10 Investments for CRNAs to Build Wealth

One of the most common inquiries to hit my inbox is about where to put money. This answer to this question varies based on personal situation, objectives, and risk tolerance. However, there are some common investments all CRNAs should make (or at least consider).

I’ve chosen 10 so there is something for everyone. I invest in almost all of these areas, which doesn’t mean much coming from an obscure financial blog. But coming from a 20 something CRNA doing relatively well and looking to give back to the CRNA community, please consider the following:

One: Self-Investment

Before you comment, “how cliché,” let me explain. We have all invested in a purposeful career that pays extremely well. Good job. You are (or will be) a CRNA.

I will consider any additional anesthesia related training that increases your value to the marketplace as “worthwhile.” Provided the cost to value increase is great enough. Think fellowships, pain management, or doctoral education.

These either bring increased pay or increased job opportunities. Let’s not limit self-investments to anesthesia. Consider increasing your financial literacy.

I was reading a Glen Zediker book about handloading competition-grade rifle cartridges. Allow me to paraphrase two memorable points from his book.

First, he has a 4-year degree in English, so he knows language rules well. Because of this, he violated all rules multiple times per page. Even more so than my attempt at writing conversational blog posts.

Secondly, he said his book costs $35 and that is expensive for a book, but a small price to pay. If you load one batch of inferior ammunition, you just wasted $35. Might was well give him your $35 and have perfect ammunition for a lifetime.

And I hate to say it, but he was right. I won multiple club shooting matches with his reloading advice. All because he categorized interventions as essential, variable, and worthless. Enough about the late Glen Zediker – Read the stuff in the “must-read list” and become a money boss.

Two: Emergency Fund

10 is a long list so I have decided numbering was necessary to validate the 10 investments. Anyway, you need an emergency fund of $1,000-2,000 all the time -- regardless of your financial situation. Absolutely crucial.

Leave this fund around $1,500 until you pay off any high-interest debt. Leaving it low provides a sense of urgency. Hopefully not panic, just a little flame under your backside.

Once your ducks are in a row, increase the fund to 3-6 months of living expenses. Anesthesia group loses a contract? Hospital replaces you with AAs? Don’t like the coffee in the breakroom? No problem, you have the safety net to quit and the savings to wait out credentialing at a different facility.

It doesn’t matter if a car breaks down or the water heater goes out. You have the reserves to handle it. No pulling money from your 401(k). Just utilize the emergency fund to clean up the unforeseen mess.

And for those of you thinking an unforeseen mess will never find you, think again. I don’t say this to intimidate, but rather motivate. Clean up the high-interest debt and buy your umbrella for that rainy day.

Three: Pretax Retirement Accounts

This is the 401(k) or similar for the W2 folks. The solo401(k) for the 1099 crowd. Decrease your taxable income by investing in a pretax account. Uncle Sam will still receive plenty of your coin, but you can minimize this amount by utilizing pretax accounts.

W2 crowd, throw in $22,500 per year. Catchup contributions start at age 50. This increases your contribution max to a cool $30,000. Hopefully your employer matches a portion of that.

1099 community, you play the employee and employER. $66,000 is your max. Age 50? You can also add another $7,500 like your W2 counterparts.

Many ask what investments to choose in these accounts. Many W2 employees are limited to Target Date Funds. They will work. These automatically start with a higher allocation of stocks, but slowly tilt in the favor of bonds as the date of the fund nears.

If you have options, a passively managed, low-cost index fund is a solid choice. I’d take a total stock market fund, but an S&P 500 fund will do. Maybe throw in a bit of total bond market funds for some spice (or lack there of).

I have a bunch of content regarding investment options, so I’ll allow you to peruse that at your leisure if you have questions. Read More Here.

Four: High Interest Debt

This type of debt is extremely dangerous. Compound interest is the eighth wonder of the world. Debt, especially high interest debt, means you are on the wrong side of compounding interest.

Anything with an interest rate > 5% is considered high interest and should be cleaned up AFTER you have an emergency fund in place. And AFTER you meet your employer 401(k) match.

If you want to chip away at this debt before any retirement contributions, I can’t argue with that. Debt is a mental drain. It bogs you down. Debt increases risk if something happens because payments will always be due. Debt doesn’t care about your health issues or losing an income.

Try to refinance anything and everything. Just watch the terms and fees of refinancing. If the debt will only be around for a short while, it’s most cost efficient to simply pay it off.  

Five: Health Savings Account

Ahh, the HSA. This is basically an account that accepts pretax dollars, grows tax free, and can be used for healthcare related costs without paying taxes on the growth. The only true start to finish tax free vehicle.

Access requires a high deductible healthcare plan. Annual max contributions are $3,850 for individuals and $7,750 for families. This doesn’t sound like much compared to other accounts but throw in the max year after year to see the power of this tax advantaged account.

I don’t recommend using this account for healthcare expenses as they arise, but rather letting it ride. I’m planning to use it for the expensive healthcare bills expected later in life – if I make it that long. Mrs. TFC will probably just get to upgrade her room at the retirement home.

Six: CPA

For the 1099 community, a CPA is worth it. My opinion. They will pay for themselves and save the time of filing taxes. Keep receipts and make their life as easy as possible. Worth it.

W2 folks – taxes aren’t as bad. Pretty much just write your income on the line. After Trump raised the standard deductions, it’s often not worth itemizing. Maybe if you have an expensive mortgage, but I wouldn’t know much about that. Child tax credit, sure. If you want a CPA as a form of “buying time,” I can’t argue with that.

I have been recently working with a CPA for 1099 stuff. He is worth it.

Seven: Insurance

I’ll link a recent blog post about insurance here. This is one of those things we buy and hope to never use. Health insurance is essential. Life and disability insurance are recommended for most.

I say most because those with the least amount of financial horsepower need the most insurance. If you are leveraged up to your eyeballs, your family will drown in debt if something happens to your income. Not good.

Good ol’ student loans. Not bankruptable. If you refinance through a private lender, which I recommend if you can get a better rate, they may not disappear after you are six feet under. Read the fine print.

Student loans are the worst, but don’t forget about all of the other factors. If you can’t bring in that CRNA bacon, your financial situation will change drastically. Good luck with the vehicles, house, and student loans. Not to mention saving for retirement.

Being uninsured and without a paddle is one of the dire situations I suggest everyone try to avoid. Eliminate consumer debt to protect yourself. And keeping living expenses reasonable will decrease your insurance needs because there are fewer bills to pay.

After reaching FI (financial independence), life and disability insurance essentially become optional. The biggest potential complication is a situation where unforeseen expenses arise such as extensive medical care following an accident.

Anyway, early in life, protect your financial self. It’s almost counter intuitive to think that living becomes cheaper the more money we have.

Eight: Roth Accounts

Roth IRAs are amazing. This is a posttax account meaning you have already paid taxes on the contributions and the principle grows tax free. The downside is the money has already been taxed at your current rate.

Being a CRNA, Uncle Sam takes +/- 30 cents on the dollar. And there is a good chance most full time CRNAs don’t qualify for such an investment vehicle because of income limits. Sort of.

For the average American, this account is number 1 after any employee matches. This is where the standard everyday millionaire had most of their nest egg. It’s an incredible tax advantaged vehicle. Especially in a low tax bracket.

There is a thing called a “backdoor Roth” that allows high income earners to essentially put money into a traditional IRA, pay taxes on it, and convert it to a Roth IRA. I don’t recommend this for any practicing CRNAs for one reason – Taxes.

I ABSOLUTLEY recommend this for EVERY SRNA because SRNAs have no income. This means taking the 401(k) dollars invested prior to anesthesia school can be taken as income. Perfect time since the tax bracket will never be this low again.

One can take the standard deduction max as income and pay $0 to convert a traditional IRA to a Roth IRA.

This basically makes the account as good as an HSA for the SRNA crowd. At least for a couple bucks. Sure, if you have $100,000 in your 401(k) as an SRNA, you will pay some taxes to get it all transferred over. But the taxation is significantly less than what it would be until you retire from giving anesthesia.

I have Roth accounts from my time as an RN. I wish someone would have told me about backdoor Roths as an SRNA because it would have saved me $10,000 up front, plus all of the taxes I’ll pay when withdrawing the money in retirement.

This is the call to action for anyone in academia. Please tell your students about this.

Because I have an income, I’m kicking taxes down the road as much as possible. No backdoor Roth for me until early retirement. Then I’ll switch everything to Roth.

Nine: Real Estate

Hot button topic here. In most areas, buying a personal residence is not a strong investment. I say this via anecdotal evidence found here. In short, I discuss how many homebuyers simply compare mortgage payment vs rent. And that’s far from all the considerations.

Mrs. TFC and I have a mortgage payment just under $1,600. Figuring in down payment, renovations, taxes, increased utilities, maintenance, capital expenditures, and realtor fees… it costs us $4,000 per month to live in this house.

I suspect we could rent this same place for under $2,000 pretty easily.

But we get a whopping $255 per month in equity. And the house appreciates approximately 3% annually, but we purchased during COVID, so we are probably in the red. Appreciation would only be $600 per month during the average year.

Our mortgage isn’t big enough to deduct on taxes, so that argument is negated. And let’s not forget the investments we miss out on.

The only support that I have found for personal real estate being an investment is for those who can’t reliably save money. A mortgage forces an investment reliant on home equity and the appreciation of the real estate market. Not great, but I’m trying to see both sides of the coin.

Rental Real Estate

Okay, one could make a solid argument that this is a fantastic investment vehicle. Amazing tax advantages, cash flow, equity, and appreciation. There are many ways to invest in real estate and this isn’t the post to discuss them.

Just know you can be an active manager, an owner/investor, or a passive investor via a REIT. From the research I have done, there is great potential for monetary gains, however, managing or owning usually turns into a second job.

If you don’t want to be hands-on, well, then you need to pay a property manager 8-10% of gross rents to handle that for you. It’s also wise to set aside money for maintenance, repairs, and vacancies. This means you don’t necessarily see the money until you sell and transfer into a 1031 to buy more properties.

I can make far more doing locum work than being a landlord due to the time commitment and unreliability of realtors in this small town. I was hoping to dip my toe into the real estate pool, but maybe in a different town.

As a side note, REITs or Real Estate Investment Trust is best held in Roth accounts or an HSA. They are really volatile, but if you are convinced by real estate and want a passive role, it’s something to consider.

Ten: Business Ventures

This is a vague point with a simple underlying message. Businesses have potential to make big bucks.

The tax code is very business friendly. No one made billions working a W2 job. In last week’s post, I spoke to how CRNAs are risk averse because they would give up a nice income to start a business. And most small businesses don’t make it.

Being a CRNA doesn’t limit what type of business you can start, but the income makes you think twice about leaving.

Starting something on the side, like this blog, limits the amount of time I contribute because I’m currently working around 1.75 FTE. Probably 230ish days of call and 310+ days of working this year.

Poor work life balance? Probably. Sanity – questionably intact.

1.75 FTE really limits my supplemental activities. And yes, I would give up a sizable income to blog full time with no guarantee the blog would ever make money. Same goes for my founding of any other business from doughnut shop to full time real estate.

The upside potential of a business is amazing. Hold a bunch of anesthesia contracts and take a piece off the top. Great way to leverage your time.

Start an anesthesia group. Teach nerve blocks. Teach whatever. Create an app. Create something conducive to advertisements.  Find something unrelated to anesthesia.

Business is about leverage. And with an online presence, the world is your oyster.

Amazing investment opportunity, but it doesn’t come without risks. And it’s certainly not for everyone.

And a bonus investment, but I couldn’t resist a pun…

These go to eleven: Charitable Contributions

I have been holding in this obscure reference for a while now. If you haven’t viewed the remarkable 1984 comedy, This is Spinal Tap, Nigel Tufnel explains why their amplifiers are superior. You guessed it, other amplifiers to go 10 and these go to 11. If I knew more about copyright laws I would link the video clip because it is that impactful.

I’m a believer in karma. Not a handout, but a hand up. Find a worthy cause to support. Make an impact with your time, expertise, or financial contributions. If nothing else, you will feel good about your efforts.

Most local fundraisers get my money. Especially those stemming from the surgery department at our small hospital. Everything from a diaper shower to dance uniforms to a sympathy dinner for a coworker whose Ma passed away.

I have told this story about karma before, but one of my best investments by percent return was a pan of chocolate chip cookies that I passed out to the 7 other apartments on my floor. I did this as the newcomer simply hoping no one would steal my stuff.

Little did I know, one pan of cookies led to one overflowing bag of sweet corn, one bottle of cranberry wine from the local vineyard, one beer with a neighbor, one request for the recipe, two thank you cards, and two verbal thank yous. And nobody stole my stuff.

My goal throughout life is to have purpose, support the family, enjoy the earnings, and give it all away at the end. Not to mention, donations may be tax deductible. Less to Uncle Sam and more to organizations with minimal waste.

Heavy is the head that wears the crown. My objective is to see each and every one of you become successful to the point where your financial contributions make a ripple. May that be in your family, community, and/or profession. May that ripple be impactful spreading far and wide.

Your financial and personal successes only further strain the neck and burden the head. As always, thank you for reading.