Vlad Dzhashi, MD
💡 Bonus: Hospitalist Gig Checklist – Ask RIGHT questions, Make MORE money! 💡
My first ever conversation with the locum tenens recruiter:
Excuse me, sir . . . do you think you might possibly maybe somehow pay me 150$/hr or so?”
Can you guess what the answer was?
We’ve all been in the awkward situation when we felt we were not getting paid what we deserved, but due to lack of the business training and experience, we just accepted whatever was offered.
My first conversations with recruiters were pretty stressful, since every time, I failed to get what I thought was a fair deal for the type of hospitalist gig I signed up for.
Over the years I got really good at negotiating and have been consistently getting higher pay rates than most of my colleagues.
In fact, a few of my hospitalist friends asked me to negotiate for them, and in one case, I was able to negotiate the rate from an initial $160/hr to $200/hr! Needless to say, I got few unexpected Christmas gifts and postcards that year.
In this post I’m going to give you “tools of the trade” for negotiating the pay rate with the locum tenens agencies to get what you deserve!
Here’s what you are going to learn today:
1 – How to get into the right “negotiation” mindset
2 – How to know how much to ask for
3 – How to make legitimate arguments to get what you deserve
4 – How to make the agency want to work with you and not others
5 – How and when to use the Locumguy’s secret Plan B
All right, boys and girls, without further ado, let’s get clicking….
1 - Locums on my mind...
First things first: you need to get yourself into the right “mindset.” Now, what do I mean exactly?
You have to remember, as a doctor, your skills are in very high demand! You’ve probably heard that before but never realized how great the demand actually is. Let me tell you, or rather, show you, what I mean:
As you can see, in 2016 the estimated physician shortage was 19,300. By 2030 it will only get worse, which means plenty of locum gigs in the future.
The reasons for the huge demand are a growing aging population and the low doctor supply that has not kept up with the demand.
Besides giving me an inflated sense of self-importance, knowing this makes me more comfortable negotiating and asking for higher pay. It is also much easier to walk away from the bad deal if you find the pay rate unacceptable.
Now, let’s internalize what we’ve learned so far by repeating out loud:
I am a highly sought after professional; my skills are in a great demand!”
You need to do this 100 times first thing in the morning and 100 times before bed for two weeks.
If you don’t have time to do that, just practice saying it out loud a few times before calling the recruiter. I AM NOT KIDDING!!!
2 - Homework
The next step is to figure out what other people are paid for similar gigs in your area of interest. This is crucial!
There are two ways to do it:
1 – Talk to your colleagues practicing in the area.
2 – Check out my calculator here and read this post to get an idea of what affects the pay rate.
In any case, a hospitalist should not get less than $150/hr.
Set up your goal
Your goal will be the average pay rate based on your research + 20$/hr (+10-15%).
This is the rate you will request when talking to the recruiter. Why? Because of the effect of the “anchoring bias”. We tend to think in relative categories, so the first offer would set the stage for further talk.
Not only will you potentially get a great deal, but the recruiter won’t even consider playing games and making a ridiculously low offer.
3 - Lights, camera, action!
Before you make the call to the locum company, make sure you write down your goal number on a piece of paper and keep it in front of you during negotiation. You will also need it to write down the answers you get when asking the recruiter all the important details about the locum tenens job.
While talking to him, make sure you highlight what I call the “pain points.” What are those?
Pain points are anything that you think makes the job more difficult or increases your liability.
For example, here are some of the things that I and many other hospitalists find “painful”:
– PA/ARNP cosigns
– Open ICU
– Procedures
– Census higher than SHM recommendations
– More than an hour of driving from the closest airport.
If you decide the job would be a good fit (there’s no point to waste your time if it’s not, unless you are having too much fun negotiating), the next step is to talk about the pay rate.
Here’s the intro script that I tend to use:
I plan to work locum tenens long term and would like to build a relationship with an agency. So I’m currently in contact with a few locum firms and looking to get a competitive pay rate.”
Then you name your pay rate and back it up using the “pain points” that you highlighted. Mentioning them helps to justify your asking pay rate, because most doctors want “comfy” locum tenens gigs and recruiters know that.
Here are possible scripts that will help you to justify a higher pay rate:
This hospital seems to be busy: it has an open ICU; the census is high (refer to SHM guidelines); plus it’s in a rural area, so there will be some driving involved from and to the airport. That’s why the fair pay rate would be $***/hr.”
This hospital clearly lacks subspecialty support. I’ve had a stressful experience in the past when I had to transfer patients out every day which took lot of time and effort. So it will be worth my time only if I get $***/hr.”
You can also use “general” scripts that would work in any situation:
I’m currently getting $***/hr, so there’s no point in switching if I don’t get paid more.”
I talked to my colleagues working in the area and they get ***/hr, so I expect the same rate.”
These are just examples, but now that you’ve got an idea, you can come up with your own scripts that work the best for you.
Want to learn how to screen new locums gigs properly to avoid unpleasant surprises and negotiate the highest possible pay rate to make tens of thousands of $ more?
4 - The second round:
If the recruiter insists on the lower pay rate, I use a different kind of argument.
Instead of talking about the assignment itself, my strategy is then to give them a “flavor” of why they need to work with me rather than somebody else.
Here are the scripts that have worked like magic for me:
“You will LOVE working with me because…
I plan to work 14+ shifts a month.”
The more you want to work, the more appealing you are. It is always easier to credential and deal with one physician who’s going to average 14+ shifts/month rather than multiple locum guys committing to only a few shifts a month.
I’m very flexible and can do nights and/or swing shifts.”
Most physicians prefer to sleep at night, so you will stand out.
I am extremely liked everywhere I work. Because of that, I tend to stay long term in one hospital, and they always ask me to come back and take more shifts. “
Keep in mind that the recruiter’s salary depends on commission, so the longer you work, the more money they are going to make for themselves and the agency.
I live within commutable distance from the hospital and won’t need any accommodations or travel arrangements.”
This is a good one! The agency can save money on your travel expenses so that you can make more too!
Wash, rinse, repeat
If you cannot make the deal, then call another agency working in your area of interest. If there are too many firms covering the same area, aim for at least three. You should be able to get a good pay rate after that.
If still no luck, it could be one of few things:
- You need to do more thorough research to figure out how much you could get paid.
- The timing isn’t right, meaning too many docs have applied and possibly already started credentialing or even working at the facility.
- Location might be too “hot” Again, supply vs demand is not favorable.
Just wait for a couple of weeks to see if anybody calls you back. If you don’t receive any calls, contact the agency that offered you the best deal.
5 - Plan B
Even if you have to accept the offer that was far from your goal, do not get frustrated. I’ve got something really good for you:
Go through all the steps needed, secure your shifts, and after working for some time (few weeks to few months), use my secret plan B, which is….N.E.G.O.T.I.A.T.E!
Yes, again!
Let me explain:
I’ve noticed that I could get a healthy pay hike real easy after working and already making money for the agency.
Why is this so effective?
It’s easier to pay you more rather than find a new “working body.” Even if found, it will take a few months to have somebody start seeing patients due to credentialing, licensing and other hassles.
Here’s what you need to say when you call them up again:
Hi, (dear recruiter), I am approached by so many agencies working in …(your target state, city or area), and they are offering a much better deal. I hate to leave, so let’s find a pay rate that will work for both of us.”
Another hack is to use any newly discovered “pain points” to make an argument of why you need to get paid more. It won’t be too hard to find them. Believe me, after working at the facility, you always notice things that didn’t fit the initial info the agency gave you.
For example, the patient census is higher than what you were told, one of the core subspecialties is not there on the weekend, or whatever it may be.
P.S. Now, I would like to hear your thoughts. Do you find it hard to negotiate with the locum tenens companies? Can you share any tips or tricks that you use when negotiating? Please let me know in the comments below!
Thanks for all of the great content on your blog. I’m an IM resident starting to plan my post-residency life (hopefully locum) and I have been binge-reading your blog today. I really appreciate your in-the-trenches perspective on locum tenens work.
With regard to negotiating between multiple firms: I have heard that some firms will have a clause that doesn’t allow you to use another firm for a hospital that they have already sent your resume to. Is this sort of ‘non-compete’ clause common? Do you have any recommendations for dealing with or preventing it?
Bill,
I’m glad that you find this blog helpful.
You are correct, this ‘non-compete’ clause does exist. If you are presented to the hospital by one firm you won’t be able to get there through a different agency.
There’s really no way to prevent this other than negotiating your rate BEFORE you are presented.
So make sure you ask all the questions about the prospective hospital, negotiate the rate and if they are not able to offer what you think is a reasonable rate, call another agency or try to approach the hospital directly.
A lot of times the recruiter will ask you how much you want to be paid even before they tell you about the particular gig ( I think it’s a part of their questionnaire that they need to fill out to put your name in their database). That’s why I avoid answering this question and always tell them: “Every locum gig different so it depends”.
Also always tell the recruiter you do not want to be “presented” without your permission, which is actually considered to be a standard approach these days but it’s still better to ask.
Where are you planning to work as a locum?
Good Luck!
I understand a non-compete clause if you’ve accepted an assignment and gotten paid through an agency. But I was told yesterday by a recruiter that the position I was looking at was going through a “vendor management” firm. I had been called by at least three agencies about this position in the prior 2-3 days, and I told them all that I was already scheduled to start an assignment next month. I told them they would need to beat the rate I was quoted and gave them permission to start negotiations for me. The recruiter above called back to verify that I had given permission for others to present me to that hospital. When I said yes, she said that the first agency to present me to this vendor management firm basically “owns” me for that hospital for the next year. I did not consent to be “owned” by anybody, nor am I being compensated for the privilege of being ‘owned”.
To me, this sounds illegal. I engage various firms to try to get me the best rate for a position, but I don’t know their cost structures. If the first one won’t get me the rate I want because their costs are too high, but a second agency has lower costs and could get me the rate, but they are prohibited, then that whole process puts an artificial cap on the rates that I or anyone else can get.
I’m sure that’s why the vendor management firm exists. But it inhibits the true free market. Furthermore, I don’t know or have any control over which agency “owns” me for that hospital, nor do I know the start or end date for that period of “ownership.”
I have no problem with there not being a floor for a locums rate, but there shouldn’t be a cap either, which is what this process accomplishes.
Do you have any experience negotiating with the added layer of a vendor management firm, (who of course is another hand dipping into the revenue stream) and how can you still accomplish the goal of maximizing your reimbursement? Is there a workaround for this? It sounds like a type of antitrust violation to me, but I’d like to find a simple way to deal with this.
Mark, hi!
I am working on figuring it out. I’ll let you know what I find out.
Thanks.
Hi Mark… I started doing locums about a year ago and quickly learned about VMS as it seems that many hospital systems are going towards using them because they’re marketed so well to hospital HRs. My next contract I’m in the process of acquiring, I personally know the people at the facility and they have already committed to hiring me. However, since the hospital is signed up with a VMS, I now have to reach out to random recruiters that are signed up with the VMS and those extra two layers now get a cut since I can’t contract with the hospital directly. Very frustrating since I secured this without their help. To increase the insult, one recruiter I spoke to told me she doesn’t want to work with candidates that call around trying to get the best rate… huh?? Makes no sense to me and I was actually pretty insulted she would think I’d blindly accept whatever she offered me
But, what I’ve come to learn is that different VMS work differently. Some are more of a bidding type structure where the recruiter submits a rate that they’re willing to take (encourages lower bidding) and others are set up so that they present a rate as what they’re offering and candidates are submitted. But I would always have my rate confirmed before agreeing to be submitted. And negotiate the rate as described in this article before that
I am so in need to this blog and thank you for it.
My question is does the daily rate of the physician decided by the hospital or the locum agency?
Nida, Hi!
The pay that the agency gets is negotiated “behind the scenes” between the two: agency and the hospital. Then the agency negotiates this with you as a physician and makes money on the difference.
Is it reasonable to ask to be paid for your travel time if it takes more than 8 hours to get to your destination? I currently travel across country and I am in the airport a minimum of 13-14 hours, and with delays it has reached over 24 hours.
Julie, Hi!
You can negotiate everything!
If you spend so much time traveling to your locum assignment, you should ask them to pay a higher hourly rate.
I suppose you can ask them to pay a “travel” stipend too.
At the end of the day, it doesn’t matter how you call it, as long as you are paid well for your time.
On the other hand, if your flight got delayed once or twice due to the weather or airline, it may not sound like a very good point for negotiation.
Does your one-way trip take 14 hours? or both ways?
Hi ,
I accepted a locums assignment few months back and finally got credentialed. However, was supposed to start 2 weeks back and still don’t have a new date for start from agency or from the hospital. Every time I talk with the agency there is a new date and they have not reciprocated actively. I gave notice from my previous job to start this assignment and feel like it was the worst decision ever. My question is what should be my next step.
Vandana, hi!
The biggest question here is if they’ve ever confirmed your shifts e.g. sent you a “confirmation letter”? Because if they haven’t, it means you shouldn’t have relied on them.
What are your next steps? Start looking for other locum gigs asap. Some hospitals offer emergent privileges and you can get credentialed within a couple of weeks. You can also contact any hospitals you’ve worked at before since they may be willing to hire you as a locum.
Next time, try to work with multiple agencies and get credentialed at two or more hospitals at the same time. This way you’ll always have a back up.
If you are transitioning from a permanent job, then you can ask your employer to extend your contract for another a couple of months until you find new locum assignments.
I hope it helps!
Hi. Great blog. I am applying for a job and the agency wants me to sign a general locum contract BEFORE I talked to the chief hospitalist and was offered and accepted a position from the hospitalist division standpoint. They claim they can’t introduce me to the chief hospitalist without me signing it. This wasn’t the case with my previous agency. Is it a norm for some agencies?
Evgeni, Hi!
It’s quite typical for them to do that. They don’t want you to make an agreement with the hospital “behind their backs”.
Having said that a few things need to happen before you sign it:
1 – You need to make sure they tell you all the details about the assignment so that you decide if you want to do it or not (you can download a checklist at the end of this post)
2 – You need to negotiate your pay.
You don’t want to fill out tons of paperwork before you know this is going to work for you.
P.S. – I’m glad you enjoyed my blog. Please rate the agencies you’ve worked with here to help our colleagues know who is who in the locums world.
Thanks! Rated them already before posting a question 🙂
Thanks, Evgeni!
Hello Dr. Locumguy,
Great website; super informative. I’ve worked with locums agencies in the past but never really thought to negotiate the contract until my most recent locums experience for an occ. med part time position. My wife comes from the world of finance/ corporate so she has a different perspective for negotiating fees/ compensation/ etc that she will be sharing with me later. I will let you and other readers know how things are going and what I have learned; I’ll share the locums agency when we reach a deal. Thanks once again!
Hans, Hi!
Great to hear that you are gonna put all this knowledge into work 🙂
Keep us posted on how it’s played out!
Tell me how to navigate this before I accept. After getting burned from a company that held my candidacy and waited for a cheaper locum after I named my price with 20 years of experience. So now I’m in middle of trying to get a gig but the up front low ball offer is unreasonable. After I convince the medical facility I can do what they need, how do negotiate something reasonable with the locum provider without them pulling the deal from under me? Please don’t post my email
I am having the same issue, I think.
tahoeNP ,
that’s why you need to work with multiple facilities and agencies. The biggest mistake is that we tend to “trust” those agencies too much. Their primary goal is to make money so they would do whatever it takes to do that.
The best advice is – always have a couple of hospitals in the “pipelines”. This is the rule: be proactive.
And if they play stupid games with you, just move forward and never work with the same agency again. There’s a plenty of work out there!
I have a verbal deal to go to a hospital in a high covid area – I made this 4 months ago – would it be unreasonable to renegotiate now that there is this huge new burden (no hard contract signed (im a pulmonologist)
I definitely encourage you to renegotiate this as the demand is much higher now.
How do we, as providers, know that the rate we are asking for is truly what the agency presented. Lately I have been getting the feeling they are not presenting the terms I asked for, especially the rate? Can you ask the agency for an email, or other type of proof, that they actually presented me at the rate I asked for?
Also, how much profit do the agencies get hourly for a locum above what we are paid. I want to learn, from start to finish, how agencies work. Any websites come to mind?
Kate,
I don’t think there’s a way to know how much agency charges the hospital in each particular case.
Keep in mind they DON’T present your rate, they present THEIR rate and just pay you whatever your ask for.
Hope it helps.
Oops. I just started 2 locums assignments out of training in July/August because I liked the short-term, instant commitments, after my post-training vacation plans are no longer feasible. I shopped around for assignments with a few different agencies (most were paired solely to each other – hiring facility and agency vs. hiring facility and multiple agencies) and have a sense of my market value for the geographical location and work/schedule. However, after reading your posts/comments, I now know to ask for a higher rate vs. accept the agency “going” rate, which I was given the impression was pre-fixed/agreed upon for the agency reps to find doctors willing to work at the rate. I do think I will like these assignments, but I cannot help but feel that the agency is taking more of my cut. My question is when/how should I consider renegotiating my rate? Could I do that while in the initial contract ends? The contract print states that I can leave for whatever reason – financial or otherwise with 30 days’ notice, but I don’t want to destroy potential good future relationships… I am currently in a 3 month and 6 month contract to end Nov 2020/Feb 2020…
Does being fresh out of residency or being a foreign medical graduate affect your starting pay rate? If so by what percentage? I would like to follow your steps and negotiate but would like to know what would be their counter “pain points”, if you could please elaborate on that.
Thank you for this great resource.
Is it fair game to ask for paid orientation- I.e for EMR training, billing software etc?
Absolutely, I’ve always been paid for orientation. I get the same pay rate for orientation as my clinical hours.
Hello. Just stumbled across your blog. Great stuff, thanks! Do you have recs/ info/ where to look for surgical subspecialty rates?