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SaltyDog said:
With regards to that job, is making 28$/unit counting all the units he's generating supervising multiple rooms, or are they just paying him based on his time? If it's the former and he's supervising 2-4 rooms at all times that's not bad. If it's the latter or it's MD only that's embarrassingly bad.
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Lots of places in Southern CA are well below that 28 value so that tells you something about that market
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Ezekiel2517 said:
Lots of places in Southern CA are well below that 28 value so that tells you something about that market
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That's my market dude. My previous gig had a crap payer mix and no subsidy, and our unit still came in better than 28$. Rates are much higher in the South. I still wanna know how they are counting his units in that arrangement.

For all you padawans out there: If you are working a reasonable full time schedule MD only, you will generate 10-12K units/year. Now you can translate unit values to income.
 
I guess it also depends on how they count your units. Is it just the startup plus time, or do they include the add-on units for lines and blocks for post op pain, intrathecals etc? 28 is very low. So is 10-12 k units per year. I don't work too hard, and I don't remember making less that 15K units a year for the last 17 years. We count every billable unit.


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Wiscoblue said:
I guess it also depends on how they count your units. Is it just the startup plus time, or do they include the add-on units for lines and blocks for post op pain, intrathecals etc? 28 is very low. So is 10-12 k units per year. I don't work too hard, and I don't remember making less that 15K units a year for the last 17 years. We count every billable unit.


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15k units/year MD only is working pretty hard. Let's say you average 50 units/day which I find pretty typical factoring in call, light days, etc. if you only took 2 wks vacation that would be 12.5k units/yr. either you do ALOT of hearts or you live in the hospital when you aren't on vacation. Either way, good on ya for putting in that much time for that many years.
 
SaltyDog said:
That's my market dude. My previous gig had a crap payer mix and no subsidy, and our unit still came in better than 28$. Rates are much higher in the South. I still wanna know how they are counting his units in that arrangement.

For all you padawans out there: If you are working a reasonable full time schedule MD only, you will generate 10-12K units/year. Now you can translate unit values to income.
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Yes. My brother is in Los Angeles no subsidy. All MD. Blended units. Most guys generate 10-14k.

But the general guys make around $400-425k 1099 no benefits (take around 5-7 weeks off). The cardiac guys (who do Ob and General like my bother) make around $475-500k now. But revenue is decreasing. He was making close to $600k.

That's working around 60 hours a week as well and working post call for a few hours as well (post call guy takes room with least amount of units/shortest day). Or occasionally day off completely with zero units
 
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aneftp said:
Yes. My brother is in Los Angeles no subsidy. All MD. Blended units. Most guys generate 10-14k.

But the general guys make around $400-425k 1099 no benefits (take around 5-7 weeks off). The cardiac guys (who do Ob and General like my bother) make around $475-500k now. But revenue is decreasing. He was making close to $600k.

That's working around 60 hours a week as well and working post call for a few hours as well (post call guy takes room with least amount of units/shortest day). Or occasionally day off completely with zero units
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That doesn't sound good at all.
 
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SaltyDog said:
15k units/year MD only is working pretty hard. Let's say you average 50 units/day which I find pretty typical factoring in call, light days, etc. if you only took 2 wks vacation that would be 12.5k units/yr. either you do ALOT of hearts or you live in the hospital when you aren't on vacation. Either way, good on ya for putting in that much time for that many years.
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We had a thread in the private forum about this a couple of months ago.

I am in an MD only practice, averaging about 50 hours per week with 4 weeks vacation. Heavy Cardiac and Thoracic load, but certainly not overworked. Over past 12 months, I am just shy of 18000 Units. I am probably pretty average for my group and I would imagine the highest is around 20000 Units. I too think 10-12k/year is pretty low. 50 Units per day would be only working half days for me
 
sethco said:
We had a thread in the private forum about this a couple of months ago.

I am in an MD only practice, averaging about 50 hours per week with 4 weeks vacation. Heavy Cardiac and Thoracic load, but certainly not overworked. Over past 12 months, I am just shy of 18000 Units. I am probably pretty average for my group and I would imagine the highest is around 20000 Units. I too think 10-12k/year is pretty low. 50 Units per day would be only working half days for me
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Not doubting you at all. Doing a lot of hearts and thoracic is how you're able to crank that many units in that time frame. A generalist not doing the cardiac volume would need to put in a lot of hours (more than I or my partners would find acceptable) to bill that many units.

If I was generating those units I personally would expect to be making >650k as well.

I really outta join the private forum.
 
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SaltyDog said:
Not doubting you at all. Doing a lot of hearts and thoracic is how you're able to crank that many units in that time frame. A generalist not doing the cardiac volume would need to put in a lot of hours (more than I or my partners would find acceptable) to bill that many units.
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I think endo, ortho, or an ent room might be better for unit generation than cardiac or thoracic.
 
aneftp said:
Dentists can play the tax game the best of the medical professions. My dental friends claim w2 incomes around 50-60k while really pocketing (in real money) 250k or more. That's after paying their staff and expenses. And they work 4 days a week with Friday or Monday's business close. They do open one Saturday a month.
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I am sure that they do. It's called cheating on your taxes. Just like claiming phony deductions.
 
BLADEMDA said:
What are 1099 people doing about their health care? It seems HSAs are not allowed any longer on the exchange. How are most locums buying health insurance?

http://www.forbes.com/sites/gracema...r-attack-in-obamacare-exchanges/#7e1ae4dc1ceb
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Blade they still have them in Florida. The sneaky exchanges "hide" HSA compatible plans. You have to filter them out on the left hand side of healthcare.gov website under search options.

I found one for around $1150 a month for family of 4 with $3200 individual deductible. (They are "embedded") which means one individual is capped at $6450. The "max for the family is $13100. In Florida.

But like u said its getting harder and harder to fine.

And pre ACA. My premiums for HSA was $6000 max for family of 4 (max out of pocket everything including co insurance and deductible ) in 2013. With $750 a month PPO.

So in 2016 it's $1150 with essentially a max of $13100 and more narrow network "hmo"
 
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aneftp said:
Blade they still have them in Florida. The sneaky exchanges "hide" HSA compatible plans. You have to filter them out on the left hand side of healthcare.gov website under search options.

I found one for around $1150 a month for family of 4 with $3200 individual deductible. (They are "embedded") which means one individual is capped at $6450. The "max for the family is $13100. In Florida.

But like u said its getting harder and harder to fine.

And pre ACA. My premiums for HSA was $6000 max for family of 4 (max out of pocket everything including co insurance and deductible ) in 2013. With $750 a month PPO.

So in 2016 it's $1150 with essentially a max of $13100 and more narrow network "hmo"
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Because now we are paying for all the high-risk and Medicaid who were uninsured before.
 
BLADEMDA said:
What are 1099 people doing about their health care? It seems HSAs are not allowed any longer on the exchange. How are most locums buying health insurance?

http://www.forbes.com/sites/gracema...r-attack-in-obamacare-exchanges/#7e1ae4dc1ceb
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Just to add, older locums (age wise) probably benefit from obamacare since there are no pre existing conditions. It's not cheap. But most can afford the premiums (it's a tax write off any ways). Better than getting rejected on the individual market pre ACA.

Obviously the exchanges favor poorer people with subsidies.

But u can game the exchanges and retire early as well. My next door neighbor is retired bond trader from New York. Moved to Florida. Was paying $1200/month just for himself and another $600/month for his wife (wife 54) he is 59.

He's been retired since age 54 with pre existing condition (perforated bowel from diverticulitis at age 52). He barely found an insurer that would take him at age 55 when he went off cobra. They had a 12 month exclusion period (meaning they wouldn't cover any health expenses due to his colon or abdominal areas).

Now with obamacare he's paying $400/month for himself and his wife! Subsidies baby! Subsidies. Guess how? He's only showing income of around 55k! He's not even tapping his retirement accounts. All of that $55k is from dividends and stuff. Plus he's smart. He's got tax exempt muni bonds etc (he's a bond trader duh)

And his brought his $800k house cash.

So the major flaw of obamacare exchanges for subsidies is it doesn't take into account total assets. It's just takes into account income. Income is not assets. The 400% poverty line is $40k for one person.

So someone like my neighbor who shows a $55k Income and his MAGI is much less which is what the exchanges is based on. My neighbor is not super rich Wall Street but he's pretty comfortable. Enough to be on the golf course 3x a week. Enough to pay for everything he needs and take vacations to Europe twice a year. So obamacare helped with his early retirement.

It can help locums docs or docs who want to retire early before Medicare age.
 
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urge said:
I'm considering early retirement with some locums to supplement income. Somewhere between 3 to 6 months a year.

Few questions for those who have done locums before:

1 Do they pay for your flight? Let's say it is a 2 to 3 hr flight.

2 Do they pay for a car rental?

3 What is the going rate for cardiac? How much for call and overtime?

4 How do you deal with health insurance for the family?

5 How much money you think you can make working 6 months, taking call and overtime?
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I am a neurologist. I just converted from a $350k employed position to going full time locum. Will work about 6 months a year, at a rate of $2500 per day. Doing it to spend time with my children. I just did 35 days in a beautiful city for $75k. Taking 3 months off.
 
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neurochica said:
I am a neurologist. I just converted from a $350k employed position to going full time locum. Will work about 6 months a year, at a rate of $2500 per day. Doing it to spend time with my children. I just did 35 days in a beautiful city for $75k. Taking 3 months off.
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Does the 2500 daily rate include malpractice, car and living arrangements? Or do you pay for that yourself out of the 2500?
Is this a 12 hour day or an 8 hour day? Do you take your children and spouse with you?
Did you reach out to groups directly or did you through an agency?
Wow, didn't even know neurologists made 350K. Thats great.
Seems like you have an awesome gig.
 
neurochica said:
I am a neurologist. I just converted from a $350k employed position to going full time locum. Will work about 6 months a year, at a rate of $2500 per day. Doing it to spend time with my children. I just did 35 days in a beautiful city for $75k. Taking 3 months off.
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I'm impressed. Congratulations for taking the move.

Question:

Is the 2.5k for 8hr work, or are you taking call bringing the pay to that? Most of the anesthesia jobs pay 1.5k for 8 hrs which is ok but not that great in my opinion.
 
When I make my pitch I say I will be on call 24/7. However, in a month, I'll usually go in maybe twice. Last month I received 4 pages after 5pm all month and I handled it from my Rv.
 
First, i was working in a pseudo academic/ private practice center with $350k plus benefits working 1 week on/off. I started doing locum about 6 months ago and started testing waters off h0w things work, places that i was interested etc.

Does the 2500 daily rate include malpractice, car and living arrangements? Or do you pay for that yourself out of the 2500?

they cover malpractice and i cover everything else. I bought a kick ass 45 ft RV and live on it etc all tax deductible. hospitals usually want to pay for all this for $2000 a day- if they for an apt for 30 days @$2k and rental car for $1500 for the month, thats $3.5 of expenses for them. by charging $2500 a day, ill make and extra $15k and my expenses are around $2.5 a month (rv payment $300 mo, $500 food, $1000 month rv parking etc and pocket the rest.

Is this a 12 hour day or an 8 hour day?

i take call 24/7 call. last month, i went in maybe twice and I received 4 pages after 5pm.

Do you take your children and spouse with you?

yes. 2 kids under 4. i am trying to structured my locum business to where i only work when they are off from school i.e. summers, spring brake etc.....last month while on assignment, spent all week in watermarks, museums etc. i figure i can make about the same of what i make right now working 20 weeks a year.

Did you reach out to groups directly or did you through an agency?

agency first, then directly.

Wow, didn't even know neurologists made 350K. Thats great.

Yes, i am extremely happy with my salary, group, and the city where i am right now, but spending time with my family is more important to me (if i wanted too, i could make over 1 mil--two hospitals want me for the entire year) .i am still staying in my city--this will be my home base, but ultimately this is what the american dream is all about. I left the rat race and become responsible for my future.

Seems like you have an awesome gig.


chocomorsel said:
Does the 2500 daily rate include malpractice, car and living arrangements? Or do you pay for that yourself out of the 2500?
Is this a 12 hour day or an 8 hour day? Do you take your children and spouse with you?
Did you reach out to groups directly or did you through an agency?
Wow, didn't even know neurologists made 350K. Thats great.
Seems like you have an awesome gig.
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Wow neurochica, seems like you got it made. I can't imagine being on call 24/7 and only going back in twice in one month. Doesn't happen in the world of anesthesia. Call can suck ass!!
I may have to buy me an RV and try to be like you.
 
I have a couple friends who are psychiatrists. Both do quite well working 8-4 M-F with some pager call that consists of "I'll work you in next week." Or, "Go to the ER immediately."
However, the patients are difficult to deal with, and I had zero interest in spending a lot of time talking to the mentally ill. I don't have the patience for that.


--
Il Destriero
 
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Planktonmd said:
There was a time when neurology was a specialty that no one wanted to do and the salaries were in the range of family practice!
Everything in medicine is a cycle!
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350 one week on one off is way more than I'm getting. How is that even possible? Where does the money come from? I doubt the clinic and consultation brings that much money, specially if only working 6 mo out of the year.
 
urge said:
350 one week on one off is way more than I'm getting. How is that even possible? Where does the money come from? I doubt the clinic and consultation brings that much money, specially if only working 6 mo out of the year.
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There are new pharmaceuticals coming out to treat neurologic diseases. Some of these require infusions and many neurology clinics set up infusion centers. Rheumatology is another specialty seeing growth in that regard.

Neuro-ICU and stroke code teams are other ways that neurologists have expanded and diversified their practice over the past few years.
 
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urge said:
350 one week on one off is way more than I'm getting. How is that even possible? Where does the money come from? I doubt the clinic and consultation brings that much money, specially if only working 6 mo out of the year.
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I've seen a few jobs on gaswork one week on one week off for around 350k. You're on call everyday during your week on though, and that can suck.
 
Chloroform4Life said:
I've seen a few jobs on gaswork one week on one week off for around 350k. You're on call everyday during your week on though, and that can suck.
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It's different. The OR usually runs late past 9pm every day. If you work that late every day you would go insane. I doubt Neuro is regularly seeing patients past 9pm. For all I know they close the clinic at 5pm.

I know an anesthesiologist who used to do the 1 week on call 1week off thing and he burned out within a year.
 
Planktonmd said:
There was a time when neurology was a specialty that no one wanted to do and the salaries were in the range of family practice!
Everything in medicine is a cycle!
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Until the cycle is broken by midlevels. ;)
 
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Planktonmd said:
There was a time when neurology was a specialty that no one wanted to do and the salaries were in the range of family practice!
Everything in medicine is a cycle!
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No it's not. Look at pathology.
 
IlDestriero said:
I have a couple friends who are psychiatrists. Both do quite well working 8-4 M-F with some pager call that consists of "I'll work you in next week." Or, "Go to the ER immediately."
However, the patients are difficult to deal with, and I had zero interest in spending a lot of time talking to the mentally ill. I don't have the patience for that.


--
Il Destriero
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Unless they are on SDN.;)
 
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aneftp said:
It all depends on your life situation. Kids or no kids. Single (or spouse willing to travel with you or not travel with u!).

The "professional locums" I know who have done it 10 plus years love it. These guys (it's usually the guys) are usually in their 50s. Good health. Kids out of school. Some divorce. Some travel with their spouses. So lots of flexibility.

The key is to have flexibility if someone wants to take lots of time off in between assignments. Also as the poster said. The key is to find overtime/call assignments.

You point out stable income with full time job 25-30k w2 a month plus benefits. That's a good point.

But the professional locums is willing to go to the boonies work hard plus call. Make $10k plus a week (realistic money in today's tougher job market) Do it for 4-6 week blocks. Take 2-3 weeks off. That's how the game is played. Work hard. Makes lots of overtime. Take lots of time off.

Back in 2007. I was AVERAGING $55k a month as locums (plus having travel and hotel and car paid for). My starting rate was $200/hr (guaranteed 8 hours even post call) . Highest rate was $300/8 hours guarantee (they were desperate and I was already credendialed).

The big cities these days Try to cut locums cost by giving just $1200/8 hours and no overtime. That's only $24-28k a month no benefits. Again. It depends what you want. If you just want to be home in your own house and bed. It's perfectly fine. If those assignments are easy and you just want some income than they are fine as well.
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It's sad how things have changed
 
DetectiveAlonzo said:
Damn... neuro is starting to look pretty good....
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You say that until you've worked up your 457th octogenarian for "dizziness" and the gun barrel starts looking mighty inviting.
 
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Consigliere said:
You say that until you've worked up your 457th octogenarian for "dizziness" and the gun barrel starts looking mighty inviting.
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lmao ur bad Consigliere. Hope you're still killin' the game. Thanks for being a good role model.
 
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Neurology is just 40mins of guesswork until the MRI comes back.

Then it's diagnose and Adios.

"Well Mr. Smith, you have a very rare neuromuscular disorder."

"OK doc, so what are my options?"

"Oh there's nothing we can do for you, but isn't it interesting."
 
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SaltyDog said:
Neurology is just 40mins of guesswork until the MRI comes back.

Then it's diagnose and Adios.

"Well Mr. Smith, you have a very rare neuromuscular disorder."

"OK doc, so what are my options?"

"Oh there's nothing we can do for you, but isn't it interesting."
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LMAO. I swear that everytime we learned about some condition in neuro... it was noted that A) by the time the diagnosis is made, there's nothing you can do.... or B) we don't know what is actually going on and how whatever we DO use to treat it actually works...
 
I guess that shows how much room for growth there is in neurology. That is why it is one of the most exciting fields to a lot of people. It used to be just tpa for strokes, now they are actually going in there and extracting the clots
 
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anbuitachi said:
I guess that shows how much room for growth there is in neurology. That is why it is one of the most exciting fields to a lot of people. It used to be just tpa for strokes, now they are actually going in there and extracting the clots
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The neurologists ain't the ones doing that.
 
SaltyDog said:
Neurology is just 40mins of guesswork until the MRI comes back.

Then it's diagnose and Adios.

"Well Mr. Smith, you have a very rare neuromuscular disorder."

"OK doc, so what are my options?"

"Oh there's nothing we can do for you, but isn't it interesting."
Click to expand...

Neuro is what is known as a spectator sport.


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