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?

Motivation

I was listening to someone talk in the lounge saying they would never leave this area.  Her husband was offered an amazing opportunity and they said no as it wasn’t in the city.  Their kid was going to college and they begged to have them closer to home and now they think they might return to the same city.   

I guess this idea of staying in one place for life or not entertaining moving for career or home is foreign to me.  I’ve moved around and met new people my whole life.  Freinds of the long term capacity can be hard to come by.  However, within the military life of moving i found lifetime friends.  I know moving has allowed me to make friends around the country and understand different types of people, culture, and demographics. 

I tend to think anyone could do the locum life if they were so inclined but I’m learning that the more rigidly settled a person is the less likely for them to do locums.  Per diem in multiple hospitals in the area might be their perfect gig and while it may be 1099 it is unlikely to be billed as locum.  Others find a w-2 job that will allow them to work 2 full time jobs.  I see them race from call shift to call shift and i wonder how they do it when i know how it feels working 60-80 hour weeks and how lovely it can be at 40 hours.   

I think it all comes down to motivation.  Part of my motivation is to keep up in all areas of practice so I’m well rounded.  My goal is to be flexible, work a fair amount and over.  I want to be capable of going into any room and being comfortable.   I love new sights and allowing family to see all that surrounds us and our opportunities as we grow together.  Others, look for safe, secure, & what is known.  Others look for moving up the ladder of success in leadership, research or business as they grow and that is their motivation.   

Its fun to learn where people are in life.  Then it is nice to remember those people and in going to new places meet those who might also mesh well with others and who might build people up to their potential.   

So, dream big and bring others along the journey.  Find a passion and a motivation!   

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

Post Turkey Post

Let’s talk cold turkey.  Who is ready to do locums? What things do you have to consider?   

Insurance

this is a big one and i hate paying people in the off chance i need insurance.  I would rather put my money to work for me so that it can pay for what i need in the future.  Alas, i still pay for the family insurance for health, vision, dental and then have a malpractice policy.  I put up that we have liberty healthshare, some form of VA, and Cigna PPO.  Vision is VSP pro and dental is Delta Dental if i recall.  Malpractice insurance is through the AANA.  Are these perfect? Nope, and they don’t cover everything.  I’m on my way for a sleeve gastrectomy in Mexico.  I have tried every weight loss plan known to man and am doing this not because insurance thinks it’s a good idea... in fact they do not cover weight loss surgery even in morbid obesity.  It’s a $9,000 surgery and not covered.  I’ll see if they will cover any portion but my guess is no.  

Time off

I absolutely love and hate time off.  I love it because i work hard and want to truly enjoy life.  I hate it because i am losing income and spending $$.  I do everything i can not to miss paychecks in the year!  Being a locum does allow me to take months off per year if i need it though.  My daughter was born in January and I didn’t go back to work until March.  I contracted for the 2.5 weeks over thanksgiving to be off for surgery and vacation.  I’ll also be off all of January this coming 2018.   

I’ll also be speaking in Costa Rica for an hour in January!  sooooo, you can see time off can be had and when it’s important.  That doesn’t however mean that i tell facilities i can work only special hours or days.  I tell them I’m here to work.  Work extra??? Most times that is a hell yes! 

What else? 

there is plenty to talk about!  Let me know what you think.  Locumcrnas@gmail.com

Hello Hawaii

Here i am in Hawaii and I’m working on credentialing paperwork for the hospital and home loan paperwork for the mortgage.  It always seems i have to do some work on vacation.  I guess that’s part of being an adult these days.  

I try to be complete in getting things returned very quickly.  I told everyone that they should have paperwork done as I would be on vacation.  I figured I’d get some mortgage stuff as my brother is my broker and he is here... but credentialing for the hospital.  Canitant that I’ve done the agency/group/ and now hospital credential paperwork?  I know some hospitals third party credential... but why is it we can’t be centrally credentialed?   

I guess i can see how it would be negative because if you had any speed bump that would keep that group from credentialling and you’d be out of a job anywhere.  I just don’t see how we can get so many background checks?  Mine has been checked about every 6 months since i was 18. 

i hope i get in on that central credentialing agency! :). Granted it would likely be run by the nbcrna, aana, or nursys :) 

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.

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. 

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