Locum CRNA

Feeling Adventurous

Listen up! This is the time to really consider your future and consider starting your business. If you are looking for something in addition to anesthesia or even entertaining a business in anesthesia, this is the time. You all probably know that I am starting a laundromat, and some rental properties. I am always looking to how I can further develop and grow business in the Locum world and outside of it. I use locum anesthesia in order to have these investments. This is, however, the first time I have had to take a business loan. I thought for sure I would be raked over the coals. The contractors for the rehab are making an extensive penny or two from me. I’m still using them because of their reputation and that I know the job will get done. This is sometimes how it works in anesthesia as well. If you have a good reputation and have worked with people before, it bodes well that even with an increased rate, that you will be called over another person. It doesn’t always work that way, but you have a better chance.

I really wasn’t going to write a lot about locums except to say that you can utilize this lifestyle in order to make your entrepreneurial side hustle a real life adventure. I had no idea how I was or … if I was going to get the loans to make this Laundromat work! Here is what has happened so far. I had bids from a great contractor but it would be may before they finished. I had a bid from someone that was not exceptionally or commercially adept, and finally the bid I ultimately took which was based on recommendation and experience in commercial development. I also had the laundry equipment person out to help in design, layout, function, setup of equipment and then the company designed the necessary templates for the construction crews. I talked to a bank which was willing to help but wanted me to be in person and in place all the time so after weeks and weeks I made a switch to another bank. This banker has been awesome. He was proactive in getting the city and state co-loans processed and ultimately approval for all the rehab. The laundry equipment was fully financed by the equipment maker.

I had expected the personal guarantees as I just don’t have millions in assets and it was 100% financed. That said, I expected high interest rates and was thinking that I would be up the creek and paying for it. This is the time to get a mortgage, a business loan or go for a dream. I think it will be harder as time goes forward in the coming years and interest rates are increasing.

This business is less than $2500/month to make an amazing attempt. Yes, there are incidentals, insurance, bills, utilities and the like that will cause some creep but those are operational expenses. Did you think you could have a business with upside potential at $2500/month?

OK, if you don’t want to take on a risk like this. I completely understand. That is where your multi-level marketing companies come in.. Don’t like that?? Then consider your on-line businesses or the many opportunities for growth within anesthesia. You have to take a leap. Listen to the goals Youtube presentation again and make your audacious goals. You can do this!

Are you thinking gees I couldn’t take that risk? It’s not far off from Locum Anesthesia. One day you can have a contract at $160/hour then have a $120/hour assignment. Things change and some day you’ll look for when you can take that vacation and realize that no work = no pay and that you wish you had even a $100 coming in from some investment.

Just a couple thoughts as we are still in the new year…. but tomorrow is Feb 1 and the year will be flying by! Learn, grow, and stay on the journey. You CAN do this!

January 2019 update

I haven’t been writing or “vlog” -ing lately.  I think it’s important to occasionally update you on the site.  Where we are and are headed can help you see the new information and point to available resources.  

we had a conversation with Bonnie about her career as a locum CRNA via Skype which was transferred to YouTube.  She comes across quiet due to recording via Skype.  In the future we’ll go back to zoom as it records better. I had a couple other recordings but CRNAs decided they would prefer not to post.  Conversations don’t have to be 45 minutes or longer!  Even a recorded question or two would be great, if you want to post for the benefit of the group!  

We are adding to the CRNAandSRNA.com site many of the resources that are part of the LocumCRNA.com site.  The Amazon Store has added books and common travel needs for CRNAs.   

We added a financial advisor with MassMutual who was at the VANA conference and have asked about some guest posts for our blog.   

On the CRNAandSRNA.com site we added CRNA owned companies that are not just CEU or recruiting agencies.  Recruiters can post on the job board that is relatively new on both sites and CEU companies (all CRNA owned) have there own static page always available to you!   

Needs:

I need people willing to discuss on the YouTube channel.  

I need to update the CEU listing for current programs. 

i need to finish all state boards of nursing and CRNA licensure requirements, all state boards are linked to their respective website but I haven’t completed listing their individual requirements.   

I’d love to get more of the CRNA owned companies on the website and maybe list by state.  I think many would be reps like R&F and I think if that’s the case we can put a primary post for the company then each individual that sells.... I can’t have 100 R&F companies as many would quit looking after one scroll.   

I, also, would love to get more information on helpful static pages.  I am going to work on one for student loans as this is always a re-post on the sites, otherwise I need to know what would be most helpful for you?  

Thats your update for January 2019!  Email me at LocumCRNAs@gmail.com if you have suggestions or want to help-out! 

 

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

Walking into a new environment

I’m just about to walk into week 3.  It’s amazing to find a new place to work.  Each new place has its’ nuances and differences.  

I find that each place has a few people that are challenging to work with that challenge the way in which we are used to working.  This comes full circle into relationship building.  Most of the time I do awesome at saying “this is what I’d like to do and this is why”.  For the first time ever (as I recall) I found someone that didn’t respond to that and has been a bit difficult to work with.  However, I have tried to maintain a high road and be respectful.  I try to daily go in positive on the day and the work that has to get done.  With each case and with each good day I feel the rest of the group becoming more relaxed in understanding that I bring some ability to the practice.  

I take every opportunity to tell the person running the board I’m available and ready to work.  I come in a little early and set-up my room.  I have my coffee early and don’t assume I’ll get out right away for a break in order to get coffee or breakfast.  I try to be available and flexible in order to get the work done so others can go home.  I don’t ask to get out early assume that I’ll be afforded the same opportunity to either go home or take a break.  Most places I go to seem to want to test any new CRNA in case types, personality, proficiency, & the willingness to do within the group.   

This all comes down to relationship building and interpersonal communication as much as it is about CRNA skills.  A place can usually work with someone that needs a skill or a case set more than they can teach flexibility and good attitude.  So, continue to grow in personal development as much as your CRNA development as you continue your journey.  

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

 

 

 

Change is inevitable

It’s Thursday and I’m in my last two days of Massachusetts. This is what I’m doing.  I’ve confirmed my credentials for Texas and started the credentialing in Virginia. Virginia is a different group as the previous took 8 months and came back with telling me I would have to resubmit everything and starting over.  I’ll never deal with a group that does that again.  

So, I’m preparing my luggage and work bags.  I’m making sure copies of hotel bills are sent to the agency.  I’m making sure the final hourly bill is sent tomorrow after work.  I’m slowly packing and getting things ready to go.  I’ll be doing homework the next two nights so more time can be spent with family when I get home.   

I sent in my foreign corporation documents by fax and mail to Texas.  This took 4 minutes from searching the foreign corporation and Texas Secretary of State.   

Min the meantime I’ve been in contact with my accountant.  Talking about the change of location.   

I’ve tracked my route to Texas and planned the day of start in Texas so that all is ready and done for a good and quick start.  I have a badge and person that I’m meeting.  Hotel is set and ready to go.  Seems all I need to do is show up and get started. 

Otherwise we are working on the real estate.  We are offering currently on another potential rental, but we are only getting it if it’s at a deal level. The market is turning again to a buyer level in some environments like where I invest, YouTube for Francisco (growing and getting ready to monetize with ads), and getting Elizabeth set for schools and bank accounts (preparing to pay her annually for work). We are finally hunting for what may be our November vacation as we haven’t done a just Francisco and I vacation in a year or two ;).  The journey continues.   

 

Leveraging Relationships

  you relationship building and keeping up with your previous facilities, colleagues, and friends?  Are you taking opportunity to go to state level CRNA meetings for continuing education?  

Everyday facilities are looking at the cost of anesthesia and if they can keep expenses low.  Groups are turning over, people go on vacation or maternity/sick leave, & independent practitioners are looking for quality people that don’t want their job but can come in and help.   

Update your resume and keep people aware of your ability to help them given your scheduling.  Keep your files up to date so your credentialing would be easy.  Keep some of you appointments at facilities you might like the opportunity to return to.   

Maintain quality interactions and keep your social media up to date and appropriate so that people know your personal and business life are together.