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. 

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.  

Mid Year Assembly

I am admittedly non political by nature.  It’s very different for me here at the mid-year assembly and I sometimes feel an almost uninvited vibe being here.  Maybe it’s not uninvited but almost disingenuous vibe.  That feeling of people meeting people to say they know them but no uniform familiarity.  I have to say I came here on a whim and not as a planned event to where I would meet with certain people or advance specific agendas.  I am excited that I have seen some people that I knew from years ago.   

I’ve seen some of the very active and vocal people in the profession and learned from the sessions despite my critiques.  I think we all have our roles and I’m still wondering where mine will be in the coming years.  Totally worth trying new things though.   

I feel like I’m trying to grow but I’m still at the kids table.   I look forward to my meetings over the next few days and will totally share with you some pictures of our trip in DC.  It’s a great time to be out and about and I know Francisco and Elizabeth are getting plenty of pictures while here :).

Locum world

CRNAs glamorize locum position thinking that life is greener on the other side.  It can be nice but it can have its negatives.  It depends on your attitude, expectations, experience, and what you plan to walk away with.  It’s not all roses.   

I look at being a locum as slightly higher paid than the average CRNA as I risk not being able to find work, having to travel with or independent of my family, having to find my benefits, and learning the business end of anesthesia.   

Why am I needed?  When a place has a strained relationship, malignant personality, change in practice type, change in group, or people move-on/retire/pass away.  These are the typical reasons I get called to a group.  The less likely reason, albeit valid at times,  is vacation coverage.  This is typically a nicer reason or maternity leave can be more fun in small places.  

I don’t say this to whine or complain.  This is what goes with the job.  I am still expected to go in happy and excited to be at work.  Happy and excited to work with that Anesthesiologist or surgeon that people warn can be “a little challenging”.   

I would be remiss in not telling you that there are negative things that come with being a locum just like come with W-2 jobs.  You are very unlikely to find a perfect 7-3 m-f no call no overtime on some days and you can do everything you want and or say I don’t do XYZ.  That’s hard to find permanently much less as a fill-in worker.  Flexibility and optimism are definitely needed in our work.  

I am not saying you have to do what’s unsafe for the job.  Please don’t think that.  I’ve shipped out and cancelled cases that needed to be.  I’ve done some cases that were not wanted by others though because they had to be done.   

Please please as you walk into the land of Locums know it’s not all roses... even roses have thorns.  :).  

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?

To Sep or Solo

A big question asked often is weather to Sep IRA or Solo 401k.  Of course, I must make the statement that I am not a tax or financial advisor of any kind.  Now, I talked to Vanguard about starting a Sep IRA or a Solo401k.  

I talked to a business advisor and not just the personal finance advisor.  I had them and said I'm a 37 year old 1099 earner with my own Llc S-corp with flow through Gross X amount and taxable net income amount of X.   

He said, ok so for a Sep IRA you can do up to 25% (up to 52-54k) business contribution in basically any investment vehicle through a brokerage account.  A Solo401K you can do 25% (up to 52-54k) business contribution plus $18000 personal addition to your 401k.  They will only allow vangaurd funds for the Solo 401K.   These are also different if over 50 years of age.   There are eligible catch-up contributions as well depending on the IRS regulations.  (This is where a tax/financial broker will help.)

I said ok, if I have others in ownership of my company do I have to pay out the same amount or percentage to them?   

Yes, if they are paid owners from your corporation then they will require the same amount as a percentage of their income in retirement for either the Sep or Solo but personal contributions don't have to match. 

No, if they are unpaid. 

So, I clarified again that both are pre-tax IRA investments and should decrease the overall taxable earnings in the future with the understanding that taxable income in the future would likely be less in retirement than right now.  They agreed.   

I have asked for the information on the accounts and will include them as attachments to the Blog if possible.  I will also add the supporting IRS fact sheets for both the Sep and Solok.   

The phone number for Vangaurd Business Solutions is: 800-992-7188

I chose Vanguard based on the discussions on the Dough Roller Money Podcast based on the simplified minimal basis point costs and overall low fee structure.  Low fees and good management history points toward a possible growth in the future despite my negativity on the overall stock market.   

I also have questions on rights of survivorship so will review the forms for potential to rollover on death to other family as a paying IRA in the future.

SOLO 401K IRS PAGE

 SEP IRA IRS PAGE

Individual 401(k) New Plan Kit Vanguard

New hospital day

Today I will go to another new hospital.  I'm meeting them at 6:30 in the lobby and I'm pretty sure it's a 7:30 start.  I've been up for 20 minutes and have a 45 minute drive... so here are my ten minute notes on today.   

I have an 8 hour day today so it's not so long and I know I'll make it through.   

When I drive into the parking lot I'll note the main entrance as that's where I'll meet another CRNA to give me the quick run-down.  Hospital systems are a little harder to just go in and 30 minutes later be in a room.  The "red-tape" isn't just paperwork and long credentialing.  These places require smart ID's to let you in and out, and sign-ins for multiple computers/programs/machines.  Even cases will typically be a couple starter cases to get used to equipment, paperwork, and get to know staff.  

Ok, well I hope your day is awesome... mine will start with a bit of a drive.  Thanks to podcasts at least I have the opportunity to learn a little as I go! :).  

1st weeks

The first days in a new place are the hardest as one doesn't know the Doctors, CRNAs, Surgeons, Techs or admin.  

I had a lot of fun getting to do a variety of cases.  I'm hopeful that in the coming weeks I will have even more fun with the group here.  I have gotten back into hearts after at least a year or two off from them.  The surgeon is pretty nice and relaxed.  I've had a good group of people to work with and I truly look forward to the days to come. 

 I'm supposed to be going to multiple hospitals so next week will start a whole new day 1 process and a getting used to the system at a new hospital.  I'm excited to see this group and how they work together.  

It's interesting dynamics hearing what people do and don't like and how they express themselves.  It's not difficult to read people and see that they have reservations or dislike or like what they do.  

I have not seen it all and done it all.  I had a new experience of a doc on group text stating their displeasure with a call schedule and they will resign next week if it isn't changed.  It's just a whole new experience.  

I get a little perspective into other facets of anesthesia and management as I continue to work with people through this site, these facilities, and continually keep in contact with others.  The interesting thing is that it boils down to .. "just business".  What we do on a daily basis is truly the personal touch and a true people profession.  Please don't let me detract from that but the where we do, how we do, and when we do ... those things come down to business.  Some politics in how much hands are tied and what has to be done and how.  The thing is that business drives those decisions.  

When a new anesthesia management group takes over.  It's not because one was liked more or less or even that a group did a sub-par job.  It comes down to the buck.  Places get comfortable and complacent and happen to think they won't be taken over by another but they also have to realize that the board for the hospital, anesthesia group, surgical center, or whatever company ... may not be in the same profession.  They may have an MD/MBA and have never practiced medicine.  They may not have either a MD or MBA title.  The owner of a company may still outvote a board of directors that is supposed to be running the company.  All this is said to remind you that a contract is a contract and all have a term to them.  When things change it is business.  It is not because of the individual or that something happened.  

So, one week down and the business of anesthesia shows as a new group has merged with these hospitals and it seems to be eggshells for some.   I try to be mindful of the stress and go in happy and excited to be here.  There are things that help and happy patients are very important as the surgeons, anesthesia, and all parts of the group are more easy going and perceive a positive experience.  So ... the 1st week has to be a good week :)

Journey forward with me as we go :)