In the post, The Job Search, I spoke to my criteria in choosing my first job out of school. My priorities were as follows:

1.      Type of work – Max scope of practice. Truly not negotiable.

2.      Compensation – High. Yep, I said it. Close second.

3.      Work Schedule – Total hours per week/time off. Distant third.

4.      Location – Warmer than where we are now. More of a bonus.

This is a straight cut and paste overview from the post that doesn’t provide a great deal of rationale. If you want to read about why I chose these 4 as my selection criteria, here is the link to that post.

Type of Work

I don’t think any of us ignore this aspect of a job. I was looking for an independent practice with a full scope. And a job that actually used the full scope.

Type of work might mean ACT vs independent vs solo. It may be setting based such as hospital vs surgical center. Maybe endoscopy cases only. Because there are so many factors included in “type of work,” I’ll leave it to the individual to determine what this means.

Compensation

Again, I know this at least crosses everyone’s’ mind. And that’s okay. Money is a tool, and it affords access to various opportunities. Nothing wrong with this being high or low on your priority list. Enough said.

Some jobs have great benefits, others are cash heavy. Consider total compensation per hour worked. Prioritize the package that aligns with your objectives.

Benefits

Health insurance is a big one. Insurance on the open market is expensive. If you work at a place that has a group rate, the difference can be significant. W-2 positions typically have significant benefits including various insurance offerings, retirement accounts or pensions, malpractice coverage, and health savings accounts among other things.

W-2 vs 1099

W-2 simply means one is employed. This position is straight forward and common at larger facilities. Benefits are typically included. Taxes are automatically withheld, so filing is relatively easy. Viable option for those looking to put their taxation on autopilot. Click here to read a blog about W-2 vs 1099.

There is a shift to more 1099 independent contractor positions out there. At the simplest level, one can be a sole proprietor or establish a limited liability corporation. Independent contractors need to be acutely aware of tax laws to make the most out of the available advantages.

Business expenses allow for a lower effective tax rate, thus getting more bang for your buck. This doesn’t come without hassle. And I would encourage partnering with a CPA because there is quite a bit of gray around the business side of being a contractor for those looking to maximize the advantages.

Responsibilities

ACT vs independent vs solo. Consider general autonomy and responsibilities within each system. Strict ACT practices may limit CRNAs to intubating patients and running the room. Other ACT practices may allow for significantly more opportunities, which translates to liability.

Independent practices may allow for a full scope, but how often does one perform the full scope of practice? Solo providers are just that. Best to have your ducks aligned.

There is no right or wrong. Not everyone wants to perform regional blocks or mange OB patients. Not everyone wants to work in a CVOR doing hearts all day. Not everyone wants to be alone with minimal resources. There is nothing to say you can’t switch after a time.

Work Schedule

When I examined “work schedule,” it was about time off to locum. I wanted to stack callback days to locum 1 week at a time.

Most people consider work schedule to include nights, weekends, and call shifts. Maybe work structure is a better word than schedule. I know jobs that require significant call, but guarantee the post call day off. They typically include 4-5 additional weeks off per year. That’s significant time off, but it’s spread out.

For someone not looking to locum, that 4-day workweek plus PTO may be appealing.

Similarly, a surgical center schedule may have no call, no nights, no weekends, but very little PTO. Plan on working the 260ish working days per year. It’s a great structure and allows you to see your kids every night.

Vicinity

Probably a big one for many. This may be proximity to friends or family. Perhaps your spouse has a job in a certain area. Certainly, school systems are more desirable in some areas than others.

Let’s not forget about the commute. I know many who refuse a long commute, but there are plenty who do it. Consider airport access for those weeks off. An international airport will fly directly to your destination, where a regional airport will cost you a full day of travel each way.

Entertainment is another consideration. If you choose to stay in the city on your off weeks, you will likely be looking for places to eat, things to do, and venues to shop.

Desirable Location

I’m thinking about places that have a “sunshine tax.” Maybe those little islands in the Pacific. Beachfront property is pretty desirable. Anywhere that avoids the frigid cold of the winter is on the list for many.

Too many specifics to list, but if you go to a place with a high supply of CRNAs, expect other aspects of the job to take a hit. I’m thinking Hawaii and tropical Florida for starters. Urban areas of California and New York are expensive but pay above average. Accounting for taxation and cost of living, I would still consider them to have a location tax.

Job Security

We would all like to think our jobs are secure, but reality begs to differ. I would assume hospital employees are the most secure while locums, PRN employees, and small groups are the least secure. Ask around to learn as much as you can prior to accepting a position.

The hospital at which I practice has experienced regular turnover in the past 10 years. Not just with individual providers, but who holds the contract. High amounts of locums to fill the gaps. All the more reason to handle your finances and set aside an emergency fund.

Company Reputation and Culture

Are CRNAs under med staff or the Director of Nursing? Do CRNAs have voting rights? Are you looked at as a provider or a peasant? Does your professional opinion carry weight? Do you have access to the physician lounge and physician parking? Do the RNs respect you?

Purely anecdotal, but I found small facilities welcome CRNAs a bit more than the trauma centers. Probably because CRNAs are the only anesthesia providers, so there isn’t much competition.

That being said, I was not treated well by a particular small rural hospital during my interview process. I applied and had not heard back for 2 months. As someone who was waiting to apply for other positions, it would have been nice to know the vacancy had been filled shortly after I applied. Shame of it is, Mrs. TFC worked there at the time.

Guess that goes to show one should evaluate each facility by asking the right questions.

At the end of the day, there are CRNA openings in a variety of urban and rural areas coast to coast. Each with their unique pros and cons. Even less ideal jobs are far better than what most professions have to offer, so it’s truly tough to go wrong.

There are surely more criteria out there, but if you select a few from this list as “top priority”, it’s a great start.

Happy job hunting and thanks for reading!