr outpatient. A month or two later he'd forget we talked and try again. Usually I'm a genuinely empathetic guy even w/ locums recruiters (tough job!), but this guy was sooooo patronizing I couldn't help it.
So the easiest way to do it would be to get enough locum neurologists on a thread/email chain, get a few of the more trustworthy sounding recruiters and tell them if they get an opportunity paying $x/hour outpatient or $y/inpatient then there's enough people that they will probably get it filled. Again--make money on volume, not margin.
Slightly harder would be just having a business development person (?part time, ?independent contractor) do the cold calling/beat the bushes for business in exchange for a commission (you'd have to have ?10 to make this appealing). Have group/shared calendar and thumbnail of skillsets so they know availability. (Licensing is becoming much less of an issue d/t spread of IMLC, though it could rule out <3 month opportunities).
Alternatively split the cost for a locumssmart subscription (this is where a lot of the locums companies get business via direct bidding)--15 k/first six months then 1k/month thereafter.
From there, handle it like a per diem job (directly expense malpractice, travel etc).
--Slightly harder would be direct contracting. I actually messaged with neurochica about this (if you're still haunting the forums--you rock! Thank you). I really don't think the obstacles are that insurmountable--Flexmedstaff.com (no affiliation--just a big fan) has an education section about this. Anyways, yes, initially sending a bunch of cold emails (?Virtual assist at 12/hr) and once a few contracts in the bag I think it would be an old-school group private practice style partnership but with a lot of the work triaged to remote/tele.
Finally there's this: I'm a solo earner dad with two young kids I want to be away from as little as possible, and live in a city where I'm just not willing to work for love (academic center w/ annual salary <$200k) nor money (dumpster fire of a department in the alternative cross town). I really enjoy what I do, but I've seen the downsides of both corporate and tele-medicine.
Ultimately, I just don't have a flipping choice about trying something unconventional. I suspect I'm not alone.
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I know, man. Travel sucks, hotel/airline miles aside. Long-term I think I can do 1 week away (at least till my kids get old enough they don't want to hang out with me anyways). Big issue w/ locums for me is that it's good pay for a week, then I'm twiddling thumbs for 3 weeks.
--Re: Teleneuro--I just think that while teleneuro has some cool abilities, it also has the potential to be really pushed into a widget, assembly-line style of medicine.. Cost structure is a big part of this--it dictates the productivity needed to stay profitable. The result is 1) tele by large, nationwide companies is probably not as cheap as one might think and 2) there's a lot of "hidden" costs--increased LOS (quick visits lead to the lots of testing/treat everything as a stroke approach). Finally, I think while tele-neurology is somewhat reasonable for inpatient (great for stroke/seizures, though it doesn't work well for somatoform, anything peripheral, neuro-ophtho), it's not very good for outpatient initial visits at least.
I do know a guy who's doing combined 1 week on ground/3 weeks off-site (rural system, does outpatient/inpatient, triages patients to remote follow-up), also helps get an APP up to speed and staffs for questions).
I've approached a few rural hospitals about this with some (fingers crossed) interest. I'd imagine pre-Covid they'd have thrown me out on my ear. I'd still rather work with a group of partners to a) have relationships with a few hospital systems, and b) tbh, always felt like this was just the best way to practice before corporate medicine killed it.
--Re: The lack of variety is one of the main reasons I wanted to practice rural and did a 50/50 neurophys track--a true generalist, ideally with some affiliation with a local academic program so I didn't get too divergent. Plus seeing people who actually need to be seen is much more fun anyways.
