Sunday Day off or Work Day?

It is Sunday, today.  What is your philosophy for Sundays?  Work day or day off?  If you are a locum you could consider it as either.  Even if you are not physically in the hospital.  I am one that is always learning.  It doesn't much matter on the topic but it is important to have down time.  I can honestly say that there are not to many days that go by that I haven't learned something.  Here is my weekend in a nutshell....

This weekend isn't much of an exception to the learning thing.  I try to have each day be a learning thing by reading or listening to podcasts or watching YouTube videos.  I try to share what I learn through different outlets such as this site, my family, Facebook, or other.  I try to share my experience when people message me or call.  

Yesterday, I had someone ask me about setting up a fee structure for a small hospital locum contract that just kicked the group out and the hospital still needed the CRNA to come up for a scheduled time.  I worked about an hour on my presentation for Education Adventures in Costa Rica coming in June.  It's still not where I want it.... but it's coming along.  I learned about backyard gardens for about 2 hours and am going to take people up on the learning they offered!  I listened to three podcasts. I lost $100 at the casino this was a major reminder not waste money and time at casinos.  I discussed two rental home projects that are in process, and the financials. I went for a haircut which was major down time and depressing to see how many were in-line... I think I should own the hair salon but that is a different investment I don't have money or time for.  Elizabeth (my daughter for all unfamilliar) went to the doctor yesterday for a sick visit and needed a nebulizer treatment for what sounds like a chest cold.  I spoke with two agencies about how I can work with them in presenting jobs on-line they might have, being a liaison of sorts for when questions or comments are shared, and discussed some options for feedback that are anonymous and not discussing specifics but will keep them aware of negative (negative are not shared immediately and specific details are not shared) or positive feedback on great recruiters or pay.  I think this is a way that can improve the interaction especially when they know a large forum discusses pay, agencies, independent contracts, hospitals, and the process of being a locum.  I seriously think it scares some. That was my Saturday.  

Today, I will again go to the gym (like I did yesterday) and hope not to see a kid eat treadmill. I have three hours driving that will be broken up by conversations with a small Anesthesia Management Group that is CRNA run.  They are looking for hospitals, surgery centers, endo suites or other to add to their portfolio.  I think we will have a great conversation.  I'll visit some family and see a sheep farm which will be a nice change of pace.  Then it's the drive home and some podcasts.  I'll continue to read two books that I'm in the middle of and prepare for my 60+ hour week coming up.  I'd like to say that I'll be on top of it and plan my garden but I'm not sure that I'll get that far today but I think after returning home I'll be building the garden and getting it ready for planting.  It snowed here last night so I don't think I'm behind yet :).  OK... just my laid back weekend.  I hope yours was awesome.  I know I loved mine :)

How can I help?

I think some are confused at this point.  I think some of you truly think I'm a recruiter for BlocHealth or National Anesthesia or some other company.  Some think that I'm some fancy dude that is just rolling in bank.  I hate to tell you that this is just so far from the truth.  

I'm a CRNA.  I've been a CRNA since December, 2009.  I have made my way through the locums world since 2011 and have been relatively happy.  I share my experiences and what I've learned along the way.  Yes, I've learned the hard way because honestly half the most out-spoken people just don't know everything and if they say they do... ask yourself if you know everything after being a XYZ of 10-20-30 years.... I'm betting the answer is no.  I prefer to state that I'm no lawyer or accountant but this is my experience, as it's the truth.  I'm not a financial expert or licensed as such so to give counsel... I can't do that.  I can tell you the things I have done or the people I have talked to.  

I can tell you what has and hasn't worked for me.  That's what this site is about, educating you so you don't make the same mistakes I have or collectively understanding where we are and where we go from here.  Giving you options and helping you to be able to figure out decent people to work with.  I can't tell you they are all perfect because part of the information is gathered from our peers to make this a more wholistic site.  I'm trying to give you all the information and not just one perspective.  

So, I'm not a recruiter because I don't call hospitals and get contracts for work.  I don't place CRNAs with hospitals or groups. I ask people to say that I referred them to all the agencies (when this site is instrumental in doing so) when they are going to go the agency route as the referral helps me make this site stronger for you and helps support the number of hours put into this resource. 

How many have looked at the other links at the bottom of the main page?  Anyone see the Store, Financial information that has Accountants and Financial advisers, Mortgage information, and maybe even the Where we go page that has the article by one of our own on RV'ing it across the country?  Take a moment to see all there is to offer.  Jobs come and go from the job board too.  

Any time I discuss with someone I try to make sure I ask.. How can I make this better?  What would help you more?  So, I'll leave you with my E-mail LocumCRNAs@gmail.com  

I did get a request from an undergrad resource wanting to place links to anesthesia schools and feel that first one has to be done with school and should get their practice down before considering locums... so unfortunately, I declined that request.  I'm trying to keep this a clean but solid resource.  so... How can I help?

A little independence

It’s been a great start.  Do you ever get to the point of I’m going to a new place and you are super excited until a little before you actually go?   

After all the excitement dies, the nerves kick in. You wonder why are they having such difficulty? Why am i needed?  What are the surrounding politics and issues? Then it’s a myriad of conjecture that has you just about to say “nope, I’m good to stay home.” Yes, after multiple years i continue to get those pre jitters.  This time was more because it was very temporary and only a couple weeks work.  I need the work but I could just ride the debt wave just a little.  If you don’t know debt and your a Ramsey fan... i sooooo applaud you and I’m jealous.  

Anyways,  I’m here & so happy i didn’t just give in to staying home.  I’m at a GI center with just myself and another CRNA and it’s nice.  Just enough work to pay some bills. Yet, I get home in time to do things and relax.  We even went to find a YMCA to join while we are around the country! (Did you know they have babysitters for two hours a day?!) yes, that last comment makes me sound ... older.   

Today is another day that will be busy with deliveries and paperwork that is all being pushed to Francisco and my parents as I’ll be working!  It’s awesome to be able to say that I’m sorry and have to work. It’s very true as i had more available weeks and they just couldn’t use me.   

I’ve supplemented with work back in Massachusetts for two weeks!  That’ll be somewhat more of a challenge but still fun to see people i worked with in the past.  

I can’t wait to keep you updated on locum life.  this weekend I start making my presentation for Costa Rica! What an adventure the next 6 months will be!

Getting ready for a change

We are getting ready for our next adventure.  I am packing up the desk and supposed to be doing that so I decided to delay the inevitable.  I have credentialing papers to notarize and get back to the agencies.  I will be going through Austin Major and Odyssey.  Neither of which are paying what I have been making and Odyssey isn't paying housing at all which makes it a bummer of a short term contract.  It is intermittent GI coverage for just two months while I await credentialing with Austin Major. 

It is definitely a different story for us as we tend to look for places that have both the pay and hours/work types that I want.  This is the first time I have said I want to be in this area and need a specific area or work radius.  I was trying to independently do a contract but the group/anesthesia Management Company figured I would just take a full time job with them and I wouldn't stick with locums as I have reason to be in the area for a year or so.  They were mistaken and although they need people they have decided not to use me as I am the cost of a standard locum.  Unfortunately, this group doesn't know my work, ability, or flexibility.  However, I do have the ability, albeit at a lower rate, to find a couple more groups that will know for the future.  

So, I'm packing up things.  We have hired Uhaul movers to pack everything and load all into the Uhaul on the 3rd of January.  I will drive down to Virginia either late the third or the fourth.  Maybe close on our house.  I start work on the 5th of January when things are unpacked.  It will be crazy times.  I will be at a GI center for the day and some intermittent weeks.  

Things are crazy with the 11 month old that turns one year 2 days after we arrive in Virginia.  She is starting to crawl well and some surfing some while standing.  We still have the two dogs that will join us in the trek from Philadelphia to the Virginia Beach Area.  

The house is still a big question mark as we have had to push back closing due to a tax problem where they are saying we didn't file although they were sent back in 2016 :(.  This has now caused the builder to impose a $150/day penalty on not closing and the IRS is saying it'll be weeks.  How does one sue the government again?  Oh right, you can't.  Bonus they might even charge me a penalty for them saying they didn't receive my taxes!  Bad week this week.

Things have a way or working out... I'm just hoping somehow all comes together like it should.  Getting ready for the crazy that is January.  Are you ready to do another new environment with me?

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

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.  

A New Kid on the Bloc

A new kind of agency is emerging out of the cries for transparency and concern that CRNAs are working for the same pay as ten years ago.  Yes, we have seen some recent movement in the pay of CRNA locum providers in the past year. However, it still seems our pay is sometimes below or at that of w-2 providers with benefits factored in.   Part of this slight increase could be attributed to the education of providers and the demand for CRNAs to fill gaps as anesthesia management groups grow. 

BlocHealth is trying to prove a transparent model of bringing together platforms of providers searching for competitive but higher rates and groups/hospitals looking to decrease agency fees and overall hourly fees for the temporary workers. Win for both the client hospital or group and the contractor/provider.  This matching process is still a growth project where they are actively searching for exactly what our providers are looking for in the areas they are looking.  This could branch out into a system whereby “Employers” are independently contracting “Providers” through a web-based matching system and negotiating a contract more completely on-line.  Part of this may include a more automated credentialing platform where provider data is streamlined to the requesting hospital expeditiously.  Although there is no completely automated system, at this time, for the job-seeker and employer.  However, BlocHealth is an agency right?  Sure enough, they are an agency and their fees are still in place.  However, using an automated process and setting in motion an atmosphere of a less hands-on approach will allow for lower overhead and expense ratios.  What’s that boil down to?  Sometimes this is less than 1/3 the fees of a standard agency. 

I believe that this will put some of the credentialing process on the provider as there will initially be less funneling of paperwork to the hospital as a larger agency might initially do. This means credentialing would be of some effort on the part of the client.  We’ve all done this paperwork 100 times and have given the same information to either hospitals or agencies before.  This time it’s to get the rate you want and possibly the area you want to work in.   I believe that as the process grows this automation will decrease the paperwork burden. 

They are also up front in saying that at this point they want providers to state realistic rates, time-frames, skill–sets and areas of desired work.  Then BlocHealth is looking for positions that will fit the provider and group.  Where-as most agencies advertise positions open in hopes of getting a CRNA to fill them.  This may be known places that need help or calling in the region to see if groups are in need or struggling. 

Overall, I see intriguing changes for the future that could grow into a good niche with-in the locum world. 

Why do I say all this?  I called and talked to them.  I tried to understand the company dynamic and what it could be.  I put them up on the site and have a referral contract with them and want to know that they are trying to be clear and work for the follow through.  I even filled out my information on their site and found the process to be just about as easy as any other. 

I almost able to do all the paperwork on my phone.  Recently, I was told BlocHealth now has a convenient and easy way of accessing a personal folder on the cloud that contains all provider information in one place. 

I may just work with them in finding contracts for other CRNAs in the future. 

Fun plan

Today I was at a third hospital and people say things like I can't believe you remember from place to place what you need to do.  The good news is anesthesia is anesthesia.  Knowing where everything is even at a place you've worked for a year has a bit of a relativity factor.  Meaning you get used to a place fairly quickly and if you get a halfway decent OR crew, anesthesia tech and are surrounded by decent people... it's probably going to be ok.  

Now, Fun.  Seriously, you have to go to work having fun!  Plan each day to be exciting and happy.  If you drag people down everyday and you are around people stressed and unhappy. Where will your job satisfaction be?   

You have to have fun on the weekends, after work, and plan vacay!!! Life isn't just work.  What you do outside of work leads to your whole self health.  When I get off work I'm going to.... 

If your friend said when I get off work I'm going to take my daughter out for a walk along the river, see the urban culture of a melting pot of people at a skatepark to skulling for their college crew teams, then shower and have a relaxing corona by the pool.  Would you think they were negative about the city or bored?  If you are on an assignment you have to be the person that makes your afterwork and weekend plans.  You have to be the friend that says hey let's go to Atlantic City.    

Every place is what you make of it and it's important to keep yourself and others excited about what you do.  That first plan was my night tonight.  It cost 2$ for the beer and otherwise it was a free nights entertainment.  Your colleagues, nurses, techs don't need to know when you spend $1000 on a trip but they should hear how excited you are about what's happening in their backyard.  It also leads to your overall satisfaction by not becoming TV bound or complacent.  

Best of luck and add some fun to your plan!   

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! :).  

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!