Your Guide To Your First 90 Days As A 1099 CRNA

Everyone says starting out as a 1099 CRNA is not as hard as you think — so how do you actually start? Well, prep for the first 90 days begins way before day one, so let’s start there.

90 Days Prior

At least ninety days before your first day, you want credentialing completely done. You’ve picked where you’re going to work, settled on a rate, and signed a contract — now you’re just waiting for the credentialing committee’s approval. Why ninety days? Because credentialing at a new facility takes an average of ninety days — sometimes a minimum. You don’t want to go 1099, quit your job, and have no income for three months or more.

Before Day 1

• Contract terms you actually understand. Pay rate, payment schedule, cancellation/no-call policy, who covers you if a shift falls through. Read it before you need to reference it in a dispute.

• Entity and EIN. Whether you’re operating as a sole proprietor for now or have already filed for an LLC or S-corp election, you need an EIN before money starts moving. If you’re leaning toward S-corp, know that the election has a timing requirement — it’s not something you can backdate whenever you get around to it. Do I actually need an LLC?

• Malpractice and tail coverage. As a 1099, you’re likely responsible for your own coverage now, not the facility’s. Confirm what kind of policy you have (claims-made vs. occurrence) and whether tail coverage is something you’ll need to plan for later. What kind of malpractice insurance should I get?

• W-9 submitted. The facility or staffing agency can’t pay you correctly without it, and a delay here is one of the most common reasons a first paycheck gets pushed back. You’ll need your LLC’s EIN to fill this out, so file your LLC first if that’s the path you’re following. If you’re not working as an LLC yet, fill it out with your individual details — your own name, address, and Social Security number.

• Separate business bank account. Open it before your first payment lands. Commingling funds from day one makes your bookkeeping — and your life at tax time — unnecessarily hard. I’d recommend a business checking account plus a business HYSA — or simply an LLC brokerage account. The checking account is where money flows in and out, and where it sits until distributions. The HYSA/brokerage is where you keep your tax money earning interest before it’s due, plus money for business bills that are a long way out — like disability insurance if you pay annually.

• Disability insurance. Make sure you’re already covered, with a policy that’s started by day one.

Weeks 1–2: Build the Financial Skeleton

This is where we get our hands a little dirty — and it’s the part most people dread enough to decide they can’t do 1099 because it’s “too much” for them. It’s not. Let’s walk through it now, before too much money has moved and it becomes a hassle.

• Track income and expenses from the first dollar. This is honestly the easiest way to stay on top of it. Before you spend the first dollar on your business (and this can be as far back as when you’re paying to file your LLC), you need to decide how to keep track of your spending. Personally, I’m opposed to paying a subscription for things that should be one-time payments, so I use an Excel spreadsheet to track my business expenses and income. At year’s end, I download it and send it to my CPA. Download a copy of these spreadsheets here!
  • Alternatively, some people find QuickBooks and similar online software easier to use. That’s also a good option — just find something you can stick with. Whenever you make a business expense, log that line item immediately so it keeps a running total. When you earn income, do the same. If you use our spreadsheet, diligently updating your income and expenses gives you a more accurate picture of your quarterly taxes, so you’re not overpaying unnecessarily because you didn’t factor in your expenses.
• Shift your tax mindset immediately. No one is withholding for you. That means the tax bill isn’t a future problem, it’s a running balance you’re accumulating with every shift you work. A rough rule of thumb: set aside 30% of your net income for taxes from every payment before you touch the rest, so you’re never caught treating gross pay as if it were net pay. If you use our spreadsheet above, it calculates 30% of the net for you automatically (as long as you’re inputting your income and expenses diligently). After you’ve been 1099 for a few years, you’ll see your actual effective tax rate and can fine-tune how much you set aside for taxes.
• Get on a quarterly estimated tax schedule. The IRS expects payments four times a year, not once. The dates for these estimated payments are not a mystery — search this year’s deadlines and they’re right at the top of Google. If you miss a deadline, there’s a penalty. And no, historically, the interest you could earn parking that money in the S&P 500 all year does not outpace the penalty’s interest. How much do you owe? A good estimate is 30% of your net income — that’s how much you made from your business minus how much you spent on it. Here’s a calculator to estimate your quarterly tax payments
• Decide your entity structure — or decide when you’ll decide. Sole proprietor, LLC, or S-corp each carries different tax and admin implications. If you’re not ready to commit, that’s fine, but set a real deadline to revisit it with actual numbers, not “eventually.” If you’re an S-corp, you’ll need to set up payroll. You can do this through a CPA or simply by using an app like gusto.
• Start your retirement account setup now, even if you won’t fund it yet. A Solo 401(k) takes time to establish — it’s not something you open the week you decide you’re ready to contribute. Getting the account open early means it’s ready when the cash flow is.

Weeks 2–6: The Operational Reality

Alright, once we’re done with the legalese, we can move on to more fun — but still very serious — things: protections. You have to put systems in place to make sure you are alright in case of an emergency. Here’s how:

• No more PTOs and no more sick days means no more safety nets. If you don’t work, you don’t get paid — full stop. As scary as that sounds, that’s absolutely fine because you prepared for this. As a 1099 CRNA, you’re a business owner — and a business owner needs to always have at least six months of emergency funds on hand.
• Figure out your real buffer number. You don’t have six months saved up just yet — that’s fine. A common starting point is 1–2 months of essential expenses held separately and untouched, but the right number depends on how variable your schedule is and how many facilities you’re contracted with. If one contract dries up, does another one absorb the loss, or are you exposed? Even if your schedule is relatively full right now, if you plan to be 1099 for a long time, start from day one working toward a minimum of six months of expenses saved — and eventually up to a year. The freedom that amount of savings gives you is indescribable.
• Expect the first payment cycle to be slower than you think. When you’re W2, you get paid every two weeks like clockwork. However, different agencies pay on different schedules. Make sure you know when to expect payment, because some people honestly don’t pay until 6 to 8 weeks after you’ve worked your first shift. That’s something you need to be ready for and to factor into your calculations.
• Track your hours and shifts in a way that serves two purposes. One, it backs up your tax and expense records. Two, it gives you real data the next time you’re negotiating a rate or deciding whether a contract is worth renewing. Don’t rely on memory for either. It also helps you know when to expect money, especially considering that everyone pays on a different schedule. We’ve created a spreadsheet specifically for this — it’s called the 1099 CRNA Cashflow Planner and you can download it from our resources page. It goes week by week: each week you enter how many shifts you expect to get paid for from each agency, so you know how much money you’re expecting to come in.

Weeks 6–12: First Course Corrections

By now, you’ve got enough real data to stop guessing and start adjusting. This stretch is less about setup and more about checking your assumptions against what’s actually happened.

• Make your first estimated tax payment — or confirm the math if it’s not due yet. If a quarterly deadline has passed, this should already be done. If not, use this window to calculate what you’ll owe based on real income so far, not a rough guess from week one.
• Recalculate what you’re actually netting. Gross pay per hour or per shift looks good on paper, but once you factor in self-employment tax, the health insurance you’re now buying yourself, retirement contributions, and any admin costs, the real number is often lower than expected. This is the point to re-run the math with your actual values.
• Evaluate the contract or facility fit. Most people know by this point whether a contract is working — the schedule, the culture, the pay relative to the workload. If something’s off, this is a reasonable time to start exploring alternatives rather than waiting it out on inertia.
• Turn the one-time setup into a recurring rhythm. Monthly bookkeeping, quarterly tax payments, periodic review of your buffer and retirement contributions — these need to become habits, not tasks you did once during onboarding and then let lapse. This is usually where people either lock in a sustainable system or start falling behind again.
• Revisit the entity decision if you deferred it. If you pushed off the sole prop vs. S-corp question in week one, now you have real numbers to make that call with instead of guessing at future income.

Ninety days in, you’re not an expert. You’re just past the point where the wheels usually come off. If your paperwork’s filed, your buffer’s holding, and you’ve actually made a tax payment instead of just thinking about it — you’ve done the hard part. What’s left is refinement, not survival.