New PGY3 going into hospitalist medicine, how to set myself up over my final year to get the monies?

[CleverAlias]

I'm graduating residency in 2023 from a solid university program and going into hospitalist medicine. I'm single and have absolutely no geographical restrictions, and my goal over the next few years is to make as much money as I can so as to build a strong financial foundation for the rest of my life.

To this effect, I really don't care where I work so long as it's in a low tax location and the hourly rates are high. If it's Alaska or Wyoming, that's totally fine with me. If it's working shifts last second or on holidays, no problem. The only caveat to this is that I would like to take at least a few extended (3 weeks +) vacations per year to enjoy the fruits of my labor and would prefer not to do nights to avoid the health issues.

Theoretically at least locums should be my best bet, but I will have to acknowledge that I know nothing about the current state of the hospitalist locums market. Given that I am completely willing to uproot myself and move across the country at a moments notice, is the locums market robust enough to allow me to achieve the level of flexibility where I can consistently count on stringing together like 60 shifts in a 3 month period and then being able to take a month off before stringing together another big block of shifts? And what is a reasonable expectation for hourly rates doing locums if I am willing to go to wherever those hourly rates are highest?

Alternately, if I decide to just get a full time job in the classic 7 on/7 off schedule, is it common for these jobs to allow you to periodically work a couple of weeks in a row in order to get a couple weeks in a row off and variations thereof?

Finally, when is a good time to start looking and applying for jobs?

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[DrMetal]

and my goal over the next few years is to make as much money as I can so

Well, at least you're honest.

If you're seriously that flexible, locums might be the best way, and you can tend to negotiate for higher rates. Check out CompHealth.

 

[chessknt]

Locums, look for highest hourly rates. Your taxes will be complicated and the rest of your career will be impacted by having multiple state licenses (ie credentialing and future licensing will be exponentially more difficult). There are many downsides to locums especially straight out of training but for the highest possible pay that is the only answer. If you decide that having support in the hospital and making your future slightly less complicated are worth a hit to pay then you need to poke around listings in the midwest/southeast (ignore taxes at this point) and start getting an idea of where they are on the MGMA pay scale from the recruiter. If the listing is posted by a firm figure out where the job is WITHOUT contacting the recruiter and contact the hospital directly.

 

[rokshana]

Well, at least you're honest.

If you're seriously that flexible, locums might be the best way, and you can tend to negotiate for higher rates. Check out CompHealth.

Not CompHealth…they are terrible and shady with their compensation.
Weatherby, while a sister company to CompHealth, is better.

 

[rokshana]

Locums, look for highest hourly rates. Your taxes will be complicated and the rest of your career will be impacted by having multiple state licenses (ie credentialing and future licensing will be exponentially more difficult). There are many downsides to locums especially straight out of training but for the highest possible pay that is the only answer. If you decide that having support in the hospital and making your future slightly less complicated are worth a hit to pay then you need to poke around listings in the midwest/southeast (ignore taxes at this point) and start getting an idea of where they are on the MGMA pay scale from the recruiter. If the listing is posted by a firm figure out where the job is WITHOUT contacting the recruiter and contact the hospital directly.

As someone with 10 state licenses, it has not really made a difference for credentialing… but being clean from a malpractice standpoint is what has the biggest effect on credentialing… much faster when you are clean.

 

[DrMetal]

Not CompHealth…they are terrible and shady with their compensation.
Weatherby, while a sister company to CompHealth, is better.

I'm not that loyal to either, explore both. CompHealth paid me well once . . .but no reason to limit your search

 

[collegestud2013]

I'm graduating residency in 2023 from a solid university program and going into hospitalist medicine. I'm single and have absolutely no geographical restrictions, and my goal over the next few years is to make as much money as I can so as to build a strong financial foundation for the rest of my life.

To this effect, I really don't care where I work so long as it's in a low tax location and the hourly rates are high. If it's Alaska or Wyoming, that's totally fine with me. If it's working shifts last second or on holidays, no problem. The only caveat to this is that I would like to take at least a few extended (3 weeks +) vacations per year to enjoy the fruits of my labor and would prefer not to do nights to avoid the health issues.

Theoretically at least locums should be my best bet, but I will have to acknowledge that I know nothing about the current state of the hospitalist locums market. Given that I am completely willing to uproot myself and move across the country at a moments notice, is the locums market robust enough to allow me to achieve the level of flexibility where I can consistently count on stringing together like 60 shifts in a 3 month period and then being able to take a month off before stringing together another big block of shifts? And what is a reasonable expectation for hourly rates doing locums if I am willing to go to wherever those hourly rates are highest?

Alternately, if I decide to just get a full time job in the classic 7 on/7 off schedule, is it common for these jobs to allow you to periodically work a couple of weeks in a row in order to get a couple weeks in a row off and variations thereof?

Finally, when is a good time to start looking and applying for jobs?

Locums is an option as suggested above, but if you want to stay in once place and not have to learn a whole new hospital system frequently and have unpredictable job stability that comes with working as locums, some other options to make more money are to work as a nocturnist, work in an undesirable area (though on a full-time basis which will often still pay high), or work at a place that pays mostly by RVUs but staffs its hospitalists thinner so you are seeing high patient volumes (eg 25-30 patients per 12 hrs shift) but still with good subspecialty and ancillary support so you can safely and more efficiently see higher volumes.

 

[chessknt]

As someone with 10 state licenses, it has not really made a difference for credentialing… but being clean from a malpractice standpoint is what has the biggest effect on credentialing… much faster when you are clean.

Maybe if you have a an office elf doing all your paperwork for you but if you are filling out your own paperwork that is going to add lots of time and money to an application for licensing and make credentialing paperwork very complex because they'll want a supervisor/contact for literally every hospital you have ever worked at. Instead of that being a single page it can get to many many pages if you get around.

 

[rokshana]

Maybe if you have a an office elf doing all your paperwork for you but if you are filling out your own paperwork that is going to add lots of time and money to an application for licensing and make credentialing paperwork very complex because they'll want a supervisor/contact for literally every hospital you have ever worked at. Instead of that being a single page it can get to many many pages if you get around.

So you have found this to be difficult?
I keep a running file that has all my info in it…simple enough to send the packet with the information…just means you have to stay a bit organized.

 

[chessknt]

So you have found this to be difficult?
I keep a running file that has all my info in it…simple enough to send the packet with the information…just means you have to stay a bit organized.

Much more difficult than when it was literally one hospital. The hospitals I work at tend to restructure and the numbers stop working, supervisors quit etc. It isnt a reason to not do locums but it is something easily overlooked. The feds also won't let you send a packet, has to be on their forms in their format.

 

[CleverAlias]

When would be a good time to start contacting these locums agencies given that I do not graduate until mid 2023? Also, in addition to agencies, are there any large contract management groups that have "firefighter" positions similar to EM?

Locums is an option as suggested above, but if you want to stay in once place and not have to learn a whole new hospital system frequently and have unpredictable job stability that comes with working as locums, some other options to make more money are to work as a nocturnist, work in an undesirable area (though on a full-time basis which will often still pay high), or work at a place that pays mostly by RVUs but staffs its hospitalists thinner so you are seeing high patient volumes (eg 25-30 patients per 12 hrs shift) but still with good subspecialty and ancillary support so you can safely and more efficiently see higher volumes.

I'm only really familiar with the "flat" hourly rate/shift model. What is a ballpark annual figure you could expect to earn in a very busy RVU model setting doing 7/7? Can it approach 400k? Also, if I were to decide to do a fulltime job rather than locums I would definitely insist on being able to do locums on my off weeks if I wanted to. Is it common for jobs to try to bar you from moonlighting on your off weeks?

 

[collegestud2013]

When would be a good time to start contacting these locums agencies given that I do not graduate until mid 2023? Also, in addition to agencies, are there any large contract management groups that have "firefighter" positions similar to EM?



I'm only really familiar with the "flat" hourly rate/shift model. What is a ballpark annual figure you could expect to earn in a very busy RVU model setting doing 7/7? Can it approach 400k? Also, if I were to decide to do a fulltime job rather than locums I would definitely insist on being able to do locums on my off weeks if I wanted to. Is it common for jobs to try to bar you from moonlighting on your off weeks?

Maybe high $300ks in a busy RVU based payment if you're only doing the standard 7on7/off (~26 weeks, or ~2184 hrs per year, which comes out to about 15 shifts per month), full time, and only doing day shifts. To get to low $400k this way you will probably have to do extra shifts on your week off (likely 16-18 shifts per month)

Some jobs require you to get permission from your employer if you want to moonlight at an outside institution on your time off (to make sure it's not a conflict of interest), but many will offer opportunities to moonlight within the same institution which I think its much easier to do (though it may not pay as much per hour

 

[CleverAlias]

Maybe high $300ks in a busy RVU based payment if you're only doing the standard 7on7/off (~26 weeks, or ~2184 hrs per year, which comes out to about 15 shifts per month), full time, and only doing day shifts. To get to low $400k this way you will probably have to do extra shifts on your week off (likely 16-18 shifts per month)

Some jobs require you to get permission from your employer if you want to moonlight at an outside institution on your time off (to make sure it's not a conflict of interest), but many will offer opportunities to moonlight within the same institution which I think its much easier to do (though it may not pay as much per hour

Are such restrictive covenants industry standard or something you can reasonably expect to avoid if you look hard enough? To be frank, being restricted from moonlighting on my "off weeks" is a complete non starter for me. I may entertain some reasonable qualifiers such as not picking up shifts within my employer's catchment area but a blanket ban on on my ability do as I wish during the weeks I am not being paid for is out of the question.

 

[collegestud2013]

Are such restrictive covenants industry standard or something you can reasonably expect to avoid if you look hard enough? To be frank, being restricted from moonlighting on my "off weeks" is a complete non starter for me. I may entertain some reasonable qualifiers such as not picking up shifts within my employer's catchment area but a blanket ban on on my ability do as I wish during the weeks I am not being paid for is out of the question.

Probably more common in large health systems (especially academic institutions) but I wouldn't say it's industry standard. If you want to moonlight on your weeks off it's usually much easier just pick up extra shifts within your same institution anyways (rather than going through the hassle of getting credentialed at an outside hospital and learning a whole different system just to do a few extra shifts here and there).