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Anesthesia Education Business/Finances

#100 – Vantage Point January 2024

Have you noticed how stoked podcasters get about their one hundredth episodes? 

It’s kind of a thing.

If you want to hear interesting shows – check out the hundredth episodes.  Or 200th.  Or 1000th.  

Podcasters usually get super stoked about hitting triple digits with their shows and often set up the number 100 episode as some sort of tribute to themselves by taking a look back over their favorite episodes.

Don’t get me wrong… I’m pumped about number 100.  But this isn’t going to be a look back at all the best shows or highlight moments.  I’d rather hit on the why behind Anesthesia Guidebook.  

Some of you all might just be joining us.  

Maybe this is the first time you’ve heard Anesthesia Guidebook and you’re taking a look around.  Maybe you’ve been listening since From the Head of the Bed… either way, I’d like to hit on where we came from and where we’re going.

I love when one year turns over to another.  I’m not big on new year’s resolutions and my wife and I don’t even stay up any more to see the clock tick over midnight on New Year’s Eve.  We’ve got a 2-year old who’s potty training this weekend and his 9 month old brother is crawling all over the place.  So we generally go to bed early to wake up and keep pace with these little dudes.  But I do get stoked when a year comes to a close and another begins.  It helps mark a rhythm in our lives.  Just after the winter solstice, the longest night and shortest day of the year.  Then we turn to a new year where new things will happen and the best of the old things are brought with us.  So there’s the 100th episode and there’s the new year… it’s like toast with Nutella and bananas.  Doubly amazing.  

In this show, I touch on what Anesthesia Guidebook means to me and what I hope it means for you. I’ll hit on a couple of upcoming shows headed your way in 2024 and then we’re out. Happy New Year and thanks for checking the show out and getting after it out there!

In Memory of Peter Strube, DNP, MBA, Lt Col (ret), CRNA, FAANA. Matt Zinder wrote an amazing eulogy here and copied below:

The profession of nurse anesthesiology has lost one of its greatest advocates. Peter Strube, DNP, MBA, Lt Col (ret), FAANA passed away peacefully in his home Monday, December 11, 2023 following a brief illness. Dr. Strube’s dedication to colleagues, students, residents, and to the profession of nurse anesthesiology was evident in his tireless efforts to promote and educate all those who had the good fortune to work with him.

Dr. Strube earned his BA in Nursing from Luther College in 1994 and his Master’s in Nurse Anesthesia from St. Mary’s University in 2006. He went on to earn his Doctor of Nursing Practice degree from Rosalind Franklin University in 2017 and his MBA from Edgewood College in 2019.

Dr. Strube retired from the US Army Nurse Corps after 21 years of service, having achieved the rank of Lieutenant Colonel. He deployed four times, which included service in both Iraq and Afghanistan. He earned the War on Terrorism medal, the Enduring Freedom medal, the Mobilization Armed Forces Reserve medal, the Iraqi Freedom and Global War on Terror medal, and held numerous certificates of achievement, appreciation, and training from the United States Army.

Dr. Strube was an Assistant Professor at Newman University School of Nurse Anesthesia and was a developer of the pharmacology CPC Modules for multiple CRNA education programs. His teaching background included serving as an Assistant Program Director at the University of Wisconsin Oshkosh, an Associate Professor at Saint Mary’s University of Minnesota, and an Assistant Professor at Rosalind Franklin University of Medicine and Science.

Peter was the CEO of Strube Educational Services, where he provided invaluable tutoring services to nurse anesthesiology residents, enabling them to excel in their studies and succeed in their anesthesia board exams. His tutoring program has assisted over 500 residents with their success in their medical training. Furthermore, he authored numerous professional articles and shared his expertise as both a national and international speaker. He successfully guided and contributed to over 10 doctoral projects.

Beyond his professional accomplishments, Dr. Strube was deeply committed to his community. He served as a member of the Mount Horeb Board of Education, acted as a Commissioner on the Dane County Ethics Board, and offered crucial mentorship to veterans in crisis through court appointments. Furthermore, he proved to be an active and dedicated CRNA representative and advocate, having served on the Wisconsin state association board, AANA Region 3 Director, and most recently, being honored with induction into the esteemed AANA 2023 Class of Fellows.

Dr. Peter Strube left an indelible mark on his profession and everyone with whom he collaborated. He was a great friend and family man and will be sorely missed.

He is survived by his wife, Rebecca, and children, Noah, 23, Xander, 21, and Sarah, 18, and is also survived by mother Nancy Sommerfeld, father Donald Strube, sisters Shannon and Nicky (Troy) Cross, niece Josie Cross and nephew Chance Cross.

Services will be held Tuesday, January 16, 2024 at:
Evangelical Lutheran Church
315 E Main St
Mount Horeb, WI 53572

Visitation to begin at noon and service will begin at 3 p.m.

Obituary contributed by Matt Zinder, MS, CH, CRNA.

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Anesthesia Education Anesthesia Equipment and Technology Business/Finances Preparing for Grad School/Residency

#96 – Virtual Reality in Anesthesia Education: SIMVANA with Peter Stallo

What up yall this is Jon Lowrance and this is episode 96 – virtual reality in anesthesia education: SIMVANA with Peter Stallo.  

This show is coming out in early August of 2023.

First up: I want to give a quick heads up that our team from Maine Medical Center where I currently serve as chief CRNA will be at the American Association of Nurse Anesthesiology Annual Congress in a couple of weeks in Seattle.  If you’re headed to AANA’s Annual Congress this year, be sure to swing by the exhibit hall and check out the MaineHealth booth.  My friends & colleagues April Bourgoin, Cat Godfrey & Steve Breznyak will be there to tell you all about career opportunities at our level 1 trauma hospital, Maine Medical Center, and other MaineHealth hospitals.  We have everything from independent, CRNA-only practices to a high acuity level 1 trauma center within MaineHealth, so if you’re interested in finding out more about what life looks like in the upper right hand corner pocket of the US, come chat with us!  I believe Peter Stallo with SIMVANA – who we’re talking with today on the show – will also be at Annual Congress, so be sure to swing by and tell him you listened to this episode and see what SIMVANA is about in person!  

This show is very interesting for a couple of reasons:

  1. I’m stoked to talk with Peter Stallo.  Peter created Prodigy Anesthesia back in 2004.  This was probably the very first computer-based anesthesia educational & board preparation study tool.  Kids these days can’t imagine getting through anesthesia training without programs like this.  And Prodigy is what Kristin & I exclusively used to study for boards back in 2015… so I’m personally very grateful for Peter’s development of that program.  (side note… I have no financial ties with Peter, Prodigy or SIMVANA to disclose… this just pure gratitude I’m working with here).
  2. I’m also stoked about what we’re going to chat about.  Virtual reality simulation will likely become a central aspect of anesthesia training in the future.  As the technology becomes more widely available and the user experience further developed and refined, programs like SIMVANA will likely become ubiquitous… just like with Prodigy over the last 20 years.

I’m reminded of something Elon Musk stated in a documentary about SpaceX.  Now, I don’t know how you feel about Twitter becoming X & how Elon is reshaping that organization or many of his other decisions.  But I think we can agree on the fact that the man has created & lead some remarkable organizations built on tenacious visions of what’s possible for the future.  In this documentary on SpaceX, Elon talked about how progress isn’t inevitable.  Some people just assume that the future will be better… that space travel will become routine or that will we become a multi planetary species or that we’ll solve for global warming & climate change.  But these things won’t actually happen unless individuals first imagine that they’re possible and then 2) put the work in to bring them into fruition.  Elon is someone who has devoted himself into putting the work into creating paths to a better future.

Similarly, Peter Stallo is someone who didn’t stop progressing after he passed boards back in 2004.  I always say that boards is an amazing finish line & culmination of years of preparation & hard work.  We’re in that season again right now as anesthesia programs & residencies wrap up between May, June, July & August.  It’s awesome to watch trainees make that transition from graduation into clinical practice.  So while boards is a finish line of sorts, it’s also a starting line.  It’s when the start gun goes off for the rest of your career.  And back in 2004, just after Peter took boards, he got back to work.  With 2 master’s degrees in healthcare behind him, he set about creating Prodigy Anesthesia.  Then in 2014, he completed a Graduate Certificate in Orchestral Composition for Film and Games from Berkley College of Music… I didn’t even know there was just a thing.  And in 2018, he began developing a virtual reality anesthesia training program which would eventually become SIMVANA.  Peter picked up his third Master’s Degree – yes, his THIRD, in 2021 from the University of Alabama in healthcare simulation and is currently working towards completing a PhD in healthcare simulation from Massachusetts General Hospital Institute for Health Professions.  

What’s remarkable, is that Peter’s career has spanned the timeframe from when anesthesia boards was a pen & paper exam, through his development of one of the leading digital board preparation programs and now into the first virtual reality anesthesia simulation program.  Peter has embodied the very idea that Elon Musk talked about:  progress isn’t inevitable.  Having virtual reality as an available tool for anesthesia training – whether you’re in Cincinnati, Canberra or Cape Town – isn’t automatically going to be a thing.  Someone’s got to put the time in.  Or better yet, a team of someones, which Peter will talk about in this show.  

So with that, let’s get to the story… 

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Anesthesia Education Anesthesia Equipment and Technology Business/Finances Preparing for Grad School/Residency

#95 – Could ChatGPT be a CRNA?

Quick 5-Question Post Podcast Survey HERE

Today I’m joined by John Fratianni who created the content for this episode as part of his Doctorate in Nurse Anesthesia Practice at Virginia Commonwealth University in Richmond, Virginia.  John earned a Bachelor of Science in Nursing at the University of North Carolina at Chapel Hill, a Master of Science in Nursing at the University of Alaska Anchorage, and completed his critical care nursing training with the United States Air Force where he served 7 years on active duty. John conducted a study to determine if ChatGPT, an artificial intelligence (AI) program, can assist us in providing anesthesia care to our patients.  

I want to give a special shout out to Peter Stallo who founded Prodigy Anesthesia and SIMVANA, both of which are digital educational tools for anesthesia trainees. Peter worked closely with John to grant access to Prodigy’s vast database of board-style anesthesia questions. If you haven’t checked out Prodigy or SIMVANA – which is a virtual reality based anesthesia education platform, links are in the show notes. I also want to personally thank Peter for creating a great board prep program in Prodigy… it’s all my wife and I and several of our classmates used to study for boards and we passed on the first try. Nice job, Peter and thank you!

Since this episode is part of John’s doctoral work with Virginia Commonwealth University, he kindly requests that you take a quick survey that’s embedded in the show notes. It’s 5 questions and will literally take you 30 seconds… click the link and give John & me some feedback on how we did with this.

With that, let’s get to the show.  

Quick 5-Question Post Podcast Survey HERE

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#91 – Vantage Point for January 2023

What up yall. This is Jon Lowrance. I’m still here. 😂 We’re still here. This is the first episode of 2023 and the first episode on Anesthesia Guidebook since October – October!

I’m so glad to get back to the podcast and bring you this update. This is a re-cap of the last few months of my world. It’s also a reminder of what Anesthesia Guidebook is about and a look forward into 2023.

I’ve got some very exiting news to share… my wife is pregnant with our second baby boy, due in March, and I’ve also transitioned in my role at Maine Medical Center from the SRNA Clinical Coordinator and into the role of chief CRNA.

In this episode, I talk about that transition and a bit about the philosophy of organizational leadership that I have found to be most compelling that’s shaping my approach to supporting my team and will undoubtedly continue to influence the podcast.

Thank you to everyone who reached out in the last couple of months! Your check-in’s, DMs, podcast reviews and emails have been encouraging and much appreciated! I’m honored to share this space with you and to be part of your runs, Peloton rides, commutes, baby naps and all the other times you tune into Anesthesia Guidebook to stay sharp and get your learn on.

I want to share the link for the group that I have the opportunity to support as chief CRNA here: Maine Medical Center. Search for the CRNA positions in Portland, Maine. Come work with us… I hope to share more about our team and the why behind what we do a little later in the year. It’s a special place with an amazing team. Reach out and we can talk about it.

That said, I will always work to maintain a professional degree of separation between my place of employment and this podcast in terms of the information and opinions I share.  My views and opinions – and those of my guests – do not necessarily represent those of any of our employers.  With any medical education content, you should always consult with other healthcare experts, medical texts and peer-reviewed journals before acting upon anything you hear in a podcast or social media post. 

Take care and welcome to 2023! 

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Anesthesia Education Anesthesia Equipment and Technology Business/Finances Case Studies Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency Wellness

#89 – Distraction in the OR with Heather Turcotte, DO

What’s up y’all this is Jon Lowrance and this is episode 89 – Distraction in the OR with Heather Turcotte, DO. Y’all, I am so stoked to bring you this conversation… I caught up with Dr Turcotte earlier this summer as she was finishing her residency in anesthesia and I’m pumped to finally get this out to you in early September of 2022. This topic was the focus of her residency project and senior grand rounds presentation and it definitely created a stir in our group as CRNAs, physicians, residents & SRNAs grappled with how to appropriately use cell phones and other technology in their practices.

Since it’s late summer, early fall… I gotta give a shout out to all the residents & SRNAs out there who graduated this summer. It’s always fun to see yall wrap up clinicals & residency projects and transition into your new jobs or fellowships.

I love getting texts & photos from SRNAs of their board results with the word PASS printed in the middle of the page… It’s such an incredible moment that makes all of the hard work worth it. So thanks to all of you who have reached out by email, text & social media recently with your passing boards photos, positive reviews & ratings of the podcasts and questions. This podcast puts me in touch with so many amazing people… I’ve recently heard from experienced providers to newly minted CRNAs on the day they pass boards, to brand new CA1’s to ICU nurses who found the podcast and are on the path to becoming anesthesia providers. Wherever you are in your own journey, my hope is that Anesthesia Guidebook will be a go-to guide for you as you seek to get your learn on and master your craft.

Heather Turcotte, DO joins me in this is fascinating conversation that weaves through the considerations around using cell phones in the OR, checking email/internet, music that’s playing, conversations, door swings and other forms of distraction in the operating room.

Dr Turcotte was born and raised in the great state of Maine. She earned a doctorate in physical therapy and practiced as a physical therapist for 4 years before going back to medical school in 2014 at the University of New England. Dr Turcotte finished her residency in anesthesiology at Maine Medical Center in 2022 and entered into private practice. Outside of medicine, she enjoys spending time with her husband and 3 kids, who are 9, 6, and 1 years old at the time of this recording, going to the beach, and drinking lots of coffee!

In this conversation, Dr Turcotte brings this discussion to life with a case study where an anesthesia provider settled out of court in a dispute on negligence in a case where the patient experienced hypotension and a PEA arrest, survived the case but died a few days later. The anesthesia provider had used their cell phone and anesthesia station computer to check email and online news stories. Interestingly, an expert anesthesia witness testified that the actions of the anesthesia provider in managing the patient were flawless. But just because the provider had used their cell phone & surfed the internet on the work computer, the legal team advised they settle to avoid a jury verdict on the case.

Cell phone use, open internet access including email, music playing the OR and so many other forms of distraction are common elements in operating rooms across the United States. Some institutions create policies that limit cell phone use in the OR. Others have policies that are more vague while others have no formal policies around cell phone use in the OR. There’s legitimate considerations for each of these… On one hand, how does a hospital enforce a policy that is very strict? Does creating a policy set that institution up for compliance issues or litigation? On the other hand, how can hospitals help engineer safe and reliable environments for providers to work in? As technology continues to become more and more central t0 the work we do, the issues of attention span, distraction, user experience of technology and systems engineering to create & maintain safe environments will remain important factors for each provider, group and institution to consider.

References

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Anesthesia Education Business/Finances Clinical Tips Preparing for Grad School/Residency

#83 – Positive Deviance as a Catalyst for Change with Cherie Burke, DNP, CRNA

“Positive deviance is really about… taking those things that people are doing right and sharing them with everyone so that everyone is doing things to improve our patients’ care, our patients’ outcomes.” 

Cherie Burke, DNP, CRNA

Dr Cherie Burke joins me to unpack how positive deviance can be a catalyst for change in healthcare.

Positive deviance is all about looking for what’s going right and transferring those lessons to other opportunities, processes & providers to improve performance.

Aggressive action & investigation is the norm when something goes wrong. Think about when a sentinel event happens. There’s mandatory reporting, root cause analysis (RCAs), critical incident debriefs and a concerted effort to prevent errors & improve processes in the future. Positive deviance is a process of applying a similar degree of effort to what’s working right. Can we find the high performers, figure out what they’re doing well and transfer those techniques, processes & beliefs to other domains?

Cherie Burke, DNP, CRNA completed her Master of Science in Nursing at DeSales (duh-sales) University, her Doctorate in Nursing Practice at La Salle (la-sal) University, a post-doctoral fellowship in patient safety at the VA Medical Center in Philadelphia and is currently a PhD candidate at Duquesne (do-cane) University.

Dr Burke and I worked together at Maine Medical Center in Portland, Maine and have also taught alongside one another with Cornerstone Anesthesia Conferences. Cherie is actually who connected me with Jayme Rueter, the CRNA who founded Cornerstone and who gave me my first shot at teaching other CRNAs at continuing education conferences.

I think you’re going to enjoy this conversation… learning how to find positive deviance at play in our organizations is key for us to improve the work that we do.

This episode was originally released on From the Head of the Bed on January 26, 2016.

Resources: 

Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M. (2009). Research in action: using positive deviance to improve quality of health care. Implementation science, 4(1), 1-11.

Ford, K. (2013). Survey of syringe and needle safety among student registered nurse anesthetists: are we making any progress?. AANA journal, 81(1).

Gary, J. C. (2013). Exploring the concept and use of positive deviance in nursing. AJN The American Journal of Nursing, 113(8), 26-34.

Lawton, R., Taylor, N., Clay-Williams, R., & Braithwaite, J. (2014). Positive deviance: a different approach to achieving patient safety. BMJ quality & safety, 23(11), 880-883.

Prielipp, R. C., Magro, M., Morell, R. C., & Brull, S. J. (2010). The normalization of deviance: do we (un) knowingly accept doing the wrong thing?. Anesthesia & Analgesia, 110(5), 1499-1502.

Rosenberg, T. (2013, February 27).  When deviants do good.  The New York Times, Retrieved from http://opinionator.blogs.nytimes.com/2013/02/27/when-deviants-do-good/?_r=0

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#82 – How Change Management can Build Value with Randy Moore & Desirée Chappell

Randy Moore, DNP, MBA, CRNA and Desirée Chappell, MSNA, CRNA join me to talk about change management in healthcare. They are both on the leadership team with NorthStar Anesthesia, which provides perioperative services at over 200 facilities across 20 states.

This conversation focuses on how leaders can navigate change, develop culture and build successful anesthesia practices. We discuss the challenges facing anesthesia providers right now after 2 years of the COVID-19 pandemic and what market forces are at play including provider shortages, pressure from reduced reimbursement rates and lower surgical volumes. This episode will be relevant for any anesthesia provider who’s looking to build value in their career and especially relevant for those practice managers, owners, leaders & entrepreneurs who want – and need – to know how to navigate change, find sustainable & deliberate growth and develop cultures where providers want to invest their careers.

Desirée Chappell, MSNA, CRNA is the Vice President of Clinical Quality at NorthStar Anesthesia. Desirée has an extensive background in education and quality improvement in anesthesia. She is the managing editor & lead anchor of TopMedTalk, a podcast on anesthesia, critical care & perioperative medicine with nearly 1600 episodes. She is also adjunct faculty for the Acute Pain Management Fellowship at Middle Tennessee School of Anesthesia and serves on the board of directors for the American Society for Enhanced Recovery. Desirée received her Master of Science in Nurse Anesthesia from Texas Wesleyan University.

Desirée Chappell, MSN, CRNA, VP of Clinical Quality at NorthStar Anesthesia

Dr Randy Moore, DNP, CRNA, MBA is the Chief Anesthetist Officer at NorthStar Anesthesia. He recently left his role as the Chief Executive Officer of the American Association of Nurse Anesthesiology and has a long background in organizational leadership. He retired as a Major in the United States Army after 22 years where he served as an active duty CRNA with tours in Afghanistan at Forward Surgical Bases. His doctorate of nursing practice is from the University of Alabama, his MBA from Southern Illinois University and Master of Science in Nursing anesthesia from Bradley University.

Randy Moore, DNP, CRNA, MBA, Chief Anesthetist Officer at NorthStar Anesthesia

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#81 – How to Navigate the Business of Anesthesia with Tracy Young, MSNA, CRNA, MBA

I caught up with Tracy Young, CRNA, MBA & CEO of YPS Anesthesia Services in Houston back in November 2019 to talk about the business of anesthesia.

Tracy is one of the most sought-after experts on the business of anesthesia not just at CRNA conferences but throughout the healthcare management & business industry.

In this episode we discuss a broad range of topics including anesthesia billing & staffing models, trends in reimbursement, differences between W2 & 1099 work, advice for establishing your first anesthesia staffing contract, how to succeed both in your career as an anesthesia clinician and how to transition into the business of anesthesia, how to maintain balance & wellbeing over the course of your career and other key insights.

Tracy covers the origin and mission of his business, YPS Anesthesia Services, which at the time of this interview (8 December 2019) supports over 450 anesthesia providers to staff over 60 endoscopy & ambulatory surgery centers and hospitals across seven states in the United States.

Tracy Young, CRNA, MBA, CEO of YPS Anesthesia Services

Tracy Young earned his Master of Science in Anesthesia (MSNA) from Texas Wesleyan University in 2000, found YPS Anesthesia Services in 2003 and went on to earn a Master in Business Administration (MBA) from George Washington University in 2008.

Leading YPS Anesthesia Services for nearly 20 years has provided Tracy a wealth of first hand experience in the anesthesia and healthcare business world. He enjoys giving back to the anesthesia community through teaching on business related issues for SRNAs at several anesthesia programs and for CRNAs through private conferences across the United States. Tracy also enjoys developing venture capital opportunities with both businesses in and out of healthcare. Tracy has been a long-time active member of the Louisiana State Association of Nurse Anesthetists, serving 2-terms as the president of the association.

All of this experience, coupled with Tracy’s easy-going Louisiana style, makes him one of the most sought-after expert presenters on the business of anesthesia. His presentations on business related topics are really some of the best I’ve heard. The power behind his talks comes from his deep personal knowledge coupled with an ability to communicate the relevance of business topics to practicing clinicians, both those working in employed W2 settings and those working in 1099 practices. But it’s not just this deep knowledge and keen teaching ability that Tracy brings to his talks. Perhaps the most powerful aspect of his ability to communicate is his character & integrity and emphasis on professionalism as a key to success in business.

Tracy often talks about the 3 A’s of Anesthesia.

The Three A’s of Anesthesia:

Amicable + Affable + Available

He encourages providers to understand that you’re in the service industry and your clients are diverse: it’s not just the patients, but the surgeons, the OR nurses & techs, the hospital administration and other staff. You’re in a service-oriented industry and embracing a positive attitude (being amicable & affable) while being available and supporting the delivery of efficient, high quality anesthesia care are critical aspects of developing a successful anesthesia practice or business.

I’m so glad you’ve found this podcast… it’s just an amazing conversation and I think you’re really going to enjoy it.

If you want to hear more from Tracy Young, I’ve linked in the show notes to another interview he did on the business of anesthesia with podcast host Jason Duprat of the Healthcare Entrepreneur Academy.

I should also mention, if it’s not obvious already, that Tracy is always recruiting physician anesthesiologists & CRNAs to join one of his many clinical sites or expand into new contracts. So if you’re looking for a great team to join with competitive benefits & compensation and flexible work schedules, be sure to drop them a line on their website at YPSAnesthesia.com.

Quotable moments:

“Some days you’re the bug & some days you’re the windshield.” – Tracy Young

“Trust takes a long time to build – 6 months, a year, multiple years to build that trust – but it only takes 5 seconds to loose that trust by one bad decision.” – Tracy Young

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#80 – How to do 1099 Anesthesia Work with Sandry Gaillard, MSN, CRNA

What’s up yall, this is Jon Lowrance with Anesthesia Guidebook. This is episode 80 – how to do 1099 anesthesia work with Sandry Gaillard, MSN, CRNA. This is the second episode in a short series on the business of anesthesia. I’m gonna do a little run of interviews and topics on the business of anesthesia in the next few weeks. In the last episode you heard from Navin Goyal, MD & Saket Agrawal, CEO, both with OFFOR Health on how physician anesthesiologists can expand their careers beyond their clinical practice. In upcoming shows you’ll hear from Tracy Young of YPS Anesthesia in an episode covering lots of topics on the business of anesthesia and another episode with Randy Moore & Desirée Chappell of NorthStar Anesthesia on change management & leadership in anesthesia.

These conversations are incredibly valuable for anyone in anesthesia even if you have no interest in running your own business or becoming a practice manager or leader. These podcasts are relevant for every staff CRNA, physician anesthesiologist & anesthesia resident because they help you understand the contexts that we all work in. A mentor shared with me that there’s four pillars of anesthesia: your clinical practice, which everyone has at least initially in your career, education & research, advocacy work & the business of anesthesia. While you might anchor yourself solely in your clinical practice as your primary or even only professional interest, it’s helpful to have a basic understanding of the other domains – education & research, advocacy & policy and the business of healthcare – so that you can be a more informed provider and adept at navigating your career.

This episode was first released on 14 February 2015. At the time, Sandry Gaillard, MSN, CRNA was working as an independent CRNA in a 1099 practice in rural Western North Carolina.

This episode was released as part of the initial launch of From the Head of the Bed, the podcast that preceded Anesthesia Guidebook. It’s an interview between Kristin Lowrance (formerly Kristin Andrejco) who at the time was a SRNA at Western Carolina University. Kristin and I both worked with Sandry while we were SRNAs at WCU and Kristin invited her on the show to talk about the basic difference between working as a W2 employee and 1099 contractor, as well as some of the unique characteristics of working in a small, rural independent CRNA practice.

Sandry clearly outlines the key differences between working as a W2 employee and working as a 1099 independent contractor. Her and Kristin discuss the financial & business considerations including filing taxes, hiring an attorney & accountant, setting up a business structure and insurance considerations. They also discuss the personal leap it takes to transition from working as a W2 employee to 1099 work where you have to learn to manage you finances & certain aspects of your career in much greater detail. Sandry shares her story of making this transition and gives some wonderful encouragement for others who might be considering making the switch.

Beyond discussing the financial & business considerations of working as a 1099 independent contractor, they discuss the unique characteristics of working in a small, rural CRNA-only practice.

It’s important to recognize that you can work as a 1099 “independent contractor” while still working in a group or with an anesthesia care team or with a larger company, whether that is a larger CRNA-only or physician-only group or an anesthesia care team model that includes both CRNAs & physicians. Filing taxes as a 1099 doesn’t mean you work in a CRNA-only or physician-only group. It’s simply a different business structure for your professional life and means you’re not a W2 employee. Working as a 1099 contractor brings certain tax benefits – as well as additional financial responsibilities – that W2 employees don’t have.

The bottom line is there are lots of opportunities for setting your work life up depending on what your interests and goals are. Many people prefer the relative ease of working in a W2 setting where an employer offers a benefits & compensation package including health insurance, retirement and professional liability insurance as well as a lot of other administrative support. Others prefer the flexibility and tax advantages of working in a 1099 setting. Layered on top of each of these fundamentally different financial & tax arrangements is the decision around whether you work as an independent provider or as part of an anesthesia care team or group.

This episode unpacks all of these considerations and is a great place to start if you’re wondering about what kinds of career opportunities or business structures are available for CRNAs and physician anesthesiologists.

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#79 – The Future of Healthcare with Navin Goyal, MD & Saket Agrawal, CEO with OFFOR Health

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I’m really excited to bring you this episode on the future of healthcare with Dr Navin Goyal and Saket Agrawal of OFFOR Health.

This is episode 79 of anesthesia guidebook and it’s coming out on June 24, 2022.

This is one of the most interesting conversations I’ve had with contributors to this show.  Navin & Saket are here to discuss what the future looks like – or what it could look like – for physicians in healthcare.  They hit on something that’s not talked about very much in medical school or residency programs or every around the OR amongst your colleagues, which is “what more can you do” as a physician anesthesiologist?  What else is out there?  Graduating from medical school and completing your residency is really just the beginning – or as Navin puts it – fills one particular bucket in your career.  But there are other possibilities out there and now more than ever, he and Saket want to share with you how physicians can engage in new ventures and roles both in the healthcare sector and beyond as a way to leverage the value you bring as a highly trained clinician.

They unpack this story and create this invitation to look beyond your clinical practice through sharing the story of OFFOR Health and the path they’ve been on as business partners. 

So let me tell you a little about each of them and then we’ll get to it…

Navin Goyal, MD

Navin Goyal, MD is a physician anesthesiologist and a co-founder of SmileMD, a mobile anesthesiology startup that is aiming to change the accessibility of anesthesia to small practices. He is also a co-founder of Loud Capital, a venture capital firm that provides financial support to early-stage startups as well as value-added services such as business development and guidance in scaling sales operations.

Navin received his MD from the University of Cincinnati College of Medicine and trained in anesthesiology at the University of Chicago Medical Center.

Saket Agrawal 

Saket is the CEO of OFFOR Health, a company that brings access to specialists closer to home by partnering with local dentists and medical offices to deliver specialized care. Saket became CEO of OFFOR Health in 2016 after working for years in the technology space in Silicon Valley. 

Sakate graduated from The Ohio State University with training in computer science and engineering, earned his MBA in North Carolina, and worked in tech in San Francisco for nearly 10 years before SmileMD’s mission drew him back to Columbus.

So one of the contextual frameworks we worked off of in planning this discussion was physician anesthesiologist burnout.  Navin is going to share with you his own story of being over a decade into his clinical practice at a large academic medical center when he began to feel bored with the daily grind and started wondering what else was out there.  We talked before we recorded this about the MedScape 2022 Physician Burnout & Depression survey.  Now this is a survey I’ve been following for several years and sharing in my own talks at anesthesia conferences on wellness.  Each year, Medscape surveys around 13-15,000 physicians across 29 specialities and reports data on burnout, what contributes to burnout and how to mitigate it.  In their 2022 survey, they reported that 47% of physicians reported feeling burnt out last year.  

We certainly know the pandemic has created an incredible degree of stress on everyone’s lives – not just healthcare providers – and has served as a huge lever or catalyst for individuals across sectors to re-evaluate what they’re doing and why.  Physician anesthesiologists, along with CRNAs & other healthcare providers, are right in the middle of this cultural upheaval.  

And that’s another reason why I’m so pumped to bring you this talk.  Navin & Saket talk about what motivated them to create OFFOR Health and provide novel solutions – not only for patients in need – but for providers who are looking to shake things up in their own professional lives. 

You may remember back in episode 26 I spoke with Paul Samuels, a pediatric physician anesthesiologist about mobile pediatric dental anesthesia.  In that episode, he unpacked the nitty gritty of what SmileMD is all about – which an OFFOR Health company – along with the specific anesthesia considerations for practicing in mobile, pediatric dental settings.  Be sure to check that episode out if you want to hear a little more on SmileMD.

Stay tuned for lots of amazing things coming your way on the podcast… I’ve got several more shows on the business of anesthesia headed your way in the coming weeks along with one on the McLott Mix for opioid free anesthesia with Mr Jason McLott himself and ton of more content in the editing phase right now.  

As always, I’m stoked to hear from you.  Thank you so much for those of you who have reached out through email, Facebook, Instagram, Twitter – or even in person for all the SRNAs at the University of New England here in Portland, Maine.  

And with that, let’s get to the show!

Resources:

OFFOR Health

SmileMD

Anesthesia Guidebook episode on SmileMD: #26 – Mobile, pediatric dental anesthesia with Paul Samuels, MD

Physician Underdog, a book by Navin Goyal, MD

Beyond Physician – a professional development platform for physicians

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Anesthesia Education Business/Finances Personal Finances Preparing for Grad School/Residency

#77 – Thrive in Training: how to land your first job in anesthesia with Jon Bradstreet, MSN, CRNA

In this episode, I talk with Jon Bradstreet, MSN, CRNA who at the time of this recording was the chief CRNA/Director of CRNA Services at Maine Medical Center, Maine’s only level 1 trauma center. Jon was the chief CRNA who gave me my first job in anesthesia. At the time he hired my wife and I, in June of 2015, there were around 50 CRNAs in our group. Seven years later, our group has more than doubled in size with just over 100 CRNAs. Jon has overseen that growth and the development of an incredibly healthy culture within the anesthesia team at Maine Medical Center. We originally recorded this interview in December of 2015.

In this episode we talk about how to prepare for the job hunt as a SRNA… everything from what to look for in a job and how to weigh various pros & cons, how to prepare your resume or CV and how to ace the interview & follow up communications with a prospective employer. You’ve worked incredibly hard during anesthesia school to develop the skills & knowledge to become a competent provider; following through with a similar degree of proactive ownership to land your first job is key to making a successful transition into working as an anesthesia provider. This episode will tell how to do just that.

Key topics:

  • CV Preparation – what works and what’s fluff on your CV
  • When to and how to contact prospective employers
  • Tips for interviews including:
    • What chief CRNAs are looking for in your interview
    • Questions you should be asking in your interview
    • Things to consider doing and avoid doing in an interview
    • When to follow up on an interview
  • Tips for promoting yourself as a CRNA
  • Advice for how to prioritize important aspects of jobs including location, practice type, group culture, compensation packages and more
  • Advice for CRNA couples who are in the job hunt together

Parting words from Jon Bradstreet, MSN, CRNA:

“Have fun… we have a great profession and we have a great lifestyle.  We’re very lucky to do what we do for a living.  Always keep that in mind – how fortunate we are in this profession.  And then finally I think I would say listen to your gut.  It’s taken you very far in life already… don’t repress what it’s telling you as you’re in that interview.”

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Business/Finances Personal Finances Wellness

#73 – Midlife Van Life: reinventing work-life balance with Kyle & Jen Steen

This show is so much fun and launching this now coincides with the launch date of my friends’ journey, which you’ll hear all about in this episode.  

Kyle & Jen Steen have been friends of mine for the last 7 years.  Kyle’s been a CRNA for 13 years, Jen is a fashion designer and farm-to-table chef.  The short story is they built out a custom Sprinter van into a tiny home on wheels, sold pretty much everything they own, including their house, and hit the road this week on a mid-career van life adventure with no end date on the calendar.  Kyle is 41, Jen is 39.  They’re in the middle of their careers.  

Kyle Steen, MSN, CRNA, van builder, adventurer, husband to chef & creator Jen Steen.

In this episode we talk about the why behind their decision and the how – both financially and specifically: like what kind of van they built, how they paired down 25 years of accumulated stuff to the absolute bare necessities and what they hope to do while they’re on the road.

This is a long-form interview.  We take our time over the next hour to talk through their decision & dream.  I can remember talking with Kyle & Jen when they first hatched this plan and I’ve watched them pull this dream together over the last couple of years.  We did this interview from their van on the day before their epic road trip kicks off this week.  You can see photos of the van in the show notes to this episode, on Anesthesia Guidebook’s Instagram page or in the biggest and best way by following Kyle & Jen on Instagram @FrankvannSteen. 

It’s not every day you see a highly intelligent, socially well-connected couple quit their high income day jobs and hit the road full time in a tiny home van.  We talk in this episode about the American Dream and the accumulation of wealth, status & possessions.  What I love about Kyle & Jen’s story is that they kept seeing people embrace the mantra of delayed gratification all the way up to retirement and then hit walls:  walls like ailing health, limited physical ability, cancer, strokes or just the fear of change that security & stability can subtly bring to one’s life… and they didn’t want that.  They didn’t want to just keep contributing to retirement accounts and doing the same thing every day while the best years of their life passed them by.  So they’re doing something different.  They’re taking a break from their careers to travel & create an adventure and a life worth living.


I think it’s so interesting because many people who go into anesthesia get very used to the income and routine of their careers.  Kyle & Jen’s decision drops the gauntlet for the rest of us to re-evaluate our lives and the why behind our lifestyles.  Where do you really derive your sense of enjoyment from?  If money wasn’t an issue, what would you do with your time?  Are you able to get to the point, even for a short period of time like a month, 3 months or a year, where your financial situation would allow you to chase that dream? To do that thing that may right now already be fading from the front of your mind under the scrutiny of Common Sense, your Practicality or sense of “but what would people think?”  

And maybe it’s not about finding a bunch of days all strung together but the ability to drop down a day or two per week.  We work on average four 10-hour shifts at our hospital.  My wife just dropped a day and now only works three 10-hour shifts a week.  That extra day off each week has made a huge impact on her well being and satisfaction, especially because it gives her more time to spend with our little 9-month old munchkin.  We also both take around 10 weeks off a year.  We could certainly work more and make more money, but we value the time more than the money we would make.

I came across this idea years ago that “what’s not important will continue on without you.”  

Kyle’s decision to step away from full time anesthesia work to adventure with Jen came at the same time that a couple of our other CRNAs, physician anesthesiologists and even our lead administrative specialist, retired after long, long careers at one institution.  Those people will be missed and there was a lot of legitimate nostalgia shared when looking back over their careers.  But the patients keep coming, the department has hired replacement staff and the healthcare machine churns on.  

I’ve always been wary of the sense that CRNAs and physician anesthesiologists are just cogs in a giant healthcare wheel.  It can be de-personalizing, anonymizing and demoralizing.  When you think about the statement “what’s not important will continue on without you,” it’s a reminder that we have to actively build for purpose in our careers… 

Research shows* that if you can arrange for 20% of your time at work to be geared towards something you truly are intrinsically motivated for, it’s protective against burnout.

(*Swensen, S. J., & Shanafelt, T. (2017). An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety, 43(6), 308-313.)  

I wanted to share Kyle & Jen’s story with you as an opportunity for you to re-evaluate where you’re at, where you’re headed and whether you need to make changes so you can take a step in the direction of being more fully alive.  LOTS of people go into anesthesia because it’s an amazing field and a fascinating type of hands-on, brainy kind of work that can be very rewarding and a service to others, but also, because the income allows us to pursue other things in our lives.  This podcast is an invitation for you to re-calibrate your story.  I hope you enjoy it and what it does to you as much as I have! 

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Anesthesia Education Business/Finances

#66 – The CPC Assessment (Exam) Overview

This is run down specifically on NBCRNA’s Continued Professional Certification (CPC) Program Assessment (or Exam) for CRNAs.

Episode 64 was a 10-minute run down on the whole CPC Program – a quick overview. In episode 65, I did a whole hour-long deep dive on the program, including the CPC Assessment. This episode cuts out all the other content on the CPC Program and just focuses on the exam. This is the element of the CPC Program that causes the most anxiety for CRNAs so it’s worth doing a whole show on. I talk about the background of the exam, the layout & nature of the exam, the decision about taking in person at a Pearson Testing Center or at home on your own computer and tips for preparing (or not) for the exam.

In April of 2019, I interviewed John Preston, DNSc, CRNA, FNAP, APRN and Lisa Kamen, CAE of the NBCRNA on the CPC Program for the podcast From the Head of the Bed. At the time, Dr Preston was the Chief Credentialing Officer at NBCRNA; he is now the CEO of NBCRNA. Lisa Kamen is an association manager who supports the work of NBCRNA as a full time staff member. Several elements of the CPC Program have changed since 2019 so the last 3 episodes on Anesthesia Guidebook are all new.

Drop me an email or comment on Instagram/Facebook if you’ve got questions on the exam after listening to these 3 episodes. Links below for content from NBCRNA to help you naviaged the CPC Program along with the powerpoint outline I’ve used to present on the CPC Program at state & national conferences for CRNAs.

The CPC Program at a glance.

Check your progress in the CPC Program here: NCBRNA Website

More on the CPC Program:

NBCRNA CPC Program

CPC Program Overview: Lowrance 1-hour presentation PDFDownload

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Anesthesia Education Business/Finances

#65 – 1-hour CPC Program Overview

This is an all-new 1-hour overview of the NBCRNA’s Continued Professional Certification (CPC) Program for CRNAs.

In April of 2019, I interviewed John Preston, DNSc, CRNA, FNAP, APRN and Lisa Kamen, CAE of the NBCRNA on the CPC Program for the podcast From the Head of the Bed. At the time, Dr Preston was the Chief Credentialing Officer at NBCRNA; he is now the CEO of NBCRNA. Lisa Kamen is an association manager who supports the work of NBCRNA as a full time staff member. Instead of brining that episode forward to Anesthesia Guidebook, I’ve decided to complete re-write this update because the CPC Program has evolved even since 2019.

Episode 64 of Anesthesia Guidebook includes a brief 10-minute run down on the CPC Program that you can share with friends who just want a quick overview. I recorded the 1-hour run down first and then realized that there’s probably some CRNAs out there who just want a quick overview, so I hammered episode 64 int0 just over 10-minutes.

The CPC Program at a glance.

Check your progress in the CPC Program here: NCBRNA Website

More on the CPC Program:

NBCRNA CPC Program

CPC Program Overview: Lowrance 1-hour presentation PDFDownload

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Categories
Anesthesia Education Business/Finances

#64 – 10-minute CPC Program Overview

This is a short overview of the NBCRNA’s Continued Professional Certification (CPC) Program for CRNAs.

In April of 2019, I interviewed John Preston, DNSc, CRNA, FNAP, APRN and Lisa Kamen, CAE of the NBCRNA on the CPC Program for the podcast From the Head of the Bed. At the time, Dr Preston was the Chief Credentialing Officer at NBCRNA; he is now the CEO of NBCRNA. Lisa Kamen is an association manager who supports the work of NBCRNA as a full time staff member. Instead of brining that episode forward to Anesthesia Guidebook, I’ve decided to complete re-write this update because the CPC Program has evolved even since 2019.

Episode 65 of Anesthesia Guidebook includes an all-new 1-hour run down on the CPC Program. I actually recorded that show first and then realized that there’s probably some CRNAs out there who just want a quick overview, so I’ve hammered this episode out in just over 10-minutes. I covered the basics of the CPC Program but if you want to know more details, some back story on the program and more tips on crushing the CPC Assessment (exam), be sure to check out the next podcast!

The CPC Program at a glance.

Check your progress in the CPC Program here: NCBRNA Website

More on the CPC Program:

NBCRNA CPC Program

CPC Program Overview: Lowrance 1-hour presentation PDFDownload

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Categories
Anesthesia Education Business/Finances Preparing for Grad School/Residency

#63 – Anesthesia Billing Models with Ian Hewer, CRNA

Dr Ian Hewer is the program director of Western Carolina University’s Doctor of Nursing Practice in nurse anesthesia program.  At the time of this interview, Ian had been a CRNA for 20 years, was an assistant professor in WCU’s nurse anesthesia program, held two master’s degrees – one in sociology, the other in anesthesia – and was enrolled in his PhD program at the University of North Carolina-Charlotte.  His PhD is in Health Services Research and the focus of his dissertation was economics & billing practices in anesthesiology.

I originally recorded this interview with Ian back in February of 2015 when I was still a SRNA at WCU and Ian was one of my professors and clinical preceptors.

We discuss the differences in billing models such as medical direction, medical supervision and independent practice in the United States.  We talk about the Tax Equity and Fiscal Responsibility Act of 1982 and how TEFRA – again that’s the Tax Equity and Fiscal Responsibility Act – requirements influence reimbursement and anesthesia practices.  We go over opt out and what that means – how in nearly half of all states, CRNAs are not required to have supervision by any physician, podiatrist or dentist in order to bill directly for their services.  We discuss how market forces such as an evolving payor mix can influence decisions on billing models and practice structure for anesthesia groups, hospitals and individual providers.  We talk about the challenge of studying big data in establishing differences in quality outcomes between CRNAs and physician anesthesiologists. We also discuss the future of anesthesia economics and concrete steps healthcare organizations and providers can take to lower costs and maximize efficiency while maintaining high quality outcomes.

If you want the inside scoop on economics in anesthesiology, start with this podcast. 

I’ll also mention here that Western Carolina University is likely opening their bridge program for Master’s prepared CRNAs to obtain their DNP in the summer of 2022.  So if any of you master’s prepared CRNAs out there are looking for DNP programs, keep WCU on your radar.  

Resources:

Lewis SR, Nicholson A, Smith AF, Alderson P. Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010357. DOI: 10.1002/14651858.CD010357.pub2

Hewer, I. (2018). ANESTHESIA CARE TEAM TYPE AND HOSPITAL CHARACTERISTICS: ARE INCREASED LEVELS OF SUPERVISION ASSOCIATED WITH DIFFERENT ACUITIES AND OUTCOMES?. (Thesis). University of North Carolina at Charlotte. Retrieved from https://repository.charlotte.edu/islandora/object/etd%3A1088 

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Anesthesia Education Business/Finances Personal Finances Preparing for Grad School/Residency

#60 – Kate Balzano-Cowan Paid Off >$100k Debt in a Year

All right y’all, you’re about to hear from Kate Balzano and how she paid off over $100,000 in student loan debt in a year.

There’s three reasons I wanted to bring Kate’s story to you:

The first is that Kate is all around an amazing human.  I have the privilege of working with her on a regular basis and get to see her passion for anesthesia, the balance she brings to her life and her interest in training SRNAs as a top notch clinical preceptor. 

The second is that Kate and her husband paid off close to $140,000 of student loan debt in just about a year after she passed boards as a CRNA.  She’s gonna unpack the why and how behind that decision in this podcast.

And the last is that she is a rare human in that she wholeheartedly believes that anesthesia training was actually easier having 2 young children than what she imagines it would have been prior to having kids.  You heard that right.  Kate thought it was easier to do anesthesia school as a mother WITH kids than without them.  She’ll explain why during this show.

Kate Balzano-Cowan, MSN, CRNA currently practices anesthesia as a CRNA in the Department of Anesthesiology and Perioperative Medicine at Maine Medical Center in Portland, Maine.  Prior to nursing, Kate was an organic chemist with research and management experience in both industrial as well as pharmaceutical research labs.  Kate has earned a Master’s of Science in Nurse Anesthesia from the University of New England, a Bachelor’s of Science in Nursing from the University of Massachusetts, and an American Chemical Society certified Bachelor’s of Science in Chemistry with a minor in Biology from Northeastern University.

If you’ve been following Anesthesia Guidebook, you know that I started a podcast called From the Head of the Bed back in 2015 and having been pulling some of those episodes over to Anesthesia Guidebook before phasing out the old show.  This is one of my favorite conversations and Kate and I released this back in October of 2019.  Bringing this forward to Anesthesia Guidebook here at the end of December in 2021 is super special because just last week I made my final payment on my own student loans.  While I was nowhere close to Kate’s 1-year pay off timeline, I can’t tell you how good it feels to pay back all $197,000 of my student loans in 6 years and 6 months.  That’s an average of $2700 a month for 6 & half years.  And I’m am stoked to be done with those loans.  When I got out of anesthesia school, I had 17 different student loans and opted to consolidate all those bad boys down to one behemoth monster.  Doing that brought my overall interest rate way down and just made my repayment plan more manageable… I only had to make one payment.  I also signed on with a group who happened to have a rolling student loan repayment program that didn’t phase out after a 3-year sign on bonus or specific amount like many groups.

It hasn’t really sunk in yet that I’m done paying off almost $200,000 in student loans.  I’m 38 years old and I’ve been in debt with student loans for 20 years, over half my lifetime.  While my payoff time of 6 & 1/2 years after graduation can certainly be classified as aggressive, Kate’s is otherworldly.  Another colleague we work with had over $200k in student loans and got hers paid off in right around 4 years.  That’s super aggressive and I saw her put in the hard work of delayed gratification and working epic amounts of overtime for those four years.

While I’m going to talk more about finances and why you shouldn’t do anesthesia for the money in the future on the podcast, I want to just say right here that Kate’s story and my story and that of so many other CRNAs who pay their loans off quickly and move forward towards their financial goals are testament that you can do it, too.  As Kate says in this show, where there’s a will there’s a way… anesthesia school can seem daunting, especially now with it shifting to a doctoral degree for entry to practice for CRNAs.  But it’s worth it.  It’s totally worth the financial hardship you’ll endure up front.  The pay off is totally worth it.  You’ll be able to handle your student loans in stride and have more than enough to be well and happy! 

Check out the links below to think more about student loan debt.

Death, Sex & Money podcast series on student loan debt.

Take the Quiz… see where you line up on WNYC’s Death, Sex & Money student loan project quiz.

Beyond the Mask with Jermey Stanley:  Episode 23 – The Wealthy CRNA. Get tips on financial management specific to CRNAs in the above podcast and through Jeremy’s company: CRNA Financial Planning. Cycle back to Episode 18 of this show to hear Jeremy talk through freelancing options for CRNAs.

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Anesthesia Education Business/Finances Preparing for Grad School/Residency Wellness

#59 – How to Achieve Your Goals

This is episode 59 – How To Achieve Your Goals.  This is one of my favorite episodes and the content here is something that I come back to again and again.  I’ve listened to it probably 5 or 6 times since I first released it and every time I come back to this, I leave with refreshed clarity around what’s important and a renewed sense of how to move forward.

This episode was first released in January 2020 on From the Head of the Bed – the podcast that was the podcast before Anesthesia Guidebook.  You know, the thing we did before we did this thing.  Cause there’s always a thing before the thing.  Or the thing behind the thing.  There’s evolutions to what we do.  Chapters.  Seasons.  Change and growth and movement.  I talked about that a bit on the last episode about the rhythms in your life…

This episode is a follow up to that.  The last episode was really about how to rest and carve out time to restore your energy and clear you mind.  This one is about how to set a trajectory in your life and do the work to achieve your goals.  

Transcript: #59 How to Achieve Your GoalsDownload

References

Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt.

Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc.. 

Dalio, R. (2018). Principles. Simon and Schuster. 

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Anesthesia Education Business/Finances Preparing for Grad School/Residency Wellness

#50 – Parenting during Anesthesia Training with Lien & Nate Woodin

I’m joined today by Nate & Lien Woodin who are married and the parents of two boys – aged 6 & 9 as this show comes out on the first of October 2021.

If you’re a critical care nurse, medical student, resident or SRNA – or a spouse or partner to one of these folks – and you’re wondering how to hold it together as a parent & partner during anesthesia training or even if it’s possible for you to go back to anesthesia school – this podcast is for you! 

We don’t hit a list of bullet points on this one.  There’s no simple how-to here.  Instead, we walk through Lien & Nate’s story and in it you’ll find some incredible insights of how they prepared for anesthesia school, parented during anesthesia school and stuck together as a couple all the way through.  

Lien just wrapped up her Master’s of Nursing in Anesthesia at the University of New England a couple of weeks ago and decided to go back to school after working as a nurse for 20 years – 17 of which were as a critical care nurse in a cardiothoracic intensive care unit.  Nate is a Licensed Marriage and Family Therapist who focuses his practice on child & adolescent therapy.  He completed his Bachelor of Arts in Psychology at the University of New Hampshire in 2000 and his Master’s of Arts in Marital & Family Therapy from the University of San Diego in 2007.  He completed a post-master’s Certificate of Studies in Play Therapy in 2009 from the University of California, San Diego.  

Lien worked as a critical care Registered Nurse at Maine Medical Center and came back to train for a couple of months with the anesthesia team at Maine Med, where I work as the SRNA Clinical Coordinator.  We got to spend a few days in the OR together and that’s where I first heard snippets of her story.  When she talked about how hard it was to make the decision to go back to school after working as an ICU nurse for 20 years, how her & Nate have a son with PANDAS which encompasses a set of neuropsychiatric disorders and how Nate is a child & family therapist who Lien always bragged about as being such a huge support to her as a SRNA and their boys, I knew I wanted to get them on the podcast and hear more about their story.  And it’s a remarkable story.  I think you’ll really enjoy hearing it.  

A couple other things before we get to the show… 

Lien was in the same class as Robert Montague.  You may remember Robert and his wife Jenny from episode 15 titled “Significant Others and Anesthesia School.”  That episode came out in December of 2020.  Robert also just successfully passed boards and became a CRNA along with Lien.  He and Jenny are doing well and are also enjoying life after anesthesia school.  I think both this and that podcast would be key shows to listen to if you’re considering going back to anesthesia school as parents – or if you’re in an anesthesia program or residency now and need a little encouragement to keep going and find ways to make it work.  They’re great shows for you and your partners.

There’s never really a good time to go to anesthesia school and having a significant other and kids can make the process very challenging.  And while both of these families have found ways to thrive during their programs, others are frankly not.  For, I think the first time ever on the podcast, in this episode, I talk a little about my own path in anesthesia school which involved going through a divorce in the fist six months as well as meeting my wife in the program who I now share a life with along with our 3-month old son and how helpful marriage therapy has been for both of us.

I know other SRNAs who are either in or have gone through extremely challenging family situations including the loss of a child, or a partner, severe illnesses, trauma & surgery, ugly divorces, restraining orders, physical & emotional abuse and more.  For those of you out there who are struggling I want you to know that you’re not alone and that help is available.  The AANA has a wealth of resources available that I’ll link to in the show notes.  There’s also a free 24-hour Crisis Text Line if you need support right now… you can text anything to the number 741741 and a trained counselor will reach out with support over text.   You can also find support at your university or hospital through wellness committees and student or employee health services… there are usually always free, confidential counseling & therapy resources available.  Don’t struggle alone.  Reach out to one of these resources.  Get help.  It’s a very human thing to do.  

And hopefully you’ll find a little hope & encouragement through Lien & Nate’s story…

Resources:

AANA SRNA Wellness

Crisis Text Line text “hello” or “help” or whatever to 741741 and a trained counselor will respond. It’s free and it’s over text.

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Anesthesia Education Business/Finances Personal Finances Wellness

#39 – The 5 Keys to Achieving Financial Independence with Shane Garner, MS, CRNA, NSPM-C

In this episode you’re going to hear from Shane Garner, MS, CRNA, NSPM-C on the 5 Keys for Achieving Financial Independence.  This show was originally released in April of 2020 on From the Head of the Bed and I’m pulling it forward to Anesthesia Guidebook on August 30, 2021.  

I’m pumped Shane brought this intel to the podcast… anesthesia providers are high income earners but it’s rare to see any formal training on financial literacy as part of core medical & nursing education or during anesthesia training programs.  CRNAs & physician anesthesiologists get out and make great money but often fail to apply basic financial principals like living below your means, becoming debt free and saving & investing for the future.  It sounds like boring stuff but these are some of the keys that will create freedom and peace of mind for your future.  If you apply a fraction of what you’ll hear in the next 30 minutes, you’ll set yourself on a trajectory you can truly be stoked about and you’ll thank yourself down the road.  You owe it to your future self to check this episode out and apply what you hear.

The 5 Keys to Financial Independence are 1. Set goals to live below your means. 2. Pay yourself first. 3. Avoid debt. 4. Invest in low cost index funds. 5. Educate yourself.

Shane Garner is a CRNA who works in Ripon, Wisconsin and is passionate about teaching anesthesia providers on personal finance as well as regional anesthesia.  He has a Bachelor of Science in Nursing from the University of Minnesota and graduated from Rosalind Franklin University with his Master of Science in Nurse Anesthesia in 2012.  He went on to complete a fellowship in Advanced Pain Management at the University of South Florida before becoming board certified in Nonsurgical Pain Management through the NBCRNA. Shane is an adjunct faculty member at the University of Alabama at Birmingham’s nurse anesthesia program and regularly instructs with Twin Oaks Anesthesia & Cornerstone Anesthesia Conferences.  

Shane Garner, MS, CRNA, NSPM-C

Resources

The White Coat Investor

The Bogleheads‘ Guide to Investing (book)

The Simple Path to Wealth (book)

The Millionaire Next Door (book)

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Anesthesia Education Business/Finances Clinical Tips Preparing for Grad School/Residency

#38 – The Master Anesthesia app with Matthew Willis, DNP, CRNA

Dr Matthew Willis is the CRNA who created and produces the educational app Master Anesthesia, which is available from the App Store and Google Play Store.  

I’ve been using this app for the last several months and I’m super impressed at a few things:

  1. it’s packed with real-world information that’s evidence based from case tips to pharmacology
  2. the calculator is amazing… it’s so easy to use and gives you all the information you really need super fast.. more on that in just a sec
  3. Matthew has made crowd-sourcing the continued build of the app super easy… he’s looking for people to contribute so the quality and scope of the app will continue to improve as more people make contributions.  It’s like a curated wikipedia app focused specifically on anesthesia content.  And you get recognition in the app for your contributions. 

And lastly, the app is 100% free!  My other go-to anesthesia app cost me $100 and it only gives me half the information Master Anesthesia does.  I’d have to pay another $100 for access to the coexisting disease information.   

I can’t say enough about how significant it is that Matthew has kept this app completely free for the anesthesia community and he continues to dump an incredible amount of personal time building it despite having a full time job and a family.  The Master Anesthesia app is quintessential free open access medical education or FOAM… a concept I recently talked about on the podcast in episode #34.  FOAM removes pay walls and financial barriers so healthcare providers – and importantly students and residents – can access leading content for free. 

For the first 30 minutes of the discussion, we unpack the app and its features and in the back half of the interview, Matthew discusses how he started the app as his DNP project and what fuels his motivation now.

So the app features a run down on common surgeries, pathologic conditions, anesthesia-related drugs and a super high-powered calculator.  This calculator is unlike anything I’ve seen; it really is unique.  It tells you everything from common vital signs, airway device sizing, tidal volumes, drug & fluid calculations and local anesthetic dosing all based on the weight and/or height of your patient.  The local anesthetics dosing also does combined medication dosing so you can rapidly see the remaining maximum dose amounts and volumes based on what’s already been given for any concentration of local you plan to give.  It’s amazing… if you only get the app to use the calculator, it would be worth your time & effort.

Matthew Willis, DNP, CRNA has a background in finance, web and mobile design.  He received his undergraduate degree in nursing from Boise State University in 2014 and completed his doctor of nursing practice and anesthesia training at the Louisiana State University Health Sciences Center in 2019.  He currently works as an independent anesthesia provider in Iowa and has a wife and 4 children.  

I reached out to Matthew after I made suggestion on content within the app and he graciously agreed to come on Anesthesia Guidebook to share his story.  Again, Matthew currently is not making any revenue off Master Anesthesia and I have no financial connection with Matthew or this app… this episode is just good ole’ storytelling with no conflicts of interest. 

App Store Link: 

https://apps.apple.com/app/id1550793078#?platform=iphone

Google Play Link:

https://play.google.com/store/apps/details?id=com.masteranesthesia

Website Link:

Landing Page

Facebook Group Link: 

https://www.facebook.com/groups/masteranesthesia

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Anesthesia Education Business/Finances Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency Wellness

#37 – Emotional Intelligence of SRNAs with Shawn Collins, DNP, PhD, CRNA

This episode is coming out on August 21, 2021 but it FIRST came out way back on September 19, 2015.  

The show is on emotional intelligence of SRNAs with Dr Shawn Collins, DNP, PhD, CRNA.

At the time of the interview, Dr Shawn Collins was the nurse anesthesia program director and the interim dean of the College of Health & Human Sciences at Western Carolina University (WCU).  I was super early in developing the podcast From the Head of the Bed and was actually still a SRNA at WCU even though the show was published after I graduated.  In the show, Dr Collins will walk us through what emotional intelligence is and how, if harnessed, can impact your work as an anesthesia trainee and provider.  

I think emotional intelligence is central to human behavior, relationships and success in whatever you’re doing… it’s about how we relate to one another.  I love how Dr Collins talks about getting a bird’s eye view of any situation you’re in and reading the emotional state of the other people around you.  Exercising emotional intelligence is often about learning how to walk through your life with this third-person view point of the situations you’re in.  It’s about understanding where other people are at, where they’re coming from, what their biases & goals might be and adapting your interaction with them to get you both – or a whole team of people – moving in the direction you want.  It’s thinking about: who is this person, where are they coming from, what might their hopes, dreams, fears or concerns be right now, how do they perceive me, who do they think I am – who am I FOR REAL – where am I headed, what are my goals and how can I tailor my interaction with this individual, in the context of all this, to get us both moving where we need to go.  This is every day stuff for anesthesia providers.  Emotional intelligence, when harnessed, will make your interactions with patients so much better and more meaningful.  It’ll help you deal with surgeons, OR nurses, CSTs, hospital administrators, preceptors, your boss, your trainees & students with greater skill & efficacy.  Emotional intelligence is like a key that unlocks an incredibly powerful, supercharged tool in relationships and it will help create success for you in whatever stage of your career or, for that matter you marriage or dating relationships or business partnerships, that you’re in.  

Dr Collins completed his master’s in anesthesia at Erlanger Medical Center at the University of Tennessee Chattanooga, his doctor of nursing practice degree at Rush and his PhD in leadership at Andrew’s University.  

Dr Collins is currently the associate dean for academic affairs and graduate studies for Loma Linda University’s School of Nursing, where he supports 2 master’s programs, a PhD program and 8 clinical doctorates. 

He was the program director when I attended WCU and was instrumental in helping my classmates and I launch the podcast From the Head of the Bed, serving as our project chair and one of the co-authors of the paper we published on social media in nurse anesthesia education in the AANA Journal.  Without him giving us a huge GREEN LIGHT and a lot of support & guidance along the way, From the Head of the Bed, and therefore this podcast would not exist… 

And with that, let’s get to the show…. 

Resources

Collins S. Emotional Intelligence as a Noncognitive Factor in Student Registered Nurse Anesthetists. AANA Journal [serial online]. December 2013;81(6):465-472. Available from: Academic Search Complete, Ipswich, MA. Accessed September 19, 2015.

Collins S, Andrejco K. A longitudinal study of emotional intelligence in graduate nurse anesthesia students. Asia Pac J Oncol Nurs [serial online] 2015 [cited 2015 Sep 19];2:56-62. Available from: http://www.apjon.org/text.asp?2015/2/2/56/157566

Kristin Andrejco was a co-author, along with Dr Collins, of the above study published in the Asia Pacific Journal of Oncology Nursing. She helped create From the Head of the Bed and still exerts a bit of influence on Anesthesia Guidebook under her new name.

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Anesthesia Education Business/Finances Preparing for Grad School/Residency

#36 – DNP: The Future of CRNA Education with Shawn Collins, DNP, PhD, CRNA

This episode originally appeared on the podcast From the Head of the Bed on August 6, 2015. It’s re-released here on August 17, 2021. Dr Shawn Collins, DNP, PhD, CRNA and I discuss the transition from Master’s level training for CRNAs to practice doctorates, most commonly the Doctor of Nursing Practice degree or DNP.  

Every CRNA program must transition to the doctorate level for new classes by January 1, 2022, with every SRNA graduating from doctorate level training by 2025.  Most of the 124 CRNA programs in the US have already transitioned to doctorate degrees, with some having done so more than a decade ago.  Dr Collins and I discuss why CRNA training transitioned from the master’s level to the doctoral level and what this means for education, clinical practice and business.  

Beginning the fall of 2019, the Council on Accreditation of Nurse Anesthesia Educational Programs, which sets the standards for university programs, began revising those standards based upon recommendations from a “Full Scope of Practice Competency Task Force.”  The COA updated several standards and requirements of CRNA doctorate programs including increasing the number of required anesthesia cases, mandating specific training in the use of point of care ultrasound for diagnosis and therapeutic interventions, 12-lead ECG interpretation, radiology & flouroscopy use, chest X-ray interpretation and more.  You can read about these changes and the specific requirements for CRNA doctoral programs at the COA’s website.

At the time of the interview, Dr Shawn Collins was the nurse anesthesia program director at Western Carolina University and the interim dean of the College of Health & Human Sciences.  

He was the program director when I attended WCU and was a huge source of encouragement and support to me personally as I ran the gauntlet of anesthesia training.  He was also instrumental in helping my classmates and I launch the podcast From the Head of the Bed, serving as our project chair and one of the co-authors of the paper we published on social media in nurse anesthesia education in the AANA Journal. 

Dr Collins has obtained both his doctor of nursing practice degree and his PhD and compares these degrees, along with other types of doctoral programs, in this podcast.

He was instrumental in developing the DNP program at WCU, transitioning the master’s-level nurse anesthesia program to a practice doctorate.  Dr Collins is currently the associate dean for academic affairs and graduate studies for Loma Linda University’s School of Nursing, where he supports 2 master’s programs, a PhD program and 8 clinical doctorates. 

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Anesthesia Education Business/Finances

#35 – Asynchronous learning and the future of anesthesia education

This podcast follows up on the previous show which discussed free open access medical education (FOAM) and the use of social media in anesthesia education. Here, I discuss the power of asynchronous learning to shape the future of anesthesia education.

The power of asynchronous learning comes from the ability of content experts to produce something truly informative and engaging once and then make that widely available to learners over a prolonged span of time. 

The opportunity, the chance, the potential of asynchronous learning is to harness the best educators and minds to create engaging content to help raise the level of expertise of providers while reducing the upfront workload and cost of producing that content.  

Asynchronous learning challenges traditional paradigms of education. It brings up numerous questions for us to consider…

Why does every university need to have an expert in pharmacology on campus to deliver semester-long courses on anesthesia pharmacology year after year? 

Why do universities struggle to find and retain content experts when they could harness the power of asynchronous education to share a library of the best resources for cheaper tuition?

Why do universities, who charge astronomical tuition fees, then require their students to purchase third-party board preparation programs?  Shouldn’t the tens of thousands or even hundreds of thousands of dollars in tuition be enough to get students successfully over the hurdle of boards?

Why are continuing education conferences so boring and expensive? 

Why do continuing education conferences rarely improve clinical skills or change practice? 

Why are thousands of grand rounds presentations given every year across the US and only a very select few individuals who happen to show up hear what leading experts are saying?

Why does it take on average 17 years for new evidence to find its way into widespread practice?

Why do we too often put profits ahead of advancing our field and improving access to patient care?

We have the opportunity to redesign the way we do education in the future.  Harnessing technology to maximize the benefit of asynchronous learning can reduce costs and likely make education more efficient and effective.

Some of you are today’s thought leaders and content creators.  Some of you will be the content creators, professors, educators and clinical experts of the future.  How will you step into those roles?  How will you harness the technology available to us to create more compelling, more interesting and effective learning tools?

These are the questions that will help us redefine what is possible in the way we train anesthesia providers and build better continuing education.

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Anesthesia Education Business/Finances Preparing for Grad School/Residency

#34 – FOAM and social media in anesthesia education

Free open access medical education – or FOAM – is any medical educational content that’s shared freely on open access platforms, meaning the public can consume it without having to be a member of an organization or pay a subscription fee.  The reason it’s significant is that it brings evolving science & literature – and discussions around the art & science of medicine – into the hands of providers without the traditional paywalls that trade associations or peer-reviewed journals put up between you & their content in order to fund their work.  FOAM is all about the accessibility of information and given the rapid pace at which medical information evolves and podcasts, blogs & online journals can be updated, FOAM helps shape conversations around what’s happening right now in healthcare.  

It’s been said if you want to know the state of the literature 5-7 years ago, read the latest edition of any textbook.  If you want to know what was going on 2-3 years ago, read the print journal that just came to your mailbox.  And if you want to know what’s happening and changing right now, get on social media. 

In this episode, I discuss the history of FOAM and talk through the influence of social media in anesthesia education. We take a look at the incentives that shape the behavior of content producers in the social media world and look at ways of harnessing FOAM and social media platforms to leverage these tools for the greatest impact.

Resources:

Andrejco, K. (2017). Social Media in Nurse Anesthesia: A Model of a Reproducible Educational Podcast. AANA journal, 85(1).  Retrieved from https://www.aana.com/docs/default-source/aana-journal-web-documents-1/social-media-0217-pp10-16.pdf?sfvrsn=89cd48b1_6 

Chan, T. M., Stehman, C., Gottlieb, M., & Thoma, B. (2020). A short history of free open access medical education. the past, present, and future. ATS scholar, 1(2), 87-100. https://www.atsjournals.org/doi/pdf/10.34197/ats-scholar.2020-0014PS 

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Anesthesia Education Business/Finances Personal Finances Preparing for Grad School/Residency Wellness

#30 – The mid-to-late career phase with Cindy Farina, DNP, CRNA

In this episode Dr Cynthia Farina and I talk about the mid-to-late phase of your career as a CRNA.  Every stage of your career has unique challenges & opportunities. There’s so much attention focused on getting into CRNA school, the SRNA/resident/training phase and becoming a new CRNA… this conversation is for the part of your career farther down the road.

Dr Farina is a CRNA from Michigan whom, at the time of this recording (December 2019), served as the chair of the American Association of Nurse Anesthetists’ (AANA) Health and Wellness Committee and the Michigan Association of Nurse Anesthetists Wellness Committee.

Dr Farina completed her Bachelor of Science in Nursing at the University of Michigan, Ann Arbor and then her Master of Science in Nursing in the anesthesia track from Oakland University in 1996.  She then returned to the University of Michigan to complete her Doctor of Nursing Practice degree.

Cindy practiced full-time at a large suburban teaching hospital, where she also served as a clinical and didactic instructor in the Oakland University-Beaumont Graduate Program of Nurse Anesthesia. 

Cindy has a strong interest in creating and sharing educational material on personal and workplace wellness for CRNAs and SRNAs. In her most recent work, she has explored the topic of career phases and transitions for nurse anesthetists.

You may contact Cynthia Farina, DNP, CRNA, CNE at: cindy.farina@icloud.com or via her LinkedIn profile at www.linkedin.com/in/cynthiafarina

AANA Thrive: Resources for Career Stages

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Business/Finances Clinical Tips Personal Finances Preparing for Grad School/Residency Wellness

#29 – On Retirement with Eric Carlson, CRNA

I caught back up with Eric Carlson, CRNA to discuss his recent retirement and advice he has for anesthesia providers still in the thick of it. Eric was interviewed by Kristin Lowrance, MSN, CRNA way back in 2015 for our podcast “From the Head of the Bed.” We just re-released that podcast as #28 – Can’t Intubate, Can’t Oxygenate (CICO) during stat C-section: a case study with Eric Carlson, CRNA on Anesthesia Guidebook. If you haven’t listened to it, it’s a harrowing story of how he managed this incredibly difficult airway and situation.  

I wanted to catch back up with Eric following his retirement and today you’ll hear us reflect back on that podcast he & Kristin did several years ago.  I was surprised by what he had to say about it.  

We also take a look back on Eric’s career… what influenced his decision to go into anesthesia, how to look for your first job in anesthesia and what influences where you work throughout your career.  Eric spent most of his career in a tertiary care facility with over 800 inpatient beds and 50 operating rooms.  We touch on how challenging it can be to keep pace with a very demanding practice setting and walk through an article by Judy Thompson published in the AANA Journal in late 2020 titled “the certified registered nurse anesthetist as a late career practitioner” that looks at whether anesthesia providers should have mandatory retirement ages or cognitive testing as part of recredentialing. The link to that article is here:

Thompson, Judy. (2020).  The certified registered nurse anesthetist as a late career practitioner.  AANA Journal. Retrieved from: https://www.aana.com/docs/default-source/aana-journal-web-documents-1/thompson-r.pdf?sfvrsn=ea716ae2_4 

We also talk about how Eric planned financially for retirement and tips for practicing anesthesia providers on how to get there.  You’ll hear him discuss the last case he ever did and what it’s been like to step over to the other side… beyond the OR and into retirement.

Eric served as a preceptor for Kristin and me during our anesthesia training at Western Carolina University and we were always impressed with the depth of his knowledge, the sense of being anchored & unflappable that comes from deep competence, his willingness to teach and kindness as a preceptor.  Eric is a remarkable human being and I think you’ll really enjoy hearing from him as we look back over his career and the advice he’d give to folks who are still in the thick of it.

This podcast is absolutely relevant for SRNAs or anesthesia residents.  It can be profoundly helpful to hear from someone who is way down the road when you’re just getting started.  It’s like seeking out the village elder when you’re preparing to begin your own journey & adventure.  Listen to his stories.  Hear this wisdom in his voice.  

The following interview was posted by the North Carolina Association of Nurse Anesthetists in an email on 15 May 2015 to members titled “Spotlight on CRNAs” where a North Carolina CRNA is introduced at greater depth to the membership.  Of note, Eric was interviewed by Dustin Degman, CRNA, who has also contributed to our podcast in the Combat Trauma Anesthesia series.  In the interview, Dustin talks with Eric about his experience with the difficult airway case that he speaks to in the show featured on this page.  This interview is posted with the permission of the NCANA.

Eric Carlson, CRNA

Interviewed by Dustin Degman, CRNA

You were recently on the podcast “From the Head of the Bed” where you explained a case that, I guess you could say, changed the way you practice today. You got to give your history, the beginning of the scenario, and there was a moment that you said “I had a difficult airway case”. I must tell you that I was completely locked-in at that moment. Nothing was going to distract me from listening to the next 25 minutes. What I want to ask is, what about that event changed you most, either as a person or in practice?

This is a challenging question to answer. I am sure the event changed me both as a person and a CRNA practitioner. At the time of the event, I was very early in my career and riding high in self confidence. The event changed my level of confidence and reinforced the significance of the risks we take as CRNAs performing our job every day. I had to actively work on rebuilding my confidence over the ensuing months, slowly, I was able to regain some of the loss, but for better or for worse, I probably did not get back to the level I had been. In the long run, I think it made me a better CRNA because I realized that bad things can occur in our line of work at any time and you always need to have a back-up plan in mind. Be prepared for the unexpected. As a person, the event may have made me a more humble individual and helped me realize that we are all susceptible to very challenging occurrences in our profession.

People, who know you, know that you are a wonderful provider. Your patients, colleagues, and the students really look up to you. Is there something you would like to share about being a great mentor?

I appreciate the feedback and compliment. I consider myself very fortunate to have made the decision to become a CRNA more than 30 years ago. We all have many forks in the road when we have to make a choice that could affect the rest of our lives. When I had been a nurse for five years, I began to consider what specialty I may want to pursue to fulfill my desire to have a career pathway I may enjoy for the long term versus bouncing from one subspecialty to another. As an ED nurse at a teaching hospital, I was exposed to CRNAs both directly helping out in difficult cases, and assisting/teaching new Anesthesiologist residents with different tasks in the ED. These episodes spurred my interest so I talked to the Chief CRNA and learned more about the profession. That conversation led to my decision to pursue becoming a CRNA versus my other consideration of becoming a flight nurse. To this day, it was one of the best decisions I ever made. I am very proud of my profession and can honestly say I still love my job after three decades. I still tell my students they have chosen one of the coolest careers they could ask for. I guess my enthusiasm spills over.

I find the NCANA to have some of the most motivated members I have ever met. I feel like they bring out the best in me and am so thankful for the work that they do for our profession. You have been involved with the board and different committees for the past 15 years. Why did you choose the government relations committee for this term?

I was involved with the NCANA in the early 2000s. I decided to take leave from the active involvement in order to devote time to my family and help my wife raise our two children. Now that my children are grown, I have the opportunity to participate in the NCANA once again. Overall, the NCANA is under appreciated by the majority of its members, the active members serving on the Board and Committees are doing a lot of work that most members are never aware of. These dedicated members are volunteering their time and efforts to help preserve our profession and our livelihoods. Major changes can take place in the laws and regulations that govern our profession. These changes could directly effect our day to day job description, if the NCANA is not keeping watch over the potential changes in the laws and regulations then who is? We could go to work one day and find that our scope of practice has been completely redefined and we would be at a loss to change it at that point. One role of the NCANA, and the primary role of the Government Relations Committee is to monitor and respond to activity of the North Carolina General Assembly, the Board of Nursing, and the Board of Medicine that may effect our profession. Being part of this committee has allowed me to learn more about the importance of its function.

Any sound advise you would like to pass on to students who are about to graduate and become members of the NCANA?

Yes, be proud of your accomplishments and your career choice! Be active in the NCANA, so you and others can continue to enjoy the many rewards of being a CRNA. Someone has to take the helm, if not you….then who?

In the past 30 years, you have witnessed significant changes. We now typically use the ultrasound for central line placement, new adjuncts in airway management, and a significant increase in monitoring, e.g. pulse oximetry. What was the biggest adjustment for you as a provider? And, was there anything that occurred during your practice where you said “This is really going to change the way we do anesthesia”?

When I first started anesthesia school, we had to fight for the one automated non-invasive blood pressure machine in the department. The practice of anesthesia was full of many risks at that time, and still is today. The primary change has been technology allowing us to identify a problem before it becomes a crisis. The first time I used a pulse oximeter, I was annoyed by the beeping. At the time, I had no idea how much technology would change the practice of anesthesia.

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Business/Finances Clinical Tips Outpatient Anesthesia Pediatrics

#26 – Mobile, pediatric dental anesthesia with Paul Samuels, MD

Paul Samuels, MD is a pediatric physician anesthesiologist who works with SmileMD to provide mobile anesthesia for dental offices. We talk about the unique characteristics of working in a mobile anesthesia setting for pediatric dental cases. Topics include:

  • skills required to excel as an anesthesia provider in a mobile, pediatric setting
  • preoperative screening of patients
  • patient safety during anesthesia in dental offices
  • prevention and management of emergencies in mobile anesthesia
  • who makes up the anesthesia care team
  • how medications are handled, including controlled substances
  • typical anesthesia plans including mask induction, IV placement & airway management
  • conflict management and other challenges unique to work in unfamiliar settings
  • how documentation & billing is managed
  • the benefit of mobile anesthesia services for pediatric patients and outpatient dentists

You can hear the overwhelming enthusiasm Dr Samuels has for caring for healthy pediatric patients in an outpatient dental setting. His years of experience as a pediatric physician anesthesiologist in a large tertiary care center not only gives him a wealth of experience to bring to an outpatient setting, but also sets him up for a really enjoyable day taking care of healthy kids for dental procedures.

SmileMD is a mobile anesthesia service currently operating at dental offices in Ohio, Illinois and Kentucky. You can learn more about SmileMD through their website here, or through this podcast with founder Dr Navin Goyal.

Conflict of Interest Statement:

SmileMD reached out to me with the invitation to connect with Dr Samuels to conduct this interview on mobile anesthesia. No financial exchange was made between SmileMD and Anesthesia Guidebook or Jon Lowrance as part of the development of this podcast.

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Anesthesia Education Business/Finances Clinical Tips Preparing for Grad School/Residency

#20 – Rural Independent CRNA Practice with Chuck Frisch, DNP, CRNA, FAAPM, CH

Today my guest is Chuck Frisch, DNP, CRNA, FAAPM, CH, a CRNA with over 35 years of experience in anesthesia who serves as the director of anesthesia at Box Butte General Hospital in Alliance, Nebraska.  He’s here to talk about rural, independent CRNA practice.

Chuck initially studied molecular, cellular & developmental biology in college before switching gears to nursing school in effort to get out of the solitude of research labs.  He completed his associates degree in biology in 1978 and a second associates degree in nursing in 1979 at Mesa College, which is now Colorado Mesa University, in Grand Junction, Colorado.  In 1985, Chuck completed his bachelor’s in anesthesia at Mount Marty College, which is now Mount Marty University, in order to becoming a CRNA.  He then completed a Master’s degree in Health Administration in 1989 with the goal of one day being a chief CRNA.  After 15 years of working in an anesthesia care team alongside physician anesthesiologists, chuck moved to Alliance, Nebraska to work in an independent anesthesia practice in 2000.  While first a co-director of anesthesia, following the retirement of his partner, he became the director of anesthesia at Box Butte General Hospital in 2002.  Chuck returned to school to complete his doctorate of nursing practice degree in 2014 at Rocky Mountain University of Health Professions in Provo, Utah.  He has served on numerous state association committees in Nebraska and served as the director of the state association for 1 term.  Chuck is a Fellow of the American Academy of Pain Medicine and served on the AANA’s practice committee and help write and verify the first NBCRNA pain management certification exam.

He’s been married for 43 years, has 4 children, two of whom were adopted internationally and his first grandchild is due to be born in June of 2021.

We talk about the unique challenges in working in a small, rural setting including patient screening for elective cases, how CRNAs are utilized throughout the hospital as airway and critical care experts, who your resources are and what kind of mindset you need to succeed in a rural independent practice. 

Dr Frisch’s bio at Box Butte General Hospital is here.

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