The Obstetrics & Gynecology Rate & Negotiation Toolkit

What's Inside

Not "a PDF." Six specific tools:

1. Rate Benchmark Database

   OB/GYN rates by state and setting — urban hospital and rural/critical access — at the 25th, 50th, 75th, and 90th percentile. Fifty states. Includes MFM subspecialty premium data and 24-hour call rate ranges.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The malpractice tail negotiation script — how to make tail coverage a rate equivalency, not an afterthought
   • The rural L&D script for solo obstetric coverage assignments
   • The MFM premium script for tertiary and academic center placements
   • The 24-hour call structure script — how to separate call coverage from base hourly negotiation
   • The renewal script when they try to roll your old rate forward
3. OB/GYN Leverage Points

   The specific OB/GYN credentials and coverage capabilities that justify a higher rate:

   • MFM subspecialty commands 44% above the general OB rate at tertiary and academic centers — market range $326–354/hr — this premium is consistent but not priced automatically
   • Malpractice tail coverage ($50,000–240,000) is the most critical contract clause in any OB/GYN locum agreement; confirming tail before discussing schedule is not a secondary point, it is the first one
   • Solo L&D coverage at rural CAH facilities is the highest-leverage assignment profile in this specialty — these facilities have no alternative and will meet your rate more often than they decline it
   • The highest rural OB demand is in North Dakota (73% of counties are maternity deserts), Oklahoma (63%), and West Virginia (62%) — assignments in these states command rates at or above the regional P75
4. Contract Red Flag Checklist

   On-call obligation structure, C-section volume and comfort expectations, malpractice tail inclusion and policy limits, scope of gynecologic surgery, and coverage for high-risk deliveries. OB/GYN tail coverage is the single most expensive contract clause in the specialty. One page, annotated.

5. Agency Markup Framework

   Combined OB and gynecologic surgical coverage in one provider eliminates the need for two placements. That value is negotiable. Most agencies don't volunteer to price it for you.

6. Locum Tax Framework

   The 1099 math: S-corp threshold, Solo 401(k) gap, tail insurance as a pre-tax deduction, and the effective net rate after malpractice costs in the states that pay best.

What It Looks Like on the Call

When a recruiter quotes $225/hr for a rural South L&D assignment, this is the sentence from Section 2:

"The rural OB/GYN median for the South is $248/hr. For solo L&D coverage I'd expect to be in the $275–295 range, with tail coverage confirmed in writing before the assignment start date. Is there flexibility to get there, and who's providing the tail?"

Ask about the tail before anything else. 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.

I started with surgery. 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 OB/GYN. Write down how many give you a number. Then ask whether the tail is included.

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. For OB/GYN, that review should specifically cover tail coverage.
• Hiring a negotiation consultant: $3,000–$5,000.
• This toolkit: $99. The tail clause alone is worth more than the price.

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.