At the Grind

Here I am back at the grind of everyday life of a locum.  I met with BlocHealth yesterday and it is so exciting to be meeting with agencies and making sure they are actively seeking great opportunities for you!  I made sure those getting credentialed are well on their way and doing well.  They are actively gaining daily contracts with groups across the US that are big and small!  

I was on call last night and I'm currently in the hospital enjoying being back at a facility I have had a long standing locum relationship despite a change of Anesthesia Management Groups.  

Relationships in Anesthesia are where it is at.  Keeping a good working relationship and providing services that can be dependable and cost effective are the keys to mutual respect.  

I've added a Newsletter to the main page so as strategic relationships and major advancements come to the site I can keep you informed and up to date.  I'm not anticipating doing mass e-mails or annoying mail on a regular basis so I hope you sign-up and stay up-to-date as we grow!  

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?

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!

Rough start

We left Philadelphia and things were looking good for the first 30 seconds.... 

We hit rush-hour traffic and were in a losing battle of time and weather.  I drove the blasted uhaul (26 foot beast) straight down as much as I could.  By 8:30pm it was snowing.  I was supposed to be in by 8:55 and I had so far to go.  Francisco became overwhelmed by the night and snow forcing he and Elizabeth to stop about 80 miles from Hampton Roads.  I forged on with the thought that i would not miss closing on the house or work.   

  I woke this morning to the information that the tunnel was closed and snow would last well into the day.  I made e-mails and texts in order to get the closing on the house accomplished.  Finally, i had an Uber to the notary’s home.  I officially closed and Uber said no cars were available.... i walked through the snow in order to get back to the hotel.  We are now the proud owners of a home loan.  

I found out i was cancelled for work on Friday.  Very happy for the 8 hour guaranteed day!   

This potentially gives me time to get things moved into the house!  Many things to be done!   

All those on the New England coast... be careful in snowmageddon.  

Calendar

i don’t know about you but it’s pretty crazy around our household.  My calendar for January is looking busy. Next week will be a crazy time and my husband might disown me.  

Wednesday, like all days I’ll be up and going to work at 6 AM.  The difference is that the movers will be walking in the door at 6AM.  They are packing everything then loading the Uhaul.  Then, I’ll get home from work and we drop off the keys, fobs, and say see ya later to Philadelphia.  We are to make it 2.5 hours south into Maryland.   

Sounds totally easy right?  We only have to put the dogs up front in the Uhaul.  Get the kid in the back seat of the Jeep and have everything packed/loaded in 10 hours.  The next morning we have to leave by 7AM.  If not we miss the walk-through on the home that has caused some stress over the past weeks.  

We’ll drive another 2.5 hours and arrive immediately at the house.  Park in the driveway walk through the home and make sure all is in good order.  We’ll rush to the hotel and drop off the dogs, check in for my parents and us for the two whole nights.  Then it’s again off to closing in Virginia Beach.  When that part is done we’ll again be home-owners.   

It doesn’t sound like too much.  But, I start work the following day so again it’s up to Francisco to get things unloaded from the Uhaul and unpacked.  my parents are coming to help install, set-up, baby-proof, and shop.  I don’t know if they are ready for what they are in for!

The one-day move and in-between contracts.  It’s going to be a bit stressful but i know we can do it!   

The rest of the month is just surrogacy, 3 work places and contracts, two birthday parties, and having a fence built.  

Planning just like all things is key but being able to maintain the plan as a fluid work is key.  Happy almost New Years! 

Holiday

Merry Christmas Eve, 

This means the Holidays are here!  You would not believe the trouble that surrounds this time of year.  Scheduling work is more challenging as most groups are not looking for summer vacation or the recruiters seem to know this time of year can be more challenging so pay can be less.  I see groups looking for just the holiday week coverage thinking 105 is great pay for that.  It’s sad that groups, recruiters, or CRNAs take advantage of other CRNAs by paying so little.  These rates have been the same since the early 2000s where R.N. travel rates have continued to climb steadily.   

I’ve seen many new CRNA owned companies coming out for CEUs, jobs, & other.  We are becoming more resourceful and entrepreneurial.  Just like going to a new group or workplace please do your diligence in knowing the people you are working with.  I’m going to be speaking for the first time with Education Adventures for CRNAs.  I have a one hour trial lecture with them in Costa Rica where I hope to talk on the pros and cons of locum anesthesia and what i believe some of the requisites, helpful qualities, and needs of the market are through my experiences in the past 7-8 years.  

Christmas can be a challenge for some and even for those that don’t “do” Christmas it’s a period that comes with down-time.  Less activity, less to do and work is minimal.  Look out for those that might have challenges, recent loss in the family, seem to be super happy but no plans.  Sit and chat or ask how they are doing.  Lend an ear or just be a happy person that’s there for them!   

I hope you have an amazing holiday season and from my family to yours.  Have an excellent holiday season and I’ll be chatting with you right here! 

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!   

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.