The CRNA Entrepreneur’s Guide to Business, 1099 Work, and Advocacy
Dr. Joseph Rodriguez (Joe), Chief Development Officer and co-founder of Guide Anesthesia, has grown his company to manage over 150 anesthesia providers across Arizona, Texas and Florida. His journey, however, began not from a desire for market disruption but from a moment of professional dismissal when a former leader told him, “If you wanted to do that, you should have been an MD.”
Brett Fellows CFP®, Founder & President at Oak Capital Advisors, spoke with Joe about building an ethical, profitable, and empowering business model in the complex world of anesthesia.
The Truth About Starting Your Own Group
Many CRNAs dream of starting their own practice but are intimidated by the financial realities. Joe offers a blunt warning: if you desire work-life balance, don’t do it. He compares professional life not to a zoo where everything works out, but to a jungle where you can be killed.
The financial reality is challenging. The general rule of thumb for net income in the service industry is about 5 to 11% after costs, but many new groups operate on far less. Guide Anesthesia operated at one or two percent net income for the first seven or eight years. You must be prepared to fail a lot. You cannot have a mission without a margin, as the organization must be financially viable to survive crises. If you choose this path, do it because you want to create something; that purpose must be the primary driver, not the money.
The Anesthesia Business Model and CRNA Ownership
Anesthesia groups exist to organize, bundle, and deliver services in a way that is better than the alternative. However, the economic model faces enormous pressure because the cost of services far outstrips the traditional reimbursement. Fee-for-service revenue only covers 30% to 60% of the overall expense. This volatility often leads hospitals to try managing the service line in-house, where a lack of focus causes expenses to rise again.
Guide Anesthesia focuses on empowering local clinicians and building adhesion and long-termism. To achieve this, every primary team member gets shares in the organization. This kind of program is exceedingly rare for a CRNA-owned company and makes people feel like they’re part of something bigger.
1099 vs. W2: A Growing Trend
Joe’s group is entirely 1099, believing it aligns with the nature of the profession. Anesthesia providers are independently licensed professionals. Even as a W2 employee, you are always responsible for yourself and your individual judgment. The W2 model essentially trades control over your behavior for employee protection.
Joe notes that the 1099 model is growing because:
- It aligns with the professional autonomy of a CRNA.
- If you’re good at your job, you have a strong expectation of being gainfully employed and paid for your services.
- Operating as 1099 is straightforward if you work with a decent CPA and other financial professionals.
The Critical Importance of Advocacy and Communication
Joe has served on the AANA Board of Directors and argues that current regulatory advocacy is often asking the wrong questions.
- The Regulatory Problem: State governments are often largely incompetent when it comes to making decisions about anesthesia models.
- The Solution: Power and control should be put back at the local level. Clinicians at the local level know what is best for the patient, and the market will continue to move past the regulatory environment and work around outdated regulations.
Beyond advocacy, the number one differentiator for a CRNA, outside of technical skills, is communication. If you can verbalize and articulate your plan of care and thought process, it is an X factor in how you are perceived.
The Two Decisions That Define Your Future as a CRNA
Joe stresses that money alone won’t lead to happiness; the fundamental question is: “What do you really want out of your life? Of your career?”. This focus is tied into the two most important decisions a CRNA must make today to protect their future:
- Individual Differentiation: When “change comes” (which he is certain it will), what differentiates you from all your peers? If you don’t have a good answer, you should take the time to develop it.
- Community Contribution: American society and the free market system do not care about CRNAs. To maintain the unique opportunities American CRNAs have, you must contribute time or money to the professional community. If you don’t, your opportunities will begin to shrivel.
Next Steps: Securing Your Future Through Strategic Planning
The complex journey of CRNA entrepreneurship, advocacy, and professional growth highlights a universal truth: success requires strategy that goes far beyond a paycheck. Whether you’re looking to start your own 1099 group, optimize your existing practice, or simply ensure your personal wealth is protected against market and policy changes, specialized financial guidance is essential.
At Oak Capital Advisors, we understand the specific financial tensions of the anesthesia world—from navigating 1099 tax requirements to building the long-term wealth required for a secure retirement. Don’t let a “DIY” financial plan cost you your professional freedom or dream retirement.
Ready to see how Oak Capital Advisors can help? Schedule a meeting.
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