To answer your questions.1. One of your fellow AAs will have to answer what kind of facility you would work in.
2. Insurance. I can only speak for CRNAs.
Method A. An individual policy. A policy only covers you in one state and runs around $4,000 - $6,000 per year. The CRNA would be the named insured and it would be a "claims filed" policy, which means when the CRNA goes to retire, he will have to buy a tail to cover into his retirement years. A tail can cost 2-3 times what a yearly policy costs and he may have to buy one for each state he practiced in. I personally think this is a BAD approach for a person doing locums.
Method B. Get added to the policy of the group you are going to work for. This requires a lot of trust. Did they add you by name or were you "covered" under a generic term? If by name, it is pretty hard for them to later argue you were not covered. If by a generic term, well gee, it did not specifically say "AAs" so the debate begins. If it was a claims filed policy and the claim against you just happened to be the fourth claim and the policy only allows three claims, you are hosed. If the group folds and the policy lapses, there goes your coverage also. This also is not a great way to get coverage IMO.
Method C. You develop a good working relationship with one agency. You work a lot so they get a lot. They supply you with a policy on a daily basis. Claims occurred, you are named on the policy and it only costs $40 a day. This IMO is the way to go. If you only work 100 days a year, you only pay $4000 a year. If you work in 10 states, each days coverage covers you in the state you were working. It is claims occurred so when you are not working, you do not have to pay and do not have to worry about a claim showing up in your retirement to haunt you. This is how I do it.
3. Do not be fooled about the "better pay." You must realize that is really GROSS pay. So first, you have to consider you are probably getting a 1099 form and working as an independent contractor. As such, you are considered self employed and what goes down on the 1099 is usually every dollar they gave you. Hourly pay, call pay, per diem, mileage, housing allowance, etc. Every dime.
If you do not keep good records to show what you paid out (hotel, food, mileage, office space and supplies, license fees, credentialing fees, etc) you will end up paying taxes on the GROSS amount. You want to deduct every single expense you can to lower the gross amount. (Which is why I mentioned the RV.)
Once you get the GROSS amount down as low as you can go, then you start calculating taxes.
First, you have to pay BOTH sides of the Social Security payments and Medicare. That is 15.3%. Then you have to pay your federal income tax. Figure at least 10% and more likely 20%. And be warned, if you work in five states that have income tax, you will have to file an income tax form for each state. That is a lot of paperwork.
By the time you get done, you end up with slightly more than 50% of the gross. To save worry at the end of the year, I use 50% throughout the year to figure what money I get to keep.
4. The BIGGEST catch is this: You will see a job listed for a lot of money. Say 20% more than what anyone else is offering. Or they offer you a $100 per day per diem and housing allowance. It will be something that really pulls you in.If you are motivated by money, you will go for it. Then you find out the catch, expenses in that area are VERY high and you have to spend 2-3 times the amount you are accustomed to for food and lodging. There is an easy way to avoid this.
Use an agency. If you have a good working relationship with them, they will watch out for you. They will be able to tell you what the "catch" is before you get there. The agency knows that if they screw you once, you can just go to a different agency so they will do their best to keep you happy.
As far as the other catch, MDAs who are a pain in the butt, surgeons who are really slow, etc, you can find that out from the agency if they provided coverage there before. Ask them to give you the number of someone who worked at that facility.
Also look up the facility and see if they have any advertisements as that often gives you a clue as to what to expect.(There is one place I was looking at and in small print in a job ad they said they do 2-3 dental rehabs a DAY. I hate dental rehabs and now know to stay away from there.)
Hope this helps.
