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.   

 

Debt reduction as a locum.

I’ve been so fortunate that Francisco is an amazing parent!  Elizabeth has been at home with Francisco 90% of the time and we found a great babysitter through a friend.  Francisco has been knocking it out-of-the-Park with his YouTube channel/ website ConMuchoSabor.com.   

I looked at our debt 7 months ago and was so stressed that we were over $250k in debt not including our home.  I traded my truck for less than half the cost new SUV.  I went to work on locums and raised my rate while telling the place I needed any hours or call I could get.  I’ve been away from the family returning about every 4 weeks for a few days to a week.  We’ve still had time to visit family and a good “working” vacation.  I’m happy to report that our net worth is positive and debt is below 100K.  I’m going to a 2 week on 2 week off lifestyle with intermittent days on my weeks off that will allow us to keep decreasing our debt and allow me more time at home!  Our rental properties have picked up and are now paying for one new property per year and paying thier own expenses.   

I have approximately 3 more weeks away before getting started on my new locum contract!  I’m 12 weeks into my MBA carrying a 3.8 gpa and learning weekly.  I get to pour over financial reports and am doing better each week with my own reports as well!   

I continue to consider business opportunities and think that with time 1,2 or 3 could become something just like the rentals, YouTube or the websites.   

I just wanted to check in and thank you all for the positivity and thank our Locum professionals for keeping us in great standing so we can work, travel, & provide for our families!  We are so blessed!   

 

Flexibility with Travel, Work, & Vacations

The flexibility & vacation time in working locums drew me in and kept me as a locum nurse Anesthetist.  

Work flexibility with a few facilities around the country has allowed the opportunities to do more with my time. 

Recently, my family visited Costa Rica and extended family!  I was able to speak and although I was a little excited, nervous, & even got a little lost in speaking; it was great to see other CRNAs and have them meet the family.   

We moved to Virginia for surrogacy and failed our first attempts.  It was a true and sad failure but due to locums I’ve been able to pay down the debt that occurred for this attempt.   

We’re paying down our debt load and continued to build the real estate venture over the past 6 months.  It’s been amazing to follow a move and family changes over the past 6 months.  I’ve been able to build on relationships and although working a lot... we are still well on our way to continued financial success in our lives.  Although, I know it’s possible to do this in one location with one job, it’s getting done on a condensed schedule.   

Life, flexibility and continue strong work ethic are leading to change as I continue all the things that are important in our family life.   

Finally, school is just about to finish the first 10 week term toward the MBA.  Nothing game-changing but working on a business mindset continues to be a fun opportunity for change despite my whining and complaining :).   

Totally looking forward to the coming weeks and months!  More to come. 

Why?

Multi-Level companies ask the important question that isn't always looked at from a job perspective or from a daily perspective.  I had someone ask me in passing what is the end point.  What is the goal and why are you doing what you are doing?  Not asking why I was a nurse but why I traveled and was spending time away from the family.  

I didn't feel like chatting.  I said so I can retire in 5 years.  So I can work less and spend time with the family.  I either compress the work down by working more hours, get a raise, or I live in a way that I don't desire.  This is why I do locums in big hospitals.  I get a large number of hours and call.  I have worked with these companies before and they know how I work.  I get paid pretty well.  This way I earn more than is spent... most of the time.  

Surrogacy and family building have been a focus of ours.  This has increased the debt load and thus I'm working away from home for a period of time to cover those bills so that credit card interest doesn't really cost what apps like Credit Karma would say it'll take to pay off debt.  

I'm also working on Taxes as I spent the money that came in and little things added up.  I don't recommend getting in as deep as I did.  It's a difficult hole to claw out of.  Every interaction and purchase needs to have a why.  To what end is this thing going to be of benefit.  What will this do in the coming days, weeks, months, or years.  So, I'm asking myself, as things come up, "why"?  

It turns out a year ago I would have sat down and bought a new laptop "for school" when my excel version didn't have what I needed and the computer was somewhat slow.  Today, I bought office but not the recurring monthly billing and not a new computer to go with it.  I dind't save 2000$ but at least I didn't spend it.  

My goal is to be working 1-2 days a week by the time Elizabeth is 5 years old and living about the standard of living we are currently living.  It's a challenge... especially when that is 3.5 years away. That means developing our spending in the right ways.  That means developing our business in the right ways.  That means finding my why for each thing I do.  

People wonder about the going back to school piece.  I happen to question myself a lot at the moment as I'm doing my most disliked statistics and algebraic equations course.  I love business and simple math.  I don't like big math.  I think I should be able to use a spreadsheet and be able to do basic math skills that most calculators can do.  Beyond those things.... there are applications and computers to help compute what might be needed.  I know someday I'll tell Elizabeth she just has to do it to advance to the information she needs to learn... so I'll tell myself the same.  But, school is costly right?  In this case I have the GI Bill and it wasn't transferrable.  It was to the time of use it or lose it.  This will allow a free education and allow extra minimal income toward bills.  It's a time loss though.  Sometimes, I wonder how I can fit it in.  I study and keep thinking I'll learn something that I can use in the future.  

Why is definitely a hard question when I have to answer why I'm away from my family. Why I'm working 60+ hour weeks.  Why is because we enjoyed life for years and now it's time to be ready for Elizabeth to have her time.  I want to be there for her school events, her trips, and her development.  We want another child in our family so that is part of why I'll continue this pace until all is done and paid for.  Then it's time to settle into life and have things set on auto for a while.  Work with a little family balance.  Tip the scales to the side of enjoyment. Bikes, hikes, and family time.  

So, Why are you thinking locum work?  Why are you afraid to travel?  Why are you doing what you are?  It's definitely worth finding your Why and what is the end point of it?

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.   

The busy locum

Another busy week looms in the balance on this Sunday evening.  I am well on my way to paying down the bills as we spoke on in weeks passed.  My Sep IRA through e-trade was set-up and funded.  I’ve traded in the truck for a small SUV that now is less than half the payment and has a better APR with half the balance I was paying.  I’ve also paid off 20k in credit cards.  I still have a long way to go and am paying my dear old Uncle Sam dearly with every paycheck so I can get in the good graces.

Today, I worked at the hospital ... from pediatric code to sepsis and multiple cases in-between it’s been a crazy day.  I was able to get back to my hotel in time to spend some time on homework.  My math class work for the week is complete and now it’s on to business analysis with its’ primary focus being communication this week.  The MBA program is challenging my time management and my brain in ways that I haven’t managed in a while.   

This week is a 60+ hour week and call for the entire next weekend.  I keep my focus on the benefits I see in the long-term as right now I sacrifice time with the family to get us ahead. We are seeking some freedom from the absolute need to work for thought of if things went sideways “what would I do if...” scenarios.   

I’d say in just a few weeks I’ve learned a good amount on every level and look forward to the coming weeks in engaging with colleagues, growing businesses, learning in the structured university education, and then managing life around the critical elements.  

This weekend I spent time on the farm with my favorite veterinarians and did c-sections for sheep.  What an amazing opportunity and so glad I spent a little time with family.   

What an amazing life we lead.  Now it’s off to laundry.  Feel free to e-mail me anytime locumCRNAs@gmail.com