Employment Options for Certified Anesthesiologist Assistants (CAAs)

Your future as a CAA offers a wonderful combination of steadily high income, job security, and flexible employment options. You may have heard of non-traditional employment structures like Part Time, PRN, and Locum Tenens. These arrangements all have unique properties, and can often be confused. Today, we will explain the difference between different employment structures and terminology.

If you’re well versed in the joy of income tax, this may be old news to you. But for many new graduates, this will be your first time dealing with the cumbersome, confusing world of paying your taxes. Luckily, there are really only two tax statuses you will need to concern yourself with.

This is the most traditional employment arrangement. This refers to full or part time employees who are in a two-way agreement with their employer (the hospital or anesthesia group). In this arrangement, you will work a consistent number of hours per week or per pay period (typically 2 weeks). In return, you will be paid an agreed-upon salary as well as receiving a host of benefits including paid vacation time, health insurance, malpractice insurance, and more.

In this arrangement, your employer also (mostly) handles taxes for you. This means that each paycheck you receive will be about 60-70% of your total salary, because funds have already been “withheld” according to your tax bracket. At the end of the year, the IRS will calculate how many taxes you owe, subtract how much you have already paid, and determine whether you owe more or are eligible for a refund. You can do some adjustment to how your taxes are withheld, but it should typically come out pretty close to even.

This tax status applies to those who work as contractors. This is a common arrangement for PRN and Locum Tenens employees (more on that in a moment!). In this structure, you will be paid 100% of the income you have been promised, but will receive no extra paid benefits. You will be responsible for managing your own taxes, as well as paying for extra benefits like health insurance, malpractice insurance, and expenses like Continuing Medical Education (CME) and renewing your license. You can submit money quarterly to the IRS in order to prevent a large tax bill at the end of the year, or you can save the money and pay it all in one lump sum when tax time comes.

Now we’ll discuss the different types of employment. Each of these types may be compensated for in a W2 structure or 1099 basis. Most often, a full time or part time job will be W2 and PRN or Locum Tenens will be 1099, but there are exceptions to these rules. It all depends on the employer and how they have decided to offer compensation.

This is the most common, traditional employment structure. You agree to work a consistent number of hours per time frame, and your employer agrees to offer you this many hours. Your agreement may include a requirement to take call or work nights, weekends, and holidays. In exchange, you will receive an agreed upon salary or hours worked-based compensation model.

You will likely have to use PTO when you don’t work, which will keep your income steady. You should receive full benefits with this arrangement, but if you work under a certain number of hours you may be required to pay for a larger portion of the benefits. Sign-on bonuses are typically only available for this type of employment, and will be dependent on working a fixed number of hours for a certain duration of time.

An ongoing relationship with an employer who uses your services “as needed” is often referred to as PRN employment. In this arrangement, you will tell the employer when you are available to work, and they will use you for whichever shifts they need you for. This is not guaranteed, however, and you can be canceled if their needs change. You will typically receive a cancellation fee if this happens within 24 hours of your shift, commonly equivalent to 2 hours worth of work. It is also common to have a guaranteed minimum of hours, meaning if you show up to work, you will be paid for a minimum number of hours regardless of how long your shift lasts. These details should all be agreed upon in writing prior to the beginning of this working arrangement.

The beauty of a PRN arrangement is that it can continue indefinitely. You may work PRN for the same group for years, filling in the gaps when they are short staffed or during times of expansion. However, if the group suddenly finds themselves fully staffed, you will likely no longer be offered shifts. It is always a good idea to have a few PRN arrangements or another employment option at the ready if this is the path you choose. PRN can also be a great way to supplement a regular job, allowing you to pick up shifts when you have expenses arise, or boost your baseline income to reach your financial goals more quickly.

In recent years, widespread staffing shortages have led to a tremendous increase in use of Locum Tenens (LT) providers. These are short-term contracts which are typically arranged through a staffing agency. The agency will negotiate the terms, find suitable candidates, present them to the employer for consideration, and then work throughout the process to ensure both sides are satisfied with the agreement and that the contract is completed as promised.

A standard LT contract will outline the number of hours needed per week, what sort of shifts are required, whether or not call or nights/weekends are included, what types of cases will be required, and how much the provider will be paid for their time.

Here is an example:

"CAA needed in Fantastic City. 40 hours guaranteed for 6 months, option to extend. Can work 8s, 10s, or a combination of longer shifts. No call required. Mostly General cases, some healthy peds, light OB, no cardiac. OT available. $180/hour, $200/hour over 40 hours."

At the end of the contract, the terms will have to be renegotiated if both parties decide to extend the arrangement. Other items that can be negotiated include travel expenses, parking fees, and per diem money (for necessities like food). A location with widespread needs and extremely short staffing may be willing to negotiate on schedule or other factors as well.

Much like PRN, this arrangement does not cover things like PTO, health insurance, and CME reimbursement. The higher hourly rates are meant to compensate for this, but it may not always work out in your favor. It’s wise to calculate your out-of-pocket expenses prior to entering one of these agreements. Make sure you also factor in taking time off, emergency savings (in case there is some lag time between contracts), and saving for retirement. You may also have to purchase your own malpractice insurance, depending on the location.

Throughout your career as a CAA, you will certainly have options. At different times in your life, different employment arrangements will become more beneficial. Immediately after graduation, you may want to work a full call position with overtime in order to pay your loans off faster. Once you have some money saved and develop external life obligations, PRN may become more attractive. Or, you may find yourself in a position to travel for Locum Tenens positions and maximize earning potential.

One benefit to this career is that you can alternate between arrangements without really affecting your long term potential. As long as you maintain relationships and leave a good impression everywhere you work, your options will remain open for the duration of your career.

By familiarizing yourself with the employment options available to you after graduation, you can craft a more compelling application that demonstrates your understanding, commitment, and readiness for the field. To help you on this journey, consider subscribing to the newsletter, which offers tailored admissions advice specifically designed to help you gain acceptance into an anesthesia program.