Brett Fellows, CFP®, Founder and President of Oak Capital Advisors, sat down with Amanda Kay, CRNA, coach, and founder of The Mindful CRNA, for a second conversation. The first happened only a few months into her 1099 journey, and a lot has changed since then. Amanda is now fully independent, running an S-corp, working 15 to 20 shifts a month across surgery centers and a locum contract in Indiana, and coaching aspiring CRNAs through a program she has been building since 2022. She also has Roth accounts set up for her sons, an HSA she is using, and a clearer picture of her money than she has ever had. The road to get there was not always smooth.
The Year of Survival
2024 was, in Amanda’s words, “a year of survival.” She lost a hospital contract, and the independent market had started cooling from its peak. There were months when income was unpredictable, which led to difficult conversations with her husband. At one point, she nearly went back to a W2 position, and when she brought it up, he told her he didn’t want her to go back.
“He was like, ‘I do not want you to go back to W2. I know you love this… It’s working.”
That moment marked a shift, and Amanda did not go back. She found a locum contract in Indiana, rebuilt her schedule, and got more intentional about where her money was going.
Salary vs. Distributions: The Lever Most CRNAs Never Pull
One of the biggest differences between year one and year two of her S-corp was strategy. In 2024, she took whatever salary felt reasonable and moved on. In 2025, she started asking better questions: how much should flow through payroll versus distributions, where does it make sense to fund a SEP, and should coaching income stay under the same S-corp or belong in its own LLC?
These are the tax levers that most CRNAs running their own S-corp never pull because nobody has ever walked them through it. Amanda spent much of 2024 telling her accountant to handle it and trusting that things were fine without knowing what was happening. That changed when she sat down with Brett for a tax return review.
The Moment Her Numbers Made Sense
“Within two seconds, he explained more out of my tax return than I ever knew.”
Amanda described it the way a patient might describe a provider, finally explaining their labs. All those pages, all those lines and numbers, made sense for the first time. She took notes and started understanding the gap between what she was bringing home and what she was keeping. More than that, she realized she had handed her financial picture to an accountant and stepped away, assuming everything was running correctly, and the review gave her a reason to look.
Brett offers a free 30-minute tax return review. No obligation, no sales pitch. If you have been doing the same thing Amanda was, it’s worth scheduling a call.
What CRNAs Are Getting Wrong at Tax Time
Amanda spends a lot of time in CRNA communities online and coaches aspiring providers every week. When the conversation turns to money, the question she hears most often is not about investment accounts. It is about deductions: are we capturing enough, what counts, and how do we even keep track?
Her answer is honest: most CRNAs are not doing as well as they could be, and it is not because they are careless. By the time tax season arrives, nobody has time to sort through a year of bank statements. The receipts are gone. The system was never set up. Money gets left behind, year after year. Amanda uses a simple Evernote document, logging purchases, noting when she renewed her ACLS, and marking when she bought a stethoscope. It wasn’t complicated; just consistent. As she put it: “We give anesthesia. Organization and bookkeeping are just not our forte.” A basic tracking habit and a quarterly check-in with someone who understands your entity structure can make a real difference.
What the 1099 Market Looks Like Now
Amanda has had a close view of the independent CRNA market for several years. In 2024, rates were at a level nobody expected to hold, and everyone knew it. Providers worked hard and stacked hours while they could. By 2025, things leveled. New graduates entering the market played a role. Some facilities are now fully staffed, while others still have turnover and genuine need, but the market from two years ago is not coming back.
Her advice for staying protected: keep your clinical skill set broad across OB, blocks, and high-acuity cases, because having range keeps you employable when any one piece of the market shifts. She also flagged cancellation policies specifically. If a surgery center cancels you at the last minute, you should get paid regardless. Get that in writing, and build a pool of facilities around you so that when one contract ends, you have somewhere to turn.
The Financial Principles She Lives By Now
Amanda is more intentional with money than she used to be. She and her husband talk through their numbers regularly and have agreed on a baseline income figure that gives him confidence and gives her room to breathe. The credit card gets paid off each month, and the cash rewards cover Christmas. She gives money away, which has not changed. Back in CRNA school, she was drawing from an almost empty account because she believed it would come back, and she still does. Small daily habits like leaving items in her cart for 48 hours before buying them have compounded into a genuinely different financial life than the one she had a few years ago.
What She Would Tell a New CRNA
If a brand new CRNA came to Amanda in their first year and asked where to start with money, her first question would not be about investment accounts or tax strategies. She would ask what they want their life to look like, because her core philosophy is to build your career around your life, not the other way around. Get clear on what you need, what enough means to you in this season, and what the next one, five, and ten years should feel like. From there, the financial plan has somewhere real to go.
Ready to see how Oak Capital Advisors can help? Schedule a meeting.
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