OR Travelers

NedRN · Jan 20, 2017

1. Yes. However you will be on a steep learning curve on every assignment. It may be best to start at smaller hospitals, but hopefully your recruiter(s) will find appropriate assignments. You can discuss what services you are expected to do during the hospital interview.

2. Most places will ask you to extend in my experience. But if you stay in the same area for a year, you lose the tax benefits of being a traveler.

3. Yes. You work by the contract and are not tied to any specific agency (unless you want to be).

4. More than half of the ORs I've been to require call. Generally they will wait several weeks until you know the place pretty well and can survive without daytime support staff. Again, your recruiter can find appropriate assignments, and you can discuss such things further in the hospital interview. Sometimes call can be easy money, and sometimes you earn it!

Argo · Jan 22, 2017

I can agree with Ned on everything with some additions.

1. Yes, depending on what service lines you have at your current place. If you have limited exposure you need to be up front with it. Dont take an assignment that has you doing complex spine or neuro if you have only done general surgery.

2. Yeah, you can stay and I have extended at each place I have been. You will have to take 1-3 months off in each calender year depending on the agency. Theere are firm rules on this due to gov standards though. If you stay over you pay taxes on everything. That can get expensive, very expensive in a place where you get $8000+ in tax free money.

3. I take off alot between contracts but also put in vacations on my contract if I want off in the middle of one.

4. I haven't had to cover call yet but I look for specific contracts that dont require it.

NedRN · Jan 22, 2017

2. Yeah, you can stay and I have extended at each place I have been. You will have to take 1-3 months off in each calender year depending on the agency. Theere are firm rules on this due to gov standards though. If you stay over you pay taxes on everything. That can get expensive, very expensive in a place where you get $8000+ in tax free money.

I have to take exception with this. It is partly true, in that agencies can have (must have) some policies in place in case they are audited by the IRS. This demonstrates minimal due diligence required by the IRS to ensure minimal (again) compliance required for the agency (like the universal housing questionnaire) to offer so-called tax advantage, where tax free stipends are given without requiring any further evidence of eligibility on the part of individual travelers or expense receipts.

These agency standards are minimal for competitive reasons. If another agency offers a more lax eligibility standard, they will take away business from agencies who do extensive due diligence to ensure most of their travelers really do have valid tax homes.

So agencies that meet IRS minimal standards (which are often negotiated during an agency audit by the IRS) will not be held liable for additional withholding taxes because some of their travelers were found not to have legitimate tax homes or meeting other standards like commuting from home or deriving most of their income from a single area.

However, if the traveler is audited, they can be held responsible for the full amount of back taxes, interest and penalties if they were not eligible to receive tax free stipends. That can really add up, and although audits of Americans at our income levels are rare, those who are audited can have life altering amounts due to the IRS if they have been skirting the law for years. There certainly is a big reward for skirting the law, but I don't believe the rewards are big enough for the risk taken.

Time outs by an agency (the main reason I took issue with your post) do protect the agency as I said. The deal is that businesses do not want to act as the IRS police, so having these policies relieves them from - extreme example for this point - sending investigators to check on a traveler's physical tax home et cetera to validate eligibility to receive tax free stipends.

But the agency will not help you if you are audited by the IRS. A recruiter stating that a time out is allowed by the IRS is not the full truth as it pertains to you personally. If you work at only one hospital (or the same general area) for two years (for example) and are audited, that three month time off will not change the fact that that area has been your new tax home for the last year (or even longer depending on when you agreed to extend) and you will owe taxes on all compensation received for that period.

Some traveler return to the same location or hospital year after year. If most of their income comes from that area, even if they take some assignments somewhere else, that becomes their tax home.

For those who have never traveled, much of the above will be so much gobbledegook. For those that have traveled, this should ring some bells. You can read much more about tax homes and when they can shift on PanTravelers and TravelTax. When you read enough about these topics, you begin to actually understand and even agree with IRS "logic". Saying you have a tax home and using a friend's home as an address of convenience is not going to impress an auditor. Neither is saying you took an agency approved break.

heather42r · Jan 22, 2017

Thanks for everything!

I've done general, urology, c-sections, gynecology, spines, ortho, podiatry, ENT, eyes, bariatric plastics, wounds, dental and minimal neuro. We have a special neuro team, as well as a dedicated heart team so I've never been near a heart. We don't specialize other than that; they want us able to do everything which is kind of nice. Gives a good variety to the day!

We don't get a lot of trauma but I've had one gun shot patient and I've been around for a car crash but only as an observer.

I was just curious about the call only because ours don't take it. I'm not opposed to call!

Thanks for the advice! (and the tax advice. my goodness, I had no idea and you are right. I don't understand everything you've said!!!)

NedRN · Jan 22, 2017

I'd suggest you read up on tax homes before traveling. The IRS allows you to deduct (or be reimbursed by your employer) for the extra expenses incurred when working away from home (think business trip). To reduce paperwork, the IRS also allows for stipends to be given to employees (assuming eligible) based on GSA locality based per diems (Google them) without requiring receipts. That can save qualified travelers tremendous amounts of money, in fact more than $10,000 a year extra bankable money from the tax savings.

The caveat is that if you have no home, you do not incur extra expenses for working away from home and are not eligible for tax free treatment of housing and per diems. Worth some serious planning prior to giving up your residence to travel.