How Finances Influenced My Job Selection

Money is a tool -- the currency of modern times. Both in the literal and figurative sense. Literally trade money for goods and services. Or use money to buy time, security, and comforts.

Don’t discuss money. Don’t share your salary. Keep all things money to yourself. Well, that way of thinking is a sure-fire way to start at step 1 of all things personal finance.

While studying medicine, we examine the previous generations. What went well? What was a good attempt that came up short? Why forfeit potential gains by refusing to learn from others?

Financial success isn’t a zero-sum game. Hence why I started this blog. I’m a realist and my advice is far from perfect. I like to think The Financial Cocktail leaves readers in a better place than where they started. Be that accepting advice found in the blog posts and other times deeming ideas too ridiculous. Confirmation that current practice is sufficient.  

Juice Worth the Squeeze

I wrote about job selection criteria. And it has a part II. Practice type found itself atop the list of priorities, but compensation was a close second. How and why did compensation earn such a high position on the list?

The opportunity cost of becoming a CRNA is high. Insanely high by most standards. Just how high? In my case, $550,000 and three years. This is likely on the low end for most who also went the doctoral route.

And this doesn’t include the entire opportunity cost from high school. This only examines the opportunity cost of an RN transitioning to CRNA. The real cost is far greater.

Why $550,000? This accounts for missed wages of $125,000 per year. That’s not what I made at the time, but if anesthesia wasn’t in the cards, I would have been travel nursing. My baseline prior to anesthesia school was working straight weekends which carried a premium. And I wasn’t afraid to pick up shifts.

$125,000 annually isn’t a stretch with what travel nurses make these days. And I was in school when the COVID healthcare shortage reared its ugly head. Big dollars were doable, not desirable. This also means $125,000 annually may be an underestimate.

Then we have education costs. Nearly all of the CRNA programs had transitioned to doctoral level when I was applying. This translates to a full three years of training, plus VERY expensive credits. About $100,000 in tuition alone. Throw in some fees and you are well over half a million dollars.

Ultimately, becoming a CRNA is/was a self-investment in many ways. Higher earning potential for one. I added working years because the workload shifts from the low back to between the ears. Despite a potentially longer career, I am impatient and desired a timely return on my investment.

The Break-Even Point

Here is what the $125,000 annually earning RN look like compared to the opportunity cost of becoming a CRNA at age 28. Assume that CRNA earns the profession average of $200,000 annually. The break-even point is 8 years. Age 36 in my case.

No debt or interest on the graph because I didn’t have any loans. I’m aware this comparison is between a top tier earning RN and a 50th percentile earning W2 CRNA. Oversimplified, but illustrates the point.

This basically told me an average compensation package wasn’t for me. Not for what I’m setting out to achieve financially. Sure, the slope is much steeper as a CRNA, but I could do better.

Fortunately, my job search priority led me to positions that generally paid at or above average. Rural, independent CRNA jobs. From there, it was a matter of assessing various jobs on a number of other criteria such as call, average hours worked, frequency of skills, and many more found in the blog post linked above.

Get While the Gettin’s Good

CRNA compensation is fragile. I know there have been predictions for decades now that speak to the extinction of the profession and they have been far from how reality played out. But, I do take note of the factors at play.

Employee compensation is based around productivity. Productivity is measured by generated revenue. AKA, how much value one brings to the marketplace.

CRNAs are important in many ways, but the value generated in the marketplace depends primarily on reimbursement. There have already been a couple insurance companies decreasing CRNA reimbursement. If this happens across the board, CRNA compensation will match the tide.

Compensation is not directly related to importance. Step back from healthcare and look at our service men and women. Don’t forget about first responders. Incredible work, but none of these professions are paid what CRNAs make.

I passionately believe providers who see patients in the clinic and focus on primary prevention are extremely important. Early detection improves standard of living and ultimately decreases medical costs over the lifespan.

Mrs. TFC worked as a Nurse Practitioner in a rural clinic and acute care. Her work impacted society far more than mine, but she was paid far less. All thanks to reimbursement.

Take those docs, NPs, and PAs working in the clinics. Now compare them to dermatologists and orthodontists who don’t play nearly the crucial role in society, yet their average compensation is 10x of their clinic provider brethren.

It’s not up to me to determine reimbursement. And quite frankly, I don’t want to. Way too many moving parts. I simply note that CRNAs are reimbursed well for providing a service. I was reading that the average CRNA generates something to the tune of $1.7M in annual billings. Collections is a whole other animal, but you get the idea.

Take it one step further and say the MDA/AA combo replaces CRNAs. Or augmented intelligence replaces all anesthesia providers. Now CRNAs have difficulties finding work and therefore do not generate revenue. It sounds unlikely now, but the future is a tough one to read.

One day, external factors well beyond my control may decrease reimbursement and therefore compensation. Not to mention the infinite possibilities of internal factors that may influence life’s trajectory. So I’m taking advantage of the situation and stockpiling money like the opportunity won’t be there tomorrow.

Young, Wild, and Free

Mrs. TFC and I started our journey as DINKs (dual income, no kids). Because graduate school entered both of our lives early, extensive traveling wasn’t in the cards. Trips, sure – living elsewhere, not so much.

Either way, we were not opposed to relocating for work. That is an advantage of being without kids. Aspects of an area such as school systems and community are not pressing issues. This being said, there will be a day when we decide to settle down. The job “priority list” will change. And actually, some of those changes have crept in.

During my time as an SRNA, I made it a point to ask preceptors why they worked their respective job. The urban trauma center CRNAs overwhelmingly said, it’s a lifestyle job.

They are in the city. Minimal call. If there was call, it was in-house paid hour-for-hour towards their 40 hours per week. Everything was shift work, so the CRNA parent was available to pick up their child from school every day. And a lack of beeper time meant they could attend the orchestra concerts and soccer games.

But at what cost?

Most of the rural CRNAs were paid better. They loved the autonomy. No relief from the night shift when you room runs late. And let’s not forget the call. Significant call, usually between 10 and 17 weeks annually. That’s a lot of time when you can possibly attend a soccer game but may be called away. Not to mention you can’t make the away games during those weeks.

After working at an independent/solo practice, I get it. I missed major events, family reunions, and most holiday gatherings. And the few major events Mrs. TFC and I attended such as baptisms and funerals weren’t that easy to pull off. We would fly out on Saturday morning and return Sunday afternoon.

Not ideal. Not much of a break from work. Really a ball buster when I average 4 days off per month. Yep, every other weekend away from work.

Anyway, all of this — move across the country and unintentionally do nothing but work — stuff won’t fly forever. At least not for us. We are accepting of undesirable positions that pay well to build a nest egg. This requires the discipline to set aside dollars and not just spend all willy-nilly like. If there isn’t a healthy brokerage account to show for the sacrifices, it would defeat the purpose.

I sense questions arising about, don’t you feel like you are missing out? Not really. Mrs. TFC and I decided to set aside a few years for work in order to have immense flexibility down the road. We spend quality time together, not quantity time. We make the most of when we have time together.

We both find purpose in our work. I genuinely look forward to Mondays. Down the road, I may not have the passion for giving anesthesia. And if/when that day comes, I don’t want to be living my life on payments where I need to suffer through a job I REALLY don’t want. The pros and cons of delayed gratification really deserves its own blog entry.

When I started my anesthesia journey nearly 15 years ago…that makes me feel old…I was hoping for 10 great years as a CRNA. 10 years to do great work. 10 years to make an impact and have significant purpose. 10 years to earn enough to support a family for a lifetime. And thus far, the profession has not let me down.