Beyond The Mask: Innovation & Opportunities For CRNAs

As much as you love the work you do, eventually you’ll want to step away and enjoy time to yourself in retirement. But what’s the best way to invest for your future? Should you contribute your pre-tax money into a traditional IRA or is Roth a better option? Let’s discuss all the options available to you and what factors will determine the best route to retirement.   Full Show Notes and Additional Resources: https://beyondthemaskpodcast.com/?p=2200    Today's Rundown:  1:52 – Today we’re talking whether CRNAs should be contributing to a Roth or a pre-tax retirement account. Or both? 2:43 – There are two sides to remember to this. First you have Roth IRA vs Traditional (or pre-tax) IRA. And now you have Roth 401k/403b vs Traditional 401k/403b 3:43 – There’s no blanket answer. It’s different for everyone. 4:40 – Let’s start with the Roth IRA. Here’s what you need to know. 6:17 – The big debate is pay taxes now or pay them later. Here’s what you should consider. 8:20 – There’s an opportunity cost for utilizing the Roth. What if you took that extra pre-tax money and invested that elsewhere? 10:23 – What are some other reasons we might potentially choose the Roth? 12:25 – If we know you need to control your taxable income, Roth can be utilized. 14:19 – Planning helps you determine what percentage of your money to put into each account? 15:36 – Why the retirement system is skewed against high-income earners like CRNAs.    17:02 – How can you save more than the $19,000 limit? 18:55 – Jeremy explains backdoor contributions. 21:22 – Here’s the caveat to the backdoor though. 22:55 – Let’s talk about another option for CRNAs that have 1099 gigs. 25:18 – Can you contribute to both Roth and pre-tax within the same employer retirement account? 26:59 – How healthcare can impact your decision. 29:17 – Jeremy’s goal is to help the CRNA community be prepared. 30:47 – Everyone should have a financial check-up every year. 32:02 – Final thoughts on the topic.

Ronald Caulk poured more than 50 years of his life into being a Certified Registered Nurse Anesthetist and his impact on the profession can still be felt today. Among his lifetime of achievements was his determination to have CRNAs around the world recognized for the work they do. Today we’ll look back at his life and his legacy with Sandy Ouellette, CRNA.   Full Show Notes: https://beyondthemaskpodcast.com/?p=2192    On This Episode:  1:59 – Sandy Ouellette back in the studio with us today to discuss Ronald Caulk. 2:37 – Who was Ronald Caulk and what did he accomplish? 5:02 – Most of his level of service at the state level was with the Arizona Association of Nurse Anesthetists. 6:09 – He had many AANA contributions. 7:10 – The establishment of the council on recertification and how he ended up meeting his wife Susan Smith. 10:13 – How did Sandy and Ron get involved together? 10:42 – They began working very closely when the idea of the IFNA began. 12:40 – How the IFNA formed. 15:22 – One of Ronald Caulk’s most memorable experiences happened on a trip to Ghana. 17:47 – Tell us about his contributions to the AANA and IFNA. 21:18 – Sandy tells a story about a time they visited North Carolina and Sandy’s jeep got stuck on the beach. 26:02 – How will Ron be remembered?

The nurse anesthesia profession hasn’t traditionally been a field known for its diversity but that’s something leaders are trying to change. At the forefront is Dr. Courtney Brown at Wake Forest. She joins the show to discuss the importance of recruiting people from all backgrounds to nurse anesthesia and what’s being done to make that happen.     Show Notes: https://beyondthemaskpodcast.com/?p=2150   Today's Rundown:  2:16 – Welcome in our guest, Dr. Courtney Brown 3:23 – Dr. Brown has made many efforts to improve diversity and inclusion at Wake Forest and that will be our focus today. 3:46 – Why is this topic of diversity so important for our field? 4:35 – We’re behind many other health professions 6:00 – Explain diversity and inclusion and what they mean. 6:28 – An example of a recent graduate that almost didn’t apply to the program because of the marketing materials. 8:26 – Is there a negative perception of nurse anesthesia due to the lack of diversity? 10:26 – Why do people associate promoting diversity with Affirmative Action? 13:37 – Now that things are on the radar, is progress being made? 16:58 – How does recruitment work and what do you look for? 19:01 – Dr. Brown shares the updated statistics from her program. 20:23 – Explaining pipeline programming and how it works. 23:04 – The balance of male versus female in the profession. 24:49 – What can faculty at other programs do to improve diversity and inclusion? 27:20 – Where can the average CRNA start? 31:52 – What should be a part of the national agenda to assist in diversifying our profession? 27:17 – Final thoughts from Dr. Brown.  

Happy Thanksgiving! To celebrate this wonderful day of gratitude, we welcome on AANA CEO Randy Moore and AANA Senior Director of Federal Government Affairs Ralph Kohl to help us give thanks for an organization that does so much for the CRNA profession every year.   Full show notes: https://beyondthemaskpodcast.com/?p=2172    On this episode:  1:37 – Thanksgiving morning! 2:00 – We’re thankful for our guests today, Randy Moore, CEO of the AANA, and Ralph Kohl, the Senior Director of Federal Government Affairs for the AANA. 2:35 – This podcast will focus on giving thanks for the AANA. 3:12 – Ralph explains what he’s thankful for. 4:15 – What this organization means to Randy. 6:31 – What mentors – past or current – are you thankful for knowing? Randy first. 8:13 – Ralph on his mentors. 10:23 – What does success look like for the AANA from Randy’s perspective? 11:49 – Ralph’s idea of success. 12:39 – What should every CRNA be thankful for? 14:49 – How would you explain your enthusiasm for the AANA? 18:43 – How do you want to be remembered if you move on, Ralph? 20:55 – What about Sharon, what are you thankful for from the AANA? 22:00 – Jeremy shares what he’s thankful for.

Dan Simonson and Jack Hitchens are long-time CRNAs that identified a need in the profession to be able to easily track and manage data. That’s why they created the Open-Source Anesthesia Electronic Medical Record, which they believe provides great value – at no charge – to CRNAs around the world. Find out everything you need to know about OSAEMR and its future.   Full show notes: https://beyondthemaskpodcast.com/?p=2163    Today's rundown:  1:55 – Welcome in our two guests, Dan Simonson and Jack Hitchens. 3:55 – Today’s topic is OSAEMR or Open-Source Anesthesia Electronic Medical Record. Here’s some background on what it is. 4:46 – Why is this important for our profession? 5:32 – This even allows you to track your data as a student. 6:26 – This is a project Dan and Jack have worked on for five years. Here’s how it all started. 8:54 – A labor of love for Dan and Jack. 10:21 – It’s been a way for both guys to contribute to the profession and more than 400 CRNAs are using it now around the world. 11:44 – How does this interface with other systems already in place? 13:10 – Have these EMRs been helpful in the development in OSAEMR 15:02 – Is there a reason people wouldn’t want this data out there? 16:14 – What is OSAEMR’s motto relative to data? 17:28 – There’s no data being captured in plastics work but this can change. 20:04 – Pain management procedures are going to be a part of the data collection. 21:09 – Here’s what CRNAs can do to help OSAEMR continue to move forward and grow. 23:04 – There are three versions of the product currently. 25:56 – What are the near-term goals for the product? 26:51 – Final thoughts from Dan.

We were on location at the North Carolina Association of Nurse Anesthetists and wanted to get a historical perspective on CRNAs. With the help of past AANA presidents Sandy Ouellette and Nancy Maree, we take a look back at the important battles fought and won by nurse anesthetists through the years that help shape the way our industry operates today.   Full show notes: https://beyondthemaskpodcast.com/?p=2167    On today's show:  1:37 – We’re recording live from the North Carolina Association of Nurse Anesthetists meeting. 1:51 – Two popular guests, Nancy Marie and Sandy Ouellette, join the show. 2:37 – Sandy highlights some of the past challenges that will help CRNA’s unite and fight future issues. 3:12 – Background on Frank vs South and why that decision is still important today. 5:04 – The next important case involved Dagmar Nelson in the 1930s. 6:34 – The road to reimbursement was a 7-year process in the 1980s.   7:50 – How the ANA helped turn around the industry when it began dying out in late 80s. 9:25 – The ongoing issue of federal supervision of nurse anesthetists in Medicare. Why we need to remove it and what role states are playing.   13:31 – ANA threw their support behind antitrust cases. 18:06 – Antitrust fights still go on today. 19:24 – Nancy explains the antitrust and fraud case against Twin City Hospitals in 2004 and what came from it. 23:42 – What role has the ASA played in all of the challenges and crises the industry has faced? 26:30 – The recent Anesthesia Care Team statement and why many believe it’s restrictive. 29:13 – What can ANA members do today to help the association succeed and remain strong moving forward? 30:36 – Why membership is so important for ANA. 32:24 – New students and new graduates seem to be the biggest hole in membership. 36:20 – Can the ANA be listening to members better? Here are issues they have spoken out on. 40:24 – Jeremy’s perspective as an outside on the membership issue. 44:11 – Final thoughts from Sandy on why it’s such a great time to be a CRNA.  

Accepting a new job is such a rewarding feeling that motivates you to get to work and continue growing your career, but understanding your employment contract first is vital. Mark Silberman, legal counsel for the AANA, will break down the specifics of a contract, what you need to know, and how to protect yourself. Plus, he’ll help us understand the different types of employment statuses and which is better for CRNAs.   ***CE CREDIT ALERT: Did you know you can get continuing education credit from the AANA for listening to this episode? Go to https://knowledgenetwork.aana.com/home to get the details and get your credit today! And see a list of other episodes that qualify for CE credit here: https://beyondthemaskpodcast.com/series-ce-credit   Show Notes: https://beyondthemaskpodcast.com/?p=2142   Today's rundown: 2:29 – Welcoming on our guest today, Mark Silberman, who is legal counsel for the AANA 3:05 – What we’re talking about on this show and why it’s important. 4:17 – Mark breaks down the parts of a contract and what you need to know about one. 5:45 – A real-life example from a CRNA of a contract that didn’t get put in writing. 6:47 – Let’s define the differences between an employee and an independent contractor. 9:08 – Mark explains independent contractors even further. 10:20 – Trying to understand why some independent contractors are classified that way when they appear to be an employee. 12:02 – It all comes down to what is the intention. 13:16 – You have to remember that employers will almost always have leverage because they hold the commodity: the job.   13:57 – Define ‘employee at will’ and how many states have that status. 15:48 – What’s the difference between job description and employee contract? 16:59 – Job descriptions are not enforceable. The contract specifics are. 18:02 – Does every CRNA need a contract? 20:06 – The biggest mistake people make when they’re looking at a contract. 21:44 – What are the most important things CRNAs should pay attention to in a contract? 20:07 – Can you re-negotiate your contract? 24:31 – Let’s talk non-competes. Every state has its own interpretations of these. 27:46 – How do we find out if these non-competes are enforceable? 29:12 – What happens when a new employer takes over? 31:39 – Should Independent contractor CRNAs incorporate for protection? 33:11 – Final words of wisdom for CRNAs entering a contract.

Nurses have all the right attributes to be successful in politics but there are so few in office around the country. We want to help change that by empowering nurses to feel confident and comfortable running for office. We’ll spend this episode discussing why it’s an important topic and we’ll learn more a new campaign school that Sharon Pearce and Kimberly Gordon are working to launch in 2020. On this episode:  1:52 – Introducing our topic and our guest Kimberly Gordon. 2:19 – Sharon talks about what her and Kimberly have done together in the past. 3:45 – Why is this topic so important? 4:57 – Only two nurses serve in office at the Federal level right now. 5:21 – Why aren’t there more nurses in office? 7:01 – North Carolina has three nurses in state legislature, including Gale Adcock. 8:10 – Who are the two nurses on the national level? 8:52 – Neither of those are advanced practice nurses, which we’ve never had at the Federal level. 10:01 – Let’s talk about the breaking down barriers project Sharon and Kimberly are working on at Yale. 12:37 – We’ve met nurses from all over the country and they feel like this is very important. 13:40 – We as nurses are really late to this game. Physicians have been training people for politics since the 70s. 14:34 – Is it intimidating for nurses to consider running for office? 15:35 – Occupation-specific schools have become popular for a reason. 16:29 – A huge barrier is we don’t like to ask for money or help and that’s an issue.                                                                                                                    18:41 – We’re not asking people to run for governor. We want to build a pipeline that starts in county commissions, school board, places like that. 19:32 – Maybe one day we’ll have a nurse as president. 19:55 – What kind of timeline are we talking about for this project? 20:34 – Yale has provided so much acceptance and assistance through this process. 21:39 – “If you’re not at the table, you’re on the menu.” 22:51 – Applications open on January 1, 2020. Get the full show notes and additional resources here: https://beyondthemaskpodcast.com/?p=2135

  Retirement means many different things but one of the most important is transitioning to a new healthcare plan. For many people, Medicare becomes the best option but it can be difficult to sort through and understand. Who is eligible? What are my options? How much are premiums? We brought on Medicare guru Joanne Giardini-Russell to clear up a lot of questions for us. On this episode:  1:51 - Today we're talking about Medicare decisions for the retiring or retired CRNAs. 2:48 - Our guest today is a Medicare expert, Joanne Giardini-Russell 3:29 - Joanne gives us her background in the industry. 5:47 – Let’s start with the basics: what is Medicare? 7:09 – Who is eligible for Medicare and is it mandatory? 8:22 – If I’m still working at 65, does that effect anything? 9:44 – You don’t have to take Medicare at 65. It’s important to know that everyone’s situation is different. 11:14 – Understanding how the Health Savings Account plays into your decision. 11:54 – A lot of people don’t understand that premiums are income-related. 13:09 – When you start talking about retirement, planning needs to begin as soon as possible to work through options like these. 13:43 – Your HSA contributions get taxed and many people don’t know that.   14:40 – What does the acronym IRMA mean? 17:51 – Client story about a couple found out they were paying more than they needed to for premiums. 19:35 – Are there other costs for Medicare beyond the premium?        21:11 – You have two choices to handle the 20% beyond Medicare’s coverage. 23:02 – What are the pros and cons of the Medicare Advantage plan? 25:27 – What else does a CRNA need to know after they enroll? Let’s talk basics. 27:22 – If you’re over 65 and you’ve enrolled in Medicare, can you make changes or are you stuck? 28:44 – Pre-existing conditions do come back into play with Medicare. 29:33 – It’s very important to know that people with pre-existing conditions have one shot to get into Medicare. Here’s what you need to know. 30:23 – How much flexibility do you have in picking an insurance carrier? 32:29 – What are my annual requirements with Medicare coverage? 35:19 – Final thoughts from Joanne Show notes and additional resources: https://beyondthemaskpodcast.com/?p=2123

What does the next 5, 10, 20 years look like for the healthcare industry? That’s a question everyone would love an answer for, but there are many opinions out there. We sat down with Steve Mund to pick his brain on everything from insurance to costs to payments and more. On this episode:  1:59 – Introducing our guest on this episode, Steve Mund. 2:29 – Sharon shares some background on Steve. 4:24 – It’s an interesting time in healthcare and there’s no way to predict how it will change in the years to come. 6:57 – How to be a problem-solver for your department. 7:58 – The three payment models healthcare needs to engage in for the future. 10:14 – What about the accountability on the patient side? 11:19 – The providers get penalized but what about the payer? 12:57 – Jeremy shares a recent discussion he had with an insurance executive about drug costs. 14:01 – Let’s talk about mergers. Are their benefits to these large mergers? 14:59 – One prediction projected operating margin to be -16%. 15:55 – The length of stay can be an area of improvement potentially. 16:47 – Hospitals only operate on a 2.5-4% margin. 17:41 – Where is all the money going? 20:04 – What factors are driving the utilization of healthcare?              22:03 – What does Steve see as the future of healthcare payers? 23:36 – The best way to stay informed is Becker’s Review. 25:29 – How do you determine value in healthcare these days? 26:58 – So how can providers show their value to their organizations? 27:42 – How can we help cut down on waste in financial, clinical and personnel areas? 29:16 - The waste isn’t always about money, it’s also about time. 30:40 - Some final thoughts from Steve. Show notes: https://beyondthemaskpodcast.com/ep-#43:-the-future-of-healthcare-with-steve-mund/2115/