The New Grad CRNA Career & Financial Playbook

Okay. So, this is a webinar. It is for primarily for students and new grads. You know, actually a lot of the material in here I get because of I threw out

a question a few months ago on one of the CRNA Facebook pages and I said, "If you could give any advice to new grads, what would you say?" And so, a lot of this was kind of built around that. But in a webinar we recently

hosted, there were a few students that really wanted us to talk about more things to gear towards new grads. and so that's how we evolved and made this. so my name is CoryAnn Kleinhaus

I'm a nurse and estatist and I have I graduated in 2018 and my first job was a W2 job at a major medical

center. and I did that and I still work for that company. But I slowly cut back my hours and actually after being out of school just for one year, I

got my first 1099 job and it was in a rural hospital and that's cuz I just wanted to keep my foot and have all my clinical skills. So I did that a couple times a month and then I ended up actually getting another 1099 job at in

a clinic. So I was doing hospital, rural hospital and clinic work and I did that for a few years and then COVID happened and so my 1099 work kind of died off and I had my W2 job and then I

have it now I I have another 1099 gig at another major medical center. So, that's kind of my employment history. Just to give you guys a little background about so with running a

1099 business, it's great. There are so many benefits, but you also have to be very diligent and treat it like a business. And I was tracking everything

manually and it I was missing out on a ton of deductions, I realized. And so, I wanted I tried QuickBooks and it was a little bit too complicated and not quite what I needed. And then I tried some other apps and finally my husband who's

a software engineer is like we just build an app and so I we made an app called 1099 hub and so it's an app it's primarily for CRNAs who do 1099 work and

it really just helps them maximize their tax deductions and stay organized as a business. So that's a little bit about me. and then with that we have I realized there was just a huge need for

education and I really like teaching. Um, and so we have just been putting out and so we have just been putting out like free webinars and free resources for people and just really trying to educate CRNAs how to maximize their tax

deductions. because my philosophy is you worked really hard for that dollar and you should keep as much of it as you can. And then I met Jake because in the fall my husband I thought my husband had

a bad disability insurance policy and so I really wanted to find a better policy. So, I threw out on the CRNA business webs Facebook page and I was like, "Hey, who do you guys use for disability

insurance and so many people said Jake?" And so, I reached out to him and he actually helped me walk through my husband's policy and was like, "You actually have a really great policy. He should stick with it." And so, I

thought that was very honorable and that he didn't, you know, just try to convert me and get my my dollars. So, we So, I invited here him here to this web, webinar. So, I'm going to have him

introduce himself now, too.

>> Cool. yeah, thank you for the kind introduction, CoryAnn. And you're way more brave than me cuz I graduated in 2013 and it took me almost a decade of working jobs before I was brave enough

to make the switch to 1099. So, way to go doing it after only a year. That's awesome. so I've been in every type of setting. I my most recent like

super full-time W2 job was as a chief CRNA and I realized that I absolutely loved taking care of my colleagues because I have had a lot of bad bosses and a lot of jobs over my career and I

wanted to like I didn't have any leadership training but I wanted to avenge all the bad bosses. So if someone said hey you know my kids first school play is Thursday morning. Is it okay if I come in late? I would be like,

"Okay, surgeon, your flip room's canceled because this person is going to be able to is going to have to come in late because their kids school play." Um, so it made me very popular with the so it made me very popular with the CRNAs. We had pretty much no turnover for a number of years, but very

unpopular with the management above me. Um, and so the writing was on the wall and so the writing was on the wall that that position was not going to last long. Left, went 1099. Was like, "Holy crap, I work for myself. I control my

hours. I'm making a lot more money working less. I just happier on all the levels." called my friends asked them like, "Hey, come do this. I'll help you get started." And everyone said, "It's too complicated. I'm overwhelmed. It's

safe where I am. I'm going to stay because most like nursing jobs except for travel nursing are W2. Even a lot of travel nursing jobs are W2. So, a lot of us are very very uncomfortable with the concept. So, my mission is kind of like

run in parallel with CoryAnn's, just smooth the process, help help guide people through this in in different ways. You know, my specialty is disability insurance. We'll get to that later, but it's so cool to see CRNAs who

are just like, how can I help make other people's careers better? And especially like I wish I had this presentation when I graduated cuz I made all sorts of mistakes. If I had had this, you know, this webinar, which is, you know, it

would have been an hour of my life or less time before, it would have saved me tens if not hundreds of thousands of dollars. So, my hats off to, you know, people who are doing this stuff and I'm glad you guys are here and thank

you for having me. Yeah, thanks Jake. Sure.

>> Okay, so let's get started. you guys, uh maybe you've graduated, maybe you're maybe you've graduated, maybe you're going to graduate or you're in clinicals, but essentially we'll define graduation as mile zero. So you are

starting out, it's really important just to kind of take an inventory of where you are financially. And so one good thing is just to calculate, you know, your net worth. So that's just your

assets minus your debt. and then sort of start to have a plan around your student loans and there's it changes year to year all the refinancing options. So,

we're not going to go into that, but just always good to have an eye out for the most current interest rates and everything. And then also, you know, look at insuranceances right away. Get

disability insurance, life insurance. We're going to talk about that stuff. So, those are just some ground zero u for your path. So, and then one of the

things that a lot of CRNAs when I asked the question like what should we talk about they really talked about, you know, what is your trajectory over the first one to three years of your career because that's really going to shape

shape your market your marketability as a CRNA for the rest of your life. And not that you can't ever pivot or change cuz you definitely can. It's just you

know where you take your first job will really help hone in on your skills. And so, for example, I have a friend, her first job was at a small surgery

center just because it was convenient and close to her home. And it really pigeonholed her where she a few years later she realized they were going to move and she wanted to do 1099 work.

Well, there was only a couple facilities where they were moving that would actually consider her because the rest of them were major medical centers and she didn't have that training behind her. So, whether you do 1099 or

whether you W2, just some things to really consider is more of a long-term vision. So, you know, maybe you take a lower pay, but you're really going to focus on skill building and autonomy,

and this can lead to higher earning in the future as, you know, you have all these other skill sets that other people and other facilities are going to want. And then same thing with just looking at

a support system. So when you graduate, I I thought I knew everything. No, I'm just kidding. I know I didn't know everything, but it was just a huge learning curve my first year or two

even. I joined a a call team and I was really grateful that I had two other colleagues on my call team that had a lot of years under their belt. So when

things happen, I you know, weird things happen when you're on call. And so it's really great to have people that you can rely on, that you can trust, that have your back. And then same thing just looking for a place, you know, as you're

taking a job, does it have a stable culture? especially if you're doing something like a sign on bonus and you're going to be there a few years, you really just want to make sure that it it has a good culture there. You don't want to

take a job and then get burned out or feel like it's not a great place to work. And then kind of we're going to talk a little bit, we're going to go into some things to look at in contracts

right now. So, one of the things that you should really pay attention to is your sign on bonus. if you're taking that, there's a lot of I'm not a lawyer, so this is not like a legal presentation

or anything. but just really watch some of the the verbiage around the sign on bonus, you know, is it a long time you're committing to? Because if you're

I mean kind of how you look at it is maybe you should take a smaller sign on bonus for more flexibility with the with the verbiage versus if you're going to take something that has really strict

wording maybe take a higher sign on bonus. So just you kind of have to look at everything in the contract to really understand it. And one CRNA was really adamant that I shared this and I really

appreciated it because I had never thought about this but they actually took a job got a sign on bonus and then another company came in and provided that so that their company got kind of got fired essentially and another

company came in and provided the anesthesia. Well, I think they had a non-compete or something in their contract. So they couldn't come and work and yet they were stuck with this paying back a sign on bonus but they had no job to pay it back with. So, just

something to kind of consider is if you're taking a sign on bonus, just make sure there's a clause that allows you to keep it without repayment if for some reason there's a turnover or

something like that. So, if you can and then the rest of these termination and non-competes and all this malpractice we're going to get into right now. So, this is now a lot of this

stuff is for both W2 and 1099. Some sides might be a little bit more towards if you're doing 1099 work. just some things to pay attention to in contracts.

So, when you're when you're considering your contract, you really want to I don't think I I did not look at any of this my first contract or two probably. Um, I think I think by the second

I think I think by the second contract, I kind of had a little bit of inkling, but definitely by the time I took my third one, I my third 1099 gig, I was like, I know what to look for. So, uh, minimum weeks guaranteed. And like I

minimum weeks guaranteed. And like I said, I my first two jobs were during the pandemic. I lost all of my shifts because of the pandemic and I had no guarantees. So, I learned very quickly that it should have a guarantee

or if you get cancelled. So, now I personally do a twoe cancellation period that if I get cancelled within they have to pay me 50% and then if it's within 48 hours it's full I get a full

paycheck or for the day that they cancel me. And and I had to learn that along the way. That was a mistake that I made. And so just make sure you have cancellation protection. And then payment terms. I think I think I

would hope most companies are pretty good. I haven't ran into this problem, but there's different payment stipulations like net 15 or net 30. So that's kind of do you get paid every 15 days, every 30 days? And then if they're late on the payment, are there payment

fees? I haven't ran into that, so I actually don't pay much attention to that. but if definitely if you are taking a contract with a company that

you don't know a lot about that it is a good thing to have in your contract. And so just some red flags watch out for one-sided cancellation. ambiguous pay. So you would not want to take a

contract where they're like it's based on your productivity. You want it hourly based or daily rate based. And then just some if you have to cancel, you don't want any penalties that you

have to pay or anything like that. So, um, so you just really want to push for so you just really want to push for reciprocal cancellation rates and not having to pay if you h have to cancel. So, those are just some things to

consider. Another thing is indemnification, and I had no idea what this was until a couple contracts in as well. So, indemnification determines who covers

the legal costs if a third party sues. So, essentially, you just really want it. The biggest thing if you take away one thing from this is you want mutual indemnification. And what that means is

just both of you parties are liable. And so if it's li so language you want it limited to so you want it to be about your job because if it's if it's really

vague language so the in the language uh area I say gross neglig negligence or area I say gross neglig negligence or will for misconduct versus the

facility saying provider shall indemnify defend and hold harmless facility from any and all claims arising out of any provider services even if that's caused on the facility is negligence, which is

essentially, you know, if one of their equipments break down, if their nurse does something, if they have staffing failures, billing issues, you don't want to be held liable for those things.

And then, there's also this thing called the carveout. So, you explicitly state that inification does not apply to claims already covered by medical malpractice insurance. And essentially that says that if your malpractice

insurance is already covering a claim, they can't come out for your personal assets. So they can't double dip and say, "Well, we want you now to cover our legal fees. It's already being covered by your malpractice insurance." So it's

a way that companies and facilities have double dipped, and you just want to protect yourself. So those are just some basic languages. and oh, you know, one thing I forget, I I I I don't

want to forget to tell you guys this. We have a tool that my husband's working on. It's going to be on our website soon and you can actually are it will be a tool that you can upload your contract to and see if there's any, you know, red

flags or things. So, I just want to throw that out there because I keep forgetting to to mention it to people. So, just pay attention to or look out for that, I should say.

>> That's so cool.

>> Yeah. Yeah. It was my I was I was sharing with Jake earlier, my husband, he's like an AI programmer, so he is trying to incorporate more AI stuff. And so that like one idea that I had, I was like, it'd be really great if

you could just throw your contract up there and have it be like, oh, this is a red flag in there. So, we're trying to make that. and he thinks it's very easy. So, hopefully at some point we will have that.

>> That's cool. CoryAnn, someone put in the chat if someone can let in.

>> I just let in the last person. So, um, there there are no people in the waiting room right now. I just let someone in. Maybe it was her.

>> Cool. Awesome. Oh, she's in. Yeah, thank you.

>> Okay, perfect. Sounds good. All right, so then another thing to watch out for is non-competes. Now, this can be so it's state specific. So, some states

non-competes don't really matter. So, you just have to know what's in your state. Other states it really does matter. And so, you need to know the language. And regardless if it if your state doesn't matter or not, it's best

just to try to have it eliminated from your your contract. and so, you know, at the best thing would be just to push if there is a non-compete, just to

say that you don't want it and kind of push aggressively to have it removed. If it is, if they refuse to remove it, you really want it to be highly localized. So, you want it to be a

narrow scope. So, rather than a 2-year non-compete, you really want it to be 0 to six months. And rather than a 50 mile radius, you really want it to be just around the facility, like 5 to 10 miles. And then if you are a PRN or if you're a

locom, they should not include this. This is it's not or 1099 it should it should be waved for locoms and 1099 people. This is more for like something someone that's a W2 employee. so if

you do take a 1099 job they you should really push for them to eliminate it and it's a red flag if they don't. Now, and then another protective clause that you can have added is that

it it doesn't apply if you're terminated without cause. You know, something like the pandemic, something that is unforeseeable, they let you go, you should not be held liable to to that if

if it was on their if it was their decision. And then and then also just sometimes they can say throw in like weird verbiage which is called an evergreen trap. I've never ran into

this, but just that restrictions apply to any facility provider that they work at during the term. So, that can just be some weird limiting language that you just want to watch out for as well.

Now, termination clauses. So, this is really common to have in in a contract. You really want to push for mutual every like if take away the word mutual. Things should be both sided. Mutual

notice periods of 60 to 90 days. That that's pretty standard. and then clearly documented. you want it to be for a cause. So like if your license is revoked, if there's a bad patient

outcome, like those are reasonable things. And then what you can also look for, some contracts will have a cure period. And so that's a 30-day cure period allowing you to fix anything, any

documented issues before termination is finalized, unless it involves patient safety. So, you know, if you're missing something, you can try to reconcile it before your termination is done.

And then what you want to avoid is just that the the facility or the group that you work for has all the the control and they're the ones that get to terminate you and you don't have that mutual

termination clause. And then vague language as well. So, you don't want it to just say that for conduct deemed inappropriate. you really want it to be uh more specific language. It will help

more specific language. It will help you be less vulnerable. And then here's just some red flags. Maybe these are obvious. I hope they're obvious, but you know, especially as a new grad, I think there can be a lot of

pressure to you. You you don't know what the culture is like. You don't know what the culture is like at that hospital or different places, but you can kind of get a peak into the culture just by how they treat you when you talk about the

contract. So, are they trying to rush you to sign a contract rather than giving you time to review it and look at it? Are they gaslighting you and saying something like, "Well, we've never had anyone ask that question before." I

mean, that's okay. That means that you're probably a lot smarter asking those questions. And then stonewalling, just flat out refusal to clarify any language or put the other thing is you

do not want a verbal promise. You want it in writing, either in the contract or in an email sometimes is okay, too. It can be it's verbal, it's written, at least you have some sort of proof.

especially around like scheduling stuff. I would say you don't if you are going in there with a scheduling expectation, you should really get that at least in an email so that you can you can refer

back to that. And then same thing and then what the last thing is just the friction. if there unreasonable resistance to adding small things or

a small protective clauses like mutual notice that's just a red flag. all the places that I have gone to I have never I've always had great negotiations with the contracts. So for instance the

last facility or the my current facility that I'm at you know I negotiated that they paid for my lunch break. Actually that was something I was like I'm I'm there. I'm giving my time and they they agreed to it. there was no push

back and they pay for my mileage. And so there's just some things that you can you can ask for. It's not especially if it's a 1099 gig. I mean, W2s kind of be are more standardized

language. usually not as many red flags or they don't try to sneak things in, but sometimes with more with contract work, they'll try to sneak things in. I don't know, Jake, do you have anything you want to add for the contract stuff?

>> No, I'm I'm just loving this because I wish that I had like I'm I've been a CRNA for 13 years and I'm learning things today I didn't know. I wish I had had this before and I appreciate you putting this together. I was nodding just because I've been rushed, gas lit,

stonewalled, and the friction did. so I've I've experienced all these things. I think you know, one thing I I want to communicate to this group as

someone who has hired 1099s and hired W2s is that I know that when I first graduated and I was going into my first job, I you know, you guys, I'm sure

don't always leave clinical feeling, yay, I'm awesome. Like, you know, it's a it's a several year beat down and you leave not feeling so great about yourself. But when you're hiring a new

grad nurse that like you know you're going to need to orient and like the I think that my only experience was being a new grad nurse where you're kind of much lower on the totem pole. I don't like new grad CRNA experienced CRNA a

lot of times the new grads were better um and more adaptable and more able to and more adaptable and more able to do you know cases that like like I haven't taken care of neonate in a decade but like a new grad probably has. So, you have all the power. The

facility, the facilities need you more than you need them. Don't be afraid to negotiate. And everything is negotiable. Like, if all right, you're not going to increase the salary. I want you to cover my parking. You're not going to

like everything is on the table. And so, my answer is usually like, okay, if you can't do that, like, how about this? How about this? How about this? And you like you have the power. No one is going to

take your job away because you asked for something. and if they do, that's not a place you want to work anyway. It's not, as long as you're respectful, it's not seen as something that's that's

rude in any way. It's a normal part, and they're also going to start off with their lowest offer.

>> so there's there's always like the the hospital or the business always has something built in to offer you, they're going to start with the lower and most of the time just by asking like, oh yeah, we can go up. So,

>> yeah, I completely agree. Thanks for that input.

>> Yeah, of course. yeah, my slide, right?

>> Yeah, your side. This is his side. that insurance person.

>> Cool. So, you guys mostly is anyone not still in school or not like new gradish?

>> I think there's a couple that are not new.

>> So, if you're a new grad, you probably are in school. You're probably somewhere as broke as I was. I met my wife. I had to put groceries back because I didn't have the money for them.

she's still with me, which is awesome. And a fun fact is you're going to make over $10 million in the rest of your career. And all this hard work is going to pay off. You are going to make

millions and millions and millions of dollars. You know, if you think about average salary somewhere like 300 some you probably have a better facts than I do, but every couple years you're making a million dollars. So when I think of

building wealth, I think about it like any sort of sports ball game you want to use an analogy for. So you have offense and defense. Your offense is you going to work, you making money, and then you're doing smart things with that

money, like investing, building your savings, which I know CoryAnn and you're going to hit shortly. My job is the defense to take all of those bad things that life can throw at you and put them as a buffer around your wealth so that

they don't take it. So, you know, you already do this. Your auto insurance, your homeowners insurance, your health insurance, most of it's all stuff you're already doing. However, now your income

is going to jump substantially. And for most people, you know, your million dollars every couple years is going to be the most valuable asset you own. And there's about a one in4 one or one in

five chance of having a disabling event that takes you out of work for longer than 3 months in your career. So most expensive thing and also you know one

of the most likely bad things to happen. So it makes sense to insure for it. Not for everybody. If you have rich uncle, $10 million trust fund, 100 Airbnbs, you

don't need this. This is for people who can't afford to not be able to work and to only keep for that period of time. So once you have a certain amount of wealth, we recommend getting rid of this. So there are three things to know when purchasing disability insurance.

First big one is get your own policy. Whether you're W2, 1099, you want a policy that you can control because a hospital policy has a lot of limitations on it. It's generally taxed differently.

So you make less money on it. It's generally not true own occupation and most importantly it doesn't go with you. So even if you're like I'm W2 I this is my town. I'm going to work at that hospital. I was born there. I'm going to

die there. We've had so many people who unexpectedly their group gets bought out by a private equity group and then all of a sudden their benefits are gone. They need to find it later in life. So

getting your own policy, even a really really small policy just so that you have a foot in the door if things change um is is generally a smart thing. We is is generally a smart thing. We usually recommend if you're in a W2 job

and you have access to a policy through your job, get that policy, but also just a little one of your own to supplement. That's thing number one. Thing number two is lock it in. Disability insurance

is available at the insurance company's pleasure. They have no obligation to offer you insurance. they can deny anyone they want that they think is going to cost them money for any reason.

So there are a whole lot of things that are hard ASA1 things. There are things that we don't think twice about if someone has them. ADHD guilty right here. people who go to chiropractors,

people with migraines, people with insomnia, anxiety, guilty here as well. All things that like all of us have or a lot of people have some of. Still an ASA1, but it can make getting disability

insurance much much more challenging. We're all as healthy as we're ever going to be for the most part. So even if you have some stuff going on, doesn't mean you can't get the coverage. It just means that getting it now before other

things pop up is smart. Same. It's priced by age. So if you start your policy at 35 years old, you pay the 35-year-old rates forever. You start the policy at 45 years old, pay the 45y old

rates forever. So again, wish we were all younger, but it's never going to be as inexpensive as it is now. So it makes sense to get it early in your career. And it actually is an option to get some during school. If you're in your last

year of school, you can get a really really small policy. Costs a little bit um to to sort just lock in some to to sort just lock in some insurability. The last thing is how to buy it. So any

insurance agent, myself included, is paid on commission. Meaning that if you buy something from the agent, we get commission from the insurance company. There are two types of agents. There is independent agents and captive agents.

Captive agents work for a specific company and their incentive is to send you to their own company whether or not that's the best fit for you. An independent agent shops around to all the companies. There are some cases

where one company is far better than the others. So having someone who can shop around for you, whether that's us or anyone else, is really important. And again, heavy heavy bias here. but I

recommend working with someone who knows CRNAs because the companies that are good for physicians are not necessarily good for CRNAs. Like there are some that are true in occupation for physicians

but not for CRNAs. the most important feature right on the slide is true in occupation means they can never force you to do anything else if you can't do anesthesia. And it protects all

the really really hard agonizing work you're doing right now. and it allows you to go do anything else you want and still collect your full benefit because you can't do what you're working hard to get. Two other features to look for.

Number one, features that lock in your health and let you buy additional um coverage in the future even if your coverage in the future even if your health has changed. And the next one is um this actually more important in my

this actually more important in my opinion than true in occupation is what's called partial disability coverage. It lets you use your disability policy if you're not fully disabled. So, for example, if you get cancer, you work 410s, you're missing

two of them, you get half your benefit. If you don't have that feature on your policy, unfortunately, we've seen some people who have gotten it with people who are well-meaning but just, you know, not really up to speed on it. they

didn't have that policy, they couldn't get any benefit because they were still able to work a little bit. so that's disability insurance. And, life insurance is if you die, obviously

much less likely to happen. So, it's a lot less expensive than disability insurance. There are two types broadly speaking. There's term which is where you buy the coverage for a set period of

time like 20 or 30 years and there's permanent which is where you have the coverage forever. My goal for you is that you are wealthy at you know late 40s early to mid-50s definitely by your

60s and at that point you can self-insure and you don't need life insurance past that point. Permanent insurance I would say like less than 1% there are some situations where it's appropriate especially if it's involving

special needs children. 99 plus percent of us term insurance is the much better option because it focuses the coverage when you need it cost a fifth is permanent but a lot of agents push the

permanent insurance and they make up all sorts of fancy stories about why you need it because they make five times as much money. So red flag I red flag would be if someone is pushing permanent

insurance I would maybe get a second opinion on that one. malpractice. I am not a malpractice agent. So, CoryAnn, please feel free to rescue me at any point here where I mess up. But, broadly

speaking, there are two types of malpractice insurance. There's occurrence and there is claims made. Occurrence protects you if you have something happen while the policy is in

force. So, if I have an occurrence policy right now and someone sued me for something I did a long time ago, I'm covered. Am I Am I good so far?

>> Yeah. Yeah.

>> Cool. Claims made.

>> Go ahead. Yeah. All right. Claim claims made requires that you have the policy in force when the thing happened. So if

I have a claims made policy, but

>> and when it's filed.

>> And when it's filed.

>> When it's filed. Yeah.

>> Gotcha. Yeah. so that gets much more complicated. Again, CoryAnn's going to do a much better job explaining this. So I'll turn this back over to you in a second. But and tell me tell me if you think based on your experience this is

um was a good plan. I just told myself was a good plan. I just told myself because I I learned like just basically those two definitions and I was like that second one seems like a lot of work. So I'm only going to ever have occurrence coverage. So that's what that's what I've done for my career. Is

is that a good plan?

>> Yeah. I mean essentially a current space it's more expensive upfront. So there is no when you look at it and I would say I've never ran I mean I can't remember who you recommended but when I

was getting claims I felt like most people were pretty upfront that a current space is is more recommended even though it's more expensive and so that's you know you you work at a facility you have it during that period

you're protected if you leave you don't have to purchase anything else claims made is when it's cheaper upfront so you know maybe it's tempting you're like oh I'm going to I'm going to be making more

eventually. I I'll get the cheaper one now. Well, it's not really the best because that tail coverage can be extremely expensive, especially if you've had anything happen during that time or if you've been there for a

number of years, you've taken care of a lot of patients, it can just be more costly. so, and especially yeah, so you so in general, if you're buying your own insurance, you just want to get

occurrence based. Now, there is a stipulation. So, we kind of mentioned this if you're going to do 1089 work. So, if you're W2, you I I haven't ran into a facility that had

um I personally haven't heard of people I personally haven't heard of people talking about bad experiences as a W2 employee with malpractice insurance. Now, if you're 1099, sometimes, you

know, you have to pay attention if it's if they want you to cover if they want you to use their insurance, you need to find out, okay, well, do I have to purchase tail insurance? It's just something you want to keep in the back

of your mind. some places like actually two of the facilities that I've gone to in the past, they have required me to use their insurance. Pretty standard language is one 1 million

per an occurrence and 3 million aggregate. So that's kind of standard 1 1 million 3 million and that's what I had in my policy. Well, one of the facilities they wanted me to use theirs which was 2 and six. So they had a bit

bit more of a buffer which was good. And then another facility is just like, "Nope, we make everyone use our insurance. There's no negotiating." Well, that's fine. A lot of times, sir,

um, so I talked to my insurance agent so I talked to my insurance agent and I was like, "Can you just walk me through, do I need to keep these policy, these places on my coverage then?" And they really did a great job explaining that you, if you're going to be covered

by the facility, it's actually best practice to not have that facility listed as a primary facility. So, meaning you just you just call up your malpractice insurance and you just say,

"Hey, can you exclude this facility for my malpractice?" And that's because they explain that. Now, I'm not a I'm not a lawyer, so I'm not going to get into legal jargon or anything, but essentially, if you have two primary

policies, it doesn't make you any bit safer. And what happens a lot of times is if you have too many primary policies, the hospital policy will tend to they could have different agendas or

different things that they want. like maybe they hospital wants to settle outside of court. your policy, you know, it is you would like to go to court to try not to settle, but it's

just these two conflicting interests and it doesn't keep you safer necessarily. Now,

>> what you can do is have it as a secondary policy. So, you can have like extra insurance. Sometimes that's overkill. you just the advice that I've received multiple times has been don't

have two primary policies. I think that's kind of it. Jake, anything that I missed there with that?

>> No, I mean that's also not a lawyer here so I have nothing useful to add. The only other thing which is kind of unrelated is I would I just had like a a

pretty simple thing I did when I had a 1099 contract. They would usually say like, "We cover malpractice, but we're going to take $5 an hour out of your pay for that." And so what I would always do

is I like, "Okay, how many hours am I going to work here?" Multiply that number of hours by the number of times it costs. And then I got a quote for mal practice insurance. And I would just do whichever was cheaper. because a lot of times if you're there for more than a

couple months, it's cheaper to just get your own policy. That way you control it. I have run into situations where they're like, "No, everyone needs to use this." And I'm like, "I'm not." and it I had to push push a little bit, but

all of the times they have been willing to like, okay, we're going to give you $5 more dollars an hour because you're not you're not taking care of malpractice.

>> That's that's good to know. I guess maybe I didn't push hard enough.

>> Yeah. Can can I throw out two other red flags real quick for disability insurance? So, two things to look at. Again, my goal is that you leave here empowered and like whether you come to us or someone else, I want you to

know the questions to ask to make sure you don't get taken advantage of. one of the big ones is what's the premium structure. A lot of people will get a quote for like a ridiculously low price and they'll be like, "Well, this one's like a third of what all the

others are." There are two premium structures. There's level, which means the price stays the same every year. And there's graded, which means it gets more and more expensive every year. So, a lot of we see this all the time. People get like, "Hey, this guy gave me a lower

price than the others. He said the coverage is the same, but that price doubles every year." So, a couple years in, they're now paying like two or three times what what they could have paid. So just knowing it when you see the

price what the premium structure is. The other thing is you do not need to apply to get quotes for your disability insurance. So if anyone wants you to

sign anything, you should never have to sign anything to get a quote.

>> so you should be able to see what the policy costs, what you're eligible for. It's not a guarantee from the insurance company. but it's really important that that that you know if you've

applied or not because if you apply without knowing it, there are some some downsides. so you should be able to get an upfront price without having to fill out any paperwork or sign anything.

>> There was one other thing that you told me about for my why I reached out to you about my husband's insurance. I'm trying to think of the verbiage, but mine didn't have it and his dead and it was

>> was it non-cancellable or guaranteed renewable?

>> Yeah, that's what it was.

>> Yeah. Yeah. So, there are two there are if you think about insurance on a spectrum with your home or auto being on the crappiest end you know if you get in a car accident in a year, State Farm's going to double your rates or if

you live in Oklahoma and there are a lot of tornadoes, they might stop offering homeowners insurance there. the top two tiers of insurance are non-cancellable and then guaranteed renewable. Non-cancellable, it's on the

insurance company, not on you. You can cancel at any time, but they cannot cancel your coverage or raise your rates, which is great. It means that even if you get a horrible diagnosis, your coverage is locked in, your price is locked in. Right below that is

guaranteed renewable. Still good. They can't cancel your coverage, but they can raise rates across the board. one is non-cancellable is better. You can sometimes save some money with guaranteed renewable. It's just

important to know the downside.

>> Yeah. And I just want to say also with disability insurance, it's really important that you pay with after tax dollars because the benefit will be taxed if so if you have a 1099 business, you don't want to have it as a business

deduction.

>> Very good. Yeah, I missed that. Thank you for saying that. That's a really important one because getting taxed or not getting taxed on your your benefit if you're disabled is significant.

>> Yeah. Yeah. And then yeah, I can't I cannot stress like get it now. Get it when you're young. I had a life insurance and disability insurance. I got it when I was young and then or

life insurance when I was 23 and then a disability insurance as soon as I graduated. just this past year I was kind of looking at insurance policies. We wanted to add on to our life insurance and I cannot tell my rate is

like it was triple what it would have been when I was 23. So do it when you're when you can when you're young. I think that's kind of it. So we'll keep moving just so we have enough time

for questions at the end too. So now we're going to kind of jump into W2 versus 1099. Now this is this is there's a lot of information that we

could cover. This is a overview. So I do I did just host a webinar on tax strategy for W or for 1099. and so if

you guys want that, just shoot me a message and I'll get it to you guys. And then we are going to be hosting in two more weeks. We're calling it 10 steps to 1099. and so it's just kind of some

basic setup steps that you don't want to miss. I'll start with W2. So W2 is just, you know, you're an employee. So you have an employer and it's simple. You have taxes are withheld

automatically. The employer play pays for 50% of the Medicare and Social Security costs or taxes and then you usually have benefits. The cons are you

can't deduct expenses and it's less control. there's less flexibility. Now, on the complete opposite side, there's 1099 contracting. So, it ultimately

can provide a lot of flexibility with your schedule, which is why a lot of people love it. There are a lot of opportunities for tax deductions. And even if you are just doing like a hybrid

and doing both, there are so many deductions you can take running having even just like right now I only do 1099 about 2 days a month. So, but there's still so many deductions that

you can take. now the investment stuff, obviously, you make more, you can invest more, but there's a lot of opportunity just doing 1099 work in general. Now, the cons are that you have to pay both half of the social security

and the Medicare, and you have to really you're running a business at that point. So, you really need to be organized and confident in what you're doing. And a lot of times too with 1099 contractor I

um my most recent 1089 contractor job my most recent 1089 contractor job that I I started. I got there I saw one case and then they're like, "Okay, go for it." And then the next day I showed up, I was giving like 10 units of blood

in just a normal or ortho case that had gone wrong. And I was like, "Wow, good thing I know how to give blood and know how to do these things cuz that's, you know, you're expected just to be able to

do that." so just some sort of things. I think everyone, this is just my own personal opinion, I think even if you're doing a W2 job, I think everyone should have some sort of 1099 gig. It

really just helps lower your taxes and just allows some flexibility with what you want to do in life. So, highly recommend it. No, this is things. So, when I graduated

CRNA school, I also was living paycheck to paycheck in school with my husband and so I and I was not very financial like I didn't know a lot about

investments and so I'm going to briefly walk you through a number of things you can do even if you're a W2 employee. So, these are just really basic things. So, uh, the biggest thing that another the biggest thing that another comment that came up multiple times when

I asked CRN is what would you tell new grads? And they said, aim for 3 to 6 months of savings. And that's because you don't know when a pandemic's going to happen. You don't know, you know, when you're going to have an accident,

go disability. So, having that built in just gives you freedom to make choices and not be in a rush. Especially if you do 1099, you should have at least 6 months built in. Now, a lot of people

will put in high yield savings account. Uh something that I learned about five something that I learned about five years agoish was treasury bills which so the way I like to explain it so when

you put your money in a high yield savings account which is a really it's a great opportunity. I mean rates can vary it varies. It changes daytoday. So like let's say 3 and 1 half to 4 and a.5%

is kind of a ballpark. Well what the the banks do is they take your money and they say okay well we're going to give you you know 3.8% return. Okay, they're

going to go take your money and they're going to go buy a treasury bill typically is what they do and they're going to get a return that's like 4.5% and then they're going to keep the difference. They're going to give you

3.8, they get 4.5. Now, what you can do is you can go and purchase your own treasury bills and so it tends to be a higher interest rate than a high yield

savings account. Not it's not as high as the what the banks get. They kind of like get to buy every the T bills first. It's a whole system. But the the one of the biggest benefits is especially if

you live live in a state that has high income state taxes is that treasury bills are only taxed at an IRS or at a federal level. So I live in Minnesota. I

don't have to pay Minnesota state taxes on my T bills, but I would have to pay it on the high yield savings account interest. So, and it's only the interest that you're paying taxes on. and

so that's kind of what it is. I I have a whole if you guys want to know about how to buy them and everything, if you join the 1099 hub Facebook page and go to the files tab, I have a document that walks you through how to buy tea bills.

it's they're super easy. So, that's kind of one thing. Another thing that I didn't learn about, I had been doing HSA wrong when I was a nurse. I had HSA I I I used an HSA, but I was I didn't know

about the investing part. So, I didn't learn about that until I was a CRNA. So essentially, you know, if you choose and elect a high deductible account for your insurance health plan, it has a

triple tax advantage savings. So you're not taxed on the money that goes into your HSA account. So that's one. It grows taxree and then when you withdraw

it, you can it is it is taxree. And so a few strategies. So a lot of times like what my what we do is we take

all of our money and we just invest it. And I've had great returns on my investments in my HSA account with Fidelity. So like I it's been really great to see it just it keeps growing. And then rather than pay for things now

with with that if I need it, what I do is we pay for cash for any medical expense that comes up and I save the receipt. And I have a whole cabinet that I store my receipts in for my HSA

expenses only. And you can save right now how the I the the rules are now this could change but right now the rules are that you could take those expenses and you can reimburse yourself in 30

years. So, you can just keep saving and saving and saving them and oh, now I have $10,000 I need. Well, I'm just going to reimburse myself with my HSA money when I'm retired. So, it's just

another retirement vehicle. Or, I mean, you might need that money at retirement for your health stuff. So, it's just a really great way. I think I calculated out one day if I took I think it's like $8,000 we can invest this year. If I

don't touch it for 30 years, that'll be like 150,000 about, which is just crazy. That's how I mean that it it'll grow and be worth way more valuable to me then than it is right now.

Um so that's one thing. Another thing to so that's one thing. Another thing to look at is the backdoor Roth. Now we're not going to get into this. at the end of the month I'm actually going to be hosting a financial webinar and we'll get more into some of the backdoor Roths

router rules, all that stuff. But just essentially, if you're a W2 employee, it's a great way if you have excess funds right now or when you when you start working, if you've already maxed out your 401k, you can do what's called

the backd dooror Roth. So, you take money you contribute into an IRA and you essentially flip it into a Roth so that when you retire, it's tax-free. Now, there there's something called a PR ad

rule. I'm not going to get into all that now. Just know that that's another vehicle for investment. Now, the last vehicle I like to talk about is taxable brokerage accounts. And mostly I just

like to mention it like it's right there's so many opportunities to do either, you know, pre-tax dollars or Ross or all this stuff. But so if your goal is to retire early, like in your

50s, taxable brokerage accounts are actually something that you want to look at because a lot of those retirement accounts you can't touch to your 40 59 and a half. So, if you're like, I want

to retire when I'm 55, you either have to have that just saving enough, you either have to stay casual so you can keep making income or have it saved in an account or you can have a taxable

brokerage account. So, it's been growing in interest and you do have to pay the interest when you or the taxes when you withdraw it and everything, but at least it's another savings vehicle to kind of bridge if you want to do an early

retirement. So, just something to think about. and then so lastly, we're just going to talk about 1089 as a business. So really, this is and this is

my I love I love teaching people about it because I just think there's it's really cool to have your own business and it's really so neat all the tax advantage strategies you can utilize,

but you have to treat it like a business. And so, you know, even if you're just working one to two shifts a month, it unlocks business deductions. Um, you should be confident, like we

you should be confident, like we said, to to start. And really, even if it's something that you want to do, if if you're in your, so if you're a senior and you're like, "Yeah, I want to start. I want to get a 1099 job." Or if

you're like, "Well, I want to work for a year and then get a 1099 job." You can actually start to have startup costs. I can't remember what it is for this year, 2026. I want to say it's around $5,000

you can deduct in startup costs. And that's because, and I' I've talked to my CPA about this multiple times, the IRS knows starting a business costs money before you get money. Okay? So, as a

CRNA, we are one of the very few businesses, if you have a 1099 business, we're one of the very few businesses out there that has almost an immediate return for our dollar. And that's amazing that we have that. Most

businesses don't make money for like 2 to 3 years. And so, the IRS knows that. And so they do allow you like if you're graduating and you know you want to do 1099 work, you can start to record

things such as, you know, if you're going to meet colleagues or you're going to a business meeting to try to connect with someone over a 1099 job and you're you're paying for a meal, you can save that receipt. startup costs for

office expenses or you know if you're getting malpractice insurance like all those things you can save the receipts for and you can deduct those. Those are startup costs. same thing

if you go on an education trip and your maybe your W2 if you do a W2 they only cover a portion of that. Well the rest of it you can deduct and that's this is really if you are starting a business.

If you're not starting a business this is not legitimate for you. and then the other great thing is like there are so many options for retirements. We're not getting into it today, but there's typically two vehicles. One's called a

SE IRA and the other one's a solo 401k. I would say generally people want to do a solo 401k, but it's really situational based. because solo 401ks are a little bit more complex and you do want

to have the right documentation in place. you don't you you would it's best to have it set up by a CPA. I know people say you can do it yourself, but I talking to financial adviserss

and everything, there's like if you don't set it up correctly at the beginning, there's certain things you might not be able to do later. So just some forewarning there versus separas are super simple. and then just kind

of looking at tax structure. So there's okay, there's when people say 1099, it's different from locom. So you have 1099 which is just you know it's a contract

work that's how you're getting paid. it's your business. And then there's locom 1099 which is you know you are it's 1099 pay but it's more of like a contract where you're traveling

typically versus what I do is more smaller contracts where like I said I I just do it a couple times a month. So there's different ways to do 1089. Then

there's two different paths. So typically you know it's not required to have an LLC but it really does provide that protection. So you I I recommend everyone it's not expensive. It's very

easy. Open an LLC if that's if you want to have a 1099 business and then right away just open up bank accounts for that LLC. typically people say to save

about 25 to 30% of what you make not only for taxes like you might not pay that much in taxes but just to make sure that you're when you are paying for things you're paying out of your business account and that you have the

money there to pay for your business expenses. So if you so if you look at path A LLC sole proprietor you pay the income tax self-employment it's great it's really

great if you're part-time sometime if you're part-time it can make sense to do an S-Corp but you really want to have a CPA look at it because S-Corps do cost more money so with S-Corps the

difference is so let's just I'm going to throw out a number 300,000 let's say that's what you only do 1099 work you make 300,000 you decide to pay yourself a reasonable salary of 140,000 let's say

now you have talk to your CPA to make sure what the reasonable salary should be, all that stuff. But you are, the benefit is you're only going to pay the FICA taxes. So, Social Security and,

um, my gosh, I'm blanking on the other my gosh, I'm blanking on the other tax. What is it? Medicare. There we go.

>> Yeah, you're paying Social Security and Medicare only on that 150. Now, Medicare tax, I think it's like 2.9%. you will continue to pay that on all of

your income, but you're saving really on that social security taxes. Now, you the reason you need to talk to a CPA is, you know, they they just have to do all the calculations and the

numbers and make sure it makes sense. Typically, I hear a lot of different ranges. I've heard the most consistency about 150. If you make if you're making that in your 1099 work, it's a good

opportunity to switch to an S-Corp, but really just depends on your CPA's take on it. so we I hosted a whole webinar on tax strategies. So if you

guys want to learn more about that, that's definitely a great place to turn to. And then this is, okay, so this is another passion of mine. So the reason my husband and I love our app is it

makes it super easy. It was made for medical professionals. Okay, so when you when you record everything, you need to have it needs to be an itemized

receipt when we were creating this app. So between creating the app, going to conferences and talking to our users, I've talked to over a thousand CRNAs about this issue, this question. And so

many CRNAs think that you can just have a credit card or bank statement and that that's sufficient for recording your expenses. Now, your CPA can file your

taxes with that information, but if you are ever audited, that is not sufficient um for the IRS. You need to have an for the IRS. You need to have an itemized. So, it has to have like the date, the place, the amount, what you

bought, and the business purpose. So, if you go out to eat, you need to record.

>> and they want to make sure you're not buying alcohol. Like, that's why it needs to be itemized. They want to make sure you're buying just like one meal for yourself, not taking your whole family out to eat.

>> And and so you need to record that. And then the other thing is I was going to say something else. Oh, just a little caveat. if you something that I

didn't know my first year, learned my second year, you cannot deduct your meal for just like every day that you work as a 1099. It has to have a business purpose. So you like go out to eat with a CRNA to discuss business. It's not

just I worked therefore I can deduct my meals. So that's a common mistake that people make as well. so you just really Oh, and then then the cool thing about the app is that it's everything

is categorized for CRNAs. So, we have unique categories like CEUs and things like that that normal business apps don't have. So, if you use and if you

even if you don't use our app, you should use something to keep track of it. But just know that you're going to have to go back at the end of the year and make sure you're pulling out and labeling things for your CPA so that they know very clearly like this was for

um travel cus, this was for this versus travel cus, this was for this versus RF. You can just click it in there and type notes and it's super easy. I think that's kind of all that I wanted to say on that. Oh, the other cool

thing, just a little plugin for the app, too. So, we had in the app you you can make a shift and then it will autorecord your mileage. A lot of people also make big mistakes on mileage. So

whether you choose to do actual expenses for vehicles or just a mileage deduction, you need to record your record your odometer at the beginning or the end of every year every single

year because you can't just deduct your whole entire car and all the expenses. The IRS needs to know how much of the vehicle was used for business

purpose. We go into that in the tax seminar, but I'm just mentioning it here because that's another super common mistake that people make is not recording their odometer. Okay. And finally, just our app. I love

it. It's super fun. we we've made so many things based off of just user feedback. We listen to you guys and we try to integrate it right away to the much to the best of our ability. but

we're coming out with new things all the time. So, these are just some overviews. Okay. So, students, if you're if you're already a graduate and you're working, just reach out to me. I'm happy to give you guys a promo code. For

students, if you guys know that you want to do 1099 work and you're graduating this year, reach out to me and we can give you an extended trial until you're like settled into your 1099 gig. So,

just contact me and I'm happy to set you up with a free account until you are really ready to jump into that. and I think that's kind of it. So, oh, and one other thing I'm going to mention. If

you have an Apple phone, sign up on our website first because Apple Pay doesn't have the best uh customer service for you. You have to

customer service for you. You have to go to Apple, not to us directly to get customer service. And so, it creates this weird triangle versus if you sign up through Stripe, which is on our website, or if you're an Android user,

you just can sign up directly. we can work with you guys directly to help resolve any issues. So, it's been it's just much easier for us to provide the customer service that we want to. So, that's it.