Well, Sharon, today we're going to understand the difference between being W2, PRN, and 1099. You know, I find a lot of times that CRNAs really don't understand the differences. Well, I think they know definitely what a W2 is. The other things are a little murky. Yeah, I think they understand the generalized concepts of it. But how does it all fit into their particular situation? And really, we want to break that down today. And some of this seems a little basic, but you'd be surprised how many people really don't understand it and get it. So as we get into this today, I know that you'd be in 1099 now and coming from the W2 world. And you've worked PRN. You'll be able to speak to all three of these situations. Yes, I will. So, you know, we'll just kind of break it down. You know, when you're a W2 employee, what does that mean to you, Sharon? Well, that I have a locker at the same place every day. Very true. And you know what? The way I kind of describe that is, you know, that's the CRNA that, you know, they do like to go to the same place every day and work with the same people. Sometimes park in the same parking spot and get really mad if somebody else is parking in their parking spot. That is true. You know, it's a regular schedule, a regular work location. And, you know, overwhelmingly, the majority of CRNAs, this is how they work. You know, I would say it's upwards of 80%, 85% of CRNAs every day work as a W2 employee. There are some pretty big differences, though. You know, when you're a W2 employee, your employer tells you when you have to be at work. They tell you when you can be off. They tell you what room you've got to be in at what time. And they furnish you with drugs and everything else that goes along with being a W2 employee. But you also get benefits for being a W2 employee. One of the ones that you get is employer-paid Medicare and Social Security taxes. And we'll break that down in another segment here. But that basically is the equivalent of 7.65% of your hourly rate, subject to a cap, is paid into employer Medicare and Social Security taxes for you. Sharon, you ever been working, and then all of a sudden your paycheck got bigger at a later part in the year? Oh, yes, whenever you reach the cap for Medicare. Yeah, Medicare. That's changed over the years. What's the breakdown now? What's the limits? And it's changed several times over the last few years. It changes every single year, Sharon. And nobody's really talking about it. And Medicare, remember, is unlimited. Medicare, no matter how much money you make, you pay that. It's the Social Security portion that breaks off at certain limits. And that's been increasing dramatically throughout the years. Another thing that you get when you're a W2 employee is benefits, such as vacation or PTO. Depending upon how long you've been there, you get longer vacation schedule. You might get a better schedule throughout the week and so forth. So you can rise up in seniority there as well. You get your insurances, which is a big point for people, especially if you're considering transition to the 1099. And I know, Sharon, in your particular case, that was a big deal. It was a very big deal for me. Yeah. And I think it is for most CRNAs. Health insurance is one of the biggest reasons people stay at their W2 positions. Either the cost of it or they're worried about they might not be able to get as good a coverage as they got. You also get your disability insurance there, which, as a CRNA, especially as you age, can be pretty expensive. You get your malpractice covered as well. You're under a group malpractice policy throughout your employer as well. And you get probably a lot of other benefits that we're not going to delve into at the moment. You also get retirement contributions matched in a lot of cases in the retirement plan. And there could be some other benefits there as well. Yeah. Well, I will tell you one of the things that kept me in W2 employment at one particular institution was we were in a group with the anesthesiologist. And whatever retirement contributions, percentage-wise, they did for themselves, they had to do for us because we were grouped together. So they really had a high percentage for themselves. So they had to do it for us. There you go. And that's another reason to stay W2 as well. The downside is that you really have very little scheduling flexibility or control in that schedule. And as you'll hear me say a lot about CRNAs, I know none of you want to be in control. You're all type B personalities. Nobody wants control, right, Sharon? Right. Well, I will give you an example. If you work with good people, it's extremely helpful. When I was a AANA president, I was a W2 employee. And I worked for a CRNA-owned company. And he was very good about letting me be a AANA president. Of course, I went to a part-time mode. But then if something changed and I need to be in Washington, DC, they would make sure that somebody covered me. And that just meant that all my colleagues were willing to help out. So even though I was a W2, even though I was just part-time, my colleagues helped me immensely with the scheduling that if I would have been somewhere else would probably not been an easy thing for me to do. Very true. Very true. There are some flexibility out there in some positions for sure. Another thing I hear from a lot of W2 employees is that they get caught up in the politics of the hospital or the facility. That's right. And you go to the same place every day, you work with the same people, you get stuck in those rumor mills, you get stuck in the politics that goes along with that place. And sometimes that's a real big turmoil for CRNAs. That is true. Yeah, so again, W2 employees, just want to make sure everybody understands the difference. And then, Cheryl, let's switch over and talk about PRN. You've worked PRN before. I did that many years. And basically, that just means as we need you, right? We'll call you if we need you type of thing. And PRN is a little bit different in the fact that you don't have the steady employment. It is on an as-needed basis, no guaranteed hours. But you're still considered W2 as a PRN, which is interesting because they do match your FICA taxes, your Social Security, and your Medicare. Usually, that's about the extent of any benefits you get as a PRN. Every once in a while, I've seen some retirement benefits for PRN. But not very often do I see that. In fact, that's probably less than 5% of the time. Actually, I did have some retirement benefits. Whenever I left the CRNA-owned company and went as a 1099 contractor, but because I had worked for them for 16 years, they still wrote me back in as PRN when I still worked for them occasionally. And I had retirement benefits. But for me, that was a plus. Yeah, absolutely. And that is very seldom seen in the PRN world. Typically, your malpractice is provided by the group or hospital, whoever you're working for there. But because you're not getting benefits, per se, 401k match, health insurance, those type of things, you typically get a higher rate of pay as a PRN than you do as a W2 employee. And then back to that favorite word again, control. You do have some flexibility and control as to when you work as PRN. I got to say my favorite word then, no. Whereas whenever I worked full time as a W2, they called me and said, hey, Sharon, you're driving four hours to go do a case that somebody else won't do. And then it became, as a PRN employee, when they called me and I'm like, I'm not doing that. Yeah, yeah. And sometimes you got to be careful with that because you can get a little blackballed if you turn that down and don't take it. So again, you've got a little bit of politics in that PRN world as well. And then the last column over here, the 1099 independent contractor. And Sharon, we're seeing more and more CRNAs out there transition to 1099. And that's kind of the crux of this course is why are people doing that? What are they getting out of it? What are they trying to accomplish by doing it? But the good thing about 1099 is you well know, Sharon, you make your own schedule and work where you want to work. I do. Yeah, and it goes back to that control. You're in control of your destiny there. But you also are running your own little business at that point. So now you've switched hats from being an employee to actually being a business owner. And that is where I see most CRNAs get hung up. They don't understand that. I say it all the time, Sharon, you guys are the smartest people that I know, absolutely without a doubt. The problem is, is that you've got a nursing background and typically they don't teach you about this business stuff anywhere along the way. Not at all. Not at all. And it scares a lot of CRNAs, right, Sharon? It scared me, it scared me. You had been talking to me for literally years. Yeah, yeah. And I wouldn't do it. Part of that, you don't get Medicare Social Security paid by your employer, it's paid by you, both sides, 7.65 and 7.65, and we'll delve into that a little later. No benefits at all. Malpractice may or may not be provided. Sometimes malpractice is provided on 1099 situations. We always tell our CRNAs to make sure they get a copy of that malpractice policy. Send it up to A&A Insurance Services, have them look it over, make sure it's what you think it is. We did a podcast a while back with A&A Insurance Services, and we learned a lot from that podcast about why you need to make sure you understand that malpractice insurance policy. Actually, one of the places that I work at consistently, I am on their insurance, but it's through A&A. Whenever I work at the hospital, I have to provide my own. So I'm kind of a hybrid in that regard. Okay. Well, it's like I tell people we work with, A&A has your back. If you are to get in trouble or something happened, you want to make sure that whoever is carrying your insurance coverage has your back and can't settle the claim on your behalf. And I think John Fetcher told us about this, where a claim was settled and the CRNA didn't even know that it would happen. Until she went to go apply for another job and they checked her record and she had had a claim settled and she had no idea. No idea. Yeah. You know, so that's another point. And you do get the highest rate of pay between being a W-2, a PRN, as an independent contractor. And that's really commensurate because you're not getting any benefits. You have no job security there. You're running your own business. You're taking all the risks. And what did you tell me about CRNA pay the other day, Shane? Oh, it's skyrocketed. But you're getting paid that because of... Oh, it's commensurate with the level of responsibility that we have. Absolutely. And you're seeing that as a 1099 independent contractor, because not only are you having to find your own work and find your own benefits and run your own business, you're doing all that and giving anesthesia. So therefore you do get a higher rate of pay. And then the last portion is the independence. You know, I'll tell you from that standpoint, you know, in my particular situation with my wife, you know, being able to have the flexibility of being 1099 and or some flexibility being PRN is worth a lot, especially if you have children and, you know, you want to be there for them, or you have mother-in-laws that live with you and you need flexibility in your schedule. Or if you want to travel. Or if you want to travel, there you go. There are a lot of reasons to do this. And we're seeing more and more of that. Yeah, Pierce and I went to Italy and Croatia for a month. And your wife takes three months off during the summer. Yeah, three months off during the summer. And, you know, then she doesn't work full-time even after that. And then she takes off, you know, when the kids are out of school. And, you know, it's nice to be able to have that flexibility there and say, you know what? I don't want to work today. And then you don't have to. So understanding the difference between these two, I think is a foundation as we move forward throughout these modules. Because so many times people think that PRN is 1099. And we just wanted to clear that up and make sure they understand that it's not.

W-2 employment

1099 employment

CRNA classification

tax implications

employee benefits

CRNA

taxes

benefits