LocumTenensGuy

DEA License Transfer: How To Transfer A Dea License To Another State.

May 16, 2022 by LocumTenensGuy

Vlad Dzhashi, MD

Before you hit the road to get to your new locum tenens gig or before moving to a new state for a permanent job, you definitely want to transfer your DEA license to another state.

Although the DEA transfer process is straightforward and you can complete it online, I recommend you to read on to avoid mistakes.

First thing to remeber is that to link your DEA registration to a different state, you need to get an unrestricted or locum tenens license in that state. You won’t be able to do it if you have a trainee (resident’s) license.

Second thing to remember that for some states you need to have a state specific Controlled Substance License (also called registration).

Here’s a step by step process to transfer your DEA license to another state.

How do I transfer my DEA license to another state?

There are several ways to transfer a DEA license to another state: online using the CSA portal, by calling the DEA Diversion Control Division at 1-800-882-9539 or your Local Diversion Field Office. You can also email your request to [email protected].

Let’s look at the step by step process of transfering your DEA registration online as it’s the most convenient way to do it.

1 - Go to the CSA Registration Portal

The CSA Registration Portal is an online resource provided by Diversion Control Division. This is where you can file an online request for the DEA license transfer to another state.

2 - Enter your DEA license number

On the first page you enter the DEA number that you want to transfer.

3 - Enter other pertinent info for your current DEA registration

Here, you’ll need to type in your last name, your current DEA license zip code, expiration date and your social security number.

You can find zip code, expiration month and year from your DEA certificate.

4 - Validate your date of birth

Enter your date of birth to validate it.

5 - Click on “State Licenses” on the status screen

Next you’ll see a crowded status page with complete information of your current DEA registration.

To change it to another state, you need click on “Edit” of the “State Licenses” section.

6 - Change your state license information

On the new page, you’ll need enter your information for a different state license you’re looking to transfer to. The info includes the license number and expiration date. Once you’re done, click on “Update” button.

7 - Change your business address:

Now, go back to the main license page and click on “edit” button for the “Personal Information” section.

Here, you need to type in an address to reflect your new practice location in a new state and move to the next page.

8 - Update confirmation:

Click on “Update” to confirm the changes.

You’re all done! You’ll see a confirmation page at the end.

Note that you can check the status of the transfer by logging back into the portal.

When you receive an email confirming that the your application was approved, your DEA transfer will be official. You will be set to hit the road to your new state!

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Is a DEA license state-specific?

Yes, the DEA license is linked to the state of your choosing (as long as you have an active and underestricted medical license in that state) and it cannot be “attached” to more than one state. However, you can transfer it from one state to another using the process I covered here.

How long does it take to transfer a DEA license?

Once the request to transfer has been submitted to the DEA, it can take anywhere from 2 days to a few weeks for the transfer to be approved.

Is there anything you can do to speed up the DEA transfer?

No, but the good news is that the transfer is usually done within a few days. Once it’s completed, you’ll be able to print off a copy of the transferred DEA license.

How do I change my address on my DEA license?

Login to the CSA Registration Tools. Here, you can make the changes to the address on your DEA license using steps I described above.

How do I change my name on my DEA license?

You’ll need to login to the CSA Registration portal and select the option to make changes, where you can update your name. Be prepared with the documentation that shows your new name such as your updated medical license, government-issued ID, marriage license, and/or SSN card.

Alternatives to transferring your DEA license to another state

The alternative way to transfer your DEA license is to call the DEA Diversion Control Division at 1-800-882-9539 or call your Local Diversion Field Office.

You can also email your request to [email protected]

How to transfer a DEA license: Key takeaways

Getting all your ducks in the row to transfer to a new state may seem overwhelming. Luckily, the process to transfer a DEA license is fairly easy and I hope you found this information useful.

Locum Tenens Tax Deductions Explained In Plain English {Bonus 1099 Expenses Tracker Included}

October 31, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

💡 BONUS: click here to download the expense tracker that lists all the tax deductions and lets you easily track them for CRAZY tax savings 💡

Paying taxes is an inevitable evil.

On top of that, taxes are confusing!

But…I’m absolutely convinced that every locum tenens guy and gal needs to grasp the basics. This is especially important for “newbies” who are either graduating from residency/fellowship or switching from full-time employment.

What was it?

You don’t feel like reading about locum tenens tax deductions?

Hmm…how about MAKING MONEY? Everybody LOVES reading about how to earn more.

Now…using tax deductions, reducing the tax burden, and saving on taxes is THE SAME as making more money since in both cases you’ve got more cash left in your pockets.

Ahh…now I see you got interested…

Let’s dive in and learn in nauseating details 100% legal ways to keep more $$ for ourselves!

Disclaimer: Always discuss the specifics of your situation with a CPA and consider signing up for a tax review and tax tips with an experienced tax professional providing custom-tailored services to the locum tenens doctors.

Physician locum tenens taxes vs W2 taxes:

The first thing first, If you are new to locum tenens work you must know that now you are an independent contractor which means you are self-employed and your locum tenens taxes will be different from W-2 taxes that you used to file.

1 – Nobody withdraws your income tax from your paycheck anymore so now it is YOUR responsibility to make regular tax payments to the IRS (federal tax, self-employment tax, and state tax).

2 – Your tax return will look different: you will have to pay taxes four times a year in contrast to once at the end of the year.

3 – Now you can deduct business expenses, i.e. the thing that cost you money but are required to conduct your “business” as a locum tenens physician.

This will be the case REGARDLESS of whether you work using a staffing agency or work directly with the hospital as long as you are paid as a 1099 physician.

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HOME OFFICE locum doctor tax deductions

What is a home office in the IRS' eyes?

A room or an area of your home that you use ONLY for your “business” activities on a REGULAR BASIS: e.g. charting, communicating with locum tenens agencies, applying for new licenses, printing and scanning documents, bookkeeping etc.

Your home office could be a whole room or a part of it (e.g. you have a bedroom that you use as such but you also have a desk with a printer).

What expenses can you deduct?

A portion of mortgage interest, insurance, maintenance, which is based on the square footage of your home office area, are allowable in locum doctor tax deductions

And…great news if you are renting as you can also use this deduction!

Can I deduct rent if I work away from home?

Yes! As a locum tenens doctor, you may work away most of the time, but the good news is YOU CAN deduct a part of your rent proportional to the area you are using as your home office deduction.

Non-deductible:

Room or area that you use for business activities AND it serves as a media room or bedroom at times (even if occasionally).

PERSONAL CAR tax deductions for locums doctors

If you use your personal (i.e. not rented) car to travel to locum tenens assignments, your tax advantage will usually come in one of the two forms:

“All-inclusive” IRS mileage rate

The most common option is to use the “all-inclusive” IRS mileage rate, which changes every year and it is $0.575 per mile in 2020.

So, for example, you decided to drive to the neighboring state instead of flying and covered 500 miles both ways. Also, while working away from home you drove 10 miles every day for 15 days to get from the hotel to the hospital and back.

Your total mileage would equal: 500 + 10 * 15 (10 miles daily for 15 days) = 650 miles

To calculate the money value you need to multiply total mileage by IRS rate, or 650 miles x $0.575 which equals $373.75.

Now, when you work with an agency this amount will be added to your paycheck and will be tax-free.

If you work with the hospital directly as an independent contractor, this amount is allowable as tax deductions for doctors.

Actual car expenses

A second option is to track ACTUAL car-related expenses and write them off: gas, maintenance, insurance, repair costs, etc.

It’s much more cumbersome and may not lead to any extra tax savings compared to the first approach.

Non-deductible:

Commuting is NOT deductible, i.e. your driving between your home and clinic/hospital that you work at on a regular basis.

Locum tax deductions for TRAVEL EXPENSES

What locum tenens travel expenses are considered to be deductible ?

Any travel expenses that you have while spending a night(s) away from home for an assignment that is temporary (will last less than a year).

What travel expenses CAN locum tenens physician deduct?

If you are paying for your travel expenses out of pocket you can deduct following:

Airfare including baggage fees
Rental car or Personal car expenses (if driving your own car)
Gas
Hotel/Accommodation
Parking and tolls
Meals (please see detailed explanation below)

If your expenses are REIMBURSED or PAID by the agency, the only travel deduction you can claim is meals.

Non-deductible:

Parking, toll fees, gas expenses while commuting (i.e. not spending night away from home working on a temporary assignment)

MEALS: doctors’ tax deductions for food

Meals are deductible as long as you travel to your locum tenens assignment and not just commuting.

Any travel expenses that you have while spending a night(s) away from home for an assignment that is temporary (will last less than a year).

You've got two options here:

Are per diem meals 100% deductible?

Per diem meals are deductible at 50%, and is the standard method of tracking meal expenses on the road, as it’s easy and effective. To prove the per diem days you claim were in fact days you were contracted to work, it’s a very good idea to save your assignment contracts.

Non-deductible:

Any meals you paid for at the hospital/clinic within commutable distance from your home (i.e. you didn’t have to stay at a hotel and drove back home after work).

HEALTH INSURANCE locum tenens physician tax deductions

What health insurance expenses can locum tenens doctor deduct?

Health insurance premiums (i.e. your monthly payments including dental insurance) and HSA contributions are tax-deductible.

Non-deductible:

Healthcare expenses, e.g. doctor or hospital fees, medication costs unless paid using the HSA fund.

TRAINING/CME tax deduction

Airfare, hotel and course fees are deductible as long as they are required to attend your seminar.

All other educational expenses are deductible as well including: books, journal subscriptions, ACLS/BLS certification, board exam preparation course etc.

Non-deductible:

If a CME conference is just an excuse to have an extended vacation, GOOD TRY, but the personal portion of the trip’s cost IS NOT deductible.

UNIFORM: are scrubs tax deductible?

Only clothing specific to the job (i.e. scrubs, labcoat) will be deductible.

Non-deductible:

Anything that can be seen as “street” clothing is NOT deductible.

Damn it…no “cheap” Gucci shoes for me!!!

CELL PHONE locum tenens tax deductions

Estimate how much of your usage is business-related and deduct the respective portion. I typically deduct 50%.

You can deduct 100% of your phone expenses ONLY if you’ve more than one phone and use it EXCLUSIVELY for your locum tenens related communication.

You can also deduct the cost of the phone itself, again, keeping in mind how much of its use is personal vs business.

Other deductible locum expenses

Check out these other tax deductions for doctors:

How much can a locum tenens physician write off the taxes?

A lot of doctors want to know how much money they can deduct from their 1099 taxable income. In my experience, if you travel away from home and work locum tenens full time, you will be looking at anywhere between $5000 to $15,000.

So, if you are in the 30% tax brackets, you will save $5000 * 30%, or $1500 per year on the lower end and $15000*(keep in mind these are very rough calculations).

Legal entity and tax deductions

Now, I cannot give advice on forming a legal entity like an LLC or C-Corp this is why it’s a good idea to get professional tax advice.

The last thing I wanted to mention is that you can claim all the 1099 deductions for physicians that I mentioned even without setting up an LLC or Corporation.

Keeping track of your expenses

Once you learn what those deductible expenses are, the next big thing is to make sure you keep track of ALL of them.

This was something I was struggling with initially. You see, when there are so many different items to deduct it’s really easy to forget about them which means you are literally LOSING money. So I used to waste a lot of time going through all the transactions for that tax season.

That’s why you HAVE to use one of the approaches that I describe in my post on organizing the locum tenens life whether you use debit or credit card to pay your business expenses.

And, make sure to download the spreadsheet below to make your life easier.

BONUS: 1099 expense tracker

💡 BONUS: click here to download the 1099 expense tracker that lists all the tax deductions and lets you easily track them for CRAZY tax savings 💡

DON’T FORGET!

Don’t forget to add your allowable locum tenens tax deductions as expenses in my locum tax calculator when estimating how much tax you’ll likely pay.

Key takeaways on physician independent contractor tax deductions

As you can see as a locum tenens/independent contractor physician you can deduct a lot of expenses. By now you should have a pretty good idea of what these things are and how to keep records of ALL your expenses.

Locum tenens health insurance: comprehensive guide

October 29, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Are you switching to locum tenens and looking for health insurance to replace your employer sponsored plans?

Great!

Stick around as today I’ll cover how to do EXACTLY this without the risk of brain freeze.

But…FIRST…

Congrats on going “rogue” and starting your locum tenens career! You’ve made a really smart move.

That said, before you rush to celebrate like there’s no tomorrow, here are some points chock-full of reality:

So…the bad news, it is YOUR job to make sure you’ve got your safety net before switching to full-time locums.

The good news is that this guide is going to give you actionable steps to make this transition as smooth and painless as possible.

Without further ado…let’s get on it!

Cash “insurance”:

First, you will need some cash. That you don’t spend. Like a cash reserve.

You see, cash is your most important locum tenens insurance and the rule of thumb here is to save enough money to cover at least six months of your basic expenses.

Having that reserve will not only give a piece of mind if your gigs fall through the cracks but you’ll be in a better position to negotiate with hospitals and locums agencies.

Believe me, it’s easier to say NO to a crappy gig with a large chunk of cash in the bank and you’ll have more patience to search for better opportunities.

Now, to make sure your reserve stays intact at all times, “park” it in a separate bank account (saving or yield account) and check it only a few times a year.

Out of sight out of mind…

FREE GUIDE: How to replace benefits when switching to locum tenens including retirement plan, disability and life insurance.

Health insurance for locum tenens physicians:

Now, let’s take a look at your locum tenens health insurance.

If you’ve never shopped for your own insurance before, this WILL BE CONFUSING.

I remember when I was shopping for it, this probably took me days of internet research and multiple phone calls to finally figure this out.

Read on as I’m breaking down health insurance options in more detail.

Health insurance through a family member

If your spouse or partner is employed, check out what it may cost to get on that company’s health insurance plan and this would be your cheapest option in most cases.

Note that you may qualify for this insurance even if you’re not legally married.

COBRA

The Consolidated Omnibus Budget Reconciliation Act (not the snake) guarantees the right to temporarily remain under a former employer’s health insurance plan after you leave your job.

You may stay on COBRA for 18 months, with an option to extend for additional 18 more months.

Compared to the employer sponsored health coverage, you’ll have to pay more out-of-pocket for the insurance since your employer is no longer footing the bill which means your monthly premiums will be HIGH.

And I mean…REALLY high…

For example, when I was switching from my permanent job to locum tenens, COBRA would cost me $2500 a month (!!!)

Whoops…

The main reason for signing up for COBRA despite its cost would be to keep your current treating doctors and avoid other annoyances of switching to the new insurance plan.

Health sharing (Group) insurance plans

Health sharing plans are NOT health insurance. They share health care costs among members of a group. Your premium is deposited into a “potluck” (or rather “pot unluck”) i.e. a community fund.

When you need medical care, the bill’s paid out of that fund. This type of health coverage is typically cheap, sometimes as low as $100/month.

Here’s a list of the major health sharing plans:

Christian Healthcare Ministries
Medi-Share
Samaritan Ministries
Liberty HealthShare
United Refuah HealthShare
MCS Medical Cost Sharing
Altrua HealthShare
Freedom HealthShare
Trinity HealthShare

Most of these companies’ sites have an option to get an instant quote.

Short-term health insurance

Short-term health insurance plans are temporary, year-long, low-premium and high deductible insurance policies that may be renewed for up to three years.

Short-term plans don’t cover things like pre-existing conditions, maternity care, mental health, or prescription drugs.

Caveats: coverage limits and pre-existing conditions

Ok, let’s say you’ve decided to save money and go with cheaper options, i.e. group shared plan or short-term health insurance. Make sure you understand two important caveats.

Coverage Limits

The first one, is that even if you’ve maximized your deductible for the year you may end up having to pay A TON OF MONEY out of your pocket since these policies have an annual or lifetime coverage limit.

The limits may be as low as $100K a year in case of the shared plan or a lifetime limit of $2.5M for short-term insurance policy.

Pre-Existing conditions

The second issue is that you HAVE TO know how your insurance company defines pre-existing conditions as this is where a lot of people got “burned”. Check out this case-study that describes how things may go wrong.

Ok…now when you know all your options, let’s look at how to pick the one for you.

Choosing your health coverage when switching to locum tenens

Here’s a “decision tree” you can use to make a quick choice:

Now if you’re still unsure, just stick to the private insurance as they are regulated by the government and although in most situations costs are high but manageable compared to how much we as doctors make.

Moving on…

Private insurance

The private health insurance is what most locum tenens docs are using (including myself). These plans have no coverage limits or preexisting condition requirements and work similarly to the plan you’ve had as an employee.

Cost of private insurance

The rule of thumb is that your monthly premiums will be at least TWO times MORE and your deductible will be TWO times HIGHER compared to the employer sponsored plans.

Here’s a great resource for the average monthly premium by state and metal tier.

Shopping for the private healthcare insurance

In any state you’ll have at least a few private health insurance to choose from and in the states with lots of insurers you’ll have dozens of options.

There are TWO ways to shop for them: using a broker or using your state’s health exchange site.

Broker may be a good option if you’re purchasing your own plan for the first time and you have some specific questions regarding your personal situation.

You can find brokers here: https://localhelp.healthcare.gov/.

Personally, I used a broker when I bought my shopping for my private insurance for the first time and after I understood the process well, I was purchasing it on the Washington state health exchange.

To use your state’s health exchange you should go to the healthcare.gov and choose your state from the list.

Bronze, Silver and Gold insurance tiers:

Typically you would have a choice of bronze, silver and gold plans (a bag of gold doesn’t come with, sadly).

Here’s an example of WA state:

The lower your premiums are, the higher your deductible is going to be. So for example here your bronze plan has a monthly cost of $321.58 and a deductible of $8,550 whereas the gold plan’s monthly premium is $551.18 and a lower deductible of $5,250.

Gold plan would make sense when you expect to use your insurance frequently, e.g. you need prescriptions, have chronic conditions etc.

HSA or Health Saving Account:

When choosing your locum tenens health insurance, it’s important to decide if you want to go with an HSA plan or not.

Health Saving Account is a savings account that lets you put aside money to pay for your healthcare expenses including your deductible and copays.

Here’s a kicker: HSA gives you a triple tax advantage.

This means you can put pre-tax money into the healthcare fund which grows tax free and if you pay for the healthcare expenses without having to pay tax.

The other good thing, even if you get employer sponsored insurance later on, your HSA fund money would keep growing as an investment.

Personally, I always sign up for HSA if this option is available.

Vision Insurance

Most vision insurance policies cover your annual eye exam cost and the cost of contacts or prescription eyeglasses. The coverage you get depends on the insurance policy and benefits plan you choose.

Unlike employer-sponsored plans, buying it yourself means you are responsible for the full cost of coverage. Employers typically contribute to the cost, reducing your out-of-pocket costs.

On average, vision insurance packages provided by employers cost the business between $5 and $10 per month for each employee. If you purchase this plan independently, the cost ranges between $5 and $35 per month for an individual.

Dental insurance

Dental coverage will typically fall under two categories.

General Dental: This includes x-rays, routine cleanings, small fillings, teeth bleaching, and fluoride treatments.
Major Dental: This policy provides coverage for more extensive treatments, such as dentures, bridges, crowns, and teeth extractions.

The deductible depends on the type of plan you choose. Major dental policies tend to be more expensive than general dental policies.

With an employer-sponsored plan, your employer receives discounts for covering multiple people. The employer may also pay part or all the monthly premiums.

For an individual dental insurance plan, you can expect to pay on average $40 to $50 per month. While this is true, you can find plans that cost as little as $13 per month.

If you opt for major dental, you may pay $140 per month or more.

Offsetting the insurance cost:

As you can see, most if not all insurance options for locum tenens doctors would have a higher premium, higher deductible or if you go with plans with low monthly payments, you would have a bunch of limitations.

Now, the good news is that the IRS lets you take a self-employed health insurance deduction.

NICE! I totally love the IRS now…kinda…

And…you may be able to deduct some medical expenses (doctor visits, hospital fees, and even prescription eyeglasses) that exceed 7.5% of your adjusted gross income.

Now, after we’ve covered a lot of ground for healthcare insurance, let’s talk about other optional health insurance coverage.

Travel Health Insurance for locum tenens

As a locum tenens physician, you will be on the road a lot. If you become ill and need to go to the hospital, you need to ensure you have proper coverage for those situations.

The cost of travel insurance varies based on what you need. But, you can find policies that range in price from $250 to $500.

Some of the factors that will impact your insurance cost include your age, how long you are traveling, and the type of coverage you want. Usually, travel insurance plans cover any medical-related expenses. If you are injured or become ill and require emergency care that may not be covered by your regular health insurance fully, travel insurance may help.

The policy may also cover you being taken to a nearby hospital or even flown home if you become sick or injured. You can purchase travel insurance from a broker or online. The process to purchase it is simple. You can simply:

Answer questions related to your travel plans
Receive quotes for coverage
Select a plan
Review the coverage and policy
Purchase the plan

Some plans offer a cancelation period, too, when you can cancel the policy and receive a refund.

If you plan to be traveling for six months or more, having a long-term travel medical insurance plan can be beneficial. With the right travel medical plan, you receive the extra coverage you need while away from home.

You can receive emergency care coverage and coverage for emergency evacuation. When it comes to costs for this insurance, the price is dependent on factors like where you are going.

But, on average, you can expect to pay between $70 and $100.

For longer travel plans, the cost will go up.

If you work with facilities directly, spend lots of time on the road and the travel insurance seems to be too expensive, consider getting a medical evacuation policy.

Medical Evacuation policies:

Emergency medical evacuation companies will assist with your transfer in case of the medical emergency.

This policy will cover the cost of your transfer to the hospital close to your home and family, which may run in tens of thousands of dollars if you don’t have this coverage.

As soon as you get to your “in-network” local hospital, your health insurance will cover 100% of your care.

Although this type of coverage will not pay your medical expenses, the medical evacuation plans are MUCH cheaper than a full travel insurance and the cost for these policies are around $200 per year on average.

For locum tenens doctors, this is a smart option and I personally have it.

I’ve been a member with Medjetassist for a few years now. The annual cost is $189 in 2021 and the company has a very good reputation.

Conclusion: health insurance for locum tenens physicians.

Setting up your “safety net” is the most important first step before taking the leap into the locum tenens.

As you can see, you can easily replace your employer sponsored health insurance as long as you pay attention to all the things I covered today.

Now, if health insurance is still too confusing, find a local broker who can help you with choosing the right plan given your situation.

FREE GUIDE: How to replace benefits when switching to locum tenens including retirement plan, disability and life insurance.

Ultimate guide to buying your own locum tenens malpractice insurance

August 4, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

If you’re looking to buy your own malpractice insurance for locum tenens work, you may be in for a surprise.

You see, it’s much more than just having vs not having malpractice coverage. There’s lots of important things you need to consider when buying your policy.

And…if you’ve never done it before, this can be pretty confusing.

FEAR NO MORE!

You got LUCKY to stumble upon this post…

Today, you’ll learn what kind of coverage you need for locum tenens, how to save money on it, what to watch out for in your policy to avoid legal troubles and more…

On top of that, I’ll explain everything in PLAIN English, without using any confusing legal jargon, to make sure it’s as clear as it can be.

Let’s jump right in.

Disclaimer: I am not a lawyer nor am I an insurance agent. This post doesn’t provide legal advice or consultation; it is simply for educational purposes. Seek professional opinion.

Occurrence vs Claims-made malpractice insurance

Let’s start with the basics here. There are two kinds of malpractice insurance: claims-made and occurrence.

Claims-made, “Tail” and “Nose”

Claims-made policy will cover you only for liability that happened AND was reported (i.e., a claim is filed) while the policy is active (i.e., you are still paying for it).

A little confusing, isn’t it?

Let me give you the visual…

In the above example, your insurance will cover your defense costs and the settlement payout, if it gets to that.

In this case, you are not protected by your medical malpractice policy UNLESS you’ve purchased TAIL coverage from the same or other insurance company.

What is “tail” coverage?

The tail is a supplement that covers events that happened during your policy, even if they were brought up against you after your insurance’s expiration date.

This “upgrade” costs about 200% or more of your last year’s premium.

Ouch…

Another option is to purchase a “NOSE” coverage (also called “prior acts” or “retroactive coverage”). It will cover prior events, and sometimes you can get it cheaper than tail coverage when switching to a new insurance carrier.

Now, keep in mind that claims-based annual cost goes up over time, reaching its maximum in five years (this is called “maturing”). When your insurance gets to its maturity it would cost at least twice as much as your first year.

Check out the example below which is a quote I got from a broker a couple of years ago…

Occurrence

This type of medical malpractice insurance doesn’t require tail no matter when the legal claim is reported as long as the event “occured” during your policy coverage period.

So this one is easy to understand as it works the same way as your car insurance: you pay what you pay without needing to buy tail or nose coverage later on.

And that’s the reason the occurrence policy is more expensive than the claims-made premium, especially if you compare it to the first year or two of the claims-made cost.

Again, here’s a real life quote:

You can see that a claims-based yearly cost is lower than an occurrence policy in the first couple of years. After that, the difference is minimal, especially if you take the cost of the tail coverage into your calculations.

💡 TLDR:

Claims-based:

Pros: Cheaper (the tail cost excluded)

Cons: Each year gets more expensive until year five

Cons: You need a “tail” or “nose” coverage, which can be 2-4 times of your annual policy cost

Occurrence:

Pros: NO need to buy “tail” or “nose” coverage.

Cons: More expensive compared to the claims-based without the tail

Malpractice insurance COVERAGE LIMIT

Now, the other big question is how much coverage do you need?

In the locum tenens world, the standard coverage amount has been $1M/3M.

What do these numbers mean?

The first number ($1 million) is for the annual maximum your insurance company will pay for each case and the second number ($3 million) is the total annual amount if you’ve been sued by multiple patients.

Generally speaking, I would stick with the $1M/3M limit as there are potential issues with having too little or too much coverage.

Let me explain…

With the LOWER LIMIT you may be at risk of needing to pay out of your pocket. This may be OK if you practice in state(s) with a very low risk of getting sued (e.g., MN,SD etc…) AND the state has a cap on noneconomic damage (e.g., TX, IN).

Now, you don’t want to have a very HIGH POLICY LIMIT either, as you can become a “scapegoat” if multiple doctors are named in the lawsuit. You don’t want to end up in a situation where your insurance pays out more money than other defendants’ policies, as this may look like it was mostly “your fault.”

The bottom line is: with malpractice coverage limit, you want to be like everybody else.

💡 TLDR:

$1M/3M is a typical coverage limit for locum tenens

Important malpractice insurance CLAUSES

“The devil is in the details…”

And, dammit, this is so true when dealing with legal mumbo jumbo in the fine print…

As a matter of fact, there are several very important clauses you HAVE TO know about when buying your own locum tenens malpractice coverage.

Defense cost limit:

You want to make sure your policy has NO limit on defense costs, i.e., your lawyer’s fees, expert witnesses fees and other admin expenses.

The trouble here is that these fees can get very costly (hundreds of thousands of dollars at times), and you don’t want to end up paying them out of your pocket.

Deductible:

Believe it or not, some medical malpractice policies have deductibles, which can range between $2,500 and $10,000.

How do they work?

With the indemnity-only (also called “loss-only”) deductible you pay the deductible ONLY if you’ve “lost the case” i.e., the insurance company needs to make a payment to the plaintiff.

With “Indemnity and Expense” you need to pay after the legal case is open regardless of the outcome.

A deductible is not always a bad thing, as it makes your policy cheaper.

“Consent-to-settle” clause

A “consent-to-settle” clause FORCES your insurance company to get YOUR permission before they would settle any case against you.

This is definitely a must-have “perk” as some insurance companies may be tempted to settle the claim even if there’s no fault of yours. This happens if the settlement amount is less than the cost of defending you.

The problem is that this will be reported to the NPDB and will remain in your “biography” forever.

After all, it’s all about money for the malpractice insurance company, but for you, it’s about your reputation.

Hammer clause

The “hammer” clause is something you want to avoid.

It is closely related to the “consent-to settle” clause but may work against you.

Imagine a situation when after the claim is reviewed by the plaintiff and defendant lawyers as well as expert witnesses, your insurance company recommends you to settle the case (i.e. make a payment on your behalf to your former patient or his family).

Despite the advice, you refuse to settle and want to proceed to the jury trial.

Now, let’s say the jury’s decided you are responsible for a higher payout amount than was recommended by your insurance before.

In this case, the “hammer clause” will force YOU to pay the excess, which, of course, can be A LOT of money.

💡 TLDR:

Make sure your policy has a “consent-to-settle” clause.

Avoid defense cost limit and “hammer” clauses.

Check to see if your policy has a deductible, and if so, its amount and the type.

Moving on…

Locum tenens malpractice insurance cost:

I’m sure it’s not a surprise to you, but malpractice insurance can cost a LOT.

What you may have not known, however, is that it can cost up to hundreds of thousands per year.

What…!?

You heard it right…

So pay attention to what AFFECTS your coverage cost, as this may change your approach to where and how you work locum tenens.

Let’s take a look…

Specialty

Some specialties are naturally higher risk, i.e., on average, they get sued more frequently compared to lower risk specialties.

Here’s an interesting data point that was published in NEJM in 2011. They looked at a one-year period to determine what percentage of doctors is being sued based on the specialty.

The other interesting point is that some specialties, like general surgery and Ob/Gyn, are not only getting sued more frequently, but their insurance would make a payment to the plaintiff more often as well.

Where you practice

The cost of your malpractice policy varies a lot based on where you practice as well. This is based on the general risk of being sued as well as the average payouts specific for the area.

What’s interesting is that rates can be different, even within the same state, as more affluent counties tend to sue more and the settlement payouts to the high-earners are larger as well.

When you buy your own locum tenens malpractice coverage, keep in mind you need to let your carrier know if you are going to work in a new location so that they can adjust rates accordingly.

Your cost may go up, go down or remain the same.

If you work across multiple locations with different costs (even if it is within the same state), you’ll pay based on the highest premium.

Look at the example below that gives you a good idea how big of a difference your specialty and geography can make.

Internal Medicine Annual Malpractice Insurance Cost

ObGyn Annual Malpractice Insurance Cost

General Surgery Annual Malpractice Insurance Cost

Besides your specialty and your practice geography, there are other factors that can affect the cost.

Past claims and losses

The more claims you’ve had and the higher the payouts, the more your insurance will cost you.

Coverage limit

Lower limit will mean you’ll get a cheaper policy.

Deductible

If you agree to have a deductible built into your policy, your cost will go down.

How much you work

Your malpractice insurance premium is prorated based on how much you work, so if you work 50% of your average weekly hours for your specialty, you get a 50% discount.

Shopping for your own malpractice coverage

Now, after learning the basics of the locum tenens malpractice insurance, let’s see how we can shop for it like pros.

Where to buy it?

The best way to shop for your own malpractice insurance is to use a broker.

It’s much easier to work with a broker, as you can get quotes from multiple insurance companies and compare the prices.

On top of that, your broker can answer your questions, which is helpful if you’re a newby.

Buying from an insurance carrier is an option too, but I don’t think it is worth it.

You see, you’ll have to request quotes and complete multiple annoying applications to compare the rates between different companies. This will take MORE time and effort on your part without giving you any advantage.

How to find a legit broker?

To find a broker, just google “medical malpractice insurance broker” or use referrals from other physicians.

Here’s a few questions you need to ask before signing up:

Does the broker specialize in malpractice insurance?
Does your broker operate in your state of interest?
Ask for their insurance broker license number and verify online on the official government website (e.g., here’s one for WA state).
If in doubt, ask for past clients’ contact info to make sure the broker has good reviews.

Decide on what type of policy you want to get

Once you’ve hooked up with a broker, you need to decide if you want to go with a claims-made or occurrence insurance.

The way to do it is to figure out how long you need your coverage for and calculate the cost.

For example, using this quote:

You can calculate how much you’ll end up paying for occurrence vs claims-based options:

So as you can see, with this particular insurance quote, you will be better off purchasing an occurrence policy as you will end up paying less from the get go.

Let’s look at another quote (two different insurers):

As you can see here, it would make sense to get a claims-based policy as it will cost you less.

So…run the numbers before buying to see which options would be better.

Keep in mind that you can switch between claims and occurrence insurance as long as your insurance company provides both options.

Also, you can actually cancel your policy at any point, in which case you can get a prorated amount back, although most carriers will keep at least 25% of the annual cost regardless of when you’ve canceled your policy.

This gives you peace of mind, as you have flexibility if your locum tenens gig dies off or you decide to jump ships and work with a locum tenens company instead.

Insurance carrier ratings

If push comes to shove, you want your insurance company to pay the settlement, right?

After all, that’s why you’ve bought the malpractice insurance in the first place.

That’s why you need to check your carrier’s AM best rating. An “A minus” or above is a good indicator the company has a strong financial base.

Five ways to save money on malpractice coverage:

Now, I want to suggest a few ideas on how to save your hard earned money when buying locum tenens malpractice insurance for yourself.

Depending on your specialty and how much you work, this may save you tens of thousands of dollars every year (you are welcome!)

Avoid high liability areas:

The best way to deal with problems is to avoid them in the first place.

Thank you, Captain Obvious!

That’s why picking up locum tenens gigs in state(s) with a better liability situation is the best overall strategy.

If you’ve got coverage already, check with your insurer to see how much you can save by working in a more physician-friendly state. You may be surprised how big of a difference this can make.

Consider a lower limit:

Even though 1M/3M is standard for locum tenens doctors, you CAN go with a lower limit and save money.

$500K/1M or even $250K/$500K may be a good option if you are in the state with a noneconomic damage cap AND your specialty is in a “low-risk” category.

Don’t shy away from policies with deductibles:

If you are ok with having a deductible, you can potentially save tens of thousands every year, as long as you don’t have any past claims.

This makes even more sense if your deductible is low, e.g., $2500 and/or your deductible is indemnity-only [jump link here]

Reduce your hours:

Another approach that can give you cheaper coverage is to cut your work hours to be considered “part-time.”

Of course, you need to crunch the numbers and see if this makes sense for you.

For example, if I were to work part-time only, I would save about $10K a year on the malpractice insurance premium every year. But…I would “lose” $150K-200K by reducing my work hours.

So for me, as an internal medicine hospitalist practicing in WA state, switching to part time just to save money on malpractice insurance would be nonsense.

On the other hand, this may make sense if your malpractice premiums are sky high (e.g., you’re an ObGyn physician working in affluent Florida counties).

“Clean” background discount:

Some insurers offer a discount (10-15%) if you have no malpractice history, so check with your broker if this can be applied to your policy.

What if your policy is TOO cheap?

Now, we’ve talked about how to make your malpractice coverage cheaper, but what if some insurers’ quotes seem TOO LOW to be true?

If this happens, my suggestion is to ask your broker why.

Does the policy have one or more of the “sneaky” clauses I talked about earlier?
Is there a high deductible or defense cost limit?
Does the insurance company have a low AM Best Rating? Or maybe it’s not rated at all?

This is where your broker’s knowledge and expertise can help you to weed out “bad” players from the good ones.

That said, if there’s a potential risk, I would always prefer a more reliable option, even if it’s more pricey.

💡 TLDR:

Use a specialized malpractice insurance broker to get quotes from multiple companies.

Figure out how long you need the coverage for and calculate if claims-based or occurrence policy makes more sense.

Pay attention to the insurance company “AM Best Rating”, A- or higher means the company has a good financial base.

Save on malpractice coverage: avoid high-risk areas, consider lower policy limits and policies with deductibles, work part-time and ask for a “clean” background discount.

If there’s a big difference between different quotes, ask your broker for an explanation.

The Anatomy of Malpractice Certificate Of Insurance (COI)

Now, after you’ve paid your “dues,” your next step is to get a copy of the Certificate Of Insurance (COI).

COI is a document that confirms your insurance status. Think about it as your insurance policy ID.

Here’s what it would look like:

Once you’ve received your certificate, pay attention to the spots I highlighted for you on the image, and make sure your name, address, policy limit and insurance type are all correct.

Since you typically need your previous COI’s when applying for hospital credentialing, I suggest you scan it and store it on cloud storage and your laptop.

Moving on…

The little big FYI: how NOT to get cancelled...

No, I am not talking about “cancel culture” here, I am talking about legit and legal reasons why your malpractice insurance carrier will revoke your coverage.

These things may seem to be obvious, but it is still worth mentioning since losing your coverage is a HUGE deal:

If the physician DIDN’T disclose anticipated or pending claims before signing up for a new policy.

If the physician was under the influence of intoxicants or narcotics while treating a patient.

If the treatment provided by physician was experimental, or was part of the research or trial.

Conclusion: Knowledge is power!

Phew…

Today, I’ve given you a crash course on buying your own malpractice insurance.

Now you know more than 99% of US doctors about this extremely important topic, which, if not approached with caution, can mess up your career and finances.

As always, I am on the lookout for your questions, so leave your comments below and I’ll respond ASAP.

As featured on

How to Negotiate Locum Rates like a Pro: No BS Guide to Getting What You Deserve

July 24, 2021 by LocumTenensGuy

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?

Download the Hospitalist Gig Checklist I’ve created.

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!

7 Rules For Nailing The Highest Hospitalist Salary On Earth

July 17, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Bonus: Hospitalist Gig Checklist – Ask RIGHT questions, Make MORE money!

Let’s face it, if you are an internal medicine or family medicine physician, you are among the lowest paid doctors in the U.S. You made the conscious choice to go to the IM or FM residency, and I’m sure you were passionate about it.

However, sometime after the start of your first job, the excitement of the first few paychecks starts to lessen. You realize that although you earn an above average wage, you do not feel rich or even well off.

That becomes especially evident if you live in any large metro area where the cost of living continues to rise.

You soon realize that with your current income, it will take years, if not decades, to pay off your medical school debt. Plus, you have a family to support, hobbies to enjoy, and dreams to fulfill.

With an average primary care or hospitalist salary, these dreams are not easy to achieve. That’s why you need to leverage your highly sought after clinician skills to maximize the financial gains as well as optimize your work time.

Here are the seven rules that will take you from average to highest paid!

Are you looking for a locums job?

My agency offers the Highest Pay Rates in the Industry

Rule 1 WORK FULL-TIME LOCUM TENENS

The best way to leverage your skills is to become a full-time locum tenens hospitalist. A locums hospitalist salary is substantially more as compared to permanent employment as it’s one of the most flexible physician jobs.

Just by switching to a full-time locum tenens position and working the same hours and numbers of shifts, you will make at least 20 percent more than your colleagues.

Most of my locum colleagues make much more than that, and some make 70 to 100 percent above the average hospitalist salary. Just consider the long-term gain from this approach!

Have you heard the advice to consider the fellowship for a more lucrative specialty, let’s say cardiology or GI, if you want to make significantly more than an average hospitalist? That’s certainly advice I’ve been given.

Well, what you might not have realized is that generally speaking, these specialties must work a lot, pretty much every day, with one or two weekends off a month at most.

We’re also talking about regular night or 24-hour calls, very busy clinics, plus at least some administrative meetings and obligations.

Think about how much you can make as a hospitalist working 25 shifts a month. You’re looking at income very close to, if not more than, the average cardiologist or GI physician would make.

And this is without spending at least three years of fellowship, going deeper into student debt, and not being able to enjoy life due to lack of time and money.

Here’s another consideration: flexibility. Do cardiologists or Gastroenterologists have the same flexibility as locum hospitalists? Not even close! As a locum hospitalist, it’s so easy to cut back on the number of shifts, in case you want to work on a side project or enjoy two months of mini-retirement while traveling all over the world.

I don’t know of any other way that internal or family medicine physicians can make more than that while also retaining a high degree of independence and unparalleled flexibility.

Have you noticed that one’s life and career always seem to be plagued with the constant conflict that revolves around money and time? For example, either you have no money to spend or you have no time to spend your money? The problem is how to get both at the same time. Locum tenens allows you to do just that!

One argument I’ve heard against working locum is that you have to travel a lot, and some people don’t want to do that. But travel is not necessary. You can minimize or even completely eliminate the need to travel as a per diem hospitalist.

Rule 2 NEGOTIATE

To get the highest possible pay, you must negotiate your pay rate and refuse to accept a below market rate. Unfortunately, I’ve seen a lot of physicians starting locum tenens work who don’t negotiate, and so, they sell themselves short.

Keep in mind that every $10/hr pay rate increase will produce $20K of extra income annually. Use this locum tenens salary calculator to play with the numbers and see for yourself.

Negotiation seems to come more naturally to some people than to others, but it’s not that difficult and anyone can do it; you just need to know how to negotiate locum rates. Just remember, as a physician, your skills are in high demand and you must be paid adequately for your hard work.

Interestingly enough, pay isn’t the only thing you can negotiate. You can also negotiate accommodations and travel arrangements. You may be surprised, but a few times, I even negotiated my daily patient census!

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 per year? Click Here to download the Hospitalist Gig Checklist I’ve created.

Rule 3 PICK THE RIGHT LOCATION

Locum tenens allows you to work pretty much anywhere in the U.S. and even beyond, so it’s crucial to focus on the right location for you.

Two important considerations are pay rate and taxes.

Based on my experience, you can expect higher pay, on average, in the South and Midwest as compared to the Northeast. I’ve seen a significant difference between facilities in metro areas and those in rural/semi-rural settings.

The pay gap may even exist within the same state. For example, as a rule, you will get higher pay in Northern California than you would in Southern California.

Working in low or no income tax states can make a substantial difference in your income. No income tax states are AK, FL, NV, TN, TX, WY, and SD. Examples of low income tax states are IN, ND, WA and PA.

One caveat to that is the tax law can be complicated and they change. For example, self-employed physicians in Washington are taxed 1.6 percent, even though the state has no income tax for employed individuals. If you work in multiple states, the issue of reciprocity and tax residence also comes into play, which leads me to the next rule.

Rule 4 BE SMART WITH YOUR TAXES – GET A CPA!

Do you know this guy?

Who cares if you are on a hospitalist $500k a year salary a year and most of it goes to taxes? It only makes Uncle Sam happier, right?

You work hard to earn your money, and you want to keep what you’ve earned (use this locum tax calculator to estimate your tax burden).

That’s why it’s important to hire a CPA who can show you how to minimize your tax burden.

I prefer personal references as the best way to pick from accountants for locum doctors. Before you hire an accountant, make sure the person has experience with self-employed professionals.

For more useful tips on how to choose a quality accountant, check out this resource.

Rule 5 HAVE FUN!

You cannot become the highest paid hospitalist if you constantly work in a super stressful environment. A lot of things can make the facility difficult to work at, e.g. inadequate subspecialty support or crappy EMR, among others.

On the other hand, if you enjoy your locum tenens hospital, you’ll be able to pick up a few extra shifts a month and get a fat paycheck, and that’s even if the pay rate there is a little less.

While there’s no ideal hospital, you can always find one where things are reasonably organized and the overall culture is healthy.

Another point to consider is what you enjoy doing after work. If you crave sunshine and the beach, like I do during gloomy Seattle winters, then California, Florida, or Hawaii might be a good fit for you.

Do you love skiing? If you do, there’s probably no place better than Utah or Colorado.

Just remember to start your locum tenens licensing application at least a few months in advance.

If being close to your family is important, then find locum shifts within a commutable distance from home.

And even if you are couch potato and just enjoy watching TV in the hotel room after work, be sure you stay in decent locum tenens housing.

Whatever makes you tick, choose accordingly.

A good indicator that you are in the right spot is your overall energy level and feeling of well-being. So if you wake up every morning feeling good and even the most obnoxious drug-seeking patient doesn’t stress you out, make sure you work at that hospital and location as long as you can.

Rule 6 BE MINDFUL OF BURNOUT

Are you wondering why I’m talking about burnout? You might be asking, “How about all the so-called best locum tenens companies promoting the idea that locum tenens is a cure for burnout?’

Well, the truth is, you can burn out working locum tenens, too.

Burnout is tricky because it can sneak up on you. So pay attention to how you feel.

Early signs for me were feeling down without an apparent reason, being cranky, feeling annoyed, and being disturbed by minor things, like an RN requesting a Dulcolax suppository order at 2:00 a.m. (Ok., ok. That one doesn’t count.)

When burnout sneaked up on me, I took a break for a few weeks and had to rethink my long-term strategy. I reassessed how many shifts I was actually comfortable working, how close to each other I scheduled them, and how much I traveled. After that, I completely switched to the locations I would enjoy the most.

Good remedies that helped me to fight burnout were regular exercise, spending time outdoors, and tweaking my diet. When working away from home, I find that socializing with my new colleagues also helps a lot.

I know it’s tempting to schedule 20 plus shifts a month to make lots of cash in a short period of time. However, you should treat your locum tenens career like a marathon and not a sprint. Create the schedule that gives you the highest yield long-term, while also preserving your sanity and well-being!

Rule 7 CHECK OUT THELOCUMGUY.COM!

Last but not least, check out my website, especially if you are new to the locum tenens world. I update the site on a regular basis and share everything I know, so you can find lots of useful information here.

Now let’s look at the current hospital medicine salary in the US.

Hospital salary guide: how much do hospitalists make?

So…how much does a hospitalist make these days?

It depends…

Thank you, Captain Obvious!

Ok, ok…I’ll show you actual hospitalist salary numbers shortly but first, let me explain WHAT it depends on.

🗺️ Region: Lowest salary – Northeast and Highest – Midwest

🎓 Practice settings: Lowest – Academic/University settings

💪 Productivity: how many patients you see daily

🚑 Critical care/ICU coverage: Lowest – Closed ICU, Highest – Open-ICU

⏱️ Type of shifts: Days, Swing, or Nights.

Average hospitalist salary:

According to the most recent Today’s Hospitalist survey, the hospitalist national average salary in the US is $285,365. As you can see below, this is based on 14-16 shifts a month.

Hospitalist salary pay structure:

There are three different models of how hospitalists get paid.

1 – 100% Salary: the pay is based on the number of shifts or hours you work.

This model is simple: you get paid a fixed amount for a set number of shifts. It doesn’t account for how many patients you see and how busy you are.

So, no matter if you are seeing 10 patients or 20 patients a day, you still make the same amount.

2 – Hybrid: Salary AND bonuses/incentives.

With a hybrid model, you have a fixed base salary and you get a bonus which is usually based on quality metrics and work RVUs.

3 – 100% productivity: Salary is based on work RVUs. The more patients you see, the more money you make.

What are the highest paying hospitalist jobs?

Locum tenens would give you the highest pay rate and salary.

Other than locums, working nights would give you more money per hour.

The other option to get the highest paying hospitalist job is to sign up with a private hospitalist group with a 100% productivity compensation. Unlike the hospital-employed model when you get a base salary and a (small) percentage of the billing collections, these guys pocket as high as 90% of work RVUs.

I’ve talked to a few hospitalists working for private groups and are making $500K+ a year doing only 15 shifts a month, but they see 25+ patients a day.

Because of a very high patient volume, they rely heavily on consultants even for little things, for example, cardiology consult for sinus tachycardia or infectious disease consult for uncomplicated UTI or pneumonia.

And what about a hospitalist starting salary?

A hospitalist physician starting salary paid to the residency graduates may be different from that of an experienced hospitalist.

The difference can be as high as 20% and can take the form of a lower base salary or lower percentage of productivity (work RVUs) you get as a bonus.

Having said that, there are a lot of hospitalist programs with no difference in pay between new and experienced docs.

Hospitalist nocturnist salary

So if you don’t mind or even enjoy working nights, you are in for a prize: nocturnist hospitalist salary is typically higher than that of day hospitalists with a 20-30% pay differential.

Having said that, it comes in two different forms.

1 – Nocturinists work 7 on/7 off and make 20-30% more per year ($330K+ year).

2 – Nocturnists work 7 days on and 14 days off and make the same salary as regular hospitalists.

The other good news for nocturnists is that a lot of times their shifts are shorter, e.g. 10 or even 8-hour shifts, hence your hourly pay can be as high as $230/hr.

Internal medicine hospitalist salary vs Family medicine hospitalist salary

There’s a common misconception that a family medicine hospitalist salary is lower than internal medicine hospitalist salary.

In my experience, this is not true and the average salary would be the same.

One difference, however, is that some hospitalist programs exclusively employ internal medicine hospitalists on the grounds that Internal medicine doctors have better inpatient training.

Other programs would only hire family medicine doctors with a few years of hosptialists experience.

What about locum tenens?

As mentioned above locum tenens hospitalist salary will be at least 20% higher than that of a permanent hospitalist.

Hospitalist salaries: my conclusion

To be the highest paid hospitalist, you need to work locum tenens long term, negotiate your pay rate aggressively, and pick the right location that pays well and where you enjoy working, ideally with no state tax.