In this episode, Kristin and Sandry Gaillard, a CRNA who works independently at a critical access hospital in rural western North Carolina, sit down to discuss the business of anesthesia in terms of working as a 1099 employee verses a W2 employee.

Topics Discussed Include:

* Differences between 1099 and W2 work arrangments

* Advantages/Disadvantages of 1099/W2

* Responsbilities of 1099 employment

* Tips for starting 1099 employment

* Types of coorporations

* CRNA-only practice

Shownotes:

Difference between 1099 and W2 employee:

– Based on 3 sets of criteria – whether there is behavior control, financial control and what the      relationship is between the parties involved

– W2- specific requirements by the employer – job is directed to what, how, when, where you are going to do your job

– Independent contractor – no requirements by employer

– 1099 – you can have a 1099 as an independent contractor or work in a care team

Advantages to W2

– Don’t have to worry about business side of things (taxes)

Independent Contractor Advantages:

– more control, flexibility, more money potentially, autonomy

Disadvantages of 1099:

– stressful, deal with all business aspects

Responsibilities for 1099:

– Liability insurance and health insurance

– Responsible for employee portion of Social Security and Medicare

– Disability insurance, Unemployment insurance

– Money to plan for sick days

– Determine money to put away for taxes/business/personal (**Good rule: at least 30% of what you bring home for taxes – don’t know what tax bracket you are going to be put into at the end of the year)

Tips for 1099:

– Get a business attorney – someone who does small business

– Do your research!

– Do you plan to incorporate? Keep your business and personal separate so both are protected

– Find an accountant for help managing taxes (who also does small business)

Types of Corporations:

PC – Professional Corporation (available only to certain professions – you apply for this through the state that licenses you)

S – Corp – Requires annual board meeting, documentation of minutes

LLC – Limited Liability Corporation – similar to PC, less complex, less paperwork (combines the best features of your PC and S-corp)

**Business attorney can help you make a good choice for you

– You can do this yourself if you are business savvy!

– Lots of info online

CRNA only practice:

– Depending on size of practice could cover call, weekends, holidays

– Responsible for pre-op medical reviews, review anesthetic plan, see if they need to be cleared for surgery by other health care provides

– Post-op: follow ups, if they are going home – make sure they have appropriate instructions to go home; post-operative teaching, managing post-op phones, in house post-op visits, make sure patients are pleased with anesthetics

– Critical access hospitals are able to reimbursed for medicare part A – CRNAs providing anesthesia services in a rural critical access hospital

– A signature by a physician is required by federal government for reimbursement;  this signature does not mean that physicians are legally liable for anything that the anesthetists does

– Independent practitioners are liable for whatever they do.  If a surgeon dictates how he/she wishes you to administer the anesthesia, he/she may be liable for those decisions.