State of Locums market

[nimbus]

I’m very familiar with enloe. I know the details well duh. I worked there briefly after that event.

The only difference between enloe and other hospitals using locums docs is how well they sweep bad events under the table. Just within the past 12 months. I know 4 hospitals including top rated hospitals very similar events. Deaths, patient recall (locums didn’t turn on sevo during long eras case and patient complaints , wrong sided blocks. You name it. It’s happened with locums.

You really think this stuff doesn’t happen everywhere? It does. Sheer volume of cases are hospital everywhere. Stuff happens. Yes deaths.

I have a large network of friends everywhere.

Just two days ago. Locums got patient coded with bad intravascular nerve block.

Just depends how well the hospitals cover things up

2 years ago Gi doc killed a patient having rn push propofol on Saturday morning cause anesthesia was not available cause doing cases in OR. Did you hear about it? Nope.

If you “know the details” why would you write this?

But nothing I see as true clinical incompetence to be honest. Just dishonestly.

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[Anesthesia_Guy]

2 years ago Gi doc killed a patient having rn push propofol on Saturday morning cause anesthesia was not available cause doing cases in OR. Did you hear about it? Nope.

I did and it still angers me to this day.

 

[aneftp]

If you “know the details” why would you write this?

The media reports what they want to report. From California to New York to Texas to Florida etc.

Same stuff happens. Just different locations and how it’s reported or not reported.

 

[coffeebythelake]

I did and it still angers me to this day.

Did this make the internet news? Link to article? I hope thr GI lost his license. And the nurse involved???

 

[aneftp]

My friend just made 30k this weekend taking 72 hr call in house (with Crnas). Not a trauma hospital but they only had 2 cases Saturday. Sunday they got slammed with 14 cases to 3am.
Friday was average daytime. Busy to 11pm than nothing.

I just made almost 25k just doing beeper call at slow community hospital doing 2.5 days of call. Beeper rates all Negotiable. I negotiated a very high beeper rate. Guess it depends how desperate the hospital gets or the amc gets. Total of 4 Or cases with crna and I did one cs myself and a couple of epidurals. Slow ob hospital. That’s it. Not bad. At hotel watching college football Saturday and nfl on Sunday.

But I’d prefer to get this gig closer by that pays $2k every 24 hours and do nothing from home. $400/hr if called in. These dudes off load work to sister hospital where people can make 7k-8k they working for it potentially to 9-10pm solo cases Work smarter not harder. So I’d take the $2k to sit at home and do nothing to be honest and manipulate the work load at sister hospital.

Lots of ways to make side hustle 1099 money.

The money for 1099 is in the calls. Not the daily grind of 7-3/5pm

 

[dabears505]

All the recent locums we have had have all been excellent. Some even fellowship trained. The current day locums are not like the old school locums.

 

[mrrogers]

My friend just made 30k this weekend taking 72 hr call in house (with Crnas). Not a trauma hospital but they only had 2 cases Saturday. Sunday they got slammed with 14 cases to 3am.
Friday was average daytime. Busy to 11pm than nothing.

I just made almost 25k just doing beeper call at slow community hospital doing 2.5 days of call. Beeper rates all Negotiable. I negotiated a very high beeper rate. Guess it depends how desperate the hospital gets or the amc gets. Total of 4 Or cases with crna and I did one cs myself and a couple of epidurals. Slow ob hospital. That’s it. Not bad. At hotel watching college football Saturday and nfl on Sunday.

But I’d prefer to get this gig closer by that pays $2k every 24 hours and do nothing from home. $400/hr if called in. These dudes off load work to sister hospital where people can make 7k-8k they working for it potentially to 9-10pm solo cases Work smarter not harder. So I’d take the $2k to sit at home and do nothing to be honest and manipulate the work load at sister hospital.

Lots of ways to make side hustle 1099 money.

The money for 1099 is in the calls. Not the daily grind of 7-3/5pm

what state are you in?

 

[aneftp]

what state are you in?

It’s everywhere. the South. West coast east.
The plains the dakotas. Southwest. Southeast. Northwest northeast.

The goal is to make administration pay for their mistakes. There is no loyalty anymore.

 

[CubsDynasty]

The perfect spot is an AMC takeover that can't get through a non-compete (or doesn't get the old team to jump ship) and the hospital covers/subsidizes Locums pay so they don't care. (...Drools a little)

 

[aneftp]

The perfect spot is an AMC takeover that can't get through a non-compete (or doesn't get the old team to jump ship) and the hospital covers/subsidizes Locums pay so they don't care. (...Drools a little)

Correct. Follow the money flow who is actually paying the locums bill.

Usap i find has the tightest purse strings if it’s “their money”.

Now if it’s the hospital money. Usap won’t care. Imagine that.

That’s what I think went wrong with sound anesthesia (their 1099 division is called echo I think) in Oregon. Sound didn’t want to pay for locums out of their own pocket. Hospital didnt either.

As in life. It’s always about the money

 

[Status Sciaticus]

My friend just made 30k this weekend taking 72 hr call in house (with Crnas). Not a trauma hospital but they only had 2 cases Saturday. Sunday they got slammed with 14 cases to 3am.
Friday was average daytime. Busy to 11pm than nothing.

I just made almost 25k just doing beeper call at slow community hospital doing 2.5 days of call. Beeper rates all Negotiable. I negotiated a very high beeper rate. Guess it depends how desperate the hospital gets or the amc gets. Total of 4 Or cases with crna and I did one cs myself and a couple of epidurals. Slow ob hospital. That’s it. Not bad. At hotel watching college football Saturday and nfl on Sunday.

But I’d prefer to get this gig closer by that pays $2k every 24 hours and do nothing from home. $400/hr if called in. These dudes off load work to sister hospital where people can make 7k-8k they working for it potentially to 9-10pm solo cases Work smarter not harder. So I’d take the $2k to sit at home and do nothing to be honest and manipulate the work load at sister hospital.

Lots of ways to make side hustle 1099 money.

The money for 1099 is in the calls. Not the daily grind of 7-3/5pm

what was your negotiated beeper rate so we can get a data point>

 

[aneftp]

what was your negotiated beeper rate so we can get a data point>

You can structure it anyway you want.

I was targeting at least $5000 per 24 hours including beeper rate and a max of $10000 which I thought was reasonable demand.

So $2000 Friday night beeper
$4000 beeper Saturday
$4000 beeper Saturday

It’s a back and forth game

Originally $1000 for Friday night and $2500 for weekend per 24 hours beeper.

So I billed them for 38.5 hours. Actually double billed them while sleeping in hotel due to time clock change. Running epidurals can inflate billable hours. I had put in epidural at 1am Sunday morning with time clock change at 2am time change. That was a little annoying.

Don’t have to be in house for epidural. But can still bill. That’s the key.

38.5 x $400/hr equals $15400
Plus $2000 Friday beeper
Plus $4000 Saturday beeper
Plus $4000 Sunday beeper

My cap was 10k per 24 hours with them in the contract

So if I did no work. I’d be at 10k guarantee which I’m totally fine with as well. It’s 15 min the beach so I win either way.

 

[caligas]

I’m in the locums game now…there are some very unemployable people who depend on this market. Show up 30-60 minutes late regularly, can’t do the professional song and dance especially in situations where they’re new, struggle through >50% of procedures. Forgot there were people out there after being in a good PP group for so long. It’s a minority but would not make partnership at a decent PP group. One long term locums I met said this has been the best past few years of his career, eventually was fired for not picking up his phone on call.

The number of opportunities is definitely not decreasing. The asking rate in large metro centers is approaching 325, and that’s just what they’re asking. Have to have the patience to say no, line up a few opportunities at a time. Get credentialed, let them bid for you, recruiters who I disdain don’t like it, except when I accept their offer. It’s definitely a weird game.

If the ASA was smart they would leverage this for AA legislation, but they’re not and they won’t.

This is the problem with being a commodity. I’m worth 3X these guys you describe, but we all get the “warm body” rate.

 

[dabears505]

You can structure it anyway you want.

I was targeting at least $5000 per 24 hours including beeper rate and a max of $10000 which I thought was reasonable demand.

So $2000 Friday night beeper
$4000 beeper Saturday
$4000 beeper Saturday

It’s a back and forth game

Originally $1000 for Friday night and $2500 for weekend per 24 hours beeper.

So I billed them for 38.5 hours. Actually double billed them while sleeping in hotel due to time clock change. Running epidurals can inflate billable hours. I had put in epidural at 1am Sunday morning with time clock change at 2am time change. That was a little annoying.

Don’t have to be in house for epidural. But can still bill. That’s the key.

38.5 x $400/hr equals $15400
Plus $2000 Friday beeper
Plus $4000 Saturday beeper
Plus $4000 Sunday beeper

My cap was 10k per 24 hours with them in the contract

So if I did no work. I’d be at 10k guarantee which I’m totally fine with as well. It’s 15 min the beach so I win either way.

You were getting that much to be on call and then 400 hr on top of that for work done? And a running epidural counts as hours even if you are not in house?

 

[aneftp]

You were getting that much to be on call and then 400 hr on top of that for work done? And a running epidural counts as hours even if you are not in house?

Yes.

Couple of things that work in my favor.
1. They desperate and i'm available. My original locums contract with them a few months ago was standard $1000 beeper weekday, $2000 beeper weeekend (per 24 hours). $375/hr

I just merely doubled my beeper rate. and added another $25/hr.

 

[sevo00]

Yes.

Couple of things that work in my favor.
1. They desperate and i'm available. My original locums contract with them a few months ago was standard $1000 beeper weekday, $2000 beeper weeekend (per 24 hours). $375/hr

I just merely doubled my beeper rate. and added another $25/hr.

Good for you. Glad to hear youre not settling for less and negotiating higher. A rising tide lifts all of us

 

[Coffee PRN]

Lol hearing you describe all of this made me immediately think of a small community hospital I used to work for. Do we all know a place like this?

I'm tempted to go ask for those rates from them, but surprisingly stability is more important to me right now, which is ironic as a locums. I guess I miss seeing my partner regularly and actually knowing people. I'm giving up a fair bit of money to stay one spot.

 

[lotsapain]

Some of these locums offers are laughably bad. Worse hourly pay than my w2 cush academic job. Who the f@ck would agree to sign up for garbage locums like that

You are full of crap..... locums rates are at $400+ now at 1099 and no your academic job won't pay that ..... if it does let us know I will be there tomorrow

 

[CubsDynasty]

You are full of crap..... locums rates are at $400+ now at 1099 and no your academic job won't pay that ..... if it does let us know I will be there tomorrow

I'd say >75% of the locums rates that come across my inbox start with a 2 or a low 3, so I wouldn't go so far as to say the poster is full of crap...

 

[coffeebythelake]

You are full of crap..... locums rates are at $400+ now at 1099 and no your academic job won't pay that ..... if it does let us know I will be there tomorrow

Keep your panties on. There are some locums places offering 220 to 250 an hour for 1099. In ghetto hospitals. No way in hell I'd do that when my w2 academic job pays 180 an hour / 200 an hour OT with full benefits. And yes when u do the math and accounting for different tax rates for 1099 vs w2 the amount ends up basically the same or worse

 

[aneftp]

Keep your panties on. There are some locums places offering 220 to 250 an hour for 1099. In ghetto hospitals. No way in hell I'd do that when my w2 academic job pays 180 an hour / 200 an hour OT with full benefits. And yes when u do the math and accounting for different tax rates for 1099 vs w2 the amount ends up basically the same or worse

Correct. My official w2 hourly salary on my paychecks in. The low $200s. But that’s based on 2080 work hour calculations So like $215/hr

Do I work 40’hours a week x 52 weeks? No.
40 hrs x 52 weeks equals 2080. Thats
How the hourly wage is calculated for w2

I work around 41 weeks a year

So 450k /40 hours/11 weeks off. Averages out to $274//hr roughly. 9 weeks off plus paid state holidays (2 weeks)

Add in healthcare 20k tax free
Add in almost 30k employer match

It really comes out to $312//hr w2

The keep is that’s it’s a guaranteed income.

I can also put 70k pretax into 401a/403b (Roth or pretax) and pretax 457b as most state universities allow.

Overall I’m pretty satisfied with my w2 job. I won’t leave it unless there is something better. I really work less than 40 hours a week and sleep in my bed. There are no overnights

But my next move with be the 90 day WORK YEAR FOR 475-500k Full benefits.

Always have to be one step ahead.

 

[coffeebythelake]

You are full of crap..... locums rates are at $400+ now at 1099 and no your academic job won't pay that ..... if it does let us know I will be there tomorrow

Go apply to this one

 

[Anesthesia_Guy]

View attachment 378785

Go apply to this one

If you take this abysmally low rate, then you deserve it.

 

[IMGASMD]

If you take this abysmally low rate, then you deserve it.

But but you make $10 more as 1099. And they only call you when they need you ? (As it’s a PRN position!)
Great gig.

That and all of this nonsense ultimately is designed to benefit private equity above all else. PE will be happy to leave everything firebombed, just like they did with emergency medicine.

Don’t forget the insurance company as well. Also don’t forget about all those health care systems now selling their own brand of insurance.

 

[gator2886]

View attachment 378785

Go apply to this one

That is laughable. I am getting $300/hour with 10 hour gtd in a Surgery Center. Could go to the hospital and get $350/hr for general or $450 for Cardiac.

 

[JM11]

You can structure it anyway you want.

I was targeting at least $5000 per 24 hours including beeper rate and a max of $10000 which I thought was reasonable demand.

So $2000 Friday night beeper
$4000 beeper Saturday
$4000 beeper Saturday

It’s a back and forth game

Originally $1000 for Friday night and $2500 for weekend per 24 hours beeper.

So I billed them for 38.5 hours. Actually double billed them while sleeping in hotel due to time clock change. Running epidurals can inflate billable hours. I had put in epidural at 1am Sunday morning with time clock change at 2am time change. That was a little annoying.

Don’t have to be in house for epidural. But can still bill. That’s the key.

38.5 x $400/hr equals $15400
Plus $2000 Friday beeper
Plus $4000 Saturday beeper
Plus $4000 Sunday beeper

My cap was 10k per 24 hours with them in the contract

So if I did no work. I’d be at 10k guarantee which I’m totally fine with as well. It’s 15 min the beach so I win either way.

Do use an agency or contract directly with hospitals?

 

[BLADEMDA]

View attachment 378785

Go apply to this one

In Florida CRNAs are getting 180-$200 per hour 1099 routinely these days. The cost through a locums agency for a CRNA is over $350 per hour when you include everything. I am not aware of any anesthesiologists earning $200 per hour in a non-academic setting. Even the AMCs are paying more than that as a W-2 typically around $250 per hour W-2 (when they can find a sucker to accept it). For those who are working for low rates you are in the minority as the market has moved up considerably since Covid hit in 2020.

Yes, many are asking for and getting $350, $375 and $400 per hour as 1099 workers. The rate is approaching $600 per hour when a locums agency is utilized.
Many of my colleagues are getting $450 per hour to do Cardiac working directly for an AMC or their locums company.

 

[aneftp]

Do use an agency or contract directly with hospitals?

this is the problem.

You and I both know it’s cheaper to contract out with hospitals directly.

But hospital through layers of fancy fake accounting like to use agencies. It’s funny accounting tricks but they don’t want to run anesthesia.

Hospitals create a special recruiting budget. So they pay amc or other locums agencies from this separate pot.

 

[Ashers]

this is the problem.

You and I both know it’s cheaper to contract out with hospitals directly.

But hospital through layers of fancy fake accounting like to use agencies. It’s funny accounting tricks but they don’t want to run anesthesia.

Hospitals create a special recruiting budget. So they pay amc or other locums agencies from this separate pot.

I just learned about this. It seems super sketchy and sounded a lot like kickbacks

 

[aneftp]

I just learned about this. It seems super sketchy and sounded a lot like kickbacks

I currently do some locums 1099 with one of the amc

I’m in direct contract with the medical director who makes the anesthesia schedule

It’s a mess. The amc directs him to try to use the amc’s 1099 side company (envoy, anesthesia on call, Dystaffing, echo etc) instead of a 3rd party locums company (comp health, locums tenems) etc.

Conflict of interest. Cause the amc saves/gains money using from their own 1099 Division. I do get preferential dates since I’m with one of their 1099 divisions

 

[NumTacos]

this is the problem.

You and I both know it’s cheaper to contract out with hospitals directly.

But hospital through layers of fancy fake accounting like to use agencies. It’s funny accounting tricks but they don’t want to run anesthesia.

Hospitals create a special recruiting budget. So they pay amc or other locums agencies from this separate pot.

Why don’t they want to run anesthesia and contract directly? Is it a huge administrative burden for them?
About that budget; is there something unique about the recruiting budget? Is it a way to take out of a larger pie that won’t figure into your section’s official budget?

 

[undalay]

But the question remains why do the hospital and AMCs need Locum and how is this going to change in the next few years. Why are the AMCs that are getting the contract at the hospital not able to hire Anesthesiologist full time. If there are 5 general operating rooms and one cardiac room how many full time FTE are needed to staff the place?
My take is that you need at least 7.5 FTE to run the general operating rooms and at least 2 cardiac Anesthesiologist to run the cardiac. The current situation is that there are only 3 FTE. More over the statistics are that the case load has increased 90% from 2020.

Vertically lining up cases is not possible consistently and there are going to be inefficiencies. There is a dire need Tuesday Wednesday and Thursday’s..

 

[aneftp]

But the question remains why do the hospital and AMCs need Locum and how is this going to change in the next few years. Why are the AMCs that are getting the contract at the hospital not able to hire Anesthesiologist full time. If there are 5 general operating rooms and one cardiac room how many full time FTE are needed to staff the place?
My take is that you need at least 7.5 FTE to run the general operating rooms and at least 2 cardiac Anesthesiologist to run the cardiac. The current situation is that there are only 3 FTE. More over the statistics are that the case load has increased 90% from 2020.

Vertically lining up cases is not possible consistently and there are going to be inefficiencies. There is a dire need Tuesday Wednesday and Thursday’s..

The answer to your question

We don’t have a “shortage” per se of anesthesia providers.

1. Hospital admin demands on increasing case load. Yes that’s a problem. But that’s not the only problem. It’s when the cases are done. You simply don’t have labor pool available to run cases 3pm-11pm hospitals admin wants. Letting surgeons and procedurists like ep and Gi docs post elective cases up to 9pm is inefficient and costly. That’s on hospitals admin.

2. The problem is people want “fixed hours” plus self scheduling to their own needs. Crnas have been doing this for a long time now. Now the docs are figuring it out as well time. They want time off.
What better way to get time off than to compress your work schedule. Work 2 days a week but longer hours. That’s the trend as full time. 7-8 days worked in a month. As opposed to the daily grind of 19-20 days.

 

[GravelRider]

The answer to your question

We don’t have a “shortage” per se of anesthesia providers.

1. Hospital admin demands on increasing case load. Yes that’s a problem. But that’s not the only problem. It’s when the cases are done. You simply don’t have labor pool available to run cases 3pm-11pm hospitals admin wants. Letting surgeons and procedurists like ep and Gi docs post elective cases up to 9pm is inefficient and costly. That’s on hospitals admin.

2. The problem is people want “fixed hours” plus self scheduling to their own needs. Crnas have been doing this for a long time now. Now the docs are figuring it out as well time. They want time off.
What better way to get time off than to compress your work schedule. Work 2 days a week but longer hours. That’s the trend as full time. 7-8 days worked in a month. As opposed to the daily grind of 19-20 days.

If there is not a shortage, as you suggest, then the answer is that they are not paying enough for the hours 3p—7a. If a place did something like $250/hr 7a-3p, $350/hr 3p-11p, and $450/hr 11p-7a then you would have more interest in those off hours.

It’s the same with the employee model groups where the call-taking employees didn’t really make significantly more than the no-call day docs. That’s probably where alot of this began. Am I going to miss dinner with my family 2-3 days per week and not sleep in my own bed 4-6 times per month for an extra $50k (pre-tax) per year? It was the policy of employing docs for less than they are worth that created the situation. Paying people is the only way out of it.

 

[Dr. Rude]

If there is not a shortage, as you suggest, then the answer is that they are not paying enough for the hours 3p—7a. If a place did something like $250/hr 7a-3p, $350/hr 3p-11p, and $450/hr 11p-7a then you would have more interest in those off hours.

It’s the same with the employee model groups where the call-taking employees didn’t really make significantly more than the no-call day docs. That’s probably where alot of this began. Am I going to miss dinner with my family 2-3 days per week and not sleep in my own bed 4-6 times per month for an extra $50k (pre-tax) per year? It was the policy of employing docs for less than they are worth that created the situation. Paying people is the only way out of it.

Correct. But historically it has made financial sense for the hospitals to salary Docs/CRNAs have a peel off system and gradually get more and more work out of them. The model stopped being optimal from the CRNA point of view awhile ago. Now it is falling apart from the doc point of view.

 

[aneftp]

If there is not a shortage, as you suggest, then the answer is that they are not paying enough for the hours 3p—7a. If a place did something like $250/hr 7a-3p, $350/hr 3p-11p, and $450/hr 11p-7a then you would have more interest in those off hours.

It’s the same with the employee model groups where the call-taking employees didn’t really make significantly more than the no-call day docs. That’s probably where alot of this began. Am I going to miss dinner with my family 2-3 days per week and not sleep in my own bed 4-6 times per month for an extra $50k (pre-tax) per year? It was the policy of employing docs for less than they are worth that created the situation. Paying people is the only way out of it.

The number of hours worked matters. Everything matters.

The dynamics of the old work culture of anesthesiologist. Call q4-6 days, peel off. That just doesn't work these days in 80% of the places.

We are gradually moving towards an hourly model system for docs. Crnas have been on the hourly system for decades. But crnas have morphed their hourly system towards working 2-3 days a week these days (3 12 hour shifts), or 16/24 hour shifts. This artificially creates staffing shortage for places.

But those same places are dumb because the w2 employed anesthesiologist are filling the workload for missing crnas or using crna 1099 locums that cost even more. Than it gets to system critical for the practice.

Once the docs move towards hourly model, the entire anesthesia system will collapse due to the call requirements. Sure, put me on 72 hour weekend call. I'd love that. Beeper or no beeper. Those are my hours worked and i'm gonna to be fully. The key word being fully. I"m gonna to work 6 days on 2 weekends. Pay me 500K. W2. Call it a day. 90 days of work for the year. Something like that. Many variations of how to employ this model.

The hours average out to 40-45 hours a week.

500K (90 days) with consistent coverage for w2 docs is a lot cheaper than paying me or my buddy 25-30K each weekend.
So me as a 1099 covering those same days cost the hospital 25K each weekend. That's 1.3 million I would cost them if I covered 52 weekends. Plus the 30% agency fees. So 1.6 million

OR just pay two docs 500K each for 1 million in salary of coverage. An immediate savings of 600K for the hospital and get all weekends covered. That's why I love it when my full time 1099 locums buddies who make 1.5 (I think they may hit 2 million this year) say their job is to make hospital administration pay for their stupidity. Admin are really that stupid. We aren't talking small hospital systems either. We are talking huge hospital systems.

There is place that just hired 5 full time anesthesiologist who have switched to this 90 day work year model. It works. They have been bleeding money since covid. And it takes this type of thinking to shore up places.

Sure there are anesthesiologist who despise calls. So make another system. Make a night float system. Docs on full time night float. Pay them 20% extra or give them more time off. Docs on daytime take a little less (like me) but I get the option to sleep in my own bed 365 a year. Rare for me to work past 4pm with my 40 hour week day time job. Of course I'm hustling elsewhere for extra cash also.

What I'm trying to say is the old system isn't working anymore.

 

[aneftp]

Correct. But historically it has made financial sense for the hospitals to salary Docs/CRNAs have a peel off system and gradually get more and more work out of them. The model stopped being optimal from the CRNA point of view awhile ago. Now it is falling apart from the doc point of view.

Yes!! Right on point.

 

[neutro]

The number of hours worked matters. Everything matters.

The dynamics of the old work culture of anesthesiologist. Call q4-6 days, peel off. That just doesn't work these days in 80% of the places.

We are gradually moving towards an hourly model system for docs. Crnas have been on the hourly system for decades. But crnas have morphed their hourly system towards working 2-3 days a week these days (3 12 hour shifts), or 16/24 hour shifts. This artificially creates staffing shortage for places.

But those same places are dumb because the w2 employed anesthesiologist are filling the workload for missing crnas or using crna 1099 locums that cost even more. Than it gets to system critical for the practice.

Once the docs move towards hourly model, the entire anesthesia system will collapse due to the call requirements. Sure, put me on 72 hour weekend call. I'd love that. Beeper or no beeper. Those are my hours worked and i'm gonna to be fully. The key word being fully. I"m gonna to work 6 days on 2 weekends. Pay me 500K. W2. Call it a day. 90 days of work for the year. Something like that. Many variations of how to employ this model.

The hours average out to 40-45 hours a week.

500K (90 days) with consistent coverage for w2 docs is a lot cheaper than paying me or my buddy 25-30K each weekend.
So me as a 1099 covering those same days cost the hospital 25K each weekend. That's 1.3 million I would cost them if I covered 52 weekends. Plus the 30% agency fees. So 1.6 million

OR just pay two docs 500K each for 1 million in salary of coverage. An immediate savings of 600K for the hospital and get all weekends covered. That's why I love it when my full time 1099 locums buddies who make 1.5 (I think they may hit 2 million this year) say their job is to make hospital administration pay for their stupidity. Admin are really that stupid. We aren't talking small hospital systems either. We are talking huge hospital systems.

There is place that just hired 5 full time anesthesiologist who have switched to this 90 day work year model. It works. They have been bleeding money since covid. And it takes this type of thinking to shore up places.

Sure there are anesthesiologist who despise calls. So make another system. Make a night float system. Docs on full time night float. Pay them 20% extra or give them more time off. Docs on daytime take a little less (like me) but I get the option to sleep in my own bed 365 a year. Rare for me to work past 4pm with my 40 hour week day time job. Of course I'm hustling elsewhere for extra cash also.

What I'm trying to say is the old system isn't working anymore.

seems interesting and well worth it to get ahead financially short term, but i do not know if this will work if you have a family and kids in school.
the travel and "jump and go" lifestyle requirement may be prohibitive for a lot of anesthesiologists. Stability is important too.

Im assuming you're having to travel a lot and you're providing services in rural states.
Please do tell us whats your home base and home state so we get an idea about the market. You can PM me - i tried sending you a message but your profile does not allow it. I'd like to pick your brain about some of this. I do something similar and find it rewarding but not to the same scale.

TY

 

[Shimmy8]

Group in Asheville at Mission is straight hourly. HCA employees. People seem happy?

 

[GravelRider]

Correct. But historically it has made financial sense for the hospitals to salary Docs/CRNAs have a peel off system and gradually get more and more work out of them. The model stopped being optimal from the CRNA point of view awhile ago. Now it is falling apart from the doc point of view.

It actually never made sense. The day doc working from 7-3 for 40 hours per week has predictability and consistency. The employed call taker was banking on the peel off list to make up for some of the discrepancy. Again, it’s based on a gamble that you’ll get some “free” hours. Sometimes it worked out and you actually worked a little less per week than the day doc, but we all know those times where it doesn’t work out because rooms run long, CRNAs call out sick, emergencies, etc. Now you’re actually working more hours per week and many of those hours are the undesirable “off hours.” Was that really worth the extra $50k per year over the day doc who knew he could pick his kid up from school everyday?

 

[Dr. Rude]

It actually never made sense. The day doc working from 7-3 for 40 hours per week has predictability and consistency. The employed call taker was banking on the peel off list to make up for some of the discrepancy. Again, it’s based on a gamble that you’ll get some “free” hours. Sometimes it worked out and you actually worked a little less per week than the day doc, but we all know those times where it doesn’t work out because rooms run long, CRNAs call out sick, emergencies, etc. Now you’re actually working more hours per week and many of those hours are the undesirable “off hours.” Was that really worth the extra $50k per year over the day doc who knew he could pick his kid up from school everyday?

It did make sense for decades because there used to be some excess capacity in the system in the name of "service" and accommodating the surgeons. This often led to unexpected early out days in many practices. Because money is tighter than ever and the surgeons have less power than ever, those are now rare birds that are getting rarer. Now mostly happen where there is a same day cancellation.

 

[BLADEMDA]

W-2 Anesthesiologists are going to run the numbers. Do the math. That means your hourly rate needs to exceed $250 per or even $275 per hour at a minimum. Add up all the benefits, the actual hours worked per week then run the numbers.

45 hours per week at 500,000 x 44 weeks (8 weeks pto)= $252.00 per hour plus benefits ( malpractice, healthcare, retirement). Let's use $20,000, $20,000 and $30,000 for those benefits= $70,000. That adds $35 per hour to the $252. Total: $287 per hour.

As you can see that is still below the locums rate as a 1099 but perhaps acceptable to some. The better jobs should be paying $300 per hour (total) as W-2 to be competitive in this market.

 

[BLADEMDA]

Group in Asheville at Mission is straight hourly. HCA employees. People seem happy?

If the rate is $275-$300 per hour plus benefits then maybe most are happy. It's all about the numbers in this market knowing locums are getting at least $300 per hour with many over $350 per hour.

 

[neutro]

W-2 Anesthesiologists are going to run the numbers. Do the math. That means your hourly rate needs to exceed $250 per or even $275 per hour at a minimum. Add up all the benefits, the actual hours worked per week then run the numbers.

45 hours per week at 500,000 x 44 weeks (8 weeks pto)= $252.00 per hour plus benefits ( malpractice, healthcare, retirement). Let's use $20,000, $20,000 and $30,000 for those benefits= $70,000. That adds $35 per hour to the $252. Total: $287 per hour.

As you can see that is still below the locums rate as a 1099 but perhaps acceptable to some. The better jobs should be paying $300 per hour (total) as W-2 to be competitive in this market.

Locums/ independent contractors and prn 1099 have the advantage of not having a boss, not having to worry about time off and when that time is allotted, and saying no to poor working conditions/ schedules/ hospitals/militant CRNAs.

That has tremendous benefit to some.

 

[neutro]

W-2 Anesthesiologists are going to run the numbers. Do the math. That means your hourly rate needs to exceed $250 per or even $275 per hour at a minimum. Add up all the benefits, the actual hours worked per week then run the numbers.

45 hours per week at 500,000 x 44 weeks (8 weeks pto)= $252.00 per hour plus benefits ( malpractice, healthcare, retirement). Let's use $20,000, $20,000 and $30,000 for those benefits= $70,000. That adds $35 per hour to the $252. Total: $287 per hour.

As you can see that is still below the locums rate as a 1099 but perhaps acceptable to some. The better jobs should be paying $300 per hour (total) as W-2 to be competitive in this market.

I mean you're missing the tax benefits of being 1099.
All those things are tax deductible. Retirement is 60 k (SEP). Even more via a cash balance plan. Depending on how you much you want to reduce taxable income.
Secondly, when you do a conversion of W2 to 1099 and take equivalent pay - you (not the employer) gets the benefit of tax deduction from health insurance, and malpractice.
A good accountant is important.
So if you are comparing 1099 to W2 in terms of equal dollar value, 1099 will be able to reduce taxable income far more. Ask any accountant...
In-fact my accountant told "im sorry if youre w2, i cant help you"....it stuck with me.

 

[aneftp]

Locums/ independent contractors and prn 1099 have the advantage of not having a boss, not having to worry about time off and when that time is allotted, and saying no to poor working conditions/ schedules/ hospitals/militant CRNAs.

That has tremendous benefit to some.

There are lots of factors to do pure locums

Most of the pure locums docs (and crnas) I know fit one of the following. Pure locums meaning locums is there only means of income. Not 0.5, not 0.75 etc. but zero regular income as w2.

Most of the pure locums are
1. Single
2. Married with spouse who has healthcare
3. Married, kids out of the house or close to college age (15 and up)

Very few of pure locums fall outside of this category

Meaning I know very few pure locums with a non working spouse and young kids at home. Their wives want them around. The ones I know who are married with kids and they travel for locums ….they have side chicks (or even side dudes). (The traveling women anesthesiologist/crnas

 

[neutro]

There are lots of factors to do pure locums

Most of the pure locums docs (and crnas) I know fit one of the following. Pure locums meaning locums is there only means of income. Not 0.5, not 0.75 etc. but zero regular income as w2.

Most of the pure locums are
1. Single
2. Married with spouse who has healthcare
3. Married, kids out of the house or close to college age (15 and up)

Very few of pure locums fall outside of this category

Meaning I know very few pure locums with a non working spouse and young kids at home. Their wives want them around. The ones I know who are married with kids and they travel for locums ….they have side chicks (or even side dudes). (The traveling women anesthesiologist/crnas

That sounds about right

 

[BLADEMDA]

I mean you're missing the tax benefits of being 1099.
All those things are tax deductible. Retirement is 60 k (SEP). Even more via a cash balance plan. Depending on how you much you want to reduce taxable income.
Secondly, when you do a conversion of W2 to 1099 and take equivalent pay - you (not the employer) gets the benefit of tax deduction from health insurance, and malpractice.
A good accountant is important.
So if you are comparing 1099 to W2 in terms of equal dollar value, 1099 will be able to reduce taxable income far more. Ask any accountant...
In-fact my accountant told "im sorry if youre w2, i cant help you"....it stuck with me.

I have been 1099 status in the past and still do 1099 work now. I fully understand the tax code and the advantages of 1099 over W-2. But, for many out there the point was how does your W-2 compensation compare in this market to a 1099? Is your employer paying you a fair wage for the work? Again, many providers need the stability of a W-2 position in one location so 1099 isn't an option unless it's side gigs. I do agree that a total package cost of $600K W-2 vs $600K 1099 then latter gig is the way to go.

 

[Anesthesia_Guy]

I have been 1099 status in the past and still do 1099 work now. I fully understand the tax code and the advantages of 1099 over W-2.

Get ready gang! Here come 3 articles and 6 charts/graphs to support this....

 

[BLADEMDA]

The Best of Both Worlds​

Perhaps the best of both worlds is to get some of your income as an employee and some of your income as an independent contractor. That way you can write off all your work expenses that are required for your independent contractor job (but are used for both jobs—like CME, uniforms, licensing fees, DEA fees, specialty society dues, etc.) against your 1099 income. This way also lets you have your employer provide your benefits and at least the employer portion of the Social Security taxes, which are the lion's share of the payroll taxes for a doctor with a median physician income.

Another bonus of having two jobs is you may get two 401(k)s as well, allowing you to protect more of your hard-earned money from both Uncle Sam and any potential future creditors.

W-2 vs. Self-Employed | White Coat Investor

Is it better to take a job as an employee or as an independent contractor? The short answer is "it depends." The best answer may be "both."

www.whitecoatinvestor.com