Locum CRNA: Lessons After 1 Year
I accepted my first locum contract in late 2023 and began work as a full-time locum in January of 2024. Here's what I learned after one full year of traveling as a full-time locum CRNA.
The Objective:
There were two objectives. The first being financial. We plan on minimizing expenses and maximizing investments during this time. I want the portfolio do the heavy lifting through our 40’s, 50’s, and beyond.
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Without having kids in the school system, Mrs. TFC and I agreed that there would be no better time to undertake locum work and extend the midlife crisis.
Our second objective was to travel. Neither of us had a chance to undertake travel nursing before going back to school. Locum work was our way of seeing the country on someone else's dime.
The idea was to work 48 weeks in 2024, but it ended up being 50 weeks with a few long weekends. Plus 25 weekends and 175ish days of call.
Our Situation:
We sold our house and moved back across the country with an infant and a dog to undertake locum work in the Midwest. Yep, we sold most of what we owned. We were fortunate to have a slick storage situation to house what belongings we kept. Thanks…You know who you are. This allowed us to restock on weekends if needed.
LLC Setup:
We setup an LLC in 2023. It really wasn’t bad. Like personal finance, there is a bit of up front work, but everything goes on autopilot after that.
Realistic Thoughts:
Great jobs in great places don’t need locum coverage. I, as a locum, am going to aid a staffing issue. I offer to cover whatever needs to be covered. I volunteer for every weekend and holiday. Most places don’t take me seriously when they ask how many weekends I want for the next schedule when I reply, “all of them.” I’m here to relieve staff workload. I’m here to work.
There are only a few reasons to bring in locums:
Anesthesia Contract Turnover
Staff Retention Issues
Toxic Environment
Undesirable Location
I’m of the opinion that jobs in undesirable/rural locations are the way to go. That doesn’t bother me. Maternity/Paternity/Vacation coverage is another good one, but this is short lived. Okay if you just want a few weeks. Less okay if you are trying to fill weeks.
Job Criteria:
Full-time jobs pay better in the Southwest. Locum jobs pay better in the Midwest. That’s my experience.
I had ties to two Midwest motherships I would be working with. I figured credentialing with multiple facilities would allow for a quicker transition if a job fell through. Credentialing takes months and I prepared for the worst.
I went through a recruiter and presented the criteria of independent or autonomous practice. In the Midwest, this limits options to rural and critical access facilities.
The second criteria compensation achieved by call and weekend coverage. Since we were taking the time to prioritize work and income, why not be on the clock as much as possible. And I was.
I selected the jobs during the fall of 2023. The job allowing for the most call and hours was given priority. I filled over half my schedule with Job A.
Then I looked at the next most desirable job (Job B). This again filled a large chunk of vacant weeks. There were a few weeks remaining and they were filled by a third facility (Job C).
Housing:
All of the jobs were in towns with a population under 15,000, so housing was limited. Job A, my primary location, had a short-term rental about 2 minutes from the hospital. That was awesome, especially because I was usually on call. It was a nice little two-bed, one bath place with a one stall garage for Mrs. TFC’s 4Runner.
Job B was a Monday through Friday, no call position. We stayed at a hotel, which is less than desirable with a dog. Pet rooms were on the first floor, so the walk outside was short. This cost us a $25 per night pet fee. $125 per week adds up.
Job C was a solo gig. Sunday to Sunday. This was usually a 7-night hotel stay for us.
Short-term rentals are greatly preferred when traveling as a family. They cost a bit more, but the hospital lodging stipend will often cover the price. It’s nice to have a kitchen because it gets old eating out. Plus, rentals often have a washer and dryer.
We made the hotels work, but Mrs. TFC is currently over that.
Contract Negotiations:
I have learned a great deal in this area. Enough that it would warrant its own blog post for considerations. The overarching take-home message is to remember that no one is your friend. Not the agency (if you use one). Not the hospital. Your locum work is a business…treat it as such.
Vague language will always go in favor of the agency or hospital. Be as proactive as possible to minimize the downside risk.
Firstly, ensure all dates and times are correct. What are the shift hours? Is there a daily guarantee? Is lunch paid?
Specify an overtime and callback rate. When does that rate start? What’s the response time? Is there a callback minimum?
Secondly, add some protection. What happens if shifts are cancelled? What is the required notice to end the contract? What’s the force majeure language?
Thirdly, get the numbers right. What’s the rate, callback rate, and beeper rate? What’s the weekend rate, OT rate, and callback rate? What’s the stipend situation?
Fourthly, consider these areas…Are there recognized holidays and am I paid on these days? Who covers malpractice? What’s the non-compete clause? When is payday? Who can amend the contract?
I’m rambling…Anything can be negotiated. I have become that annoying person who not only negotiates pay rates, but I also request verbiage changes within the contract if they heavily favor “the company.” I overlook a major point of every contract I sign. I learn from my mistakes and make notes.
The Job:
Despite having been in two of the three facilities previously, it had been years, and I was a student at the time.
For context, all 4 positions I worked in 2024 were at rural facilities in the Midwest spread over 3 states. I tried to limit drive time to 4 hours between jobs.
I started with Job A. At 0630 Monday morning I walked through the emergency department doors and made my way to the locker room. At 0645 they handed me the call beeper. They said, weekend call CRNA leaves at 1000 this morning to catch a flight. He will get you set up for the 0730 case.
IT will find you before 1000. They have your computer login and badge. A pharmacist will come by eventually to give you an Omnicell log in. Qualifies as hitting the ground running.
From there, it was just a matter of giving anesthesia. At this location, there were 2 CRNAs, 2 ORs running. The day was mostly bread and butter cases. Call for the week and sometimes the weekend. Callback was heavy. A great reason to have a callback minimum. I don’t know what inhibited sleep worse, a newborn baby or the hospital house supervisor.
Ended up being close to 60 billable hours per seven days plus call pay.
Job B was a nice Monday through Friday job. 0700-1500. No call, which was a bummer. This mothership didn’t pay locums any more than needed. No overtime. No call. Basically, stressed the full-time staff as much as possible to keep me off the clock.
I get it. It’s a financial thing. But that risks losing the staff that’s still around.
Job C was a solo gig. Sunday to Sunday carrying the beeper. Upon arrival, I meet the CRNA in the hospital. She hands me a badge and login credentials.
We stand in the center nurse’s station and she points down 3 separate hallways 90 degrees from each other. This is the OR. Those are the two OB rooms. That’s the ER. Then she shows me the supply closet containing the anesthesia cart. Any questions? Nope. Then she leaves town for the week.
Light surgery schedule. Callbacks for things like IV starts and emergency department sedation. Called for all codes, traumas, and anything hospital staff doesn’t feel comfortable with at a low acuity facility.
It isn’t my job as a locum to interfere with the workings of a hospital. If they were used to calling anesthesia for an IV, I responded without complaint. If they wanted anesthesia on standby for something, I was there. I did my best to be helpful and kept my unsolicited advice to myself.
The jobs were surprisingly pleasant and no one gave me a tough time for being a locum. Staff was just happy to have help.
Traveling:
Traveling sucks. A lot.
It was rare we were in a location for more than two weeks. This means we completely unpacked and repacked everything we traveled with 3 or 4 times per month.
We started by traveling with WAYYY to much stuff. It fit in my 6’ truck bed with a topper, but it was too much. We had 6 totes, duffle bag, cowboy boots, vacuum, cooler, stroller, and our pillows. We tried to make it feel like “our space” which was a mistake.
We quickly downsized to 3 duffle bags, 2 totes, vacuum, cooler, and stroller. Each family member has their own duffle filled with clothes. The totes contain a bare bones kitchen set to cook, laundry supplies, and miscellaneous items. The cooler is helpful to transport food and the few condiments we carry.
What We Changed Mid Year…
This is when we finished up with Jobs A, B, and C. Hospitals looked to fill their staffing needs internally, which meant I was on the out. I was happy to have a relationship with a few hospitals, which would provide options if a future contract fell through.
No bad taste, just business. So, we slowed down and accepted a longer contract at a single location. Job D began in August. This was something like a 20-week contract to fill out 2025.
NO MOVING WEEK TO WEEK! This saved time packing and commuting. I covered a few weekends at other places, but this was not a total moving situation.
Job D was Monday through Friday 0700-1500 with 7 days of call per month. This was a slightly larger facility, but still rural. Another pleasant site.
This hospital utilized many locums. This meant they had apartments and houses to avoid paying a lodging stipend. We were given an older house in a nice neighborhood.
The setup was really accommodating for our family and pet situation. The 20-week contract allowed us to travel heavily to this location. We had many locum luxuries. We brought our espresso maker, air fryer, and rice maker as well as our own pillows.
Staying in one location eliminated the need to eat-out during travel days. We were able to meal prep and acquired a few more condiments. It’s the little luxuries that make all the difference.
The Downside of Locum Work:
Job Instability
Actually Traveling
Unfamiliarity with Everything
Unfamiliarity with Everyone
Lack of a Home
Minimalist Lifestyle
The Upside:
Compensation
Exploring New Cities
Workplace Experiences
Networking
Going Forward:
Mrs. TFC is a great stay-at-home parent. Despite working a lot, the family spends a great deal of time together. We no longer have conflicting schedules. We are free anytime I’m off the clock. This is a definite plus.
Job autonomy is a factor that makes work enjoyable for me. Without being part of the entire perioperative scene, work isn’t the same. I enjoy performing the skills I was trained to perform. I’m sold on autonomous practice.
Compensation will continue to be a driving factor. The disparity between full-time and locum work is too great to give up. Just a few years of locum work could realistically set us up to retire. And with kids in the picture, the timeclock for working big hours has started.
Assignment duration is a major factor. Moving week-to-week is tough as a family unit. And it takes a great deal of time to pack, drive, and unpack as evidenced by my lack of blog posts during this time.
Housing is a secondary consideration for future contracts. I think Mrs. TFC is officially done with hotel stays for longer than weekend coverage. Having a place to cook has become a must. Having a house, short-term rental, loft, apartment, or suite truly makes a difference. These can be tough to find in rural areas and has influenced my decision to pass on descent assignments.
I was going to add a locum FAQ or commonly asked questions, but this post is long enough already. Maybe next time. Thanks for reading.
