Locums, 1099, and W-2 CRNA Practice Explained: What Every Future CRNA Should Know

If you've spent any time online exploring nurse anesthesia, you've probably heard people talk about locums and 1099 practice—the promise of more money, more freedom, and more flexibility. But if I stopped most aspiring CRNAs, or honestly even many practicing CRNAs, and asked them to explain the difference between a W-2 employee, a 1099 contractor, and a locums provider, many would struggle to give a clear answer. Today's episode is not telling you which path is better. It's about helping you understand one of the most talked about and often most misunderstood career models in nurse anesthesia. To help us do that, I'm joined by a CRNA who has spent the last 5 years building a career in the 1099 and locum space and has become one of the most recognized voices discussing these topics online. Together, we're going to start with the basics, break down the terminology, explore the advantages and challenges, and discuss why some CRNAs choose this path while others do not. Today I'm joined by Dr. Najma Youssef, a practicing permanent 1099 CRNA, entrepreneur, and national advocate for nurse anesthesiology. Dr. Youssef is the founder of Direct to Locums, a company dedicated to helping anesthesia providers successfully transition into 1099 practice and connect with opportunities that support both professional and personal goals. Through her work She has helped countless CRNAs navigate the business side of anesthesia, gain greater career autonomy, and create careers that align the lives they want to build. Beyond her clinical practice and entrepreneurial work, Dr. Youssef is deeply involved in professional leadership and advocacy. She currently serves as Region 2 Director of the Illinois Association of Nurse Anesthesiology and is a member of the AANA PAC Committee. She's helping to advance and protect the future of nurse anesthesia through legislative engagement and political advocacy. Welcome to the CRNA Mentor Podcast here, Nijma.

Hi Tyler, thanks for having me.

I'm happy to have you here today. And, uh, again, one of my friends on the CRNA Mentor Podcast, and our friendship, uh, ironically went back to both being social media, uh, we guess social media ambassadors with the ANA. You since kind of moved on. I'm still kind of within that, that group, um, and you're doing big things in this space. But today I really want to kind of focus on obviously all of your 1099 work and, and, uh, helping people navigate this space. Because I'll be the first to say, I, I, we have many locums, uh, that practice with us, uh, but I don't completely understand. I'm always kind of picking their brain in terms of, you know, what they're doing, how they're navigating pieces of this. But, um, this conversation is going to go kind of beyond what a locum is, uh, explore 1099, and kind of talk about everything in between here. So appreciate having you today. Um, I, Ninjima, I really want to kind of start at the beginning, uh, you know, before we, we talk about 1099s, uh, you kind of— you've become known as like the, the Locums Girl online. Um, how did this happen?

I, I love that so much. I've worked hard for that title. Um, oh gosh, um, it kind of just happened organically. Um, I, I never saw myself as the Locums Girl. I actually didn't really know what locums was when I graduated CRNA school. I think our, our program didn't really focus on the business aspect of anesthesia, and I, I think, you know, as locums becomes more of a thing, I think, you know, programs are shifting their curriculum to accommodate for that education. But, you know, I came out of school just like most CRNAs do, just excited to have a job and, and, you know, work with my skills, work within my scope. I started at an academic institution, one that I had done clinicals at I chose it because it promised to give me the ability to practice with, you know, my scope and, you know, with a wide range of patient populations. And, you know, after getting started, I quickly realized that it— that just was not the case. And so I maybe 3 months into having started that position, I started to talk with some of my CRNA mentors, the ones that I had been with me throughout the program. And actually one of my mentors told me he had started a locums company and, you know, he was mentoring me through all of the locum space, you know, what it meant to be a 1099. But I think for me it was based on this principle of like working within my scope. And so I saw that as a CRNA he was able to perform regional blocks and, you know, do cardiac anesthesia and practice more independently. And so I wanted to be part of that group of CRNAs, and so I jumped ship and started doing locums, and it's, it's been locums ever since. That's great.

Yeah, one of the things, uh, you know, in our discussion leading up to this podcast is that I was very impressed by how you navigated the space even as a new grad. And I do want to rewind just a little bit. You know, you're talking about this big academic center, and you went before you signed on there and you're like, you brought a bunch of your friends from your class with you seemingly, and then you said, hey, I want to do this skill, I want to do this, I want to do this. Can you accommodate that? Is that kind of how it played out or can you kind of give us some more details with that? Yeah.

So I've always— I think negotiating just comes naturally for me. I, I'm a social butterfly. I'm really good at networking. I've worked really hard on that skill in undergrad. I took a lot of communications courses. I wanted to be a public speaker. And so, you know, I've always— there's always something to negotiate. And so, you know, people think of negotiating in terms of compensation, but I think especially as a new grad, the focus should not be on how much money you're making, although that's very important, but it should be about the support that you're getting as a new graduate provider and the skill set that is going to be offered at this facility. And so I knew that my program prepared us for that. You know, we were searching for jobs that, you know, are going to allow us to do that. And so when we, when we started looking around for positions, this was a chief CRNA that, you know, I was familiar with. He and I were friends. You know, my class was sent there, you know, to do clinicals. And coincidentally, we actually did our regional skills there. They're a 4-hospital network, and one of the hospitals was just completely spine and ortho. And so we had a lot of opportunity to practice our skills. And so, you know, I thought, hey, I'm gonna, you know, I'm gonna talk to this guy, I'm gonna be upfront with him about what we want. And, you know, the market was also booming back then. And I said, listen, I know you guys need staff, and if you can guarantee that, you know, CRNAs here do blocks and they're, you know, they're getting in the OB rooms and they're doing spinals and we're doing C-sections and I could be taking call on the cardiac team, you know, I think I can convince my little groupies in my program to come with me. And I did. I believe there were 5 of us that started together. And if I do say, we were very strong students. I was very happy with the people that started with me. And, you know, it was like, wow, like the Rush crew is coming in, you know. We all started together. It gave us a lot of confidence, you know, to the support that we had with each other. And, you know, just when I was negotiating with him, I told him, listen, we're going to do a monthly check-in. And I feel that, you know, we're not getting the cases that we want or, you know, there's a little bait and switch. We're going to leave. I don't— I'm not really concerned about the sign-on bonus. I'm not concerned about breaking my contract. I'm looking for a position that's going to allow me to become a great independent CRNA. And that's what you're promising me.

That's so powerful. I honestly, like, I think even probably the way that you outlined it is, you know, the position of strength here. I find that many individuals, you know, would, especially as new grads, would go into this situation and kind of, oh, well, you know, it's not quite meeting my expectations. You know, I'm going to stick around for a little bit longer. I'm going to, you know, maybe it's just the timing of stuff. You're like, no, 3 months. This is not, you know, aligning with my goals. Thank you very much, but I'm going to move on. And I think that is also, you know, there's many parts of your story, Nejma, that are very impressive to me. But, but even as a new graduate, to, to advocate for yourself and for your skills, uh, that's incredible. Uh, so nice job with that. I, I, I, I would guess that many CRNAs would not be as, as, um, upfront with that and kind of make that decision as early as you did. So you kind of talked a little bit about how you kind of got interested in 1099 practice. Uh, you know, let's kind of assume the audience, you know, many of these listeners are ICU nurses. They've never set foot in the operating room, many of them, and they're not— they've heard the term 1099 CRNA.

What does that actually mean? So that's a good question. Um, it's astounding, you know, how confusing these terms are for people. And, you know, it really just goes back to the lack of, you know, business and accounting courses that we have in our programs. But, you know, 1099 is associated with travel, right? It's associated with moving around. Um, you know, people think of like nursing travel contracts, but 1099 is actually just the way that you get paid. So if you just think of it in a vacuum, it's W-2 or 1099. There are two classifications. If you're a W-2, that's kind of what we're all used to, you know, upon graduation. It's your typical employee-employer relationship where the employer withholds a certain amount of money, um, that would go towards your tax burden to the IRS, and you get paid the rest of that amount. Um, conversely, 1099, you are an independent contractor. So for all intents and purposes, you're a business owner. And, you know, people kind of get scared, you know, when they think of that. They get a little overwhelmed, like, oh, I don't know anything about owning a business. But it's really just terminology, right? And so you're an independent contractor the way that A barber would be an independent contractor, or a plumber that owns his own company. And so you get paid the full amount, and the tax burden is on you as a business owner to, to take care of, you know, during tax time.

Why, uh, do people kind of use the term locums then and 1099 interchangeably? Are they actually the same thing?

So they're definitely not the same thing. So, um, you know, 1099 is referencing how you get paid and the relationship that you have with your employer. When we talk about locums, if you look up the word locums, it literally means temporary. So it is assigning, it is assigning your work hours to— it's a descriptor of your work hours. So you are a temporary independent contractor. You are there to provide a service to fill a need, um, on a temporary basis, whereas the converse, uh, descriptor would be just a permanent staff. So if you're staff, you're permanent, you're there, that's your position, you know, you're integrated into this network, you have a, you know, a direct relationship with that employer. As locums, you are there on a temporary basis, and most, most often within a 30 days notice, you could, you know, you could be given a 30 days notice and then all of a sudden you wouldn't be providing services for that facility.

You have this idea also, um, not just locums and 1099, but, uh, permanent 1099. Can you, uh, explain that a little bit? Sure.

And so, and so, you know, I think the easiest way for people is if, if you just, you know, there's two different umbrellas. So there's 1099 versus W-2, and you kind of just always keep those in those buckets. And you just separate 1099 from any other descriptor that it comes with. So the other umbrella is how— what is your relationship with that facility? So are you permanent staff? Are you a locum staff? Are you PRN? Um, are you part-time, right? So how often are you, uh, providing availability, providing shifts to this facility? So you can be a permanent staff that just happens to get paid in a 1099 way. Most often you are permanent, that is getting paid W-2. You could be a locum staff, that is a 1099. Most often that's the case, but there are some states that have strict 1099 rules where you are a locum but you're getting paid in a W-2 fashion, and one of those states is California. So, so, you know, it's— they're, they're not mutually exclusive. You could be a 1099 perm and you could be a 1099 locum. And I think after doing this full-time for 5 years now, I think I would say when I mentor people, I would advise people to go 1099 perm because it really is the best of both worlds in terms of giving you that stability that people are afraid of with locums. You know, it negates some of that risk that's associated with constantly traveling or looking for new gigs, but you're still getting paid at 1099 and you have the ability to to take advantage of the tax credits that— the tax advantages that come with 1099. And so it's kind of the best of both worlds.

Yeah, that's great. You know, I want to talk a little bit about why CRNAs choose 1099 practice. And, and I think for the vast majority of times, people hear 1099 and they often think money, right? But, but when I hear you talk about it, even as you— you know, we've opened up this episode, you're talking more about freedom. About, you know, this ability to, to kind of practice with all these skills. Clearly from the start of your career, that was very important to you. What, what are some of these, the biggest advantages with 1099 practice?

So that's a great question, and I think one that's often very overlooked and not discussed. So, you know, um, as CRNAs, we graduate and I think we have a bit of an identity crisis because we're constantly caught in these two worlds of, you know, we, we were nurses, we're part of the nursing profession, we're very proud to be part of the nursing profession. But as CRNAs, we're advanced practice nurses, we're, you know, we have doctorates, we've done terminal degrees, we've done a residency, we have the same scope and skill set as an anesthesiologist. And so you're constantly, you know, finding yourself in, in between these two worlds, and some people have difficulty with that. And So I think that the advantage that I found with 1099 is that it allows you to develop your persona and your character as an independent practice provider. And what I mean by independent is not in terms of the practice model that you're practicing, but just independent-minded thinking. How do you represent yourself as a CRNA? A lot of us that take W-2 academic setting jobs, we kind of start to identify with the culture of that specific hospital or of that setting, right? This is the way we do things at Rush, right? Like, that's kind of how our training program always— and I still, I'm a very loyal alumni. You know, Rush is the end-all be-all, is the greatest program. And so it's just the way medicine should be, right? That was their logo. And so that was their slogan. And so you become accustomed to thinking, to practicing the way that those anesthesiologists, those CRNAs that you're working with that are mentoring you practice. And sometimes that's a great thing. And, you know, when you speak of your skills, you, you know, people say, oh, that, you know, that CRNA must be from a big academic institution, you know, the Mayo Clinic or Rush or what have you. But more often that's a negative thing because if you have CRNAs that are being constructed that are not working within their scope, that maybe have, you know, I hate to use the word toxic, but a toxic culture where there isn't any support, and unfortunately that does exist. Um, you know, sometimes it's, it's not purposeful, but it's like the dynamics, the workflow that doesn't allow for CRNAs to, to, to practice in the way that they should. You know, you get, you get boxed into that environment, and the longer you stay, the harder it is to make a change. And so for me, I think what's important for 1099 for, for CRNAs is that it gives them the advantage and the flexibility to represent our profession. You know, often when I started a new facility, you know, I practiced the way that I am wherever I am. And so, you know, I respect the culture of the place that I'm at, of course, but I do blocks the same way, I pre-op the same way, I, I, you know, treat my patients the same way, I have the same work ethic. My relationship with surgeons and, and how I interact with a surgeon that might be a little bit more difficult to deal with is, is all the same process. And so when a facility sees an incoming CRNA that's a little bit different than maybe the CRNAs that they're used to, there's, there's, that's an advocacy, you know, opportunity for us and vice versa. Sometimes the CRNA is used to a certain setting and then they pick up a 1099 locum position and in the middle of nowhere, rural Kansas, and they see CRNAs doing things that they didn't even know CRNAs could do, you know, prescribing, you know, or putting pre-op order, you know, pre-op and post-op orders. You know, the dynamic and the relationship with like PACU nurses and with the hospital in general. And so I think for the provider and for facilities and for advocacy, 1099 gives us a great advantage to showcase our profession. Ninjima, that was a gem.

And I don't even— there's a lot to kind of unpack there. You know, even looking at big academic centers versus this 1099 practice and this idea that You are representing this profession, and sometimes, you know, when you find yourself in these bigger settings, uh, you can't really develop as you want to. And then 1099 affords you that opportunity. That's, that's definitely going to be a clip here. That was amazing. Thank you. You're making me want to do 1099 here.

Yeah, yeah, listen, that's, that's— we need to get you on board.

Um, Ninjima, how much, um, control do you actually have over your schedule? This is one of the big things that draw people to 1099 practice?

So I would say, you know, there, there have been times where I've been tempted to take a full-time position or to get into leadership and take a chief role and to kind of, you know, bring myself back down to earth a little bit. And the thing that stops me is the schedule, the, the flexibility, the freedom that we have. And so I, I'm really excited to speak about 1099 in different aspects other than just compensation, because to be honest with you, compensation goes up and down. Markets change. There are a lot of permanent W-2 positions that pay really well, that have great benefits. I wouldn't advise somebody to get into 1099 for the compensation. You can always pick up a gig that's paying a crazy high rate every now and then, just for fun and just to make some extra money. But ultimately, I think the, the freedom and flexibility of schedule that 1099 gives you goes so far beyond, you know, I could take vacation whenever I want, right? Like, that's what people think, like, wow, you're so lucky, you could just, you know, pick up and go to Europe for a month. And, and while I can do that, and that's great, I often work way more than, you know, if I just had a regular job and I, you know, I was taking 6 weeks off. Um, for, for me, the flexibility flexibility of schedule allows me to do the things that I'm passionate about. And I think, again, if we're— everything ties into advocacy for me. I think part of the reason why a lot of providers aren't in advocacy is because they frankly just don't have the time. You know, they get 6 weeks off, you know, they're— they have children, right? They can't travel. If they're going to travel, you know, it has to be part of their PTO, or they have to figure out how to use their CME money. And, you know, it's just not feasible to do when you're working a W-2. And so I think 1099 lifestyle has given me that ability. The other thing, you know, for people that are kind of like, well, what if I don't, you know, I'm not into advocacy. The other thing that it does for you is that in terms of because it increases your compensation significantly, because you have tax advantages and the ability to write off your expenses, because you have flexibility of schedule, you're able to pursue other passions. And so that passion could be starting a business, right? It could be opening up a coffee shop or it could be starting a locums agency. It could be building a mentorship platform the way you do. And so I often am impressed with what you do because I know that you don't have a lot of time. And so you're doing it on your drive home from work or waking up early in the morning. But imagine if you were able to just take 2 weeks off every month to pursue those passions. And I think that's kind of the understated thing about 1099.

Yeah, that's amazing. And I do want to point out here, Ninjima likes to have fun, but this week I believe you said you're off as well and it's all about advocacy, right?

Yeah. So I always say we have different seasons in our life and I think, you know, I'm often ridiculed by my friends and the people that are close to me that I work too much. And honestly, this is going to sound so cliché, but I always think back to that. If you love what you do, you never work a day in your life. And that's truly how I feel about anesthesia. I think I am always working, but our field and our abilities to practice are just so diverse. You know, there's advocacy, there's talking to legislators, there's working on bill amendments, there's starting businesses. Right? Building platforms. Like, like, I'm working on, on building an app right now, and we could talk about that later. But, you know, working on designing with design teams and building brands. And, um, you know, there's PR, right? So I do social media for, um, the Illinois Board of Nurse Anesthesiology. And so I'm sometimes out shooting content for that. And so, yes, I'm always working on anesthesia, but it's just so different. And, you know, I think it's, it's really, you know, given me that appreciation for our profession from, you know, my ability to kind of see it from all angles.

Yeah, that's, that's amazing. And, and I, I agree with you, like when you're doing something that you're so passionate about, like it, it, it doesn't drain me. It energizes me. Like I come off of an awesome phone call. I come off of, you know, some of these podcast episodes and I'm talking my wife's ear off about it. And, and she, you know, it, it, it doesn't, it doesn't resonate with her cuz she's not in anesthesia, but it's one of those things that it's like, it can energize you and it, and it drives you to do more and, and other stuff. And, and yeah, that's great, uh, Nijima. One of the things that, that I, I kind of keep going back to is you're talking about with the 1099 practice and, and how much it has kind of afforded you to grow professionally. Uh, you've practiced in different environments. How has this made you a better CRNA as opposed to just staying put at one place?

So I think the thing that we discount the most is the mentorship and support that we get from our colleagues. You know, a lot of CRNAs, um, when they graduate— I think most healthcare providers, you know, when you graduate, you want to assert yourself, you want to establish yourself as somebody who is able, somebody who's capable of doing the skill. And I will say that you never really stop learning. And people say that, but I don't know if they truly grasp what that means, is that you might not be in a classroom or you might not be taking a course or a certificate. But the beautiful thing that we love about anesthesia is that there's just so many different ways to do the same thing. And so often, you know, I've been a CRNA 5 years, which I think in our profession is, is middle, mid-career. I don't, I don't want to call it mid-career, but right, it's not, it's not, you're not novice, right? And, you know, and so sometimes I get a little, you know, like, I know, I've been there, done that, I know how to do this, right? You know, how, how many different ways can you do a total knee, right? But, you know, with each new facility you go to, you discover that people do things differently. You know, they have— even if the actual anesthetic is the same, the processes are different. And so I think 1099 gives you that opportunity to constantly add things in your toolbox. You know, I think people tend to, you know, gravitate towards certain cultures. And so, like, I mean, work environments. And so sometimes if you're at a facility too long, you kind of— everybody starts to think the same way. Like facilities have certain cultures, like, you know, we don't give fentanyl for EGDs, or, or we do, or, you know, or we don't give Versa because it's a, you know, it's a surgical center and we want them to go home fast, right? And so you, you start to just adopt those things and you, um, your toolbox, you know, gets empty a little. And so I think when you travel and you, you work with CRNAs that are a little bit older, CRNAs that are new grads, and You, you, you discover, you take a little bit from everybody and you add things to your toolbox.

No, that's great. And it's really, you know, I talked to a lot of folks that have had traveling contracts as ICU nurses. And, you know, the great thing about that is you get to learn from each different facility exactly kind of what you're experiencing. And it really adds so much dimension to who you are as a nurse and as a provider. And I think that You know, a lot of that translates into anesthesia school. You know, in my experience, as soon as I got comfortable at one place, I was going to a different clinical site. And, and again, everybody's doing stuff differently. There's different, you know, practices. And, and, uh, you know, this is exactly what 1099 is as well. And it just makes you a stronger provider just out of the design, you know, of, of bouncing around.

Um, you know, I want to add one thing. Yeah, sorry, I want to, I want to add one thing to that that I think is very important, you know. We talked about kind of doing the same thing and we're focusing on the anesthetic, but there's also the safety and adaptability of anesthesia. And so, you know, if you happen to be lucky to work at a big academic institution where you have a lot of anesthesia techs that check your machine and, you know, somebody's— somebody else is always doing the thing that you need to do, right? Like check the oxygen canisters, right? And, you know, when you go to other places that are more rural or maybe don't have as big of a budget, you become that tech, right? You, you have to really know anesthesia and you have to be knowing what to look for in terms of safety. Like, do they have a malignant hyperthermia cart? That's not something you might check at an academic institution. Like, of course they have it there, right? And so I think 1099 makes you a better provider from that aspect in terms of you dictating what you need, the safety, your practice, and, and what you're bringing versus the, the place dictating everything for you.

That, that's amazing detail there, and, and I 100% agree with you. It really— you own it more, right? And this is the episode last week with TD, is like, as you know, him being an independent provider at a solo, you know, CRNA facility, you own everything that you do. And you're— I think you're 100% right. You're, you're going to own it more as a 1099. Um, you know, we talk about all these great things, and I didn't really realize that this episode was for me before we scheduled to shoot it. Oh, that's great. I love that. All these amazing things about 1099, but, you know, also have to kind of realize the other side of the coin. You know, is, is 1099 practice right for everyone? You know, I think oftentimes we see on social media how it portrays like 1099 is, is the ultimate goal. Do you think that's accurate for most or for everyone or for some people? How do you feel about that statement? And you're going to be a little bit biased here. I will kind of say, you know, maybe a little biased, but what are your thoughts?

So listen, so I, of course, I'm biased. However, you know, I look at everything from an advocacy lens and from a lens of what is good for our profession. How are we representing ourselves? And so you know, um, not everything you see on social media is accurate, right? Sometimes you do things for the views, um, I will say, or, you know, for the algorithm to pick it up, or, you know, to attract the thing that everybody's thinking about, right? When I do my one-to-one consults, um, with new grads, with aspiring CRNAs, with, with people that are interested in getting into locums, you know, I have honest conversation with them. I ask them, you know, program they're coming from, you know, what their clinical experiences look like, what their numbers look like. And so, you know, to focus on that a bit, you know, as CRNAs, we are all capable when we graduate of being independent providers. That's besides the point. But what I'm talking about is the mental, emotional, spiritual connection that you have with your abilities when you graduate. And we're not— we don't all start on the same playing field.. And so some people, and there's this, this is not a good or a bad thing, it's just different. Some people need a little support. Some people need mentorship. Some people love feeling like they're part of something, right? Like I'm part of, you know, Penn State anesthesia group, you know, and I want to go to grand rounds and I want to, you know, have a chief CRNA that knows who I am, that knows my family, that, you know, if I have an emergency, I can text her and say, hey, like, I need to come in late, right? People love that, right? People— there are a lot of people out there that don't want to travel, you know, all bounce around and, you know, constantly be looked at as like the travel CRNA, you know. And so I think that, you know, um, 1099 draws in, you know, people are thinking, well, it's the, it's the smart thing to do because I'm going to be making more money. And that's just not the case, you know. You can make a lot of money as a W-2. You can make a lot of money as we discussed, as a 10 perm, right? You could do a bit of both, right? You can have a part-time job where you're working maybe 30 weeks at a W-2 place and you have that support, you have that stability, you know, you have that culture set, and then you're picking up PRN 1099, right? And so I think the thing that I try to do for people is really just customize it to their, uh, goings-on, right? If you have a family, if you have small children, sometimes 1099 is not the best for you and you might, you might do it. You could do it. There's a lot of people that do it with families, but if you're that person that is not going to be happy being away from home, then it's not the right thing for you. Right. And so I would say the people that I deflect away from, from locums are the new grads. And while I am not against new grads doing 1099 or doing locums, I, I do think it's very important, and, and from my experience with new grads doing locums, I think it's very important for at least the first year to be solid in yourself, to have that stability and have that mentorship and support for you to ground yourself and deal with basic airway emergencies, you know, uh, get a foundation of how you like to do things separate from your clinical, you know, preceptor Yeah, and I think that's important to point out.

Um, you're bringing me back down to earth a little bit here with this part of the conversation. Uh, yeah, but, but I also kind of want to acknowledge that, that there is very much a spectrum of what you will experience in anesthesia school in terms of independent practice, independent thinking, you know, this even being left alone in the OR, you know, by yourself, you know, in your, in your senior year. And I think What you'll see out there, and this is something that if I could do anesthesia school all over again, really prioritizing the, the programs that they— oh, I agree, I agree— a lot of emphasis on that, right? Because this is going to kind of set you out, you're going to get out of the gate here a bit quicker than some of the other folks. Not saying that they can't do it if they haven't had this experience, but the, the programs that really prioritize that are the ones that are going to equip you the most if you want to entertain these things in the future Right after grad. Absolutely, absolutely. A CRNA that would tend to thrive in a 10-99 practice model, is there like a personality type, or is there like, who, who tends to do kind of the best in this setting?

Yeah, you know, there's definitely a personality type. Um, I think locums is for everyone, honestly. You know, if you're comfortable, if you're able, there's environments for everybody. Um, we're so fortunate to, to have such a diversity of options you know, there are smaller practices that are more intimate. There are large academic centers with 200, you know, CRNAs. And so you'll find where you belong. But I will say, often I speak to, uh, you know, on these mentorship calls, and I'm talking to somebody and I'm thinking, yes, like, this is going to be— Locust is going to be so great for you. Like, you're, you're the perfect candidate. And what I, what I am looking for, honestly, is the personality and the work ethic. I, I'm not necessarily concerned at that point with your skill set because, you know, most of these guys are still students. But is your ability to open your mind and think right? Are you, you know, you want to learn everything? Are you somebody that is a blank slate? You know, do you take criticism? You know, are you, are you somebody that is, um, a go-getter? The thing that I think people don't think about is as a locums CRNA or provider, you have to be really confident in yourself. And because people look at you coming through the door like, oh, here's this locum, you know, she's making a ton of money and, you know, we're going to give her the hard cases and we're going to expect so much out of this person, right? And so if you have a more shy, quiet, you know, introverted personality and you're not able to deal with conflict easily, or, you know, every single word kind of you take it personally, right? Then maybe locums and travels is not the best for you. Um, the other thing I look for is, uh, what is your— what does your practice look like in the ICU, or what did your practice look like in CRNA school? You know, even if often I meet with students and they tell me, you know, I'm in Florida and there are not a lot of like independent practice sites, and so, you know, we, we got our numbers, but I don't feel secure about, you know, this skill or that skill or whatnot. What can I do in my last 6 months to prepare me for locums? That's, that's the question I get most often. And I say, stay late, come in early, fight for skills, fight for cases, right? Go above and beyond. You know, I know you're tired, I know you're tired, but you have to, you know, you have to put yourself first and put yourself in the battlefield and know that, you know, your residency is ending and you're going to wish that you had taken those opportunities You know, when somebody tells you, hey, there's a liver, but it's at 9 PM, and you're thinking, well, I got an exam tomorrow, or whatever, you know, it's like, stay late, you know, don't sleep. You know, that's what I tell people. It's like to get every opportunity that comes to you, because at some point you're going to look back to that experience and, and work off of it. That's great.

Uh, Ninjima, is there like a certain stage of a CRNA career? You know, I'm— for myself, I'm thinking, you know, practicing for 10 years. Is there you know, a stage of your CRNA career where this makes the most sense to pursue 1099 practice?

You know, I, I hesitate to answer that question because I think it's very different for a lot of people. Um, so what I mentor people to do is to find a 1099 perm job. And I always say to them, you know, if you 6 months in, you know, because, because people come to me wanting to do locums and I say you're a new grad, you know, should really establish yourself. So why don't you do 1099 perm and see which— see how you feel. And sometimes I get, you know, 6 months in, they're like, listen, like, I built off of my skills from school, I'm very confident, I know how to do regional anesthesia, I've done, you know, X amount of epidurals, like, I'm very comfortable with emerg airway emergencies. And they're giving me specific, you know, cases. And I say, well, great, you know, because at the end of the day, when you're a locum, it's not like you're stranded in the the middle of Afghanistan. I mean, you will always have support. You'll always have a chief. You always, you know, if you're working in a setting where there's, you know, anesthesiologists, you know, they're always willing to help, you know, especially if it's medical direction. And so it's not that you're not going to have support. It's just that you want to be, um, you know, you want to be confident in your skillset that you're not routinely asking for that support. Right. And so, you know, some people 6 months in, they're ready to go. Others need a little bit more time, you know. They, you know, maybe they go 6 months and they don't see any emergencies, or they don't get called in on a call, or, you know, everybody's experience is different. But I would say, you know, I wouldn't wait longer than 2 years, you know. I think, I think, um, more— this is my personal opinion and it might be controversial, but the more CRNAs that do 1099, the better we advocate for our profession and the better our profession is showcased. And, and that's my viewpoint. And so if somebody like you, Tyler Anderson, you know, you're, you're a fabulous mentor, and so you have 10 years of experience, what would that do for us if you were a traveler and you went from facility to facility and you met somebody like me that's only been a CRNA for 5 years, and you're teaching like, hey, I know this hack, or I— let me, let me show you a better way to do it, let me show you an easier way, do this every single time and you're gonna get that LMA in. And instead of, you know, uh, you know, um, fumbling and, and trying to deal with it, right? And so I think that we lose a lot by having these advanced providers that, you know, have the seasoned providers that have all this experience remaining in, in the same facility.

Sure. Now that, that's certainly a good perspective there. You know, you, you've talked a lot about, you know, all these great things, and, and, and I think The information that you provided is really shedding light, especially for myself, understanding this a bit more. I want to pivot a little bit and talk about, you know, some of these common misconceptions that we hear. Some of them I think we've touched on a little bit, but, um, I guess to start, does, does 1099 automatically mean that you're constantly traveling?

No, and that's my favorite question. I actually have been able to do 1099 quite differently than most people. And I think that's maybe the thing that, you know, prevents people from doing 1099 is, is their fear of, you know, constantly having to pick up and go. I've had 3 different jobs, all within driving distance of my home in Chicago, for the past 4 years. And so I, I think I'm lucky in that regard. I think if you live in a big city, most likely that will be available to you. Because most practices are just short. And so, you know, they kind of give you the spiel when you start, like, you know, if you, if you like the place, well, you know, we're getting staffed up, so make sure you sign a contract if you want to stay working with us. And I'm like, nah, I'll take my chances, you know. And so, um, yeah, I've kind of been with the same groups. Um, one of my favorite groups that I'm working for is about 2.5 hours away from where I live, and so So I leave Sunday night and I come back Friday. I stay out there the whole week. I work 10-hour shifts, so 50 hours a week. And I absolutely love it. I love the practice. And yeah, you don't necessarily have to travel. I will say that there's a little bit of strategy and in terms of working close to home, and that's what I love about, you know, my business and my consulting is that I help people, you know, strategize and how they could do the this long term. You could most definitely travel, but I, I think that, you know, with that comes, it comes its own, you know, risks and difficult hardships.

Next kind of misconception here, and you've kind of answered this a bit already, but is 1099 work inherently unstable?

It could be, it could be, because the way most I would say it most definitely is. That was a biased answer. It most definitely is unstable. But again, if you have mentorship, you could set things in place where you're navigating that instability. But it most definitely is unstable. The market is unstable. And the general thing for people to think about, and I think the thing that is most valuable with my mentorship is to say that you don't need to find a job, you know, 1 year, you know, before you graduate. So often I say, well, I only have 1 year left, I need to find a position, or I only have 3 months left, you know, I need to, you know, make sure I lock something down. And that's just absolutely not the case. The market changes every 2 to 3 months. It's very dynamic. And sometimes you finding a job and getting in early works against you because the rates go up, right? There's better jobs that open up. So generally speaking, the way locum contracts work is that you, you and the employer have a 30-day out. So what that means is if I want to cancel shift and I want to take vacation, I have to give them a 30-day notice. If they get staffed and they don't need me anymore because I'm a temporary worker, they have to give me 30 days notice. And that's, you know, people generally stick to that. And so sometimes you have, you know, your whole schedule booked out to the end of December. And so, you know, it actually happened to me in July. So at the beginning of June, I was canceled the last week of July. And so it was technically a 30 days notice. And this site has never canceled me before. And so it really made me worry because, you know, I'm like, wait. So then I started looking, I looked up QGenda and I wanted to see, you know, did they hire some new CRNAs or or, or what was the, the deal. And it had— it just so happened that a very busy surgeon that had— that was always running two rooms just quit out of nowhere. And so they were kind of staffing down to accommodate that. And so, you know, things could change, you know, in an instant. And I always tell people, don't take it personally. People take it personally, like, how could they do this to me? You know, what am I gonna do now? Right? And so again, it's— locums is all about strategy. It's all about lining up gigs. And so all I did was I called the other two gigs that I'm at and I said, hey guys, I have this week open, do you guys need some help? And of course they need help. So, um, it's just setting things in place to kind of accommodate for the risk.

But locums is inherently unstable. Yes. Uh, next question, it kind of operates from my perspective. Uh, do you need to completely understand all the financials? Uh, you know, the tax law, business structures and accounting before getting into 1099 work?

And so this is a big one. I feel so passionately about the answer to this question because I think it really prevents people from doing the thing that they want to do because they go so tripped up on knowing the specifics of every detail of, you know, I see people bring notes to my mentorship meetings and it's like, you know, S corp versus C corp. And I'm like, no, no, no, we are not accountants.

Like, this is not what we do. This is analysis paralysis, right? Yeah.

Analysis by paralysis. Yes. And, you know, it's part of who we are, right? We're very intelligent people, right? We're go-getters. We wanna understand everything. You know, we don't want anybody to take advantage of us and all that's true, as you should. You should understand every contract that you get into. It's much simpler than people make it. No, you don't have to have all that figured out. Out to start locums. Gotcha.

And last misconception, and you touched on this, and I want to kind of flesh this out a little bit more. You kind of prefaced this with saying, you know, I might— this is my perspective, uh, 2 years is about that window, say you graduate, to get into some 1099 work. Uh, the question is, is 1099 practice only for highly experienced CRNAs? And before you answer it, I do want to say that One of the big reasons I brought you on this podcast is because I value your perspective, and I think having somebody like yourself who navigates the space for other people, um, there might not be a right answer to the exact timeline, but you're giving us and all of our aspiring CRNAs and our, you know, uh, nurse anesthesia residents some sort of framework or a timeline as to like, okay, this is a good idea of a window of time, this 2 years. Can you elaborate on that just to a little bit more?

So that's a very good question. I think that, you know, what does experienced mean, right? That's such a vague term. You can be 6 months out of school, but you graduated from National University and you've been working independently throughout your residency and you were taking call, right? And so we all kind of have a different gauge for experience. I think the thing The thing that people should remember is that when you— wherever you go, you are representing CRNAs. And unfortunately, it's just part of who we are that we are always under a lens. One thing I want to mention about this is that depending on the culture and the practice model of the facility that you are working at, that will dictate whether you're able to do locums or whether you're experience will allow you to do locums at that facility. And so what I mean by that is I'm not necessarily pro new grads going into locums. However, I always tell new grads, if you're just gonna pick up a place— you know, I don't mean to offend anybody by this— if you're going to pick up at an academic center that's very restrictive, that's ACT, where you have to call for every little thing, you know, you're not doing any kind of advanced skill set, you, you may as well be locum there. You may as well be a locum, right? Because you, you know, there's absolutely no difference in your treatment, in your support, in the mentorship, in your capabilities. So if you're comparing oranges to oranges at that facility, go make more money and be a locums and have a better schedule, right? Okay. But if you're, if you're looking at your skill set and, you know, you want to invest in your potential as an independent provider It's not so much the, you know, experience is part of it, but there's another layer of what is the facility like that you're looking to do locums at.

Yeah, that's, that's good perspective. I want to pivot a little bit here, Najma, in terms of providing some advice, some for some of our future CRNAs, whether they're in school already or, you know, looking to get into school. You know, these folks, some of them I talked to on the phone, and they're, they're worried that these opportunities won't exist by the time that they graduate or get through their program. Uh, what would you say to them if they're interested in this, you know, 1099 work?

So, you know, there's a lot of fearmongering in our industry. There's a lot of gatekeeping, you know, there's a lot of, you know, big egos and, you know, you should do this now, or, you know, you know, that kind of thing. Or, you know, if you don't have, you know, 4 years of ICU experience, you're never going to get into CSRA. I often hear this And it's very, it's just not true. It's just not true. And similarly, the locums market is very variable. It's hot, it's on fire. And if somebody had the answer to that question, they would be a millionaire because everybody wants to know when is this going to be over? When are we going to be staffed? When are we going to stop paying CRNAs and MDs twice or 3 times what they're worth. Right. And so every, you know, the employers are just waiting for the locums market to fizzle. Right. The truth of the matter is nobody really knows what's going to happen. You know, there are, there, it's multifactorial. You know, on the one hand, we have an aging population in terms of providers. So I think anesthesia is, is one of the specialties where the last statistic I read was like 50% of anesthesia providers. MDs and CRNAs are in retirement age. And, you know, many, you know, many anesthesia providers that are working way past— like, they should have retired 5 years ago, right? Right. And so there's a little bit of longevity in our profession, especially because we love it so much. But that isn't to say that these people are out the door, right? And we saw with COVID anybody that had 5 years left or, you know, 5 to 7 years left, they're like, I'm not dealing with this kind of airways. Like, I'm not exposing myself. I'm older. I'm just going to hang the hat and I'm going to retire early. And I think that kind of contributed to the shortage as well. So we have this looming shortage. Additionally, we have more and more out-of-OR procedures that are happening. We have interventional cardiology that's booming, right? We have interventional radiology. We have GI more and more that's moving to ASCs and wanting CRNAs to cover those. We have a lot of ortho centers that are moving, you know, ortho cases that are now moving to ortho centers and we're doing ASA 3 patients and ASA 4 patients and, you know, bigger and sicker and we're able to do more at surgery centers. And so I think the demand for anesthesia is just going to continue to grow. And on the other hand, supply, right? And so right now we have an issue with supply. And I think that there are, there's people instituting things that are going to help diminish that, that shortage in terms of starting CRNA programs, right? We have CRNA programs popping up all over the place. And I, I must say, you know, I'm very proud of, you know, advocacy in the CRNA profession in that we're advocating for patient access and more states are becoming full practice. And so you have this influx of MDs that are, instead of supervising or directing, that are now providing anesthesia. And so that kind of helps with the supply as well. And you you, you eliminate that duplicity of, of service services. And so there's just too many, there's too many factors up in the air to, to really truly give an accurate representation of where we think the locums market is going to be. I would say anesthesia is a wonderful profession. It is very rewarding. It is a thriving community. It, you know, it will give you a, a great stable career for decades to come. And, you know, when I would tell people, when I graduated, CRNAs were making $155,000 W-2. I wasn't even, you know, we didn't even know what that meant. It was way more than the $70,000 I was making as an RN, right? And so we weren't concerned with the compensation, truly. We were concerned with the scope of practice. Wow, I'm going to be doing that. I'm going to be running this by myself.. And, and so it's just such a jump off from being in the ICU and being held back and, and being, you know, put into your place and, and, and not having that ability to do more. That CRNA gives you that. And so I would say don't focus on the money, don't focus on the compensation, stop thinking about the locums market, pay attention to your skill set, to your scope, you know, find a program that's gonna make you the best provider that you you can be and give you that support. And I promise when you get into the market, you're going to love the job. I love that.

And so not what you're hearing out there online. Everything's money, money, money, compensation, which is an important part of it. I don't want to play that down, but all the things that you just spoke about, it's only helping our profession move forward. And that's part of your advocacy. Nijma, I think one of the big things that I see in you and in your story, uh, how much self-advocacy that you've done. Why is this such an important part for CRNAs, but I guess in particular, uh, 1099 CRNAs?

You know, I think that, um, advocacy is, is, um, you know, it's a spiritual relationship with the profession. It really is. I'm going to describe it that way. I think that, you know, it's, it's part of the fabric of who we are as CRNAs. You know, a lot of times people say like, what do I need to do to get into CRNA school? Or, you know, what GPA do I need to have? And, you know, they focus on the numbers. And I think really there's a spirit that people have that makes them a good candidate for CRNA school. And part of that spirit is, is, um, doing the best job that you could do with, with what you have. And I think that our profession has just, you know, shattered the ceiling for, for what we're capable of providing and the impact that CRNAs have in, in the world. And, you know, for me it's personal because I think there's so many CRNAs that are subject matter experts, but they get lost in this identity crisis. And most people just retreat into their corners, right? You know, I'm just gonna stick to my job, I'm gonna stick to to my family. I'm going to drown out this noise of politics and MD versus CRNA or AA versus CRNA, which is just so negative, right? And who wants to be negative, right? Who wants to embody that negativity? So people retreat. And the unfortunate part of that is they're never able to showcase what they bring to the world, what they bring to the profession. And that's where my passion is. It's like so often I meet other CRNAs and you know, they're trying to get into business, for instance, they're trying to open, you know, a med spa. And I say, oh, well, did you know so-and-so that lives in your district? You know, they own 4 med spas and they're a big name in this industry. And they say, like, I don't even know who that is. Or, you know, I often, you know, get, you know, who's this Jeff Molter guy? And I'm like, he's the president of our association. You know, like, I posted a reel because he had sent me a shirt shirt, and people were like, oh, I want that shirt, where'd you get it from? And I'm like, you know, Jeff Molzer. And some people didn't know who he was. And I think, you know, that's a problem. That's a problem we have in our profession, our branding of ourselves. And, you know, if we're not going to highlight our abilities and, and what we do, what we bring, our impact and our contribution to society, who will? That's what advocacy does for us. You know, advocacy is not politics or legislation or bill, you know, writing laws. And, and I think that's what people think it is. It's so much more than that. It's representing the wonderful community that we are a part of.

It's so inspiring, Najma. You're so— you really, again, come away from this episode, I'm going to be all fired up. I'm going to be talking my wife's ear off about all this stuff. But honestly, you've done so much for our profession and you're only getting started here. And, you know, Najma, as we wrap this up, I, you know, we talk about, you know, this 1099 and the perception on the internet. Of, of, you know, taxes, contracts, money, all these different things. But, you know, after 5 years of doing this, if you could kind of reduce this to, you know, a succinct answer, what do you think being a 1099 CRNA is really about?

I think being a 1099 CRNA has given me the ability to experience every facet of what it means to be a CRNA, and it's given me the opportunity to find community, to find purpose, to find, to find value in the skill set that I have invested and worked so hard to cultivate. I would caution people, um, and I would inspire them to go into whatever it is that they're seeking If it's 1099, if it's locums, if it's perm, our community is filled with wonderful mentors. You just have to know how to find them. There's always somebody out here for you to, to speak to. I think our association, the ANA, does a wonderful job, you know, with their mentorship program and, and making people accessible to our aspiring CRNAs, our ICU nurses, um, you know, and CRNA students, and So I would say just find mentorship, find community, and you'll be inspired to do so much more than what you're looking to do now.

I love that. And Nijmaa, you are one of our big mentors in this space. And before we wrap this up, I kind of want to give you an opportunity to talk about one of the big projects that you've been working on. Can you tell us a little bit about that?

Sure. So, you know, I started doing mentorship for 1099, for locums, out of a need that I saw, you know, aside from my one mentor that I had for the locum space, you know, there were, during my time, there weren't a lot of people that you can kind of chat freely with about this topic. And, you know, we didn't have the social media aspect. You know, we really didn't have people like you that, that were taking phone calls and answering questions. And so, you know, I started chatting with my friends and that kind of grew into something a little bit more organized, which is my staffing agency. But the more I work with people, the more I realize, you know, in addition to my passions— my passion to advocacy— I realized that there is still a hole that we're missing, which is giving CRNAs and anesthesia providers a platform to be part of something greater. And so I'm happy to be working on a platform called The Anesthesia Collective that is essentially going to be a content marketplace. It's going to be a community where CRNAs and anesthesiologists find each other and find mentorship, you know, amongst each other. And so give people to, to sell their content, to highlight their personal subject matter expertise, to have storefronts where, you know, you're able to kind of search via, um, you know, service that you're looking for, or you know, mentorship, if you know that person's name, or if you're just looking for kind of somebody in the locum space or, you know, somebody in the space that, you know, interview space, right? A one-stop shop to make our community a little bit smaller. And so we're really excited for that.

That sounds like an amazing opportunity here. And I think it's definitely needed in our space, you know, just to have everybody kind of collaborating, working together, just being more accessible as well. So that's a A great idea. Um, Ninjamaya, I really want to thank you for joining me today, uh, on the CRNA Mentor Podcast and for sharing your story and really kind of pulling back the curtain on, uh, what 1099 practice is. You know, when people hear these terms like locums, independent contractor, or 1099 practice, again, the conversation immediately goes to money. And, and I think what you really highlighted in this discussion is that it represents, you know, career choices. It represents opportunity and this kind of ability to intentionally design the type of professional life that you want to build. And I think that's so powerful. And as you mentioned, like, this is such an important part that can overlap with advocacy, you know, in our profession. So whether, you know, your 1099 practice is something that you're interested in today or, you know, in the future, or maybe not, you know, I really hope that this conversation helped you kind of understand this profession a bit better. And, you know, for me it was eye-opening. And I'm really— I might be in your ear a little bit here, Nijma, learn a little bit more. And honestly, for any— anybody that is interested, um, I'll post all of Nijma's, uh, information in the show notes so you can contact her and learn more about this. Um, if, if you're a nurse anesthesia resident listening today, if you are an aspiring CRNA, and if this episode helped you share it with somebody that, that might be interested in 1099 work as well. So thank you very much, Ninjima, for joining us. And Tyler, it was wonderful. Yeah, my pleasure. And until next time, uh, we'll probably have you back on here. This isn't— this isn't going to be your last episode. This is fun.

I'd love to be back. Thanks, Tyler. Yeah, take care.