• The Fates Of CRNAs

    Author(s): Joseph A. Rodriguez, CRNA

    Let me share two conversations I’ve had lately. They’re a summary of many conversations over the years. 

    My first friend, who works independently in both urban and rural Arizona, said to me, “Joe, I have to be honest, I don’t care if AA legislation passes.  It will impact CRNAs who work in medical direction practices, and it won’t impact me”. 

    My second friend, who works in a very strict medical direction model said to me, “Joe, hey, I appreciate what you guys do at the association, but a lot of it just doesn’t apply to me”.  

    They’re both wrong.  

    Shared Fates

    Now, perhaps I see this issue differently because I was trained and educated in Pennsylvania, where the medical direction model is nearly universal[1], and I been practicing in Arizona since graduation, where collaborative team models or independent models are more common.  So in my view, the connection between CRNAs in different models is a bright, clearly visible line.  Our fates are tied, even if we don’t want to admit it.  

    But How?

    First, if you’re a CRNA who is employed, let’s say in a medical direction model, you’re subject to market forces[2].  You don’t need an economics degree to recognize supply and demand is a significant factor in what an employee can command on the market.  And, you don’t need a PhD to realize that your autonomy plays a significant role in your satisfaction as a professional[3],[4] 

    What is the biggest force moving the anesthesia industry for more CRNA positions (i.e. demand) and greater autonomy?  It’s our association promoting more collaborative and all-CRNA opportunities.  In this way, working towards more opportunity for independent practice has a clear impact on the lives and opportunities of CRNAs in ACT models.  Simply put, more CRNA positions = a better job market.  More autonomy = more satisfaction.  

    Let’s flip it.  

    If you’re an independent CRNA, you’ve likely experienced administrators and surveyors trying to enforce restrictions that limit your autonomy and your ability to work[5], or even physician anesthesiologists .  And you’re likely aware that the ASA is trying to push medical direction as a standard everywhere[6], which if successful, would potentially change the model of care that you enjoy.  

    Now, how do we push back against restrictive regulations?  How do we make progress for CRNAs as a profession, with more practice opportunities?  

    It’s through our association.  You know who funds a large chunk of the association?  CRNAs who practice in ACT models.  

    So, CRNAs in both models benefit from one another.  

    “Shared The reality is only looking out for ‘number one’, doesn’t actually work out so well for ‘number one’.”

    Despite the natural tendency towards tribalism, the truth is, if CRNAs in one group does poorly, so does the other.  Let me give another example.  It is often outspoken CRNAs, who practice independently, who can forcefully advocate against things like AA legislation without fear of retribution.  This directly benefits CRNAs in medical direction, and only indirectly benefits the CRNAs in independent practice.  I could go on, but there exists an obvious symbiotic relationship between CRNAs in these different models.  The reality is only looking out for “number one”, doesn’t actually work out so well for “number one”.  

    Bottom line: It’s in everyone’s personal interest to promote the interests of the entire profession.  It pays dividends – both financial and otherwise.  

    [1] Though, the actual fulfillment of TEFRA guidelines was rare.  

    [2] There are two “markets” of which to be aware.  As an employee, you exchange your billing rights for being in an established practice.  The other market is the contract market, in which you take on the risk/benefit of forming an enterprise and pursuing contracts.  

    [3] Read the news article here:

    [4] Or the research here: 

    [5] FYI, AANA was successful in getting rid of one of these regulations, which is very important for CRNAs in the fastest growing segment of surgery: outpatient procedures.  See:

    [6] Although, they are seemingly failing, as collaborative models seem to be gaining traction in the marketplace.  See here: 


    Joseph A. Rodriguez, CRNA, is a managing partner for Arizona Anesthesia Solutions, an anesthesiology group based in Phoenix, Arizona. Utilizing leadership techniques and strategies that are both old and new, Mr. Rodriguez and his colleagues have grown the group from a single office to dozens of offices, ASCs, and tertiary care centers throughout the state, with 40 FT CRNAs. Additionally, Mr. Rodriguez is the former president of the Arizona Association of Nurse Anesthetists where he’s been part of teams with a record of regulatory successes including Opting Out, the country’s first surgeon immunity statute, and establishing CRNAs of AZ PAC, which has grown to be Arizona’s top political action committee. Mr. Rodriguez resides in Northern Arizona where he maintains a clinical practice in addition his administrative responsibilities.