CRNA education

Investments without large fees

Investing is not one of our best endeavors and many just don’t take the time to learn. With only a few minutes left in the year, here is some information you might not want to miss.  

I was just listening to the ChooseFI podcast and found out a few things to pass along.  First, I recommend listening to them as you journey through life whether you are planning to retire early or not.  

HSAs or Health Savings accounts for any high deductible insurance plan that is define as 1350 for an individual or 2700 for a family.   You can put away 3450 individual or 6900 for a family in an HSA TAX FREE.   Any medical expenses can be taken out TAX FREE at any time / any year!  This of course means you have to keep your receipts for your accountant for years.  After age 65, it acts like a traditional IRA or can be used for medical expenses later in life.  If your plan started dec 1 you could find the entire amount.  Fidelity now has a zero fee HSA management account (funds or investments places in the account may have some fees).  

This is way different than an FSA as those funds don’t fully roll-over year to year.   these funds are for your yearly medical expenses and are typically use or lose.

We are typically interested in low fees and trying to keep our income in our pockets.  Mutual fund investments are just about the most common across the nation and ChooseFI often touts the Vanguard total stock index fund or VTSAX which had a hefty $10k minimum which has now changed to a $3k minimum for getting started.  This opens the fund up to those who are wanting to get started investing at one of the lowest fee mutual funds on the market at an annual fee of just 0.04%! 

Some of you may know these things but the mutual fund information is pretty new.  If you are thinking of setting up the Solo401k it has to be done and funded by the end of the year and if you are looking at a sep IRA it must be done and funded by April 15.   

It’s time to get your investment on! 

LocumCRNA.com and a new investing page?

I’m thinking it might be interesting to go through investments?  We work hard and make a decent income. What do we do with that income, or how do we invest and protect our investments? 

I’m thinking about using my continuous growth in showing what I have been up to on the investment space.  I can show the websites and what I’m working on in that space.  I can go through real estate holdings and what that looks like.  Not to forget sep IRA V’s Solo 401k and stock market investments.  Then businesses and the different types of investments that I look at and consider. 

I wonder if this is something you would want as a page as it only somewhat relates to our site because locums is the way I finance life and the investments?  

Credentialing, A Recruiter Perspective

I asked questions of an agency for their views on credentialing.

Credentialing is a beast and can cause major headaches for the CRNA as well as the recruiter.  I’m taking time to ask a recruiter some big questions.  

What is internal credentialing and how does it vary from the facility credentialing?

 --Often times there is internal credentialing for the agency which just looks to make sure all items are up to date and in hand for presenting an Anesthetist to a facility. A cursory look that all information is up to date and filled in is just the start.  

The credentialing packet that is recommended by LocumCRNA.com at https://www.locumcrna.com/credentialing/is a great start and the FREE CV template available at the bottom of https://www.locumcrna.com/store/are a great set of tools to provide a recruiter.  

It’s highly recommended to put all documents in a folder on your laptop or iPad so it can easily be sent to a recruiter or hospital administrator.  For example Dropbox is one place.  

Is there a credentialing packet for the hospital too?  

--Yes, some agencies will have someone to pre-fill data for you and others will send you the packet and have you fill out the packet with an overnight return envelope.  The faster and more complete the information the more likely all will be submitted and done on-time!  

Does TIVA pre-fill in data?

--Yes, our credentialing team will pre-fill our internal on-line app as well as any hospital applications.  Some facilities have a pre-app as well as a hospital application.

How long does internal credentialing take and what is the estimated time for most Sheridan facilities to finish credentialing?

-- Internal credentialing with TIVA is about 2 weeks and the facilities range from 45 days to 90 days from the time the hospital application is back to the MSO. 

 Does a group ever tell a credentialing department how long they have to approve or deny credentialing? 

--The group does not dictate the time to credential; that comes from the Medical Staff Office and the hospital by-laws.  Having everything together and in with the first submission will make it significantly easier for everyone. 

 

Robert Moore – Senior Recruiting Consultant/Key Contributor

Ads now on the job board at LocumCRNA.com

Office 954-939-7010

Cell 954-232-5323

Robert.Moore@tivahealthcare.com

www.tivahealthcare.com

 

Another 6 Great Reasons to be a Locum CRNA

6 Great Reasons I love being a locum nurse anesthetist. CRNAs work hard and locum CRNAs go location to location to provide much needed respite to CRNAs and groups across the US. Be sure to follow-us and subscribe to our YouTube channel as well at https://www.youtube.com/channel/UCosn5QjtJBZt_g2Mbu12Szg

Researching your next Locum CRNA Position

Everyone has a different strategy for researching a Locum position and what they want in a position so this is going to be variable and be flexible.  

Most people know that for the most part I use a recruiter to do Locum positions however this long-term assignment just came by word of mouth.  I say that because however you go about finding your Locum positions you need to let people know what you are looking for.  If you call a recruiter and say that you want a very specific type of place it may be challenging but if you say that you are looking in a wide area or with-in several states or locations that typically have some needs you are more likely to get feedback. Likewise, having a cover-letter that states your typical set of cases or specialties you might be well qualified for and what you are looking for in a position it may be significantly helpful when trying to be placed or knowing if you are a good fit for a position.  

If you independently contract I would think it just as important if not more to be able to send a CV and cover letter that explains a little of your background and your wide variety of cases.  When dealing with solo and CRNA only places make sure you highlight independent situations or practice.  Side-note, ask a surgeon you work with either independently or 90% independently to write a letter of reference so that not all your references are CRNAs or friends.  

Highlight your flexibility and also provide awareness of any dates that are non-negotiable and must be off (family vacation).  I don't feel you need to explain why.  Just the dates you need off as upfront as possible.  

When talking to a facility ask about case types, variety, cases you would be expected to do and also tell them if you do things like: Pediatrics, OB, Neuro, Traums, Hearts, Transplant and Vascular.  Sometimes, your experiences might outweigh another applicant for a position.  These can also be a method to command a higher pay structure as not all CRNAs have this experience. 

I ask questions about the type of city, size, accommodations, expectations, call, pay differentials, length of contract and escape clauses.  I ask if anyone has been there before and if they would ask one of the people having been there to call me so I have a good idea what I'm in for.  How often will I be paid and by whom?  I ask them to never put my pay on my timesheet.  I do not want my information to be a source of contention with staff or other locums.  

I ask what type of environment they use, CRNA only, Solo CRNA, Anesthesia Care team as medical direction or supervision. Each of these are not like the other.  Solo CRNA should likely come after CRNA only group, CRNA only group might come after a few years of anesthesia care team (ACT).  Each type of practice requires a base of experience and a base level of ability to discuss on a collegial and appropriate level with either anesthesia providers or surgeons and each requires a strength of practice that grows with experience.  I have worked in each of these environments as a Locum and some as a w-2 employee.  Each will need a different level of care and attention.  Each will likely come with differing roles and responsibilities, and experience.  For example: I would not take a solo position if I was not routinely comfortable with lines, big and small cases along the age spectrum and being able to discuss with ICU/ER/Surgeons and other attendings that are non-anesthesia providers.  

Each place also takes some breaking in period where the providers will assess your comfort level as well as getting to know your practice.  Some ACT environments have Anesthesiologists that think they have to push drugs they didn't draw up.  This is typically a control struggle and I don't try to engage that other than to say something like.  I was planning to just give Xmg of Propofol because you know this patient has XYZ diagnosis.  That way I get what I want without just addressing the drugs.  I try to always address in such a way to say "this is what I want to do and this is why I want to do it".  This shows thought and gives them the rationale ... if they go against it, I chart drugs per Dr. so and so.  They may be on the chart but something I do not agree with will be charted as done per them and they can fight it if they want.  I do agree that their name is on the chart and the care is shared but if you do something they don't agree with or that causes harm they'll say you were physically with the patient and it's your license.  Please be careful.  I have only once had to tell a doctor that I did not agree blatantly and this still causes a negative dynamic.  I would try my best not to blatantly disregard a discussion if it is not going to cause harm.  Most of the time I respond with this is what I would do and this is why, and almost always they take the discussion or will say that they were thinking XYZ and say why.  Then it's a collegial discussion and a plan can be made.  

Just my thoughts for the day.  Please see the YouTube channel under videos and subscribe for future information as I continue both written and video content.  Sometimes it will be similar and likely, most of the time, be completely different.  

Here to help you in the journey as a Locum CRNA, business, communication, and more.  

 

Should Locum Professionals be a 1099 Contractor or W-2 Employee 

I've been approached by several W-2 and 1099 Locum CRNAs and many ask what the difference is.  Tom is a wealth of information and his podcast and professional speaking on these topics are highly applicable to our business.  Now for Tom's article for LocumCRNA.com!  Thank you, Tom!

By Tom Wheelwright

Life as a traveling medical professional can be costly if you don’t have the right tax strategy. Locum Professionals, who temporarily take over when others are sick, unavailable or out on maternity leave, tend to be set up as a 1099 contractor. For all Locum Nurses and Physicians, it’s especially important to understand the differences between being taxed a 1099 independent contractor versus a W-2 employee to keep more money in your pockets.

1099 vs W-2

Generally, tax reduction opportunities are much greater with 1099 income versus W-2 income. However, if you're not careful, the 1099 income can be taxed even higher than the W-2 income. 
Traveling physicians should do all they can to make sure they are independent contractors (1099) due to the much greater tax benefits of owning a business (1099) versus being an employee (W-2). For 1099 contractors, travel is 100 percent tax-deductible if you spend more than 50 percent of your day four-plus hours - working while you’re on the road.

New Tax Law Impacts

With the new Tax Cuts and Jobs Act of 2017, this tax question is even more important. After reading the entire new tax plan of over 1,000 pages three times, there are important things to note.  

If you’re set up as sole proprietor or S Corp, you may be able to take a 20% deduction on the net income from your business. Professional service companies, like doctors, lawyers and accountants (though not engineers or architects), business will only get the full 20% deduction if their taxable income is less than $157,500 ($315,000 on a joint return).

Bottom line, a good tax strategy for 1099 or W-2 income should always be developed with a great Tax Advisor to ensure long-term and permanent tax reductions. 

And for more information about the new tax plan impacts, read our newly released Tax-Free Wealth2ndEdition (August 2018).

About The Author: Tom Wheelwright is a Best-Selling Author (Tax-Free Wealth 2ndEdition, 2018), CPA and CEO of WealthAbility, which assists small businesses and entrepreneurs with tax and wealth strategies, and Host of The WealthAbility Show with Tom Wheelwright CPA Podcast. http://wealthability.com

LINK To Tom Wheelwright’s new 2018 book

https://wealthability.com/tfwamazon

 

 

 

Flexibility with Travel, Work, & Vacations

The flexibility & vacation time in working locums drew me in and kept me as a locum nurse Anesthetist.  

Work flexibility with a few facilities around the country has allowed the opportunities to do more with my time. 

Recently, my family visited Costa Rica and extended family!  I was able to speak and although I was a little excited, nervous, & even got a little lost in speaking; it was great to see other CRNAs and have them meet the family.   

We moved to Virginia for surrogacy and failed our first attempts.  It was a true and sad failure but due to locums I’ve been able to pay down the debt that occurred for this attempt.   

We’re paying down our debt load and continued to build the real estate venture over the past 6 months.  It’s been amazing to follow a move and family changes over the past 6 months.  I’ve been able to build on relationships and although working a lot... we are still well on our way to continued financial success in our lives.  Although, I know it’s possible to do this in one location with one job, it’s getting done on a condensed schedule.   

Life, flexibility and continue strong work ethic are leading to change as I continue all the things that are important in our family life.   

Finally, school is just about to finish the first 10 week term toward the MBA.  Nothing game-changing but working on a business mindset continues to be a fun opportunity for change despite my whining and complaining :).   

Totally looking forward to the coming weeks and months!  More to come. 

Why?

Multi-Level companies ask the important question that isn't always looked at from a job perspective or from a daily perspective.  I had someone ask me in passing what is the end point.  What is the goal and why are you doing what you are doing?  Not asking why I was a nurse but why I traveled and was spending time away from the family.  

I didn't feel like chatting.  I said so I can retire in 5 years.  So I can work less and spend time with the family.  I either compress the work down by working more hours, get a raise, or I live in a way that I don't desire.  This is why I do locums in big hospitals.  I get a large number of hours and call.  I have worked with these companies before and they know how I work.  I get paid pretty well.  This way I earn more than is spent... most of the time.  

Surrogacy and family building have been a focus of ours.  This has increased the debt load and thus I'm working away from home for a period of time to cover those bills so that credit card interest doesn't really cost what apps like Credit Karma would say it'll take to pay off debt.  

I'm also working on Taxes as I spent the money that came in and little things added up.  I don't recommend getting in as deep as I did.  It's a difficult hole to claw out of.  Every interaction and purchase needs to have a why.  To what end is this thing going to be of benefit.  What will this do in the coming days, weeks, months, or years.  So, I'm asking myself, as things come up, "why"?  

It turns out a year ago I would have sat down and bought a new laptop "for school" when my excel version didn't have what I needed and the computer was somewhat slow.  Today, I bought office but not the recurring monthly billing and not a new computer to go with it.  I dind't save 2000$ but at least I didn't spend it.  

My goal is to be working 1-2 days a week by the time Elizabeth is 5 years old and living about the standard of living we are currently living.  It's a challenge... especially when that is 3.5 years away. That means developing our spending in the right ways.  That means developing our business in the right ways.  That means finding my why for each thing I do.  

People wonder about the going back to school piece.  I happen to question myself a lot at the moment as I'm doing my most disliked statistics and algebraic equations course.  I love business and simple math.  I don't like big math.  I think I should be able to use a spreadsheet and be able to do basic math skills that most calculators can do.  Beyond those things.... there are applications and computers to help compute what might be needed.  I know someday I'll tell Elizabeth she just has to do it to advance to the information she needs to learn... so I'll tell myself the same.  But, school is costly right?  In this case I have the GI Bill and it wasn't transferrable.  It was to the time of use it or lose it.  This will allow a free education and allow extra minimal income toward bills.  It's a time loss though.  Sometimes, I wonder how I can fit it in.  I study and keep thinking I'll learn something that I can use in the future.  

Why is definitely a hard question when I have to answer why I'm away from my family. Why I'm working 60+ hour weeks.  Why is because we enjoyed life for years and now it's time to be ready for Elizabeth to have her time.  I want to be there for her school events, her trips, and her development.  We want another child in our family so that is part of why I'll continue this pace until all is done and paid for.  Then it's time to settle into life and have things set on auto for a while.  Work with a little family balance.  Tip the scales to the side of enjoyment. Bikes, hikes, and family time.  

So, Why are you thinking locum work?  Why are you afraid to travel?  Why are you doing what you are?  It's definitely worth finding your Why and what is the end point of it?

The busy locum

Another busy week looms in the balance on this Sunday evening.  I am well on my way to paying down the bills as we spoke on in weeks passed.  My Sep IRA through e-trade was set-up and funded.  I’ve traded in the truck for a small SUV that now is less than half the payment and has a better APR with half the balance I was paying.  I’ve also paid off 20k in credit cards.  I still have a long way to go and am paying my dear old Uncle Sam dearly with every paycheck so I can get in the good graces.

Today, I worked at the hospital ... from pediatric code to sepsis and multiple cases in-between it’s been a crazy day.  I was able to get back to my hotel in time to spend some time on homework.  My math class work for the week is complete and now it’s on to business analysis with its’ primary focus being communication this week.  The MBA program is challenging my time management and my brain in ways that I haven’t managed in a while.   

This week is a 60+ hour week and call for the entire next weekend.  I keep my focus on the benefits I see in the long-term as right now I sacrifice time with the family to get us ahead. We are seeking some freedom from the absolute need to work for thought of if things went sideways “what would I do if...” scenarios.   

I’d say in just a few weeks I’ve learned a good amount on every level and look forward to the coming weeks in engaging with colleagues, growing businesses, learning in the structured university education, and then managing life around the critical elements.  

This weekend I spent time on the farm with my favorite veterinarians and did c-sections for sheep.  What an amazing opportunity and so glad I spent a little time with family.   

What an amazing life we lead.  Now it’s off to laundry.  Feel free to e-mail me anytime locumCRNAs@gmail.com

Depressed?

I had someway say that I sounded down.  I’m so sorry, I didn’t mean to give a negative impression.  I’m excited 99% of the time.  I stress out now that I’m truly focusing on radical family development.  This involves the adoption or surrogate portion of our lives that will be the coming together of our family.  I am focusing on the bills and trying to get us away from paying interest to companies.  I don’t like the amount in interest I pay.  The focus is the revolving debt but I’m working on making my fixed debts lower as well.  

I enjoy the rentals and I hope to have many able-bodied years to continue the rentals as they are a source of income and throw off 20+% per annum.  There are times I get stressed and it’s usually a mix of buying and working on the houses.  Not with tenant issues.  I could care less if someone moves out and it sits for 3 months until the next moves in ... because I want to be particular in screening and ensuring good tenants will take care of things and pay rent.  I have the luxury of doing this now but in 5 years I may hire a property management group so family doesn’t need to manage but.. that’s a we’ll see thing. 

i start my mba program on Monday.  I have the post 9/11 GI bill for 3 years and am psyched!  It’s free education and housing allowance while I work full time.  I’d have to say that is amazing!  I’m going to see about the reserves and if I can do that in several months but I’m not sure about my history and the ability... but it’s in the back of my brain.  It may be a way we can work less and still get some long term benefits.  there is sooo much I don’t know or understand on the reserves.

i go back to Massachusetts today and I love the people but it’s so hard to leave Elizabeth and Francisco at home.  It’s better for them and stability or I’d just have them go up.  It’ll be something like 5 weeks.  I am pretty sure I’ll miss the first word unless the occasional hi sound counts like a word but it’s not completely intentional.  Elizabeth is so animated and talks to us despite no comprehensible speech yet. I love FaceTime, pictures and video.... I don’t feel I’m missing things and when I’m home... I’m with them as much as humanly possible.  I’m there for the melt-downs, when she just wakes up and is soooo cute and happy.  I’m here to take care of bills, office things, management of the home and supporting every person in the family in ways they need.   

So ... I’m happy, I’ve made my choices that will support my intermediate goals and mission so that we are happier and together more.   

Now I must get the last minute packing done.  We are off to the airport in no less than 2 hours.