money

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.

Locum tenens after residency: crush your medical school debt

July 17, 2021 by LocumTenensGuy

Vlad Dzhashi, MD

Locum tenens after residency has a ton of pros: you become a better clinician, make hundreds of thousands of dollars more and travel America in search of the next big adventure.

That said, I want to focus on one of the BIGGEST pros of working locum tenens after residency.

What is it?

I am talking about working locum tenens to pay off your medical school debt.

Most docs would agree that medical school debt is a huge pain in the butt.

It causes stress and anxiety, eating into your budget and limiting your financial freedom.

It’s especially painful for freshly-minted residency graduates.

A lot of them put it on the back burner and keep paying the minimum monthly payments forever.

But today I want to offer you a radical solution to crush your student debt FAST!

In fact, it’s so radical that you can pay off your loans in less than a year!

Don’t believe me?

Come closer as I’m going to share my “recipe” with you.

Recipe with two ingredients:

(LOCUM TENENS + “SECRET INGREDIENT”) x (1 – 2 years) = ZERO student debt!

Why locum tenens?

The obvious reason is that it pays better than a permanent job, especially for somebody fresh from residency.

How much you’ll make depends on your specialty and how hard you work. For example, a locum tenens hospitalist would make at least 30% more compared to the average salary.

However, if you play it smart using all the strategies I describe in this post, you can add an extra 50% or more.

“Secret ingredient” for faster check out:

While the first ingredient will make you more money, the second will SAVE you a TON!

Let me ask you this:

What are the average person’s largest living expenses?

Housing, transportation (i.e.car, gas) and utilities!

Now, what if tell you that 100% of these expenses will be covered?

Sounds great!…but how?

Your locum agency covers those FOR you!

Listen: after you graduate from the residency, you’re joining the ranks of the highly sought-after professionals.

Think about it this way: It’s almost like you are a US expat working in a foreign country where your expertise is unique. And employers go out of their way to entice you: they pay you really well and cover all kinds of expenses.

The same happens with doctors, the demand is so high that agencies are willing to negotiate to make your life easier.

Plus, they pay for travel expenses anyways, you just make them channel it differently.

Now, when you’ve got the big picture, let’s look at logistics.

How to do it?

You work full-time locum tenens:

The key is to work enough to make it worthwhile for an agency/hospital to cover as much of your expenses as possible (i.e. 10-14 shifts a month for hospitalists).
This way you can make maximum money while saving like crazy.

You stick with long-term locum gigs:

Again, it makes more sense to cover your expenses if you are there for a long time.

You live where you work:

You live in the hospital vicinity in the rented place that is paid for by the company.
Another option is to keep a “free” home base by the main hospital while traveling to another one for extra shifts (with travel paid for you of course!).

You live in a small town:

Your living expenses will be lower.
You will get a better pay.

You keep your other expenses low:

While most of your living expenses are covered, you still need to live frugally to pay off your medical school debt fast.
One exception where you don’t want to be cheap is eating healthy and exercising. Also, it’s ok to spend money doing things you enjoy (nothing too extravagant though, so sorry, no yacht racing for now).
This will help you to keep your sanity and prevent burn out.

You live a “nomadic” lifestyle:

You don’t buy or own any “stuff” that can slow you down.
You should be able to take off and go to your next assignment without needing to hire a ginormous moving truck.

How much will you save?

Great question! I thought you’d never ask!

Let’s take a look:

Housing:

You see, hotels are a good deal when you are staying for a short period of time, but when you work 2+ weeks a month, it can cost thousands. It’s much cheaper to find an Airbnb or corporate apartment for you and pay lower monthly instead of daily rates.

How much do you save that way? Based on my calculations, about $15K-20K of your after-tax dollars per year.

Utilities:

When you live in a hotel or apartment, you pay ZERO for electricity, gas, internet, garbage etc.

That’s another $200-$500 monthly savings ($2500-$6000 a year).

Car:

Here’s a hack that’s even better:

You buy a car using a 3-5 year loan and ask the agency to cover your monthly payments instead of paying for a rental car. You also have them pay the gas and auto insurance.

You’re not only saving money, but you are also paying off your own car’s principal!

If you’ve already got a car you plan to own for another few years, make sure you get your gas, insurance, and maintenance expenses paid. You can also ask for a flat monthly car “stipend” instead.

That’s another $5K-10K/year saved.

How many Benjamins will you save in total?

Drumroll…

Between $25K to $35K annually!

Now, you’ll be blown away even more if you calculate your before-tax savings.

Why locum tenens straight out of the residency?

This approach will work the best after your residency.

Why?

You still have spending habits of a resident.
You have fewer obligations (family, mortgage, etc.).
It’s easier to adopt a “nomadic” lifestyle.

How long does it take to pay off your medical school debt?

One to two years depending on your student debt amount, your specialty and how hard you work.

Plug in different numbers below to calculate how long before you crush your debt.

Student Debt Pay Off Time Calculator

Total Student Debt:

Shift/day pay:

Number of shifts per month:

Shifts

Average Tax rate:

Monthly Expenses (exluding debt):

Your Monthly student loan payment:

Monthly income:

Income after tax:

Money left / month:

Time required (in months):

Number of shifts/work days required:

Ok, now when you are all excited about the idea, let’s see how you’re going to do this step by step!

11 Steps to paying off your student debt working locum tenens:

Step #1 - Figure out where you’re going to work (6 months before you start locums):

I know what you’re probably imagining now: sandy, pristine beaches of Maui or San Diego…

Stop it!

If you are a guy or gal who can relax on the beach while your student debt is piling up, then Hawaii or California may be good places.

But If want to pay off your medical school debt fast, you have to play it smart and pick the states that:

A – pay well;
B – won’t suffocate you with exuberant taxes;
C – have more work than you need;

Where will they pay you the most?

For hospitalists, the winners are states in the South, Southwest, and Midwest. (download the report)

As to the taxes, no income tax states are AK, FL, NV, TN, TX, WY, and SD.

Low income tax states are IN, ND, PA and WA.

Source: https://taxfoundation.org/how-high-are-income-tax-rates-your-state/

If you want to get a decent estimate of how much state income tax you are going to pay, check out this great online resource I found.

That said, always talk to a CPA to understand other important tax stuff (e.g. working in multiple states, nonresident vs resident taxation, etc.).

So if Wyoming has zero state income tax and a good pay, should I get a license there?

No way!

Your should pick the states with at least a few million people. This will let you tap into a good number of locum gigs.

Now, keep in mind:

If you find yourself stuck in “analysis paralysis,” unable to make up your mind on where you want to go, just focus on the states that you have a good feeling for.

Step #2 - Contact the locum agencies and negotiate (5-6 months before you start locums):

Before you do, take a look at my post where I explain how to find the best locum tenens companies. Make sure you check out the agencies reviews as well.

The caveat here is to work with multiple firms, both local and national.

When talking to the recruiters you need to:

A – Tell them to look for long-term gigs (6+ months) in the states of your choice.
B – Request that they cover your living expenses instead of the typical hotel/rental car.
C – Negotiate your pay rate for each locum gig.
D – Ask them to cover your state licensing cost (do not agree to a low pay rate just because they cover your license).

Step #3 - Apply for licenses (5-6 months before you start locums):

Get 2-3 state licenses to start.

The best advice here is to invest time and money into creating an FCVS profile.

I’ve used it many times and cut my licensing time by months!

FCVS fast-tracks your licensing for any state. It verifies your credentials (identity, medical school, residency training, etc.) and sends them to one or multiple state medical boards.

All boards accept FCVS verification and some boards require it.

Step #4 - Credentialing (3-4 months before you start locums):

Next step is to get credentialed at three to four hospitals.

Make sure you submit your paperwork as soon as you can, and have your agency help you to speed it up.

Onward.

Step #5 - Schedule your shifts (3-4 months before you start locums):

Now, you may be tempted to schedule 20+ shifts in one hospital until your debt is paid off.

Wrong!

As I’ve learned over the years, it’s impossible to know in advance what hospital is going to be a decent place to work.

To avoid being stuck in a bad spot, make sure you schedule only 5-10 shifts a month at each place for the first couple of months.

Another hack is to space out your shifts at the same hospital by 30 days (typical cancellation period). This way you can drop them before it’s too late.

After checking out a few places, you’ll get a good feel for what gig would be the best fit for you long term.

The only situation when you can commit to only one hospital upfront would be if you’ve worked there before (e.g. your residency hospital) and know all the ins and outs.

Step #6 - Get four types of insurance (3 months before you start locums):

Get your disability, life, locum tenens health insurance and some savings.

This will be your “safety net,” so don’t skip this step!

Onward.

Step #7 - Get rid of the stuff you don’t need (a month before you start locums):

To crush your student debt you need to become a “locum tenens nomad.”

Here, you purge all the ~~CRAP~~ stuff you don’t need. You will not need any furniture (and yes, that includes your favorite coffee table!).

Anything bulky that is too precious to your heart can go into storage.

Now, when all the preparation is done, you can start your first locums job ever!

Step #8 Refinance your student loan (as soon as you graduate from residency)

Even if you pay the loan balance off in a year or two, you’ll save thousands on interest by refinancing. Check out this resource list for more info.

Step #9 - First months of locums work (month 0 to 3):

Ah…you’re gonna have fun times!

You’ll travel to new places, meet a lot of people and make new friends.

There will be lots of learning too: from new EMR’s and billing to how to talk to your colleagues and patients when responsibility is all yours.

That said, after the rigors of your residency years, it’s doable.

At the end of the first few months, you’ll figure out what hospital(s) is your “tier 1” and which ones are “tier 2” (back up).

Step #10 - Cranking out until your student debt is paid off (month 4 through 12 to 24):

This is probably gonna be the easiest part:

You…keep going!

Just keep freaking doing it until you’ve paid off your student debt!

Step #11 Celebrate:

Thanks to locum tenens, your student loan is crushed, destroyed, eliminated…

You deserve a celebration, so spend a couple of days (weeks/months) doing something you’ve always wanted to but kept postponing due to college, medical school, residency…

You are free!

My confession...

Now, I want to confess…

I was a little sneaky:

I’ve not only taught you how to pay off your debt fast, I’ve also showed you how to make maximum dollars in minimum time working locum tenens.

I hope you forgive me…

The good news – you can use this knowledge to:

Retire at the age of 40…
Buy a ranch…

Travel the world…
Start a business…multiple businesses…
Save lots of cash just because…

The end.

P.S. Now, I want to hear your thoughts on this approach to crushing your student debt.

Does it sound appealing to you?

Are you ok with living out of a suitcase for a year or two?

Let me know in the comments below!

As featured on

Locum tenens hospitalist salary: Is $200/hr possible? Real life numbers explored

September 15, 2017 by LocumTenensGuy

Vlad Dzhashi, MD

While working locum tenens, you can make significantly more money compared to a permanent hospitalist. However, when you’re first starting out, it is hard to find accurate locum tenens salary numbers.

And even if you come across recruiter emails or online job postings with locum tenens positions and the pay rate is listed, you can only guess if what they offer you is a starting point, the best rate they can give you, or somewhere in between.

That’s why it is better to know the numbers and consider the factors that affect the pay one way or the other in order to negotiate with either the facility directly or through one of the best locum tenens companies.

My locum tenens salary experience

Information provided here is based on personal experience, as well as experience of many of my colleagues.

I also screen a lot of emails and talk with multiple recruiters on the regular basis, which helps me better understand market conditions.

Please keep in mind that hospitalists were consistently making more year after year (until about a few years ago), so locum tenens pay rates may change over time as well.

Are you looking for a locums job?

My agency offers the Highest Pay Rates in the Industry

Hospitalist locum hourly rate: can hospitalist locums get $200/hr?

Now, I have to say that the possible hospitalist locum hourly rate is quite wide. Some aggressive recruiters can start negotiation with 130/hr, and on the other end, physicians skilled at negotiation can end up getting 200+/hr or even more.

It’s a huge difference!

Think about it: with 15 shifts a month on average, you can make as little as $280K/year with 130/hr or as much as 430K/year at 200/hr.

You can check out the Locum tenens salary calculator to see how even a small increase in the locum pay rate can make a big difference.

What affects locum tenens hospitalist hourly rate?

Intrinsic factors that affect the locum tenens hospitalist hourly rate include facility location, as well the shift type. Although eventually, it all boils down to supply vs. demand.

From lower to higher pay rate:

1 – Location: Urban vs rural area

2 – Type of shift: Daytime vs Swing vs Night

3 – ICU set up – closed ICU vs open ICU.

4 – Government vs private facility

So at the low end of the spectrum (e.g. prestigious tertiary center in the big city), pay could be as little as $130/hr.

At the high end of the spectrum, e.g. night shifts at a rural hospital in South Dakota with ICU coverage, pay could be as much as $200+/hr.

There are always exceptions, and the pay can be even higher at a facility that is desperate to fill a position.

Although, these “gigs” tend to be short-lived and won’t affect your bottom line significantly. Whether you want to work at the “desperate” hospital or not is a different story; it depends on the hospitalist lifestyle you’re after

Locum tenens hospitalist pay in different US regions.

Now, there are also regional variations, and that’s why I strongly encourage you to talk to your colleagues who are currently working locum tenens in your region/state to see what their locums hospitalist salary experience has been.

From what I’ve encountered, the highest pay rates I was offered were consistently in the Southwest region; the lowest were in the Northeast.

Again, a rural NY job with open ICU will definitely command higher pay compared to a downtown tertiary center in Minneapolis with no ICU or procedure requirements.

If you want to learn more about how much locum hospitalists get paid in different regions, check out the special report I’ve created.

Click Here to download it.

Another important exception is government facilities (VA, Indian Tribal Health, etc). From my observation, they tend to pay 10-30% less and the credentialing process is longer. On the upside, you can have any state license and work in all 50 states’ government-run hospitals and clinics.

Average pay for locum tenens hospitalist across the US

The overallaverage pay for a locum tenens hospitalist is around $160/hr for the day rounding shifts. I’ve personally never accepted anything less than $150/hr. However, if you are offered $130/hr for a very comfortable job at the hospital across the street, I would say, go for it. I’ve just never been that lucky.

Finally, when planning your locum tenens job location and target hospitalist salary, consider the state income tax burden (don’t forget to use my locum tenens tax calculator), e.g., given the same pay rate while working in CA or NY, hospitalists will have a lower bottom line compared to no income tax states like WA, FL, and TX.

If you’re interested in information about other specialities, please check out my guides that reveal pay-rates, pros and cons, demand for specialties and other crucial data here:

Locum Tenens Neurology Guide.

Locum Tenens Psychiatry Guide

Locum Tenens Urology Guide

Locum Tenens Dentistry Guide

money

Vlad Dzhashi, MD

1 - Locums on my mind...

2 - Homework

Set up your goal

3 - Lights, camera, action!

4 - The second round:

5 - Plan B

Vlad Dzhashi, MD

Rule 1 WORK FULL-TIME LOCUM TENENS

Rule 2 NEGOTIATE

Rule 3 PICK THE RIGHT LOCATION

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

Rule 5 HAVE FUN!

Rule 6 BE MINDFUL OF BURNOUT

Rule 7 CHECK OUT THELOCUMGUY.COM!

Hospital salary guide: how much do hospitalists make?

Average hospitalist salary:

Hospitalist salary pay structure:

What are the highest paying hospitalist jobs?

And what about a hospitalist starting salary?

Hospitalist nocturnist salary

Internal medicine hospitalist salary vs Family medicine hospitalist salary

What about locum tenens?

Hospitalist salaries: my conclusion

Vlad Dzhashi, MD

Recipe with two ingredients:

“Secret ingredient” for faster check out:

How to do it?

How much will you save?

Between $25K to $35K annually!

Why locum tenens straight out of the residency?

How long does it take to pay off your medical school debt?

Student Debt Pay Off Time Calculator

Total Student Debt:

Shift/day pay:

Number of shifts per month:

Average Tax rate:

Monthly Expenses (exluding debt):

Your Monthly student loan payment:

Monthly income:

Income after tax:

Money left / month:

Time required (in months):

Number of shifts/work days required:

11 Steps to paying off your student debt working locum tenens:

Step #1 - Figure out where you’re going to work (6 months before you start locums):

Step #2 - Contact the locum agencies and negotiate (5-6 months before you start locums):

Step #3 - Apply for licenses (5-6 months before you start locums):

Step #4 - Credentialing (3-4 months before you start locums):

Step #5 - Schedule your shifts (3-4 months before you start locums):

Step #6 - Get four types of insurance (3 months before you start locums):

Step #7 - Get rid of the stuff you don’t need (a month before you start locums):

Step #8 Refinance your student loan (as soon as you graduate from residency)

Step #9 - First months of locums work (month 0 to 3):

Step #10 - Cranking out until your student debt is paid off (month 4 through 12 to 24):

Step #11 Celebrate:

You are free!

My confession...

The end.

As featured on

Vlad Dzhashi, MD

My locum tenens salary experience

Hospitalist locum hourly rate: can hospitalist locums get $200/hr?

What affects locum tenens hospitalist hourly rate?

Locum tenens hospitalist pay in different US regions.

Average pay for locum tenens hospitalist across the US

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