Due diligence!

I just want to make sure you know what doing your Due Diligence means.  Before you say “hmmm, the recruiter said it was a great deal” look at it & run all the numbers.  Are you having to pay to work?

What do I mean by having to pay to work.  Are you getting a stipend but you have to get your own housing?  Did you check out the deposits, fees, pet deposits, taxes, total costs for the time you are going for and if you get your 30 day notice right away?  Is your parking taken care of? Have you found out your mileage reimbursement and is it at least the IRS reimbursed rate?  

Food?  Does it cost more at your assignment?  Is there a kitchenette where you are going?  Are you getting a daily food per diem when you work especially if you are going to an area where the cafeteria seems to charge more than any should?   

Malpractice.  Is your insurance covered by your agency or the group you are traveling too?  Ask for a copy of the COI (copy of insurance face page).  Are you making extra to cover your own insurance and have you checked to make sure your insurance covers the location or that it won’t be significantly more expensive?   

Taking on the expenses and being reimbursed.  Are you trying to get the credit card miles, cash back or other points?  Does your contract state that you are being paid for each aspect and how long until it is paid? Do you have to submit receipts?  Are you certain you are fully covered on the reservations and no cancellation fee if they don’t get you credentialed?  

Please don’t take what the recruiter says as gospel that what they are paying will cover things.  Make the calls and find out the true costs if you are doing all inclusive or stipends.  

Lets journey on. 

A Good Time

I’m waiting until... it’s a good time.  I’m waiting until after ....  

When is it time to become a locum?  I’m waiting for fall or winter to start?!?!  I’d caution you that it’s harder to start in fall or winter.  

As you might well know, the surgery schedule slows as people want to put off cases until the next deductible year.  New grads have trained up over the past few months and passed their board exams.  Contract Take-overs have leveled out their needed number of locum providers.  Snow birds have found their winter retreats and things have mellowed.  

Spring is a season of prepping for children to move in between school years.  Vacation coverages are needed for those in care teams that try to get their people the needed weeks for family vacation.  Aana state and national meetings abound.  New grads are taking positions but are pending boards or credentials.  The summer leaves places hurriedly scrambling to accommodate elective cases and vacations.   

Spring and summer are the times for a locum to find some steady work and prepare for a wintertime slowdown or intermittent coverage.  Time for vacation, CEUs, recertifications and generally preparing for the times ahead.   

So, it’s the very beginning of spring so... what are you waiting for?  It’s time to go through the Credentialing list and talk to a couple trusted agencies to get your spring and summer rolling!  If you need a recommendation contact Jared info@BlocHealth.com or Randi at RCarter@nationalAnesthesia.com

if you have questions for me... locumCRNAs@gmail.com

Credentialing

I just had the nightmare.  A recruiter for a company that didn’t follow-up on my credentials despite my repeated requests to ensure all was ready to go for my March 1 start.  I received an e-mail after hours and very late that questions 4 parts of the credentialing packet which makes no sense.  This means they could not have ever looked at my credentialing paperwork.  I’m telling them that I am taking other work and if they desire to credential I will give them days as I have them available.   

I have called them every two weeks and this failure is blatantly unacceptable.  This is the reason agencies get a bad reputation as they fail to perform at the job.  Credentialing, follow-up, and ensuring an easy contract is the whole reason I see to utilize an agency.   

I am now having to go back to some standby work in order to fill a month but those fill in days don’t pay what they should as a day here and day their do not pay for the days missed in-between.   

I honestly don’t know how I could have been more on top of this.  I have written each of the people at the company and told the how unacceptable this is.  I am now scrambling to be able to pay my financials as I have been biding my time since January to start in March.  

I have been saying more and more that I have to get to zero (credit) debt as I know things happen.  I’m now kicking myself for these things.  So, learn from me and at least have more than two months of savings.  I do have multiple places I am credentialed so work isn’t the problem... it’s work in the area I wanted that is more of a challenge.  

I am contacting several contacts ASAP.  I’ll let you know what happens.  

Write off or included in your contract?

Here are a few things I didn’t think about when negotiating my next two weeks.  

1.  How am I getting to the airport?  I typically drive to every assignment so when it came to the airport I didn’t think about ... Will I Uber there?  Do I leave my car in airport parking?  Do I assume my husband will take me?  Ok the later is typically true but, now he is sick and didn’t want to take me.  I have$7 in tolls just to get that trip to the airport.  

2.  When I get the rental car in Massachusetts will they pay the tolls to and from the airport?  It’s not in my contract per say.   

3. I have clothes for a week but they don’t have baggage as an expense for taking the flight so now I don’t have enough to wear for two weeks without doing laundry.  Has anyone been reimbursed for laundry?  I also can’t take fluids or razors so no toothpaste, shaving cream, razor.... that stuff can be expensive right?  

4.  It’s a travel day before my assignment starts ... a day with no family and a day that i can’t work.  Non-productive and a loss of income.  Does anyone get paid a travel day on either end?  Usually if I drive ... I at least get travel expenses.   

These are a few things we might look at for future travel contracts.  does everyone consider these written off expenses or do you get them paid out so you get to save the expense in the first place?

Holiday

Merry Christmas Eve, 

This means the Holidays are here!  You would not believe the trouble that surrounds this time of year.  Scheduling work is more challenging as most groups are not looking for summer vacation or the recruiters seem to know this time of year can be more challenging so pay can be less.  I see groups looking for just the holiday week coverage thinking 105 is great pay for that.  It’s sad that groups, recruiters, or CRNAs take advantage of other CRNAs by paying so little.  These rates have been the same since the early 2000s where R.N. travel rates have continued to climb steadily.   

I’ve seen many new CRNA owned companies coming out for CEUs, jobs, & other.  We are becoming more resourceful and entrepreneurial.  Just like going to a new group or workplace please do your diligence in knowing the people you are working with.  I’m going to be speaking for the first time with Education Adventures for CRNAs.  I have a one hour trial lecture with them in Costa Rica where I hope to talk on the pros and cons of locum anesthesia and what i believe some of the requisites, helpful qualities, and needs of the market are through my experiences in the past 7-8 years.  

Christmas can be a challenge for some and even for those that don’t “do” Christmas it’s a period that comes with down-time.  Less activity, less to do and work is minimal.  Look out for those that might have challenges, recent loss in the family, seem to be super happy but no plans.  Sit and chat or ask how they are doing.  Lend an ear or just be a happy person that’s there for them!   

I hope you have an amazing holiday season and from my family to yours.  Have an excellent holiday season and I’ll be chatting with you right here! 

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.

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.  

Maintaining the contract.

I like to check in about this point.   We are at two weeks into the contract and I have to say it's always a bit rocky.  I wonder what people really think versus what is said behind closed doors.  Every permanent person is your critic.  From the janitor to the OR manager, permanent anesthesia staff and other individual locums.  One poor view of you from the wrong person and the OR tech who thinks she knows everything can affect your job, contract and if you are hired again by the anesthesia management group.  

I check in with the docs to see what can be done better.  I check in with the AMG to ask them if something can be done better.  I check in with the chief CRNA to find out how things are going and what I can do to help out.  I want to be taken as part of the team and not the one just here for money.  

I was with a locum MDA this past weekend and he was so very talkative.  I had to get him to focus, he would keep patting me on the back or chest to say things like "you know how it is, big guy"... so many things I despise about that but touching me is a big no.  I knew I only had a few hours and he would be at a different facility.  I bit my tongue and tried to focus on the patient throughout.  It's definitely a learning curve and despite my inherent self I have to be a people person.  I have to keep a smile and work to keep everyone happy even when boiling on the inside.  A tech in the room is criticizing the chief surgical resident for going to get the patient with me and the chart not coming down with the patient.  In all other hospitals I have been to the OR nurse meets the patient and goes through the chart prior to entering the OR.  All of this said the people pleasing is definitely part of the contract maintenance.  

I also think that self-reliance is very important.  The more you can figure out where things are without calling every two seconds for something to be brought, the better you are perceived.  Being able to search the stock room, store cabinets, OR carts, and anesthesia drawers/kits/carts will serve you 20 fold in how you are perceived.  I typically hate calling for things and feel horrible when they are right there in the room.  

Process, this is very difficult as most places have set process' in place.  What do you do when a process doesn't work or is obviously going to be a challenge?  I ran into a problem with a patient that was having a potentially large surgery in a hospital with little process for Arterial Lines, monitoring, ABG's and other lab work.  I sent them off and was unable to get my numbers back in a timely fashion and although stable I was hoping to be able to optimize the patient.  This case allowed me to understand some missing links in the chain and to find out who in the process was unwilling to help in a hospital process.  I'm still not sure how to go about solving this but as a new takeover.  I know that there is an administrative process that might make it easier in the future to get these items fixed.  I will be using the staff that are part of the facility to bring it to the management as a potential problem in doing similar cases in the future.  This type of case should be able to be done in just about any hospital in the country and had process issues but not detrimental to patient care issues at this point.  The last thing I should do is take something to administration or try to yell, complain and make trouble for the current staff.  I am here in place of permanent staff and not as admin or a person to make policy or even affect politics.  

OK... I should stop for now.  On to a 32 hour call shift in the morning.  Best of luck to all in the next week!