My current Chief CRNA openly speaks to being proficient in delivering anesthesia and making difficult tasks appear easy. He recounts multiple instances where magic carpet hallway folks (executives) approach him about adding cases or services. He always responds, “We can do it.”

He means that the CRNAs can perform the services necessary to handle the patient load. Keep in mind, this is a small critical access hospital (CAH) with the limited and outdated resources one would expect at such an establishment.

There are instances where he says, “it is possible, but should we do it?” – looking at you VBACs. For several reasons, it is not worth the risk and manpower for our CAH to accept 1-2 VBACs per year.

BMI limit, nope. Vascular cases, sure. VATS, not a problem for anesthesia.  ASA III+, are there other options? EF 10-15%, just another day at the office. We create a safe anesthetic plan and implement it. We deliver. Looking pretty isn’t a requirement, but we will get it done. We do our best to make it look easy, but we don’t hide the fact that our training didn’t happen overnight.

We don’t hide the many considerations and limitations for such acute patients. We don’t brag or gloat, we just get the job done.

When they call for an IV start saying they have looked with an ultrasound and didn’t see anything -- but somehow multiple viable vessels magically appear when anesthesia holds the probe. I’m sure we have all been on both sides of the situation.

Remember when every intubation with the butterknife was difficult, but somehow everyone else could sweep the tongue and put the tube through the uprights like it was their job? I couldn’t resist the polarizing topic of blade selection.

Anyway, the same is true with personal finance. The successful often make it look easy, but like an iceberg, there is a lot hidden beneath the surface.

An Upper-Class Upbringing

For those of you with a private education, equestrian-filled, 20-foot fountain in the front yard surrounded by immaculately kept hedges upbringing, a CRNA income is still respectable. I’m sure bougie families would disagree, but they don’t read obscure financial blogs, so we are okay.

And no matter your background, you must dedicate time and effort to becoming a CRNA. Good for you no matter what your rich family says.

Everyone else and their upbringing

For anyone raised in a lower- or middle-class family, the average CRNA income is HUGE. 200,000 Washingtons annually. Respectable on all scales, but especially compared to low- or middle-income earners.

When someone learns you are an ether bunny, you become the “big money guy.” High roller. Fat stacks. Somehow the effort to obtain such a status and income is omitted from the conversation.

They forget how I studied and worked as an SRNA for 3 years while paying a massive tuition bill. They forget how I gave up all of my hobbies because I couldn’t get away from the books. They forget how living like a backpack toting nomad during clinical rotations sucks. They forget how much stress comes with providing anesthesia. They forget how personal relationships suffer because there is significantly less time to devote to developing connections.

All they know -- the dollar is good.

 Even now, many in my inner circle don’t understand that I can’t just take time off. My well-compensated position at an independent practice doesn’t allow me to just take off on a Friday. Or allow me to be sick.

Recent example

Mrs. TFC and I recently purchased combined $1,600 airline tickets instead of $600 tickets because of our (my) limited time off. The flight needed to leave Saturday morning and return Sunday evening. Yep, a 26-hour trip or nothing.

We met our family obligations, but no one understood why I couldn’t just take off a few more days. They don’t understand that I have two weekends off per month. 4 days off per month. That’s it. And no, we didn’t tell them how expensive the tickets were. Not something to be open about.

Lifestyle change

Now that the money is flowing and the accounts are growing for the first time in years, the inquiries are starting up again. Most income goes towards taxes and investments, but we did part some out for a house and a new vehicle (Mrs. TFC’s 4Runner coming soon).

Our discreet lifestyle allows us to fly under the radar, but those close to us know what we do for work. I don’t talk about income specifics with family or friends. But when questions show up around affording our lifestyle, I regularly remind them that…

 I work a lot. I carry the beeper a lot. Roughly 230ish days this year. And I practice to the top of my scope. Without backup. In the middle of nowhere.

The stress and undesirables are too much for the average bear. So yeah, I’m paid well, but it comes at the aforementioned cost.

Am I bragging? No. There are plenty of others who can do what I do.

Are there people who are willing to move 1,500 miles to the deserts of Arizona to give anesthesia? Yes, but not many as we are still short-staffed.

Put everything together and you get a money-hungry cowboy CRNA writing a financial blog in the desert who is married to his work.

It takes a great deal of hard work, ability, training, sacrifice, and luck to end up where I have.

Relating to the personal finance side of the blog…

Like becoming a CRNA, success with money doesn’t just happen. I would argue that on paper it is quite easy to be successful with money, especially as a CRNA, but implementation is another story. A tortoise and the hare type scenario.

Personal finance on easy mode boils down to a few principles and if followed over a lifetime, success is inevitable.

1.      Live well below your means.

2.      Pay off debt.

3.      Don’t overspend on liabilities.

4.      Invest in low-cost index funds.

Sure, there is nuance, but that’s the gist. So, you pay off your student loans in 6 years instead of 3. Fine. Your investments average 6% instead of 10%. Fine. You are only saving 20% instead of 40%. Fine. You will get there. Financial independence will be yours.

Does it help to optimize – yep. Essential for success – nope. If you could make it through school, you can wrap your head around the basic principles of financial success.

The hare crossed the starting line with enthusiasm but didn’t have the bigger picture in mind. He didn’t stay the course. Start like the hare out of anesthesia school and transition to tortoise mode after the high-interest debt is gone. Consistency over the course prevails.

Success requires effort.

We have all heard of monetary windfalls leading to bankruptcies. We all know the stereotypes of physicians, pharmacists, PAs, NPs, and yes, CRNAs receiving their windfall salaries after graduation and remaining poor forever. Paycheck-to-paycheck for life.

As with your anesthesia journey and income, don’t let onlooker comments get the best of you. It takes effort to adhere to financial principles. It takes effort to transition from a poor SRNA to a disciplined CRNA who no longer spends every dime from their Grad PLUS stipend.

It takes serious effort to say, “You know what, I think I’ll put some money into my 401(k) and HSA.” The average savings rate in America is 3.5%.

Working-class folks save 10-12%, which includes their employer match. Saving 10% of the average $50,000 salary doesn’t get you far. At least not CRNA far.

To play with the big dogs, you need a respectable savings rate month after month. Consistently investing 25-50% of every paycheck. It’s not easy to see that money and not spend it.

Spread the word.

When folks make comments about how you are making bank, remind them about the self-investment and opportunity cost of becoming a CRNA. Remind them of the discipline to put away tens or hundreds of thousands per year. The restraint to resist the sales pitch of every mortgage broker saying you can buy a $2M house.

Then provide solicited help where you are able.

I have told many about the benefits of becoming a CRNA. What a great investment in yourself. Serving a community. A fulfilling profession. And an income to support a family. Wealth to fund worthy causes.

I love my job. It’s heavy. It’s demanding. It inhibits experiences and strains relationships. But I love giving anesthesia.

Promoting the Profession

A travel nurse was saying she was looking to leave the bedside. She wanted something sustainable. A job where she could settle down. My answer – Go back to CRNA school. You are young and traveled to high level trauma centers. Fargo of all places. Becoming a CRNA meets your criteria of sustainable, versatile, and highly compensated.

CRNA peer critics

Perhaps fellow CRNAs criticizing your financial success would be open to financial assistance. Ask if they want a battle buddy. There are not a limited number of people who can be successful, so invite your friends to join.

 Perhaps budgeting is a foreign concept worth investigating. Do they trade shares of SPY for designer clothes? The chest of cash buried in the back yard could find a new home to avoid being eaten by inflation and mold. Escobar struggled with rats eating his money, but probably mold too.

Remind them it wasn’t without effort and sacrifice to arrive at your destination. Elite athletes are gifted, but you don’t reach the Olympics without serious dedication. They train like the hare AND have the focus of the tortoise.

I applaud those of you doing well. If you are a work in progress, I’ll break out some sparkly pom poms and be your biggest cheerleader.

Horn-tooting Ahead!

Mrs. TFC and I just ran our monthly finances and reached a major net worth milestone. It isn’t FI and it isn’t much compared to some of you out there, but it’s big for us. Big for a couple young punks starting their careers.

And bigger yet, it puts us ahead of OUR pace, which is admittedly quite aggressive.

Even naturally talented, skilled, and lucky individuals need to put forth a great deal of effort to stand a chance at becoming an expert. There is no reason to hide your efforts on the path to greatness.