Awakened Anesthetist

[PROCESS] CAAs Can Rewrite The Rules Of Work with Harmony Founder, Rad Zamani, CAA

• Mary Jeanne, Certified Anesthesiologist Assistant • Season 5 • Episode 82

Share episode

A denied $10 raise shouldn’t define a career, but it can redefine one. When Rad hit a wall advocating for fair market pay, he realized the problem wasn’t personal, it was structural. So he built leverage instead of waiting for permission, and Harmony Anesthesia Staffing was born.

Connect with Rad radzamani@harmonyanesthesia.com

Great Resource HERE to understand all the terms in this episode (1099, W2, Locums, etc)

A HUGE 'Thank You' to the Season 5 PROCESS sponsor, Harmony Anesthesia Staffing.

Harmony is CAA-owned, clinician-forward, and leading the way in the CAA locums market. Schedule your free 15-min consult and see how locums can work for you. Say 'hi' to Rad and Sasi for me when you do!

You can now text me! Leave your email if you need a response!

Stay Connected by subscribing to the Awakened Anesthetist Newsletter-
for more CAA specific resources, exclusive content and offers.

Watch episodes of Awakened Anesthetist Now on YouTube!


Let's Chat! awakenedanesthetist.com or on IG @awakenedanesthetist

SPEAKER_00:

Before we get into today's conversation, I wanted to take a quick timeout. This is the moment before every process episode begins where I set the stage for who you're about to meet and why their story matters for our CAA community. And actually, today's process episode is deeply connected to my season 5 flagship sponsor, Harmony Anesthesia Staffing. You've already heard about Harmony's values and their growth, but what you might not know is that Harmony wasn't created to be just another staffing agency. It was born from a real lived struggle. A moment when a CAA looked around at the way things were and thought there has to be a better way. And instead of waiting for the system to shift, he decided to build what he couldn't find. That origin story is why Harmony feels so aligned with my work here at Awakened Anesthetist. Everything I talk about, living intentionally, designing a life that reflects your values, creating something that didn't exist before. Harmony is doing that inside our CAA profession. And today you get to meet the CAA at the center of that beginning. Harmony's founder, Rad Zamani. If you are a CAA or SAA who has ever wondered what it really looks like to step outside the traditional path, to shift from clinician to entrepreneur, to navigate uncertainty, and to choose alignment over comfort, this conversation is for you. So with that, let's step into this process episode with fellow CAA and Harmony founder Rad Zimani.

SPEAKER_01:

I would say that for anyone who's interested in pursuing an entrepreneurial venture, and I know it sounds cliche, but you really got to dig deep and think of the why. Why are you doing this? What is your purpose? If you don't have a mission and you don't have a purpose, any kind of financial success will not be enough to sustain the headwinds that you are going to be facing, the disappointments, the challenges, the grit that you need to have to persevere those challenges. You have to have a why.

SPEAKER_00:

Welcome to the Awakened Anesthetist Podcast, the first podcast to highlight the CAA experience. I'm your host, Mary Jean, and I've been a certified anesthesiologist assistant for close to two decades. Throughout my journey and struggles, I've searched for guidance that includes my unique perspective as a CAA. At one of my lowest points, I decided to turn my passion for storytelling and my belief that the CAA profession is uniquely able to create a life by design into a podcast. If you are a practicing CAA, current AA student, or someone who hopes to be one, I encourage you to stick around and experience the power of being in a community filled with voices who sound like yours, sharing experiences you never believed possible. I know you will find yourself here at the Awakened Anesthetist Podcast. Welcome in. Let's start off with sort of a deeper question, which is what's something that most people get wrong about you and your entrepreneurial journey?

SPEAKER_01:

That's a good question. I think that there is a misconception that things are easy when truly there is a large burden of responsibility that you carry. If you truly care about your community and you have a mission-driven, purpose-driven company. And so, yes, it's it's it's great to have success, but with it comes its own hardships. And that um burden of always wanting to over-deliver is stressful. And sometimes it's out of your hands. I mean, sometimes it's not something that can be controlled, but you feel the responsibility to do the right thing. And it's easy to do the right thing when you can control all the parameters. It's hard when when sometimes they're not completely in your control. So that I'd say that's that's that's a challenge. So yeah, it's not always easy.

SPEAKER_00:

Mm-hmm. I'm so excited to get into the realness of this because I think a lot of CAAs just heard themselves when you said it's it's nice to control when you can control everything. And I do feel like the CAA profession has a large amount of control. It's like you want heart rate to go up, you give this drug, heart rate goes up. And yet there's this part to a lot of us to maybe be creative or to start something new or to make a change in our profession. It's like this juxtaposition of who we are. Um, and it's so helpful to hear someone who's kind of gone before and done it so that we can all be expanded. That's truly the purpose of this podcast. So I'm excited to get into your story. Let's rewind a little bit and start with who you were growing up, your cultural background, your upbringing, like to help us shape um an understanding of who you are. Yeah.

SPEAKER_01:

So my origin story is I am a true immigrant. My parents sacrificed a great deal to come to this country from Iran. And we came here when I was approximately eight years old. My mom worked for the Iranian embassy. Um, I was born in 1978. So, right at the kind of height of the revolution in Iran and the regime change that has occurred, that's still ongoing today. And the plan was to always go back. And so I remember in high school, my dad would say, you know, once the Ayatollah passes, then we're gonna head back to Iran. And we have a whole, you know, life there. And my mom would say, We're not, we're not going back. You know. So my origin story is a successful story for immigrants. I would say anyone who thinks that the American dream is dead, you know, I would I would challenge them to have a conversation with me because it it's not. And so we grew up with, I would say, looking up at middle class, with my parents doing everything they could to provide a very happy and fulfilling childhood. And they did, they did that amazingly, but with limited resources because you know they came to this country not doing what they were trained and really positioned to do their whole lives, right? So I've always had a bit of an entrepreneurial mindset just because of my upbringing. My parents uh owned everything from what would be kind of a mom and pop FedEx shop to uh an auto-repair shop to oriental rug uh repair business. I mean, so they've done multiple things, and I was there along the way and watched them do it.

SPEAKER_00:

So I did not know that depth of your story. Thank you so much for sharing that. And I have a follow-up. What would you define the American dream as?

SPEAKER_01:

I think the American dream is a social contract that exceeds your expectations, right? If you go to school and you do well and you work hard, that there should be a job and an opportunity and a lifestyle available for you. And I think a lot of countries fail to deliver on that promise. And I think the American dream is a dream that's still very much alive because it's exceeded all of my expectations. And that social contract has been delivered.

SPEAKER_00:

Well, let's talk about how you got to that American dream because I guess similar to your parents, you have done many things. So maybe kind of give us a brief overview as you build up into going to CAA school. And I have some questions for you about how you um ended up going to AA school, but yeah, tell us kind of all of the parts of you leading up to AA school.

SPEAKER_01:

So I graduated Emory undergrad in the year 1996, which is you say that like it was hundreds of years ago.

SPEAKER_00:

In the year 1996.

SPEAKER_01:

I'm going to my 25-year uh Emery reunion, so it feels that way. Yeah. But you know, it was when the managed care agenda was very much front and center. And so I remember sitting at the kitchen table with my parents and one of our close friends who's who happened to be at OBGYN and contemplating uh medical school uh because I was I was always interested in medicine. And she was very adamant about do not go to medical school. It is not what it you envision it to be. And you should go into administration because that's that's the future. You know, it every healthcare is going to be managed by these large organizations. And you know what? Fast forward, she wasn't wrong. She wasn't wrong. Her advice had a profound impact on me and my decision making at that time to pursue maybe a different career path, still medicine related, but maybe having a little bit more business, right? So after Emory undergrad, I decided to go to public health school and get a degree in a master's in healthcare administration. I went to the American College of Healthcare Executives, the ACHE is essentially the ASA for healthcare executives.

SPEAKER_04:

Okay.

SPEAKER_01:

I went to their annual conference, met a partner of a company that I thought was outstanding, and took a job with them out of school. So I thought I had my dream job. This is what I wanted to do. And here I am. And then I had an aha moment when we're at one of our team outings where the partner had to step away from dinner uh to take a phone call from his five-year-old daughter to wish her a happy birthday. And I thought, that's that's not the future that I see myself in, you know. And so I decided to to pivot. And I thought, well, I I I like the smaller company because I had received an offer from Price Waterhouse Coopers and you know, wasn't in love with the big conglomerates. So I decided to work with a startup company that a friend of mine had started. And it's called Nerstar Solutions. And NerfStar Solutions was a teleradiology company. I knew nothing about teleradiology. They hired me on as a director of sales and marketing. I knew nothing about sales and marketing, but I said, yeah, I'll figure it out. And so I launched a new website for them and did some marketing collateral for them, went on sales calls with them, and did really well, surprisingly, even though my uh undergraduate degree was in neuroscience. So completely unrelated. Um, but yeah, you just kind of figure it out as you go along. And then at that time, when I was making the transition from working for stock and impent associates and working for Neurostar, I had applied to the AA program because my dad had a friend who was a CAA, and my dad said, Hey, you should talk to this guy. And I went and chatted him one day and I was like, wow, this is pretty, this is this is pretty neat. And I can't believe I didn't know about this profession having gone to Emery undergrad, right? I mean, lit I literally walked by the building like a thousand times in undergrad and never knew that the AA program even existed in that building.

SPEAKER_00:

But it was different time, different time.

SPEAKER_01:

Yeah, absolutely. And I loved it, and I thought that the profession was wonderful. So I applied just to keep my options open, right? And then uh, you know, lo and behold, I got into the program and had to make a decision and uh decided to pivot, you know, to what I consider to be the good guys, which is the providers. And so um, yeah, 20 almost 20 years later, uh, here we are.

SPEAKER_00:

Now, I sense this being a theme in your story, like wanting to keep your options open because that seems to be your mindset of like, okay, I'm always maybe is it an itch to learn? Is it an itch to like have a different impact on the world? Like what made you think, well, you know, I'm pretty happy where I am, but like, hey, let's apply to this entirely different program. And and mind you, we're not gonna skip past the fact that I know that you forgot you applied to AA school.

SPEAKER_01:

So I'm we're gonna circle back, but yeah, you know, I've always I'd like to keep my options open always because I have have a lot of interests, you know? And I felt like the AA program was a way for me to dip my toe into medicine, have a great deal of responsibility, and determine whether I absolutely loved medicine before I committed eight, 10 years of my life to pursuing a career in medicine, right? And I also had asked when I was in at the program, what is a percentage of AAs that go on to get an MD and their acceptance rate? And it was like 100%. Now, you know, they couldn't tell me exactly how many had done it historically, but they're like, no, it's everyone who's gone from AA school and decided to pursue an MD as an anesthesiologist, they've been very successful in doing so. I was like, well, this is a a a great conduit to doing that, right? Um, and so this was a way to keep the options open. And you know, I remember sitting down with my dad and and coming up with a pros and cons list of A versus M D. And I had so many other interests that I had that I felt like I just wouldn't be able to pursue those if I had gone the MD route, if that makes sense. Right? Totally. And so yeah, I felt I felt like the AA program, and I it is uniquely it's a very unique profession in that when you step out of the operating room, the work does not follow you home. And you can, I feel like, design a career path as an AA that gives you the opportunity to pursue other interests that you have, whether they're you know, creative or or business or or whatever you want to do. It's it's an outstanding profession. And and I I do feel like I need to give back to the profession because it's done so much for me.

SPEAKER_00:

I am right there with you, Rad. I totally agree with that. Um I just wanted to highlight a little bit of just the culture change around CAA school that you, like me and many people who are of our CAA generation, were thinking, oh, I'm gonna go to medical school. Maybe not. Okay, what's a CAA thing? And my dad was a CAA, and I was still thinking, oh yeah, I'm probably gonna go to medical school. And then CAA was, it felt like this backup, which is a completely different experience from those pre-AAs right now who are wanting to get into AA school. And I think it's because those of us who are CAAs have done a really good job explaining what you just explained, that you get this time and life back. And it is so deeply fulfilling in the role in in clinical medicine. You still get all of those like wonderful parts of clinical medicine. And so when I tell the listeners that you initially told me that you forgot you applied to AA school, and then what you got an interview, and you're like, oh, what's that thing? Like that is sort of when you had that conversation with your dad. Is that right?

SPEAKER_01:

Yeah, you know, I so Emery was a client of the company I was working for. So Emery was a client of Nurstar. And so when I got a call from Emery, I thought it was a client asking about the product and wanting to, you know, take the next steps. And I then quickly realized that, oh no, this is the Emery AA program calling me for an interview. I was like, oh, I was like, sure, I'll come in for an interview.

SPEAKER_00:

Everyone's rolling their eyes right now, Rad at you.

SPEAKER_01:

Well, and I remember calling my then girlfriend, now wife, saying, Hey, I got the and she was in medical school, by the way. Um, and I said, Hey, I I got this interview request. What do you think? And she was like, go and make a decision later. You there's no decision to make until you actually get in. I was like, Yeah, that's true. So then I went on the interview. Don Biggs, David Bizzetti were the two interviewers, you know, they had the dual interviewers. And, you know, lo and behold, I got accepted. And I was like, oh man, now I have to make a decision. And honestly, the um the company that I was working with, Neurostar, was they thought I was insane. They're like, you're you're you're quitting? Like what? You're doing like you're killing here, you know? Like, why would you give this up? And I was like, I think this is what I want to do. Um and I and I am I'm the type of person that I don't listen to a lot of the noise. I I tend to do what I feel like is the right thing to do, which I think has helped me in the entrepreneurial journey that I've been on. Because if you just listen to a lot of the noise, it can be deafening, right? And you have to have conviction in your decision making in order to pursue the life that you want. And so that's that's what I did.

SPEAKER_00:

I would love for you to speak to the non-traditional AA applicants right now who are listening, which has, you know, become like a category now for pre-AAs because you are the epitome of that. And I just would love for you to speak to what it felt like as having that non-traditional path, having all of that life knowledge from your other roles and your experiences and how AA school felt for you versus maybe how you saw AA school for maybe a more traditional colleague you had in your program?

SPEAKER_01:

Well, I think what's what's really attractive about the AA profession at large is that the work-life balance is extraordinary. You know, when you're in sales or consulting or in the business sector, the work follows you home. You're always technically on, right? I mean, we're talking about the days when like Blackberries were like a thing, you know, and then I had your Blackberry and his busting. It never stops. And working in the consulting world for a revenue cycle consulting company, yeah, it'd be Saturday at four o'clock and you get an email from, you know, your general manager and you need to respond, even though you're technically not on the clock, right? Whereas the AA profession, I mean, you step out of the operating room and it is, it's done. You've taken care of your patients, you've fulfilled your duties for the day, and you don't have to worry about doing anything outside of you know, uh in your off hours, essentially, right? So you can pursue other interests. It's it's it's so gosh, what's liberating is probably the word I can use, um, as a profession. There's not a lot of professors out there that allow that, you know. Even my wife as a physician is beholden to committee meetings and staff meetings and having a great relationship with administration. And we're completely inoculated from all of that, right? And it's, I mean, it's amazing. I tell people all the time if Harvard Medical School's dean were to show up in my front door tomorrow and tell me that I had a full ride and could choose a residency of my choosing, I'm not the guy. I'm like, I'm sorry, I'm not interested. You're gonna have to find somebody else.

SPEAKER_00:

Did you have a sense of that when you were a student because you had seen the counterpoint? Like you had experienced the opposite of that lifestyle, and so you just felt differently in school and that kind of, you know, like, well, I guess I'm asking, what was school like for you as a non-traditional AA student?

SPEAKER_01:

Well, I think I was of the mindset of this is a great profession. I'm very grateful to be here. This is a choice that I've made. I gave up a successful career path to be here, and so I'm gonna make the most of it. Right. So I do feel like, and I and I I do agree with you, there's some younger AAs who come into the program straight out of school, straight out of undergrad, and don't have that perspective. And so that level of gratitude for what you do have isn't there, and it is a little frustrating sometimes because it's like this is you're in a great place. And it's an exciting time to be an AA. I there's never been a better time to be an AA. And so, yeah, I think that that prior life experience just gives you a different perspective on um how good we have it, quite frankly.

SPEAKER_00:

Mm-hmm. I totally agree. And I was the person who came right out of undergrad. Um, you know, I didn't know what I had until years into the profession. Hey Awaken Anessis community, jumping in here with some behind-the-scene details that feel especially connected to today's conversation with Rad. When Rad and I were meeting for our very first discovery call to prep for his process episode, he shared a moment that really stuck with me. Rad told me that this all started when he requested a$10 an hour raise, a raise that simply matched his market value, his experience, and his skill set, and he was denied. Of course, he said it felt deeply personal at first. These were his work colleagues, his work friends, telling him he didn't have value. But then he realized it wasn't personal, it was professional. And the only way he was going to get what he knew he needed was to become his own advocate. And honestly, that story is familiar to so many CAAs. I've lived a version of this story myself when I wanted to go part-time after years working for my private anesthesia group, but I had no leverage. I kept showing up to the negotiating table, hoping someone would see and honor what I needed. And when that didn't happen, after so much struggle, I finally made the difficult decision to leave altogether. It felt personal too, until I recognized the same truth as rad. I had to take my power back. No one was going to recognize my value until I truly recognized it. This is exactly why Harmony Anesthesia staffing exists. Harmony was built by CAAs who've lived these stories. CAAs who wanted a career that honors themselves as a whole clinician, not just as shift coverage. Harmony's growth has come through trust, through transparency, through CAAs saying, I want something different and I deserve it. So if you're at a point in your career where you want more flexibility, more alignment, more agency, and you don't want to leave the profession you love, Harmony may be your path forward. You can schedule a 15-minute consultation directly with Rad using the link in the show notes. It's a no-pressure conversation about how working locums can be the answer you are looking for. And honestly, it might be the moment you start taking your power back too. All right, let's jump back into Rad's process episode. So walk us through just the early days of your career. Um, I actually don't know if you ever worked somewhere completely like a normal W-2 full-time, or if you jumped straight into 1099. We probably should define some of these terms as well.

SPEAKER_01:

So, great question. I started off with a group called Georgia Anesthesiologist at Kenistone Hospital in Marietta, Georgia. I took the job because, quite frankly, a number of my classmates took a job there. So it's kind of comfortable going in with a cohort of friends, right? And I was a volunteer at that hospital when I was uh in high school. So I was like one of those candy stripers and volunteered in the summer and you know, wield the patients wherever they needed to go. And so, you know, the the site and the hospital resonated with me. So I felt like it was a good fit. I did take a 1099 position with them, which is very untraditional. Um, and the reason I did it was because I was a little bit brazen saying, well, I mean, I don't really need your benefits. I'm really young, like I don't need health insurance and this retirement stuff you keep talking about. And I just want to pay off my student loans and make as much money as I can. And so back then, again, we're talking 2007, I took a 1099 position with the group that unfortunately offered that. And 1099 essentially is just an IRS classification of an independent contractor versus a W-2, which is not an independent contractor, you're an employee of an employer. So your employer would be the hospital or anesthesia group or whoever. Whereas a 1099 independent contractor, you're the employee and the employer. So that's really essentially the difference, and it's an IRS classification. So I took a job with them, but I was also very transparent, and I said, my wife or my fiance at the time is applying to residency programs, and she has applied to Atlanta Medical Center and Emory and some local places, but you know, in the mass process, we don't know where she's gonna go. And so I actually um you know, pat myself on the back. I didn't take the full sign-on bonus uh because I said I may be gone in a year, and I don't want to have to pay taxes um on a bonus that I have to return later. So I said, I'll commit to being here for a year, but then after that I don't know what's gonna happen. And they're like, no, totally understand. And my wife got a residency in Macon, Georgia. And so we moved to Macon. And there I took a W 2 position because 1099 was not available.

SPEAKER_04:

Okay.

SPEAKER_01:

So I took a W 2 position at a small hospital in Macon. Now it's called Piedmont Macon. At the time it was an HCA hospital. And I wanted to kind of do more, you know, my wife's in residency. She's working 100 hours a week. I was like, I'm in Macon, Georgia. What am I gonna do with myself? So I thought, well, I I need to go to the sister hospital. It's called Navison Medical Center, the Med in Middle Georgia. It's a 111 trauma center. And the ATA hospital that I was at was a little bit of a more regional hospital. So they sent all the big cases to the medical center. And I was like, oh, I'm too young in my career to just be at these small. I want I want the gnarly stuff, right? I want the hard cases. And so I started doing some PRN work for them. And when a position opened up, I resigned at this regional hospital and I took a W-2 position at the big medical center. Um, and then fast forward four years, my wife's done with residency, and she said, We are absolutely not staying in Macon, Georgia. We need to go to a big city or somewhere close to an ocean. And we ended up back in Atlanta. So that's a short, short story.

SPEAKER_00:

And Atlanta, is that the hospital where Harmony was born? Like, is that where you were working when you had the idea for Harmony?

SPEAKER_01:

Yes. So I came back to Atlanta and took a job back at Kennestone Hospital with Georgia anesthesiologist. And that's when Emory um had a massive comp reset uh where they increased everyone's compensation uh in order to retain staff because it was becoming harder and harder to recruit anesthesia professionals. So two rounds of WT raises, and I went to my friends, the anesthesiologist that I work with, and I said, Look, I do cardiac for you guys, I do nights, I do weekends, you know, I'm super flexible. I'd like to get an increase in my rate because at the time, again, I I went back to them as a 1099. And I said, Oh, absolutely rad. Uh, we'll talk about the next board meeting. You know, one month goes by, two months go by. Hey, you know, what's going on here? Can we revisit this? Oh, I'm so sorry. We'll talk about a next board meeting again. Six months went by and I was like, okay, I'm feeling like maybe I'm not top priority here. And I talked to a colleague, uh, which is still a friend, an anesthesiologist friend of mine, and he said, you know, you should really just go talk to an agency, they'll represent you better, and you'll get more leverage. And I thought, okay, sure, let me do that. Uh, I've never worked with an agency before. I've always just gone directly to the groups that I know, but let me go talk to an agency. And so I did that. I reached out to some of the big names that are out there, and lo and behold, they didn't staff DAAs. Or I'd go on their website and I'd click on the little drop-down menu and it would say CRNA and MDA. So frustrating. And I was like, why? This is crazy. And then on top of that, Mary Jean, I'm the guy that they're sending, and I'm not claiming to be the best anesthetist. I'm not like some superstar anesthetist. I think I'm pretty good, but I'm not like, you know, you know, top tier by any means, right? I mean, I'm not doing doing like pediatric hearts or anything like that. But but, you know, they they would send me to get this locum out of a room that was uncomfortable being there because you know, this locum had been at outpatient centers that was uncomfortable doing belly cases. And I'm like, oh wow. So these groups are paying a premium to agencies that are not doing a very good job of sourcing candidates. So they're frustrated. I'm having to go in there, or another of my one of my colleagues, and they're getting frustrated. I was like, I can do this better. I can absolutely do this better. So I kind of read the tea leaves and said, I'm gonna give this a try. And I and I 100% recognize the importance of an agency because you get the board's attention, you get the hospital system's attention because you're providing a collective solution. And it's not that the group didn't care about me, it's just that they had bigger priorities to deal with, right? And so when they are working with an agency that's providing them a collective solution of maybe 10 FTEs. You know, uh you, this one independent contractor, you know, you're just not going to be high priority for them because they're working with a bigger entity that's going to solve a bigger problem for them.

SPEAKER_00:

Yeah. I know that that is such a resonant problem within all of anesthesia, but also like personally for CAAs, like I felt that exact frustration. But I do want to just rewind a little bit and just pull out some parts of that journey for maybe um listeners who aren't as familiar with, you use like a lot of terms and like a lot of things that feel normal if you're in this world. But um I just want to highlight exactly the problem that you were facing, which was that you were a 1099 employee. You just created your own personal like solo LLC or however you classified yourself. You were working directly for a hospital. It was during a time when they were really struggling to hire people. So what happens in that environment is that everyone at a hospital gets a raise to entice new employees. Like, hey, look, we're getting we're all getting, you know, top dollar in the city. And it sounds like they had to do that several times, which means they were probably quite low compared to um like other people in the city to draw new employees in. And during that time, you were like, okay, I'm a 1099, I'm not receiving those W-2 increases in pay. So I'm gonna go and advocate for myself to my friends, the group that is of anesthesiologists, this private anesthesia group that has hired me and values me, I know, and they weren't able to deliver value back to you in the form of compensation. And that is that frustration of being a highly capable, highly needed, very skilled CAA, but you don't have the power to advocate for yourself. And you're saying particularly is because you were solo and not part of a staffing agency. Um, and that agency word, I just want to make sure people understand. So, yeah, what were we gonna say?

SPEAKER_01:

Well, ironically, the name of my LLC company when I was working solo is called One Source Anesthesia, which is kind of funny. But yeah, you're one guy, right? An agency is a staffing agency, just like you can think of a sports agency that represents a lot of athletes, right? A staffing agency presents a lot of providers and is able to provide a collective solution to a practice that's, you know, if they're short staffed with five full-time equivalent employees, then an agency come can come in like Harmony and say, look, we can provide you with all five of those employees until your recruitment department can adjust their package and do a better job of recruiting full-time staff.

SPEAKER_00:

Mm-hmm. Yes. Okay. Talk to me about the transition from one source anesthesia, which yes, that is ironic, to becoming harmony while working at the same institution, right? You you just kind of like switched up how you were billing them, or like I don't even know the appropriate words. Like, talk to us about that, I'm assuming, clunky transition period.

SPEAKER_01:

I would say the primary word that I would use is just transparency. I've always been very transparent with what I'm trying to do. And I find that it's always the best approach because I went to the groups and I said, Hey, I talked to some agencies. I have noticed that you're having some staffing difficulties. I've noticed that you're using an agency that doesn't utilize CAAs. What do you think about me providing you with some folks that would be a better fit? And they're like, You do you think you can do that? And I was like, Yeah. You're like, well, sure, send us the contract. And I was like, I'll get right on that, you know? And Google how to create a contract. Exactly. I went on Google and I was like, you know, how do you how do you uh, you know, write a contract and and did some research and and pieced one together and sent it to them and and uh you know got the first first contract. Of course, then it's like, oh man, now we have to deliver on this, you know? And so then again, reaching out to our network and and saying, look, this is what I'm doing, this is what I'm trying to pursue. Is anyone interested? And then fortunately we had the faith of our community that said, Yeah, well, we'd we'd love to help you with this. And and yeah, we would certainly be interested. And and that's how it kind of began. Very grassroots. Very grassroots.

SPEAKER_00:

And when was this? What year was this?

SPEAKER_01:

This was uh November of 2019, is when we decided to officially, I decided to officially launch Harmony and get going as an agency. Which wasn't the best year, because I was gonna say 2020 was it was a little rough, you know. Um a lot of furloughed employees and had to have some really difficult conversations about you know uh cancellations of of of uh shifts and things of that nature, which happened to me as well. Um, and so yeah, that was a rough year, but uh, I'm glad that's all behind us.

SPEAKER_00:

Yes, trial by fire, I suppose. Um you learned a lot, I'm sure, unfortunately. Unfortunately, but um, and just so the the first few employees, like the first few contractors, were again your CAA friends, your CAA community in Georgia, which is very strong. It it is where the CA profession was born. Atlanta in particular has probably the densest population of CAAs, I would assume. Um, and so you kind of reached out to that network and was like, hey, is anyone wanting this type of arrangement? And you just got some yeses and ran from there, I assume.

SPEAKER_01:

Yep, that's exactly right. And you know, we had the opportunity to expand the agency into other subspecialties, and we intentionally decided to essentially stay in our lane and stick to what we know and be a single specialty focused agency, right? And so we decided that cRNAs, CAAs, and anesthesiologists were gonna be the only provider types that we were gonna focus on on staffing because hospitals were asking us, well, oh, well, we also need anesthesia techs, we also need surgical techs, we also need packing nurses, we also need that. And we're like, maybe, maybe not. Let's just stick to let's just stick to a arena that we're comfortable with.

SPEAKER_00:

Okay, so now I I would love to hear the the nitty-gritty or the what it really felt like to build harmony from, you know, you can give us a little bit of the COVID because certainly that was right when you were building it, but just kind of what it felt like to take this from zero to uh a functioning, profitable, impacting company.

SPEAKER_01:

I would say that for anyone who's interested in in pursuing an entrepreneurial venture, and I know it sounds cliche, but you've really got to dig deep and think of the why. Why are you doing this? What is your purpose? If you don't have a mission and you don't have a purpose, any kind of financial success will not be enough to sustain the headwinds that you are going to be facing, the disappointments, the challenges, the grit that you need to have to persevere those challenges. You have to have a why. And so for me, my why was very clear. And so going from an agency that received success, proof of concept in in early 2019, and then being met with the challenges of COVID literally months later, if you don't have that why and that purpose-driven mission in mind, you cannot persevere. And so I would say that you know, the biggest challenge to a lot of I think young entrepreneurs is not having that that mission and that purpose. And once you have that, then I think the grit comes with it. I know it sounds cliche, but but it really is what allowed us to continue to go forward even though we were faced with a number of challenges.

SPEAKER_00:

Along my own journey, like you saying you have to have a why, I'm thinking, I know my why, right? And like something just deeply came up for me. Like, well, I'll just share. My why is to create connection in the CA profession and with ourselves, like connection with myself and connection with others in the CAA profession. Um, and that is my deepest why. And you can take that into everything I I do. And I I know that that has changed, it's evolved, it has hit different things for me. But that's been at the essence. And I'm just wondering if you can articulate kind of what that why was for Harmony and and what kept you going.

SPEAKER_01:

I mean, the why for us has always been to be a non-agency agency. Okay. That is the why, because I almost felt like an agency was like a dirty word for a lot of these groups. Like, oh, we don't work with agencies. Like we absolutely don't work with agencies. And so we wanted to be something different, right? While still servicing our CA community. And so the why for us was saying we we can do this significantly better than what's out there, right? And so just seeing the opportunity and wanting to be that non-agency agency, being transparent, being mission-driven, being the agency that actually does a deep dive into vetting and provides quality folks instead of just a warm body that that is filling a void. Yes, I think that's always been the why for us. You know, with that also comes a lot of altruistic benefits that we never realized when we're doing this business. Um and by that I mean providers who've come up to me and said, Hey, I just want to let you know, you've completely changed my life. And I'm like, Oh, you know, and they're like, Oh, well, I, you know, I I used to miss my my daughter's softball games all the time because I was being held late at the hospital, or you know, I'm now more present at, you know, with with the family. And a lot of it has to do with with you know working parents. And so that just feels really, really good, right? And so those are kind of just I would say gravy on top when you're building a business that help you kind of continue to push forward, right?

SPEAKER_00:

Yeah. I'm hearing two things when you say non-agency agency. And one of them you kind of touched on when you were sharing that, you know, you're a high value CAA, 1099, who's being asked to go and relieve a locums who doesn't feel comfortable. Like that is a very stereotypical sort of version of understanding what a locums is. It's it's an anesthesia provider that maybe can't fit in with a group, like a normal group. And so they go into the locums market, or someone who has limited skill set for whatever reason and just like comes in as a locums. And if you're in a W-2, like you're the full-time employee, you're like, oh, the locums doesn't do caratives, they don't do harsh, they don't do okay, so the locums has to be in lack collies all day. Like that is a very stereotypical usage, I guess. And your approach is so radically different and also, you know, holds up CAAs in a way. And here comes my question is that like I feel deeply protective over CAAs. Like, no, we are an amazing group of practitioners. Like, we have this underdog spirit of us that I think always wants us to be seen as competent and good enough. And and I don't want to put that on you, but I'm just wondering if there's any of that in your why that, like, no, I want to prove that CAAs can be this solution that you never saw coming because we are that amazing. Like, I just I'm hearing maybe a resonance there, and I'm wondering what you think about that.

SPEAKER_01:

Well, a hundred percent. First of all, you are on point when you say that locums 15 years ago, when I started doing it, the question I would get from anesthesiologist is, oh, where do you work? I'm like, well, oh, this is what I do. Yeah. And immediately there's like, well, there must be some kind of like personality issue with this guy, or or maybe he doesn't have the right skill set, you know. And you'd have to just, you know, just let all that kind of bounce off and say, no, no, no. This is this is a lifestyle that I am choosing, right? And this is something that I'm doing because it's best for my family. Because my wife is an OBGYN, she takes a lot of call, and we don't want the kids raised by the nannies and the opairs. So this is a choice that I'm making. It's not that I don't have opportunities as a W-2, I'm just choosing to do this, right? So I 100% agree with you that 15 years ago, that was the overarching perception of locums. And a lot of it was the correct perception because there were a lot of folks in the locums arena that just couldn't get W-2 jobs or had certain personality issues or whatever. That's completely changed. Completely changed. Now it's a lifestyle choice. It's something that a lot of even young anesthesiologists are coming out of practice, a private practice group, and saying, well, I'm I'm an employee of a hospital, there's no partnership track here. And you know what? I value my work life balance more so than I do a paycheck that this hospital is offering. And so, no, I'm choosing to do locums because it's it's what I want to do. I want to travel, I want to have other interests, I want to do whatever. So it has provided a conduit for them as well, right? And then to answer your second part of your question, the why, yes, I love going to practice groups. Let's say it's CRNA owned. And they, there's just so much misinformation about CAAs in that community. And it's like, no, no, we work hand in hand with CRNAs all the time. And guess what? If you if you are comfortable bringing CAs into the group, you'll get lunches and you'll get to go home on time. And we can help your workforce challenges. And your current CRNA community isn't meeting that need, so why not explore an alternative option, right? And so, no, I I love doing that. And we do a lot of that education and we do a lot of advocacy. My business partner, Sassy, and I are very, very involved in that educational and advocacy portion of our business.

SPEAKER_00:

So thank you for putting a finer point on that because yeah, I mean, you even hear in my own like relay, sort of bias understanding of locums. And I was wanting to do locums. Like when I had a career transition, I was like, okay, locums maybe is the place for me. And I did not know about Harmony at the time. This was like five years ago. So you were just getting started. And I went to a big locums agency, and that drop-down box didn't have CAAs. And I called them and they were like, who the heck are CAAs? And I was like, okay, click, I'll find something else. But yeah. So thank you. Okay, I actually you transitioned beautifully because I have a whole bunch of questions on the impact that I see Harmony making in the CAA community. And you just said your business partner, Sassy, and you do a ton of advocacy work, like boots on the ground, explaining what a CAA is to people who've never heard of us. That is relentless, tiresome work. And I know you're so passionate about that. So tell me, kind of in this new, let's call it a new uh era of harmony, like as it's expanding and getting, you know, we're seeing you at the Quad A, like talk to us about that evolution.

SPEAKER_01:

So we do staff in 10 different states, and we are unofficially, because I don't know if anyone's measured this, but unofficially represent more CAs than any other agency in the country. And the advocacy work that we're doing is very I'll give you examples. I think that works better. Please. So we're we're at the ASA Advance meeting, uh, meeting with practice administrators, meeting with CFOs, talking to them about how we can solve their workforce challenges with an alternative provider, which is a CAA. Right? We went to the Carolinas and Tennessee Society of Anesthyologist meeting in Asheville. Again, speaking to practice administrators, speaking to boards, the board of the TSA, letting them know who we are, and getting a lot of interest from practice groups that say, yeah, we are really struggling with our workforce, and we would love to learn more about what CAs are. We get questions like, well, can CAs take call? Of course we can say call. What do you mean? You know?

SPEAKER_00:

Yeah. It's shocking. It's shocking how how much misinformation there is, how much ignorance, and not in a horrible way, but just like you just didn't know. They they just don't know about us.

SPEAKER_01:

100%. And you know, the uh states like Tennessee that where we just got licensure, big kudos to the quad A for all their efforts there. You know, there's a lot of interest. They're like, look, we've put forth all this money, time, effort, energy in getting licensed for CAAs. There's a reason for it. And the reason is that they need workforce solutions and they want to incorporate CAs into their practice. And so we talked to them about bylaws changes that need to happen, how to do it. You know, I think you have to be this very upfront with the staff and introducing the right candidates to an opportunity that may be challenging at first, right? You may enter a hospital where you may not be welcomed initially, but you have to represent the CA profession well to make sure that everyone feels comfortable with this new provider type. And not just the anesthesia department. Surgeons, the nurses, the PACU nurses, everyone in the interoperative setting needs to be comfortable with you. And you have to present yourself in a very professional manner that that shows that you're very competent, you're very professional, and you're there as a guest to help solve their problem.

SPEAKER_00:

And you kind of spoke on this a little bit, but I'm I'm thinking of maybe practicing CAAs who are listening. I'm like, I kind of want to do the locums thing, and maybe I will contact Harmony and and am I that person who um feels like they could well represent the CAA profession? And what are you exactly looking for? Like, can you tell me sort of your ideal CAA candidate that you would have represent Harmony and represent our profession?

SPEAKER_01:

Well, I would say right off the bat, you want to have at least two years of experience. Okay. A lot of the agencies will engage with new graduates. We do not. We think that if you don't have at least two years of experience, then you're not out there to represent the profession in the best way possible, right?

SPEAKER_04:

Okay.

SPEAKER_01:

You got to be flexible. You were there to do the cases that nobody else wants to do, right? So you may do GI every single day. You may do thoracic every single day. You know, we can talk to the practice group and say, hey, listen, you know, so and so, you know, Mary Jean is capable of doing more than GI, you know, and she's she's told us recently that she's been there for the last two weeks, you know. Could we maybe reassign her someplace else? Most practice groups, we can do that. We can solve that problem, right? Because we want to make sure that you have a good assignment. We also want to make sure that we're fixing the problem for for the for the group. So I would say flexibility, experience, professionalism, right? When things don't go your way, if there's an issue that needs to be resolved, we have to present ourselves in a way that's very professional. The approach to solving a problem is oftentimes what gets people in trouble, right? So you have to maintain the concept that you're there as a guest. You're not an employee of this group. You're there as a guest in order to solve their issue, their problem. And in order to do that, you have to be super flexible. I mean that's yeah, I can't stress that more. Um, so yeah, I mean, I say those are characteristics of an ideal candidate.

SPEAKER_00:

And like in my own, in my own experience of working PRN, which you staff people who are PRN and who have longer what are referred to as locums contracts, which are generally like three, six, twelve months. Um and again, there's a lot of language in this that might be new to some people, but in my PRN experience, I want control and I have to give flexibility. And when you're saying I need CAAs who are willing to be flexible, it doesn't mean you can't also, as the provider, have a sense of control over your schedule or control over the types of cases you want to do. And not meaning I can't do these types of cases, but what we're saying is like, hey, I can do the bigger cases. You don't have to isolate me into, you know, one room all the time because you think I can only do that. And just for a really tangible example of this in my own life, as someone who works PRN and only one day a week, that's my control. I control, I work one day a week. It is always Thursdays. However, I was getting put into GI every single time and I wanted to do the bigger cases. If I'm only working one day a week, I want to do A-lines every so often, and it's not gonna happen unless I change something. And so I ended up telling them I want to work 12-hour shifts. Would that be something you need? Could that solve a problem for you? Because GI closes at 5 p.m. So I knew I had to go somewhere else from five to seven. And they were like, yeah, great, that's actually really helpful because it allows more people to go home earlier. And like I just always have approached this like, hey, I get something, you get something, and there's a way to meet. And I would assume that's what harmony helps match. You know, what are the needs of the institutions and then what are the needs of the CAA who's applying, and how do we make those match? That's the role an agency plays. Am I right in that understanding?

SPEAKER_01:

100%. And we're we're at the bare bones, ground level, we are matchmakers, right? And if we're not doing a good job of sourcing candidates, setting their expectations for the appropriate site, yeah, then we're just not doing a good job. You know? Interesting to say that about the GI situation. I mean, we actually have had a number of candidates that work full-time at a GI center that want to have exposure to larger cases to maintain their skill set, right? And say, look, I want to do locums, like you said, one day a week on a PRM basis at a larger institution because I want to maintain my skills. Yeah. I mean, I do cardiac one day a week because I want to maintain my skill set. I still like doing central lines, I still like doing A lines. In fact, I love being in the OR still. It's significantly more fulfilling than my admin days, you know, working on harmony. So yes, I completely agree with all of that.

SPEAKER_00:

Wonderful. I just I'm hoping CAAs are hearing opportunity when they hear us talking about this. Because yeah, I just think if you've never thought about how you can serve the CAA profession by like going out into a new location or like taking a chance and being that for are there CAAs in Tennessee? I don't know. But being the first CAA at a hospital, not yet, not yet.

SPEAKER_01:

Not yet, not yet.

SPEAKER_00:

Okay, it is like huge opportunity.

SPEAKER_01:

Yeah, Sassy, um, my business partner is actually the TN AAA president. So he's gonna be the state society president, and so he's from Memphis, and so he's just a great fit for it. So that's another example of of the advocacy that we do, you know, as an agency.

SPEAKER_00:

So and um, you know, not a secret that you are supporting me as a CAA entrepreneur and as someone who is trying to make change within the profession. Like Harmony has enabled you to move outside of the operating room. And, you know, I see you at the Quad A, like before we had this partnership. I saw you at the Quad A and I see you on Instagram at all these other um state society meetings, both for Quad A component societies and the ASA component societies. I'm like blown away by how much work you're doing for the CAA profession. I guess I want to know where you see this going in 10 years. Like what would be a beautiful payoff for all this effort? Or are you just like living in the moment? Let's see where it goes.

SPEAKER_01:

Um, no, there's all there's always a roadmap for success, right? Tell us, yes. Yeah, so advocacy. Uh Sassy, my business partner, is uh a GAA board. Okay. Member over the GSA. I'm a member of the GSA. We're diamond sponsors uh at the Quad A and we'll be again next year. We're sustaining members of the Quad A, right? Sassy, like I said, is an incoming TNAA president. I'm on the legislative committee of the Quad A. We are again very much involved in the profession. And roadmap to success, I think, would be for CAA locums to be an option in every single state where we have licensure. When you go to Gasworks, and if we have licensure in Washington State, which we do, there should be CAA locums opportunities there. Either for groups who are currently employing CAAs and even for groups who are not currently employing CAs that want to incorporate CAAs into their practice. And they want to demystify a lot of that misinformation about CAAs by introducing locums into their practice, right, as these temporary employees to let the staff know that look, this is a great alternative to a CRNA pool that's not currently meeting our needs, right? So that would be, I think, the recipe or or the pathway to success. In five years, we would be able to look at the map, go to gas works, go to these job boards, go to bag mask.

SPEAKER_00:

There you go. I was like, go to bagmask.com.

SPEAKER_01:

Yeah, go to bag mask, you know, uh support another CA entrepreneur and be able to choose a locums position in every state that we have licensure in. Currently, that is not the case.

SPEAKER_00:

Yes, yes, that sounds amazing. And I foresee that happening in our lifetime, like in our career span. It's gonna happen 100%.

SPEAKER_01:

I mean, we're not stopping until it does, like it will happen. So, no question about it, Mary Jean. This this is happening, and it it will be I will check the box for we have succeeded once that happens.

SPEAKER_00:

I love it. I can't wait to celebrate when that happens for you and for us. And I also want to say that um we spoke a little bit before we started recording, and I was like, Rad, how much do you work? Like, how what are your hours? Because I do think part of that entrepreneurial dream and um, you know, some of what's sold in like the zeitgeist of being an entrepreneur is that you're, you know, sipping like margaritas on a beach somewhere, and you're working more, you're working more on harmony than a full-time job, in addition to working nearly full-time hours as a practicing CAA. So this is this is a fuel inside of you that like keeps going. It's not necessarily an end point. It's not like, okay, I started harmony. Harmony can like run on its own two feet and like I'm in and out, retire, and like sit back and stop doing everything that I started.

SPEAKER_01:

Oh, yeah. Yeah, not not at all. I mean, we are not on easy street, you know. I would say 60, 70 hours a week easily are spent on work, um, both clinically and on harmony, more in harmony than clinical hours, you know. Um, I'm in the operating room two, maybe three days a week. Heck, I'm working this Sunday because one of our clients needed it. So I stepped in. But yeah, I think that if you don't have going back to what we were saying before, if you don't have that mission-driven mindset, if you don't have that purpose, it's gonna be tough to put in those hours, right? Um because at this point, the drive is is in the mission, is is more so than any kind of financial benefit that we would get from it. It's it's beyond that.

SPEAKER_00:

Well, I am so grateful to share your story and to hold you up as what it means to be a CAA right now. And I'm just excited to continue watching your journey. And I am grateful that you decided to partner with me for season five of the podcast. I am not shy in saying like your belief in me has allowed me to um, you know, buy health insurance for my family. Like there are really logistical, practical things that CAAs who are entrepreneurs need. And when you agreed to be um the partner, you were like, I want to help you. Like, I want to see you succeed. And there's this sort of, yeah, there's like a little cluster of people who are in the CAA entrepreneur space. And we always are like shouting out to each other and trying to hold each other up. Um, and it's just really cool to be a part of. So I'm just grateful for you on a lot of levels. And yeah, I'm excited to uh continue supporting you and seeing where it all goes.

SPEAKER_01:

Likewise. And kudos to everything that you're doing, uh, Mary Jean. Uh I I love it. I think that uh there's an audience that is craving to hear these stories. And I hope that we're uh able to provide a value to them when they listen to this podcast. Um and so yeah, thank you for for having me. Um, you know, doing a podcast wasn't on my bucket list, but I guess I can check that box now too.

SPEAKER_00:

So it's so fun, isn't it fun?

SPEAKER_01:

I just want the I just want the viewers and the audience to get something out of it, you know. Yeah, and I'm hoping that we can provide that for them.

SPEAKER_00:

You did. You totally did, and I'm excited to share it with everyone. So all right, thanks, Radio. Thanks for listening to Awakened Anesthetist. If this episode resonated with you, share it with a CAA friend, an AA student in your life, or a perspective, and let them know why you loved it. It's the most important thing you can do to support this podcast and its mission. You can always find more ways to connect with me and this CAA community at awakenedanesthetist.com, including an invitation to join season. Mindful Connections. These are free virtual gatherings open to anyone in our awakened anaesthetist community. And while you're scrolling the website, check out my trusted CAA partners who make this podcast possible with a special thank you to my season five sponsor, Harmony Anesthesia Staffing. Talk soon.

Head Shot

Mary Jeanne Roberts, CAA

Host