Motivation

I was listening to someone talk in the lounge saying they would never leave this area.  Her husband was offered an amazing opportunity and they said no as it wasn’t in the city.  Their kid was going to college and they begged to have them closer to home and now they think they might return to the same city.   

I guess this idea of staying in one place for life or not entertaining moving for career or home is foreign to me.  I’ve moved around and met new people my whole life.  Freinds of the long term capacity can be hard to come by.  However, within the military life of moving i found lifetime friends.  I know moving has allowed me to make friends around the country and understand different types of people, culture, and demographics. 

I tend to think anyone could do the locum life if they were so inclined but I’m learning that the more rigidly settled a person is the less likely for them to do locums.  Per diem in multiple hospitals in the area might be their perfect gig and while it may be 1099 it is unlikely to be billed as locum.  Others find a w-2 job that will allow them to work 2 full time jobs.  I see them race from call shift to call shift and i wonder how they do it when i know how it feels working 60-80 hour weeks and how lovely it can be at 40 hours.   

I think it all comes down to motivation.  Part of my motivation is to keep up in all areas of practice so I’m well rounded.  My goal is to be flexible, work a fair amount and over.  I want to be capable of going into any room and being comfortable.   I love new sights and allowing family to see all that surrounds us and our opportunities as we grow together.  Others, look for safe, secure, & what is known.  Others look for moving up the ladder of success in leadership, research or business as they grow and that is their motivation.   

Its fun to learn where people are in life.  Then it is nice to remember those people and in going to new places meet those who might also mesh well with others and who might build people up to their potential.   

So, dream big and bring others along the journey.  Find a passion and a motivation!   

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 LocumCRNAs@gmail.com

Post Turkey Post

Let’s talk cold turkey.  Who is ready to do locums? What things do you have to consider?   

Insurance

this is a big one and i hate paying people in the off chance i need insurance.  I would rather put my money to work for me so that it can pay for what i need in the future.  Alas, i still pay for the family insurance for health, vision, dental and then have a malpractice policy.  I put up that we have liberty healthshare, some form of VA, and Cigna PPO.  Vision is VSP pro and dental is Delta Dental if i recall.  Malpractice insurance is through the AANA.  Are these perfect? Nope, and they don’t cover everything.  I’m on my way for a sleeve gastrectomy in Mexico.  I have tried every weight loss plan known to man and am doing this not because insurance thinks it’s a good idea... in fact they do not cover weight loss surgery even in morbid obesity.  It’s a $9,000 surgery and not covered.  I’ll see if they will cover any portion but my guess is no.  

Time off

I absolutely love and hate time off.  I love it because i work hard and want to truly enjoy life.  I hate it because i am losing income and spending $$.  I do everything i can not to miss paychecks in the year!  Being a locum does allow me to take months off per year if i need it though.  My daughter was born in January and I didn’t go back to work until March.  I contracted for the 2.5 weeks over thanksgiving to be off for surgery and vacation.  I’ll also be off all of January this coming 2018.   

I’ll also be speaking in Costa Rica for an hour in January!  sooooo, you can see time off can be had and when it’s important.  That doesn’t however mean that i tell facilities i can work only special hours or days.  I tell them I’m here to work.  Work extra??? Most times that is a hell yes! 

What else? 

there is plenty to talk about!  Let me know what you think.  Locumcrnas@gmail.com

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.

Liberty as an insurance provider? Is it for me?

People ask me quite often what I think of Liberty HealthShare. Most days I’m happy with them.  I have had great experiences and less than amazing experiences.  I am not a skinny person … I am about to go for a sleeve gastrectomy which is expressly not covered by Liberty.  Page one states they do not cover weight loss surgery.  I pay an additional premium and have conversations with a health coach showing that I am trying on my weight-loss and I have a plan and goal.  This is a requirement.  This would also be the same for a smoker and the plan to cease smoking along with a health coach.  Some hypertensive medications require the same. 

I started Liberty approximately last December.  My husband was not able to be insured by them as we stated his positive TB skin test revealed calcified lesions on the lung which mean he has had exposure.  This is not Medically treatable but the primary care physician was either not educated or not aware of the medical treatment and stages ofl TB classification and treatment.  They would not write in the record that TB treatment was not indicated nor needed.  Francisco uses US Health Group for his insurance.  Just one month later my biological daughter was born via Surrogacy in Mexico.  She was hospitalized from birth requiring additional medical test & procedures.  She was in the hospital for 12 days and the costs were over $1000 US per day.  It was my anticipation that no insurance would cover me.  Traditional insurance said that after 30 days they would cover my child.  I called Liberty and asked if I could add her from her date of birth.  They said yes and added her for $50.  I asked if they would cover any part of her medical bills in Mexico.  I was told that they would if they had the bill in English and in US Currency.  I couldn’t deal with this until I was at home over 2 months later after being very stuck in Mexico. 

I had the bills translated at a cost of about $150 US and sent everything certified and called them several times to explain.  The hardest part is the system for uploading bills is only set for one bill at a time.  I sent all to them and explained that it was a lot of money out of pocket up front.  They seemed to put a rush on it and with-in 2 months I had been fully reimbursed for the medical care of Elizabeth in Mexico.  She and I have since had all of our doctor’s visits this year.  We have paid our premiums and otherwise been reimbursed for countless exams and rule-out tests.  She had to be ruled out for cystic fibrosis both in Mexico and in the US.  I have had 1-2 urgent care visits for a cold. 

What’s the negative?  I have found no provider that will take Liberty as insurance and bill directly.  All have made me cash pay and be reimbursed.  This works while we are healthy or bills aren’t super high.  However, I worry about ER visits or possible surgery or Emergency that lands me in the hospital.  I know I don’t have 100K to pay a hospital bill… Thankfully, I have the insurance card and my assumption is that a hospital bill would come to me and I could send it directly to them or have them call the hospital billing directly if needed.  In the US they will let you out of the hospital with an unpaid bill.  In Mexico they would not let Elizabeth out of the hospital with an unpaid bill. 

Every appointment since has had about a 90 day delay in reimbursement.  It’s something I have come to expect.  Most providers give a significant cash pay discount and so the amounts for doctor’s appointments have ranged from $90-$1400. 

I will continue to use them as I know how they work and I believe the coverage is sufficient for now. 

This has been our experience so far.  Hope this helps.  To see a comparison of health sharing organizations...  The insurance page of the site and scroll down to health insurance

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 :)

Accountant

I was told this week by a 1099 person that for years his accountant only allowed him to write off his cell phone.  I'm not sure what everyone does for their accountant.  Here is what I do: 

Quarterly, I send statements.  Bank statements, car insurance, phone bills, house payments, insurance, utilities, anything and everything!  I highlight any meals for work, meals out, any CEU or training, job hunting, computers, tablets, phones or anything remotely for work purposes. This includes printer ink, office supplies, shoes or clothes, my new stethoscope as my other was just getting old, my work bag, and car tolls.   

These are just a few things that can be on the write off side.   

Talk to your accountant.  Ask if they'll review EVERYTHING?  If not go to www.locumCRNA.com and find an accountant that will work for you.  They are listed in the financial section of the website.   

5 hours could bring you tens of thousands of dollars.   

1099 house

I'm a sole earner 1099 locum CRNA.  I have an accountant that does an excellent job.  Due to my propensity to do what I want at the time I want to do it, I am trying to buy a house. I have decided to buy a (for me) expensive home.  Expensive is anything I have to get a loan for.  So, there is this 360k house we have found that could be good for us for at least a few years.  

Paperwork on a normal w-2 loan process can be easier but generally it's been the same for me.   

Except, I have rental properties that are claimed as losses on my taxes.  I have my income written down significantly based on may exemptions, deductions and whatever magic accountants do.  My net income is 160k which is respectable.  However, if you recall rental homes, surrogacy and life are all expensive experiences.  Therefore, cars, loans, & credit are all taken into account.  

So,  although my income is significantly higher than appears and I save on taxes.  Now I need to be concerned for qualifying for a moderate home in an average city.  often times I hear that people need to claim a higher income and pay more taxes to buy more house.  I think that if I had less debt based on my income I could have pushed my loan amount to 600k on 160k of earnings which is just shocking to me as the payment would be pretty high for a supposed income level of 160k.  

The good news is that I am not looking for an amazing, blow it out of the water home. I'm looking for reasonable, decent re-sale, good schools, and place to let the dogs outside.  

I'm taking into account sale and realtor fees.  However, houses have been sitting on the market for a while at the current rates.  I'm moderately concerned that we could be at the top of the market.   

If that is the case we will need to watch for not over upgrading a house.  We'll need to recall that kitchen and bath are selling points.  Going too small with a high price or too large can mean that the home will be more challenging to sell. 

Buying a home makes it more challenging as a locum as well.  If looking to only do locums in one area it can be rough.  The hospitals will try to do per diem vs locum.  The housing amount provided going toward paying off a mortgage is highly important in keeping my plan alive for 5 years from now.

We will be looking at 2-3 houses today and if not impressed we have our home picked out.   

Will keep you updated as we go through this process.   

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.