What is happening

I hate the idea of a W-2 or 1099 job... or is it just a job?  You know what that stands for right.... Just Over Broke.  Here is what I'm thinking?

Many CRNAs in this area have been here a long time and many are ex-military which is awesome.  Highly trained and reliable workers utilized to care for the region.  This is perfect except for the problem.  They don't need benefits and they don't always know their value.  So, many are 1099 ... can you believe I've heard one place pays 1099 90$/hr.  This is $50 an hour lower than most all-inclusive locum contracts and $85/hour lower than an AZ or NM contract I reviewed in the past couple months.  I want to plead with 1099 providers to know your worth and actually approach it with your expectation of pay!

I am a locum guy.  You know that.  Here is my concern and correct me if I'm wrong.  I'm looking for something in the Hampton Roads area for a year or so... could be 2 years could be 6 months.  Why?  We are working on a second child and we are in talks with a clinic in that area.  If all works out we would need to be in the area.  

So what?  I'm a planner and don't want to get to March and have to be there with no plan.  

There are jobs there... why not just take one?  --- I've been a locum for a while and take two jobs in 7 years.  Each one had flaws with my thinking in why I was there.  That said... I have a solid why for being in the area.  I look at these jobs and they pay less than I live on now.  Which either means taking two jobs or revamping life a little bit.  I had a plan to pay things off and get to my goal in rental houses by the time Elizabeth was 5.  I'm not certain that is possible in going to the area and doing surrogacy.  

The other thought is taking a full time yet not full time job and then supplementing as needed as a 1099 per diem.  The per diem is lower than I accept as a locum and causes the difficulty of having to work harder for the same pay :(.  

The other thought is to do locums in anther part of the state and drive 2-6 hours every time there is a medical appointment.  even the options for locums i am presented with would drop my pay by 10-20$/hour.  

A New Kid on the Bloc

A new kind of agency is emerging out of the cries for transparency and concern that CRNAs are working for the same pay as ten years ago.  Yes, we have seen some recent movement in the pay of CRNA locum providers in the past year. However, it still seems our pay is sometimes below or at that of w-2 providers with benefits factored in.   Part of this slight increase could be attributed to the education of providers and the demand for CRNAs to fill gaps as anesthesia management groups grow. 

BlocHealth is trying to prove a transparent model of bringing together platforms of providers searching for competitive but higher rates and groups/hospitals looking to decrease agency fees and overall hourly fees for the temporary workers. Win for both the client hospital or group and the contractor/provider.  This matching process is still a growth project where they are actively searching for exactly what our providers are looking for in the areas they are looking.  This could branch out into a system whereby “Employers” are independently contracting “Providers” through a web-based matching system and negotiating a contract more completely on-line.  Part of this may include a more automated credentialing platform where provider data is streamlined to the requesting hospital expeditiously.  Although there is no completely automated system, at this time, for the job-seeker and employer.  However, BlocHealth is an agency right?  Sure enough, they are an agency and their fees are still in place.  However, using an automated process and setting in motion an atmosphere of a less hands-on approach will allow for lower overhead and expense ratios.  What’s that boil down to?  Sometimes this is less than 1/3 the fees of a standard agency. 

I believe that this will put some of the credentialing process on the provider as there will initially be less funneling of paperwork to the hospital as a larger agency might initially do. This means credentialing would be of some effort on the part of the client.  We’ve all done this paperwork 100 times and have given the same information to either hospitals or agencies before.  This time it’s to get the rate you want and possibly the area you want to work in.   I believe that as the process grows this automation will decrease the paperwork burden. 

They are also up front in saying that at this point they want providers to state realistic rates, time-frames, skill–sets and areas of desired work.  Then BlocHealth is looking for positions that will fit the provider and group.  Where-as most agencies advertise positions open in hopes of getting a CRNA to fill them.  This may be known places that need help or calling in the region to see if groups are in need or struggling. 

Overall, I see intriguing changes for the future that could grow into a good niche with-in the locum world. 

Why do I say all this?  I called and talked to them.  I tried to understand the company dynamic and what it could be.  I put them up on the site and have a referral contract with them and want to know that they are trying to be clear and work for the follow through.  I even filled out my information on their site and found the process to be just about as easy as any other. 

I almost able to do all the paperwork on my phone.  Recently, I was told BlocHealth now has a convenient and easy way of accessing a personal folder on the cloud that contains all provider information in one place. 

I may just work with them in finding contracts for other CRNAs in the future. 

Students

SRNAs:  Because this comes up several times per month and I had an experienced CRNA ask me my thoughts.  Some will say they are appalled I would state this and some would back it 110%.  I'm going to explain the perceptions and then the exceptions and leave it out there.  

Seasoned CRNA: 

I didn't think most agencies would hire new grads.

Me:

No they typically won't. A few reasons and I don't say it to be mean. 1) most are wanting to credential before passing boards. They can't do that because a provider must be qualified to practice in order to be credentialed.  A facility hiring a new grad may go through all the steps of credentialing pending boards and licensure but both boards and licensure take time post graduation. Then the credentialing office verifies those two things and your off to the races.  Unfortunately, locums the facility can't guarantee you will pass boards and be licensed and therefor the same dilemma of time between graduation and taking a first job exists.  2) The SRNA pending CRNA isn't proven safe in an established practice for a period of time. If they have been in practice less than 3-6 months were they let go from a facility for cause either interpersonal dynamics or poor practice?? 3) Locums are used because a facility or practice is short of help and needs someone that has developed their practice and can jump in and provide skilled care in less than optimal conditions. 4). It can be hard to go from student mode to alone especially if most or all your education and training was 1-1 with someone always there.  This transition is helped by going to a practice that has people that can facilitate the growth from student role to provider role.  I believe this can be established in any role but some are definitely more challenging than others.  

For example some ACT keep CRNAs in a very restricted environment that can be more of a hindrance so the CRNA fully develops all of their skills.  Other ACT environments use CRNAs to their capacity but have the Medical Direction model and each does their part in a collegial practice.  Some CRNA only or private groups where both MDAs and CRNAs work on independent cases will say that you are a CRNA and should do only what you know.  Others will teach and build you up to the full capacity of that practice.  Still some only do a certain type of practice, which they are excellent at. However, they lose other skills and if branching out find a difficulty in full scope of practice. Solo practice... Most say a highly skilled CRNA of at least 5 years practice should go to these places.  This depends on training and the experience they had in 5 years.  If they have been doing blocks, spinals, epidurals, lines, kids, adults, critical to fast paced out patient for 5 strong years. That's what the solo practice is looking for along with someone that wants to learn and grow as a provider.  Really, this is what a locum agency and average short-handed facility would like too.

Am I saying that new grads have not gone directly into locums or solo practice?  Nope.  Am I saying they are poor providers? No.  I'm saying that it's not recommended and many agencies will discourage the practice of locums for new graduates.  Most request 1-2 years of practice to be comfortable in your role and discussing with medical staff regarding patient care.  

If you feel I've missed something please e-mail me and I am happy to edit this.  LocumCRNAs@gmail.com

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 LocumCRNAs@gmail.com

AANA Meeting

I wish I was able to meet everyone up in Seattle but this year is the new family time.  We have so many things we want to do each and every day it's just impossible to do all of them.  

I hope that all will make time for the vote and meetings as they are on-line this year!  

I am truly trying to make this site and blog helpful.  Help me make it standout as a site that others go to for solid information.  The only way to do this is to have people know that it exists and then to give feedback on how I can improve it.  

I have sent more than ten companies e-mails asking for tips, blogs, and information on how to help CRNAs in the tax, financial, mortgage, and insurance areas.  These areas are key to the financial health and well being of the independent/locum CRNA.  

I'm hopeful to get more and more information to you as I am able to get these very busy professionals to pass along their professional information.  I will continue to strive to give you excellent content and information as able.  

Please make time to go to the exhibits and tell locum agencies they can post their ads up so you can see what just applies to locums.  Also, give people both the Facebook and LocumCRNA.com site so that they can be involved and continue to learn.  

I look forward to hearing your experiences in the future.  

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!  

Busy Life

Can I just say how fast life is flying by?  I have been in Philadelphia a month and a half!  We are settled in and Rosie has broken 2 Leashes... it's a miracle the little Frenchie is not DEAD.  We live in the very busy downtown area of Philly and there are highways and significant throughways all around our apartment!!

We must be getting busy because we are talking about how busy we are and how much we have to do.  That usually means we are settled in a place and are just becoming cranky that life is catching up with us!  We love getting to do all these things here in the city but housework is not loved by anyone!  

So, when you decide you are going to locum.  You have to think about what you are going to do and how you will live in the city.  Francisco loved the hotel where they came to clean each and every day.  Life was totally different pre and post Elizabeth and the hotel was almost do-able before the little girl blessed us ... but now we move.... EVERYTHING EVERY TIME.  We plan for long term options and what we can do in the event things change.  

I have to look at what the best options are for us and where the opportunities exist.  We also look at cost of living.  We are also down to one car as our truck wouldn't fit in the parking garage here.  We only did this for a short time in Dodge City years ago but we had bikes and other activities in a small town.  Now we have lots of activities but two dogs, two of us, and the kiddo soooo we are again a little limited.  

The great thing is we are paying bills and getting ready to pay off the Jeep we have with us!  I'm so stinking excited.  Each month I see the total debt reduced in a significant way, I'm so happy.  It makes the amount of work worth while!  

Francisco is starting his food channel on YouTube and talking to me about the food truck again.  I think someday we might work on a restaurant but it will be so difficult to bring that into the mix.  

Just my thoughts on today!

Lazy

Lazy is totally unacceptable... at work anyway.  It's another Sunday and yesterday was housekeeping day.   I found my Solo 401K paperwork sitting on my desk under the mountain of paperwork.  Don't let this be you.  

1.  Grab your EIN (employer Identification number).  This is what you, your accountant or whomever filed your incorporation documents sent on-line to the IRS which makes your company a living number.  For a sep or solo 401k... you need this

2. Your business name as it is in the incorporation documents complete with punctuation  

3.  Print the documents and decide how much you are going to put aside.  

4. Do it and actually send them in.  Your account and tax saving definitely won't start with out this!!

Yesterday, I was catching up on thank you's.  So, I have to vent a little.  Francisco has been a little self-oriented lately and I'm not sure if I have just overly appeased or somehow in thinking of the other... I over did it but I've had to tell him it's not just about him and I need some time for doing... everything.  He cooks and cleans amongst the everyday dog and Elizabeth duty but when I get home it seems that all shifts to me as well... so now I'm having to tell him I have to work on the business, the desk, the rental homes, the bills for the house, accountant, & lawyer.  He's like soooo you going to go to the gym in 30 minutes?  Short of having him do ... because it won't get done... how do I get him to notice all of this because he thinks it's 10 minutes worth of work?? 

I hired help but she has been on vacation and dealing with big family things for weeks.  I missed my oil change yesterday which was severely frustrating.  Francisco says what's the big deal?  Oil is on its last 10% life and I work 5 10's followed by 24 hour call. I'm not sure (when we have 1 car) here just what he thinks I can do and with what time?  

I'm reading reading reading on my gastric sleeve, talking to patients from the surgery, and reviewing everything.  I grow more convinced that I found the correct surgeon.  I think I have the normal pre-surgery jitters and it's months away.  I can't wait to fit into clothes it's been years since I saw.... granted they are mostly in Kansas so I'll be looking like baggy clothes guy for a while as I'm cheap,  in some respects!   

Work,  I was leaving Friday and found security slapped a sticker on my jeep window for move-it or be towed.  I couldn't believe it and I was fuming.  They told me to park in the garage and I did.  They failed to say or show any designated place in the garage.  So I got off early to find said sticker and called them to remove it.  They refused.  I tried to peel it and that was wrong.  I stopped at AutoZone for a razor thingy to get the sticker off... remarkably easier than I thought.   I then apologized to the security people explaining I had never dealt with a sticker and though it would be much worse to remove.  

After the sticker situation I was stuck in a GPS nightmare!  The main road was closed getting home.... construction!!! Seriously the road was fine!!! Drivers on the road they need to fire!  Seriously, they need 1000 cops pulling over these crazy drivers every time they use their car as a battering ram!  I saw an Uber driver with a dash cam... best thing ever!   

Ok, I've vented enough...back to your regularly scheduled life! 

House Keeping

Today is general housekeeping day for cleaning and the like.  But, I'm referring to the site and FB Page.  I am trying to clean it up and look for ways to improve the site and make it more viable for others.  If you know of a way that I can improve things.  LET ME KNOW!  LOCUMCRNAS@GMAIL.COM or CONTACT ME!  It really is that easy.  I'm working on the states licensure requirements.  I do this on a weekly basis as it's quite tedious and some states really do not make it easy to find the requirements.  

Elizabeth is taking a nap and Francisco doing cleaning in another room so I really do need to get moving to work on this mountain on my desk!  When I say organization is key... it's because some days I feel a little CRAZY... like today :)  

I hope you have an amazing weekend.  Let me know your questions!

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?