Expected pay for locum hospital medicine

[Patho]

Need some input from the group. I was offered a hospital medicine position requiring me to rotate between 3 local hospitals where I'll work for ~3-4 months each time, 2 sites are 30 min, 1 is 1hr away. The position is basically styled as an internal locums position by this company that staffs hospitals. I'm not familiar with the pay scale for locums position but usually they're higher paying as 1099 with no benefits besides from travel related expenses. I want to push for 100/hr but overall is this a fair offer? Comes out to be 173K/yr. Any other fields like UC makes more than this with benefits? 

Details

• Maryland, Washington DC area
• W2 Employee
• 10 hr shifts 7 on 7 off
• 15 patients case load (I used to see 14, so don't mind as long as I'm fairly compensated)
• No Codes
• Pay: 95/hr 
• PTO: 14 days annually + sick
• 6 paid Holidays
• Health, dental, vision covered
• 401K 2% match, 4 yrs vesting period
• 100% Malpractice with Tail 
• CME: 1500

Last HM position I worked, MD/DO's saw 14-18 rounding patients, Doc rate was 108/hr. So with 15pts per shift I'm seeing doc range but also have to act as a locum PA traveling around. I feel 110/hr is fair but the HR person was being difficult. Would asking for a sign-on bonus be more effective in this case or keep asking for more until I get a final ultimatum. 

Thank you.

Edited May 23 by Patho

[SedRate]

I'd take it. 

[ventana]

What is your cost of living area?  
 

$95/hr is fair in my area

[Patho]

37 minutes ago, ventana said:

What is your cost of living area?  
 

$95/hr is fair in my area

MCOL, Washington DC Suburbs 

[ventana]

if DC proper that is EXPENSIVE

 

use some COLA estimator to see what it is really worth

[TWR]

So, $6650/week that you work ($95x70 hours) !!!!  What's the problem??????????  Take it.  Negotiate after you prove you are worth more.

[cinntsp]

Try to find out what the W2 rate is and assume you should be making 20-30% more. 

[Patho]

5 hours ago, TWR said:

So, $6650/week that you work ($95x70 hours) !!!!  What's the problem??????????  Take it.  Negotiate after you prove you are worth more.

I was offered this job 1.5 yrs ago at a rate of 75/hr, no PTO, other benefits same as above but didn't take it. Either they hired someone else and couldn't keep them or have been struggling to fill this role since that time which is a red flag. I'll find out later today with the medical director and chief of operations.

I assume they will be working the hell out of me. So I realize the rate is higher than other HM positions, in fact I only made 54/hr at my last HM position after 4 years. But if they're going to work me, I just need to get paid and up front. I am not a physician but I will be taking on a similar patient load as a physician. 

[Patho]

4 hours ago, cinntsp said:

Try to find out what the W2 rate is and assume you should be making 20-30% more. 

The W2 rate is 95/hr, the 1099 rate is 110/hr (no benefits except travel related). Its a difference of ~27K annually, so I'm trying to close the gap as much as possible. I'll find out later today but some positions don't have built in raises or market adjustments and as inflation rises I will be taking a pay cut every yr so I need as much as possible up front in base pay.

[cinntsp]

10 hours ago, Patho said:

The W2 rate is 95/hr, the 1099 rate is 110/hr (no benefits except travel related). Its a difference of ~27K annually, so I'm trying to close the gap as much as possible. I'll find out later today but some positions don't have built in raises or market adjustments and as inflation rises I will be taking a pay cut every yr so I need as much as possible up front in base pay.

I'm confused.  Are you wanting to be paid as an employee or contractor?  The $95/hr plus benefits is very fair.  15 patient encounters is not a whole lot in today's market, especially if you are at a facility with a lot of specialty availability.

[Patho]

9 hours ago, cinntsp said:

I'm confused.  Are you wanting to be paid as an employee or contractor?  The $95/hr plus benefits is very fair.  15 patient encounters is not a whole lot in today's market, especially if you are at a facility with a lot of specialty availability.

sorry it's confusing. 

I was initially offered 110-115/hr as 1099 by a locums company who was trying to staff this same position several weeks ago for this hospital group, however I was not allowed to work for the hospital group as a locums bc I applied and was offered this same job 1 yr ago. Apparently theres an agreement with this hospital group and the locums company in Maryland that if a prospective employee has made contact with them at any point locums company are not allowed to "present these candidates to them." Thats how the locum company explained it to me. I'm guessing it has to do with this group not wanting to pay the locum company a finder's fee or whatever fee they charge them for staffing the position since they already knew me from before.

A couple days after that conversation with the locum company the hospital group HR recruiter called me, offered the above pay and benefits, said they will hire me directly but not thru a locum company. 

So I'm tryin to get them to come closer to what the Locums company was offering me.

Several friends of mine make 70/hr in the area but only round on 10 patients/day. Here they are asking me to see 15pt/day. I used to be paid Doctor's rate (100/hr) when I rounded on 15-16 patients at my previous hospital. 95/hr for this work is fair, not spectacular. This company uses the hell of out PAs, but in doing so they don't have to hire as many docs so they save a lot of money with us. I'm asking for as much base pay as I can bc they can afford it.

Edited May 25 by Patho

[Hemmingway]

I'm confused about 1099 and having fixed hours and benefits. The IRS 20 rules describe who is and isn't a contract employee vs W2. I  have a long story about losing a staffing agency I started from scratch because the state wandered in about 3 years after I opened and said all my contractees were actually my employees the whole time and I owed 200k in back unemployment and penalties. They invited me to challenge them in court. I closed the doors.

I have heard of locums agencies providing benefits but only to people who work a lot of different contracts in a row so they meet a threshold requirement.

Unrelated to your question I know. I'm just curious.

[Patho]

7 minutes ago, Hemmingway said:

I'm confused about 1099 and having fixed hours and benefits. The IRS 20 rules describe who is and isn't a contract employee vs W2. I  have a long story about losing a staffing agency I started from scratch because the state wandered in about 3 years after I opened and said all my contractees were actually my employees the whole time and I owed 200k in back unemployment and penalties. They invited me to challenge them in court. I closed the doors.

I have heard of locums agencies providing benefits but only to people who work a lot of different contracts in a row so they meet a threshold requirement.

Unrelated to your question I know. I'm just curious.

These were the 2 competing offers

Locum Company Medicus Staffing: 110-115/hr as 1099 contractor, fixed 10 hr shifts 8a-6p 7on7off schedule for 1 yr term contract with possibility of extension, only benefit from these guys were travel related expenses

Hospitalist Group Offer: 95/hr + the benefits listed in the original post

 

At this point I only have the offer from the hospitalist group left bc they told me they will not hire me thru a staffing agency, only directly thru them. This has been quite the experience learning that hospital groups and staffing agencies have all these rules and back room deals. I was shocked by the hospital group blocking me from being a 1099 contractor thru Medicus Staffing bc I've never worked for this hospitalist group nor have ever signed any contracts with them. 

 

 

[Hemmingway]

7 minutes ago, Patho said:

These were the 2 competing offers

Locum Company Medicus Staffing: 110-115/hr as 1099 contractor, fixed 10 hr shifts 8a-6p 7on7off schedule for 1 yr term contract with possibility of extension, only benefit from these guys were travel related expenses

Hospitalist Group Offer: 95/hr + the benefits listed in the original post

 

At this point I only have the offer from the hospitalist group left bc they told me they will not hire me thru a staffing agency, only directly thru them. This has been quite the experience learning that hospital groups and staffing agencies have all these rules and back room deals. I was shocked by the hospital group blocking me from being a 1099 contractor thru Medicus Staffing bc I've never worked for this hospitalist group nor have ever signed any contracts with them. 

 

 

It is pretty standard. The group agrees not to hire away a contract employee and the employee promises not to hire on where he was sent. It just protects everyone's financial interest. 

There is typically a fee involved if someone wants to hire a contracted person and it isn't cheap. When I had a small staffing company it was anywhere from several thousand dollars up. I made my money by placing people. I couldn't have them stolen away.

[Patho]

13 minutes ago, Hemmingway said:

It is pretty standard. The group agrees not to hire away a contract employee and the employee promises not to hire on where he was sent. It just protects everyone's financial interest. 

There is typically a fee involved if someone wants to hire a contracted person and it isn't cheap. When I had a small staffing company it was anywhere from several thousand dollars up. I made my money by placing people. I couldn't have them stolen away.

That's exactly how they see it. Front their POV: we've already made contact with this PA, we know his number and have his resume ready, we just need to send him a text or call for direct hire, why pay a locum company a fee for an introduction for this person we already know.

[cinntsp]

4 hours ago, Patho said:

That's exactly how they see it. Front their POV: we've already made contact with this PA, we know his number and have his resume ready, we just need to send him a text or call for direct hire, why pay a locum company a fee for an introduction for this person we already know.

It is standard practice everywhere.  In my experience there is a 3-5 year timeline before a locums company can present you to a company that is already familiar with you.

[cinntsp]

5 hours ago, Patho said:

sorry it's confusing. 

I was initially offered 110-115/hr as 1099 by a locums company who was trying to staff this same position several weeks ago for this hospital group, however I was not allowed to work for the hospital group as a locums bc I applied and was offered this same job 1 yr ago. Apparently theres an agreement with this hospital group and the locums company in Maryland that if a prospective employee has made contact with them at any point locums company are not allowed to "present these candidates to them." Thats how the locum company explained it to me. I'm guessing it has to do with this group not wanting to pay the locum company a finder's fee or whatever fee they charge them for staffing the position since they already knew me from before.

A couple days after that conversation with the locum company the hospital group HR recruiter called me, offered the above pay and benefits, said they will hire me directly but not thru a locum company. 

So I'm tryin to get them to come closer to what the Locums company was offering me.

Several friends of mine make 70/hr in the area but only round on 10 patients/day. Here they are asking me to see 15pt/day. I used to be paid Doctor's rate (100/hr) when I rounded on 15-16 patients at my previous hospital. 95/hr for this work is fair, not spectacular. This company uses the hell of out PAs, but in doing so they don't have to hire as many docs so they save a lot of money with us. I'm asking for as much base pay as I can bc they can afford it.

I am never against fighting for more pay but you should expect to make 20-30% less as a W2 than as a 1099 because you are being offered benefits and the company is paying the employer's portion of federal taxes that you would be responsible for as a contractor.

[SedRate]

On 5/25/2023 at 8:34 AM, Patho said:

Several friends of mine make 70/hr in the area but only round on 10 patients/day. Here they are asking me to see 15pt/day. I used to be paid Doctor's rate (100/hr) when I rounded on 15-16 patients at my previous hospital.

Using the market rate of 70/h for 10 pts, calculate pay based on 15 pts which is 50% more work, so ask 50% more pay = 70 + 35 = $105/h

On 5/23/2023 at 10:07 AM, Patho said:

Last HM position I worked, MD/DO's saw 14-18 rounding patients, Doc rate was 108/hr. So with 15pts per shift I'm seeing doc range but also have to act as a locum PA traveling around. I feel 110/hr is fair but the HR person was being difficult. Would asking for a sign-on bonus be more effective in this case or keep asking for more until I get a final ultimatum. 

You can get as creative as you want. I've asked for a sign-on as a way to make up the difference in my salary. The problem with that is that it's a one-time thing -- good for short-term, not as good long-term.

I've also negotiated guaranteed quarterly bonuses as a way to take the place of an annual raise.

On 5/24/2023 at 12:23 PM, Patho said:

Either they hired someone else and couldn't keep them or have been struggling to fill this role since that time which is a red flag. 

I assume they will be working the hell out of me.

Sounds like you have some negotiating power. Keep to your numbers and be willing to walk if those numbers are not met.