A more appropriate title would be something like, “7 reasons I transitioned from full time W-2 employment to a full-time independent contractor.” The current title sounded better, and my lack of creativity couldn’t create a sufficient alternative.

Mrs. TFC and I were working full time jobs as W-2 employees in the Southwest. Changes happen. The situation provided us with a few options.

1.      Stay and put up with it.

2.      Find another full-time job.

3.      Transition to locum work.

We went with door number 3, full-time locum work.

TL;DR

• Our life situation dictates full-time locum work is best for us.

• We can work when and where we choose.

• Everyone loves a good payday—don’t deny it.

• 1099 is the true way to pay yourself first.

Transition to Full-time Locums

Our previous jobs were W-2. Most full-time employment opportunities are W-2 positions. I have noticed an increase in 1099 full-time permanent positions on the job boards. Last I heard, something like 80% of CRNAs are W-2 employees. So right or wrong, I associate full-time employment with W-2 income.

Most locum positions are filled by CRNAs using one of two avenues -- sole proprietorship or limited liability company. Both are considered independent contractors and collect 1099 income. For reasons to be discussed in future entries, I chose the LLC route. In short, the type of work we decided to undertake made the decision to transition to 1099 for us.

The Return to Discomfort

I’m a fan of discomfort. Or maybe I have an aversion to comfort. I don’t feel as though I’m developing as a person if things become easy and remain so. Reaching out of my comfort zone has been beneficial historically. And it keeps life interesting.

Going through anesthesia training – challenging. Working independently as a new grad CRNA – thrilling and terrifying. Starting a blog – very uncomfortable. And now hitting the road as a traveling locum CRNA – into the deep end once again.

This journey commenced with the creation of an LLC, vetting and selecting a CPA, acquisition of business bank accounts and credit cards, comparison of health insurance options, and communication with recruiters to secure sufficient work. Not to mention credentialing, submitting case logs, and applying for malpractice insurance. It wasn’t bad looking back, but at the time, the laundry list was daunting.

W-2 life is easy. That was the appeal coming out of school. Keep the focus on anesthesia and the business aspect will follow.

The government takes their taxes. The employer takes withholdings. What remains enters my bank account. Easy and expensive.

Taxes are simple. Employer sends a W-2. I carry over the numbers to the tax form. All there is to it.

1099 life has a few more moving parts. I’m learning and taking notes along the way. Similarly to how I share my personal finance learnings on this blog, I will share my 1099 experiences. All with the intention for the initial to-do list to be more manageable for those starting 1099 work. I’m still taking notes at this point.

And not to mention the work itself. I’m continuing with rural anesthesia. I was comfortable with questionably high acuity because I was knowledgeable about available resources. Not only what was available in the operating room, but what the emergency department and “ICU” could handle.

New places. New faces. New cases. New drugs. New equipment. New anesthesia standards. New charting.

I’m back to basics. I feel like a student going on rotation. All emergency equipment is readily available. Dots and crosses on all “I”s and “T”s. At the end of the day, same anesthesia, different location.

Financial Incentives

This could really be, and likely will be, its own post. It’s full-time locum work in the Midwest. Yeah, we relocated 1,400 miles into the tundra that is January in the Midwest.

Full-time jobs pay better in the Southwest. Locum jobs pay better in the Midwest. To state the obvious, the pay as a locum is quite good. And that’s coming from me.

I’m covering small facilities. I offer full scope of practice plus call. I’m finding out that full scope of practice isn’t getting me as far as I anticipated. More scope of practice, same pay. This doesn’t make me happy. The willingness for solo call and ability to run the OB deck make a difference.

1099 income is truly paying yourself first. You see the entire sum of your agreed upon compensation. Then business expenses are deducted. Then the government takes theirs.

I expect my effective tax rate to be lower than my 2023 rate. Not much room to go up, so it won’t be worse. Year end take home pay was a big draw to the 1099 world.

Flexibility

We were going to use the time between graduation and starting work as a window to explore Europe for three weeks. Well, COVID happened. Travel restrictions and border closures galore. We never made it. Sad.

My job in the Southwest was fairly flexible on paper. Three weeks on, one week off. It didn’t really work out that way.

Staffing was slowly improving as I made my departure. Seeing back-to-back weeks off would have been possible because my coworkers were really easy to get along with. But three weeks is not in the cards. So a multi-week European exploration is off the table for pretty much any full-time job. There may be opportunity between jobs, but that’s a bit rigid.

Three weeks may be greedy, but I would rather make the flight worth it. And there is a great deal to see in Europe.

With locum work, Mrs. TFC and I set blackout dates before releasing our availability. This being said, we already have a multi-week trip to Asia blacked out at the end of 2024.

Flexibility not only applies to long stretches of time away from anesthesia, but also to weekends, holidays, and an upcoming trip to Mexico. Too many blackouts may limit interested facilities. The downsides deserve a post of their own. For now, I’m looking forward to vacations which were nonexistent in my last gig.

We are going with the “work hard, play hard” approach to 2024. I’ll keep you updated with how that’s working out.

Career Exploration

There is not a single way of providing safe, quality anesthesia. I’m not ignorant enough to say the way I was practicing was the best. I use evidenced-based practice when possible, and there is always new data coming to light.

Think about going on rotation as an SRNA. It was far easier to identify aspects of a practice you disliked. Things you vowed to never do again. We all have a few of those.

Well, staying in a practice for many years hides some of those ugly actions as they become the norm. I’m looking at this experience as a way to see anesthesia performed differently. And speak with those who have differing ideas. I’m not an old dog, so I’m enthusiastic to learn new tricks.

Networking

As the cliché states, it’s all about who you know, not what you know. I have met some great CRNAs both as a student and practicing CRNA. The profession is only 60,000 members nationally -- not a lot. My home state is one of those with 600 CRNAs statewide. A really small circle.

Networking connections have already assisted me with finding a CPA after vetting 2 that did not cut the grade. Networking connections assisted me with finding desirable work. And I like to think if I deliver on expectations, the folks I’m working with will have something good to say.

Maybe this will lead to a better anesthesia practice. Maybe this will lead to pocket job listings. I don’t know where any of this will go, but I tell myself that being a trustworthy person and doing good work will only lead to good things.

Take The Financial Cocktail, an obscure financial blog. I don’t advertise. I just started a Facebook page though! Feel free to follow the page for notices and additional content.

It’s amazing how one young gal who reached out for financial coaching makes a difference. Just looking for a second set of eyes on her family finances. Within a matter of weeks, 4 of her classmates reached out for financial coaching. The combined power of upholding expectations and networking.

It has been a real pleasure and honor working with each of them.

Proximity to Family

Let’s not overlook the expansion of the TFC nuclear family. This addition reinforced the decision to relocate closer to family. Mrs. TFC is on maternity leave, which may be a forever maternity leave.

Full-time positions near family do not pay well (relatively). So, in order to live close to family and have Mrs. TFC on maternity leave, locum work is the way to go.

This is one of those give and take pieces. When folks say I can’t do ___ because of ___, I think to myself – did they exhaust all options? Did they only examine pleasant options?

After all, overpaying is the price of success.

It would have been fine for me to accept a W-2 job close to family, but that would have radically thrown off our financial trajectory. The $20,000+ monthly investments would be out the window.

I would rather accept the downsides of 1099 locum work instead of compromising our path to financial independence. Our current situation satisfies both requirements.

I know the 1099 aspect and locum aspect sort of blurred together in this post. Both appeared to be the best choice for us at this time. I’m looking forward to releasing more 1099 and locum content in the future. Thanks for reading!