The Wrong Type of Freelancing

I’ve been a big proponent of multiple income streams and freelance work on the side, both as a way of accelerating income production and ergo savings, as well as a way of employing arbitrage and earning a global market wage, which is often higher than the prevailing local wage in all but the most wealthy countries. That strategy may be nearing an end.

In finance, there’s a saying that you need to constantly reinvent your algorithms, because what used to be a solid moneymaker eventually gets discovered by all and then exploited such that there’s not any more easy profit to be wrung. It’s also the case with football. Things evolve and you must constantly innovate – west coast offense, spread offense, zone read, RPO – as defenses catch up and the easy gains are no longer there.

So it is with lifehacking. We identify low hanging fruit, it gets popularized, and eventually the margins are driven down to almost zero such that it’s not worthwhile doing anymore. We see it with all gigs. Uber and Lyft have low margins due to competition from other drivers. For menial tasks, Fiverr, Taskrabbit, and Mechanical Turk have created a marketplace with an endless supply of low cost foreign labour, with unsurprising results as this article shows:

The internet makes all workers equal; there’s no way for a buyer to know who really is sitting behind the computer doing the work. This is a boon for many. Graham talked to people who did not have legal immigration status in the countries where they lived, but were still able to earn a living online, and older workers who had lost their jobs, but had disguised their age and were finding work.

But that also means similarly talented people can charge equal rates, regardless of their actual qualifications, even if they live in countries that have vastly different costs of living—and that Americans and other skilled workers in the developed world have a particularly hard time competing. That’s partly why the Harvard economist Richard B. Freeman warned more than a decade ago that the growth of the global workforce, with its proliferation of educated workers everywhere, “presents the U.S. economy with the greatest challenge since the Great Depression.”

Monika Taylor lives in the United States and offers psychic readings for $5 on Fiverr to supplement her full-time job. She had mostly been selling her readings on Facebook and Pinterest for about $65 to $85, she told me, but when she stumbled across Fiverr, she figured it was a good way to broaden the number of people she could reach. Though she balked when she saw that others were charging just $5 for psychic readings, she decided to list her services anyway, figuring she could raise rates once she had enough clients. She got a few clients over the last few years, but when she raised her rates recently, to $15 from $5, people stopped buying her readings, she said. Now, she has gone back to mostly selling on other platforms. “If I had to make a living on Fiverr,” she told me, “I would be living under a bridge.”

That’s the keyword – you can’t rely on these side gigs (essentially anything that trades time for money) anymore.

The following avenues are still open, but facing increased competition:

  1. Being elite in any particular field (you can name your price as a top consultant)
  2. Being niche in your focus (e.g. Pashto expert before the 9/11 attack)
  3. Being hyperlocal in a job that can’t be digitized and outsourced, ideally in something that’s not very popular (handyman in SF)
  4. Create a product that generates passive income, ideally attached to your brand
  5. Rental real estate with enough cash flow to cover costs from tenants

By having multiple streams of income, we can more easily compensate for stagnant strategies and shift attention and focus so that the stream as an entirety continues to grow.


Harvard Spills Admissions Secrets

Want to join the world of the elites? Historically, there’s no better ticket to this kind of life than an Ivy League education, particularly Harvard at the very top. Though, if you think about it, their incentives aren’t to enrich the country or to educate talented kids. No, they want to preserve their power, influence, and wealth. They’re a fantastically profitable business disguised as a nonprofit. The way they make money is not really through tuition, but rather the donations that are expected to come from alumni who make it big. This incentive does align somewhat with students’ needs. Harvard will generally try to give you a quality education from the best faculty money can buy, and they will tape their alumni network to get you a great job afterwards whether in terms of money or influence. Then they’ll hound and shame you into giving back.

You can see why they naturally would not want to build their class through meritocracy. Rather, they want legacy (rich kids), athletes, and socially suave (politicians) who have at least an above average mind. They’ve identified this demographic as striking the best balance between satisfying existing donors and slowly broadening the base of donors for the future. You can’t bring in too many “freshies” without family ties, because that will mean displacing a worthy legacy entrant.

This is where earnest middle class kids make a mistake. They grow up thinking that academic accomplishment is all they need. No, the reality is that you need to be well rounded. Just look at this comment dredged from WSJ’s comments section:

My wife used to interview applicants for her alma mater (a very prestigious school in northern CA).  By the fourth applicant, she wanted to stab herself in the ears with her pencil.  All the kids had the same story- they were indistinguishable from each other.  All A’s and great test scores; played a sport; played an instrument; extracurriculars like model UN, robotics club, theater; fancy-sounding summer internship; volunteered for something; wanted to major in engineering, pre-med, pre-law, biosciences, etc.  They were all passionate about being careerist, but nothing else.  Every once and awhile, she’d come across a kid who was really passionate about something- the kid who made Bollywood musical movies, or the one who wanted to major in Classics, or the one who wanted to be an astrophysicist, or the one who organized flash volunteer mobs and pop-up stores.  But, sadly, those were the rare exception.

There’s you have it. From the horse’s mouth, we have the secrets to getting into a prestigious university. If you’re competing in CS, economics, or physics, you had better be top notch. Like top soccer players around the world, you must have started at an early age and been basically groomed for that position your whole life. Basically, to be angular, you need to be so angular as to leap ahead of 99.99% of your peer competition from all over the world. This means International Olympiad level in the math/sciences.

Or you can do reasonably well enough in the academic and invest time in playing a weird sport really well (try rugby, lacrosse, water polo, curling, and field hockey). Then after high school, go live in a commune in Latin America teaching surfing, creating avant garde post-feminist art, and doing eco-sustainable architecture design with recycled garbage all at the same time. Use this opportunity to write a book on your experiences and discovering oneself through medication and purposeful living. Do something crazy and off the wall like that and you’ll stand out to the admission panel.

You can always switch to premed once you’re through the gates.


Is There an Opportunity in the Trades?

On this site we’re always interested in spotting market inefficiencies, which are actually arbitrage opportunities for those in the know.

In the US, the chorus from advisers that students from high school on are exposed to is that they must attend college. Anything less and they’ll turn out to be failures in life. Indeed, higher education attainment has traditionally been associated with desirable socioeconomic outcomes – more stable marriages, higher lifetime earnings, longer life expectancy, and increased life satisfaction. However, one has to question if we’ve exceeded the tipping point. By not only neglecting but actively stigmatizing those in vocational education, we’ve created a relative glut of educated liberal arts graduates, relative to a shortage in STEM graduates and labourers. It’s as if the constant exhortation to go to college outweighed any consideration of what to study when you’re actually in college.

Maybe if we unraveled the data we’d find that on a whole, college graduates do better than high school graduates or those with an associates degree. But maybe that’s from self selection bias. What if we took someone motivated and smart enough to go to college but have that person start a business instead? Or as I advocate in my book, consider getting a head start on earning and investing by working in the trades. Given today’s shortage of mechanics, plumbers, and construction workers, it may not be a bad idea to acquire expertise and then start a small business hiring others to do the work on a larger regional scale.

Perhaps if we also parsed the data more finely, we’d see that your choice of major can cause you to be saddled with debt and have more trouble getting a job that pays less than the trades. See this aggregate of studies from Georgetown, which shows that median starting wages for arts, humanities, and liberal arts graduates is just $29000 annually. You can do better than that as an ironworker, even if you’re a woman.

In a quest for prestige and rankings, and to bolster real-estate values, high schools also like to emphasize the number of their graduates who go on to four-year colleges and universities.

Jessica Bruce followed that path, enrolling in community college after high school for one main reason: because she was recruited to play fast-pitch softball. “I was still trying to figure out what I wanted to do with my life,” she said.

Now, she’s an apprentice ironworker, making $32.42 an hour, or more than $60,000 a year, while continuing her training. At 5-foot-2, “I can run with the big boys,” she said, laughing.

As for whether anyone looks down on her for not having a bachelor’s degree, Bruce doesn’t particularly care.

“The misconception,” she said, “is that we don’t make as much money.”

And then she laughed again.

Let’s all do our part to stop denigrating vocational education and instead invest in expanding its reach. Germany, through dedicated focus, has made it a very successful track to a stable middle class life. We should stop channeling students (and our children) blindly into higher education when it may not be the best path. College is not for everyone.


Banking on Dollar Decline

The bulk of my assets is invested in low cost index funds, as all the experts recommend. That should be good enough for most people out there, but if you want to gain an extra edge over the market, there are a few options. I discourage trying to time the market or to bet on individual securities. Rather, if you must deviate from indexing, the safest is to practice strategic reallocation.

What this means is to skew the composition of your index funds towards a mix that fits with your investment thesis. For instance, an aggressive investor may stick with Warren Buffett’s recommended mix of 90% S&P 500 index tracker, and 10% short term US treasury bonds, implemented like this using iShares ETF tickers:

  • 90% IVV
  • 10% SHY

Whereas a more conservative posture with a higher allocation towards bonds may look like this:

  • 40% IVV
  • 20% SHY
  • 40% AGG

There are of course a myriad of other strategies in allocation that can be done. Some popular ones include splitting between growth vs value stocks, international vs domestic, and mixes of various types of bonds (domestic, international, short-term, long-term, TIPS, municipal, business, high-yield). Generally speaking, you get the most diversification when choosing between major categories such as stocks vs bonds rather than within a category.

My own inclination is not to mess around too much with these sub-categories, as they generally have higher fees without adding to extra return. I stick with the tried and true basics to minimize the temptation of tinkering with the portfolio.

However, if you were to force me to make a bet on the future and to structure my portfolio against a macro trend, I would bet against the US dollar. If there’s one thing we can all do to prepare it’s for a slow drop in the value of the US dollar relative to the rest of the world. With soaring deficits and entitlement obligations, declining prestige, tariffs/trade wars, I don’t see how the dollar can rise in the next few decades. At best it will tread water. The implications for quality of life in the US are profound. We can anticipate more costly imports, especially electronics. For food we should be self-sufficient, but overall prices will rise as food is now sold on the world market, and farmers would have incentive to export their hogs and corn instead of keeping them for domestic consumption. While there may be more low-end jobs such as manufacturing and textiles, the country will also be beset by wealthy foreigners 

How can we best position our portfolios to benefit from this trend? I would diversify outside of the dollar with a splash of international equities and bonds (especially in Asia). However, note that with the S&P 500 companies already having significant international operations, even if you invest purely in “domestic” companies you’ll automatically have some international exposure. This is also why when the dollar falls, the earnings (measured in dollar terms) of S&P 500 companies generally rise. No wonder foreign personal finance bloggers look on with envy at the cheap, mature, and diversified American stock market.

This would look something like:

  • 50% IVV
  • 40% IXUS
  • 10% SHY

Which actually is close to my own allocation.


It’s Never Too Late to Pivot a Career

My wife and I just went to see Ready Player One in the theaters. It blew my mind. I understand why it won’t be everyone’s cup of tea, but it has a tight plot and pays loving homage to tropes, characters, and memes dear to gamers worldwide. We all need our heroes, and the early creators of video games are underappreciated today for their contributions to the field, though their influence was as great as J.R.R. Tolkien.

On a personal finance note, what interested me about the movie was the situation of the author. His Wikipedia article can be summarized as such:

  • Currently 46 years old
  • For most of his youth, was an amateur stand up poet, of no particular note
  • In his mid 20s, transitioned to becoming a screenwriter, without much critical/commercial success
  • In 2010 at age 38, he wrote a novel for the first time and it became a rip roaring success
  • At the same time, he was able to monetize it further by selling the film rights and even writing the screenplay

What can we learn from him?

  • You just need to hit one home run to make it big (unwritten, but we can assume that he tried to sell publishers on other manuscripts which were rejected, before his big break)
  • It’s never too old to transition your career (he actually did it multiple times, from poet to screenwriter to author)
  • You can derive unexpected synergies from past careers (writing the screenplay on his bestselling book, and probably his experience with movie pacing led to a good book)
  • When you do have a success, monetize the crap out of it before it recedes from public memory

Armed with that confidence boost, now you too can go out there and write the next bestseller.


Think Ahead to Minimize Regrets

Three articles today, all with the same theme about regrets. Each has a different story to tell regarding personal finance.

  1. Going without a car. It’s easy to do in a big metro area with good public transportation. We all know that. Still, the author does a good job crunching the numbers on how much saving they derive, and how to compensate for the lack of a car when you’re out in the countryside and want to visit natural parks or get groceries.
  2. Bride regrets her expensive wedding. This does hit home due to my recent wedding. In planning my wedding, I had an ongoing conversation with my now wife about costs. We are both frugal people, and in the end came to a happy balance where we were able to have a quality memorable experience by not skimping on the things that matter while not fretting about minutia.
  3. Letting go of FOMO. Also known as “fear of missing out” – it’s supposedly big with the millennial crowd. My personal experience with Bitcoin was reading the first summary of its original release posting on Slashdot, back when I followed tech news religiously. In this article, various academic elite all comment on why they, and many other experts, missed the Bitcoin bubble. Yes, many of them thoughtfully evaluated the technology very early on, like I did, and concluded that it had minimal value except as a tool for money laundering and other illegal activities. None of us really entertained buying because we knew the intrinsic value was likely close to zero. Still, it’s not easy to have that kind of lottery ticket regret when you recognize a bubble early and could have ridden it. The article does suggest ways to mentally cope; perhaps the best one was that other experts similar dismissed it too.

Turbocharge Wealth Accumulation with Naked Puts

Post written per special request from a new reader

I’ve been playing with options for almost a decade now. Some trades have made money, and some have lost money. It’s the nature of the beast. However, I eventually honed in on one strategy that was a sure win-win: selling naked puts. It’s less daunting than it sounds and can be a real moneymaker if you know how to use it right and compensate for its limitations. Let’s first explain the nature of option contracts.

The Basics of Options

An option is a promise or a bet on a security. You can be either the buyer or seller (also known as writer) of options. As the seller, you get to choose the security, the date the option expires, and the strike price. Then there’s the type of option. The big two categories are calls and puts. You can remember them with the mnemonic call me up and put me down. In other words, a call is a bet that a the subject of the bet will rise, while a put is a bet that it will fall.

The main permutations of the above controllable aspects of options thus becomes translated as such. A seller of a call option sells the promise of “I will sell you ___ security on ___ date at ___ price.” Correspondingly, a buyer of the same call option has the option (that’s where the terminology comes from) of “buying ___ security on ___ date at ___ price.” At the scheduled date, the buyer can decide if it’s worthwhile to exercise the option. Obviously, that will depend on if the price of the security is above or below the strike price. If the buyer chooses not to exercise the option at the date, it expires worthless. In return for owning this flexibility, the buyer pays the seller a certain amount of money called the premium.

Our strategy focuses on put options, so let’s explore that side of things. Using the same terminology, the seller of a put option sells the promise of “I will buy ___ security from you on ___ date at ___ price.” This is selling downside protection, or insurance against a market crash. As you can imagine, there would be a lot of people interested in this type of insurance, namely those sitting on big gains who fear losing it all in a market crash. It’s here where we can exploit a psychological inefficiency. People feel a lot more pain losing money than they gain in pleasure from making the same amount of money. Thus, premiums on put options are quite high. If only there were a way to pocket that for ourselves.

Creating a Win-Win

Here’s another reason that put options are win win for the seller (the one exploiting the fears of buyers). Let’s imagine the two possible outcomes, based on what I actually do each year. Every year in January I check to see what level the S&P 500 index fund (SPY) is at. Let’s say it’s selling right at $200 per share. I then sell/write a put option for a year out (next January) for the SPY security at $180 (my preferred 10% margin of error). In return for doing so, I pocket about $7 per share upfront as the premium. Fast forward a year later. If the stock market stays the same or rises, the option expires worthless and I make money. If the market has dropped, I would be forced to buy in at $180. The only way I would lose money from this is if the price of SPY is less than $180 – premium, which comes out to a break even price of $173. Although it looks like in this situation I would have lost money, I choose to see it in a different light psychologically. I’m a young person with a long time horizon, and stock indexes over the long run have done well. If I would have been comfortable buying in at $200, I should be ecstatic to be able to buy in at an even lower price. Even if I’ve lost money in the short run, I’m in the accumulation phase of my investing life where dollar cost averaging and staying disciplined buying at regular intervals will pay off.

In other words, think of put options as being paid to hold a limit order at the strike price you want.

You can also tweak the margin of error to suit your personality. If you are more conservative or are worried about imminent market drops, set a larger margin of error (known as selling options far out of the money) and sell fewer options. Keep in mind that each option is equal to 100 shares of the underlying security.

I would never sell options like this on individual stocks. That’s far too risky and exposes you to company specific random tail risk events (like Deepwater Horizon). Instead, the SPY security is widely traded, incredibly liquid, and a low cost investing vehicle that I would love to own at any time and at almost any price.

I also like to set my options for a year out. YMMV, but I’ve found that this gives me a reasonable time window to avoid being hit by flash crashes. My options tend to get exercised less the longer out I write them for. This makes sense because over longer time horizons, the more likely it is that the stock market will go up.

Swimming Naked

The astute investors among you may notice a problem. In selling an option, you need to place on hold the underlying security (for call options) or money (for put options) as a kind of escrow. Using the above strategy, this can easily tie up hundreds of thousands of dollars each year. That’s huge opportunity cost due to not being fully invested. This is why my strategy really only took off once my brokerage approved higher level options trading – naked options. Selling naked options means that I don’t put down the escrow. Rather, due to a large portfolio size, the brokerage has calculations that estimate how much margin they can extend you. Mind you, this is different from margin trading, which actually uses margin. Having margin on hand allows us to sell the above put options and use our margin buffer as escrow. An added benefit is that since the margin is not being used unless the option is exercised, we don’t get charged interest.

This also raises the importance of risk management when using margin. Again, I’m a conservative investor who likes having enough buffer to survive unexpected market situations like a big crash. This means that I never write more options than is the value of half of my margin. I also try to keep the total dollar value of all options to be less than my yearly salary. This way I can start planning to save up the cash in case it looks like the market is dropping and there is a chance that the option may be exercised by whoever bought it.

The Perfect Setup

Now for the kicker. While my dad likes to invest in real estate, I’m much more of a stock person. However, from talking to him I’ve discovered the perfect complement to the above naked put writing on margin strategy – home equity lines. Think about it this way. We all need a place to live, and real estate is generally a good investment, as long as you’re in a growing rather than dying area. Most people have a substantial amount of their net worth locked up as equity in a house. That to me is idle cash sitting around not doing any work! Why not use that to act as the “cover” for naked put options?

Let’s say you have a $750,000 house that’s fully paid off. You can easily get a $500,000 home equity line of credit on it. Now let’s assume a $1 million stock portfolio. By my above buffer estimates, this is safe enough to write $500,000 worth of options each year on margin and still have all but the most apocalyptic scenario covered. Using the above guide, I write $500k of naked put options on the S&P 500 index in January, for the January of next year. I pocket $17,500 in premiums that I get to keep no matter what (I normally just plow it back into the market). In most years the market goes up or stays steady, so I get to pocket the premium year after year without ever activating my credit line. Once in a decade or so there’s a big enough crash that my options are exercised. Great! That’s the time that I should be buying in anyway (what did I way earlier about market discipline?). Even when that happens all I have to do is withdraw the cash from my home equity line and buy into the market at a bargain bin price. Then I slow down my option writing, keeping it very conservative in the next few years as I diligently pay off my home equity loan with my income and dividends from my portfolio. As it gets paid off, I start writing larger options and the process begins anew.

This setup is infinitely scalable. The more houses and lines of equity you have, the more put options  you can write. I would even add bonds to the mix. With a healthy 10% portfolio allocation to bonds, that’s also kind of like money sitting idle. I mentally add that to my total of liquid cash equivalent instruments that I can tap to cover my options.

So there you have it, this strategy can guarantee you a 1-3% boost in total returns over the market, with very little risk. By mostly holding low cost index funds tracking the market, we can juice our returns and guarantee a beat every year.


Quick Thought: Have Your Career Early

Quick hitting thought here in reaction to this article. It pays off in more ways than one to have your (hotshot) career early – it simply gives you more options in life. You accumulate more wealth and allow more time for compound interest to work. You can rise up high enough to become indispensable to your company before going on maternity leave. There’s the possibility of continuing to climb the ranks vs shifting gears to something less strenuous, and when you do with a strong CV you’ll be more competitive.

Let’s then count the cons of having fun early and then trying to spin that experience into getting a good job later. Aside from the negative of the above perks, we run into ageism, which is the defining feature of the article. Like it or not, the expectation from most companies is to get in young and then move up or out. It’s unusual for them to hire hire older (read: above 30) works at entry level positions. You’re kind of expected to be mid-career at that point and to apply for director level jobs, which you usually get headhunted for or apply for as part of a lateral move to a different company in the same industry. It’s nigh impossible to graduate and shift careers in one’s 30s and expect to get hired at that level.

That’s not to say it can’t be done. There are stories of people like Elizabeth Pisani and Tai Ming Cheung who have managed to get into a related career from their original one relatively late in life. However, that’s definitely not the norm. Don’t count on being them unless you have exquisite dedication and talent.


Another Reason to Tune Out Market Gurus

If the examples in my book didn’t already convince you of this, the latest flip flop on Marketwatch should convince you that the so-called experts don’t know what they’re talking about.

On Jan 24, the head of the world’s largest hedge fund said, “if you’re holding cash, you’re going to feel pretty stupid.” That’s the gist of it, but if you click through you’ll hear some blah blah justification about how the market is rising, valuations are reasonable (even though by CAPE they’re expensive), and that there’s still room to run.

Then we had the 10% market swoon in the beginning of February.

The next time we hear from the same guy, he’s singing a different tune: “I think we are in a pre-bubble stage that could go into a bubble stage.” He goes on to say that the chance of a recession are 70%.

Luckily, though Marketwatch doesn’t call him out on the rapid change in tone, it does provide helpful links to his prior comments. Any discerning reader with even a modicum of financial knowledge would think that this guy is utter crap and going along with the prevailing tone, fanning the flames in a bull market and turning on a dime at the slightest whiff of panic. Why would you entrust your money to someone who doesn’t know what he’s talking about?

It amuses me to have recently received mass emails from both Fidelity and Schwab advising clients to stay calm in the recent market turbulence. It seems that with each boom-bust cycle, we attract new speculators without any inkling of what it means to truly invest. What am I doing? Tuning out the noise, rebalancing, and overall staying invested in a stock:bond ratio that matches my risk tolerance and time horizon. The market’s short term gyrations don’t matter a whit.


The Definitive Guide to Locum Tenens

Having worked in locum tenens for almost 2 years now, I feel that I have a good grasp on ways to maximize the experience. This article will serve to give a honest appraisal of the pros and cons of locums practice, describe the financial/tax advantages of such, and give tips on how to make the setup work for you.

Is locum tenens right for me?

For most people, it’s a qualified yes. Overall, I think locums is a great way for new grads to learn the ropes of the profession, get exposure to different practice patterns, and pay down loans fast. Concurrently, it also works well for those nearing retirement who may not want to work a full schedule but do want to preserve flexibility in their schedule.

Generally, since locums by definition is a temporary assignment without guarantee that the placement will be based in your preferred area, it’s more appropriate for those without firm attachments to a particular place. Often times, family is the reason doctors drop out of locums. Either they get married and have a spouse who is from or has a job in a particular place, or kids come into the picture.

I’d say that locums is generally better for those who are less subspecialized, to maximize the number of opportunities around the country. Someone in primary care, hospital medicine, general surgery, radiology, and ER is much more suited to doing locums work, since shifts and warm bodies are largely interchangeable. In contrast, pathology, neurosurgery, and EP are more specialized and thus tend to only have openings in tertiary referral centers in large metropolitan areas. These are normally hot locations and with a surplus of providers, so there’s less drive for locums positions to open up.

That leads us to…

What are the pros and cons of locums?


  1. Higher hourly income than a full time job. Positions that are desperate to have shifts filled offer premium pay to attract a bunch of providers in a hurry.
  2. Benefits if you know how to use them. It’s a bit of a wash, as the benefits that normally come with a full time position are shifted into base pay and amenities attached with the assignment. We’ll learn later how to maximize them.
  3. No need to worry about billing or productivity. Since you’re paid by the hour, you’re a glorified salary worker with no benefit to seeing higher volume or worrying about maximal billing (though you still should, as we’ll see later).
  4. Taxation. Being paid on a 1099 rather than W-2 basis allows one to legally take all sorts of business deductions, if you play your cards right.
  5. Seeing the country and the world. Imagine being able to go to Maine in the summer, the Caribbean or Hawaii in the winter, and staying there at no cost. There are also international placements – many people go to New Zealand for example.


  1. No guarantee of work. Your position can be canned with a month’s notice if the position gets filled by full time hires. In other times, there just aren’t enough shifts to go around to meet your needs, either because of full timers, per diems, or competition from other locums at the site. Other times, the site just plain won’t like you and can terminate you at any time. This can be an endless source of stress if you don’t mitigate it.
  2. Lack of other benefits. Again, I’d put benefits under both pro and con because I think of it as a shift in type of benefit to other things that ultimately comes out to be a wash overall. Essentially, you lose health insurance, retirement benefits,
  3. Travel time. Having to fly back and forth to a remote location can be a real downer, taking up the bulk of a day.
  4. Taxation. Again both a pro and a con. The major con is having to file taxes in multiple states, being responsible for paying estimated quarterly taxes, and double taxation for payroll tax (Social Security and Medicare contributions)

How to maximize the locums payoff

Knowing the above, I’ll now get to how to maximize enjoyment/benefits and minimizing the downsides, based again on my 2 years of experience and background in investing/finance.

The first key is to take advantage of the benefits. Normally, contracts come with housing, flights, and a rental car all paid for by the client. My preference is to have long-term arrangements “living in” each community, with shipping or driving my car (reimbursed of course) to the site. The housing stipend (in my experience $2500-$3500) is generally enough to get a furnished apartment or a private Airbnb in the area close to the workplace. My preference is for Airbnb due to the flexibility of being able to cancel up to a month in advance if the client’s needs change. Living in the community will shorten the commute time and minimize flights back and forth. It will also let you save money by not having to maintain a home anywhere else. Yes, you’ll be a bit of an itinerant tramp, but with furniture provided for, you won’t have to bring much when you move from site to site. Living in the site will also endear you to the client. If there’s a last minute emergency shift that needs filling, you’re already on site and can take it. Also, no matter how many shifts in a month you do, the client won’t have to pay more for extra hotel days. Also, you won’t incur any flight costs for the client by virtue of relocating yourself to each new site. Finally, by shipping your car, you can reimburse the mileage driven from home to work, and again save the client money by avoiding a car rental.

If it’s unavoidable for whatever reason and you have to maintain a home elsewhere and commute back/forth, do the next best thing and take advantage of hotel and airline rewards programs. In my experience, Hyatt has the best rewards and you can accumulate free days very quickly without having to spend a lot of money. Hyatt Place is a great mid tier brand with a full free breakfast, but unfortunately is only located in major metro areas. The next best is Hilton, due to widespread availability, easy to earn status (Gold = free breakfast at HGI and Doubletree), and many free breakfast options (Embassy Suites, Hampton Inn) even without status. IHG is my third choice mainly due to availability, especially in rural areas. Holiday Inn Express, while not the best place to stay, works for a clean, comfortable, hassle-free experience with free breakfast to boot (comparable to Hampton in quality). You will accumulate points easily that can be redeemed for free nights at a fairly frequent basis, but higher rewards tiers don’t come with as good concessions (no free breakfast) compared to Hyatt or Hilton. Other locums have used Marriott or SPG, but my reading of their rewards programs is that they’re on the less generous side of things overall, and aren’t as widespread as either Hilton or IHG.

As for flights, my preference is Southwest plus another. When possible, Southwest is generally the cheapest point to point between major metro areas, and the two free bags is a lifesaver when moving homes. They also have many direct flights from the cities I care about (San Jose and Dallas), and their rewards program is quite fair in terms of availability and usability of points. The next tier in my book is Delta, mainly because their points don’t expire. They also fly to many remote locations and have hubs that I use frequently (Salt Lake, Minneapolis, Atlanta). Of course, in your situation things may be different, and United, Alaska, or American may be better options based on your home city. Sometimes they will be the cheapest and most direct flight, but my preference is not to use those if I have an equal option due to worse frequent flyer benefits (for United and American) or limited geographic reach (for Alaska, though they are improving).

After optimizing your travel/housing situation, you should turn your attention to the direct financial implications of being paid as an independent contractor. The main advantage to this is being able to expense certain things from your business. Although, with most housing and travel expenses paid for, the most rewarding deductions left over is meals while away from home (per diem accounting of this eases record keeping). However, you will be able to set up a SEP IRA or Solo 401k. The former is easier to set up and has fewer reporting requirements but you have to make more than roughly $280,000 per year to reach the maximum contribution limit of $55,000 for 2018. This is a great perk which we should definitely seek to maximize, as it’s a higher limit than standard employed 401k plans ($18,500 limit). The Solo 401k is more hassle but does let you reach the same $55,000 limit with lower income. In terms of investment options, both are the same. For me, I use a SEP IRA since I work a full time schedule and can easily clear that income hurdle.

Lastly, we’ll talk about mitigating the downsides of being an independent contractor. While there’s nothing we can do about double payroll tax, we can at least deduct the employer half from our gross business income. This leaves health insurance, which most people will either buy from the ACA marketplace or get for free from a spouse, the latter being the best option if you’re lucky enough.

Don’t forget to pay estimated quarterly federal and state taxes. Pay attention as they can be on different schedules! Normally for W-2 wage earners, your taxes owed are deducted from each paycheck. As a small business owner or contractor, you have to calculate taxes on your own. I find that the best way to navigate this is to pay enough to meet the safe harbour clause. For high wage earners (anyone over $150,000 filing as married), this means paying 110% of total federal tax from the previous year. As a simple calculation, if your total federal taxes for 2017 is $60,000, you should plan on paying $66,000 in quarterly installments in 2018 to fall under safe harbour. It doesn’t matter if you ultimately earn more than that. You’ll still have to pay what you owe, but by paying the safe harbour minimum, you won’t be charged fees and penalties for underpayment. As for how much to set aside from each paycheck, I’d go with 35% if you’re in a low tax state and 40% if you’re in a high tax state. While setting this aside it can be helpful to have the money earn interest in a money market account or short-term bond fund until you have to pay.

With the recent tax law overhaul, working professionals stand to benefit from lower rates. Yes, there’s a loophole where high-earning professionals can reduce their taxes substantially without having to incorporate as a pass through S-corp.

Of course, if this is too hard you can always find a tax accountant to do things for you.

I purposefully leave out life insurance as I feel that it’s a big waste of money. The main point is to leave something to your heirs, but if you’ve been doing everything correctly and investing on schedule, your estate should be big enough to more than outweigh any insurance payout.

How to pick assignments

Early on in your locums experience, you may be tempted to commit to one state license or one job. Don’t. Locums who fail to plan can end up with no work at a moment’s notice. Instead, get credentialed in multiple states where you think you can get work and see what’s available. I divide sites into two categories (this will be from a hospitalist perspective now). Tier one is a desirable primary site with low census, good EMR (I like Epic), low-no procedure requirements, closed ICU, and located in or close to a major metro area (to minimize flight time). Due to desirability, this site will require a long-term commitment usually on the order of 4-6 months minimum, with a minimum schedule each month (typically 7-14 shifts). Tier two is a higher census typically rural site that’s more desperate for providers and will take anything from anyone, even on a part time or ad hoc basis. It’s good having a site or two like this in one’s back pocket in the case of a dry spell. You can even have a tier three which is purely per diem arrangements with local hospitals.

This is also a rough guide to how to screen for assignments in general. Again, from the hospitalist perspective, I like bigger groups with more concurrent hospitalists. This means that any unexpected surges in workload is distributed more evenly (only 1-2 extra patients per provider) as opposed to the same volume spread over 4 hospitalists, which can overwhelm the system. No joke. I’ve heard of some hospitalists who start at a site and quit after a day due to the high workload. Average census is probably the next most important to screen for. It can be helpful to get a sense from people on the ground as opposed to just the medical director, who can be biased in trying to sell the position. My general goal is to shoot for 12 patient census for 10 hour shifts, 15 census for 12 hour shifts, and to also inquire if there are concurrent admissions. The most extreme workload that I’ve done is average census 15, 3-4 admissions, 12 hour shift, with no cap. That was brutal. The other end of the spectrum is a census of 9-13, 10 hour shift, no admissions, which usually led me to “finish” the day at 2 PM. I think it’s far better for health/sustainability and med-legal reasons to keep to the lower census sites as much as possible. Even from a financial perspective, it’s better to be able to work 21 shifts and still be fine mentally (and still be able to do stuff each day after work) rather than only 14 shifts and still feel burned out.

As an added bonus, some sites have policies in place that allow rounders to go home early when they’re done with work. These places are worth their weight in gold if you find them, and almost inevitably fill quickly. If I can work 7 AM – 4 PM, get home on time, take the remaining cross cover call from my gym, and get paid for a full 11 hour shift, sign me up to work 28 days straight here!

For me personally, EMR is an important screening criteria for sites. I grew up with Epic. It’s the only EMR I’ve used since starting medical school, barring short stretches at the VA and the local student-run free clinic which was on Allscripts. My comfort level with Epic is so high that I’m twice as efficient on there as compared to any other EMR. I can very easily navigate through all the tabs to get the relevant information on patients. As someone who prefer to type, use templates and add in smartphrases than dictate, I can type out a note in roughly 10 minutes from start to finish on Epic, as compared to closer to 30 minutes fumbling through a dictation and waiting for it to upload (full disclosure: I’ve never dictated before and don’t plan to start). This means I can tolerate sites with high workload if they’re on Epic, while a hospital using Meditech will need to tempt me with far better hours/pay to get my consideration.

As a general rule of thumb, I like to think of the US in terms of geographic areas. The Northeast is a wasteland for hospitalists. Census is generally on the upper end but the area is oversaturated due to the glut of academic programs pumping out providers who like to stay in the area. Even if you’re willing to work full time, good luck finding any position in NYC, Boston, or DC. If you do, it’s probably going to pay far less than $200k. In contrast, the South is what I like to call high workload, high pay. People who gravitate towards places like Florida, Tennessee, and Texas like the lack of state income tax (more take home pay!) and are willing to work hard for it. When I say work hard that means positions routinely advertise 20-25 average daily census, and 10-12 admissions for night/swing shifts. Moving on to the Midwest and Mountain West, I consider this to be my personal sweet spot. Perhaps due to the weather, there are far fewer providers here than anywhere else in the country. Thus, pay is high (for both locums and perm jobs) and census is generally very reasonable. My favourite is the Twin Cities, since I know the health systems well there and the fact that all the major systems are on Epic. The TC also have a great public transportation network, and it’s possible to go carless there including from the airport to all major hospitals. My second choice would be the West Coast (CA, OR, WA). Workload is in between the Midwest and the South, and pay is comparable to the Midwest. California is a great license to have, and there are generally tons of jobs, though not always in the most desirable areas. A big personal plus is that all the major health networks (Providence, Legacy, Kaiser, Sutter, Swedish) are on Epic.

How to be a good locums provider

While the previous section focused on what a site can do to be more appealing to locums, this section will be on how to be a good locums candidate and provider.

Put yourself in the shoes of a site. What they want is someone who has the fewest hang ups and is easy to deal with. An ideal candidate is willing to go anywhere, do anything, work at various hours of the day, learn the local system quickly, and not complain. This is why I’m so picky on which sites I screen for before applying. By carefully selecting just the best sites, I create an environment where I can get started on the first day and easily outperform full-time staff.

Aside from medical competence and efficiency, it’s also important to be attuned to the local political and dynamics within the group and between the group and the administration. Getting on the good side of admins, schedulers, care coordinators, and the chief is important. When the group evaluates whether to keep using locums and if there’s a crunch, which locums to cut, they’ll keep only those that they like and who perform well. Remember, you can stand to be picky when applying for jobs, but once you’re in the door, do your best to perform well. On site is not the best time to complain.

Finally, I want to emphasize how important it is to be cost-conscientious. Hospitals and groups don’t have unlimited budgets. If there’s any chance of waiving certain benefits such as rental car, or minimizing flights by living locally in long-term housing, do so. It will improve your standing in the client’s eyes and again make you more competitive to retain or to be asked back when they have options.


So there you have it – the nuts and bolts, inside scoop on the locums life from someone who’s been through it. Personally, I’ve loved locums overall. It might not suit everyone’s lifestyle or approach to things, but it fits what I want from my career at this time. Use the above tips. Structure things well and through careful maximization of benefits, sites, shifts, and tax treatment, you can earn as much as an orthopedic surgeon while working half as much.