Locum Tenens...Yay or nay?

[epay3771]

Once I have a year's experience in the emergency department (which is in a couple of months), I am looking to either relocate or start locum tenens work. I do not personally know any PAs/NPs who have done this. Is this a terrible idea for someone with only one year's experience? What is a reasonable hourly rate? Are there things that I should look for/avoid, such as certain agencies?

 

Any advice would be much appreciated!

[ventana]

One year of experience is unlikely enough.... residency yes, just working no - - I would say at least 2-3 years working north main side and express side, and really challenging yourself to learn learn learn..

 

This is for locums.... as you will have NO idea what the place you are going to work is like, rather teh nursing staff is any good, rather there is any back up ie hospitalist, surgery, neuro... Seems that the places hiring locums have problems with staff retention, usually due to some glaring defect in the department...... YMMV

[sas5814]

Locums tends to be harder than a regular job. You have to walk into a new place cold and go to work. They have staffing issues of some kind or you wouldn't be there. You may or may not have the support/backup you need. One uncommon phenomenon (but it happens) is to dump on the temp help because they are...well...temp help. Too many patients, too high complexity etc.

Just be careful if you decide to try it. Don't be afraid to ask a lot of questions about where you are going and what will be required of you. Take everything the recruiter tells you with a grain of salt. They make their money but putting warm butts in chairs and they can be dishonest in trying to get you to take an assignment. I had one try to convince me to take a short fill in assignment with a neurosurgeon including OR time. I haven't been in an OR in 25 years and never participated in neurosurgery. 

[Katera]

Locums tends to be harder than a regular job. You have to walk into a new place cold and go to work. They have staffing issues of some kind or you wouldn't be there. You may or may not have the support/backup you need. One uncommon phenomenon (but it happens) is to dump on the temp help because they are...well...temp help. Too many patients, too high complexity etc.

Just be careful if you decide to try it. Don't be afraid to ask a lot of questions about where you are going and what will be required of you. Take everything the recruiter tells you with a grain of salt. They make their money but putting warm butts in chairs and they can be dishonest in trying to get you to take an assignment. I had one try to convince me to take a short fill in assignment with a neurosurgeon including OR time. I haven't been in an OR in 25 years and never participated in neurosurgery. 

 

 

 

^^^  OMG so true!  I have found locum recruiters to be at best incompetent and at worst deceitful.  Having said that, I am now a full-time locum.  Mainly because I just could not stomach working for yet another 24 year old high school educated "administrator" within the corporate Urgent Care structure.  Who knows, I might go back FT employee someday, but right now I am rather enjoying just doing locums.  Here are a few things to consider:

 

1.  You will almost alway be paid as an independent contractor.  If you don't know what that is, I would advise against locums.  Basically though, you pay all your own taxes usually quarterly.  You have to pay your FULL social security amount, get no benefits, not even workers comp.  If you get hurt on the job, it's on you.

 

2.  I locum with a few different agencies and one of them took literally 6 months to get my pay processed correctly.  I don't know if they were incompetent or just stupid, but yea it was a pain.  Thankfully things seemed to be sorted now.

 

3.  Most agencies ONLY pay you when they are paid.  So if the place they farm you to takes forever to pay?  You have to wait.  AND if they get stiffed?  You don't get paid.  A few agencies have a "guaranteed pay" benefit, and I highly recommend looking for one of those agencies.

 

4.  Deceitful agencies are everywhere.  I took an assignment to a well known occmed company a while back, and was told by the recruiter that my sup physician and I would do the Texas computer dance (those in TX know what I am referring to) for supervision.  I showed up, introduced myself and told him we need to get me plugged in with him.  He said, I don't know you.  I'm a locum to, and refused.  I turned around and walked out.  I literally could of lost my license had I stayed and worked, not to mention the medical liability of working without a sup physician.

 

5.  30 day call off notice.  My two agencies both have a 30 day call out, which means that if for ANY reason you call off a shift within 30 days of the shift?  THEY CAN CHARGE YOU FOR THE LOST AMOUNT.  You read that right, if they are charging $120/hr for a 12 hour shift and you can't make it for any reason...you get a bill from them for $1440 bucks...Plus, they can cancel any shift you have scheduled if they give you 30 days notice, regardless of cause.

 

6.  This is pretty obvious, but worth mentioning as well.  If you get locum'ed into a place that you LOVE and they LOVE you...most agencies charge around $30k to "let you go full-time" with them.  Just an FYI.  Be very sure you want to stay a locum, or you will be restricted from working at the facility you locum at, usually for 2-3 years.

 

 

 

These are just a few little pearls to know.  Even with all that, I still do it.  The ability to create my own schedule WHERE I want and WHEN I want is glorious.  Plus I make around $70/hr so that's not bad.  I am a write off king as well, so I maximize the independent contractor thing.

 

Hope some of this helps.

[cdcd67]

Thank you for the useful information Katera! I had no idea they charged you if you decided to go full time later on.

 

So which locum agencies do you recommend?

[epay3771]

Thank you all for the abundance of information!! It sounds like a career in locums might need to wait a little longer... I knew it sounded too good to be true.

[Katera]

Thank you for the useful information Katera! I had no idea they charged you if you decided to go full time later on.

 

So which locum agencies do you recommend?

 

 

 

That's a tough question.  I would stay away from Mint.  Barton is big but generally seems to be competent.  I don't want to get to specific on names, but re-read what I wrote and keep it in mind.  Know what questions to ask.  They will absolutely put you in a dangerous possibly illegal situation and not give it a second thought.  Remember, it your license.  No one else is going to look out for it...just you.

[weezianna]

I worked locum tenens jobs consistently for about 6 year.  With the exception of one job, I was a W-2 employee, which is preferable in that taxes are withheld and you don't have to pay quarterlies or expect to lose 15% right off the top.  I think you have to have the experience and confidence to walk into an unknown setting and hit the ground running.  Some situations work out very well, and with others you just have to remember that you can do just about anything for 13 weeks.  There is generally a 30-day notice required if you want to end the assignment early, butI have never had that happen. 

 

Generally, most agencies don't offer benefits, although I believe that some have begun to offer health insurance.

 

I enjoyed the travel and always found interesting things to do and see.  Most of my colleagues were fine, with the exception of one, maybe two physicians.   The jobs were generally fairly represented, and the agencies I worked for were reputable except for one based in Florida who stole about $400 in vacation time from me on a long-term federal job.   You need to know what to ask for - salary, housing, travel - and realize that the company has some leeway in negotiating that with you as long as they make their profit margin.

 

When I leave full-time employment, I plan on resuming locums work and like many others am constantly getting solicited for assignments. 

[eighthnote24]

Bumping this because I'm also full time locums and I'm always interested to know others' opinions on agencies, facilities, etc....we should really have a website or a Facebook page like the travel nurses do to share the insider tips.

I've worked with Delta, they have gotten me the highest rates ($80/hr for ER) but my recruiter there has since left and I'm not happy at all with the new one.

I'm working with All Star Recruiting to try to get in on another place, they're also offering $80/hr for ER.

I've tried to give StaffCare a chance on multiple occasions, but they always totally low ball me. Offering $57 an hour for ER....um, hell no. Their offers are consistently $20 or more an hour lower than other agencies. Basically the same thing with Soliant.

Vista was highly deceitful about a job I actually ended up going to; told me total lies about the responsibilities of the job I was going into and schedule and luckily I was able to get out of it in 2 weeks.

Weatherby harassed me, and I do mean harassed (like called me 3 times a day for MONTHS) and then I found out that they don't want to do traditional travel back and forth locums - they literally wanted to plant me somewhere and not pay for me to go back home even once in a 3-6 month time span. No thank you.

[Katera]

Bumping this because I'm also full time locums and I'm always interested to know others' opinions on agencies, facilities, etc....we should really have a website or a Facebook page like the travel nurses do to share the insider tips.

I've worked with Delta, they have gotten me the highest rates ($80/hr for ER) but my recruiter there has since left and I'm not happy at all with the new one.

I'm working with All Star Recruiting to try to get in on another place, they're also offering $80/hr for ER.

I've tried to give StaffCare a chance on multiple occasions, but they always totally low ball me. Offering $57 an hour for ER....um, hell no. Their offers are consistently $20 or more an hour lower than other agencies. Basically the same thing with Soliant.

Vista was highly deceitful about a job I actually ended up going to; told me total lies about the responsibilities of the job I was going into and schedule and luckily I was able to get out of it in 2 weeks.

Weatherby harassed me, and I do mean harassed (like called me 3 times a day for MONTHS) and then I found out that they don't want to do traditional travel back and forth locums - they literally wanted to plant me somewhere and not pay for me to go back home even once in a 3-6 month time span. No thank you.

 

 

 

LOL yep, sounds familiar.  Locums can be VERY sketchy.  If you don't mind me asking, what region are you in?  Also, do you carry supplemental malpractice ins?  I do.  It's about $700 a year, but IMO worth it.  You never know with some of these agencies.

[eighthnote24]

I'm in TX. I probably will look into supplemental malpractice at some point.

[sas5814]

Ok ...so form an LLC, buy your own malpractice policy and be your own locums company. I did it for years. The details of a good set up are a little more involved but if you set it up right you can avoid the self employed tax liability, enjoy the write offs related to being self employed and you are getting the 20-40$/hr the locums company typically gets...which as you have seen they try very hard to screw you out of.

[eighthnote24]

Do you just contact the facilities yourself and present yourself as an available provider? I want to be able to travel all over the place, not just in my local area.

[sas5814]

I wrote a lot of letters and followed it up with a call in about a week. I also let everyone I knew what I was doing and asked them to keep me in mind if they hear of anything. Once the ball started rolling the people who had used me and liked me mentioned me to others etc etc. It didn't take long.

[ventana]

I wrote a lot of letters and followed it up with a call in about a week. I also let everyone I knew what I was doing and asked them to keep me in mind if they hear of anything. Once the ball started rolling the people who had used me and liked me mentioned me to others etc etc. It didn't take long.

 

 

what hourly do you charge?

[sas5814]

It depends on what I was doing. You have to keep in mind you have all the tax liability and they have no expenses for benefits, malpractice etc. In Fam med/primary care I charged $75/hr. In Urgent Care $85/hr. If they wanted me on a major holiday it was $125/hr

[CAdamsPAC]

Bumping this because I'm also full time locums and I'm always interested to know others' opinions on agencies, facilities, etc....we should really have a website or a Facebook page like the travel nurses do to share the insider tips.

I've worked with Delta, they have gotten me the highest rates ($80/hr for ER) but my recruiter there has since left and I'm not happy at all with the new one.

I'm working with All Star Recruiting to try to get in on another place, they're also offering $80/hr for ER.

I've tried to give StaffCare a chance on multiple occasions, but they always totally low ball me. Offering $57 an hour for ER....um, hell no. Their offers are consistently $20 or more an hour lower than other agencies. Basically the same thing with Soliant.

Vista was highly deceitful about a job I actually ended up going to; told me total lies about the responsibilities of the job I was going into and schedule and luckily I was able to get out of it in 2 weeks.

Weatherby harassed me, and I do mean harassed (like called me 3 times a day for MONTHS) and then I found out that they don't want to do traditional travel back and forth locums - they literally wanted to plant me somewhere and not pay for me to go back home even once in a 3-6 month time span. No thank you.

Being a locums PA requires IMHO very good clinical skills on top of a high degree of self confidence and demanding candor from the work sites and placement agencies.As someone who has worked locums episodically since 1990 and full time since 2009, I can say that agencies are out for themselves and will give you their droppings. I predominately work remote site in Alaska and find that the best situation is networking with other PAs and (OMG!) NPs doing locums up here.This gives you an unvarnished picture of the sites/employers and you cut out the middleman putting more cash into your pocket, you control the schedule and he annoying phone calls and emails disappear! Yes agencies will torture you with calls and emails, present half truths and outright misrepresentations of availability, support and responsiveness while picking your pocket! In closing I say and Echolocums.com to your "Locums No Fly List" for all of the above reasons.

[Boatswain2PA]

Ok ...so form an LLC, buy your own malpractice policy and be your own locums company. I did it for years. The details of a good set up are a little more involved but if you set it up right you can avoid the self employed tax liability, enjoy the write offs related to being self employed and you are getting the 20-40$/hr the locums company typically gets...which as you have seen they try very hard to screw you out of.

This isn't accurate.  Any LLC set up with a sole-owner/provider would be an S-corp LLC, which the IRS considers a "pass-through" entity only...which means you pay the full social security taxes on your net income.  (net = gross income - legitimate business expenses).

 

IF you were to set up a C-corp LLC, and the larger administrative headaches involved with that, then you COULD get a tax break by giving yourself bonuses.  However you still have to reimburse yourself a "reasonable rate", upon which you have to pay social security on.

 

Furthermore, an LLC really provides no liability protection for malpractice as malpractice suits are personal against the provider.

 

So, generally, unless you can afford to pay business expenses, and pay yourself a "reasonable wage", and THEN still pay yourself a significant bonus....setting up an LLC really isn't worth it.

 

 

I do most all locums work, but I am fortunate to be within reasonable commuting distance to many places that require locums coverage.  Better yet, many of these places do 24/48/72 hour shifts.  I've been in contact with several locums recruiters/agencies, but none can beat the current gigs I have.

[Katera]

This isn't accurate.  Any LLC set up with a sole-owner/provider would be an S-corp LLC, which the IRS considers a "pass-through" entity only...which means you pay the full social security taxes on your net income.  (net = gross income - legitimate business expenses).

 

IF you were to set up a C-corp LLC, and the larger administrative headaches involved with that, then you COULD get a tax break by giving yourself bonuses.  However you still have to reimburse yourself a "reasonable rate", upon which you have to pay social security on.

 

Furthermore, an LLC really provides no liability protection for malpractice as malpractice suits are personal against the provider.

 

So, generally, unless you can afford to pay business expenses, and pay yourself a "reasonable wage", and THEN still pay yourself a significant bonus....setting up an LLC really isn't worth it.

 

 

I do most all locums work, but I am fortunate to be within reasonable commuting distance to many places that require locums coverage.  Better yet, many of these places do 24/48/72 hour shifts.  I've been in contact with several locums recruiters/agencies, but none can beat the current gigs I have.

 

 

 

Most of what I do is locum.  No LLC here, it really wouldn't help me, but as I said I do carry a supplemental malpractice policy which goes hand in hand with my main agency based Accord.

[eighthnote24]

LIVID at CompHealth right now.

Talked them almost a month ago. They said they'd send my CV to a few places. Never heard another word.

 

This week, I got a couple of voicemails from a place in Wisconsin. Caller doesn't mention which agency sent her, just that she has my info and apparently they're interested in me, but I literally know nothing else about the job - no pay rate, no schedule, etc - things you generally want to have an idea of BEFORE talking to the facility, as a locums provider. I don't even know which agency, again, because the caller didn't mention it and I've not gotten a heads up from any agency that I'd be getting a call. I work with several agencies, and every single time a facility has wanted to talk to me - that recruiter has given me a heads up that I would be receiving a call. Since I get several calls a day and I really had no clue which job or agency this was, I figured I'd wait and see if a recruiter would contact me having been contacted by the Wisconsin girl about my lack of return call. Got nothing.

 

Well today I get an email from the Wisconsin girl again asking for info. I emailed her back just inquiring which agency sent her, because I work with several and I had no clue which one this was from or the details of the job. I get a snarky email back from her basically saying - fine, if you're not interested, never mind.

 

So now I look like an idiot, and I'll never work with CompHealth again. Although, I do have to say, kinda glad I dodged that job given the attitude of the email I received.