LocumCRNA.com and a new investing page?

I’m thinking it might be interesting to go through investments?  We work hard and make a decent income. What do we do with that income, or how do we invest and protect our investments? 

I’m thinking about using my continuous growth in showing what I have been up to on the investment space.  I can show the websites and what I’m working on in that space.  I can go through real estate holdings and what that looks like.  Not to forget sep IRA V’s Solo 401k and stock market investments.  Then businesses and the different types of investments that I look at and consider. 

I wonder if this is something you would want as a page as it only somewhat relates to our site because locums is the way I finance life and the investments?  

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.  

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.   

Lesson from the movies

I went to the movies and I'm sure I didn't take from the movie what they hoped.  I tend to take little bits out of life and try to make them part of my life.  From Financial Independence to Anesthesia I take a little bit from every day.

I went to the movie "I Feel Pretty".  It's a little different now that we are raising a little girl.  I don't know why it is but the way I look at movies and media in general.  I also look at many things that come at me from my MBA program (I'm in week one)  to Anesthesia and Locum work.  

I feel pretty tends to try to show that it's not about how you look.  Great story on confidence and looks.  If you take this concept and expand it to the comments of: 

It's what you know

It's not what you know but who you know

It's all in the experience

It's all about the environment (Nature vs Nurture)

It's the fact that you had an education that not everyone could

I'd say "it" is about all these things and none of these things.  This movie can take all those things and say It isn't about just those things but the APPLICATION of each of these things and the most successful people take all the principles and they apply them in different ways.  

I say that because you can know all the right people but if you don't apply the lessons from each person "the 5 people your closest to" can't change you.  You have to change you. You have to be open to the application of lessons learned.  

You hear about this or that and think you want that ... but you have to be "on the ball" and do what has to be done to "be" the change you want. 

It's the same idea of me always listening to financial reports and to stories of those that developed business and climbed the non-existant ladder of success.  Very few people just rise to the top without taking specific actions in those areas above.  

So, for today, I'm leaving you with the actions you take and the application of the principles mentioned that will elevate your practice, life, education, and the bring the road into focus to where you want to be.  So, take action and apply yourself to becoming better each and every day. 

50% of CRNAs Are Going to Retire Over The Next 10 Years! The Hierarchy of Retirement Needs

Jeremy L. Stanley, CFP®, AIF® | March 23, 2018 (reposted with permission)  

Even though money is fungible, we often categorize our money into different buckets, be it by types of spending or time frame. We also tend to mentally prioritize our income and assets, focusing first on covering our current income needs, then to our existing assets, and lastly to our savings for future needs.

This may help explain why bucketing strategies have long been popular.

The Bucketing Strategy

In this strategy, a retiree household assigns one-third of its savings to equities, one-third of its savings to fixed-income investments, and another third of its savings to cash. Each of these “buckets” has a different function.

While everyone’s buckets will be different because every person’s risk tolerance and needs are different, the bucket approach generally features a bucket for cash and income, a bucket for assets or conservative investments, and a bucket for future income and growth investments.

Why the Bucket Strategy Can Help

Bucket strategies like this may help because they coincide with how our minds like to place our assets into different categorize. Most often, we tend to bucket our wealth into three buckets: current income, current assets, and future income. 

This can be helpful because, even if your money is fungible, you’re still likely to react differently if you feel your wealth decreasing in one of the buckets. For example, if you start to feel your wealth is shrinking, the first and most obvious step may be to cut back on current expenses. Or, one may feel dissatisfied with their wealth if they don’t have a reasonable amount of assets on hand, regardless of the size of their income.

Whether we realize it or not, this bucketing approach implicitly prioritizes current income followed by current assets and, lastly, future income. Generally speaking, people struggle to feel satisfied with longer-term buckets if the more immediate ones aren’t satisfied.

For anyone who took Psychology 101 in class, this may remind you of Maslow’s hierarchy of needs. Maslow believed people have a motivational hierarchy of needs that must be satisfied in a particular order, starting with physiological and safety needs followed lastly by self-fulfillment needs. 

In a way, the retiree has a similar hierarchy of retirement needs that he or she strives to fulfill in a specific sequence.

Fulfilling the Hierarchy of Retirement Needs

It may be helpful for retirees and pre-retirees to consider how they can tackle each level in this hierarchy. If we look at the figure above, we see that the first need to address is current income. 

It’s difficult to feel confident in your future retirement if you aren’t satisfied with your current income, which includes your spending cash flow, your paycheck, and any passive income. This means that before you can focus on your future retirement income, you need to have a handle on your current income and spending. 

Next, once people believe they have a handle on their current income, many want to feel satisfied with their assets, from their savings account to money market accounts. For many people, this may include their emergency reserve to cover any unexpected expenses they can’t comfortably cover with their paycheck.

It seems that only once people have a handle on their current and short-term expenses can they start to focus on and feel confident in their future income and retirement lifestyle.

What Does This Mean For You?

While everyone’s needs and level of comfort vary, this hierarchy of retirement needs may be a helpful guide as you think about your future retirement. 

When looking at these buckets, which concerns you the most? What is the first step towards greater confidence in your future? At CRNA Financial Planning®, we specialize in helping CRNAs plan for and navigate their retirement. Whichever bucket or hierarchy level is currently concerning you, we encourage you to contact us to see how we may be able to help. Call our office at 855.304.3748 or email inquiry@crnafinancialplanning.com. Or, schedule a free 15-minute introductory phone call now.

About Jeremy Stanley

Jeremy Stanley is the founder of CRNA Financial Planning® as well as CRNA Tax Associates®. He has been providing advice and guidance for Certified Registered Nurse Anesthetists (CRNA) for over two decades. As a CERTIFIED FINANCIAL PLANNER™, Jeremy has met rigorous certification and professional standards set by the CFP®Board. He is committed to adhering to the principles of integrity, objectivity, competence, fairness, confidentiality, professionalism and diligence when dealing with clients. 

Jeremy is also the author of The Wealthy CRNA and A CRNA’s Life After Anesthesia. The Wealthy CRNA features insights into becoming a financially successful CRNA and how to start planning for your financial future, and has been prior approved for up to 4 Class A CE credits by the AANA. A CRNA’s Life After Anesthesia serves as your financial roadmap for a smooth emergence into retirement. It reviews recent changes in the CRNA industry along with the new rules of retirement and the final steps of legacy planning. This book has been prior approved by the AANA for up to 2 Class A CE credits. 

The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. All performance referenced is historical and is no guarantee of future results. All indices are unmanaged and may not be invested into directly.

Start getting involved

Today, I’m supposed to see one of my congressmen at MYA.  While I appreciate the attempt to make it easier for a non-political person such as myself to see our representatives I think it’s less likely to see dramatic changes when I’m going with the idea of three bullet points.  Not one has specific actions.  Not one has to do with the key function that opens the door to the full practice and autonomy that full billing rights does.   

I say this quite possibly out of naivety.  My idea is that if we can bill independently at 100% for all of our services then the right to work autonomously would be a natural progression.  

I see the ASA involved in so many layers of government and see our CRNAs in so few places.  Honestly,  the MYA was much more expensive than I expected and less well attended than I expected.  

I went to the Region 2 update and was impressed to hear about our reactivity to each of the bills in each state.  I heard of 1-5 bills presenting legislation in each state that would better AA, ASA or decrease CRNA practice.  IN EACH STATE!!! I didn’t hear that we presented bills, we sat on these committees and task force set-up by.   I heard the AANA did a first ever state leadership retreat to Vegas though.  Several were happy about this.   

I see that the Cultural Assessment is in full swing and I know people cried for this but the membership slid down a few more points this year.  I guess I don’t understand the cultural piece as this is a business and professional organization that should be fighting for CRNAs based not on culture, ideals, or in an unbiased opinion.  I think the political piece is a large part of what should be our organization but we don’t even raise 3 providers income among 50,000 CRNAs in any given year to work with.   

I offered to put a link on the locumCRNA.com page that would say to support the PAC and was told that it was illegal to do so.  I learned something new.   

I don’t know what is in our future but am quite aware that we need to do better as a professional organization and we all need to be more involved than we are.  Billing rights and autonomy of practice will be paramount principles for independent practice and advancing our profession.  As a locum that enjoys nearly all practice environments I think that this focus and becoming more involved in each states organization can only help us.  But, involvement means action, knowledge, and fricking membership for those that aren’t even a member of our professional organization.   

You have seen my financial information and I’m still a member of our AANA, donate to the PAC monthly, and despite my poor political affiliations I am here trying to learn and grow just to maintain or improve our profession in the future.  I am starting to get some of the knowledge beyond just being a provider, or clinical educator in the OR. 

Please take some time to go to the state meetings or national meetings and start getting involved in what we need to do for ourselves.  Consider a contribution to either the AANA which is tax deductible or to the PAC which is not.  Both advance us as a professional organization just in different ways.   

Just my 2 cents.