This page will feature articles by our membership about issues important to you as a nurse anesthetist. Topics will range from the pro’s and con’s of types of employment or places of employment, to tips and best practices to help you achieve balance and success in your profession.
In addition, we invite you to submit ideas or articles for inclusion on this page, which will eventually become a blog.
You Can Be An Entrepreneur
By Jonathan Katz CRNA, MSN, APN-A, President of NJANA
As Advanced Practice Nurses in Anesthesia, we are extremely vigilant, highly trained healthcare professionals delivering exceptional anesthesia daily. However, during our arduous training, we are never exposed to the entrepreneurial aspect of this profession.
Most providers, especially those in the Tri-State area, are accustomed to the care team model that anesthesia groups provide. This allows anesthesia professionals to make a hefty income that also includes vacation and sick time, mandatory breaks, health insurance (for all family members), retirement options and more.
But what about the professionals that yearn to work for themselves in the anesthesia world?
I had a vision, one that could fulfill my professional needs and personal goals. So, despite being heavily involved with my medical center workplace, I made the decision to create a corporation and work for myself. It was an exceedingly difficult decision, especially with a family to support, bills, loans, etc. The people most dear in my life thought my decision was absurd, especially since the medical center where I was employed set me up with a very manageable schedule along with a laundry list of perks. I had always covered per diem office anesthesia shifts while being employed with the hospital, but now I was going to take it full-time.
I took the risk and never looked back. I leveraged my contracts with my per diem surgical office employers and resigned from the medical center. These surgical offices, located within the Tri-state area, were equipped with less than stellar supplies and no anesthesia physician supervision. At these sites, I currently deliver general anesthesia and provide intravenous sedation without a physician anesthesiologist on-site every day of the week. If there are issues during the procedure, there is no calling for help — you are the professional everyone relies on. These sites are rural and/or cash-based businesses where CRNA’s can work independently if the surgeon desires the use of a nurse anesthetist in lieu of an anesthesiologist.
So, what does it take to be a CRNA/APN-A entrepreneur?
Here are some tips and advice to help you start considering the option:
1. Experience: I strongly believe you need approximately three to five years of solid high acuity anesthesia experience prior to making the move to work for yourself, but every individual can make their decision depending on their comfort, family life, financial situation, etc.
2. Know your worth: Outpatient offices need anesthesia, so you have every right to negotiate and leverage your rate. If you are willing to work harder than most, you can earn rates like that of our physician counterpart. In the hospital setting, I can work excessively, and it will not matter as we usually get our rate dictated depending on our amount of experience, schooling, etc.
3. Work smarter: As a sole provider it is difficult to be at multiple places to make increased income. But, if you are prudent, you can truly increase your income with the right moves as an independent contractor. Create contracts and schedules that enable you to earn higher rates and save more of your hard-earned income, making you extraordinarily successful in a much quicker timeline, working the same or even less a week.
4. Taxes: As a “1099” employee or “Independent Contractor” you could write off most of your expenses for your income tax. This can include supplies, gas, tolls, conferences, scrubs, cell phone service, vehicles (NOT a Lamborghini), and other reasonable expenses. Collaborate closely with your accountant to ensure you show you earned the least amount of money with the tax write offs, thus paying lower income tax and saving more money.
5. Planning for the future…and taxes: In addition, your accountant, like mine, should guide you on where to invest additional monies as a small business corporation without being taxed. This can include a solo 401k, which you can invest up to three times as much (up to $54k currently) then the normal $18.5k/year. This is not possible as a W-9 employee. There are a host of more tax-free investments as a corporation, but here is where I direct you to your accountant or financial advisor.
6. Incorporating: Should you incorporate as an individual or business? That is up to you, but make sure to consult an attorney, your accountant and do your research.
Becoming a solo and working for yourself is not easy. However, if you are willing to give up the “perks” and work hard to be successful, and want to find a way to provide the best care possible for your clientele on your own terms, then this can be a very lucrative and rewarding career choice.
I hope that by sharing my experiences you will see what is possible. If you have any questions or would like more information about this topic, please reach out to me using the Contact Us form.