Mid Year Assembly

I am admittedly non political by nature.  It’s very different for me here at the mid-year assembly and I sometimes feel an almost uninvited vibe being here.  Maybe it’s not uninvited but almost disingenuous vibe.  That feeling of people meeting people to say they know them but no uniform familiarity.  I have to say I came here on a whim and not as a planned event to where I would meet with certain people or advance specific agendas.  I am excited that I have seen some people that I knew from years ago.   

I’ve seen some of the very active and vocal people in the profession and learned from the sessions despite my critiques.  I think we all have our roles and I’m still wondering where mine will be in the coming years.  Totally worth trying new things though.   

I feel like I’m trying to grow but I’m still at the kids table.   I look forward to my meetings over the next few days and will totally share with you some pictures of our trip in DC.  It’s a great time to be out and about and I know Francisco and Elizabeth are getting plenty of pictures while here :).

Talking to People

This is a social media site and so lets talk a little about speaking with people.  On-line, in-person, at work, or socially are all different social situations and yet your interactions are under scrutiny.  Did you know that people review what you do and say?  

Facebook, instagram, snap chat, and all the others are great social sites, right?  You get to keep in touch with everyone in one comment.  You get to post your amazing Friday night digs and afternoon off comments.  I know I'm not the first one to say these things but this is not just you and your friends.  Your words are out there on the web.  Your picture is available to anyone.  You partying it up and saying that you did what ever you did can be taken the wrong way.  I live my life as an open book for the most part.  I show pictures of my family and say my general day on-line a lot!  But, why is that ok or not.  People get to know me and they are not seeing parties, crazy life pictures, they are not seeing the worst or best things.  They see my average life.  I take a vacation to see family and enjoy a few days but they know I'm back to work on time and happy.  They know I'm working on my health.  They know I'm not sick all the time.  I'm not posting all the details of my contracts or the people I work with. 

I am sure groups, employers, and your fellow CRNAs are looking me up before I arrive.  Not because they want to get to know me but because they want to know what type of person is coming to work with them for 3 to 6 months.  They want to know if I'll be happy most of the time.  They want to know if I'm going to call in sick. They want to know if I'll complain about every little thing.  They want to know if I will work well with others at work.  

So, why is this important? I've heard this before!  OK, well it's pretty clear that people are not secure in any environment where there is more than one person.  If you choose social media as place to be, AWESOME. Just remember the more places you go and the more you speak or post or whatever.  Realize that an employer 5,10,15 years from now can find that post and either ask about it or just cancel you.  Many people say that it doesn't matter and are happy and content where they are.  Yup, you may be for 1 year, or even 4 years ... but then life happens and a change could come.  You never expected to move to mid-size town America and now you are applying to jobs or saying now I will be doing contracts for a little more flexibility.  You start sending things out and wonder... why is this difficult.  It's obvious there are needs.  You start to question what happened and when you go to an interview the Chief CRNA says "I took a flyer on you but your pictures looked like you go out more than you do anything else".  Then you say I haven't updated in over a year or two because life had changed and you became more private.  They don't know this... they only see what is available.   

Social Media and work.  Don't be that person.  The one that talks about your colleagues.  The one that takes offense to some comment and causes trouble.  Don't be the one sharing things that can be taken inappropriately.  If you wouldn't go to your family, parents, kids with it... well... think.

If you get time, Google yourself, your business, and things around you.  See what others see about you and the things you can improve for visual perception so you stand out in a good way.  I hope you totally see the implications of interaction on-line.  I hope it's an amazing weekend.  Comments or questions

Staying up to date

If anyone is like me and had to replace a credit card and that is how your membership is renewed on the AANA site.... check to make sure your Membership in-fact renewed.  Mine has yet to be renewed as that happened.  However, the E-mail says we have until October 31 so I'm trying to make sure I pay my dues right away and don't incur interest on the credit card.  

I hop you have been looking around on the website and been able to find pages like the state meetings, financial education, CEU, and even some of the job listings mentioned.  Not to mention seeing how to support us as we aren't charging for job posting, meetings, CEU companies as all are CRNA based and working constantly to improve the site!  

We'll be updating the mortgage and qualifying information as there is much more to learn on how things are affected by 1099 work.  

Insurance page is still coming soon as I continue to ask some of the top advisors for more information on how to best give more information.  

I continue to try and make this site for you.  if you have more questions... e-mail me at

New Additions

Hello to all!!!

I'm working on getting more information on Insurances from Canyon Clifton as a blog post and then more information to feature on a page with-in the website here.  This way the information is readily available.  

I'm also working on a blog post from Matt at Mortgage Lenders of America on 1099 Mortgage loans and recommendations.  This will also be added to the blog and a separate page for future reference.  

I'm going to be reaching out to tax preparers and financial advisors for their input as well.  

Please keep an eye out for any information you would like to see added so this website is best for you!  

Taking time

One of the things I truly forget about is... myself.  Taking care of myself, taking time for myself, and just taking time with family.  

I get so involved in the number of hours, case types, and thinking ahead to length of assignment/finances/bills/investments that I lose sight of self.  I forget the 70 hours of work and 40 hours of sleep is 110 hours in 5 days 5x24 120 doesn't leave a lot of time when you drive an hour a day.  Most weekends I am off which helps but notice I say most because I offer myself up to any days.   

So, as I mentioned I'm planning our family vacation to Hawaii to see my brother and sister-in-law.  This takes financial and self awareness.  You'll recall I'm 1099 which means paid vacation does not exist.  I have to make sure all standard bills will be paid while gone and that $$$ exist for hotel/AirBNB, tours, and the like.  

This week long vacay may only be a week but I've decided to do something that 50% of people say horrible things to me about and the other half... support.  I'm going to get my gastric sleeve.  Not because I can't just go on a diet and lose some weight.  It's because I can't get myself to completely change my habits.   Why?  When I diet I can rationalize that this workout or diet for three days means I can go with friends to X restaurant have drinks and dinner and enjoy... then the next day I just skip the workout because I'm tired and have a beer with dinner because man I worked so hard.  The wagon is broken.  I'm changing the ability to rationalize by saying my body has been altered and despite all things and what people say .. I'm limited in ability to fall.  Yes in 3 years if I want to screw things up... I can.  Have you changed everything for three years and decided to return to a life you didn't like?  My hope and goal is to do this drastic thing to myself to force a change in habit.  Right or wrong I'm doing this so I am around for this family.  I feel like if I don't I'll be that 40 year old in the ER with a heart attack.  I'm hoping at 37 this will allow me to physically change and reverse the negative effects on my health before they are permanent.   No it's not because I don't want to exercise.  In fact, I walked 6 miles today with elizabeth.  It's not because I hate healthy food.  I love it... too much.  It's portion re-training:  yup, I'll have to break the Diet Coke addiction too.  

That's two things I'm doing for me... but that's in November.  You can't just take a week every 3-6 months and feel fulfilled.  I think at least every couple weekends you need a little just for you or just for family time so you see the fruit of the labor.   

What do you do? 

New hospital day

Today I will go to another new hospital.  I'm meeting them at 6:30 in the lobby and I'm pretty sure it's a 7:30 start.  I've been up for 20 minutes and have a 45 minute drive... so here are my ten minute notes on today.   

I have an 8 hour day today so it's not so long and I know I'll make it through.   

When I drive into the parking lot I'll note the main entrance as that's where I'll meet another CRNA to give me the quick run-down.  Hospital systems are a little harder to just go in and 30 minutes later be in a room.  The "red-tape" isn't just paperwork and long credentialing.  These places require smart ID's to let you in and out, and sign-ins for multiple computers/programs/machines.  Even cases will typically be a couple starter cases to get used to equipment, paperwork, and get to know staff.  

Ok, well I hope your day is awesome... mine will start with a bit of a drive.  Thanks to podcasts at least I have the opportunity to learn a little as I go! :).  

a bit of my flexible plan in progress

My plan:
Regional Anesthesia Services LLC.
Fundamental delivery of anesthesia that is sound in practice and based on widely accepted care.
Provide care as a locum anesthetist in order to allow for an income stream that is higher than average W2 and allow for better than average tax savings.
Utilize a portion of the company to inform & educate CRNAs regarding locum anesthesia and allow them to support the site by referrals, site support tab for T-shirts or someday have enough traffic to the site for advertising revenue.
Personal finance:
I want to mention this as many of us are well paid but debt being what it is, it is easy to stay in-debt.  I have a spreadsheet that shows all debts and a planned pay-off date for getting out of debt.  Strategic use of debt for assets can be good but long-term high interest debt can be a real struggle.  Set a system in place that will keep the overall monthly debt decreasing and either increase income or decrease spending in order to decrease the overall debt burden monthly.
Retirement: despite debt and the fact that it's there many are more interested in retirement savings and depending on the rates of interest on debt ... retirement planning is very important and may be more beneficial than the quick pay-down of debt.  You really need a good financial planner and CPA to discuss this with.  This year will be my first year venturing into the dilemma of solo 401k v sep IRA.  My net taxable income was pretty low compared with gross income and therefor it appears that the solo401k may be a better option.  I also now have to think of our child and my husband.  Tax, financial, & retirement planning are a family ordeal and now they have to be taken into account.  Being able to save with the least post tax income, in most instances, is the goal.
Usually a necessary evil in the world. How much is enough?  How do you protect yourself without being taken advantage of and what is too much protection?
Health insurance... most agree you have to have this.  Some plan for if something catastrophic happens at the minimum.
But what else? This depends on where in life you are?  Are you fresh out of school and can't afford a week without a paycheck?  Do you have a cushion of expenses socked away in a semi liquid investment?
Short term and long term disability?  Do you need it?  Do you have to work to pay the bills?  If so, at least long term disability might be beneficial for you.  Can you take 3 months off and be ok?  If not, short term disability might be important.  Why am I not definitively stating?? I don't know your position.  I have other investments in real estate that are acting as my disability insurance and retirement savings.  They are not liquid and for a couple years it's been a big risk not having extra insurance. But the funds that would have been paid to insurance went into property that now keep me from the stress of what if someday.  It's still not even at bill paying level so I should technically have insurance for disability but if I had to cut back and sell things... I could live off the rentals.  Sooo, it's a start.  Things to think about concerning disability insurance.  Is it an "own profession" policy if not the insurance will say you can work as a Walmart greeter and you are not disabled.  This is a clause though that means the insurance will be more costly.  Also, please look at the overall payment amount should you have to use it.  Ask your CPA, but I think this amount is taxed as income.... sooo, is it really enough?  Many say it 30-40% of income but enough to pay the bills if I get injured (speaking about short term recoverable injury), what happens with permanent disability?  How long will it cover you and at what rate?  Does it change for inflation?
Life insurance:
So when I advise financial, tax and estate planning, I tend to tell people to be very acutely aware of those that try to place them in a whole life policy or an annuity.  These are insurance products that are high commission for the agent and have a lot of loopholes for the insurance company and some questionable benefit for the average individual.  Most advisors, planners, CPA and tax individuals that are not insurance sales people have recommended term life insurance.  Term allows lower premiums during the period of life where you are least likely to pass away.  This allows you to invest more for retirement, put dollars to work so that you may have your own estate plan that covers your final expenses when you die at 150 years of age and life insurance isn't needed.
Malpractice insurance:
First know your carrier and type.  Claims made V occurrence.  Do you have your own insurance?  Do you have a policy covered by your employer and have no idea?  If you have no idea... did you know that you could have been named in a malpractice suit and it settled without your knowledge or consent? This is one expense I don't go without.  This is very state specific and hospital/credentialing requirement specific.  Independent, 1099, county, state, and length/type of practice are generally taken into account when setting up a policy.  Any move or change requires a call to your insurance provider.

This is a part of the plan but it's getting long

Let's talk skill set.

A recent question was posed about skills and the fact that some of us get rusty or haven't done XYZ in a ... while.  What do you say? How do you talk about them?  Let's use pediatrics as the skill in question.

First, have you just not done any kiddos 0-18 in years and you want to start doing them again?? Maybe the case is you want nothing to do with kids but over 12 is ok?  Where does your comfort level sit?  

When you talk to agencies you should know they want to be realistic with where you are and where you are willing to go.  Are you willing to do pediatric cases but want a hand in the room until you are comfortable??? The first 5 - 10 cases or maybe you say I'm not comfortable and don't want to go a place I'll have to do pediatric hearts or solo pediatric ER intubations.  

This is all ok.  But, you have to realize each case type you can't do or won't do may limit your opportunities.  It totally may have zero effect.  My current hospital will put you where you are comfortable.  No blocks, heads, hearts, cvl's, art lines, peds... it's ok.   

Important! Don't tell them you do and you can't do!  You should get a credentialing packet that will ask your comfort with procedures, cases, and numbers (estimated) per year.   

Please, let your agency know where you are and be optimistic about what you do and what your willing to learn.   

Continue to show your education, CEU's, ask questions, and when you are at your assignment take initiative.  Ask questions, act interested, & be ready for opportunities. 



1st weeks

The first days in a new place are the hardest as one doesn't know the Doctors, CRNAs, Surgeons, Techs or admin.  

I had a lot of fun getting to do a variety of cases.  I'm hopeful that in the coming weeks I will have even more fun with the group here.  I have gotten back into hearts after at least a year or two off from them.  The surgeon is pretty nice and relaxed.  I've had a good group of people to work with and I truly look forward to the days to come. 

 I'm supposed to be going to multiple hospitals so next week will start a whole new day 1 process and a getting used to the system at a new hospital.  I'm excited to see this group and how they work together.  

It's interesting dynamics hearing what people do and don't like and how they express themselves.  It's not difficult to read people and see that they have reservations or dislike or like what they do.  

I have not seen it all and done it all.  I had a new experience of a doc on group text stating their displeasure with a call schedule and they will resign next week if it isn't changed.  It's just a whole new experience.  

I get a little perspective into other facets of anesthesia and management as I continue to work with people through this site, these facilities, and continually keep in contact with others.  The interesting thing is that it boils down to .. "just business".  What we do on a daily basis is truly the personal touch and a true people profession.  Please don't let me detract from that but the where we do, how we do, and when we do ... those things come down to business.  Some politics in how much hands are tied and what has to be done and how.  The thing is that business drives those decisions.  

When a new anesthesia management group takes over.  It's not because one was liked more or less or even that a group did a sub-par job.  It comes down to the buck.  Places get comfortable and complacent and happen to think they won't be taken over by another but they also have to realize that the board for the hospital, anesthesia group, surgical center, or whatever company ... may not be in the same profession.  They may have an MD/MBA and have never practiced medicine.  They may not have either a MD or MBA title.  The owner of a company may still outvote a board of directors that is supposed to be running the company.  All this is said to remind you that a contract is a contract and all have a term to them.  When things change it is business.  It is not because of the individual or that something happened.  

So, one week down and the business of anesthesia shows as a new group has merged with these hospitals and it seems to be eggshells for some.   I try to be mindful of the stress and go in happy and excited to be here.  There are things that help and happy patients are very important as the surgeons, anesthesia, and all parts of the group are more easy going and perceive a positive experience.  So ... the 1st week has to be a good week :)

Journey forward with me as we go :)

Pre-amble to the real day 1

I have to say that tomorrow is my real day 1.  I have some new Mindray anesthesia machines that I'll be using for the first time.  I'll get to the hospital without a problem.  Getting to the OR might be a little more challenging :)  They took us around the hospital... then another and now I remember very little.  The good news is that I get fireworks just for coming to Philly. That's pretty cool :)  

I'll let you know how goes tomorrow :)