Contract Negotiations: Turning Your Training into Wealth の全文書き起こし

be aware of that. 00:04:31.519 --> 00:04:35.519 You need to be aware that you are stuck and have limited negotiating power. 00:04:35.839 --> 00:04:43.759 Just name it honestly rather than bluffing a I'm gonna walk away if you don't do XYZ that you can't actually hold to. 00:04:44.000 --> 00:04:48.800 The single most important tool in any negotiation is the ability to say no. 00:04:49.279 --> 00:04:54.560 Everything else discussed in this episode supports that one singular point. 00:04:55.199 --> 00:05:00.480 The term you might hear is BATNA, which is the best alternative to a negotiated agreement. 00:05:00.639 --> 00:05:09.920 And this is just knowing what happens if the deal falls through, if things don't work out, what's your contingency, your plan B, so on and so forth. 00:05:10.720 --> 00:05:13.839 Number two, every number is a talking point. 00:05:14.800 --> 00:05:22.720 For my first W-2 job, I sent the contract to a family friend and CFO, and he was really big on the every number is a talking point. 00:05:23.360 --> 00:05:31.680 Every single number throughout the entirety of the contract is something that can be negotiated, even if it's not ultimately accepted. 00:05:31.839 --> 00:05:36.319 And it's amazing how many of the how many aspects of a position can be negotiated. 00:05:36.560 --> 00:05:39.360 Chris Voss dives into this with the use of anchors. 00:05:47.519 --> 00:05:52.399 And this is something where you attempt to pin the number to your side. 00:05:52.639 --> 00:06:00.240 So, for example, a salary offer of$225,000 when the market average in the area is$250,000. 00:06:01.279 --> 00:06:06.319 You want to expect this first offer to be low, and that's the hospital setting the anchor. 00:06:06.480 --> 00:06:17.199 They are getting your mind off of the$250,000 uh market average and thinking a little bit more about the$225,000, that 10% shave right off the top. 00:06:17.439 --> 00:06:27.199 It's important that you kind of take the emotional hit and don't react because every increase from here will feel like a win, even if it's still under the roll's real value. 00:06:27.360 --> 00:06:33.680 Now, there are a few ways we can approach this, and it might not be the best to go after the crew salary. 00:06:33.839 --> 00:06:36.639 We might not be able to get the salary up to 275. 00:06:37.120 --> 00:06:40.480 There are other things that we can do that we'll touch on in a little bit. 00:06:40.879 --> 00:06:44.720 During this process, it's important to see it from the employer side too. 00:06:44.959 --> 00:06:52.480 Again, if it's a place that's hard to staff, if it's remote, if it's undesirable for any number of reasons, these positions tend to pay more. 00:06:52.639 --> 00:06:57.839 Desirable cities often carry their own cost of living tax, the sunshine tax. 00:06:58.160 --> 00:07:06.319 And through all this, never let a negotiation damage the relationship as you attempt to pull them off of this anchor for low salary. 00:07:06.800 --> 00:07:16.240 It's a small specialty that is anesthesia, and today's counteroff can become tomorrow's reference for a locum assignment. 00:07:17.759 --> 00:07:21.120 So, what's actually negotiable at one of these large healthcare systems? 00:07:21.279 --> 00:07:24.560 Yes, we talk about every number, but what do they actually move on? 00:07:25.040 --> 00:07:31.600 So if I'm evaluating the offer, a salary is usually the least flexible line item on the page. 00:07:31.759 --> 00:07:33.759 More often than not, they do a few things. 00:07:33.920 --> 00:07:35.279 One, they have a stair step. 00:07:35.439 --> 00:07:39.600 If you have X years of experience, you start at Y dollar amount. 00:07:39.680 --> 00:07:45.439 So that's where that 225 with an area mean or median of 250 comes from. 00:07:45.600 --> 00:07:47.920 You might be stuck there because of your years of experience. 00:07:48.160 --> 00:07:52.720 They may not budge because it might be the thing that sets off the rest of the employees. 00:07:52.959 --> 00:07:56.480 Alternately, it might be a facility that pays everyone the same. 00:07:56.639 --> 00:08:00.879 I'm seeing the standardization a little bit more in the Midwest at their big healthcare systems. 00:08:01.199 --> 00:08:06.319 Everywhere does it a little bit differently, and that will affect what's actually negotiable. 00:08:06.800 --> 00:08:12.240 Some of the things that are a little bit more flexible might be the sign-on bonus or relocation assistance. 00:08:12.480 --> 00:08:18.879 In my first job, they were capped at their sign-on bonus, and I was able to do the if-then sort of situation. 00:08:19.040 --> 00:08:27.759 They said, hey, we can't come up on the sign-on bonus, but we can give you a$10,000 relocation stipend, and we'll just lump it all in like a sign-on bonus add-on. 00:08:27.920 --> 00:08:28.319 Perfect. 00:08:28.480 --> 00:08:29.600 Work for me. 00:08:30.079 --> 00:08:36.399 Loan repayment, some kind of retention bonus, periodic bonus, all those things can be negotiated. 00:08:36.639 --> 00:08:37.840 CME allowance. 00:08:38.000 --> 00:08:41.360 Again, usually it's going to run anywhere between a thousand and five thousand bucks. 00:08:41.519 --> 00:08:43.039 And your CME days. 00:08:43.200 --> 00:08:44.480 Do I have time to go to a conference? 00:08:44.559 --> 00:08:47.679 Do I have time to go to a nerve block course or an epidural course or whatever? 00:08:47.840 --> 00:08:49.759 You need to find out what qualifies. 00:08:50.000 --> 00:08:53.200 I had one place who ran a pain practice. 00:08:53.360 --> 00:08:58.159 Each of the CRNAs went there one-ish day per week. 00:08:58.320 --> 00:09:01.600 So OR for four days, rotated through the pain practice. 00:09:01.759 --> 00:09:15.840 And this facility said, hey, if you work for us at about nine months to one year, we'll give an additional$5,000 for you to go to a five-day course to do pain and then come back and you can do fairly simple pain injections with us. 00:09:16.080 -->

00:09:23.200 But that was in writing to where that allotment, that$5,000 allotment, was on top of my annual CME allowance. 00:09:23.360 --> 00:09:26.639 If I had stayed for nine months or a year, I don't remember what it was. 00:09:26.720 --> 00:09:29.519 But the time frame was also in writing. 00:09:29.759 --> 00:09:30.320 Very important. 00:09:30.399 --> 00:09:31.919 We'll touch on that later. 00:09:32.240 --> 00:09:35.200 PTO structure and call frequency. 00:09:35.440 --> 00:09:39.279 You want to know how PTO is scheduled. 00:09:39.519 --> 00:09:42.720 If you can take consecutive weeks, you want to know all things PTO. 00:09:42.960 --> 00:09:48.000 And then call frequency is another big one as far as weeknights, weekends. 00:09:48.639 --> 00:09:51.519 Is it shifts per week, per month, per year? 00:09:51.679 --> 00:09:52.320 How does it work? 00:09:52.480 --> 00:09:55.039 How does it work if I'm a new grad and I'm starting in July? 00:09:55.279 --> 00:09:56.639 How many call shifts? 00:09:56.799 --> 00:09:57.840 When does my PTO start? 00:09:57.919 --> 00:09:58.960 When does my sick leave start? 00:09:59.039 --> 00:10:00.879 How much CME do I get for that first year? 00:10:01.039 --> 00:10:02.320 All negotiable. 00:10:02.799 --> 00:10:08.559 And the other one that was really big for me starting my first job was the extra shift rate. 00:10:08.799 --> 00:10:12.960 They called that a$500 per night beeper rate, which was pretty good at the time. 00:10:13.120 --> 00:10:17.840 They essentially did a locum plug and play of the numbers, even though we were W-2. 00:10:18.559 --> 00:10:27.120 And I said, this rate does not have a differentiator for a 24-hour call rate on a Saturday or a Sunday. 00:10:27.279 --> 00:10:30.320 And they said, Oh, you know, we've never had to address this. 00:10:30.480 --> 00:10:31.519 It's never been an issue. 00:10:31.600 --> 00:10:35.600 We've always had Herm people or locums pick up the coverage. 00:10:35.679 --> 00:10:39.200 We've never had to implement this extra shift rate. 00:10:39.440 --> 00:10:43.039 Uh, they said, let us look at the market rates and we'll get back to you. 00:10:43.120 --> 00:10:48.559 And they settled on$2,000 per 24-hour haul Saturday and Sunday. 00:10:48.879 --> 00:10:53.759 And sure enough, after about six months at this facility, we lost half of our staff. 00:10:53.840 --> 00:10:57.840 Um, so we went haul every other day, every other weekend. 00:10:58.000 --> 00:11:09.279 So this actually affected my compensation pretty significantly throughout the first year because I ended up taking an additional about 12 or 13 weeks of call. 00:11:09.440 --> 00:11:15.679 And instead of$1,000 to cover the weekend, it was actually$4,000 to cover the weekend. 00:11:15.919 --> 00:11:18.159 All because of one little inquiry. 00:11:18.399 --> 00:11:26.240 And don't allow the ah, it's never happened before to justify or validate this doesn't need to be addressed. 00:11:26.399 --> 00:11:27.919 Nah, it really does. 00:11:28.879 --> 00:11:32.559 You can also negotiate aspects of the contract without numbers. 00:11:32.799 --> 00:11:37.519 These may be easier to achieve, especially going through the large healthcare systems. 00:11:37.679 --> 00:11:46.960 And I actually negotiate the verbiage of my contracts as a locum, probably five points of verbiage to every one point of negotiating rate. 00:11:47.120 --> 00:11:51.039 If the rate's not where I need it to be, I don't even pursue a contract. 00:11:51.600 --> 00:11:56.080 So it really filters itself out before I even get into the contract process. 00:11:56.399 --> 00:11:59.039 But let's talk about some of the non-number aspects. 00:11:59.279 --> 00:12:00.480 Start date flexibility. 00:12:00.639 --> 00:12:04.320 As a new grad, this could influence your decision quite a bit. 00:12:04.879 --> 00:12:07.120 All things orientation and training. 00:12:07.279 --> 00:12:08.399 This was a big one for me. 00:12:08.559 --> 00:12:10.559 I had a really heavy orientation. 00:12:10.879 --> 00:12:20.159 So we looked at when my orientation started, what that looked like, who would be there to assist me should I need help. 00:12:20.399 --> 00:12:22.720 It looked at my rate, which was different. 00:12:22.799 --> 00:12:28.559 I had an hourly rate during orientation and then transitioned to a salary after my orientation. 00:12:28.799 --> 00:12:32.639 We had it in writing, the duration was going to be three months. 00:12:32.799 --> 00:12:34.720 It was to be signed off by the chief. 00:12:34.960 --> 00:12:43.840 It could end earlier if signed off by the chief, and it could go longer than three months again if recommended by the chief back to the company. 00:12:44.159 --> 00:12:46.480 So this really influenced my pay. 00:12:46.720 --> 00:12:49.279 I had a decreased rate during this time. 00:12:49.519 --> 00:12:54.080 Um clinically, it didn't end up affecting me a ton because I had a fair bit of hours. 00:12:54.320 --> 00:12:57.679 But at the end of the day, it did affect my take-home pay. 00:12:57.919 --> 00:12:59.840 So get that in writing. 00:13:00.159 --> 00:13:03.440 When you start, when do you start taking call? 00:13:03.600 --> 00:13:13.279 If you're supposed to have someone available at all times, if you're supposed to have someone on second call with you, whatever the case may be, all things orientation training. 00:13:13.440 --> 00:13:14.240 Here we go. 00:13:14.480 --> 00:13:15.600 Schedule formatting. 00:13:15.679 --> 00:13:23.679 This is the 5.8s, 410s, 312s, whatever the case may be, when your weekend rotation is, negotiate all those. 00:13:23.919 --> 00:13:25.039 Postcall day off. 00:13:25.120 --> 00:13:27.039 The facility I'm at right now is a locum. 00:13:27.120 --> 00:13:31.600 This doesn't apply to me, but the perm staff was told they were going to get a one-to-one post-call day off. 00:13:31.759 --> 00:13:32.080 Cool. 00:13:32.240 --> 00:13:35.519 Call on Monday, Tuesdays off, back in the OR on Wednesday.

00:13:35.759 --> 00:13:40.960 Then it came through they took a Friday, Saturday, Sunday call for their weekend. 00:13:41.200 --> 00:13:41.759 Great. 00:13:42.000 --> 00:13:50.799 So they said, because I'm taking Friday, Saturday, Sunday call and it's a one-to-one post call day off, I get Monday, Tuesday, Wednesday as postcall days, correct? 00:13:50.960 --> 00:13:54.480 And HR said, no, that actually counts as one. 00:13:54.639 --> 00:13:56.000 And they said, wait, wait, wait. 00:13:56.240 --> 00:14:00.320 So if I take call on a Wednesday, I get Thursday off. 00:14:00.480 --> 00:14:06.559 But if I take call on a Friday, Saturday, Sunday, I only get Monday off as a post-call day. 00:14:06.639 --> 00:14:08.000 They said, Yeah, just Monday. 00:14:08.159 --> 00:14:13.360 And they said, Well, how does that make any sense when you told me it was going to be one to one uh post-call days off? 00:14:13.440 --> 00:14:14.320 Which makes a big difference. 00:14:14.399 --> 00:14:17.360 I think their their call rate's somewhere around one and six. 00:14:17.759 --> 00:14:22.000 So that means they're going to take somewhere, let's ballpark it, say nine weekends per year. 00:14:22.240 --> 00:14:26.960 Okay, so that should be if it's a true one to one, 27 post-call days. 00:14:27.120 --> 00:14:30.879 Hospital saying, nah, not 27, actually nine. 00:14:31.120 --> 00:14:38.240 Okay, so that's 18 days that are impacted by whether or not it's a true one-to-one or the weekends clustered. 00:14:38.320 --> 00:14:47.840 Well, the long and the short is 18 days by even a modest daily rate of 1200s, about a$22,000 a year difference on whether or not I get those callback days. 00:14:48.080 --> 00:14:50.720 And that doesn't include what I can do with those callback days. 00:14:50.799 --> 00:14:52.879 You could pick up some locum work or any number of things. 00:14:53.039 --> 00:14:57.440 So it's a$20,000 a year difference of whether or not it's truly one-to-one. 00:14:57.759 --> 00:14:59.759 Good things to have in writing. 00:15:00.480 --> 00:15:03.600 Uh the next one's going to be can your PTO be revoked? 00:15:03.679 --> 00:15:07.679 There are some places where they scheduled PTO, staffing it short, and they're like, Yeah, you know what? 00:15:07.759 --> 00:15:10.559 Actually, this is not a great week to take PTO, so it's off. 00:15:10.720 --> 00:15:16.320 Well, that's not cool because you might have had a vacation planned, you might have hotel rooms, flights, all that stuff booked and ready to roll. 00:15:16.399 --> 00:15:19.519 And all of a sudden the hospital said, Yeah, we need you at work. 00:15:20.080 --> 00:15:23.039 So are these extra shifts forced? 00:15:23.200 --> 00:15:24.559 When do locums arrive? 00:15:24.720 --> 00:15:27.600 Are you going to make us cover the extra call if we go short staff? 00:15:27.840 --> 00:15:29.039 How's it going to work? 00:15:29.600 --> 00:15:32.879 History is going to tell you probably more than HR is going to tell you. 00:15:33.039 -->

00:15:35.440 They might blow a little smoke and tell you what you want to hear. 00:15:35.679 --> 00:15:39.279 But there are two neighboring healthcare systems in the area that I work. 00:15:39.840 --> 00:15:43.120 One throws the locum flag a lot earlier than the other. 00:15:43.279 --> 00:15:50.559 They're okay having higher expenses just to keep their perm staff satisfied with not having to pick up extra shifts. 00:15:50.639 --> 00:16:01.440 If they promise them one in four, one in six, one in ten, whatever, they're going to bring in locums to keep their perm staff happy so they don't irritate that group and ultimately lose more perm staff. 00:16:01.679 --> 00:16:03.279 Let's move on to the fourth one. 00:16:03.519 --> 00:16:06.879 The non-negotiables that are worth reading closely. 00:16:07.279 --> 00:16:12.639 So even when I can't change these terms, they determine my risk exposure. 00:16:12.960 --> 00:16:20.399 These are a little more negotiable on the 1099 contracting side, but either way, you should slow down and read these. 00:16:20.639 --> 00:16:24.159 First one's going to be your non-compete radius and duration. 00:16:24.399 --> 00:16:26.240 This varies a lot state by state. 00:16:26.320 --> 00:16:28.159 There's a lot of chitter chatter about it. 00:16:28.320 --> 00:16:32.080 Take a peek, non-compete radius, and duration. 00:16:32.320 --> 00:16:34.080 Next one's going to be malpractice. 00:16:34.159 --> 00:16:36.000 First of all, malpractice coverage type. 00:16:36.159 --> 00:16:37.360 Are you going to be claims made? 00:16:37.519 --> 00:16:40.480 Are you going to get a little bulkier occurrence policy? 00:16:41.120 --> 00:16:47.600 The lawyers are ultimately going to do what's best for the person holding the coverage, which is going to be the hospital. 00:16:47.759 --> 00:16:56.639 So if you have a coronal abrasion, you take a couple teeth out, they are going to settle that out of court, which brings me to the next part: consent to settle. 00:16:56.799 --> 00:17:02.320 It's best if you have to provide written consent to settle, because those are things that'll go on your NPI number. 00:17:02.559 --> 00:17:13.039 It'll ultimately cost the hospital a lot less to pay 500 or 1,000 bucks out of pocket to settle something that may be an entirely fabricated claim just to avoid going to court. 00:17:13.279 --> 00:17:20.160 But what this means is because it goes on your NPI number, you will get flagged if you go to apply for a job elsewhere. 00:17:20.319 --> 00:17:30.400 If you're a locum and you're bouncing from place to place and you go through this process fairly frequently, it's really important that you get a consent to settle clause, carrier own occurrence, insurance. 00:17:30.640 --> 00:17:33.599 That will just eliminate quite a few headaches. 00:17:33.839 --> 00:17:37.920 That will put you in control and the lawyers will be on your side. 00:17:38.319 --> 00:17:40.160 Tail coverage, that's another big one. 00:17:40.319 --> 00:17:43.759 Claims made, it only covers you for the duration of the policy. 00:17:43.920 --> 00:17:45.200 You can get tail coverage. 00:17:45.279 --> 00:17:46.480 You want to know who pays it. 00:17:46.640 --> 00:17:52.160 Are you, as the as the CRNA, liable to cover your own tail, or is that worked into the benefits? 00:17:52.400 --> 00:17:58.640 Really important that you have coverage and do not lapse as you're transitioning jobs or transitioning from employers. 00:17:59.279 --> 00:18:02.720 Termination clauses with and without clause. 00:18:02.960 --> 00:18:04.720 Some of these can be fairly liberal. 00:18:04.880 --> 00:18:08.000 Some of these depend as far as how they're written state by state. 00:18:08.160 --> 00:18:12.480 Some states are a little more employer-friendly, some are a little more employee friendly. 00:18:12.640 --> 00:18:19.119 I think it's really important if you are terminated without cause that you receive some kind of notice, some kind of compensation. 00:18:19.359 --> 00:18:24.960 If you are terminated with cause, well, you need to know what with cause means. 00:18:25.440 --> 00:18:37.920 And in that case, they usually put it towards a violation of the policy and procedures handbook, which is like a 500 or a thousand page handbook that no one actually reads, and they can pretty much get you for anything. 00:18:38.160 --> 00:18:49.599 So it's always best to have that big emergency fund when the day comes that they drag you out for something that's kind of a BS claim, but still upholds the with cause because it's in their bylaws. 00:18:49.839 --> 00:18:55.279 Anyway, read it, find out what you can get released for, what that time frame and notice looks like on their end. 00:18:55.440 --> 00:18:57.359 Also note what it looks like on your end. 00:18:57.519 --> 00:19:01.519 Do you have to give a 60-day, 90-day, 120-day notice? 00:19:01.759 --> 00:19:03.440 Keep all those things in mind. 00:19:03.759 --> 00:19:06.000 Restrictive covenants tied to your bonus. 00:19:06.079 --> 00:19:07.759 This is going to be your clawback. 00:19:08.079 --> 00:19:17.440 Is it Lincoln, Nebraska at one time had a clawback of if you didn't fulfill your entire five-year commitment, you paid back the entirety of the sign-on bonus. 00:19:17.599 --> 00:19:19.359 Most of them are month by month. 00:19:19.519 --> 00:19:27.119 So mine was a three-year sign-on, and I was liable to pay back 136th every month I fell short. 00:19:27.279 --> 00:19:29.200 So that was fairly reasonable. 00:19:29.440 --> 00:19:31.279 Definitely the way to do it if you can. 00:19:31.519 --> 00:19:35.839 For a 1k match, that's generally not negotiable because that is set for all employees. 00:19:36.000 --> 00:19:38.720 So changing it for you means changing it for everyone. 00:19:38.960 --> 00:19:40.880 Probably not going to happen. 00:19:41.119 --> 00:19:44.079 Number five, gonna be a productivity bonus. 00:19:44.240 --> 00:19:46.400 There are all kinds of ways this is structured. 00:19:46.559

--> 00:19:51.279 Some do it based on total cases, CPT count, certain metrics being met. 00:19:51.599 --> 00:20:12.240 Find out if this is applicable to you, how the productivity bonuses or the incentive pay, find out how it actually works and why it matters more at some systems than others, and ask all the questions to HR before assuming that, yep, last year they received a$10,000 bonus for each of the X number of CRNAs. 00:20:12.319 --> 00:20:14.319 We're all going to get that$10,000 again this year. 00:20:14.480 --> 00:20:16.079 It's rarely guaranteed. 00:20:16.240 --> 00:20:20.079 And in the hospital systems I've seen, it's generally on its way out. 00:20:20.640 --> 00:20:24.480 Number six, it's really important that you build your own anchor. 00:20:24.640 --> 00:20:32.799 So before I counter anything, before I set my anchor, I need real comparisons across every offer. 00:20:32.960 --> 00:20:35.920 So this is total comp, not just base salary. 00:20:36.079 --> 00:20:38.799 So the line items to look at are going to be your base wage. 00:20:38.880 --> 00:20:39.759 That's the biggest one. 00:20:39.839 --> 00:20:43.200 That's the like magical ticket everybody gets way too fixated on. 00:20:43.680 --> 00:20:47.039 Sign on, relocation bonuses, really big for new grads. 00:20:47.200 --> 00:20:54.720 This is one of the reasons it can be beneficial to job hop a little bit, but oftentimes these sign-on bonuses are going to be over four to five years. 00:20:55.119 --> 00:20:57.039 You need to look at your expected hours. 00:20:57.200 --> 00:20:59.680 Is this a job where they expect 50 hours a week? 00:21:00.000 --> 00:21:10.799 That was one of the things that in my first job, the anesthesia group had a contract with the hospital that they would run ORs until 1700. 00:21:11.039 --> 00:21:19.039 Where in our contract, it said we were going to drop down and take just one room after 1500, which doesn't sound like a lot. 00:21:29.680 --> 00:21:32.160 Are you 100% salaried? 00:21:32.240 --> 00:21:33.519 Is that call inclusive? 00:21:33.680 --> 00:21:35.119 Are callbacks inclusive? 00:21:35.359 --> 00:21:36.960 Is overtime inclusive? 00:21:37.200 --> 00:21:40.799 Or is that segregated, separated, additional compensation? 00:21:41.039 --> 00:21:44.880 So overtime, call pay, callback hours, all of those things. 00:21:45.039 --> 00:21:46.720 Holidays, that's another one. 00:21:46.960 --> 00:21:50.640 And then all your benefits, like what kind of retirement matches on there? 00:21:50.720 --> 00:21:53.039 Is it a 401k, a 457? 00:21:53.279 --> 00:21:54.880 Take a look at what they have. 00:21:55.200 --> 00:21:59.599 Malpractice coverage, all aspects of it, and then taxation as W 2. 00:22:00.079 --> 00:22:01.920 It's fairly straightforward. 00:22:02.720 --> 00:22:05.680 W-2 and 1099, we've covered in a couple other episodes. 00:22:05.839 --> 00:22:07.839 These are definitely not apples to apples. 00:22:08.000 --> 00:22:11.920 The 1099 role is typically going to pay quite a bit more. 00:22:12.000 --> 00:22:21.359 It's going to need to pay 20 to 30% more just to break even with a comparable W-2 offer once the self-employment tax and self-funded benefits are siphoned out. 00:22:21.519 --> 00:22:27.359 So with a real adjusted take-home number for each, that's what I use for direct market comps. 00:22:27.759 --> 00:22:35.359 So calls to comparable facilities, job postings, locations, get it as apples to apples as you can. 00:22:35.519 --> 00:22:37.440 And then I have my own anchor. 00:22:37.519 --> 00:22:41.359 So this is a specific, generally non-round number. 00:22:41.519 --> 00:22:44.400 And this is not a benchmark that I just accept. 00:22:44.640 --> 00:22:47.599 So the data tells me what's defensible to ask for. 00:22:47.759 --> 00:22:49.519 You don't want to be totally ridiculous. 00:22:49.599 --> 00:22:53.920 And if you are, you want to say you're going to be totally ridiculous because I have done that before. 00:22:54.160 --> 00:23:06.319 At the end of the day, if the total comp doesn't work, if they can't get to a number that you need, and you already know what you need because you did the research, you found out what the rates could be, should be, and what you need to pay your bills, your overhead, meet your retirement goals. 00:23:06.640 --> 00:23:11.039 You still have to be able to walk away to make your number stick. 00:23:11.359 --> 00:23:14.319 If you think markets 250, they're offering you 225. 00:23:14.480 --> 00:23:20.079 You say 275 because of this site, that site, and the other site, and they won't budge from 225. 00:23:20.160 --> 00:23:23.359 You need to say, you know, that actually doesn't work for me. 00:23:23.759 --> 00:23:25.440 We can address this in future years. 00:23:25.519 --> 00:23:29.839 But at this time, I'm just unable to sign with the numbers as I see them. 00:23:30.559 --> 00:23:31.599 SRNAs. 00:23:31.920 --> 00:23:35.279 Collect offers from each of your clinical sites. 00:23:35.440 --> 00:23:42.720 Even if they start to joke about, hey, you should come on, you know, perm full time, whatever, ask to see the comp and benefits package. 00:23:42.880 --> 00:23:46.400 There's there's nothing wrong with taking a peek at it, adding it to a spreadsheet. 00:23:46.480 --> 00:23:47.440 That's exactly what I did. 00:23:47.599 --> 00:23:51.839 So this is how I knew what all the local areas were were paying. 00:23:52.240 --> 00:23:54.720 You should always expect a counteroffer. 00:23:54.960 --> 00:23:58.559 So they're at 225, you offer 275. 00:23:59.200 --> 00:24:01.279 There will likely be something in the middle there. 00:24:01.440 --> 00:24:05.839 Now be ready to explain the number in terms of what produce your 275. 00:24:05.920 --> 00:24:13.680 Like I said before, maybe the benefits are different, maybe the call is different, the PTO is different, maybe it's a better area geographically. 00:24:13.839 --> 00:24:15.279 Be careful with this one. 00:24:15.599 --> 00:24:19.759 And watch out

for the quote, we've given you a fair offer line. 00:24:20.000 --> 00:24:22.319 This is a really big guilt tactic. 00:24:22.400 --> 00:24:23.920 This is not a data point. 00:24:24.400 --> 00:24:29.119 And the only real answer to this is your own market research. 00:24:29.279 --> 00:24:34.400 So anytime the word fair comes out, it's usually not going to be in your favor. 00:24:35.359 --> 00:24:39.920 Number seven, let's touch on some of the locum aspects to this. 00:24:40.079 --> 00:24:44.960 So if I'm looking at a locum assignment, this is this is going to change a little bit. 00:24:45.119 --> 00:24:47.759 And these are the things that I walk through line by line. 00:24:47.920 --> 00:24:52.079 First of all, to even get into the negotiation, I need to know that the rates are there. 00:24:52.319 --> 00:24:57.599 Every rate I'm talking hourly rate, daily rate, call rate, callback, OT. 00:24:57.680 --> 00:25:01.599 It's all got to be there for me to even talk to a recruiter to talk to a hospital. 00:25:01.680 --> 00:25:06.960 I get way too many inquiries about, hey, you should come work in XYZ state, XYZ hospital, whatever. 00:25:07.200 --> 00:25:10.400 Nah, just you could be on the phone with recruiters all day. 00:25:10.720 --> 00:25:16.000 Get the rates in the ballpark of where you need them before you even undertake negotiation. 00:25:16.400 --> 00:25:23.920 One of the things I look for is a guaranteed minimum hour for the day, whether it's eight hours, six hours, four is usually not in my ballpark. 00:25:24.079 --> 00:25:26.319 Midwest commonly does eight, so eight is what I want. 00:25:26.480 --> 00:25:28.640 If they don't have that, it's usually not worth it. 00:25:28.720 --> 00:25:34.240 Even if they tell me, oh, it's it's extremely rare that we're done before three o'clock, I wouldn't expect anything less than eight. 00:25:34.319 --> 00:25:35.279 Yeah, it doesn't matter. 00:25:35.359 --> 00:25:38.240 I want a guaranteed minimum because that's how I function. 00:25:38.480 --> 00:25:42.079 You want to make sure you have a cancellation and a no-call, no show clause. 00:25:42.160 --> 00:25:45.599 So this is essentially who is at risk if something were to happen. 00:25:45.759 --> 00:25:47.519 I like a 30-day cancellation. 00:25:47.599 --> 00:25:48.400 It looks good. 00:25:48.559 --> 00:25:54.160 So if they don't need me as I'm recording this mid-September, if you don't need me a month from now, cool. 00:25:54.319 --> 00:25:56.559 You don't need my November hours, great. 00:25:56.640 --> 00:25:57.279 You can call me. 00:25:57.359 --> 00:25:59.119 I'll try and get scheduled somewhere else. 00:25:59.279 --> 00:26:00.559 No harm, no foul. 00:26:00.720 --> 00:26:06.640 Same if I get a call from someone else, something comes up in my life, whatever, I can give the hospital a 30-day notice. 00:26:06.799 --> 00:26:09.680 Say I have something booked for a weekend, can't work, same deal. 00:26:09.839 --> 00:26:13.599 As long as it's greater than 30 days out, it's a pretty, pretty good way to go. 00:26:13.839 --> 00:26:17.200 And the reason this is because I've committed my time to you guys. 00:26:17.440 --> 00:26:24.400 I passed on all of the other hospitals, all of the other surgery centers, all of everything to give you guys my time. 00:26:24.640 --> 00:26:28.240 And I can't get credentialed anywhere five days out. 00:26:28.559 --> 00:26:32.799 So the chances that I can pick up that day are next to next to nil. 00:26:32.880 --> 00:26:39.359 So make sure you have some kind of cancellation clause in there to protect yourself and to keep some income coming your way. 00:26:39.680 --> 00:26:42.079 Travel and housing, really variable. 00:26:42.160 --> 00:26:45.680 Sometimes it's hospital supplied, sometimes it's reimbursed, sometimes it's stipend. 00:26:46.079 --> 00:26:47.279 Do whatever works for you. 00:26:47.519 --> 00:26:49.680 Stipend is by far the easiest. 00:26:49.920 --> 00:26:52.720 You essentially get dollars, spend it as you will. 00:26:52.880 --> 00:26:54.799 Sometimes it'll be an all-inclusive rate. 00:26:54.880 --> 00:26:56.079 Again, fairly easy. 00:26:56.240 --> 00:26:59.519 Reimbursement, you're gonna want to look at how it has to be reimbursed. 00:26:59.839 --> 00:27:05.279 Do you have to submit uh receipts via photo or PDF or email? 00:27:05.359 --> 00:27:08.319 Or it probably won't let you send a credit card statement. 00:27:08.480 --> 00:27:23.039 Either way, look at what you need to supply to get reimbursed and then how they reimburse it, when they reimburse it, what things they reimburse, do they reimburse rental cars, do they reimburse all rental cars, housing, all housing, Airbnbs, or is it hotel? 00:27:23.119 --> 00:27:24.480 Is it certain hotels? 00:27:24.960 --> 00:27:26.559 A lot of stuff goes into here. 00:27:26.720 --> 00:27:31.440 It's one of the areas that have kind of pinched me in the past, so I find it way easier just to take a stipend. 00:27:34.079 --> 00:27:37.279 Get your own, way easier, especially as a locum. 00:27:37.519 --> 00:27:44.000 You want to prevent coverage gaps, and then with a nice occurrence policy, really don't have to worry about it. 00:27:44.160 --> 00:27:49.200 Um, facilities are gonna want you to carry a certain minimum, and that's just so they are not a bigger target than you are. 00:27:49.359 --> 00:27:51.119 Everybody's pockets are the same depth. 00:27:51.279 --> 00:27:52.480 That's what they're looking for. 00:27:52.720 --> 00:27:53.920 Harsh reality of it. 00:27:54.000 --> 00:27:59.440 I think a lot of states we can carry 200,000, 600,000, but what I've been seeing is one mil, three mil. 00:28:00.079 --> 00:28:03.759 Anyway, look uh look a little bit of that on your own. 00:28:04.000 --> 00:28:07.200 Credentialing timeline, and this is who bears the cost of delays. 00:28:07.359 --> 00:28:11.039 So if we're gonna have a January 1 start, um, what's that gonna look like? 00:28:11.119 --> 00:28:13.759 How am I guaranteed that we're gonna

start January 1? 00:28:13.920 --> 00:28:17.680 Yeah, if you submit your paperwork December 1, it's gonna be a little close. 00:28:17.839 --> 00:28:22.240 Right now it's September, maybe October by the time this episode gets released. 00:28:22.400 --> 00:28:29.200 Um, if I'm three to four months out, what's my guarantee that I'm gonna be able to start whatever, January 1st, February 1st? 00:28:29.440 --> 00:28:34.640 So just remember that you are a contractor looking through the 1099 locum lens. 00:28:34.720 --> 00:28:36.400 So you're a contractor, not an employee. 00:28:36.559 --> 00:28:54.319 So when places try to send you all of this orientation material or try to send you all of this onboarding documentation, if it doesn't have to do with the actual credentialing process and the things that you need to do to get licensure, to get your DEA and to go through the credentialing committee at the hospital, yeah, I'm not really about it. 00:28:54.400 --> 00:28:55.519 Those are things that employees do. 00:28:55.680 --> 00:29:02.240 If you want me to do that, you can pay me, pay me my overtime rate because I'll be doing it after work of wherever I'm at now. 00:29:02.480 --> 00:29:05.839 So I don't do orientation onboarding things. 00:29:06.079 --> 00:29:09.279 With that being said, I have worked with quite a few charting systems. 00:29:09.359 --> 00:29:17.920 So that's one of the things I discuss ahead of time is that there is some degree of proficiency in paper charting in Epic and Meditech, handful of other ones, so on and so forth. 00:29:18.079 --> 00:29:22.720 But contractor, not an employee, don't get into the misclassification issues. 00:29:23.599 --> 00:29:28.559 Agency dynamics, number eight, locum agencies ultimately represent the facility. 00:29:28.720 --> 00:29:29.759 That's who hires them. 00:29:29.839 --> 00:29:31.359 They don't represent you. 00:29:31.839 --> 00:29:35.279 And keep this in mind because everybody's in it to make money. 00:29:35.359 --> 00:29:41.200 The hospital's in it to make money, the agencies are in it to skim off your back, and you're in it for money as well. 00:29:41.440 --> 00:29:44.000 Not a lot of y'all working for free, I'm fairly sure of that. 00:29:44.240 --> 00:29:49.680 So as long as you keep in mind that everybody's in it for money, and sometimes the agencies try to try to play it off that they're not. 00:29:49.839 --> 00:29:51.680 It's like, guys, you're you're literally a business. 00:29:51.759 --> 00:29:52.240 It's fine. 00:29:52.400 --> 00:29:57.519 Just admit that if I'm working for 250, you're billing for 300 or 325 or whatever. 00:29:57.599 --> 00:29:58.319 Like, I get it. 00:29:58.400 --> 00:29:59.200 It's all good. 00:29:59.359 --> 00:30:01.119 You have exclusive rights to the job. 00:30:01.279 --> 00:30:02.880 I need you to get into the job. 00:30:03.039 --> 00:30:04.160 It's all good. 00:30:05.039 --> 00:30:10.720 So locum agencies generally hold the responsibility of doing the credentialing. 00:30:10.960 --> 00:30:13.119 They have to pay me, so on and so forth. 00:30:13.279 --> 00:30:14.720 And they kind of act as a middleman. 00:30:14.799 --> 00:30:17.839 They get a little spicy when you go around them and talk too directly to the hospital. 00:30:18.079 --> 00:30:19.279 Every agency is different. 00:30:19.359 --> 00:30:22.880 Some have good reputations, others not so good reputations. 00:30:23.119 --> 00:30:29.200 Things I look at are if I get canceled, how do I get canceled when I get canceled? 00:30:29.359 --> 00:30:32.079 If they say I have dates booked, I mean, am I going to work them? 00:30:32.160 --> 00:30:33.279 That's pretty important to me. 00:30:33.440 --> 00:30:35.920 And second of all, I just want to get paid accurately. 00:30:36.000 --> 00:30:37.119 I want to get paid on time. 00:30:37.279 --> 00:30:39.039 Those things are all in the contract. 00:30:39.279 --> 00:30:48.319 If you go direct to the hospital, if you have an idea of what the agencies are making, I heard at some point it's between 18 and 30% over top of what your what your rate is. 00:30:48.559 --> 00:30:52.319 So if you're taking 250, they're probably billing a little closer to three and a quarter. 00:30:52.480 --> 00:31:04.400 I think margins have tightened up a little bit, but in that instance, say 250 an hour, and you're going to go direct instead of through an agency, you might be able to sneak up to 275, 280, split the difference. 00:31:04.480 --> 00:31:07.680 It generally works out fairly well for both parties to go direct. 00:31:08.000 --> 00:31:19.279 Then you're dealing with somebody at the hospital, whether it's their internal agency recruiter, maybe it's an HR person, CFO, whatever the case may be, find your person, negotiate with them. 00:31:19.519 --> 00:31:28.720 At the end of the day, whether it's with these agencies, whether it's with the hospital, whomever, you need to reject respectfully and you need to walk away when it's called for. 00:31:28.960 --> 00:31:32.240 Not every offer is going to close, and that's totally fine, right? 00:31:32.319 --> 00:31:37.920 So a clean, respectful decline is what keeps the door open for a future locum shift or referral. 00:31:38.160 --> 00:31:43.440 I have been in the locum market a fairly short time compared to many other CRNAs out there. 00:31:43.599 --> 00:31:50.319 And I have already seen the circle loop close, inquiring at places I've already been. 00:31:50.799 --> 00:31:56.240 And I'm really glad that I have a good working relationship at those places. 00:31:57.039 --> 00:32:00.559 Work hard while you're there, be a good sport, do what they need you to do. 00:32:00.799 --> 00:32:04.079 And at the end of the day, it's no hard feelings, no burn bridges. 00:32:04.160 --> 00:32:05.440 I've really enjoyed my time here. 00:32:05.599 --> 00:32:06.880 You guys have been great to work with. 00:32:07.039 --> 00:32:14.079 I'd love to come back in the future if our situations change, if your needs are still

that locums are a part of your everyday staffing. 00:32:14.240 --> 00:32:19.200 And if if my situation works in that way, I'd love to come back. 00:32:19.440 --> 00:32:28.160 And if a facility says all the numbers are final and it's still short of what I need, I say, thank you so much for your time chatting with me, and you walk away. 00:32:28.400 --> 00:32:32.400 And that's just the ability to say no, put into practice. 00:32:33.119 --> 00:32:37.039 Number 10, contract attorneys, they are a viable option. 00:32:37.440 --> 00:32:39.519 CFO looked over my first contract. 00:32:39.599 --> 00:32:40.160 It was great. 00:32:40.319 --> 00:32:44.559 He put everything into lay terms, really did more than I could have ever asked for. 00:32:45.119 --> 00:32:50.640 But contract attorneys are out there, and hiring a professional is a sense of security. 00:32:50.880 --> 00:32:57.680 After you've read a few contracts, you start to understand a little bit about what to expect and the commonly used business verbiage. 00:32:57.920 --> 00:33:01.200 And lately, I've leaned on AI to review my contracts. 00:33:01.359 --> 00:33:10.720 So I fire up Claude Chat and I enter a prompt starting with something like, Hey Claude, you are an amazing contract attorney with an unparalleled eye for detail. 00:33:11.039 --> 00:33:17.119 Please look over this contract and highlight every single way this contract is disadvantageous to my LLC. 00:33:17.599 --> 00:33:28.559 Include what you would have changed to eliminate this disadvantageousness and provide me with the verbiage that I should use to make the contract more favorable. 00:33:28.880 --> 00:33:31.680 This has been absolutely fantastic. 00:33:32.160 --> 00:33:36.799 You can also ask Claude or whatever AI to put it in lay terms. 00:33:37.039 --> 00:33:38.799 Hey, explain what this means? 00:33:38.880 --> 00:33:40.079 What is this section getting at? 00:33:40.240 --> 00:33:41.359 Is this common verbiage? 00:33:41.440 --> 00:33:42.720 Is this atypical? 00:33:42.880 --> 00:33:44.319 Is this state-specific? 00:33:44.480 --> 00:33:45.680 Like what's going on here? 00:33:45.839 --> 00:33:47.039 Help me understand this. 00:33:47.200 --> 00:33:48.480 And AI does a pretty good job. 00:33:48.640 --> 00:33:50.640 Flawless, absolutely not. 00:33:50.799 --> 00:33:53.680 But does it give you a rough idea of where to start? 00:33:53.839 --> 00:33:54.160 Yeah. 00:33:54.400 --> 00:33:59.279 Maybe good enough where you can take some notes, send it to a colleague, and that might be able to get you through. 00:33:59.599 --> 00:34:05.359 You can always hire a contract attorney, but I don't know a lot of people that do this for every contract. 00:34:05.519 --> 00:34:07.200 Some people do it for the first one. 00:34:07.359 --> 00:34:13.119 Some people do it if they are expecting to stay at a job for 10 plus years and they're not going to be signing a bunch of contracts. 00:34:13.199 --> 00:34:14.079 Yeah, that's great. 00:34:14.239 --> 00:34:17.440

I sign a handful of anesthesia contracts per year. 00:34:17.599 --> 00:34:20.480 I also run my furniture finder leases through that. 00:34:20.719 --> 00:34:27.360 And any other contracts I sign, I find AI just kind of like a little cheat code to get me down the uh road a little bit. 00:34:27.599 --> 00:34:28.400 Really like it. 00:34:28.719 --> 00:34:30.800 Very cost effective, very fast. 00:34:30.960 --> 00:34:34.320 And I like that it can also give me some feedback on the verbiage. 00:34:34.719 --> 00:34:46.800 Some of the things that I found are issues with it are when an agency says they cover malpractice or don't cover malpractice, Claude will flag that as, oh, this is a benefit that some some folks have in your industry. 00:34:46.960 --> 00:34:51.840 And you have to keep in mind that I want to cover my own malpractice. 00:34:52.000 --> 00:34:54.960 I want my attorney fighting for me. 00:34:55.280 --> 00:35:00.719 So even though Claude provides that suggestion, that's not going to be something I'm going to change. 00:35:00.880 --> 00:35:04.000 As long as you can read past, don't just copy and paste AI. 00:35:04.079 --> 00:35:05.280 Nothing good comes from that. 00:35:05.440 --> 00:35:06.320 Read past it. 00:35:06.480 --> 00:35:09.519 I think it'll give you a good start, give you something to look at. 00:35:10.239 --> 00:35:18.400 So just remember whether it's a system offer or a locum assignment, the contract is the first financial decision of the job. 00:35:18.559 --> 00:35:24.880 And you want to get this right on day one, not something they're going to revise once you get rocking and rolling. 00:35:25.119 --> 00:35:37.679 So it's really important that high income only becomes well through decisions like this one, to have a contract that's reasonably fair between both parties, not disadvantageous to you. 00:35:38.000 --> 00:35:42.239 And every contract I sign to this date, I always miss something. 00:35:42.400 --> 00:35:48.880 Whether the verbiage is a little too gray in one area, that's never going to go in your favor, or you miss something altogether. 00:35:49.119 --> 00:35:52.239 It's really important to take notes for yourself. 00:35:52.400 --> 00:35:55.760 So the next time you review a contract, you can tighten it up a little bit. 00:35:55.920 --> 00:35:57.760 You don't want to make the same mistake twice. 00:35:57.840 --> 00:35:59.360 That is absolutely fatal. 00:35:59.519 --> 00:36:02.239 So you need to do your work as a CRNA. 00:36:02.320 --> 00:36:03.840 And yes, this isn't anesthesia. 00:36:03.920 --> 00:36:30.000 Yes, it kind of sucks, but this is what ultimately keeps your income secure, keeps you from having a three-month break in income, keeps you getting paid on time, and keeps everything suitable, keeps you from having to pick up extra shifts when the facility does you all dirty or changes over the anesthesia contract, keeps your PTO and your vacation, your family reunion when you scheduled it nine months earlier, they can't take that away. 00:36:30.239 --> 00:36:42.800 I'm going to quit rambling now and just say that for as much as you don't want to do anything outside of anesthesia, you don't want to learn about personal finance or investing or contract negotiations or business or whatever. 00:36:43.039 --> 00:36:53.440 I've only been a CRNA for a handful of years, and just a few little contract negotiation points has literally earned me hundreds of thousands of dollars more. 00:36:53.599 --> 00:36:59.440 My first contract, just negotiating a few points,$110,000 over three years. 00:36:59.599 --> 00:37:01.280 Not too bad for a new grad. 00:37:01.360 --> 00:37:04.159 And that's only gone up exponentially as a locum. 00:37:04.480 --> 00:37:08.320 I can still say no, so I can negotiate very aggressively. 00:37:08.400 --> 00:37:10.079 And this works really, really well for me. 00:37:10.239 --> 00:37:16.639 Yeah, there are some setbacks, but at the end of the day, it works really, really well to build wealth. 00:37:16.800 --> 00:37:19.760 And that's the name of the game at the Financial Podcast. 00:37:19.920 --> 00:37:21.519 Thanks again for listening, guys. 00:37:21.679 --> 00:37:23.519 Subscribe wherever you get your podcasts. 00:37:23.679 --> 00:37:26.079 Blog at the financialcocktail.com. 00:37:26.320 --> 00:37:29.119 Next week, we're looking at a 1099 Locum case study. 00:37:29.199 --> 00:37:32.480 This is from a blog, but you're going to get a little more input on it next time. 00:37:32.639 --> 00:37:34.960 So stick around, subscribe, catch that. 00:37:35.119 --> 00:37:36.239 Thanks everyone for listening. 00:37:36.480 --> 00:37:37.599 Leland out.