Category: Personal Finances

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

#102 – Marriage + Anesthesia School with Brad & Madisson Marcum

Brad & Madisson Marcum join me to talk about the dynamics of being married and going to anesthesia school together. They met in nursing school, had divergent paths professionally for a bit, with Brad starting nurse practitioner school and Madisson considering anesthesia school. They ended up sharing the same goal of becoming CRNAs and we talk through their approach to applying together, getting into the University of Evansville together and working through the program alongside one another.

In episode 15, I talked with Jenny & Robert Montague about what it’s like for the significant others of anesthesia residents. Jenny has her Master of Science in Nutrition and works as a Registered Dietitian and supported Robert and their 2 kids while he attended the University of New England’s anesthesia program.

In epsisode 50, I caught up with Lein & Nate Woodin to talk specifically on parenting in anesthesia school. Nate is a family therapist and supported Lein and their 2 kids while she went through the University of New England’s anesthesia program.

In this episode, Brad & Madisson Marcum talk about what it’s like to both get into and work through anesthesia school together. We’re planning for this to be the first in a series of conversations with them as they progress through their program. They’re just finishing their first year of training and have yet to start clinicals. I plan to touch base with them down to the road to see how that phase of the program goes.

Folks are often making difficult decisions around when to do anesthesia school. For a couple in my program, the husband went through school 2 years ahead of his wife, who was in my class, and they overlapped for just one semester. A local couple here in Portland stacked their programs end to end with one of them fully completing the program and a semester after that, the other starting anesthesia school. That stretched their anesthesia training experience to a full six years as a couple.

My hope is that this conversation with Brad & Madisson helps you and your partner think through the considerations around what you want to do or how it’s going for you if you’re currently in a program.

Brad hails from Salem, Illinois and spent 5 years as a critical care Registered Nurse in the cardio thoracic & transplant ICUs at Mayo Clinic prior to starting anesthesia school in the University of Evansville’s DNAP program. His clinical interests are regional anesthesia and opioid sparring anesthetic techniques with an emphasis on pharmacology and pharmacogenetics.

Madisson is from Effingham, Illinois and also spent 5 years as a critical care Registered Nurse in the trauma surgical ICU at Mayo Clinic in Rochester prior to anesthesia training. Her clinical interests are regional anesthesia and difficult airway management.

They are focusing their doctoral project on the functionality and effectiveness of virtual reality training in anesthesia programs and plan to utilize Peter Stallo’s SIMVANA VR platform for research. You may remember my conversation with Peter in episode 96 on SIMVANA and virtual reality in anesthesia education. It’s a fascinating discussion on what will likely become a central element to anesthesia education in years to come.

Long term, Brad & Madisson intend to become involved in medial mission trips and create a pediatric charity foundation to provide basic necessities to children in need in their local area following anesthesia school.

Brad and Madisson Marcum

Podcast: Play in new window | Download

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

#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

Podcast: Play in new window | Download

Categories
Anesthesia Education Business/Finances Personal Finances Wellness

#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

Podcast: Play in new window | Download

Categories
Anesthesia Education Business/Finances Personal Finances Wellness

#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.

Podcast: Play in new window | Download

Categories
Anesthesia Education Business/Finances Personal Finances Wellness

#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

Podcast: Play in new window | Download

Categories
Anesthesia Education Clinical Tips Personal Finances Preparing for Grad School/Residency Wellness

#78 – Thrive in Training: how to transition to practice

This episode covers advice for the last six months of anesthesia training, transitioning out of training and into the first six months of your anesthesia practice.

The year encompassing your last six months of training through boards and your first six months of practice is epic!  

There’s a huge learning curve you encounter during your first six months of anesthesia practice following the “completion of training.” Finishing training is a bit of a misnomer given that the best providers keep training… keep practicing and developing towards true expertise and mastering their craft.

This was the first solo episode I produced on From the Head of the Bed, meaning just me and the mic. I originally published this on February 1, 2016, about 8 months after I completed anesthesia training and passed boards. At the time, I wanted to do a show on transitioning to practice before the lessons of that time faded from my immediate memory.

I think there’s three big aspects of the last six months of anesthesia training: completing your research/thesis/DNP or residency project, securing a job and passing boards. For CRNAs, we must pass boards before we begin work. For physician residents, you may start working as a board-eligible physician anesthesiologist and work towards completing boards after you make that transition to practice.

I speak a bit about wrapping up training in this episode from the experience side of things… your co-residents will likely scatter to take jobs all across the nation after training. Try to connect with them in the final months and thank your program faculty. They pour a ton of effort into developing you as a provider and launching you into the world. A little gratitude goes a long way towards helping them know their work is appreciated.

The first six months of your practice brings a massive learning curve as you’re finally charged with putting all of the pieces together on your own. This is an important time where you must answer the following questions concerning your actual practice:

  1. Why do I do what I do?
  2. Why do I not do what I don’t do?

Sounds simple enough, but you must clarify your decision making around clinical judgments and interventions finally for yourself and not because your program faculty or preceptors prefer you to do or not do something. My encouragement is that you frame your decision making on the latest evidence for best practices and not simply because you taught one way to do things. You must continue to evolve your practice after graduation.

I hope you enjoy this show. As always, drop your comments or questions on the website, social media or in an email to me. If you haven’t already, please take 3-5 minutes and drop a review on Apple podcasts. You rating, but especially your written review, helps push the podcast out to more people and helps those individuals trust the show.

I mentioned this article in the podcast:

Assante, J., Collins, S., & Hewer, I. (2015). Infection Associated With Single-Dose Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Literature Review. AANA Journal, 83(4), 281-288.

Podcast: Play in new window | Download

Categories
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.”

Podcast: Play in new window | Download

Categories
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! 

Podcast: Play in new window | Download

Categories
Anesthesia Education Clinical Tips Personal Finances Preparing for Grad School/Residency Wellness

#67 – How to Thrive in Training

This is the first episode in a series that will focus on helping anesthesia residents thrive in training. This is designed for physician and nurse anesthesia trainees and will unpack crucial beta for helping you dial your game in during anesthesia training.

In this first episode I discuss finding your why behind going to anesthesia school. Your why is what will propel you through the tough times in training and help you find the motivation to excel.

Angela Duckworth is a psychologist and researcher who, in her bestselling book titled Grit – the power of passion and perseverance, says that grit is what separates those who succeed from those who fail when facing extreme challenge.

Your why will help you develop the level of grit that you need to get through the challenges of anesthesia training.  

Grit is what you have when your passion fuels a perseverance that propels you through obstacles to achieve your goals.

Duckworth says there’s four components of developing grit: interested, practice, purpose and hope.

Do you have an authentic interest in the work anesthesia providers do? Are you stoked about the field of anesthesia and have an accurate mental representation of what it’s actually about?

You will need to develop deliberate practice in order to master the craft of anesthesia and become competent in the core skills/knowledge base. If you’re unwilling to do this, anesthesia training will quickly seem overwhelming and you probably won’t make it. But deliberate practice is the key to unlocking true skill development and expertise and will make the road ahead achievable.

You must know your purpose – or your why – behind going to anesthesia school. This episode is all about finding that. It will be the reason you come back to when the road gets tough and you have to find the motivation to push through the challenges, set backs and hurdles that will inevitably come your way.

And lastly, hope is what you will have in your back pocket when you believe that the journey is worth all the hard work you put in. Hope comes when you believe that the juice is worth the squeeze, that the payoff is worth the effort.

Interest. Practice. Purpose. Hope. When you understand and foster each of these in your journey, you will develop a grittiness that will see you through the steepest of climbs and most difficult days.

Stay tuned for the upcoming series where you’ll hear from CRNAs, professors and SRNAs alike on the following topics:

  • developing a growth mindset
  • dialing in didactics
  • crushing clinicals
  • developing time management
  • avoiding landmines and overcoming set backs
  • dealing with hardship in anesthesia training
  • financial management
  • preparing for and acing exams and boards
  • tips for the job hunt
  • transitioning to practice and through the first six months after training

This series is an active work in progress so if there’s something you want to hear about, be sure to reach out and let me know!

Podcast: Play in new window | Download

Categories
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.

Podcast: Play in new window | Download

Categories
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)

Podcast: Play in new window | Download

Categories
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

Podcast: Play in new window | Download

Categories
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.

Podcast: Play in new window | Download

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

#15 – Significant Others and Anesthesia School with Jen & Rob Montague

Jennifer & Robert Montague moved across the country from Montana to Maine with their young children for Rob to attend anesthesia school.

Today I’m joined by Jennifer & Robert Montague to talk about the experience of significant others in anesthesia school. Rob is currently a second-year SRNA at the University of New England and Jen, his wife, is a Master’s-prepared Registered Dietitian who has taken on the lioness’ share of providing child care and homeschooling responsibilities for their two children while Rob attends anesthesia school. Jen and Rob moved across the country from Montana to Maine for Rob to pursue a mid-life career change from working as an international mountaineering guide to becoming a CRNA.

This podcast is like something from Death, Sex & Money or Joe Rogan – it’s narrative, it’s a story and unfolds over the hour & half we talk.

You’ll love hearing Rob & Jen’s humor and love for one another and their kids… how resilient their children are and how they’ve made the move work financially & emotionally as individuals and a couple.

If you’re getting ready for anesthesia school, wondering if you can do it with your family and children and how it all works, we talk through all of that. Who better to learn from than a couple, with kids, who are going through not only anesthesia school but doing it all in the middle of a worldwide pandemic?

I’ve been looking forward to doing a show on this topic for a long time and I’m so grateful to bring you Jen & Rob’s story! So settle in to the conversation, break it up over a couple of commutes or an evening on the couch with your significant other and enjoy the story.

Podcast: Play in new window | Download

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

#12 – Ten Things Every Anesthesia Provider Should Know

The following ten ideas have the power to change your attitude towards and even the trajectory of your professional career and life.  There’s three core domains to developing as an anesthesia provider:  your knowledge base, skill set and attitude.  Each are unique and require different kinds of effort or deliberate practice to grow & improve.  This guide is predominately about tweaking & improving the attitude you approach your career with.  If you’re gonna show up in your life, why not show up with a level of stoke that pulls you through the doldrums & pushes you towards where you want to be?  These ten ideas may help you do just that.

1.  What you do matters because you hold the lives of your patients in your hands.

2.  You’re only as good as the decisions you make today (sort of).

3.  You provide a service and you are replaceable. 

4.  You have an incredible capacity to develop your skills, knowledge, attitude and even intelligence.  

5.  We work in systems that are designed by people, and people work in relationships.  

6.  No one cares about your money, career, scope of practice, time off, goals, wellbeing and success more than you do.

7.  Embracing delayed gratification and understanding the power of compounding interest are critical to creating a brighter financial future for yourself.

8.  You have more power, influence and capacity than you think, and so does everyone else.  

9.  Location – Compensation – Autonomy.  You can pick 2.  

10.  Joy is more valuable than your income or job.

Ten-Things-Every-Anesthesia-Provider-Should-KnowDownload

Resources

Duckworth, A. (2016). Grit: The power of passion and perseverance (Vol. 124). New York, NY: Scribner. Retrieved from http://www.simonandschuster.com/books/Grit/Angela-Duckworth/9781501111105.

Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/.

Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt.  Retrieved from https://www.hmhbooks.com/shop/books/Peak/9780544947221.

Jebb, A. T., Tay, L., Diener, E., & Oishi, S. (2018). Happiness, income satiation and turning points around the world. Nature Human Behaviour, 2(1), 33-38.

Oliver, M. (2020). Devotions: The Selected Poems of Mary Oliver. Penguin Books.

The Notorious B.I.G. (1997). Mo money mo problems [Song]. On Life after death. Bad Boy Records; Arista.

Podcast: Play in new window | Download

Categories
Anesthesia Education Personal Finances Preparing for Grad School/Residency

#6 – Van life in anesthesia school with Marcus House

Marcus House, BSN, SRNA rocking his 1995 E350 Ford ambulance as his home on wheels while pursuing his doctorate in nurse anesthesia practice.

Today I talk with Marcus House, BSN, SRNA about his decision to live in an ambulance during remote clinical rotations in anesthesia school. Marcus is currently working towards completing his Doctor of Nurse Anesthesia Practice at Missouri State University. He holds Bachelor of Science degrees in Education and Nursing, both from Southeast Missouri State University. Marcus worked for 7 years as a high school science teacher alongside his wife, Casey, also a high school teacher, before returning to nursing school. He spent 3 years working in a CVICU prior to pursuing his doctorate degree in anesthesia. He would like you to know that he “knows when to hold ’em, AND when to fold ’em, [he] once owned a Nintendo Power Glove and [he’s] comfortable being either ‘big spoon’ or ‘little spoon’.”

In all seriousness, choosing to go mobile for your housing arrangements during graduate school or residency, depending on your clinical rotations, may make a lot of sense. As Marcus points out in the podcast, he’s saving money compared to the cost of rent while enjoying a personalized home on wheels that will be his to keep after anesthesia school. With many graduate anesthesia programs sending their SRNAs wide and far for clinical rotations, it can be extremely challenging to find affordable housing on the fly in grad school while still maintaining rent or a mortgage at a home base.

You don’t have to look far on the internet webs to find a virtual plethora of blog sites, Instagram & Pinterest feeds and YouTube channels dedicated to #vanlife for ideas & guides on build outs.

I put a few photos of Marcus’ ambulance, Bernice, below and you’ll find several more at Anesthesia Guidebook’s Instagram page. I’ll also include some photos on Instagram from a Sprinter van build that my wife and I completed after we finished anesthesia school. While we were able to get through our program in traditional housing, we’ve thoroughly enjoyed having a van for weekend to multi-week road trip adventures after grad school.

Don’t hesitate to reach out to Marcus via Facebook or email (Marcus.House1@gmail.com) (that’s Marcus-dot-house, the number one, at gmail.com) or drop a question/comment below, on Instagram or directly to me via email (jon@anesthesiaguidebook.com) if you want to talk about van life in anesthesia school in more detail.

Podcast: Play in new window | Download