Well, Sharon, today we're going to be talking about the risks of being a 1099 CRNA, because there are certain risks that you do take on when you become an independent contractor. As you well know, it can be lucrative and rewarding, but making sure that you understand that, not to put your future in jeopardy, is kind of the theme of today's talk. So, you know, some of the responsibilities of being an independent contractor is one, you know, it's a benefit and it's a responsibility. You've got greater control over your schedule, but you've got greater control over your schedule. That also means that there might be times that you get called off the day before, and you're not working that day, and you had planned to do it and now there's not enough time for you to get another job. And potentially you were counting on that income. I know a lot of CRNAs do. So that's one, you're going to provide your own benefits. And we've talked about this before, purchasing and maintaining your own disability insurance, your health insurance, those are big ones, and your retirement plans. And then you're also going to have to exercise your professional judgment, you know, which position, what facilities are right for you. Sharon, you've worked in different facilities, you've worked with different positions, you've worked in different operating rooms, and you know that there are times that you've been put in situations that really weren't right for you because they wanted you to do things that you didn't feel comfortable doing. I think that's a big responsibility of a 1099 is to figure out where do I fit? You know, where can I best use my professional judgment in this scenario? Well, there are additional risks, you know, legal liability. You know, obviously, if you're shooting for malpractice, you know, hopefully you've got the right malpractice policy in place, but you could potentially still have to defend yourself in court. Yes, if you've got the right malpractice policy, you should be assigned an attorney. But having to go through this process takes time. Sharon, do you get paid based upon the amount of time you're in the operating room? Yes, so if you had to go to court on the day that you were scheduled to work and you didn't work, do you still get paid? No, because as 1099, you eat what you kill. That's right. So the time that you're out of work, you would not be getting paid for. So mitigating that and making sure you've got the right liability insurance in place is going to be a key. Financial liability, as we just talked about, you know, you're in charge. You're covering all your expenses, all your taxes, everything. You're taking care of your family. You're paying your car payment, your house payment. That's the reason people get up and go to work every day, right? And as we said a minute ago, if you cannot work or you do not work, or you get called off that day for some reason, or the cases, you know, some people don't get paid by the day. They get paid by the hour. The case is finished at 10 and they send you home. If you don't have a minimum in there, again, it goes back to negotiating that contract. You know, you don't get paid. So if you get sick, you don't get paid. If you can't go to work, if you can't find work, you don't get paid. These are all risks that you face as an independent contractor. Now, right now, it's a great time to be a 1099 independent contractor. But Sharon, you've been around the industry for a little while. I've been around for a little while. It's one thing that we know is that it does this. It ebbs and flows. And right now is a great time, but there could come a time, kind of like COVID. I remember during COVID, CRNAs weren't working. I had CRNAs that are making 400,000 plus a year. They missed a week, two weeks, three weeks, four weeks of work. And they didn't know how they were gonna pay their bills. And there are a lot of people walking around out there that rely on that income and spend that income. So there are risks when you're a 1099. These are just a few that you'll face. What we find ourselves in right now is going to last a pretty good while. Yeah, no, I agree. And I think we've had these conversations with other folks in the industry. And I think if you just look at where we are, scope of practice is improving, the aging population, more emphasis on utilizing CRNAs, the downward pressure on the cost of anesthesia, as we're seeing more and more. And I think all those things you're right lead us to believe that the future looks pretty bright for CRNAs right now. So minimizing your risk, we've talked about this before, making sure you've got the right amount of practice, consulting with an accountant and an attorney to make sure you're prepared for all the tax consequences and potential legal obligations you have as an independent contractor. And they're adding more and more obligations each year. We just had some stuff come down not too long ago that every single business owner in the country is going to have to register for. And most accountants probably aren't gonna take the legal liability of that. It's either gonna be you, and if you mess it up, the fines are pretty intense. Maybe some attorneys will wanna do it and take on that legal liability, but we're not getting less regulation, we're getting more and more. And then documenting all interactions that you have, not only with patients, but facilities, if you have a problem or an issue, making sure that you're documenting that and keeping up with that. I know that as CRNAs, you do document a lot, but if something is not going the way you think it should be going in a particular environment, make sure you document that. Dates, times, people, who was around, what was going on. I'm a big documenter. When I talk to people, I talk to them on their cell phone. We talked for 11 minutes. They told me their kid was going to baseball practice that day. I get very detailed when I document stuff. The doctor had on a green shirt with some crazy white funky shoes that Uncle Eddie wore on Christmas vacation. Again, document, right? Those are the things to do. And the legal counseling, we talked about this. A medical attorney can help you understand your legal responsibilities. Not only that, your contracts, making sure that you've got your contracts reviewed. I've told this story before. Sarah, my wife, we had a contract. And once we really figured out what was in that contract, the provider had lost the contract with the facility. Someone else came in and stepped in. She could no longer work there for 24 months. She liked working there. She liked the docs, they liked her. But the new group came in and they didn't want any part of that. They said, nope, you're gone. She didn't really understand that. Making sure you understand those non-competes and what that means for you and so forth. Getting financial guidance. A financial advisor and accountant can kind of help you manage those expenses, prepare your taxes, help you make investment decisions and really plan for your future. So many times people are transitioning to 1099. They want to make sure, one, that it's worth it. Am I going to make more money? After all the expenses and all I've got to do, am I really going to make more money? They want to understand that. Am I really going to be able to pay off my student loans faster by doing 1099? Am I really going to be able to retire earlier? Am I really going to be able to catch up on retirement? These are things that people need answers to. And then what are the industry best practices, Sharon? You're such an icon in the CRNA world and you've been around and people know you and you know where to get the answers. It's one thing I know about you is Sharon's going to get the answer come hell or high water. But a lot of people don't. Connecting with the professional organization, either at the state level or the national level at ANA, to make sure that they're understanding the changes in the industry. What's going on? What's accepted practice? Where are there opportunities out there? We've talked about this before. What is the average going rate for a 1099? What are the litigations that we're seeing? I know Brett does a whole presentation on that talking about CRNAs that have done 1099 and gotten themselves in situations they shouldn't have been. So staying up to date with policy and regulations and so forth, I think, are definitely keys. So I think the idea behind this section is just to make sure, one, that you're being proactive in managing these risks because there are risks when you go 1099. Not that they cannot be overcome, not that they can't be quelled enough to this is not worth it, but it is. But just making sure you understand that. Helping, getting help from professionals that do this day in and day out, staying up on the industry standards. As we talked about earlier, Sharon, that was kind of a good lead in, 1099 contracted CRNA work is definitely, we're on the upswing of that right now. Being well-informed and understanding the risks, you're gonna get more opportunities out there. More and more CRNAs are doing 1099. Just familiarize yourself with what's going on in the industry and what you need to be doing.

1099 CRNA

risks

independent contractor

scheduling control

mitigating risks