u/MacKinnon911

If someone tells you a study “proves” something, here’s my question:

Who paid for it?

Not because industry-funded research is automatically wrong. It isn’t.

But because funding is only the beginning of evaluating a study, not the end. You also have to ask who designed it, what question it actually answered, what it didn’t answer, and whether people are using it to support claims it never studied.

Too often in healthcare, people skip all of that and jump straight to the headline.

If you care about evidence, you should care about the entire story behind the evidence.

I break down exactly how to critically evaluate research and why this matters for every clinician, not just anesthesia.

Read it here:

1,300 applications initiated.
More than 500 submitted.
102 applicants selected to interview.
Just 30 seats.

That is an extraordinary level of interest in the National University Nurse Anesthesiology Program, and it speaks volumes about the future of this profession.

Interview invitations will be sent by August 14, 2026, with Zoom interviews taking place on September 8, 9, and 10.

To everyone who applied, thank you for putting yourself forward and for the time, preparation, and work it took to get here. This is an exceptionally competitive process, and the strength of this year’s applicant pool has been impressive.

We are excited to meet the applicants selected to interview and begin building the next cohort of National University Nurse Anesthesia Residents.

The next generation is coming.
The competition is real.
The future of nurse anesthesiology is strong.

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Most people hear the word supervision and assume it means control. They picture a supervisor at a job who tells you what to do, watches how you do it, and is responsible for the outcome.

That is not what the CMS supervision requirement means for CRNAs.

CMS does not say that the surgeon controls the anesthetic, directs the CRNA’s decisions, or becomes liable for the CRNA’s actions. In many non-opt-out states, supervision may amount to nothing more than the surgeon ordering anesthesia while the CRNA independently provides the entire anesthetic.

Opt-out does not create independent practice. It does not change state law, professional billing, credentialing, privileges, or liability. Those issues are determined by state law and by each individual facility.

What opt-out does is remove one federal supervision requirement. The actual practice may look exactly the same the day before and the day after a state opts out.

What changes is the word, and the perception attached to it.

Hospitals, surgeons, and administrators often hear supervision and assume control, responsibility, and legal risk. Removing that word eliminates one more barrier and gives facilities greater freedom to choose the anesthesia model that works for their patients and their community.

That is what CMS opt-out is really about.

Bill Bruce The AANA CEO and I wrote this article for that clarification.

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Opt-out gets misunderstood all the time.

It does not create independent CRNA practice under state law. It does not change state scope of practice. It does not change the professional anesthesia fee. It does not give anyone control over CRNAs, it does not take control away from anyone, and it does not magically add or remove liability. Those issues are controlled by state law, scope of practice, credentialing, delineation of privileges, and hospital policy at each individual facility.

All opt-out does is remove the CMS physician supervision requirement tied to the hospital Conditions of Participation for the Medicare Part A facility fee. That is not the same thing as the professional anesthesia service fee, which is Part B. Opt-out has nothing to do with the Part B professional fee.

A state also has to attest that opt-out is consistent with state law. So opt-out is not what creates the underlying authority for CRNAs to practice without physician supervision. In opt-out states, that authority already comes from state law, licensure, credentialing, privileging, and facility policy.

The issue is the word “supervision.” It creates a perception problem. Hospitals hear supervision and think liability. Surgeons hear supervision and think they are responsible for anesthesia decisions they are not actually making. Administrators hear supervision and think regulatory risk. That ambiguity is exactly what gets used to make independent CRNA practice look legally riskier when the data is clear they are not.

Before opt-out, CRNAs may already be practicing without a state-law physician supervision requirement. After opt-out, they are still practicing under the same state law, licensure, credentialing, privileging, and facility policy. The clinical practice does not suddenly change. In fact, it does not change at all.

What changes is the federal word.

Removing that word eliminates one more barrier to local control. It lets each facility choose the anesthesia model that works for its patients, workforce, finances, and community without a federal “supervision” label being spun into control, liability, or legal risk. The word does not actually create those things, but it absolutely creates the perception that they may exist.

That perception matters because hospitals often make decisions based on perceived risk as much as actual law. Removing the federal supervision language gives facilities more comfort using CRNA-only or non-medically directed models.

So opt-out is not really about creating independence. It is about removing a federal wording problem that makes independent CRNA practice look legally riskier than it actually is, and it takes away one more talking point used to make hospitals think they do not have a choice.

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This is the 26th state

Opt-out gets misunderstood all the time.

It does not create independent CRNA practice under state law. It does not change state scope of practice. It does not change the professional anesthesia fee. It does not give anyone control over CRNAs, it does not take control away from anyone, and it does not magically add or remove liability. Those issues are controlled by state law, scope of practice, credentialing, delineation of privileges, and hospital policy at each individual facility.

All opt-out does is remove the CMS physician supervision requirement tied to the hospital Conditions of Participation for the Medicare Part A facility fee. That is not the same thing as the professional anesthesia service fee, which is Part B. Opt-out has nothing to do with the Part B professional fee.

A state also has to attest that opt-out is consistent with state law. So opt-out is not what creates the underlying authority for CRNAs to practice without physician supervision. In opt-out states, that authority already comes from state law, licensure, credentialing, privileging, and facility policy.

The issue is the word “supervision.” It creates a perception problem. Hospitals hear supervision and think liability. Surgeons hear supervision and think they are responsible for anesthesia decisions they are not actually making. Administrators hear supervision and think regulatory risk. That ambiguity is exactly what gets used to make independent CRNA practice look legally riskier when the data is clear they are not.

Before opt-out, CRNAs may already be practicing without a state-law physician supervision requirement. After opt-out, they are still practicing under the same state law, licensure, credentialing, privileging, and facility policy. The clinical practice does not suddenly change. In fact, it does not change at all.

What changes is the federal word.

Removing that word eliminates one more barrier to local control. It lets each facility choose the anesthesia model that works for its patients, workforce, finances, and community without a federal “supervision” label being spun into control, liability, or legal risk. The word does not actually create those things, but it absolutely creates the perception that they may exist.

That perception matters because hospitals often make decisions based on perceived risk as much as actual law. Removing the federal supervision language gives facilities more comfort using CRNA-only or non-medically directed models.

So opt-out is not really about creating independence. It is about removing a federal wording problem that makes independent CRNA practice look legally riskier than it actually is, and it takes away one more talking point used to make hospitals think they do not have a choice.

This is a great story about CRNA Chance Nadritch who switched from accounting to nursing after his grandmother suffered a major heart attack. He then continued his education to become a CRNA and used a unique loan repayment program called Clasp to fund his tuition.

Chance was later hired as a CRNA at the same hospital where his grandmother nearly lost her life, and he calls the Clasp program a "dream" for making it all possible

I don't know about the rest of you, but I went from the comma three to the comma four and I actually noticed my truck is ping-ponging back and forth more than ever. It also seems to slow down around corners or randomly at times in a way it never has before and chime like crazy thinking I'm not looking forward even though I am as if it can't see me very well.

Is anyone else having these same issues?

We finally wrote this one up because Sun et al. 2018 keeps getting cited online like it proves CRNAs and AAs are equivalent.

It does not.

The actual study was “Anesthesia Care Team Composition and Surgical Outcomes” by Sun, Miller, Moshfegh, and Baker, published in Anesthesiology in 2018. The authors studied elderly Medicare inpatient surgical cases and compared physician anesthesiologist-supervised ACT configurations involving AAs versus CRNAs. The outcomes were inpatient mortality, length of stay, and spending.

That is a very narrow health services study. It is not a CRNA-versus-AA anesthesia outcomes study. It did not measure anesthesia-specific complications, rescue events, airway events, supervision intensity, provider experience, independent CRNA practice, or whether any outcome was actually related to the anesthetic.

So when ASA/AAAA advocates cite this as proof of broad CRNA-AA equivalence, they are stretching the paper way past what it measured.

If titles matter in health care, they have to matter for everyone.

“Provider” is vague. “Mid-level” is hierarchical. And selective outrage over titles like “nurse anesthesiologist” says more about professional power than patient transparency.

• Physician anesthesiologist? Accepted.
• Dentist anesthesiologist? Accepted.
• Certified Anesthesiologist Assistant? Accepted.
• Nurse anesthesiologist? Suddenly confusing?

That double standard is the point.

Proud to co-author this piece with David Warren, Matthew Harmon, Erik Rauch, Nijma Yusuf, Jeffrey Molter, Joseph Rodriguez, and Jennifer Banek.

Patients deserve clear, accurate titles that identify the professional, the role, and the clinical domain. Not corporate language. Not rank-based language. Not selective title protection.

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So I’m a lifetime member and what started off amazing with this product seems to have gone downhill? But maybe I’m missing something?

1. even when using 5.5 with message mode it corrects swearing. If I’m swearing for a text message I don’t want it corrected. Can’t seem to fix it.

2. seems to recently take significant liberty in shortening/interpreting med-long dictation including taking out important pieces of the context. Changing the detail. I didn’t buy a “‘make what I’m saying better” product, I just want it to dictate and fix spelling and sentence structure etc.

3. it tries to answer what I’m asking. Seems to be random but very irritating after any length of dictation.

Am I missing some settings to fix these things? I don’t think I use ANY of the options as I don’t find them useful to me. I just want a better dictation tool than the Mac native one.

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Anyone else get the chat app logged in then it just opens and closes and isn’t useful? I can use it on the browser but that’s clunky comparatively.

Any fixes? Looks like I’m not the only one with an issue

Hey all!

Long time lurker and Apple fan.

So I’ve done the searches but I’m trying to figure out if I’m missing something.

I have a M4 Mac mini and I can get the AVP to connect from the mini and create an ultra wide. But here are my questions

1. can I create more than one monitor? I currently have 2 ultra wides and I’d like to recreate that?

2. can I connect from my AVP instead of initiating from the mini? I’d like to have it in the living room or outside on the deck recreate my monitors.