CRNA Student Loan Changes: What This Means for CRNA School

If you're an aspiring CRNA, advocacy can feel distant. It can feel political. It can feel like someone else's job. Most people don't get involved with advocacy until something directly affects them, until it becomes personal, until it's their job, their livelihood, their family, or their future. And this proposed student loan legislation is one of those moments. If you're an aspiring CRNA, this is not theoretical. This directly affects whether your education is financially feasible, It affects whether access to nurse anesthesia remains a possibility for the next generation. And that's exactly where we are right now. The Department of Education is in an open comment period, which closes on March 2nd, 2026. Now, this is not the same as contacting your legislators. This is about submitting a formal public comment directly to the Department of Education. Legally, they must review all submitted comments, and it's important to note that duplicate letters are discarded. So personalized comments, even if you simply adjust the wording and tell your own story, they count. If you're an aspiring CRNA, tell them how this affects your decision. Tell them what barriers this creates. Tell them why access to nurse anesthesia education matters to you and your community. Welcome back to the CRNA Mentor Podcast. Today's episode revisits the One Big Beautiful Bill Act and its impact on nurse anesthesia education. This episode is part of our advocacy miniseries, and it is an urgent call of action to all of our listeners. We originally filmed this interview back in December of 2025 with Dr. Daniel King, but we need to revisit this topic. We only have until March 2nd to submit letters during the open comment period. A critical point to point out here that has evolved since this interview was filmed is that we have received the official language from the Department of Education as to who will receive that $200,000 cap and who is stuck at the $100,000 Kap. In the interview, we talk about what has transpired in terms of the timeline from the bill being signed into the law to the development of the RISE Committee being formed, and now the proposed rule being published. That is where we are right now. So this window to comment is closing shortly, and this will finally go into effect on July 1st, 2026. And before we get into this episode, I want to quickly walk you through submitting a letter to the Department of Education through the AANA. So let me share my screen real quick. So this is very easy to do. All you do is click the link in the show notes, uh, tell the Department of Education CRNAs are professionals, and you're going to, uh, click on this. You're gonna enter in all your information. And then the important part down here is you're going to select, um, your status. You know, this is for CRNAs, uh, nurse anesthesia residents, even, you know, they have options for concerned citizen and healthcare providers. So your friends and family can fill this out as well. So after you enter in your information, it will take you to this next page. Now this part is very crucial, as I outlined earlier, you have to change the wording, make it personal. And this is where it's very important for all of our aspiring CRNAs to tell their story. You know, as Daniel says in this interview, your story is powerful and this is exactly where you get to showcase it in this message to the Department of Education. All right, so customize it, scroll down all the way to the bottom and hit submit. It's that easy. Let's learn more about why this is so important and get into the episode.

And today I brought one of my favorite people within the AANA, Dr. Daniel King. Dr. Daniel King is a practicing nurse anesthesiologist. He is the owner of Dream Lion Anesthesia and an associate professor of nurse anesthesiology. Dr. King holds a doctorate of nursing practice from the University of Alabama and a master of nurse anesthesia from Mayo Clinic College of Medicine and Science. Dr. King has served in the profession in various leadership roles, including the AANA's board member and then the current Region 3 Director of the American Association of Nurse Anesthesiology. So thank you, and we'll bring Daniel on here. Daniel, how you doing?

I am well. How are you?

Great, great. Happy to have you today. Our last individual from the AANA was Dr. Jeffrey Darna, And he had a rainbow at his backdrop that he couldn't get rid of. And that was kind of— I brought him on the screen and it was this big rainbow. And unfortunately, you don't have a rainbow today, but we're going to have a fun time talking about this one big beautiful bill.

I'll try to channel the same energy.

I'll tell you what, from Annual Congress, his energy, I said his stage presence was probably better than the keynote speakers at Annual Congress. He did an awesome job. Just real quick, as we get into talking about this One Big Beautiful Bill Act, it's important for Daniel and I, we just wanna have a disclaimer here and say that the views and opinions that Daniel and I have and share today, they are our own and they don't represent the positions of our employers, affiliate institutions, or any organizations that Daniel or I are associated with. I've spent considerable amount of time trying to help mentees navigate this very question, and it's something that it's evolving, right, Daniel? And it's something that we're kind of in the middle of, you know, as when this started and this, you know, One Big Beautiful Act was signed in July till, you know, this coming July is when we may see it enacted.

Yeah, certainly. I mean, it's caused a lot of attention, but you're right, Tyler, this has been progressing since July.

As we get into this, you know, I'm trying to tap into all these various different resources from reading The One Big Beautiful Act myself to, you know, trying to navigate different things, and it was super timely. Give a shout out here to Beyond the Mask and actually as Grade One View, their sister podcast. Michelle Canale, Dr. Michelle Canale and Dr. Greg Collins were featured in that yesterday. That episode dropped And it kind of helped me refine some of the content that I wanted to talk about and kind of drove some points that were kind of new to me. So I'm gonna, you know, shout out to both Dr. Ken Alley and Dr. Collins. But as we get into this, you know, I want to talk about kind of the timeline of this, how things have transpired. You know, I initially talked about, you know, it was July 4th of this year that the One Big Beautiful Act, the bill act, was signed. Into law. And what kind of happened and transpired from that, the Department of Education formulated this RISE Committee. And the RISE Committee is an acronym for Reimagining and Improving Student Education. And really the aim of this committee was to address these student loan changes. They had a couple sessions, one from the end of September to the beginning of October, and then most recently, which is the one that kind of may have put this whole thing on your radar happened at the beginning of November. And so from that, you know, they didn't have these clear definitions and they got a lot of pushback is what many of you heard was, you know, that maybe that nurses weren't recognized as professionals anymore or something to that nature. And that's, you know, I started seeing it all over social media. It really kind of blew up at that point. Mm-hmm. And we're kind of in the middle right now. There's nothing that is— there's still time, I guess, is what I really want to drive home with this entire discussion. They're planning to meet the beginning and have kind of rules put out at the beginning of 2026, so likely January. And then this may— is likely to be enacted here then in July of 2026. Anything, Daniel, you know, in terms of that timeline that you might want to add?

Well, you make a really good point, Tyler, in that we're really in the middle of this, and it's a long process. What many of you may not realize is that once a bill is signed, there is typically a rulemaking period in which proposed rules actually become integrated and actually enforceable. And we see this a lot in, in the healthcare landscape. We see it in different ways, um, related to reimbursement issues that we deal with at the federal level. But this is just another example. And so the RISE Committee that you mentioned, uh, is playing an important role in that rulemaking process. The concerning thing that we have seen is how they are defining, um, professional or student titles. And that is part of that rulemaking process. It is not finalized. Yet. There are proposals that you've all heard about, but it is not final, and this is not set to be final until July 1st of next year. So in the meantime, the RISE Committee has had a couple of sessions. During those sessions, ANA and different banded coalitions have filed letters pushing to explicitly include advanced practice nursing. Nurse anesthetists or nurse anesthesiologists, nurse practitioners, PAs, as part of the language that would be part of the higher capped loans.

Right.

The Department of Education is really signaling that they want narrow rulemaking that's tied very closely to existing regulation and what Congress has intended. So they're moving very aggressively in what we've seen, and all indicators show us that they are moving very intentionally and very aggressively. Since their November 6th meeting, they had met recently in November, there's been a lot of statements come forward. AACN has been a huge leader in this space. AANA has been a big leader in this space as well. And ANA, which is American Nurses Association, we've all been banding together. AANA has collected data from program directors and sent a letter to the Undersecretary of Education that was actually signed by 85 CRNA program directors. And it detailed how a $100,000 cap would uniquely damage the nurse anesthesia profession and our educational structure. We've also seen a lot of congressional movement as well, um, which shows us some marked progress there. I think the more— congressional leadership we get to band together on the issue, the further we're going to progress. Um, but we've seen, um, uh, Kiggins as, uh, our champion again in the space, Jen Kiggins, as well as some other legislators urging the Department of Education to treat graduate nursing and advanced practice as professional degrees for loan purposes. So the Department of Education, where we're at now, is You know, they're expected to publish this proposed rule in early 2026, and that's when we'll see the official and not just the proposed language on who's gonna get that $200,000 cap and who's stuck at $100,000. And that's when public comments open for what's predicted to be a 30-day window. So that's when we're really gonna move, and we really need to mobilize as a profession and be ready. To act because otherwise the new loan caps are going to kick in on July 1st, 2026, and that will overwhelmingly hit future cohorts, which is many of you watching tonight. So the sequence is simply the bill has been signed—

Thank you.

HR 1 has been signed into law. The RISE Committee has been formulated to promulgate these rules. The proposed rule is going to come out early 2026 and go into effect July 1st. So you're right, Tyler, we're in the middle of that chain right now. We're not at the end of it. There's a lot of work to be done. So do not be defeated. Um, uh, take this energy and use it for good. The game totally changed when they decided they wanted to kill Grad Plus, um, and tie your lifetime borrowing to a category that nursing was not listed in. And that suddenly matters. And that's really what the outrage is all about. Yeah.

Yep, 100%. And, uh, you know, you, you talked about— and actually, let me share my screen here. So this was a press release, um, from the Department of Education on November 24th. And if you, if you can see some of the verbiage here is, you know, these loan limits will help drive down the cost of graduate programs and reduce the debt students have to take out. Um, you know, they go on to kind of talk about this more, but one of the things that Daniel and I really aim to do with this whole presentation, this interview, is really try and keep it bipartisan. You know, that is exactly what the ANA does as they navigate these issues, and that's very important. But as we talk through this, Daniel, can you share a little bit what you, when we were talking about this beforehand, what you kind of said as it's myth versus fact?

Yeah, for sure. So, you know, I'll just be honest and give you my most immediate impression to this is that at first, initially, as I looked at this, it appeared to be very deflective or very defensive. Expensive. And the need to publish, like, something like this comes from the fact that so many people are upset, and it's trying to set the record straight. What's interesting about this document is that the lack of evidence presented here, right? So you normally— and as many of you know or are learning, um, evidence should really guide your statements. There should be citations, there should be references, there should be substance behind what's being said. To really support the statements that are being made. And we're moving in real time trying to collect as much data as possible and stay fact-based and stay oriented and grounded in the facts and evidence so that we can act accordingly. So that's what's the most concerning thing about this document. The other thing is the statement that this will— and how it will impact tuition. And as we talk about evidence, You know, the concerning part about this, as we look at this document, is that in the short term, at least, there's no evidence to suggest that this is gonna drive tuition down. AACN has really pointed out there's almost no evidence that lowering federal loan limits reduces tuition, especially in clinical or professional programs. Instead, what it does is it just shifts students into riskier private debt, Mm-hmm. Or away from programs altogether. And there is just really little evidence that cutting federal loan eligibility is gonna make universities drop tuition, especially in high-cost, highly specialized clinical programs. And the cost drivers won't magically get cheaper as our programs in anesthesia are highly specialized. We have very high-cost simulation equipment, labs, mannequins, clinical coordination, accreditation, malpractice coverage. Um, our faculty already take a major hit in a market where there's already a shortage of very highly trained CRNA faculty. And so the programs can be more efficient and cost-conscious, certainly, and I absolutely think they should be, but expecting this law to cut tuition, in my opinion, is very wishful thinking. And so cutting the loan caps doesn't cut the bill the university sends you, it just more clearly restricts who can have access to that classroom.

Yep. And, you know, as we try and navigate this, again, I think what many of you have heard, and social media kind of blew up with, you know, this idea of this professional degree and nurses are no longer recognized as a, you know, professional degree. And there's a lot of back and forth with that. And it's largely because, in 1965, that's the definitions that they are working off of. And back then, you know, nurse anesthetists, advanced practice nurses were not recognized as a professional degree. And, you know, the question is, you know, as we talked about earlier, Daniel, is this like semantics? Is this, you know, does this matter? Does this matter, this professional degree and this nomenclature?

Yeah, for sure. I mean, when you talk about semantics, I think about the emotional aspect of that as well too, right? And We can inform others with facts, not just those emotions, and then we mobilize. And I wanna make it really clear that at the end of the day, this is about access to care. It's not about ego. And so when we think about the role of this title, it really is, has always been regulatory and financial.

Mm-hmm.

Right. Um, it's not, it's not saying that nursing is not a profession. Nursing has certainly always been a profession. Um, federal law has always had a list of professional degrees, whether it's MD, DO, dental, pharmacy. Um, and historically that was just an accounting category. Nursing wasn't on that list, but it didn't matter because we had Grad PLUS up to the cost of attendance. So fields out of the list are all graduate nursing programs, our PA colleagues, our PT, our OT colleagues, so many others.

Yeah.

But for those like ours, and when a CRNA provides the same type of anesthesia that a physician does, but you fund that route differently, the question can also become what Dr. Collins brought up in the, in the podcast that came out yesterday is, is this anti-competitive? Right.

Right.

If you're gonna fund those routes differently to achieve the same outcome, why would you disadvantage one but not the other? It doesn't really make sense.

Yeah. Yeah. That was something I was— that wasn't even on my radar when he— and Dr. Collins said that, I was like, wow. And this— he said, you know, this is kind of the angle that the ANA hopes to approach this is that this is anti-competitive, you know, and, and if we're providing the same service, Why are we allowing that? Yeah, I thought that was very interesting. One of the things I wanted to ask you, Daniel, is that, you know, in searching through all this content, having this way out in the open, so much so that the Department of Education is making these press releases specifically towards nursing, is, could this be something that not being on this list, could our, you know, friends with the ASA, could they try and leverage that for legislation? Could they try and work that angle that we, we are not professional and they are? Is that something we'd have to worry about or not so much?

Well, it's something they're already doing, and so we should be concerned about it. They already do that in different ways, and so we should always be concerned about that. The— at the end of the day, it's about access to care, and the question isn't really, are CRNAs professionals? The question is, can we afford to lose an entire generation of advanced practice clinicians over an arbitrary definition? And so for us, we've been very, very focused on this workforce shortage perception, and it doesn't make sense to, to cut out the, the legs from under your, what you need to mobilize to address the workforce shortage. So that's kind of how we're going about it. But, um, Yeah. You know, it's— you can't make it financially impossible for people to fill that workforce shortage. And that's where our focus is at the end of the day. It's on access to care. And certainly we're always dealing with that, whether it's title protection, you know, our qualifications or our scope of practice. I want to be clear that this should not— this doesn't currently impact our scope of practice, but it is something that we're always dealing with. We're always working to maintain and defend our scope scope of practice and to work on those issues. And this is just another, you know, another pawn in the game.

Yeah. And as we think about this, you know, talking about access to care, you know, one of the big questions that my mentees have had, whether it's my nurse anesthesia residents that I have in clinical, I was just talking to one the other day and we were talking about this and she's like, oh, my boyfriend just got into school. I had a phone call yesterday and, you know, this nurse was like, "Am I gonna be able to borrow enough money to cover my education?" And that really is the question, you know, and let's just break that down real quick. You know, so the category where nurse anesthetist students are defined as now is a lifetime aggregate of $100,000, or more importantly, this $20,500 per year, all right? Versus if you're professional, like, medical students, you know, they and residents, they can get $200,000 aggregate and then $50,000 per year. And, you know, looking at that, you know, that yearly allotment, that is the big concern here, right, Daniel?

Absolutely. And that's really important that you point that out because everyone is focused on the $100,000 versus $200,000 cap. That's for a lifetime cap. There is also an annual cap. Like you said, $20,500 a year. So let's do the math on it and recognize that our annual— our average CRNA program is 3 years long. So then what does the total actually become? It actually becomes closer to $61,000. Right. And so I don't know where you can find a program that the tuition and your cost of living and everything adds up to $20,500 a year. I think the average cost of living in the United States is somewhere around $77,000 per year. And you're likely to hit that $100,000 lifetime cap before you're even paid full tuition, never mind living expenses, especially when you're in a 3-year program. And what makes our programs unique is that you can't work while you're in those programs, like you could potentially a nurse practitioner program or something else.

Mm-hmm.

Um, and so the gap doesn't disappear. And students just get pushed into riskier private loans or out of the profession entirely. And in fact, there was a survey recently on nurse.org, preliminary survey that showed about 60% of people are being deterred from going to school. Nurses are deterred from going to graduate nursing programs now.

Absolutely. And, uh, you know, quick shout out to, uh, Dr. Michelle Canale. She was, she's very, uh, helpful in our community. And, uh, in, you know, that, uh, Grade 1 View podcast, she shared her tuition. So she said in her program, if you're in-state in Florida, it's $72,000 for the entire program. So, you know, those allotments, those yearly allotments wouldn't be enough to cover her program. And, uh, one of the things that was kind of foreign to me as I navigated this space going through school is really understanding the different loan structures. And I want to I know you already hinted at the graduate plus loans, Daniel, but I want to kind of flesh that out a little bit more. We're talking about the tuition. When I say $72,000 for Michelle's program, now the graduate plus loans, that's kind of a different animal. Those are for your cost of living, right? And as you said, you're not working, you have your childcare, you have your car payments, you have your housing, you have— Yeah. Everything. And if you can't work, how are you going to pay for that? And that's where these graduate plus loans came in. And many of my classmates relied on these loans throughout school. And, you know, it's something that, that is completely being eliminated. I don't know, that's, that's crazy to me that, you know, we're talking about the, the tuition and all these caps, but then that elimination, in, in my opinion, is, is the one of the biggest things here.

Yeah, absolutely. I mean, you hit the nail right on the head, and that Grad PLUS elimination is for everyone. So the proposal, it's gone for, for everyone, right? And there's no more up-to-the-cost-of-attendance safety valve that comes with a Grad PLUS loan. There essentially was no cap there. It covered all your costs to cover your tuition. It covered your cost of living expenses. And there's no way that I would have been able to afford or finance my education without those loans myself. You know, the great news about the CRNA specialty is it's a pretty good investment with a great return. And we have really high earning potential and a really, really near low, almost near zero default rate on these loans. And so again, it just really doesn't make sense. It's a great investment with a great return.

Yeah.

And the elimination of that, it just doesn't make a whole lot of sense and it's gonna make it extremely challenging.

And a big takeaway that, you know, a lot of nurse anesthesia residents will mention as these life events come up is, you know, life doesn't stop when you're in CRNA school. You know, your car still breaks down, you know, your family members still get sick. And those are all these other external pressures that, you know, are highlighted and made even more challenging because of this. So, Daniel, who's going to be affected from this? You know, we talked about 7/1/26 is when this is going to be enacted. What happens if you are already in a program or you start— say you start in the spring of 2026? Is this something that will still— you'll still be affected by it or not as much?

Yeah, that's a good— I mean, that's a good point as well. The changes apply to loans first disbursed on or after July 1st, 2026. So if you're already in a program, your existing loans don't get retroactively cut, but later disbursements could be under the new rules depending on the timing. So the biggest impact is on our future cohorts. And that's why I'm so passionate about this as well, is, is today's pre-CRNA and pre-APRN students planning to start in or after 2026. Mm-hmm. We're advocating for you. And unfortunately, who feels it the worst, and there's a major tie to equity here that is a legitimate concern as well, is our first-generation students, our students from disadvantaged backgrounds, our nurses from rural or low-income communities, those who have changed careers multiple times, right? Mm-hmm. Are those like me who didn't have generational wealth or family wealth to enter a program to lean on, or not really robust savings at all. And so this definition, it hits in many different ways, and many fields are really on the wrong side of this line here. And the cost of attendance is high, and the ability to work during school is essentially zero. So it affects all of us, and it affects— some of us in different ways.

Yeah. Now we talked about it a little bit, but you know, this idea that tuition will go down, as the Department of Education says, I just want to kind of build that out a little bit more for, for our aspiring CRNAs to understand. Um, just a quick little story here. Um, you know, I, I, I'm very vocal at work, you know, it's engaging with the nurse anesthesia residents, the staff in the room, you know, I talk to them about what's going on with this one big beautiful bill. I was talking to my old program director the other day and I said, "Do you really think the tuition will go down?" He goes, "Tyler, I took a $60,000 pay cut back in 2014 when I was your program director, when I stepped away from being full-time in the OR. That was over 10 years ago. What is that now?" And— You're looking for these people that are— and educators that are going to be shaping the future generations of our field. And you want high-quality people. It's even recently for myself, you know, I teach here and there, but I am not full-time faculty. There was an opportunity where this past year I could have interviewed for a position. I ended up going into a managerial role instead. And part of that is I have 4 kids. We recently built a new house and it made things easier from that financial side of things to make that decision. You know, as we look at the, the costs of school, what, what kind of goes into, you know, some of these, these reasons that your tuition is high? Simulation lab, do you want to talk about that a little bit?

Yeah, I mean, the, the more specialized your field is, the higher the cost is going to be because you have to meet the demands the education, um, the qualification, the capability, the skill, um, and really deliver on all those things. I mean, simulation labs are massively expensive. Um, simulation mannequins are massively expensive. And we know that anesthesia is just too high stakes to not be well skilled. And so having the right equipment in place is really important. You touched on the faculty salaries.

Mm-hmm.

Um, as well, faculty do not, um, make nearly what they could make in a clinical setting all around. Um, the Faculty Stabilization Task Force that the ANA assembled a while back taught us that, among many other things as well. And we already have a shortage of faculty, and we have a hard time retaining faculty. Um, it's hard to pull people out of a clinical environment to take reduced pay and, and to educate the future. That is a really special type of person that does that.

Absolutely.

Your heart has to be fully in it, and Tyler, you'd be a great faculty, um, and anyone would be lucky to have you. And so I do hope you consider that.

The timing's just not right. The timing's just not right.

I understand. I mean, I completely understand, um, you know, and I want to be clear that the reason to advocate is not to defend faculty salaries. It's just not the dynamic in which this happens. Unfortunately, that's not how tuition gets reduced. And I hope that is the effect. I really do. But I think that it would be a long-term consequence if it ever happens at all. And history has told us that's not the trajectory that we're headed.

Right, right. Yeah, it's, it's, in my mind, it's a crazy thought to see as we're seeing this crazy inflation to think that anything is going to go down, including our education at this time. But, um, you know, what, Daniel, could be some alternative options? You know, we talked about all these different things that are changing, but what, what's out there? I know obviously this idea private borrowing for loans.

You know, as we are advocating and fighting for reversal of this or change in this proposed rule, we also need to build in some contingency planning. We need to make sure that our members and our RNAPR members especially are educated, informed, and equipped to be successful. There are many options out there, and some of them are gonna sound like I'm just saying, oh, we'll just bootstrap harder and save more money. I want to be clear that it's certainly not that, and we're going to be much more solution-oriented than that as well. And many are going to seek initially to fill those gaps with private loans, right?

Right.

The challenge with that is, and probably the market will change because we'll have— we would have an influx in private lenders seeing an opportunity here. But the interest rates are often much, much higher for those private loans. The protections are much, much weaker, and there's no income-driven safety net either. So you have to think about different things, right? Like those with— who have property or wealth may need to think about home equity lines, but that locks out lower-wealth students, right? Like, that's a major disadvantage. You may even need to think about family loans or cosigners. And again, there's no public service option, there are no federal loan protections with the private sector. I think that we're going to potentially see, or we should think about some earn while you learn or some employer-based models. There are several employers that have recently announced that there will be hospital or system-sponsored programs with service commitments after graduation, meaning if you agree to come work with us for 3 to 5 years or however long it is after for graduation, we're going to pay for your education. That's a great investment and a very smart investment by many employers. And it's a great tax write-off as well, oftentimes.

Yeah, for sure.

For that employer as well.

Yeah.

So those can be a good option if you're clear about the contract and you're willing to commit to a specific employer.

I think that last part especially is very important. You know, I'm involved with leadership at my hospital kick around some of these ideas from time to time. Will we be doing that more now that these things are changing? But at times you have to be very careful because some of these hospitals, they may seem like all things are good, but it almost feels predatory in a sense. So you need to make sure that those hospitals are somewhere maybe you've worked and you could see yourself there for some time. Maybe it's around where you wanna settle down with your family or what have you.— and as I had this conversation with mentees quite a bit— is, should I just sign up with my hospital? You know, the market is changing so rapidly and it's not always going to be in this crazy upward trend as it's been, but you really need to kind of weigh all those different options. And if, you know, sometimes the terms are 3, 4 years, sometimes more, could you suck it up for that amount of time and kind of have that trade-off? But, you know, it's really a loaded question, uh, looking to sign up with an employer, especially if you're not familiar with the hospital or the anesthesia group.

Yeah, you're right. I mean, 3 to 5 years in healthcare is eons right now. I mean, look at all that's happened in a very short period of time. We have people signing month, 6-month, year-long contracts. I mean, there's not the loyalty to employers like there used to be. There's a lot of moving around. Um, so yes, that's an important That's a very important consideration that you need to think about as well.

Yeah, one of the things that, you know, as you talk about bootstrapping and just, I think as you try and navigate this, you know, try and stay up to date with these topics, but building out your financial literacy now, I think all of us could benefit from that. You know, I was talking to one of my mentees, I actually work with her, and I was asking, she recently got accepted to school and we were having this conversation about, just what we're talking about today. And she's like, yeah, she's like, I was just meeting with a financial planner to see like what my options are. And I said, did your financial planner, did they have any idea of like what's going on in our field right now? And she said, no, not really, but at least she's thinking ahead, right? At least she's trying to— it's great to utilize somebody in that capacity that can navigate all these, you know, different pieces to the puzzle.

Yeah, definitely. I mean, you, you should be doing all those things, building a modest emergency fund, meeting with a financial planner, paying down as much undergraduate debt as you possibly can, and think about what opportunities are out there. Does your employer offer tuition reimbursement? Can you take an educational leave of absence? And, you know, there's so many different things to think about. The ANA Foundation has scholarships. Many state associations have scholarships, and they won't cover everything, of course, but they're all things you need to be thinking about what your what your options are. And generally, that's a good idea with or without this proposed rule.

Daniel, one of the things I wanted to kind of pivot into, one of the big reasons I have you here today, aside from following all your content, listening to your lectures and stuff at the different conferences, but, you know, talking about the ANA in this position right now, where we're at as we're trying to navigate this, the ANA's mission is to advance, support, and protect nurse anesthesiology. And that is advocacy. And one of the things, you know, in attending Midyear Assembly this past year, I was just blown away at the degree at which that advocacy occurs. It's not just, oh, you know, we support nurse anesthetists, nurse anesthesiologists. We have lobbyists. Daniel, can we talk about that a little bit more specifically with our association?

Yeah, for sure. So, um, whether you're a member of the AANA or not, we are advocating for you every single day. Many people may not know that we have a robust staff of over 100 people that are actually not CRNAs, but work every single day on the behalf of CRNAs to do all those things that you just mentioned in terms of promoting, advancing, and protecting nurse anesthesiology. And, uh, that includes a team that is on the ground here at our headquarters in Wash— in, um, Chicago where I live, but also in Washington, DC as well. We have a huge, uh, a big lobbying presence and, and we stand toe to toe with some major societies like the American Medical Association and, um, the ASA. We have professional lobbyists and policy staff staff in DC working this and on this issue every single day. It is not a side project. It is our priority. And regardless of anyone's level of engagement, whether you're a member or not, we're working for them. And I hear often, you know, from people, well, I don't want to get involved because I'm not into politics, or you sponsor Democrats and I'm a Republican, or you sponsor Republicans and I'm a Democrat. And I will say we are not Democrat or Republican. We are the party of CRNA. Um, it, it takes a bipartisan effort to accomplish absolutely everything that we do. I sit in the offices of Republicans. I sit in the office offices of Democrats, all speaking to these issues. These are human beings. Often we're able to talk about stories in which their daughter had an epidural for labor analgesia, or they just had a colonoscopy and they may not have realized that it's a CRNA who took care of them. And at the end of the day, they are making decisions that impact healthcare and impact patient care, right? And they're doing that whether they're informed or not. And my first time that I ever went to Washington, DC for Midyear Assembly, and I'm sure you'll share your experience as well, Tyler, but the first time I, I sat there, I thought, Oh my gosh, these people have no idea what a CRNA is. They don't know how to say the word nurse anesthetist. They are speaking on issues, and it's up to me, or someone's got to be there to talk to them about this, because otherwise they're just going to vote uninformed, and that's going to have trickle-down effect on my practice, and it's going to have trickle-down effect on my patients, or direct impact, and that could be good or it could be bad. And so that presence is so important. And I tell people too, that's fine if you're not into politics, support the people who will go and do this.

Right.

The easiest way to do it is just be a member of the ANA. But whether you're into politics or not, politics is definitely into you. And every single day, someone is working in DC to either advance or limit your scope of practice and the role that we play in healthcare.

Yep, 100%. And yeah, no, I got the similar feel is that like, I always thought like politics is not for me. I'm not interested in that. And when I went there to Midyear Assembly and it's like, I'm not Democrat, I'm not Republican, I'm CRNA. And having an association like that that supports that, it, you know, I feel like there's people, CRNAs that practice that are not in favor of our association because it's, or they don't agree with one single issue that doesn't align with their political views. But it's not about that. It's about supporting this profession and moving it forward. And that kind of bipartisan approach is so important. I think it's so important for all of our aspiring CRNAs to know and understand that if you are supporting the ANA, you are supporting this profession, not a single issue or your specific political views. So that's great. I had the opportunity to meet Matthew Thaxton. I did an RN meet and greet at Midyear. He's our federal government affairs director. I met him, you know, kind of casual conversation before that. And then he came, I had him talk at the RN meet and greet later. I see him on stage all over Midyear Assembly. I'm like, holy crap. I went up to him and I apologized actually at Annual Congress. I'm like, Matthew, I said, I want to apologize. I said, I didn't realize how big of a deal you are. You are like the lobbyist for the ANA. He's like, ah, I'm not that big of a deal. To have people in our corner in DC all the time, like that speaks volumes. And it's just so exciting to be part of an association like that, that has our interests at the forefront of everything that they're doing. Going back to Greg Collins and, and, and you know, that, that podcast yesterday, he, you know, he's, and I thought this as I'm thinking of this podcast today, he said, why does the ANA exist? Like what's its purpose? And he said, this is our purpose. Like this advocacy right now is the purpose of the ANA. And, you know, Sharon Pierce has said this before. I've heard other leaders within the association say that if it weren't for the ANA, nurse anesthesiologists may not exist.

Tyler, I'll just add one thing to that, in that we wouldn't exist, but there's also no guarantee that we will in the future. And I know that sounds dramatic, but it's— I'm being very honest. You know, we need to think about that going forward.

Yeah, no, great point. I'm gonna share my screen here again. This is one of the call to actions, and this is kind of the most recent one in regards to all of this. And what I want you guys to do, there's still a day left, just plug in your name. And one of the things I wanted to show you down here, if you can see the screen, let's see. Concerned citizen is an option here. You know, CRNA, RRNA, and concerned citizen. So your family members can fill this out as well, I believe, right, Daniel? It can be anybody.

Yeah, anyone can fill it out.

So once you fill this out, I'm in Pennsylvania, so Senator Fetterman, Senator McCormick, Representative Resnahan, it— when you plug in your address, it populates this. So you're not searching for who do I, you know, who am I trying to address, and then it gives you this message. But go ahead, Daniel, I'm sorry.

Yeah, that's— that was the first point I was going to make, actually. Um, so we make it really easy for you. All you need to do is put your zip code in and we're going to route it to the right people. Um, but in this day and age, some of these letters can just get lost in spam filters, especially if they're in bulk. And they all look the same. So something that you can do to make it a little more successful is to just customize some of the language a little bit. And I often hear from students or prospective CRNAs and they're like, well, I'm not a CRNA yet, and so my voice doesn't really matter that much. I would actually argue that your voice actually matters a lot more, um, maybe than mine, because especially in this circumstance like you have an ability to tell a story that I can't about your own circumstance. So if you just tailor this a little bit to your story, you know, tweak a few words, it is more likely to make an impact. And it's really easy. It just takes a couple of minutes.

Yep. Yep. And so when I sent this out, I got a response from Senator McCormick's office maybe 5 days later or something. So it's super easy. And I think that's really the highlight I really want to drive home. With these call to actions. And here's a, here's kind of a list, you know, this is the most recent one. How can, Daniel, how can they sign up to receive these call to actions? Where can we find this? Anybody who's interested in, you know, following through with this.

Yeah. So there's, there's an advocacy tab at the top of the ANA webpage. And if you click on that advocacy tab, you can actually sign up to receive text alerts So anytime there's a call to action, that's going to come to you in, in form of texting. But also, if you're a member of the ANA, that's going to come out in e-alerts. It's going to come to your email. It's blasted on our social media pages. So I would encourage you to make sure that you're following the ANA on Instagram and on Facebook. I often share these alerts as well on my Facebook.

Okay.

Page, my ANA director page, and my social media as well.

So that's, you know, that's what you guys need to do is just get on there, fill those out, and that's the biggest thing that you can do at this time. Anything else to add there, Daniel, in terms of how can we continue to fight this?

Yeah, never underestimate the power of storytelling, right? I wear a CRNA ball cap every time I travel on an airplane, and you'll see they're out periodically. Like right now they're in the merchandise store for CRNA Week. Typically we have different apparel and things like this. Every single time I wear that hat, someone stops me and makes a comment or asks a question, and it's an opportunity for me to inform them about what it is that I do and how I make a difference, um, and to represent the profession and to represent 70,000, um, nurse anesthesiologists throughout the country. And that is powerful. Yeah. And I would say never underestimate that. I mentioned to you that, you know, legislators are humans too. Like they get sick, they need care, they have surgery, they've been students before, they maybe have had financial assistance. Your story can resonate in ways that you may be underestimating. And so that collective voice and that, and being able to tell our story is incredibly powerful. Thank you.

Absolutely. Um, you know, I know we talked in— and this is kind of the conversation I've had with some of my colleagues, uh, you know, they say, oh, this is— all this stuff is kind of gloom and doom. And a lot of our discussion, I may have caused some anxiety, but I, I do want to talk about how CRNAs are, are kind of well positioned in this issue. You know, even looking at our counterparts, the physician anesthesiologists, we talked about this workforce crisis And how many, you know, CRNAs are coming out each year versus how many anesthesiologists. Michelle mentioned that the other day is, you know, 2,800 CRNAs each year from all of our 150-ish programs to only about 2,000 anesthesiologists. So lots of locums being utilized, lots of understaffing, but having this on our side as a negotiating piece, or at least a piece to kind of say, this is why we need this. Also, we talked about, you know, the, the default rate on student loans for CRNAs is less than 1%. So in terms of this student loan crisis, that why they're reeling this all back, it's like, well, we're not part of that. The vast majority of us are not part of that. Um, even the high incomes that we can earn afterwards, over $270,000, you know, nationally. So there, there's lots of boxes here that we're kind of like outliers from this whole discussion. So what are your kind of takeaways or what else do you have to add with this, Daniel?

Yeah, I mean, that's a good point, right? So a lot of it may sound like I'm pessimistic or doing a lot of contingency planning, and I think that's just being smart and thinking about how to navigate. We are being smart about how to navigate this collectively. And I think Dr. Canale also said something like, You know, we are a winning bet when you think about it. Why are we well positioned? Um, because of— we have workforce data to show us that the growth of physicians entering anesthesiology has plateaued. Meanwhile, we're still growing by leaps and bounds. Um, we have always said that we are— CRNAs are the solution. We are the solution. We know we are. We are the primary anesthesia provider in many rural and critical access hospitals. Right. And we are a workforce solution. Um, we are a bet that you can make with a near 0% default rate. Um, there's a huge workforce need. There's a lot of CRNAs entering the profession. There's high earning potential to make a return on that investment. And we have a really long history of delivering high-quality, cost-effective anesthesia care that should make us more eligible for robust loans support, not less. And so we have all the talking points and look, this is not our first policy fight. Um, we have deep experience with scope of practice reimbursement and safety advocacy, and we are not giving up on this fight. We are fully in, um, for the entire process and we're gathering the data and we're talking to the right stakeholders and we're going to make progress on this in one way or another.

I love that. I mean, all of that, you know, the gloom and doom, you washed it all away with all those talking points. I just think that, you know, if we just continue to work together and continue to advocate, write your legislators, that's how we're gonna try and kind of shift this. Yeah, don't get discouraged. I know a lot of people out there are feeling very discouraged, just like, oh, one more thing. But the ANA again is fighting for you and so are all of us. So, well, Daniel, I wanna thank you so much for your time, taking over an hour out of your day to help all these aspiring CRNAs. Um, you know, I, I'm so thrilled to, to be engaging and, and talking to more people within the ANA. That's been really one of my big goals, and especially somebody like yourself, uh, you really brought a lot to this discussion that I wasn't all that— I was telling my co-workers, I'm like, I'm really gonna have to rely on Daniel quite a bit for some of this content. This is a kind of uncharted territory for me, but, uh, I appreciate all your insights and everything that you do for our association and our profession.

Thanks, Tyler. It's been a pleasure.

Likewise.

Thank you everyone for tuning into today's episode. This is so, so important. Please, please, please go to the show notes, uh, submit this comment to the Department of Education and advocate for your future. You know, we're all here advocating with you, and now is your chance to make an impact on this profession before you're even started.