Anesthesia 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?  

Happy mother’s day

Today is mother’s day and I must say mine has always pushed me to do better.  It doesn’t matter just how much I put in as far as effort, education, level of understanding or time... Mom has always been there pushing my boundaries to improve.  

I think that is missing in today’s generations and I’m hoping I can instill these values into Elizabeth’s core as she grows.  Not to instill negative worth of perception of never quite being good enough.  That isn’t the intent at all.  I see the amount of knowledge, work, time devoted to projects, continuous education, and effort that is put into every aspect of life.  I think the realization is that there is always someone that can do something differently or better in the results column.  I find an appreciation for the neighbor that has the most gorgeous lawn where mine is lucky to be mowed and have a few less weeds than a few other neighbors.  I think each of us have areas where our practice is not as strong as other.  In this area I hope that each of us would take time to learn and grow.  

Likewise, in this community of locums, business minded professionals and those that aren’t are all coming together and we can all learn.  I think our practice, our business skills, negotiation, and our personal lives have to be continually improved upon.   This is all-encompassing and is why you read so much on my personal life.  You read about my finances and how I’m making strides to have this burden significantly reduced by optimizing business, education, and leveraging my hours of work.  You see Francisco and I consider adoption as we want to build a family and seek opportunities to enrich Elizabeth’s life.  You see my real estate and investing strategies that will one day allow for a more diversified risk and likelihood of retirement or at least significantly reduced need for specific hours= specific dollars.  You read about family, conversations, my continued education, insurance and multiple facets as we continue down the road of life.  My hope is that people gain knowledge of life as a locum but also take from the stories the opportunity to enrich other aspects of their lives from family time to vacations. 

I’m continuing my journey by the FI principles of being just 1% better each time and way I can.  I hope it comes through to all out there.   

Downsizing or right-sizing

Finances, they are a booger.   Seriously there is no “perfect” way to do anything... if there was we would all be perfect together.  

My car loan... not killing me.  I owe 39k still on my truck.  You know I went into Carnac and they offered 46k and I walked away from that.  The dealership offered 50k which is slightly more reasonable as a trade meaning I have 11k in equity.  Somewhat negative as it’s not exactly equity.  I see dealerships and car people as not exactly liars and cheats but not exactly honest.  Makes it really hard to downsize to something safe, all weather and long lasting once paid off.  Sooo we’ll down size to a 15k loan that I’ll pay on over a shorter time frame and reduce credit card debt by the difference.  So, it’s not perfect... it’s still a new vs used car.  But it’s 2017,  7k below sticker price and has my one requirement of navigation system.   

This is about the time I’ll be bashed by people for not going used or getting a tiny car, lower gas mileage, the base of the base of the base car. Yup, I’m still not perfect.  I looked at these cars.  I spent time contemplating and looking at the amounts the dealerships each offered on different cars and the difference between their quality.  I’ve liked several cars and love the tiny “throw-away” cars that are so small and get you from point A to B. I see Francisco liking the small car and taking our daughter in it more often ... I see an accident that could happen and the very small impact that would total the car.   I can’t buy something I fear a smallish accident would take out my family.  So, I make concessions on not needing the tank I have but I’m not looking for a soapbox derby car.  

I paid off the high interest credit card and now will have decreased my car debt by more than 50% and haven’t lost any quality of life.  I’m going to call this a win for my week off.   

I also received a quote on mowing my lawn... it’s slightly tiny postage stamp... takes less than 20 minutes... they quoted $50 every 2 weeks... I sent them away immediately.  I guess Francisco and EE will be mowing the yard in the coming weeks.  

Thats it for tonight!  Sunday it’s back to Massachusetts and getting ready for awesome!  5 weeks will be soooo long away from home but the end of it comes with a reunion of Francisco and EE seeing her abuelitos... (grandparents from Mexico). It’ll have been nearly 6 years for Francisco.  We’ll be looking for more economical options in the future.... but I’m happy all will enjoy such a beautiful time together.   

Love to all! 

Start getting involved

Today, I’m supposed to see one of my congressmen at MYA.  While I appreciate the attempt to make it easier for a non-political person such as myself to see our representatives I think it’s less likely to see dramatic changes when I’m going with the idea of three bullet points.  Not one has specific actions.  Not one has to do with the key function that opens the door to the full practice and autonomy that full billing rights does.   

I say this quite possibly out of naivety.  My idea is that if we can bill independently at 100% for all of our services then the right to work autonomously would be a natural progression.  

I see the ASA involved in so many layers of government and see our CRNAs in so few places.  Honestly,  the MYA was much more expensive than I expected and less well attended than I expected.  

I went to the Region 2 update and was impressed to hear about our reactivity to each of the bills in each state.  I heard of 1-5 bills presenting legislation in each state that would better AA, ASA or decrease CRNA practice.  IN EACH STATE!!! I didn’t hear that we presented bills, we sat on these committees and task force set-up by.   I heard the AANA did a first ever state leadership retreat to Vegas though.  Several were happy about this.   

I see that the Cultural Assessment is in full swing and I know people cried for this but the membership slid down a few more points this year.  I guess I don’t understand the cultural piece as this is a business and professional organization that should be fighting for CRNAs based not on culture, ideals, or in an unbiased opinion.  I think the political piece is a large part of what should be our organization but we don’t even raise 3 providers income among 50,000 CRNAs in any given year to work with.   

I offered to put a link on the page that would say to support the PAC and was told that it was illegal to do so.  I learned something new.   

I don’t know what is in our future but am quite aware that we need to do better as a professional organization and we all need to be more involved than we are.  Billing rights and autonomy of practice will be paramount principles for independent practice and advancing our profession.  As a locum that enjoys nearly all practice environments I think that this focus and becoming more involved in each states organization can only help us.  But, involvement means action, knowledge, and fricking membership for those that aren’t even a member of our professional organization.   

You have seen my financial information and I’m still a member of our AANA, donate to the PAC monthly, and despite my poor political affiliations I am here trying to learn and grow just to maintain or improve our profession in the future.  I am starting to get some of the knowledge beyond just being a provider, or clinical educator in the OR. 

Please take some time to go to the state meetings or national meetings and start getting involved in what we need to do for ourselves.  Consider a contribution to either the AANA which is tax deductible or to the PAC which is not.  Both advance us as a professional organization just in different ways.   

Just my 2 cents.  



it’s always interesting going new places.  I love it.  I have fun and treat people as if I’ve known them for years.  I have fun at work while getting the serious things done in a quick and efficient manner.  I believe that this relaxes the crew and the patient.  I always state that I’m not new to anesthesia but am new to the facility and why I’m going through the paperwork a little more. 

I expect to be checked on a little more or observed more closely if in a “Care team”  model.  CRNA group the same happens just because they don’t know me or what I do/don’t know.  It’s just how things go.  I also expect them to vary the assignments from big to little to tiny and see how they wish to utilize my skill-set... it’s a way of interviewing me.  They see if I complain or fumble or have issue with those that have the most awesome personality.  These things are part of the locum political environment. I generally say that I stay out of the politics by being a locum.  I should have been saying that I remain outside of the political arena that most ACT CRNAs are in.  It’s not that it doesn’t exist ... it’s just significantly less than full-time staff typically experience.  

I have some docs and CRNAs that try to teach me at times ... from how I should hold my Miller to doing a CVP fall whenever doing a central line.  I’m not above learning and I’ll simply nod or oblige if they want something simple that’ll re-assure them that my intervention is done safely and efficiently.   

I guess what I’m saying is that each place I go I expect a period of assessment in some way.  I expect to be thrown in to the mix quickly and handed around to the different personalities and surgeons.  I always listen too.  When I hear “oh, they put him there...” I know it’ll be an interesting day.  I think we, as locum providers, need to know whom the client is, how to handle interpersonal communications, and have to be more knowledgeable in a broader scope of practice than most institutions utilize.   

I think it takes about 4-6 weeks for a place to get used to a new provider whether it be locum or permanent... then 5-9 months to understand how a place operates and if they are a good provider fit.

These are just my thoughts on the day. 



I should have thought of that!  I should have known that but no one taught me! Whaaaa!

What are you doing to educate yourself?  What are you educating yourself on?  you notice it’s not about anyone else but you. It can be aslittle as a $20 audiobook.  You can do some college course. You can start calling your resources.  Call your accountant and ask questions as to what you can do to save on your taxes.  Call your financial person and ask what tax saving instruments can help you.  Have you taken care of your house first?   Are you continually educating yourself?  Listen to your growth and development books, podcast, and be on top of the news or what’s happening around our profession.  

Don’t tell me you never go to your state or national meetings and you can’t find any groups that are autonomous.  Don’t tell me you don’t understand business or negotiation  but never tried to learn.  Take on the task of learning... if you are broke, go to the library or sit at barnes and noble.  

Basically, it comes down to us continually improving our experience,business, communication, & finally staying current in our anesthesia practice. You don’t have to spend hundreds... Just start by taking in your resources and available information.  One point of view doesn’t mean you’re educated. So please, take in multiple points of view. Take on the importance of growing your person. 

Have an amazing day! 


Merry Christmas Eve, 

This means the Holidays are here!  You would not believe the trouble that surrounds this time of year.  Scheduling work is more challenging as most groups are not looking for summer vacation or the recruiters seem to know this time of year can be more challenging so pay can be less.  I see groups looking for just the holiday week coverage thinking 105 is great pay for that.  It’s sad that groups, recruiters, or CRNAs take advantage of other CRNAs by paying so little.  These rates have been the same since the early 2000s where R.N. travel rates have continued to climb steadily.   

I’ve seen many new CRNA owned companies coming out for CEUs, jobs, & other.  We are becoming more resourceful and entrepreneurial.  Just like going to a new group or workplace please do your diligence in knowing the people you are working with.  I’m going to be speaking for the first time with Education Adventures for CRNAs.  I have a one hour trial lecture with them in Costa Rica where I hope to talk on the pros and cons of locum anesthesia and what i believe some of the requisites, helpful qualities, and needs of the market are through my experiences in the past 7-8 years.  

Christmas can be a challenge for some and even for those that don’t “do” Christmas it’s a period that comes with down-time.  Less activity, less to do and work is minimal.  Look out for those that might have challenges, recent loss in the family, seem to be super happy but no plans.  Sit and chat or ask how they are doing.  Lend an ear or just be a happy person that’s there for them!   

I hope you have an amazing holiday season and from my family to yours.  Have an excellent holiday season and I’ll be chatting with you right here! 


Hello Hawaii

Here i am in Hawaii and I’m working on credentialing paperwork for the hospital and home loan paperwork for the mortgage.  It always seems i have to do some work on vacation.  I guess that’s part of being an adult these days.  

I try to be complete in getting things returned very quickly.  I told everyone that they should have paperwork done as I would be on vacation.  I figured I’d get some mortgage stuff as my brother is my broker and he is here... but credentialing for the hospital.  Canitant that I’ve done the agency/group/ and now hospital credential paperwork?  I know some hospitals third party credential... but why is it we can’t be centrally credentialed?   

I guess i can see how it would be negative because if you had any speed bump that would keep that group from credentialling and you’d be out of a job anywhere.  I just don’t see how we can get so many background checks?  Mine has been checked about every 6 months since i was 18. 

i hope i get in on that central credentialing agency! :). Granted it would likely be run by the nbcrna, aana, or nursys :) 

Lessons Learned

As a locum, one must remember the business is part of the game.  Speaking with groups, recruiters, doctors, & CRNAs is part of that.  I’m still learning but here’s what I know so far. 

Keeping doors open can be your best opportunity.   — don’t burn the bridges you traverse frequently.

Understanding the market in the areas your discussing can help you but you may not want to tell everyone that you know the market rates.

Until you have a signed contract you have nothing.  If you sign a contract ... honor it.

Be able to state things clearly but be flexible.

Knowing your abilities and being able to spin them in a good light will help you.

Negotiations for a long contract are possible but the company or group may want an interview just like being full time permanent staff.  

Never stop learning and keep your skillsets.  The skills that you have need to be tended and nurtured so as you continue your career keep your skills up.  If one place has a lot of one but none of the other... the next place should have what you are missing.  

Speaking of skills and education.  Review the CEU tab, State Meetings tab, and if you like us visit the Store for some small items we receive a small royalty on.


1099, 1099, 1099 And w2 just not the same

Here we have the classic problem of people stating that they are locum and they are not.  Wait, what do you mean I’m not locum?  Let’s look at some examples and define locum.  

Broadly defined a Locum CRNA is on that is in place of another CRNA.  This means that the individual is covering for a CRNA on vacation, sick leave, maternity leave, or the full time FTE has quit and they have not hired for that position.   This means we are covering for an exact and defined position.   

I’m 1099 and take a full time salary in one place with a contract for 42 weeks a year at one facility with the expectation that this contract is indefinite for years.  This is a 1099 provider that has a job.  Generally, speaking the IRS would frown on this and state that 1099 is not necessarily the best way to report your income and the employer could receive fines stating that you should be w2.  Under the definitions of 1099 the independent contractor chooses when he or she works, where, & determines the best way in which the job is to be performed.  This is technically true but if you look at past precedent you would also find that the IRS has asked for other 1099 to prove that the contractor is choosing contracts at more than one place and is not based in one long term should be w-2 job. 

im 1099 and I go to 4 hospitals in my area.  They pay me a different rate based on what they pay a daily worker and it’s higher than the w-2 rate.  I must be a locum right? Not exactly,  if you are staying in one area and u are filling in days you are very likely Per Diem.  Per Diem is Latin for daily. A per Diem individual can be used because the hospital or group doesn’t need a full time or specifically a part time person but a gap exist so a per Diem individual can come in a full the day.  This person typically has a w-2 job but wants to pick up a Day here or there.  Since they have a job they don’t need “benefits”. Thus they receive 1099 pay.  The problem is here that the individual has healthcare, PTO, disability, malpractice and retirement etc so doesn’t calculate or pay those out of 1099 pay.  The group may pay w-2 at 85$/hour and offer a 1099 person per Diem 105-110/hr.  Sounds awesome because we know every 5$ on a full time basis is $10,000 annually.  The problem is you didn’t calculate based on a locum calculation and you have undercut even your w-2 counterparts pay and become cheaper labor than even the regular full time folks.

I am a full-time 1099 traveling locum CRNA.  I have gone to long term hospitals and short term.  I filled in for the group that had a changeover of management. Then I filled in for a girl on maternity leave, and then I did vacation relief for a group over the summer.  This person only has 1099 income, goes to more than one location and may plan a couple months at a time or fills urgent short term needs in critical access facilities.  This person travels to wherever the need is.  We pick-up life wherever that need is for the duration of the need from 7 days to a month at a time.  This is rarely if ever shorter than a week.  We calculate our 1099 pay based on the necessity, cost of housing, food, gas, regional entertainment or lack there off, health disability and life insurance, time off needed in the year, and travel to and from assignments.  We factor in time away from family or if a spouse can’t work because we travel. Our rates should never undrcut a w-2 worker even the rate we work for from an agency.   Our rates shouldn’t be below $140 all inclusive per hour and should in areas of the country be as high as 180-200$/hR.  We have to be business astute and undestand taxes, business, retirement and finance.   

The W2 worker has a job that is not expected to leave.  They receive benefits and stability.  They accept a pay rate lower than all the 1099 positions as they don’t need to worry on taxes, retirement benefits, and vacation.  Most places cover malpractice and even disability insurance.  Because the group provides all this the pay is typically matched to the area and to the lowest denominator that will keep and retain a percentage of staff at the hospital and is generally calculable.   

These are literally just my thoughts and opinions on the description of each and are not intended to be all inclusive of every situation. 

If you are loving the site.... make sure you check all of it out.  If you want to support the cause there is a Support tab that has a sample contract and some things from Zazzle for sale that are CRNA specific :)