Why $100 An Hour Is Chump Change

The reality is $100 an hour is NOT chump change. What actually brought this idea to mind is a memory I had of a CRNA state conference meeting I attended 5 years ago as a first year SRNA. One of the topics discussed at this conference was the future of reimbursement and compensation. What I thought was going to be an informative session quickly devolved into one where a handful of older, experienced CRNAs stood up amongst the audience to bitterly complain about how their wages have been adversely affected by the influx of new grad CRNAs.

“It pisses me off that these new CRNAs are coming into the market and working for $90-$100 an hour. They’re destroying the hard work I put in to be compensated at a fair wage! What is the state association going to do about this?”

It was simply astonishing that there were a group of individuals who had to know that there were SRNAs attending this conference as guests and yet, they still had the audacity to express a grievance of which no one was at fault. It was a rather shocking welcome to a profession that many of us were very excited to be a part of. Many of us were coming from backgrounds where we were only earning a quarter or even half of that (depending on the region from one came from). The prospect of doubling or even quadrupling our hourly wage is part of the reason why many nurses pursue nurse anesthesia. What’s wrong with that? In spite of that, this individual was basically saying making a $100 an hour was an undervaluation of our labor.

Clearly, it was an experience that has since remained with me just because it felt like an affront on what I had hoped to be a positive introduction to the world of nurse anesthesia but was anything like that. In any event, another reason why this person’s statement has remained in my mind is because as I move further into my career and accrue more experience in the profession, I find myself wondering about the value of my labor. While my salary is fixed and based on a pre-determined scale for my job in academia, private practice is an entirely different story.

In some ways, it feels like the Wild West because compensation can range anywhere between $100 an hour to $1000 an hour. That’s where the aforementioned CRNA’s comment comes into mind. She must be referring to the high rates of reimbursement that one sees when one enters private practice. While I do not condone how she communicated her grievance years ago, I find myself beginning to better understand her position. Even so, let’s not lose sight of the fact that $100 an hour is A LOT of money regardless of how you’re being compensated in private practice. The median income wage is $27 an hour, so I’m still seeing this as a huge net gain, so spare me.

Screen Shot 2017-11-18 at 11.27.53 PM
One example of payment scale offered at one of the surgery centers I moonlight at.

Anyways, I’m in no way, shape, or form making a claim that I know the value of my labor. As I mentioned earlier, I’ve found myself in situations in the private practice world where I’ve been compensated for as “little” as $100 an hour to as high as $1000 an hour. I haven’t quite made sense of this nor figured out how to maximize my income stream at the various surgery centers I work at. One thing I do know though is by maintaining a positive attitude, being friendly, flexible and having a strong set of clinical skills, you’ll be amazed how many doors will open up for you and how you will begin to see an increase in your compensation.

I’m not really one to network with individuals in order to obtain some sort of financial gain from them, but I can definitely see how an entrepreneurial CRNA can garner you a lot of business from surgery centers. You’d be surprised at how many providers there are who act like prima donnas or at least, these are the complaints I hear from surgeons and managers from these centers. It’s striking that all you need to do is exercise common courtesy and somehow, you’re everyone’s favorite provider and that’s enough to get you bumped up from making $150 an hour for one procedure to $500 an hour for the next time you visit.

Now, this isn’t something that happens at every site, which is why I want to keep reiterating that I still have a hard time evaluating the value of my labor. Is it really worth $125 an hour? $150? $300? At this point, it seems highly contextual. It’s dependent upon my relationship with the surgeon, my relationship with the CRNA who has the contract with the surgery center, the type of surgery being performed, what kind of insurance the patient is carrying, and whether the patient is paying all cash. There is a wide spectrum of reimbursement models that I’ve come across and each one is unique, but every time I’m paid more than $100 an hour for a gig, that CRNA’s voice keeps popping into my head.

If I were to share any tips to newbies to private practice, I’d say just go with whatever is being offered even if it’s a lowball offer. I’m of the mindset that when you’re new, you have to prove yourself. You’re in this for the long haul and ultimately, if you demonstrate a good work ethic and an easygoing attitude, people are going to notice and in time, your compensation will increase accordingly.

As you gain more experience and start to take on new gigs, you’ll get a feel for how things will work. It’s difficult to explain, but you begin to develop a sense for how compensation works in your area and as such, when the time is right and you’ve developed a strong reputation along with a positive rapport with the surgeon and the surgery center you’ve worked at for several months, don’t be afraid to negotiate a higher salary. If you still don’t know how much to ask for, well, ask around the community and figure out what others are being paid at. Look up the AANA’s annual survey on compensation around the area that you live in. Last but not least, don’t ever lose sight of the fact that $100 an hour is still a lot of money to make no matter how big time you become.

 

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