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

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locum tenens tax deductions
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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.
New to locum tenens? Check out my complete guide for newbies!

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:
  • Professional fees: including CPA fees, legal fees (e.g. contract review expenses)
  • Office Supplies: paper, ink, printer, laptop
  • Licensing: including fees, DEA, fingerprinting services etc.
  • Healthcare expenses: but only if they exceed 7.5% of your adjusted gross income.
  • Retirement plan contribution: e.g. SEP-IRA or other retirement accounts.

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

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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:

  • Who pays for your health and dental insurance when you work locum tenens? ...YOU.
  • Are any employee benefits included when you work with locum tenens agencies? ...NOPE.
  • Does it mean that you would need to look for them YOURSELF?...HELL YEAH!

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.

Locum tenens health insurance options
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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:

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:

Choosing locum tenens insurance
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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:

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click to enlarge this image
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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.
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  • Jumpstart your Locums Career!
  • Sign up for my coaching to access:
  • Top Gigs
  • Top Pay
  • Unique resources
  • No stress
Learn more

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.

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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.
New to locum tenens? Check out my complete guide for newbies!

How to make $400K (and $500K) in your first year as a hospitalist

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Vlad Dzhashi, MD

👉 Feeling pressure from HUGE student loans you have? 

👉 Looking to start your career with the HIGHEST possible income?

👉 Want to finally experience life to its fullest after more than a decade of hard work?

If the answer is yes, stick around and read on for different ways to start making great money right off the bat. I am going to show you what it takes to make $400K a year as a freshly minted hospitalist.

Why $400K?

I know…it may sound random, but hear me out first:

The average hospitalist salary now is $285,365 based on the most recent Today’s Hospitalist survey.

With $400K/year, you will be looking at making more than the 95% of hospitalists…

And of course…even if you live in crazy expensive cities like New York, Los Angeles, Boston, Honolulu, etc., you’ll have a great lifestyle AND would be able to put aside a large chunk every year.

Not bad, huh?

So…without further ado, let’s jump right in!

FREE CALCULATOR: HOW MANY SHIFTS you need to work to reach your financial goal.

Option #1: Full-time locum tenens or per-diem

  • Estimated # of shifts to make $400K:
  • - 17 shifts a month with $165/hr
  • - 15 shifts a month with $185/hr
  • - 14 shifts a month with $200/hr

Benefits:  you pay for your own benefits.

Note:  great for hospitalists who don’t mind being away from home for at least one week a month.

This is what I’ve done for years. I started as a full-time locum after two and a half years of a permanent job, and later on, I added per-diem shifts to the mix. 

Even with the most basic $165/hr rate, you can totally achieve this; after all, anybody can work 2-3 extra shifts a month.

With this approach, the biggest challenge is that you may need to travel. So, if you absolutely have to stay within commutable distance from your home (family, small kids, etc.) and you are NOT in a big metro area that has lots of big hospital employers offering per-diem jobs, you will be better off looking at other options.

But…if you CAN travel for at least 7-10 days a month, this is totally doable. Plus, travel can be a lot of fun: you’ll explore exciting places and meet a lot of new people.
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Onward.

Option #2: Permanent nocturnist job + locum tenens/per-diem

  • Estimated # of shifts to make $400K:
  • 10-11 night shifts at your permanent job and 4-5 extra shifts ($165/hr).

Benefits:  covered by the employer.

Note:  the best option if you don’t mind working nights.

I am not talking about 7 on/7off nocturnist jobs here: this schedule is hard and most people burn out. 

I am talking about 7 on/14 off jobs. 

You may be surprised, but there are a lot of hospitalist programs that try hard to retain their night docs by offering a 17-19 weeks a year schedule with the same full-time pay. 

With this schedule, you’ll have plenty of time off to take extra shifts: you can work extra at the same hospital as your permanent job, sign up for per-diem shifts locally or do locum tenens anywhere else in the country.

I think this is totally the best option for “night owls” since you can make great money and you’ve got more than enough time off left to enjoy life.

On top of that, your permanent nocturnist job will sponsor your benefits and health insurance which will save you some money too compared to full-time locums/per-diem.

Hate nights?

Let’s look at other options.

Option #3: Permanent critical access hospital job + locum tenens/per-diem

  • Estimated # of shifts to make $400K:
  • 10-12 twenty-four-hour shifts and 4-5 extra shifts ($165/hr).

Benefits:  covered by the employer.

Note:  great for hospitalists enjoying autonomy and willing to live in a small town.

A lot of critical access hospitals (i.e., small rural facilities) cannot justify having a “full-blown” nocturnist program. As a result, hospitalists work 24-hour shifts.

I’ve seen anywhere from 10 to 12 shifts a month to be counted as a full time.

Since you work in a smaller hospital and you are the ONLY hospitalist on, your job will look different from your typical gigs:

  • The average patient census is lower and sometimes can be as low as 6-8 patients a day.

     

  • But…it will fluctuate a lot and it’s not uncommon to see a sudden census jump of 50-100% (i.e., from 8-10 to 16-18 pts). This mostly happens during the busy winter season.

     

  • You are responsible for all medical admits that come to the hospital, so you will round AND admit throughout your shifts.

     

  • You are guaranteed to get paged at night either from RNs or from the ER to admit patients.

     

  • Since you don’t have all the subspecialties available, you tend to have a lot of transfers to bigger hospitals, which may get tricky.

On the plus side, you’ve got much more autonomy in making decisions, and patients tend to be more grateful for what you do.

Onward.

Option #4: Part-time or Full-Time — plus moonlighting/per-diem or locum tenens

  • Estimated # of shifts to make $400K:
  • 14-15 shifts a month at the permanent job and 5 extra shifts ($165/hr)

Benefits:  covered by the employer.

Note:  part-time option is great for “cautious” docs willing to get benefits AND get exposed to the locum’s world.

This approach may be the most common one that I see hospitalists are doing. You’ve got your full-time job and you work on the side for an extra income.

The thing is, if your permanent job pays peanuts or gives you less money just ‘cause you are a new grad, you may end up working a lot of extra shifts to get to our “magic” number.

On the other hand, if you are NOT interested in traveling, checking different places, working locum tenens AND you find a job that pays $300K+ a year for fresh grads, be my guest! 

Just make sure your permanent job can supply you with enough extra shifts in-house.

If not, it may be hard to find a locum gig on the side, as a lot of hospitals want you to commit to at least seven shifts a month. So you’ll end up either getting stuck with your base salary or you’ll get overstretched with working 20+ shifts a month.

That’s why I like the idea of signing up as a part-timer (7-10 shifts a month) and working locum tenens or per-diem in your time off. 

You kill two birds with one stone:  you have a stable job that covers your benefits AND you can easily find shifts on the side.

What it takes to make $500k your first year as a hospitalist?

Half a rock without a shock!?

What if half a million sounds better to you AND you are ready to churn out in a total “beast” mode?

Great, I’ve got a breakdown for you in the table below.

  • Click the image to zoom

Word of caution:

I suspect a lot of you reading this article may be tempted to work a GAZILLION shifts per month as soon as you graduate. After all, you really want to build a solid financial base ASAP.

Just remember: your career is a marathon not a sprint…

So give yourself plenty of time to rest, don’t forget to learn something new every year, pick up a hobby or two and spend time with your friends and family.

Balance is the key!

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My TeleHospitalist Experience: Yay or Nay?

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Vlad Dzhashi, MD

I wanted to try telemedicine for a while and although I’d been slammed with emails and phone calls trying to sign me up for outpatient gigs, telehospitalist jobs seemed to be few and far between.

Luckily, I work at a local hospital system that is one of the telehospitalist pioneers in the US. 

They created both telehospitalist and tele-ICU programs from scratch a few years ago. Both are fully functioning at five regional hospitals and expanding now.

I wanna say, it wasn’t easy to get on schedule, since VirtualMD positions (i.e., telehospitalist) are always in high demand and there are rarely any openings. After a few attempts, I was finally scheduled for four nights.

Today, I wanted to share my experience and give you a glimpse of what hospital medicine may look like in the near future.

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TeleHospitalist set up

Where?

Unlike many other telemedicine jobs, I didn’t work from home. The hospital provided a separate office space for the telemedicine team. 

Hours:

I worked 11.5 hour shifts, which started at 8:30 pm and ended at 8:00 am.

My workplace:

One thing I absolutely loved was my super crazy sci-fi display setup: there were six monitors, with each of them having its own purpose. 

telemedicine display set up

With this setup, I had all the info available on one of the screens, including EKG’s, EMR, Uptodate, etc. 

Another absolutely cool thing that blew my mind was that some of the patients’ rooms (PCU and ICU) were equipped with cameras so I could get connected and eyeball these patients “virtually.”

On top of that, the desk’s height was adjustable with a push of a button; you could move it up or down and you could raise it to make it a standing desk. Although I was stuck in a chair for the duration of the shift, my teammates kept switching between sitting and standing every couple of hours to prevent DVT.

The Team:

I had two “partners” in crime: RN and NP, so all the calls/messages were distributed equally. Having said that, I was the only one doing admits.

Responsibilities/Workload

1 – Cross Coverage: responding to the calls from hospital nurses across five hospitals. 

The team receives all the messages into a special email folder that is updated real-time. 

The RN would take the easiest calls: prn sleep meds, prn laxatives, ordering morning labs, etc. A lot of the orders were by default, so she would not need to discuss them with an MD or NP. 

Our RN would also help with admin stuff, e.g., getting ahold of a certain floor or a particular service department in the hospital: e.g., lab, microbiology, blood back, etc.

The MD and NP took care of all the other more complicated calls, although the MD was responsible for ICU calls most of the time.

What were the most common calls/messages we would see?

Hypotension, low H&H, other critical lab results, tachycardia/bradycardia, pain meds, patient requesting to leave AMA (my favorite: Really? At 2 am? Don’t you want to sleep?).

Volume:

The average number of calls the telehospitalist team would “process” was close to 300.

Interestingly enough, there were a few very busy times at night: 

Evenings when RNs changed shifts, then 4-5 am when morning labs were back, with a third peak around 7-8 am when morning shifts started.

The time between 1-3 am was a little slow, so I managed to take short naps.

Liability and documentation:

Of course, the liability part is there even if you cover patients virtually.

Think about it: as a telemedicine hospitalist, I was covering almost 500+ very sick patients, some of them in ICU’s.

I came up with my own strategy to provide better “virtual” patient care for the patients and to minimize the liability:

First of all, almost every time I got a message, I picked up a phone and talked to the nurse to clarify the patient’s status and ask questions. I would also glance at the last hospitalist progress note to get a better understanding of what was going on with the patient.

This approach made a big difference, as I caught myself changing my orders after talking to the nurse and reviewing the chart multiple times.

Second, I would also put a note in the chart, documenting what info I’d gotten from the nurse and what new orders or changes I’d made.

These notes were also important for day hospitalists to make sense of what actually happened with the patient overnight.

Now, you may be wondering what if a patient were too sick and needed to be evaluated? 

When this situation came up, I would call an in-house doc and ask him to lay eyes and hands on the patient.

2 – TeleHospitalist Admissions:

One of the hospitals I was covering was a tiny critical access and rehab facility that didn’t have an in-house nocturnist. 

I was responsible for admits that would come overnight as well as for covering their rapid responses and codes. (There was  also an ER doc who was physically present at night and who would help with codes if needed.)

I would first receive a call from the ER doc, discuss the patient’s case, and if I accepted, I would put admission orders in. 

Once a patient reached the floor (this would take an hour or two), the RN would message me and I would connect to the telemedicine cart.

The cart had a camera on top that I could control as well as an attached stethoscope.

I would interview the patient and then ask a bedside RN to help me with the exam. 

Here’s how the physician exam worked:

First, I ask the RN to do palpation, shine the light into the patient’s eyes and mouth while zooming the camera on the patient. She would do a brief neuro exam.

Then I would ask the RN to use the attached stethoscope to auscultate lungs, heart and abdomen, which I would hear in my headphones. 

This way, the physical exam took about five minutes longer than it would normally take. 

At the end, I would disconnect and complete my H&P and add orders if needed.

Final Verdict

Overall, telehospitalist night coverage is a win-win:

1 – It unloads night hospitalists – all they need to do is to stay focused on admission and codes/rapid responses. It keeps your nocturnists’ morale high and surely prevents burnout.

2 – This is great from the patients’ and nurses’ perspective: they get more timely responses, unlike when your night doc is juggling between admits and floor calls.

3 – Also, since all the virtual/telemedicine team does is the cross-coverage, the patients receive more attention, providing better quality of care.

Things to improve:

I would definitely prefer to work as a telehospitalist from home. I don’t see any good reason why this cannot be done from the comfort of your home.

Another issue is that admissions take longer than live admits, and some patients would prefer to see the doctor at the bedside rather than virtually.

P.S. Now, I am turning to you. Let me know in the comments if you’ve done any telemedicine work and what your thoughts are. Is it Yay or Nay?

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New to locum tenens? Check out my complete guide for newbies in 2021!