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  • General Surgery Locums Rate/Contract

    Hi, I am looking for advise on a Locums contract for covering a rural hospital about 30-40 minutes away from our primary practice.
    I will be meeting with an administrator soon to further discuss details. It is a small hospital with one general surgeon (they had two but one left recently) and they are looking for 2 weekends a month of call coverage, this would probably be 5pm Friday until 7am Monday. This would include rounding on admitted patients and any new consults coming in through ER or the floor. They have 2 ORs and CRNA only staffing.
    We have not done any Locums work before so very unsure what pricing is fair. This is in an adjacent state so they would have to cover our malpractice insurance for going there and we would need to get licensed in that state as well. Taking extra weekend call is very undesirable for us, but if the price is right we would probably do it.
    A ballpark price of $3000-3500/24hrs was thrown out in discussion as a possibility.
    Would you shoot for a fixed rate for coverage, or a set minimum rate with additional payment for getting called back after a certain time? Does anyone know the going rates? We are not going through a Locums agency so I would imagine we could get paid more and the hospital still save money vs Locums agency.
    Thanks
    ​​​​

  • #2
    Do you know how busy this place usually is? I haven’t done any locums work, but have looked into it a little bit (not for general surgery either), but I’d want some baseline guarantee plus an amount of reimbursement per wRVU.

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    • #3
      I would say at least 10k with no direct admissions

      im in a different specialty but that would be my minimum- we are also mostly in the 3000-3500day range

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      • #4
        I am working on getting weekend case numbers for the first 6 months of this year. They said last weekend they had 3 patients to round on and that is pretty typical. Any other numbers I should request?

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        • #5
          Excuse my ignorance here, but is the $3,000/24 hours just the base rate to cover call?

          If you have to go in to do a case, do you then also get to bill/collect that case?

          I'm not in a surgical specialty, so I may be ignorant here.

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          • #6
            Originally posted by WCInovice View Post
            Excuse my ignorance here, but is the $3,000/24 hours just the base rate to cover call?

            If you have to go in to do a case, do you then also get to bill/collect that case?

            I'm not in a surgical specialty, so I may be ignorant here.
            We are in early discussion of pricing. They would be billing the cases so we would not collect for any billing. 3000-3500 was a ballpark number they made for discussion/negotiation and that would include being on call, rounding, and doing the cases. We could certainly push for a base pay + additional for cases which could be hourly rate or rvu bases.

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            • #7
              The modest pace local community hospital I am familiar with pays the general surgeons $1000 to $1800 per day (rate varies based on weekday, weekend, holiday) to simply be on call for 24 hours. Call is light and the surgeons bill any patients seen on a fee for service basis.

              Given that your job would include rounding and given that the hospital bills professional fees, something around 3k per day sounds within range. I would also negotiate for a much higher rate for holiday weekends, 1.5 to 2x the regular rate for all major holidays. So.... Friday 5 pm through Monday 7 am I might ask for $7,500 for the weekend and perhaps $10k for Memorial Day weekend, and perhaps $15k for Thanksgiving or Christmas weekend.

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              • #8
                I am not a surgeon, but would you (and other surgeons) be ok with operating without an MD/DO anesthesia attending as back up?

                Seems like a potentially liability to me, as well as working more on weekends when I would prefer to be free.

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                • #9
                  Originally posted by White.Beard.Doc View Post
                  The modest pace local community hospital I am familiar with pays the general surgeons $1000 to $1800 per day (rate varies based on weekday, weekend, holiday) to simply be on call for 24 hours. Call is light and the surgeons bill any patients seen on a fee for service basis.

                  Given that your job would include rounding and given that the hospital bills professional fees, something around 3k per day sounds within range. I would also negotiate for a much higher rate for holiday weekends, 1.5 to 2x the regular rate for all major holidays. So.... Friday 5 pm through Monday 7 am I might ask for $7,500 for the weekend and perhaps $10k for Memorial Day weekend, and perhaps $15k for Thanksgiving or Christmas weekend.
                  Great insight. This pricing you list would be a flat rate? Or would you try to negotiate additional rvu rate for cases?

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                  • #10
                    Originally posted by Sampter View Post
                    I am not a surgeon, but would you (and other surgeons) be ok with operating without an MD/DO anesthesia attending as back up?

                    Seems like a potentially liability to me, as well as working more on weekends when I would prefer to be free.
                    I do not like operating without MD anesthesia, unfortunately in Indiana where we primary work (also looks like Illinois is the same) the hospitals are mainly covered by CRNAs and rural hospitals are always covered by only CRNAs. I worked for 4 years "supervising" CRNAs at multiple hospitals before I realized that the hospitals were putting the surgeons names in the chart as the supervising physicians. Until legislation changes it is something we have to accept or move to an opt out state or maybe select few hospitals with full MD coverage.

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                    • #11
                      When I was full time I got $1000 a day to cover a sister hospital that was essentially a critical access hospital, they billed. I did 2 weekends there and rounded on 2 patients and did an egd and a central line total.

                      Now I’m part time w2, I get no benefits but now it’s $1500 a day at my main hospital. They also reimburse all travel expenses and will cover malpractice and tail.

                      I might have been able to negotiate more but I didn’t care for anything except them covering expenses and my tail coverage. It’s also set up so either party can break the contract whenever.

                      As for crna only anesthesia, that’s how most rural hospitals in my area is. I don’t believe there’s any supervisory role the surgeon plays. Whenever I inquired, they carry their own malpractice and was told I didn’t have to worry. It’s been that way for over 20 years and was never an issue for any of the senior surgeons that have been around forever.

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                      • #12
                        Originally posted by Nysoz View Post
                        When I was full time I got $1000 a day to cover a sister hospital that was essentially a critical access hospital, they billed. I did 2 weekends there and rounded on 2 patients and did an egd and a central line total.

                        Now I’m part time w2, I get no benefits but now it’s $1500 a day at my main hospital. They also reimburse all travel expenses and will cover malpractice and tail.

                        I might have been able to negotiate more but I didn’t care for anything except them covering expenses and my tail coverage. It’s also set up so either party can break the contract whenever.

                        As for crna only anesthesia, that’s how most rural hospitals in my area is. I don’t believe there’s any supervisory role the surgeon plays. Whenever I inquired, they carry their own malpractice and was told I didn’t have to worry. It’s been that way for over 20 years and was never an issue for any of the senior surgeons that have been around forever.
                        It depends what state you are in. Some states have opted out of the Federal Requirement for physician supervision of CRNAs, however many have not and hospitals frequent put the surgeon as the supervisor even though the CRNAs is practicing independently in all reality. They do have their own malpractice and there are not many court cases charging the "supervising" physician for CRNA malpractice, but the door is certainly open.

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                        • #13
                          Originally posted by Mistborn View Post

                          It depends what state you are in. Some states have opted out of the Federal Requirement for physician supervision of CRNAs, however many have not and hospitals frequent put the surgeon as the supervisor even though the CRNAs is practicing independently in all reality. They do have their own malpractice and there are not many court cases charging the "supervising" physician for CRNA malpractice, but the door is certainly open.
                          The case in Colorado for sure had the CRNA's defense blaming/saying the surgeon is supervising him. Surgeon had to give up license initially, then put on probation and must only operate with an anesthesiologist present. The crna (who had another death suit in his past) gave up doing crna stuff but was still able to continue as a nurse. https://www.thedenverchannel.com/new...-incapacitated

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                          • #14
                            Originally posted by Mistborn View Post

                            Great insight. This pricing you list would be a flat rate? Or would you try to negotiate additional rvu rate for cases?
                            personally if i were you i would raise the floor (base rate) and sacrifice the ceiling (rvu for cases done).

                            you don't know what your productivity will be here, payer mix etc.

                            i think WBD's numbers are pretty close to what i'd ask for. all they can do is say no. but if you tell them $7500 for weekend and for that you'll cover everything no questions asked that would be pretty attractive to me. my guess is that you're going to have many more slow or steady weekends compared to super busy ones if this is rural. the worst of all possible worlds would be a low base rate (3k is too low for a weekend) and no cases but a bunch of annoying floor work followed by some overnight phone calls that ruin your sleep.

                            if you want some specific numbers DM me and i can tell you what my locum rate was to work EM shifts, it will help you feel better about asking for more money.

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                            • #15
                              Met with administration, deal seems really good, they average 2 weekend cases per month. No ICU so any sick patients would be shipped out. No dialysis, so no annoying dialysis lines. CRNAs take care of all central lines.
                              Does sound like every belly pain gets a surgery consult. Other than that I don't really see any negatives. They are willing to go up on price for holidays.
                              Definitely seems much more favorable to do the set price than to negotiate something more rvu based as volume seems quite low.

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