Sharon, you know, obviously, as we've talked about, you gain something, you give something up. And, you know, we hit on this a little bit earlier, but we're gonna delve into what am I giving up as a W-2? I think this is an important topic that, you know, a lot of CRNAs are really worried about giving up their W-2 position, and rightly so, to go 1099. So what are you giving up? Definitely your group medical insurance. And so I went on COBRA for 18 months after I gave up my W-2 employment. And then I had to go and look for my own healthcare insurance. But I will tell you, it's a lot easier than it used to be with the healthcare marketplace. I can imagine before then, it was a lot more difficult. Yeah, I mean, you know, insurance is one of the major reasons that people don't transition to 1099, because they're really worried about that. And now the ACA it is, and there's some other options we'll cover later on. Well, just think about the history of why employers have healthcare insurance. That became a benefit after World War II, because when people were coming back and all of the industries were fighting to get employees, and that's where healthcare insurance started for workers. Look at you. Hey, just a little history. Read the social transformation of medicine, and you'll learn all about that. Yale made us read it. Well, you know, again, that's something that's given up. And, you know, we do have to be concerned about that, because that is, you know, an additional cost. That's a lot of times your employer subsidizes that health insurance premium for you. Yeah, and they get to write it off, right? Your employer. Absolutely, they get to write it off. Look, Hemer, I've learned. Yeah, you have learned a lot. So, you know, that is something that, you know, as you look to transition, we want to get a good handle on. And then we'll be talking about this later, but all these things that you're giving up have to be factored into what you're making 1099 to compensate you for it. And you have a nice little formula to be able to show that, which I can't wait for you to share with them. Yeah, your group disability insurance, and Sharon, you know, I've referred to you before as the goose that laid the golden egg. I am. You are. You know, disability, nobody worries about disability until they need it. Right. You know, and we insure everything else. We insure our cars, we insure our homes. You know, we insure a lot of different things, our life. But if you couldn't get up and go be a CRNA tomorrow, what would happen? That goose would not be golden anymore. That's very true. So and you've got to weigh that cost into doing the transition because that's a big one that I see people overlook. In fact, a lot of people don't even know about disability insurance or don't pay attention to it. I've just seen it happen throughout my career where people really, really need it and they didn't have the right type of coverage or they had not the right amount of coverage either. So your group malpractice insurance, you're giving that up typically. There are some 1099s as you've alluded to earlier that do give you the malpractice, but you will need to get your own malpractice. Your employer paid retirement plan contributions. That can be a biggie because, you know, if you're giving up that match from the employer, again, every one of these things need to be built into your equation to say, okay, is this an apples to apples comparison of what I'm actually giving up W-2 when I transitioned to 1099? Well, some would even be willing to, it'd be the same, a break-even kind of proposition, but you get the freedom. Ah, there you go. That word keeps coming up, doesn't it? Freedom. And that's gonna be, you know, as we progress more and more into the CRNA industry over the next five, 10, 15 years, I think that word and the transition of the workforce into more of a fluid workforce with, you know, a lot of freedom is gonna continue to come up for sure. Job security, well, sort of, you know, I think right now CRNAs do have a lot of job security as there's so much supply and demand imbalance, but is there really any job security anymore, Sharon? Well, I thought there would always be job security and then came COVID and I was W-2 during COVID, but I still didn't get to work because I did office-based anesthesia and they shut it down. Yeah, yep. And, you know, so there are times even with W-2 that you don't have the job security you think you might have there. So we've alluded to this before and we'll explain this in just a minute, but the FICA tax match, which is something else that, again, they don't tell you about this, so we'll go through an example here in just a minute of how that works so you understand it, but that's something you are giving up as well. And your PTO or vacation pay. I mean, everybody wants to take a vacation, right, Sharon? That is true. But, you know, if you're 1099 versus W-2, you just eat what you kill, so vacation time. Vacation time, they don't pay you for that if you're 1099. No, they don't. Reimbursement, you know, or meeting money, you know, none of that is there, so- Well, not a lot is there anyway for CRNAs anymore. They took it away and not every place has reinstated educational reimbursement, but, you know, you can't write your educational stuff off as a W-2. I can as a 1099 and I do. Yep, yep, that's a great point. And it might be in Australia for the IFNA meeting in 2026. Oh, there you go, there you go. That's a business reason for being there, right, IFNA? Absolutely. But you've got to factor in all these things. As you look at transitioning, you've got to look at each one of these and you've got to break this down into an actual dollar figure. What is this worth to me in my situation? I've got to go out to the marketplace and I've got to purchase my own medical insurance. What is it going to cost me? It's going to cost me $1,800 for me and my family and right now it costs me 500. That's $1,300 additional a month that it's going to cost you. Right. What is my group disability going to cost? Well, you're not going to have group disability anymore. You're going to have your own personal disability policy. What's that going to cost in comparison? And break every one of these things down into a quantifiable number. So, I mentioned a few minutes ago, the FICA match and I want to just kind of break this down for you a little bit because a lot of people don't understand how this works. So there's two sides to FICA, all right. You've got social security and you've got Medicare and social security is 6.2% from the employee and 6.2% from the employer for a total of 12.4%. Sharon, that's the one that stops at a certain wage limit and this year that's $160,200, okay. Well, I can remember when it was a lot lower than that. This is where we're getting some sneaky taxes in here and nobody is talking about it. I mean, take a look at the difference between 2022 and 2023. That number went up $13,200. Close to 9% increase right there in social security taxes. Nobody's talking about it. It's a sneaky way to get that extra tax in there to build up social security that nobody's talking about. You know, there's a lot of people that say that should be unlimited. Doesn't matter how much money you make, you should be paying social security. What do you think about that, Sharon? Well, I do know that when social security first started, there were 17 workers for every one person on social security and I think the last I read, it was four people supported one versus 17. So they're gonna have to do something. I don't necessarily agree with that, but you're being penalized. And then, you know, the whole question, is it even going to be there? Well, you know, I truly believe social security will be there. I think it'll be in a different fashion than it is today, but I think it will be around for us, you know, and there's gonna be a lot that goes into that between now and the next 20 years, but the maximum per year, as you can see, is 99.32 a piece. So right at $20,000 a year, if you max out the wage base, which almost 100% of our CRNAs do, go into the social security system for them. Sharon, think about that. Think if you worked for 30 years and you put $20,000 a year into that system. That's $600,000. Yes. So if you extrapolate that out and you say $600,000 over 30 years, and it probably wasn't 600, but let's just say that in this case it is, you know, and you added a factor in there, the increase from investments or investable assets there, you know, social security is over a million dollar benefit for most people. Well, that's if you live long enough. Well, right, but the average person, if you take the averages for most CRNAs, social security is going to be, you know, close to a million dollar benefit. Well, that's pretty nice. Well, with my mother-in-law, who's bumping up against 92, she has taken out far more than she ever put in. She's beat the system. Yes, she has. She's beat the system. And she continues to do so. I was going to say, Helen has a way of beating the system. Yes, she does. She doesn't call it energizer money. She's got it. Yes, she does. And then the other side is the Medicare taxes. And Medicare is 1.45 and 1.45 for a total of 2.9%. Now, there is no earnings cap on Medicare. So if you make half a million dollars, you pay that 2.9 on the whole half a million. So the total is 15.3%. The one note here is that just remember, you've got to factor in that extra cost, and you see the employer portion of social security up there, $9,932.40 plus the 1.45% on however much you made. Remember, your employer would have been matching that. Right. You have to pay that yourself. So that has to go into your calculation as well. And I know people are sitting out there going, well, gosh, we're paying extra taxes doing 1099. Why would we ever do it? Just stay tuned. Mm-hmm, and there's more.

transitioning

W-2 position

1099 position

CRNA

financial implications