Unlocking Opportunities: The Strategic Advantages of Holding Licenses in Multiple States

Andi Stamper

February 1, 2024

Accounting

The possession of licenses in multiple states presents healthcare professionals, particularly those in locum tenens roles, with several advantages, including:

Increased Job Opportunities: Healthcare professionals with licenses in multiple states can access a wider array of job opportunities, particularly beneficial for locum tenens providers seeking short-term assignments in different regions.
Geographic Flexibility: Holding licenses in multiple states offers geographic flexibility, enabling healthcare professionals to explore job opportunities in various locations and gain exposure to diverse healthcare settings, patient populations, and working environments.
Locum Tenens Opportunities: For locum tenens providers addressing staffing shortages, holding licenses in multiple states is advantageous. It allows them to take on temporary assignments in different locations, addressing the varying needs of healthcare facilities.
Diverse Clinical Experience: Professionals with licenses in multiple states can acquire a more diverse clinical experience. Working in different regions exposes them to various cases, patient demographics, and healthcare systems, contributing to a well-rounded professional background.
Career Advancement: Holding licenses in multiple states opens doors to career advancement and specialization, offering opportunities that may not be available in a single location and allowing professionals to tailor their careers to their interests and goals.
Adaptability to Market Demand: Healthcare demand varies across states and regions. Having licenses in multiple locations enables professionals to adapt to fluctuations in market demand, increasing their employability and job security.
Personal and Professional Growth: Working in diverse locations provides opportunities for personal and professional growth. Exposure to different healthcare practices, cultural nuances, and patient populations contributes to a more well-rounded and adaptable healthcare professional.

Navigating State-Specific Licensing Requirements:

While the benefits of holding licenses in multiple states are evident, healthcare professionals must stay informed about each state’s licensing requirements and regulations, as they vary significantly across the United States. Important considerations include:

1. Education and Training: States have specific educational requirements, and some may require specific courses despite previous education and practice in other states.
2. Examinations: Licensing exams may be national or state-specific, with each state having its own licensure requirements outlined in its practice act.
3. Clinical Experience: Some states may require a certain amount of clinical experience or residency training for specific healthcare professions.
4. Background Checks: Background checks, including criminal background checks and fingerprinting, are typically part of the licensing process.
5. Continuing Education: Many states require ongoing education for license renewal, often with specific requirements such as the number of continuing education units (CEUs) or categories.
6. Application Process: Each state has its own application process, including specific forms, documentation, and fees.
7. State-Specific Regulations: Healthcare regulations vary, including additional certifications or specialized training. Understanding these requirements is crucial to prevent complications and maintain high standards of healthcare.
8. Fees: Licensing fees vary between states, and applicants are typically required to pay these fees.
9. Reciprocity: Some states offer reciprocity for healthcare professionals licensed elsewhere, simplifying the licensure process.

Staying Updated and Efficient

1. Regularly update yourself on changes in requirements through industry resources.
2. Optimize efficiency by centralizing license management through a single platform.

Take Home

Healthcare professionals must familiarize themselves with specific licensing requirements for the states they intend to practice in, staying updated with any changes or amendments to regulations.

Resources

CRNAs: https://www.aana.com/practice/practice-in-your-state/
Nurses: https://nursinglicensemap.com/states/
Other Providers: https://scopeofpracticepolicy.org

STEPS TO FOLLOW TO BUILD A 1099 BUSINESS:

Protect yourself and your assets by performing your contract work under the umbrella of a business entity. Think about what you’d like your proposed business to be named!
- Visit your Secretary of State website to see if your chosen name is available
- Check with your state’s Board of Nursing for state specific requirements
File applicable business set-up paperwork

The S-Corp Edge: How you structure your 1099 CRNA business will have far-reaching consequences, whether it is a sole proprietorship, a limited liability corporation (LLC), or an S corporation (S-corp).
An S-corp may offer several advantages over other business structures when it comes to taxation. In this structure, a business owner is called a shareholder, and the business owner is recognized by the IRS as an employee of the business. What this means is that the business owner must pay themselves a salary through the corporation. The S-corp pays their payroll taxes, which can in turn be deducted as a business expense. Income tax is paid through its owners’ tax returns based on their percentage of ownership. Moreover, any remaining profits have a lower tax rate than regular income. An S-corp may also allow 1099 CRNAs to avoid a higher tax level that other self-employed contractors pay for Medicare and Social Security.
A CRNA may structure their company as an S-corp serving as the sole owner, with their business income, tax deductions, and losses passing through to the owner, as opposed to being taxed at a corporate level – a potentially smart move for maximizing financial security in the future.

- Register for an EIN
Open a business checking account and credit card
Keep track of all your business expenses as these could save you money come tax time!
- Have an envelope for receipts or a folder on your computer where you scan these into
Be sure not to co-mingle your business and personal finances!
Remember, as a freelance CRNA, if you don’t work, you don’t get paid!
- Do you have at least six months savings should your contract abruptly stop?
Think about replacing your current benefits
- Health Insurance
- Health Savings Account/Dependent Savings Account
- Retirement Savings Account
- Life Insurance
- Disability Insurance
Procure malpractice insurance
Look for jobs!
Apply for state licenses where you want to work
- Each state needs a different CRNA license (and RN if they are not a compact state). Keep this in mind as some BONs can take 3-6 months to license a provider.
Have an employment attorney review your contract
Have your contract written to your business and deposit all earnings into your business checking
Keep A Schedule

As a W-2 employee, your taxable income and amounts taken out for taxes appeared on your W-2 form at the end of every year, without you having to calculate them. But when a firm pays more than $600 for services from an independent contractor, that income must be reported to the IRS.
What many 1099 CRNAs don’t realize is that they must pay taxes on their income as they earn it. Paying your quarterly estimated income taxes will be a new part of running your business successfully.
It doesn’t sound so difficult—keeping track of paying estimated income tax only happens four times a year. But the reality is a late payment can result in penalties and fines from the IRS. Keeping a schedule to help you stay on top of your quarterly estimated tax payments, and paying adequately to avoid underpayment, is imperative in avoiding penalties in the future. Not to mention providing peace of mind!

Make sure you have a trusted team of accounting and/or financial professionals who have experience with freelance CRNAs to guide you through this process!

CPAs
Financial Planners
Bookkeepers

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