Exploring Locum Tenens: Health Insurance and Retirement Plans. #442

All you have to do is show that your income is increased and you can buy more benefits at that time . No medical questions asked .

Welcome to another episode of Docs Outside the Box .

Y'all , let's jump into this because I am tired , I'm coming in off of night shift , I'm purely running on steam and the whole night , renee , while I'm doing my notes , I'm listening to Kendrick Lamar's GNX album , because it be like that next album , because it'd be like that , and sometimes , when you are tired and you need some fuel , that album gets me through

the night . I love that album Excellent .

I'm all about the work-life balance , and I think locums would give an opportunity for just that . I just have one question , though how do you navigate the health insurance and retirement plan component ? I'm not sure if locums provides that .

If you're wondering like locums is not until you finish residency and you are working on your own , All right . Once you start working on your own , then you start considering locums .

There's some small caveats , but just for the sake of this combo it's when you finish , and I think what you're starting to see is a lot of people are starting to realize , hey , this is a lifestyle that I want to think about , or this is a lifestyle that interests me .

Despite all the noise that I got to worry about with studying , with taking boards , with getting through rotations , this is just the lifestyle that I

want . I have a on my service right now . I have a medical student who's applying for medical school or , excuse me , applying for residency right now .

I was like you know , like I really like my job because I like the operations that I do , I like the patient that I get to see , but the way in which I jump in and jump out , the lifestyle , like you can't beat that , and I think you don't really see that in many other specialties in the surgical fields , whereas trauma critical care , it's very much like

lifestyle oriented and it's really hard when you're in , like you're very focused and then you can step out . And he said , yeah , like I really enjoy that . I'm very interested in chatting with you about that in the future . I was like , okay , you know , but I'm like that's another thing , that's like a fourth year medical student who's interested in that .

So good question , good question and it's very apropos right now . Right , so we're recording this . In January , we just actually just re-upped our one-year subscription for health insurance in the state of New Jersey .

So we get our health insurance through healthcaregov or we get it through the marketplace , the Affordable Care Act , and we've been getting our insurance through there since 2017 . So we go online and we fill in some information . It's really quick , you just go to healthcaregov .

Alfred , if you could put that in there , healthcaregov , Alfred , if you can put that in there . And when we go to healthcaregov you go specifically to the state that you live in and you , in essence , just start shopping for a different type of healthcare insurance that you need and it's based off of how many people you need to get covered .

So for us , our family , I have to find coverage for Renee , me as well as two kids , and you just get to shop . You literally get me as well as two kids and you just get to shop .

You literally get to look at like a bronze plan , you get to look at a silver plan and you get to look at a gold plan and you get to basically like just compare and contrast between all the different companies that are selling health insurance in the state of New Jersey . You get to look at that through the website .

Sometimes it can be a little bit overwhelming , but yeah , that's how we do it . But when you do locums , when you work as an independent contractor , your health insurance is not covered . Your retirement plan there is no such thing as that .

You work and you get paid and then that's it , and then you have to take that monies and purchase those benefits that you would normally get if you were employed . Right how did I do that , did I explain it right ?

When you work as locums , when you get your check right from whatever hospital that you're going to be working at , you don't have taxes taken out of that check . Don't have taxes taken out of that check , right . So if you've worked before , you know that FICA comes after you .

You got to make contributions Exactly , you got to make contributions to the government , medicare , medicaid , all that kind of stuff . So you know that you are going to have taxes taken out . Well , when you're locums , you're not employed by anybody but yourself , right ? You yourself are the business .

So you contract out and the hospital cuts you a check with no taxes taken out . Well , even though taxes aren't taken out , that means later on that you do have to pay taxes . So the question is well , what are you going to pay taxes on ? You don't have to pay taxes on that whole check .

What you pay taxes on is anything that you didn't use for running the business . So if you buy health insurance , health insurance is the cost of you doing business , so you're going to take a portion of that money and pay for your health insurance .

So when you pay for your health insurance , that money because it hasn't had tax taken out of it yet , that money is tax-free and you pay your health insurance with tax-free money . So that's what that means , and we're going to talk about this so many times over the course of the podcast .

So if you didn't get it today , don't worry , just keep listening to our episodes . You will eventually get it .

But if you go to the bottom of his article , if you pay attention to what he says in there , it says just so . You know me , working this way is cheaper for the hospital actually .

So one thing that a lot of people don't know is that when you're employed you actually cost the hospital more money versus when you work in the locums independent contracting fashion . Do you want to explain why ? Or you want me to , but I know that's one thing that a lot of people .

That's one thing that a lot of people who I think are trying to negotiate with the hospital , they get talked out of by the hospital . They're like oh why , don't you just come on as an employee ? You know ?

That's an independent contractor or maybe a department head , like a department chairperson , who doesn't understand the numbers and doesn't understand human resources , and that's no shade , but they just don't understand that part .

You actually are cheaper when you work as an independent contractor and the reason why is when you get your salary like your salary as an employee is not just the salary cost to pay you to work , but it also includes you needing to get disability insurance .

You need to get health insurance Like the hospital has to pay a portion of your health insurance , right , so you have to pay your own pay a portion of your health insurance as a premium , but the hospital is also covering a portion of that . Also right .

To get your retirement plan like they have to put money into the retirement plan to get continuous medical education Like I can go through the whole slew of things that a hospital gives you as part of its benefits . That costs the hospital money , money , right , but when you work as a locums , they ain't got to pay any of that stuff .

They just got to pay you to work , and when you come and work and then you get a check , you have to use your own money to purchase all those things that you would have gotten if you were an employee .

So what I end up finding out is for me , when you boil it down apples to apples , what really I end up seeing the hospitals really saying is is listen , as a locums , you are not predictable in terms of when you are going to work . Right ? That's how it to me . I look at it and we need predictability , right .

I get all that , but I think truly what it boils down to is yeah , I need someone to be on a schedule six months from now and I don't have time for them to be like yo . I'm in Cancun and I can't do anything about it .

There was the other part of her question , josephine's question about the retirement . How do you plan for retirement ? Right ? Because usually people think , oh well , you get retirement through your job and there are lots of different ways to get retirement funds and save for retirement or invest for retirement without necessarily being employed .

So me , you're better at those explanations than I am , so I'll let you bust that out .

But , like so your company , you yourself as a locums doc , you need the benefit of a retirement plan . Like , you have to have something that's going to help you put money away so that , when you reach a certain age , you can use that money to go and live on a boat and go wherever you want to go when you don't want to work anymore .

Right , that's the retirement plan . So you , as an independent contractor , you can purchase that , and you can purchase that through so many different places . But you basically purchase this benefit and you get access , in essence , to the ability to put money away . And when you put money away , that gets treated a certain way by the IRS .

Right , you get certain tax benefits to do that . Right , it decreases the amount of taxes that the government can tax you on right now . So , yeah , like there are , and what that does in essence , it gives you a benefit , right ? So we've done that in various ways , like when I first started doing locums 12 years ago . Man , those numbers , the double digits .

Now , yeah , we getting up there , you getting up there .

, but you can do this . Like a lot of people are doing this and yeah , there's a little bit of a learning curve . But when I first started , I just had like a regular , like IRA , right , that's an individual retirement plan , or a SEP , right , self-employed pension plan , very simple . And we did that for several years .

And then eventually we're like , look like we do locums for a consistent period of time . We see ourselves 10 years from now doing it .

So we upgraded our plan , which is an option , right , it's almost like how , when we're looking for health insurance , like there's a bronze , there's a gold , silver and bronze the same type of thing we found something a bit more comprehensive and then we transitioned into that . But y'all that took several years and then we finally got into it .

We made mistakes and you know that's how we do it now and we have money , like we even have it to the point where we were able to take a 401k loan to help . You know us purchase something , a big purchase , you big purchase over the last couple of years . So it's for us now we are at a mature level of ours .

But I just want y'all to know , josephine , that is an option that is available for you , and I highly encourage you . Whether you put 50 bucks away a month or however you want to put away , you can do that and that's the best part , I think , of locums is there is a certain level of independence that you get to practice .

That I think you know people love . You know it's just like yeah .

We'll be talking about , you know , how you get malpractice insurance . You know all the things that potentially make people have a little bit of the heebie-jeebies about getting , uh , doing locums . Right , these are , these are the things that people worry about , right , About doing locums how am I going to get my health insurance ? How am I going to get malpractice ?

How am I going to get you know , all these different things retirement plans ? Um , so we'll be talking about this in our course . So , if you haven't already signed up for notice about our course , I want you to go to the show notes and in the show notes you're going to see a link for a freebie .

Once you sign up for that freebie , you're going to be on the list so that when we are ready to announce that the course is accepting registrants , then you'll be notified . It's going to be limited , limited seat . So if you're going to be interested in signing up for the course . Make sure you do that as soon as we send out the notice .

But that was a great question , Josephine . Thank you , thankine , Thank you , Thank you . Thank you so much , and if anybody has any other questions , you can go to the show notes and you can either text us or you can do that . What's it called ? Is there a link there down there that says tell ?

In episode 176 , jamie Fleissner of Cephalife Insurance explains why the best time to buy disability insurance is during your residency .

So when you're healthy , it's easier to acquire the coverage Number two . It's also less acquire the coverage Number two . It's also less expensive because it's based on your age and your health . You're not getting younger or healthier over time , so you're at the ideal time . The earlier you get it and the younger you are , the less expensive it's going to be .

I don't think locums prevents that , though In my department protocols apply whether you are a part of the group or locums . Only difference is the hospital can fire the doctor directly , versus firing the locum group or twisting their arm to get rid of the doc . So this was an older episode and we'll link it in the show notes as well .

Like , there's multiple ways that you can be working for a hospital and you know , depending on what specialty you are in , usually that dictates things . So , for example , like ER group , er doctors normally what they do is they form a group , like they come together as a group like four or five , maybe 10 , possibly 15 .

And then they form a company , right , so you'll have a company of ER docs and then they have like a structure within them , like who's going to be negotiating contracts , who's going to be doing billing , all these different things . But they as a group will then go to a hospital or a bunch of hospitals .

As a group will then go to a hospital or a bunch of hospitals and in essence , like sell their service as a group to a hospital or several hospitals , right , and then not only that , right , like they in essence kind of run the hospital's ER department from within .

So it's almost like there becomes , like you become when you the ER docs that are part of the group . They are basically like employees of the group . But then the question is , are they also employees of the hospital ? It can get real intricate and so forth , but there are some conflict of interest things that she may have to read up on guys .

But that's a very like , it's a very unique issue . That I think is mainly for things like ER docs and so forth . But those are for ER docs who are in a group that is negotiating with that same hospital that you're at . But if you , as a locum's ER doc , is trying to go to any other regular hospital by yourself , you don't have to worry about that .

So cause there is no conflict of interest . So , but that is a good point , dr Love , cause I think Dr Love he works he's like a I believe he's a medical director through a company that he works with that contracts their services to a hospital , I believe . So he may want to write in if he hears this and go from there .

So he's given the example of you know , if you , as a doctor , see that a patient has a certain lab value that we all think is consistent with diabetes , we will give a diagnosis of diabetes and hence we will get paid a certain amount from the insurance company . That is true , right , but that's how we base our ability to diagnose .

These are guidelines and , yes , some of that stuff has to do with how insurance companies pay and so forth .

Could you imagine as a patient , you're scrolling , scrolling , scrolling and this is what you come across , and he is your doctor and you're like , well damn , when he told me that I had X , y and Z , is that even like , did I really have that Like ? Now you need , like , second and third opinions .

No , the most thing you will be able to say is I , I can't afford get it fixed , but how ?

You know , in general , they craft the story that they know will tug at women's emotions , which is , yeah , like you're let's say like you're driving and you lose control of X , y and Z . You don't want that to happen to you , do you ? Or let's say , you're picking up your kids and X , y and Z happens and guys don't care about their kids , right ?

They're like look man , I'll be all right , like we'd be skidding the whole way and stuff and we'll figure it out , right . All I'm saying is is that they use differently to manipulate men versus women , but in essence , the same thing .

And if you have a dude who don't know the lingo of what the mechanic is saying , he's going to say something to make you pay for it . The same way , maybe a little bit differently , that he'll say to you as a woman you know what I'm saying , but it's the same outcome . But basically what I'm saying is the public doesn't know .

Like , they don't understand , like if they understood , like , like how we diagnose and some of the things that we do , I think they'd be very shocked to find about . Find out about certain things , like it's like you go to a restaurant do you really want to know how your food is being made ?

But ultimately , I think if they knew how things were being made , they'd be like oh , oh , I get it Right Like there's nothing really from a doctor standpoint . There's really nothing you know on the what's the best way I want to describe it . There's nothing . I can't see people being upset about the way that they're treated from the doctor standpoint .

They essentially break their oath constantly , depending on what the illness may be .

I think when I watched the video , I watched it and I was like , I think he's sensationalizing certain things Like , for example , if somebody comes into my hospital , right , and they get into let's say , they get into a motorcycle crash and they break their arm , they get a head injury and they break ribs , like I'm going , and then let's say they're also diabetic ,

right , if I'm treating all of those different things , I'm going to list all of those different things that I'm treating , and that's going to increase the level of reimbursement that I get , right .

So , yes , I am getting reimbursed more , but that's because I'm treating more stuff , right , and the question , though , is do I have sinister intentions by doing that , right ?

I see an allergist right , I see an allergist regularly for the multitude of allergies I've developed as an adult , and I find it redundant for me to go in just for him to check on me . Hey , how's your breathing , how are you doing ? I think that's redundant yeah I always get charged a lot more for that , so I canceled those appointments .

He's like oh , I want to see you in six months , I just don't schedule them . But then it comes to a point where he will stop me from getting my shots until I see . Yes .

She was like , yeah , they won't let me get any more of my high blood pressure medications . I called the doctor and the doctor says yeah , we've been trying to schedule follow-ups with your mother for over a year , so I don't know how she's doing . I can't check her blood pressure when she comes in . How do I know that the medication is even working ?

So there's that component also , right , which is I just need to make sure you , kiara , are responding very well to the medications , that I am doing , right ? It may sound redundant , but , yeah , part of that is just doing the due diligence of making sure that you're doing well and that you have a good reaction with the medications .

Right Now , the question that you are having like is all the questions necessary , all the questions that they're asking you actually necessary , correct ? Yes , right , they're asking you actually necessary correct . Yes , right . So that's part of the general intake that they do in order to make sure that they can bill the correct way for you .

So , yes , there's that component also Right . Part of you coming in to see them is how's your breathing doing , how's your heart doing ? Any complaints , any fevers , any chills ?

There are docs who figure out how to make this work in favor of them . I don't know what everybody does and stuff , but I'm sure that there's some people who do manipulation , right . That's the reason why some doctors get sued by the government or by Medicare and so forth . That occurs . I would say the majority of them don't do that , majority don't .

practice , right , which means that when you're working for a hospital , you know who does the billing the hospital , right , like they do it based off of what you write down and what you document , and then that money doesn't come directly to you as a doc , that money goes to the hospital and then the hospital takes whatever they get and they divvy it to the

doctor , right . So it's a little bit , or actually it's very different . Now the incentives to do all those different things that he's talking about , I think for the most part , are gone , right , because now you've just entered somebody else , a big middleman or middle woman , into the picture .

. I think it's a big deal in the United States to go to medical school when you're in your 30s , because you know it's just like more than likely you've changed your career from something else .

And then , not only have you changed your career from something else , you also , like , change your financial situation because you have to take out a lot of debt right To pay for going to school .

And you know , now you're going to school in your thirties and there's just like that little bit less amount of time that you have to catch up with everybody else who went to school in their 20s . It's minor , it's a minor change and so forth , but it can be very scary , it can be very daunting .

But shout out to you , vladimir , like that's , that's a big , big deal . I think in my class in med school , the oldest that we had was in someone in their 50s , right , and I think they're still practicing now , right , because I graduated in 2006 . Oh my god , um , damn .

So it's about to be 22 years , next year's 20 next year is about to be 20 years , so they're in their 70s right now . They're in their 70s , right , I'm , I'm right , alfred , bleep out my age from that , right , and so that means you know . So , like , that should just tell you something , right , like , I've been out for 20 years . Wait , oh , 19 years .

So , like , this person is in their 70s practicing . So it's a big deal when you are changing careers , so shout out to them . Shout out to them yeah , that's a big deal . When you are changing careers , so shout out to them . Shout out to them yeah , that's a big deal .

Have you guys , have you guys ever thought of uh , like , because you know , like , when I was in , when I was in college , you know , I I knew that , like , when I finished college , the goal for me was to get into medical school , whereas with my friends who were engineers or they were marketing or whatever like , for them , it's get a good job , right ?

So then , once I got into medical school , then it's the next four to almost 10 years of my life are already predetermined , right , it's not really working , it's just in school , right ? Whereas if you are not in medical school or you're not in law school , it's you climbing up the ladder .

You're developing experience In those 10 years that you work versus that I'm in school , you could shift to different businesses or shift to different companies .

But then there's a point where I remember , like in their mid-20s to late-20s , my friends were changing jobs or changing professions and I just didn't understand that right , because I'm in the midst of finishing med school or going into residency .

And then it's funny like now that when I finished residency or fellowship , I started doing locums and then I had a major shift . And you know , now I'm doing locums .

I feel like like everything that I've done is like five years to 10 years behind my friends , my friends , are like ahead of the game because they didn't have to do the whole school thing continuously . Did y'all have to do any of that ? Like , did you guys ever have to shift gears like that ? Audrey , you too young , maybe .

The lecturer in class is struggling to make you understand , so there's no way you can understand online whatever he's teaching . So one year down the drain . So it took six years Graduated . I kind of changed trajectory .

You have to start with a salary of about $150 or $200 max and climb the ladder throughout the years and hope for the best , that you'll get a promotion or something . So I was like , nah , this can't work . So , yeah , I changed trajectory . I was saying no initially . Then I realized , oh , yeah , I did change my trajectory .

Yeah , and you go the complete other way and stuff .

Um , I went for psychology and then I dropped out and that's when I joined the military . I worked with um , I was the aircraft administration while I was in the Marine Corps . Once I finished that up , I worked at a daycare , like just just because .

And then I went to school , graduated with a bachelor's in marketing and management , and I guess essentially that's what I do now , right ? So I guess it kind of worked out , Um , and then I'm about to switch gears again and start working for a certification for data analysts , which kind of all ties in any way . So I guess that's my , my trajectory .

So you yelling at me or speaking to me in a not so nice way has nothing to do with me . I'm just the person on the other side of the phone and the error did not come from my end .

And then you always have to be like the customer is always right , Like the notion of the customer is always right . So you're on the receiving end of the not so good things and then you have to change direction and try to calm them down . And yeah , it's just too much .

I just say listen , like , consider me like I'm your coach , or consider me like we are collaborating together on your health , right , like I do not , like I work for you in this fashion of I'm advocating for you , I'm helping you get to a certain level of steadiness , but like I'm not like a worker for you who is subservient .

I'm always very clear with that and I think the way how we are in today's world with customer service , there's always this you work for me , and I'm telling you that I want to do X , y and Z , and I sometimes you may get it with , like I want pain medications and you know this , this , this , this , this , you work for me , and it's like , well , no , like

I have to help . I can't just , you know , blindly give you pain medication . I'm just using that as a one small little example snippet . You know I have to give you .

I have to look at overall how you're doing and see one yes , are you know exactly what you want in terms of , like the type of pain medications , right , like there has to be a side effect profile that I have to consider and all that stuff . But the way that I'm very clear with patients is that , look , I work with you .

I don't work for you , you know , I'm advocating for you . I will make sure that you know you get the best care and you get my best . But this is something that me and you are working on together , you know . But I definitely see I've seen it more and more that people or patients or people who are very disgruntled .

They come in with the same thought process of regular business and the customer is always right to you know what's happening in medicine is like well , but if you don't understand your diagnosis or if you don't understand what's going on , like how can you say that you're right ?

Like I can understand your complaint and I can say that I hear you and but sometimes your perception is definitely not your reality , particularly in medicine .

So you have to really be on the up and up and you have to make sure that you are explaining things in a way that you know helps them feel like they're a part of the team , right , like they have to understand . Like like you can't just say your CV joint is broken and that's it .

Like you got to say listen , like you need this surgery for your appendix because of X , y and Z , and this is what I'm going to do . And here's pictures of what I'm going to do and this is how you are going to get through . Like Renee was right on that last episode where she said like the 99% is the same but that 0.1% makes a big difference .

She explained it way better than me , right , and it's true . Like we all practice the same way .

But like my ability to kind of sit next to you and hold your hand while I'm explaining things to you , or show you pictures of what the surgery will look like or what your diagnosis will look like , or you know kind of physically , you know , take you through the process of where we're going to be over the next three months with your disease .

Disease that means a lot and you can't measure that sometimes . So that's where I , you know , for me , I really hope that I excel because I learned that message from my mom . She was a nurse's aide or a nurse's assistant , so her job is very , very tough job . If anybody understands what that is , it's not very glamorous , you know , it's a lot of .

You know it's just it's tough . So I've always kind of like think about my mom when I'm in these jobs , like what would my mom think of , what would my mom say and stuff . Because she would oftentimes say , like the doctors you know sometimes could be , you know she would talk about the doctors that were very nice to her .

She would talk about the doctors that were very rude to her . And you know , as a young boy you're like man , when I get those , when I get a chance , I'm gonna get them doctors that were really rude to her and stuff .

But I think it's very important , like when , when I was in training and this would be my last point when I was in training um , this I got to give a shout out and also a rest in peace to Dr . Dr Weaver , who is the chairperson of our department , and I remember the first thing he said to us is you will treat everybody the same .

You will say good morning to everybody the same way . You'll say good morning to me the same way you will say good morning to the housekeeper . And you know that stuck with me forever right , because whenever I see the housekeeper , or if I see you know some of the aides or the nurse's aides , I always think about like what if it was my mom right ?

So I would say good morning , miss , good morning dad . I'd never say their first names Right , cause I'm , most of them were all older than me and so forth . But there's a certain level of respect that I've always had with patients and , you know , trying to make sure that they understand that .

You know this is a collaboration , not just me telling people what to do and stuff . So you know , on that note , I'm gonna leave it at that , All right . Well , let's wrap it up . Kiara , you got to schedule us to do a review of GNX Kendrick Lamar . When are we going to do that ?