While salivating over the fact that you can make so much more than you did before, remember that higher rates often come at a price, if you'll pardon the pun. Some companies pay higher by staffing lightly. I've seen numerous jobs that offered $250 or more an hour, but once I dug a little deeper, I found it was single coverage physician in a 25,000-30,000 volume emergency department. Or maybe there was a midlevel for eight to 12 hours a day. But the point is, whoever makes that high rate will really earn it, and in a way that is not, in my humble opinion, healthy or safe. Anything that looks too good to be true may be just that.
Rates have changed a lot in the past year. In extremely slow EDs with volumes of 1,000-9,000 per year, one may sometimes get $100-$195 an hour. The rate depends to some extent on how remote the location is and the payer mix. I've also seen $200-$220 an hour in the 10,000-volume range, and, mind you, this is after the locums company has been paid so there is money out there. I've also seen $300 an hour in busy departments, and I've been told that some places in Texas and other sites in the Midwest reach $400.
Besides good hourly rates, keep in mind that locums companies pay for your travel up front or ask you to pay and then submit a voucher for reimbursement. I've done both, but I much prefer having them pay first. It's so much simpler than rounding up receipts and sending in timesheets.
Locums companies uniformly pay your malpractice. If they or the hospital won't, move on to greener pastures. You may, if you like, purchase malpractice insurance of your own. If so, negotiate a higher hourly rate. Locums companies don't typically pay other benefits. Some physicians consider this a reason never to move from employment to locums. But it's all a shell game. If you had no benefits, your hourly rate would be higher. There is no free lunch or benefit.
Some large contract management firms may use you in a locums capacity but ask you to be a part-time employee, in which case you may benefit from some withholdings and retirement money. Some also have special travel teams, in which physicians move around to new or troubled contracts. If you're flexible, this can be an adventurous and financially rewarding way to do locums.
Many locums physicians simply work as independent contractors, but I believe the best thing to do is what so many of us in locums have done. Incorporate yourself. Go to your lawyer and accountant or financial planner and create a corporation. Then ask all of your contractors to pay you through that entity.
Once done, it's as simple as filling out an entity agreement with your locums company. This provides you with some extra legal protections against litigation, some tax benefits, and also allows creative ways to contribute to retirement and pay yourself and your expenses. This takes diligence, so if you or your spouse aren't attentive and willing to learn, simply pay your accountant to help you do everything legally. Be sure your financial professionals are comfortable dealing with this because not everyone knows all the ins and outs of corporate structures.
Make sure you also have a seasoned physician and an attorney look over any contract you receive from a locums company or directly from a hospital. Trust but verify, as President Reagan once said. Keep copies of everything in named files, in print and electronic formats. Also keep copies of correspondence regarding shifts, credentialing, pay rates, and all the rest.
One of the great advantages of locums is freedom in scheduling. I've enjoyed this tremendously. You're in the driver's seat for when and where you'll work. But unlike working with a group, canceling a shift due to illness or family problem can be really difficult. And nobody has a sense of humor about a forgotten shift when it's 400 miles away. So be very attentive. Don't double book or you may be fined for missing shifts. Also note the lead time you're allowed for cancellations. It may be one month or two, but the shift is all yours after that. And many of the places you'll work are terribly short-staffed already or they wouldn't need you, so be considerate.
I'm often asked about using different EMR systems as I move about. It can be difficult initially, but once you've learned a couple and used them enough, the rest seem easier. At that point, it's just a matter of keeping track of passwords and keeping up with charts, even if done remotely. When you know how to use a system, by the way, put it on your CV. Like spoken languages, facility at EMR is valuable because it saves training time and improves coding and billing.
Finally, credentialing and licensing are among the most difficult parts of locums. Every hospital, every state is different. Allow the company to help you with this, and keep a file of all of the facilities where you worked, the dates you worked, your CME, and your license numbers and expirations. Companies can help you with this for a fee. Unfortunately, you may have to keep those ACLS, BLS, PALS, and ATLS merit badges. As annoying as it is, especially for those EM board certified, look at it as easy CME, ask the instructors difficult questions, and press on. (And the first three can be done online, by the way.)
Next month: Pearls for a happy locums experience.
Take the ‘Leap’
Read the first part of Dr. Leap's series on locums at http://emn.online/Apr16Emergistan and the second at http://emn.online/May16Emergistan.
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