The General Surgery Rate & Negotiation Toolkit

What's Inside

Not "a PDF." Six specific tools:

1. Rate Benchmark Database

   General Surgery rates by state and setting — urban hospital and rural/critical access — at the 25th, 50th, 75th, and 90th percentile. Fifty states. The number you need before you call the recruiter back.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The counter when they say "this is our standard rate"
   • The intangibles trade when the hourly is locked (stipends, call structure, tail coverage)
   • The leverage script for 24-hour call and weekend surgical coverage
   • The renewal script when they try to roll your old rate forward
3. General Surgery Leverage Points

   The specific GS credentials and coverage capabilities that justify a higher rate:

   • Endoscopy capability (EGD and colonoscopy) is near-required at rural CAH assignments and doubles the revenue you generate at a small facility — price it separately from base surgical coverage
   • ATLS certification expands rural eligibility to Level III/IV trauma activation coverage, which carries a separate rate premium
   • 24-hour call coverage ($3,800–5,500/day) is the most underpriced line item in most GS locum contracts — negotiate it as a separate line item from the hourly rate
   • Robotic surgery certification (da Vinci) is the expected standard at urban assignments — confirm equipment availability and case mix before committing
4. Contract Red Flag Checklist

   Daily minimum guarantee, call compensation, malpractice tail, non-compete language, and OR case-mix expectations. One page, annotated. Open it while reviewing any contract.

5. Agency Markup Framework

   The math behind what the hospital actually pays for your shift. A rural surgeon generates approximately $2.7M in annual hospital revenue. The agency bill rate reflects that value; your negotiated rate should too.

6. Locum Tax Framework

   The 1099 math most surgeons undercount: the S-corp threshold, the Solo 401(k) gap, and the minimum premium required to break even against a W-2 employed rate.

What It Looks Like on the Call

When a recruiter quotes $238/hr for a rural CAH general surgery assignment, this is the sentence from Section 2:

"The market median for rural critical access general surgery in the South is $257/hr. I cover endoscopy and hold ATLS, which expands the assignment scope. I'd expect to be in the $275–295 range. Is there flexibility to get there before we discuss scheduling?"

You change the numbers to match your state. You say it. That is the product.

Who Built This

For years I took every rate I was offered without pushing back. Not because I was naive. I didn't have the data to know whether I should. Neither did anyone I trained with. I built this because the information existed in federal wage surveys, peer-reviewed research, and 50 years of negotiation science, and it wasn't assembled anywhere a physician could use it before calling a recruiter back.

This is where it started. Then I built the same data model and negotiation framework for the 22 specialties with the highest locum demand. The leverage points in each toolkit come from specialty-specific research. The scripts and the data are the same framework I use myself.

The agency has this organized. Now you do too.

— General Surgery MD

Verify the Premise Before You Buy

Call three locum agencies and ask what their bill rate is for general surgery. Write down how many give you a number.

That is the problem this PDF solves.

The Research Behind It

The economic analysis in this toolkit is grounded in Nobel Prize-winning research:

• Akerlof (1970, Nobel 2001): In markets where one side has better information, the uninformed party is systematically underpriced, not because they're naive, but because the market is structured that way.
• Spence (1973, Nobel 2001): Credentials only move your rate when the agency prices them. This toolkit shows you how to make that happen.
• Nash (1950, Nobel 1994): The fair split in any negotiation assumes equal information and equal skill. Neither assumption holds on a recruiter call.

The negotiation psychology section cites 17 peer-reviewed sources. This is not a blog post formatted as a PDF.

What It Costs in Context

• Consulting an attorney to review your locum contract: $350–$500/hr.
• Hiring a negotiation consultant: $3,000–$5,000.
• This toolkit: $99. One successful negotiation adds $10,000+ annually.

One Honest Limitation

This will not help you if you are already negotiating above the 75th percentile for your specialty and state. If you don't know what percentile your current rate is, that is the problem this solves.

About the Data

Sourced from BLS OEWS public data and CMS geographic adjustment factors, processed through a locum-adjusted model. Not derived from agency-reported data.