Comparing job compensation is difficult. I’m talking apples to apples. Job offers make variables are known such as base wage, PTO, and CME allowance among others. What’s the best method to boil down the data? Well, I don’t have a great answer, but I used hourly rate and it made sense to me.

During my job search, I recall positions offering $400,000 annually! Woah! Read further and they required between 65 and 80 hours IN HOUSE PER WEEK! Others offered $200,000 for 26 weeks of work. Maybe an OB position only requires 10 24-hour shifts per month and pays $200,000. There are so many variables to account for. Hourly rate is the best equalizer I could come up with. Determining an hourly rate is easier with some job offers than others.

To best compare offers, I made a crude Excel spreadsheet to analyze the contracts I was offered. The attached spreadsheet is a toned-down version of the one I used.

To use the spreadsheet, input the requested information into the light blue cells. The remaining cells will autofill based on what you enter. Current numbers are approximations from 3 current W2 jobs. I have no affiliation with any of the hospitals, groups, or whomever posted them – they were just there. In complete transparency, my programing and Excel usage is far inferior to my writing, which doesn’t say much about this doc. More of “it’s the effort that counts.” Anyway, here we go.

Look for the big ticket items up front: Base salary, sign on, relocation bonus, and PTO/Sick leave. Other important factors that are sometimes a bit harder to find, but usually just require asking for the compensation package include: Employer retirement matches, CME reimbursement, health/dental/vision coverage, malpractice coverage, profit sharing, annual bonuses, and call pay.

Most places operate using the standard Monday through Friday 8-hour shift. Maybe 4 10s or 3 12s. Usually around 40 hours. Some contracts offer different base wages for taking 5 10s or 4 12s. They basically want you to guarantee extra shifts will be covered. Fair enough. Overtime isn’t typically paid at 1.5x your hourly rate, so this calculator will help with finding out what hourly rate you are working for.

During the interview process, be sure to speak with multiple people to feel out the expected hours. New grads – especially looking at you. This may include breaks and what time you actually leave for the day. Do you typically stay later than 1500 and are you compensated for this? Are you out the door by 1300 every now and again? Is there a 6 or 8 hour minimum? Are you paid by the day? To account for these hours, I included an “overtime” section. If you get paid for this, find out the rate and enter it. If you are paid by the day, leave it blank and enter the expected additional hours.

Call

On to the “Call” section. This is a deal breaker for many searching for the coveted “lifestyle gig.” Find out what you are being paid to take call and what it’s worth to you. Is the call included in the base or is it paid in excess? For the purposes of this spreadsheet, I consider call to be taken from home. If in-house, I would apply it to the “expected hours per week” section. Find out if there is backup call. Is there an MDA on call? How are the different types of call paid and what is the callback rate. Most importantly, ask around to see how many hours you can expect when taking call.

Many of the positions I considered were salaried and did not pay extra for call. The call was generally 1:3 or 1:4. So, fairly frequent. All of these positions clustered “post call” days so they allowed for 17 or 13 weeks off respectively. This allows for significant locum time, which I accounted for. More about this below.

My current position is salaried (call included) with 1:4 call from home. The first week is call M/W/F/S/S. The second week is call T/Th. The third week is just 0700-1500 in the OR. The call person takes all cases after 1500. I currently average approximately 15 hours of additional work after taking my 7 beeper shifts for the month. Other places may see closer to 20-25 hours of billable time if they have a two-hour minimum.

Callback days are clustered, so I have every 4th week off. This makes for a sweet 9-day break. My contract includes compensation for additional call and callback pay if available. These rates are comparable to locum rates for the area.

The average number of callback hours greatly influences your hourly rate, so do the best you can here. Trauma centers may have a graveyard shift, so at-home call is nonexistent. Small ACT practices sometimes have MDAs take all of the call, including OB, so the CRNA call may be minimal. I was at one practice like this where I had 10 call shifts before we had any cases overnight. And the crew there would be upfront that call is a light 1:12 for both weekdays and weekends. Just ask around.

I included a rate for holding the beeper. The estimated callback hours flow to the “total hours worked” at the bottom to have an accurate overall rate.

Extra Shifts

I understand there is variability here. It is a reasonable idea to have an increased rate built into the contract for extra shifts. Why not? Most places are not required to pay CRNAs 1.5x for overtime. The rate for these hours is likely the base rate or maybe $20 more. I think my overtime rate is $24 more than my base rate (which is a bit skewed with the 1:4 thing). If you work with 75 other CRNAs, overtime may be a bit more common with all of the shifts to be filled than those who work with their 3 closest friends. Maybe you want to work your scheduled shifts and be done. Great! This section should be pretty easy. No overtime available? Easy.

Retirement Contributions

These are often overlooked. Do not miss out on your employer 401(k) match (or 403(b), 457, whatever). Instant 100% gain. They often match 3-5% of your salary, which may be something like $7,000-12,000. If you have a health savings account (HSA) match, enter it in this section too. “Retirement Contributions” is a section where the 1099 crew will need to bypass.

Other Perks

I included a section again specific to W2 employees since I read something like 4 in 5 CRNAs are W2. I’ll get one for 1099 soon enough. Anyway, this is where the deep dive into the benefits package will tell you what you need to know. CME reimbursement isn’t usually tough to find. Enter that. How about insurances not limited to dental, vision, health, life, and disability? Maybe they cover these. Maybe they cover some or have a good rate. Malpractice is usually covered by the employer. We could have a discussion about who the lawyers are actually fighting for and if it is worth having a tail or supplemental coverage, but we are not going there today.

Any annual performance or retention bonuses? I looked at one position where they were paying each of the 3 CRNAs $50,000 annually. As they added more CRNAs, the $150,000 pot split more ways. The year prior to my application, each of the 5 CRNAs received $3,000 in performance bonuses. Hmmm… Funny enough, the year I applied, the hospital decided to do away with the bonus all together.

Profit sharing works similarly. Find out what the crew is splitting and how reliable that piece of the pie might be. Add it if applicable. And yes, I added lunch on there. I noted a discussion about whether CRNAs covered their own lunch costs on the FB page, and decided I would add it. Those costs add up, so why not be a bit more thorough. Our lunch is not covered, but we get a discount. It ends up to be about $5. Other places give out $10 daily vouchers. Big joints have a cafeteria where all of the cool kids eat. Kind of convenient I must say.

My contract is plain. It is a high base wage with unpaid call and below average benefits. They offer good health insurance at a reasonable rate, but really not much else is covered. The 3% 401(k) match is better than a kick in the pants, so I’ll take it. Speaking of -- I noted a couple positions with 15% employer retirement contribution and paid health insurance. Maybe even a pension. Sure, they had low salaries, but the total package was likely reasonable. Don’t write anything off until you run the numbers.

The bottom of the spreadsheet shows your expected hours and call hours. It includes a value for all hours, including those you spend writing your blog just waiting for OB to call. It’s up to you what those hours are worth. I’m okay with a 30-minute callback time at a lower rate because we don’t get called back in much. For the 128 hours I’m on call every 4 weeks, working 10% of those hours isn’t bad. And 5 of those hours come from finishing cases after 1500, so the 0200 epidurals aren’t a major issue. I typically make it to the gym, have my coffee, write my blog, clean up around the place, and wouldn’t be doing much else anyway. I’m ok with taking this sort of call at this point in my life, so it’s worth it. The hourly rate for me is worth it.

Along with the total hourly rate, I included a rate for actual hours worked. This number will be increasingly different the more call you take. If you are 1:12, not too bad. Anyway, input a few contracts with the hard data along with the guestimated soft data and see what you get. Is it what you thought it would be? Does it match the conversation of the Facebook pages?

One Last Important Factor

I mentioned all of the positions I looked at were small operations that clustered their callback days off. I assumed 5 weeks of vacation for myself. All other weeks would be locum weeks. I found locum rates for those areas and determined I could likely earn $8,000 on my off week.

For example, my current position has 13 weeks off – 5 for vacationing and 8 for locuming. I would then add the $8,000 * 8 weeks = $64,000 to the gross income. Positions with 5-8 weeks of PTO really suffered with this. The 1:3 and 1:4 gigs noted a rather large increase in gross income. For those of you wondering, no I don’t expect to take 5 weeks away from anesthesia. I am planning 2 weeks away for 2023, so my multiplier was conservative. Considering I take call when I pick up shifts, it is kind of sickening just how many hours I am tied to the hospital. Not a lifestyle gig -- hungry for financial independence.

This spreadsheet doesn’t include such a section for locum work because I assumed it was atypical to think this way. Feel free to add a section for locum work if it keeps your boat afloat.

Taxes

Not only did I calculate my hourly rate for 4 positions I was seriously considering, but I calculated my net hourly rate. Because there were a mix of W2 and 1099 positions in different states, I took things a bit farther. I assumed I would maximize the 401(k) or Solo401(k). This decreased by taxable income (2022) by $20,500 and $61,000 respectively. I assumed a max HSA. I then accounted for the standard deduction ($12,950 for singles, $25,900 for joint). This is my taxable income.

The 1099 jobs assumed minimal business expenses which only included my malpractice and licensure. There are significantly more deductions including milage, home office, supplies, CPA, etc., but simple worked fine here. Considering increased tax deferred accounts and business expenses – advantage here to 1099.

Knowing my taxable income, I can now calculate my federal income tax. Note the W2 crowd only pays a portion of FICA taxes instead of the entire 15.3%. Advantage W2. Then some of the states had really high state income taxes *cough* Minnesota, while others were without a state income tax (and everywhere in between). Finding take home pay for W2 income is pretty easy. Search the interwebs for “take home pay calculator” and you’ll find something close. Make sure to use your taxable income instead of gross income.

I didn’t get into the whole…LLC vs S-corp conversation for my 1099 calculations. A good CPA can work magic. This would have only tipped the scales in favor of comparable 1099 work, but a rough estimate of my net hourly rate plus investments was good enough for me. Multiple site suggest a 1099 position needs to pay 20-30% more to account for the expenses. Again, variable, but a good estimate nevertheless.

One could go even farther to look at cost of living and taxation on property, vehicles, ect…but I assumed a relatively similar cost of living in each area.

I am absolutely looking for feedback on excluded variables, inaccurate formulas, or improvements.  Please drop a comment or email if you find something. I’m hoping those searching for work can utilize this spreadsheet to aid in identifying the value of your time in any given contract.

As always, thanks for reading.