What about earnings?

What about earnings and potential earnings?  So, many offered the advice of... 

Selling off all assets in order to pay off debt and then re-buy assets.  

Selling the houses in a stagnant market that doesn't really go up or down would basically mean selling at a loss and then trying to re-buy them later as they are money making assets vs stocks or retirement which doesn't really make $$$.  Now, if you said take a leverage your IRA for a reduced interest rate that might make sense but I don't have enough in those IRAs to make it worth doing.  

The homes are a life insurance policy that my family would be ok if they had to go and return to a home and I died.  They would have money coming in for life that would ultimately cover the bills.  So, to sell them would give no piece of mind.  The life insurance would more than pay the bills and what's owed and they would be ok.  

The goal in going through all of this is to think about earnings as a 1099 and where the $$ go.  I may not have $200K in student loans but $100K in credit cards is pretty bad but not Rock Bottom as someone mentioned.  I say that because I have never been at the point that I can not pay the bills.  

There are some slow months that came in at about $10K for the month and having 2-3 of those months and not actively paying down the debt is what caused me the point of freaking out a little.  As a locum though, I know that if I'm willing to travel and work hard with a plan... I can wipe out most of this debt over the coming 6 months.  So, that is what I'm writing about.  I'm tired of not wondering if I can pay my bills... I'm just tired of having the bill altogether.  

I figured out the payment of the bills comes to just under 7K/month with the house-payment, rental payments and income not included as those are a long term play.  That doesn't include paying extra or paying much in taxes.  Sounds like a ton to those not sitting in the position that I can work hard and pay down over 100K in just about 6 months and be much more healthy from a balance sheet perspective.  

I have a monthly running total of debts and will be updating all of this over the coming week.  That said, I have paid in 9K to my Sep IRA this month, 10K in tax payments and 10K toward credit card debt.  That is substantial for being 2 weeks into the month.  As I continue down this path to financial independence... I don't expect it to be easy.  I don't expect to be blowing 10K here and there but making a concerted and real effort to be more responsible.  

With that said.  We are holding off on baby number 2.  This process will have to start over in 6 months as it is a 2 year process each time we do it.  We started the process and made a valliant effort with our surrogate without the agency fees etcetra. However, that attempt failed twice.  Had we been successful the $50K would have been well worth it.  Unfortunately, we did not have success and that means we have to stop, regroup, re-fund that savings.  We are not rushing into this and we are not trying to our detriment.  We knew that this was possible but we also discussed that had we failed we would have to take the time before starting over.  

I took the truck to car max and offered to sell it back but they took blue book value and slashed 20% off of that value and then offered that for the truck which would have put us at zero for the truck.  Then when I went back to wanting a truck I would have been paying carmax more for a truck in 6 months than I would have saved in truck payments and that they had offered for a smaller less equipped truck and so it was a better option to keep the truck and just continue the plan to pay it off after the credit cards.  

The house in Virginia.  We like the home and need a place to be.  We have friends in the area and it is central with good community and school for Elizabeth in the coming years.  It's not perfect and hindsight being 20/20.... I'd have done that differently but there isn't a way to sell the house and just go down the street.  We could rent it in a year or two and be just fine or at least break even but the family is happy there and I can hopefully get credentialing done and start locums in the future ... in that area.  Had the credentialing not been delayed for 5 months by ... I don't know exactly whom, I wouldn't have to be traveling away from family so much.  

So, maybe this helps with some insight into the thinking.  Honestly, this is so all can see the flexibility and ability to pay down significantly utilizing locums to do so. This also will show how in the future that debt pay down can then be used to advance my rentals and our savings to a more comfortable place and the same locum job used to bust my butt working.... can become an opportunity to slow down and be with the family as we grow the family.  

Have an amazing weekend and enjoy the journey!  I know we are :)

Think

Every day I spend time with podcasts or learning in some way.  I listened to multiple this week.  Some of the things I learned this week. 

Be Better:  Every day or every week work on how you can be better.  A little change that will help you approach your goal or commitment.  It doesn’t have to be something earth shattering.  If you do 52 weeks of little changes toward your goals you will find yourself inching toward it and be there before you know it.  I read my books this way.  I’m paying down my debt this way. I’m growing the websites this way.  I grow my life, family, & relationships by spending seconds or minutes to interact and tell people thank you or awesome job.  Make a commitment and not get overwhelmed by doing something everyday.  

Attitude:  The attitude you approach something with is how it’ll go in most instances.  You can’t say I hate I hate I hate and then get to the point of doing and expect not to hate it.  I get to work and genuinely say good morning, hi how’s today and yup I’m annoyingly upbeat.  I do this for everyone and myself.  If people see me pissy and depressed everyday I’m adding an attitude that just brings down the whole team.  I’m there to work... not to complain, be unhappy, & just be a body.  I’m there because these groups have people that act this way or they can’t keep people because they are all stressed... if I can be a stress-free person at work.  I’m more likely to be asked back. I’m more likely to feel like my days go well.  I’m more likely to truly have fun and make the days go by.  I miss my family at home and I’m so excited to see family pictures or video and I share this with the people I work with.  Kids and dogs make everyone light up a little.  

Stick to it:  If I sign a contract or give my word.  That’s it.  I’ve said I’ll do something. I’m going to darn well do it.  I’m not going to tell someone that I said I’d do their room tomorrow then not because I found out the surgeon I like has just two easy cases for the day.  If I get what I want and ask for ... I honor what I said I would do.  This makes me reliable, dependable, the person to go to, and sought out for as a provider.  I’m reasonable in my expectations, experience, and what will come.  I know the business of anesthesia, each hand in the cookie jar and the expenses that come after the reimbursement income and how the expenses trickle down.  

These are just some of the things I’ve learned this week and application is always the challenge in what I learn.  I choose to hear most of my education, so I then proceed to the application and notes to myself in how I can apply it towards my day/week/month.   

I’d like to tell all to have an amazing weekend!   

Due diligence!

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

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

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

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

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

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

Lets journey on. 

Traveling attitude

It’s another traveling day and of course I’m up way to early.  I have two options though.  #1 I can say I hat the airport, the rental car return, the drive, getting gas, & generally people at airports still act as if they have never seen one.  #2 I am sooooo excited to be on my way, I was upgraded on my 20 minute first leg of the flight and I see the family in just a few hours!   

Mind-set is everything right?!  It’s the same way when going to work.  If it’s a locum job, a full time gig, or your kiddo doing the chores they have been assigned.  It’s in how you approach it.  Yes, I understand that bad things happen and unforeseen circumstances can change things but ... by and large this is the everyday approach.  If you want to love locums, love the time that you spend at many places... you have to decide that it’s going to be good.  If you have decided that hospitals, people, this job, and working with medical professionals suck... you won’t be happy ANYWHERE.  So, find some joy, work on finding why you want to do this, then reach out with all your positive energy and let everyone know just how great you think things are.  Happy people are infectious.  People, surrounding the upbeat, are more relaxed.  These people are perceived as more personable.  These are part of the reasons people are invited back or not invited to return to facilities.    

I’m told over and over of people that are extended or given notice because of their attitude.  I’m also told that places are more flexible with those that have better people skills.  That may be that the individual is flexible or the work place is flexible?  I wonder if both are true at the same time.   

I get an earful of complaints here or there and find that misery loves company.  I had a nurse in the room that said I can’t stand so and so... they always lean-in the room and say “you good?” Thumbs up!  “It’s like he’s trying to run away as quick as possible”.  I say well... this is his first job... he was trained here and it’s what the other nurses do in his room... he’s been here a year right?  So, is this a person issue or is this what he’s been trained to do over the past year?  We are training people by what we exude, show, teach, act out, what’s said, and the daily attitude we display.  So what are you teaching those around you? 

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 :)

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.  :).  

Taxes and Investing

Many times our default is to say I don't know anything about taking care of the taxes or the accounting.  Maybe it's time we take on the task of learning as we continue in the understanding of the business of anesthesia.  

I'm not that smart and I don't know either investing or tax code.  But, I am taking control of the time to learn about these things.  I'm investing in my own understanding so that I can utilize the Locum world and combine it in order to provide for the family without providing more than my share to uncle sam, provide educational opportunities to my family, and increase my available time home.  I have to save the taxes in order to fund the financial/investing side.  I currently invest in real estate but hope to someday expand on that into the business, real estate, and stock markets as I learn.  

What are you doing?  I ask this not to sound like I'm doing much but just to be real.  I take the time to learn in each aspect by reading the business books, listening to podcasts, and continuing to ask questions.  

Recommended learning... Consider listening to the Bigger Pockets Podcast on Real Estate.  They have two Tax episodes by Amanda Han... so I would listen to those.  The application is to the 1099 type of income however passive income is different than active... so be careful on the full application.  Business books that I like include things like 4 hour work week (not for the 4 hour part but understanding how to maximize your time), Rise and Grind (the effects of early work and long term benfits), and Motivational books that will inspire increased relationship building.  

That's all I have for today.  

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?

Check

it’s always interesting going new places.  I love it.  I have fun and treat people as if I’ve known them for years.  I have fun at work while getting the serious things done in a quick and efficient manner.  I believe that this relaxes the crew and the patient.  I always state that I’m not new to anesthesia but am new to the facility and why I’m going through the paperwork a little more. 

I expect to be checked on a little more or observed more closely if in a “Care team”  model.  CRNA group the same happens just because they don’t know me or what I do/don’t know.  It’s just how things go.  I also expect them to vary the assignments from big to little to tiny and see how they wish to utilize my skill-set... it’s a way of interviewing me.  They see if I complain or fumble or have issue with those that have the most awesome personality.  These things are part of the locum political environment. I generally say that I stay out of the politics by being a locum.  I should have been saying that I remain outside of the political arena that most ACT CRNAs are in.  It’s not that it doesn’t exist ... it’s just significantly less than full-time staff typically experience.  

I have some docs and CRNAs that try to teach me at times ... from how I should hold my Miller to doing a CVP fall whenever doing a central line.  I’m not above learning and I’ll simply nod or oblige if they want something simple that’ll re-assure them that my intervention is done safely and efficiently.   

I guess what I’m saying is that each place I go I expect a period of assessment in some way.  I expect to be thrown in to the mix quickly and handed around to the different personalities and surgeons.  I always listen too.  When I hear “oh, they put him there...” I know it’ll be an interesting day.  I think we, as locum providers, need to know whom the client is, how to handle interpersonal communications, and have to be more knowledgeable in a broader scope of practice than most institutions utilize.   

I think it takes about 4-6 weeks for a place to get used to a new provider whether it be locum or permanent... then 5-9 months to understand how a place operates and if they are a good provider fit.

These are just my thoughts on the day. 

A Good Time

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

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

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

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

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

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

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