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Anesthesia Deconstructed: Science. Policy. Realities. — Health & Fitness
Anesthesia Deconstructed: Science. Policy. Realities.

Anesthesia Deconstructed: Unraveling the Complexities of Modern Anesthesia Practice

Founded in 2018 by Mike MacKinnon, DNP, FNP, CRNA, FAAN, and later joined by co-host Joe Rodriguez, DNAP, CRNA, Anesthesia Deconstructed is an award-winning podcast that consistently ranks as the nation’s top-downloaded anesthesia podcast, with two of the most well-known CRNAs in the country as hosts. We feature industry experts from across the spectrum, exploring scientific issues, policy matters, and the day-to-day realities of anesthesia practice.

Our mission is to deconstruct complex topics, recognizing that the truth often lies in the nuanced middle ground rather than at extremes. We bring unique value to our listeners by examining the nexus of clinical practice, education, and policy, offering insights that go beyond any single perspective.

Join us for thought-provoking discussions that bridge the gap between theory and practice in the world of anesthesia.

Copyright: ℗ & © 2020 Anesthesia Deconstructed: Science. Politics. Realities.

Latest Episodes:

Pre-Dawn Priorities: Essential Job Criteria for New CRNAs Oct 28, 2024

Originally featured on Core Anesthesia and back by popular demand after multiple conference presentations, this essential episode drops at 3:30 AM - straight from host Joe Rodriguez's pre-shift thoughts as he prepares for his first day at Banner University's OR. A fan favorite that's shaped countless CRNA career decisions, this discussion breaks down the critical factors new CRNAs should consider when evaluating job opportunities. Published in those quiet moments before dawn, Joe shares his seasoned perspective on what truly matters in a CRNA position, from workplace culture to compensation and schedules. This highly-requested talk, previously featured at Core Anesthesia's conference series, has helped guide both fresh graduates and experienced CRNAs looking to make strategic career moves. Tune in as Joe delivers these key insights just hours before stepping into his own new contract role. Sometimes the clearest thinking happens before sunrise.

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FTC Loses, and Non-Competes Remain - Understanding Different Types of Restrictive Covenants and What It Means for You Sep 30, 2024

SEASON 7 BEGINS!
Keywords for this Episode
anesthesia, non-compete agreements, legal challenges, FTC, healthcare law, CRNA, anesthesia practice, employment contracts, state laws, anesthesia updates

Summary

In this episode of Anesthesia Deconstructed, host Joe Rodriguez first discusses the latest updates in the field of anesthesia, including legal challenges faced by CRNAs and anesthesiologists, the AANA's bold lawsuit against the federal government, and updates on his personal practice at Guide Anesthesia, which is evolving out of Arizona Anesthesia Solutions. The conversation delves into the implications of non-compete agreements, the recent FTC ruling, and the nuances of state laws regarding these contracts. Scott Weavil, a legal expert, shares insights on negotiating employment contracts and the importance of understanding the legal landscape for healthcare professionals. The episode emphasizes the need for transparency and informed decision-making in anesthesia practice.

Takeaways

The AANA has initiated a lawsuit against the government over reimbursement issues.
Non-compete agreements can serve legitimate business purposes but can also restrict employee mobility.
The FTC's nationwide ban on non-compete agreements has been struck down by a Texas court.
State laws regarding non-compete agreements vary significantly across the U.S.
Negotiating employment contracts is crucial to avoid restrictive covenants that may hinder career growth.
Understanding the legal implications of non-compete agreements is essential for healthcare professionals.
The public needs to be informed about the qualifications of their healthcare providers.
Non-solicitation agreements are often more common than non-compete agreements in certain regions.
Healthcare professionals should be cautious of non-compete clauses that may limit future employment opportunities.
The conversation highlights the importance of balancing individual and corporate interests in healthcare.

Chapters

00:00
Updates!

10:34
Scott Intro

13:58
Legitimate Business Purposes of Non-Competes

17:18
The FTC Ban on Non-Competes

20:33
State Laws on Non-Competes

23:17
Challenging Non-Competes

25:35
Differentiating Non-Competes and Non-Solicits

28:13
The Future of Non-Competes

30:21
Conclusion

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Point B: Joe Rodriguez Shares His Positions and Rationale on Proposed Changes to AANA Board Selection Jul 23, 2024

Key Points:

Importance of the AANA to CRNA economy
Proposed bylaw changes and resolutions
Support for Board Term Extension (Bylaw 2) (with caveats) and Virtual Business Meetings
Opposition to Board Expansion (Bylaw 3) and Automatic Leadership Succession (Bylaw 4)
Rationale behind each position

Summary: Joe shares his views on proposed AANA changes, advocating for longer board terms and virtual meetings while opposing board expansion and automatic leadership succession. He emphasizes the need for efficiency, cost-effectiveness, and flexibility in leadership.

Call to Action: Members encouraged to review proposal documentation and participate in the upcoming discussion in early August.

Next Episode: Tune in next week for more CRNA insights and industry updates.

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Point A: CRNAs Propose Significant Change to AANA Board Selection Jul 23, 2024

Summary

The conversation discusses three main changes proposed by the Leadership Identification Committee (LIC) for the American Association of Nurse Anesthesiology: increasing the number of directors from seven to nine, increasing the term for directors from two years to three years, and changing the progression of the president to a three-year term. The rationale behind these changes is to decrease turnover, increase the number of eligible people for executive positions, and provide more support to region directors. The conversation also addresses concerns about the time commitment for directors and the potential impact on decision-making, cost, and the role of the professional staff. The conversation explores the proposal to increase the number of directors on the board, extend the terms of the vice president and president-elect, and create continuity in executive leadership roles. The main themes discussed include the benefits of having more directors to support state leaders, the financial feasibility of the proposal, the potential risks of electing the wrong person into an important position, the need for continuity and experience in executive roles, and the importance of informed voting. The conclusion is an editor's note, where our host, Joe Rodriguez, expresses his view after taking time consider the conversation.

Keywords

AANA, association, Leadership Identification Committee, directors, term, turnover, executive positions, region directors, time commitment, cost, professional staff, board directors, executive leadership, continuity, experience, informed voting

Takeaways

The proposed changes aim to decrease turnover, increase the number of eligible people for executive positions, and provide more support to region directors.
Increasing the term for directors from two years to three years allows for more continuity and experience on the board.
Expanding the number of directors from seven to nine helps to reduce the workload for region directors and aligns with the growth of the association.
Concerns about the time commitment, decision-making, cost, and the role of the professional staff are important considerations in the discussion.
The financial feasibility of the proposal was assessed and deemed affordable.
There is a potential risk of electing the wrong person into an important position, but the board can address disruptive behavior and provide coaching to mitigate this risk.
Having continuity and experience in executive roles can lead to better decision-making and representation of members' interests.
Informed voting is crucial, and members should take the time to understand the proposals and make informed decisions.

Chapters

00:00
Introduction and Background of the Proposed Changes

02:51
Increasing the Term for Directors from Two Years to Three Years

10:14
Expanding the Number of Directors from Seven to Nine

18:09
Considerations and Approval of the Proposed Changes

31:16
Enhancing Support for State Leaders

33:56
Assessing Financial Feasibility

37:12
Creating Continuity in Executive Roles

41:31
Decreasing Turnover and Ensuring Continuity

45:37
Mitigating Risks and Addressing Poor Leadership

48:42
Moving Away from Personal Agenda Items

59:40
Encouraging Informed Voting
Conclusion: Editor's Note

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Did CMS Actually Miss an Opportunity To Reduce the Anesthesia Shortage? Jul 19, 2024

Summary

The conversation discusses the topic of rural pass-through and its impact on the anesthesiologist shortage. It explores the idea of including physician anesthesiologists in rural pass-through and whether it would be an effective solution. The conversation also delves into the concept of shortage and how it can be addressed by utilizing anesthesia providers to their maximum potential. The importance of deregulation and allowing local experts to make decisions about anesthesia models is emphasized. The conversation concludes with a discussion on title misappropriation and the need for transparency in using the terms 'physician anesthesiologist' and 'nurse anesthesiologist'.

Keywords

rural pass-through, anesthesiologist shortage, physician anesthesiologists, CRNAs, shortage solution, utilization of anesthesia providers, deregulation, local decision-making, title misappropriation, transparency

Takeaways

Including physician anesthesiologists in rural pass-through may not have a significant impact on the anesthesiologist shortage.
Utilizing anesthesia providers to their maximum potential can help address the shortage.
Deregulation and allowing local experts to make decisions about anesthesia models is crucial.
Transparency in using the terms 'physician anesthesiologist' and 'nurse anesthesiologist' is important to avoid confusion.

Key Quotes

"Rural pass-through is about providing compassionate care close to home for rural facilities across rural America."
"The idea here is to subsidize the ability for people to get care close to home and be economically efficient in doing it."
"The shortage is artificial because of model selection and facilities."

Chapters

00:00
Introduction and Background on Rural Pass-Through

01:15
Understanding the Purpose of Rural Pass-Through

03:04
The Inaccuracy of the Article's Premise on Mitigating the Anesthesiologist Shortage

08:51
Utilizing Anesthesia Providers to Address the Shortage

19:22
The Importance of Deregulation and Local Decision-Making in Anesthesia Models

25:03
Addressing Title Misappropriation for Transparency in Anesthesia Care

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Should C-Sections Be Performed on an Outpatient Basis? Florida is going to find out. Jul 16, 2024

Summary

The conversation discusses the topic of out-of-hospital cesarean sections and the potential risks and implications. Dr. Matt Mazurek, a physician anesthesiologist and assistant professor of anesthesiology at Yale School of Medicine, provides insights and raises concerns about the definition of low-risk cesarean deliveries, the dangers of complications during and after the procedure, and the lack of resources and training in outpatient settings. The conversation also touches on the financial incentives and potential cherry-picking of patients by private equity-owned medical facilities. The need for increased access to obstetrical care and support for OBs in rural areas is highlighted as a more effective solution to address maternal morbidity and mortality rates.

Keywords
out-of-hospital cesarean sections, risks, complications, low-risk deliveries, resources, training, financial incentives, private equity, access to care, maternal morbidity, maternal mortality

Takeaways

Defining low-risk cesarean deliveries is challenging and depends on various factors.
Complications during and after cesarean sections can be life-threatening, especially in outpatient settings.
The financial incentives of performing cesarean sections may lead to an increase in unnecessary procedures.
Investing in more OBs and supporting them financially is crucial to improve access to obstetrical care in rural areas and reduce maternal morbidity and mortality rates.

Key Quotes

"OB is still very dangerous, both in the OR and postoperatively"
"It's much more common and more likely to happen in this particular group. So do we really want to gamble with people's lives in this setting?"
"It has happened and it's happened to younger, healthier patients out of the blue."

Chapters

00:00
Introduction and Background

01:23
The Challenges of Defining Low-Risk Cesarean Deliveries

06:01
The Financial Incentives and Potential Risks of Outpatient C-Sections

08:20
Improving Access to Obstetrical Care in Rural Areas

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RAISING ARIZONA Pt. 1: Arizona's Zero to Hero Story with Ali J. Baghai, CRNA, AZANA Past President and Guide Anesthesia | AzAS Managing Partner Jul 09, 2024

Episode Summary: In this episode, Joe Rodriguez talks with Ali Baghai about his journey and impact as a CRNA in Arizona. Ali shares his experiences in CRNA advocacy, the evolution of anesthesia practice in Arizona, and his role in significant legislative changes. They also discuss the nuances of owning an anesthesia business and life in Arizona.

Highlights:

Introduction

Joe Rodriguez introduces the episode and welcomes Ali Baghai.
Brief discussion about the uniqueness of Ali's name and CRNA role.

Ali's Background

Ali shares his background, including his early involvement in CRNA politics.
Discusses his time as state president and the changes in Arizona's CRNA landscape since 2009.

Initial Involvement in CRNA Advocacy

Ali's journey from student representative to board member.
The transformation of Arizona's job market and practice landscape for CRNAs.

Key Meeting in 2012

Joe and Ali reminisce about a pivotal meeting in 2012 with other CRNA leaders.
The decision to aim for opt-out and the creation of the political action committee (PAC).

Legislative Success Stories

Ali's experience with legislative processes and passing key bills.
The significance of Senate Bill 1336 and the Surgeon Immunity Law.

Opt-Out Success

Discussion about Arizona becoming an opt-out state.
The ripple effect of Arizona's opt-out status on other states.

Dental Anesthesia Regulation

Ali's involvement in dental anesthesia regulation since 2019.
The challenges and outcomes of the new rules for pediatric safety and provider registration.

Business Ownership in Anesthesia

Ali's perspective on owning an anesthesia business.
The challenges and rewards of being a business owner in the healthcare field.

Arizona Living

Ali shares his love for living in Arizona, comparing it to his hometown of Boston.
Highlights of Arizona's climate, outdoor activities, and overall lifestyle.

Closing Remarks

Joe thanks Ali for his contributions to the CRNA community and the state of Arizona.
Final thoughts on the importance of advocacy and leadership in healthcare.

Key Takeaways:

The importance of CRNA advocacy and policy changes in improving anesthesia practice.
The impact of legislative victories on CRNA practice and patient care.
The challenges and rewards of owning an anesthesia business.
The unique lifestyle and opportunities in Arizona.

Guest Information:

Ali Baghai - CRNA, former state president, and key advocate for CRNA practice improvements in Arizona.
Joe Rodriguez - Host, CRNA, and managing partner in an anesthesia group.

Call to Action:

Subscribe to our podcast for more insightful conversations on healthcare and anesthesia.
Visit our website for more information on CRNA advocacy and resources.

Note to Listeners: Don't forget to leave us a review and share this episode with your colleagues and friends in the healthcare community! Your support helps us bring more valuable content to you.

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CRNAs: An American Innovation - Reflecting on Independence Day Jul 04, 2024

In this special July 4th episode, we explore the significance of American independence and its impact on the CRNA profession. We discuss the foundations of American governance and how these ideals have shaped our national identity. The episode presents two key messages: addressing current societal tensions and highlighting CRNAs as a unique American innovation in healthcare.
The podcast emphasizes the exceptional position of CRNAs in the United States, noting their level of autonomy and economic freedom unparalleled in other Western societies. It traces the profession's success to decades of advocacy work and stresses the importance of continued effort in maintaining and advancing the field. The episode concludes by encouraging CRNAs and aspiring CRNAs to reflect on the benefits they've gained from both the American system of government and the tireless work of their predecessors, while enjoying the Independence Day celebrations.

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FTC Update With Simon Willman, JD and What It Means for Anesthesia Providers Jun 25, 2024

Episode Summary: In this episode, Joe Rodriguez welcomes back Simon Willman, Esq., former in-house counsel for one of the largest orthopedic groups in the country. They discuss the Federal Trade Commission's recent vote to ban non-compete agreements and its implications for healthcare professionals and practice owners.

Key Topics Covered:
Pre-Session: State-Level Updates from Louisiana, Maryland, and Pennsylvania

Introduction:
- Welcome and introduction of Simon Willman, Esq.
- Background on Simon's experience with Health Outcomes Performance Company and Core Orthopedics.
FTC's Vote to Ban Non-Competes:
- Overview of the FTC's recent vote to ban non-compete agreements.
- The timeline for the ban going into effect (120 days post-publication).
- Legal challenges from the U.S. Chamber of Commerce, the Business Roundtable, the Texas Association of Business, and the Longview Chamber of Commerce.
Implications for Healthcare Professionals:
- Simon's insights on how the ban might affect providers and practice owners.
- Potential benefits for healthcare providers who can move freely between employers.
- Concerns for business owners regarding the impact on enterprise value and capital investments.
Details of the FTC's Final Rule:
- Summary of the key points of the final rule.
- Explanation of the difference between non-compete and non-solicitation agreements.
- Potential legal interpretations and challenges ahead.
Non-Competes vs. Non-Solicitation:
- Breakdown of how non-solicitation agreements differ from non-competes.
- Discussion on whether non-solicitation agreements might serve as a backdoor to enforce non-competes.
Legal Considerations and Advice:
- Practical advice for healthcare providers dealing with non-competes.
- The importance of understanding the legal landscape and potential court interpretations.
- The potential costs and implications of legal challenges.
Federal vs. State Jurisdiction:
- Explanation of how the jurisdiction might shift from state to federal courts.
- The impact of this shift on enforcement and legal proceedings.
Sale of Business Exception:
- Discussion on the exception for bona fide sales of businesses.
- How this exception might apply to equity owners and business transactions.
Final Thoughts and Advice:
- Simon's final comments on the significance of the FTC's rule.
- Advice for healthcare providers and practice owners navigating this evolving legal environment.
Outro:
- Joe and Simon wrap up the discussion.
- Teaser for the next episode.

Key Quotes:

"If I'm in your audience's shoes as providers and as practice owners, I think this is significant and I don't think this is just pure speculation." - Simon Willman
"Everyone should have a right to earn a living, I think." - Joe Rodriguez

Resources Mentioned:

Becker's Healthcare article on the FTC vote.
The FTC's final rule on non-competes.

Connect with Us:

Disclaimer: The content of this podcast is for informational purposes only and does not constitute legal advice. Listeners should consult their own legal advisors for specific guidance related to their circumstances.

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We Became The Top Anesthesia Podcast in the United States AND Episode Previews Jun 14, 2024

Summary

The podcast, Anesthesia Deconstructed, has become the number one anesthesia podcast in the United States (Apple Podcasts - subsection: Medicine) due to its focus on deconstructing issues and having thoughtful and respectful conversations. The host, Joe Rodriguez, discusses his involvement in the The Nurse Anesthesiologist Facebook Group (TNAG) and the importance of creating a space for sharing ideas and discussing issues. He addresses a screenshot from another Facebook group that accuses him and others of monopolizing information platforms. Rodriguez clarifies his involvement and highlights the diversity of perspectives in the group. He also previews upcoming episodes on topics such as FTC banning non-competes, CRNA advocacy, interprofessional collaboration, and the CRNA-friendly environment in Arizona.

Keywords

anesthesia podcast, deconstructing issues, respectful conversations, Facebook groups, sharing ideas, diversity of perspectives, upcoming episodes, FTC banning non-competes, CRNA advocacy, interprofessional collaboration, CRNA-friendly environment, Arizona

Takeaways

Anesthesia Deconstructed is the number one anesthesia podcast in the United States due to its focus on deconstructing issues and having thoughtful and respectful conversations.
Creating spaces like the TNAG group allows for the sharing of ideas and discussions on anesthesia-related issues.
Rodriguez clarifies his involvement in the group and highlights the diversity of perspectives and respectful conversations that take place.
Upcoming episodes will cover topics such as FTC banning non-competes, CRNA advocacy, interprofessional collaboration, and the CRNA-friendly environment in Arizona.

Titles

Previewing Upcoming Episodes: FTC Banning Non-Competes, CRNA Advocacy, and More
Creating a Space for Sharing Ideas: The Neuroscientist-Anesthesiologist Facebook Group

Sound Bites

"Anesthesia Deconstructed: The number one anesthesia podcast in the United States."
"Wanting to have really good and thoughtful conversations, and trying to do it in a respectful way."
"Creating a place where people can share ideas and discuss issues without constant attacks."

Chapters

00:00
Introduction and Podcast Success

01:26
The Importance of Thoughtful and Respectful Conversations

07:59
CRNA Advocacy: Empowering Anesthesia Professionals

08:29
Interprofessional Collaboration: Enhancing Patient Care

11:43
Arizona: A Model for CRNA-Friendly Regulatory Environment
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Mike MacKinnon is Back! Massachusetts Opt Out and What it Means vs Jun 07, 2024

Summary

In this conversation, Joe Rodriguez interviews Michael McKinnon, podcast founder, CRNA, and assistant program director at National University. They discuss two topics: the supervision clarification advisory opinion from the Arizona Board of Nursing and the opt-out of Medicare Part A physician supervision requirements in Massachusetts. McKinnon shares his perspective on these issues and emphasizes the importance of removing barriers to competition and promoting a level playing field in healthcare.
Keywords

CRNA, supervision clarification, advisory opinion, Arizona Board of Nursing, AA, opt-out, Medicare Part A, physician supervision, Massachusetts
Takeaways

Removing barriers to competition and promoting a level playing field in healthcare is important.
The supervision clarification advisor opinion from the Arizona Board of Nursing allows CRNAs to supervise other health professionals.
The opt-out of Medicare Part A physician supervision requirements in Massachusetts eliminates the perception of supervision and reduces liability concerns for CRNAs.
The opt-out also simplifies contract negotiations and promotes collaboration between CRNAs and surgeons.
CRNAs should have the opportunity to choose the model of care that best suits their practice and the needs of their patients.
More states should consider opting out of Medicare Part A physician supervision requirements to improve access to care and increase provider options.

Chapters

00:00
Introduction and Background of Michael McKinnon
01:04
Supervision Clarification Advisor Opinion in Arizona
05:21
Opposition to Anti-Competitive Legislation
09:31
Opting Out of Medicare Part A Supervision Requirements in Massachusetts
12:20
Impact of Opting Out on CRNAs and Service Line Management
16:29
Future Plans and Conclusion

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Should CRNAs supervise AAs? And, updates on DC, SC, TN, and the Pre-CRNA Market Jun 03, 2024

Episode Date: Monday, June 3rd

Welcome to Anesthesia Deconstructed!

In this episode, we cover:

Segment 1: Pre-CRNA Market Update

Impact of late-stage capitalism on mentorship and professional development.
Feedback from current nurse anesthesia residents/students.
Questioning “Guaranteed Success” and the high cost of prep programs.

Segment 2: Key Legal Updates

South Carolina and Maryland Associations’ successes in preventing restrictive rules.
TANA’s loss of the term “anesthesiology.”
DC’s HORA Act removing collaboration requirements for CRNAs.

Segment 3: Arizona Board of Nursing Update

New authority for CRNAs to supervise other professionals
Discussion on ensuring competence and the debate around supervision and education.

Stay informed on the latest developments in anesthesia with us!

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Is it ethical to have pre-CRNAs pay for intro courses? And, where is our co-host? May 15, 2024

In this episode:

The CRNA Intro Market: We're going to explore this issue more deeply - we want to hear from you!
How You Can Contribute: We want to hear from you! Share your experiences, questions, or advice about starting out as a CRNA. Your insights could be featured in upcoming episodes!

Send Your Contributions: Reach out via email at Joe@GuideAnesthesia.com and write us or send us a voice memo (2 mins or shorter please). Join the conversation and help shape the future of our show!

Subscribe and Stay Connected: Don't miss an episode—subscribe to our podcast on your favorite platform!
Also, where the **** is Mike MacKinnon?

Your Host(s) Joe Rodriguez, CRNA -, bringing years of experience and a passion for anesthesia, and CRNAs - right to your ears.

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AANA Election Time! May 08, 2024

In this concise episode, Dr. Joseph Rodriguez, CRNA, shares a glimpse into his voting process during the recent elections. He reveals two of his four votes, choosing to keep the remainder confidential to maintain a positive election environment. Dr. Rodriguez emphasizes the importance of voting for candidates rather than against them, reflecting his commitment to promoting a constructive and supportive community. Tune in to hear which candidates earned his vote and why he believes in a selective sharing approach during elections.

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Navigating New Frontiers: NorthStar Anesthesia's Approach to Modern Anesthesia Challenges Apr 15, 2024

Introduction:

In this episode of "Anesthesia Deconstructed," we delve into the evolving landscape of anesthesia services with two leading figures from NorthStar Anesthesia: Randall Moore, DNP, MBA, CRNA, Chief CRNA, and Jim Roberts, MD, Chief Medical Officer. Together, they shed light on NorthStar's innovative strategies in navigating staffing shortages, private equity involvement, and the complexities of the post-No Surprises Act era.

Guest Insights:

Randall Moore brings a wealth of experience in anesthesia management and clinical excellence, offering a unique perspective on the role of advanced practice anesthesia professionals in addressing current challenges.
Jim Roberts shares his insights from the viewpoint of medical leadership, emphasizing the importance of strategic partnerships and quality care in the face of industry shifts.

NorthStar's Journey:

A brief overview of NorthStar Anesthesia, detailing its foundation, mission, and evolution into a leading national anesthesia services provider.

Key Topics:

Addressing Staffing Shortages: Strategies and initiatives employed by NorthStar to combat the ongoing staffing challenges in healthcare, particularly within anesthesia services.
Private Equity and Corporate Investment: An examination of the role of private equity in healthcare, specifically in anesthesia services, and how NorthStar navigates these issues.
Thriving Post-No Surprises Act: Discussion on the impacts of the No Surprises Act on anesthesia services, with a focus on NorthStar's adaptive strategies to ensure financial stability and patient satisfaction.
Blueprint for Success: Insights into NorthStar's operational, clinical, and strategic methodologies that have positioned them for success in a rapidly changing healthcare environment.

Why It Matters:

This episode offers a glimpse into the operational and strategic mindset of one of the leading anesthesia services providers, highlighting actionable strategies for navigating modern healthcare challenges. It serves as an invaluable resource for anesthesia professionals, healthcare administrators, and anyone interested in the intersections of healthcare policy, management, and clinical excellence.

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Revolutionizing Recruitment: The MOTION Behind Transforming Anesthesia Careers Apr 08, 2024

Introduction:

Welcome to a groundbreaking episode of "Anesthesia Deconstructed," where we delve into the forces reshaping the landscape of anesthesia and healthcare recruitment. Today, we're thrilled to have Jarod Collins with us, a visionary behind "MOTION" - a pioneering platform set to redefine how anesthesia professionals navigate their career paths.

Guest Spotlight:

Jarod Collins, Executive Vice President, Strategic Partnerships at MedGeo Ventures, is part of the innovative team that developed "MOTION," a platform described as the “Zillow of CRNA jobs”. This episode explores Jarod's journey, the genesis of "MOTION," and its mission to bring transparency, efficiency, and quality to healthcare recruitment.

What's New:

Introduction to "MOTION," a cutting-edge job search platform designed for the modern anesthesia professional. Unlike traditional job boards, "MOTION" emphasizes quality metrics and user-friendly design to connect talent with the right opportunities.

Why It Matters:

Elevating Job Searches: Discover how "MOTION" moves beyond the limitations of outdated platforms, offering a streamlined, intuitive experience for both job seekers and employers.
Quality Over Quantity: Learn about the unique approach "MOTION" takes to ensure listings are of the highest quality, making it easier for professionals to find meaningful employment.
Impact on Anesthesia Careers: Understand the potential of "MOTION" to transform the career trajectories of CRNAs, anesthesiologists, and other anesthesia professionals through better job matches and career insights.
A Step Towards Innovation: This episode sheds light on how "MOTION" represents a broader shift towards innovation and quality in the healthcare industry, setting a new standard for how job markets operate.

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Meet Annemarie Wiley CRNA and Real Housewives of Beverly Hills star! Feb 28, 2024

Meet Annemarie Wiley CRNA!
When you think about reality tv and especially the Real Housewives franchise, you probably do not think about adopted small town Canadian girls of Nigerian/Dutch descent raised by a single mom. Well, not only is that Annemarie, but she is also an athlete, became an RN, worked in Canada and then the U.S. and eventually became a Nurse Anesthesiologist (CRNA)! She is eloquent, intelligent, gregarious and very proud of her chosen profession, Nurse Anesthesiology! In this episode we talk about her background, her experience as an RN and CRNA, the housewives show and her families amazing charity https://projecttransition.org/ with its mission:
"To inspire, equip, and support individuals in their journey of transformation, ensuring they not only navigate transitions successfully but also emerge stronger, more resilient, and ready to lead."
Enjoy this great conversation with Annemarie and do not make the mistake I made! It is pronounced Annamarie not "Anne-Marie"!

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Josh Condado, CRNA Deconstructs the Path to Real Estate Investing for Anesthesia Professionals Dec 18, 2023

In this session, we talk with Josh Condado, CRNA, from his initial foray into a highly controlled anesthesia ACT lead to his exploration of real estate investing. It makes us wonder how fully utilizing CRNA roles can significantly enhance staff retention – but that’s for another episode. Josh is only 31 years old, but it was an enlightening conversation about diversification with real estate investing, something anesthesia providers of all types can potentially diversify their assets with.
This show has been produced by Adkins Media Co.

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Special Series: 5 Questions: Matt Mazurek, MD on Burnout and Anesthesia’s “Dirty Little Secret” Nov 06, 2023

As part of our series “5 Questions” - we’re happy to have Dr. Matt Mazurek, MD, Physician Anesthesiologist, and perennial learner. Matt has done it all: private practice, Chief of Staff, working for a “big box” shop, and now academics at Yale. Although he became known to the show from his article supporting full practice for CRNAs, we brought him back to talk about burnout and how he avoids it, work-life Integration, what he believes is the “dirty little secret” of healthcare.

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Special Series: 5 Questions: Mike MacKinnon Addresses Criticisms and Answers What Keeps Him So Professionally Driven Oct 23, 2023

Few CRNAs are as well-known as our co-host, Mike MacKinnon, and at times, he’s not been an uncontroversial leader – he’s been on the cutting edge. Leading off our “5 Questions” Series – we hear from Mike on being criticized as “anti-physician”, on what he’s learned as a leader of the past 10 years, and how he keeps a sustainable edge to remain a high-performance professional for so long.

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An Introduction to Our Special Series: 5 Questions Oct 16, 2023

In this series, we will dive deep with some of the most intriguing professionals in the specialty of Anesthesia! Through these five questions, we will be foster important conversations, gain insight into where the specialty is going, and learn how we can influence that future.
Tune in next Monday for our first episode of this special series and enjoy the ride!

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A Look Into the Core Anesthesia App with its Creators: Cole Dill & Tanner Hulin Sep 29, 2023

Take listen as Joe interviews the founders of CORE Anesthesia!

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Dr. Joe Rodriguez testifies against title protection bill in Wisconsin Jun 21, 2023

In an attempt to control the freedom of what other professions call themselves and limit titles in Wisconsin, the medical society introduced SB 143.
On May 24, Wisconsin Association of Nurse Anesthetists President Jenna Palzkill—as well as Dr. Joe Rodriguez, who was representing the AANA—helped inform and educate the Wisconsin Senate Committee on Health on why proposed SB 143 does NOT help Wisconsinites.

If passed, this bill would preclude the use of the title Nurse Anesthesiologist in the state. An attempt of one competitor trying to control another. This is the audio of that testimony that ended this attempt.

You can learn more about the genesis of Nurse Anesthesiologist here: https://www.nurseanesthesiologistinfo.com/

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Medical Malpractice Policies: What you didn't know, but should Apr 17, 2023

Meet Julie Nycum, CPCU, RPLU, ARM, the current director of AANA Insurance Services, providing medical malpractice to CRNAs across the country through Medical Protective (med pro). Julie worked for Medical Protective (med pro), a Berkshire Hathaway Company writing 2 billion in policies a year for 24 years as Vice President of Underwriting. In 2006 she met with AANA insurance services on behalf of med pro to develop the medical malpractice services AANA uses today.
On this podcast we talk about:

Occurrence vs Claims made and how important it is to know the difference related to YOUR risk and why over time claims made is MORE expensive
Buying claims made "tail" isn't as simple as it sounds. Or as good.
Time does not start until discovery starts. Might be past your claims-made policy and then YOU are on the hook.
Consent to Settle & Hammer Clauses (Scary Stuff)
You can be named (and need coverage) for NON-Anesthesia issues
Policies may cover a lot more than you are aware of like lost wages etc.
What does "1 million per occurrence and 3 million aggregate" coverage mean?
Why 1/3 mil vs 250/500K per claim/aggregates are different in different states? Should you get a 1/3 policy anyway?
What happens if a claim went OVER the max/occurrence (1 million) policy? You pay that is what happens.
Why does Admitted vs Non-Admitted matter? The Oceanus Story
Does AM Best matter to providers or facilities?
How the size of an insurance company impacts the lawyers you get access to
If you own an anesthesia company should you have special insurance for your contractors for vicarious liability?
If you are covered by a groups policy should you also have your own to protect your interest?
Does a settlement result in you being reported to the national practitioner databank?
Is there any increased cost for med mal for an independent CRNA to the CRNA?
Is there extra cost for the facility or surgeon working with an independent CRNA?
Is there decreased cost for the CRNA or facility when working in an Anesthesia Care Team with a physician anesthesiologist? "liability shield"
If you do ketamine clinics, medical aesthetics, IV infusion work does your CRNA medical malpractice cover these things?
Medical Malpractice rates have not increased for CRNAs at Med Pro for 14 years. Now they are increasing, why and what does that mean?
When do you have to report to the med mal company? Can you self-trigger coverage by hearing something might happen or when an event occurs? Can claims made do this?
Whats the process and length of time of a claim?

Addendum: If you are threatened with a claim (lawsuit) you should report that to medpro in writing ASAP.

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The CRNA Scientist: Dr. Rhea Temmerand Designing Drugs with Spider Venom Mar 23, 2023

Anesthesia Deconstructed host Joe Rodriguez talks to a rare professional: Dr. Rhea Temmerand, CRNA who is a pharmacology PhD and actively involved in bench research while maintaining a clinical practice. We talk about everything from what it is like to be known as a Scientist and as a CRNA, and why CRNAs often do little bench research.

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Simon Willman, JD - Do Non Competes Get Enforced? Nov 23, 2022

Simon Willman, JD, former in-house counsel for CORE Orthopedics and Current owner of McDowell Mountain Law, speaks about non-competes and their impact on Anesthesiology Professionals, which touches every practicing provider, 1099 or W2. The bad information out there on this topic is rampant – Simon lends his expertise as a healthcare business and contract lawyer to give us a brief introduction. Send us your questions so we can discuss them with Simon again in the future!

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Mark Silberman JD - Former General Legal Counsel for the AANA Aug 26, 2022

Meet Mr. Silberman JD from the BENESCH law firm! We talk about the New Hampshire ruling and Nurse Anesthesiologist, Qui Tam lawsuits and anti-trust, The risk of medicare fraud with medical direction and TEFRA, if Extubation is part of emergence as it related to TEFRA based on the Donegan v. Anesthesia Associates of Kansas City, PC, Liability of surgeons with CRNAs in the ACT or independently and MUCH more!
A little about Mark:
Mark is an experienced trial lawyer, health care attorney and litigator. His practice focuses on helping health care professionals and businesses navigate the complex and changing landscape of health care with an emphasis on achieving governmental and regulatory compliance.

Mark concentrates on managing internal and external health care investigations, False Claims Act cases, white collar criminal defense, all forms of health care litigation, and all aspects of the Illinois Certificate of Need program.

Mark handles audit, compliance, investigations and enforcement actions involving HHS-OIG, the Medicare/Medicaid programs, the Illinois Department of Public Health, and Illinois Health Facilities and Services Review Board (Certificate of Need). He advises clients regarding managing and avoiding allegations of health care fraud and health care-related criminal conduct, addressing concerns related to the Anti-Kickback Statute, and pharmacy and pharmaceutical related litigation. He provides counsel and litigation services for physicians, facilities and pharmacies engaged with any federal agency, along with handling Medicare/Medicaid reimbursement issues, False Claims Act/Qui Tam defense, and various health care transactional matters. Mark also served as the outside General Counsel to the American Association of Nurse Anesthetists.
More about Mark can be found here

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Interview with A CPA: How to go 1099 to Maximize Career Benefits Aug 25, 2022

In this episode, you will hear from Mr. James Laubham CPA, owner of Capital Accounting, PC on why Nurse Anesthesiologists and Physician Anesthesiologists are turning to 1099 to maximize their career benefits. He goes through the ins and outs as well as what you need to know when deciding to go 1099.
Learn from a CPA who is an expert in anesthesia business accounting!
Learn more at the Capital Accounting website https://www.capitalacctpc.com/

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Part 3: Interview with Dr. Randall Moore Chief Anesthetist Officer of Northstar Anesthesia Jun 29, 2022

Meet the former AANA CEO and now Chief Anesthetist Officer of Northstar Anesthesia Dr. Randall Moore DNP, MBA, CRNA. We talk about ALL the things in this 3 part interview! Topics range from anesthesia reimbursement, the impact of the pandemic, the difficulty recruiting, why he left the AANA, culture, what his new role entails at Northstar, and what it takes to build a functional anesthesia team!
There is an incredible amount of information packed into this 3 part interview from a leader in one of the leading companies in anesthesia services in the United States.
https://northstaranesthesia.com/our-culture/leadership.html

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Part 2: Interview with Dr. Randall Moore Chief Anesthetist Officer of Northstar Anesthesia Jun 15, 2022

Meet the former AANA CEO and now Chief Anesthetist Officer of Northstar Anesthesia Dr. Randall Moore DNP, MBA, CRNA. We talk about ALL the things in this 3 part interview! Topics range from anesthesia reimbursement, the impact of the pandemic, the difficulty recruiting, why he left the AANA, culture, what his new role entails at Northstar, and what it takes to build a functional anesthesia team!
There is an incredible amount of information packed into this 3 part interview from a leader in one of the leading companies in anesthesia services in the United States.
https://northstaranesthesia.com/our-culture/leadership.html

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Interview with Dr. Randall Moore Chief Anesthetist Officer of Northstar Anesthesia Part 1 Jun 01, 2022

Meet the former AANA CEO and now Chief Anesthetist Officer of Northstar Anesthesia Dr. Randall Moore DNP, MBA, CRNA. We talk about ALL the things in this 3 part interview! Topics range from anesthesia reimbursement, the impact of the pandemic, the difficulty recruiting, why he left the AANA, culture, what his new role entails at Northstar, and what it takes to build a functional anesthesia team!
There is an incredible amount of information packed into this 3 part interview from a leader in one of the leading companies in anesthesia services in the United States.
https://northstaranesthesia.com/our-culture/leadership.html

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Interview With A Lobbyist: Kelsey Lundy from Compass Strategies, Arizona Mar 31, 2022

Everyone wonders what a lobbyist is, what they do, and do you NEED one? There is always a lot of demonizing lobbyists and their role in the media but what is the truth? On this episode, we interview Kelsey Lundy, Managing Partner at Compass Strategies in Arizona, and talk about lobbyists, grassroots involvement, Political Action Committees, how politics work, and how a good lobbyist can be critical to your legislative goals. We also discuss how to find and interview a firm as well as how to assess the effectiveness of one you have. There are so many pieces of the puzzle when it comes to getting a bill across the finish line and Kelsey has been critical for more than 20 years in guiding many clients to success!
You can learn more about Compass Strategies at https://www.compassstrategiesaz.com/

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Dr. Jeff Gadsden MD Discusses Regional Anesthesia & Nerve Injury Feb 03, 2022

Dr. Jeff Gadsden is a Physician Anesthesiologist who did a large portion of his residency with Dr. Admir Hadzic at the New York School of Regional Anesthesia (NYSORA) where his love of regional anesthesia was born. He has since brought that passion and expertise to Duke University where he currently serves as the Chief, Division of Orthopedic, Plastic & Regional Anesthesia. Dr. Gadsden is not only an expert at regional anesthesia but passionate about it which comes across in every video he does, to every trainee he mentors and in this podcast!
We talk about everything regional anesthesia from the movement away from epidurals, new blocks, the utility of the nerve stimulation, new drugs, adjuncts in nerve blocks to nerve injury, and the evidence! If you love regional anesthesia you do not want to miss this one!
You can see his phenomenal regional anesthesia videos on his youtube channel titled "Regional Anesthesiology and Acute Pain Medicine" located here https://tinyurl.com/y8zt37od
You can also follow him on Twitter at https://twitter.com/jeffgadsden and with the hashtag #DukeRAP

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The Butterfly IQ+ Ultrasound With Butterfly Network CMO Dr. John Martin Nov 30, 2021

On this episode we talk to John Martin, MD the Chief Medical Operator at Butterfly Network, Inc. about the utility, future and applications of the powerful Butterfly IQ+ portable ultrasound probe. We discuss the butterfly iQ+ built in educational videos teaching point of care ultrasound (POCUS) and how it is all three probes in one right on your hip. Will this be the replacement of the stethoscope and be on everyone's hip? Listen and find out!
Learn more at https://www.butterflynetwork.com/iq

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From Anesthesiologist Assistant (AA) to Nurse Anesthesiologist (CRNA) Oct 24, 2021

In this episode we talk to Lee Austin, a former Anesthesiologist Assistant who went back to school to become a CRNA. Lee explains how different the educational programs were, how different the focus is on training between the independent practice trained CRNA to the assistant role of the AA and how that difference really resulted in professional fulfillment for her. We also discuss the Texas Christian University AA to CRNA bridge program and how Lee feels every AA should consider it!
This is a great insight from someone who has been through both programs and worked as both types of provider.
Listeners can learn more about the TCU AA to CRNA bridge program HERE !

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The Title "Nurse Anesthesiologist" Aug 31, 2021

On this podcast we talk about the title 'Nurse Anesthesiologist' it's genesis, the movement within the CRNA community that pushed it into the spotlight, why it is important to CRNAs and patients, some of the misconceptions related to it and the controversy surrounding it. This is the inaugural episode with Dr. Joseph Rodriguez as a co-host talking about this topic.
As a special addendum we add some clarifying information about the ASA President's letter to the ASA members on the topic which came out after this recording.

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Rural Surgeon Talks About Surgery and CRNA Only Practice Jun 30, 2021

Meet rural surgeon Dr. Nathaniel M. Wolkenfeld a general surgeon who has worked in both rural and urban practices. On this episode he talks about the difference between rural and urban general surgery as well as the resources, challenges and benefits of practicing in a rural area. We also get his thoughts on independent CRNA practice after having the opportunity to work for 7 years with them.

This is a rare view into the world of rural medicine and CRNAs from a surgeon who has actually been there and seen it! Do not miss this one!

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The Business of Anesthesia Part 2 May 04, 2021

Please join me for Part 2 of this discussion with Joe Rodriguez MSN CRNA where we talk about the trials and tribulations of building an anesthesia company, being successful at it and all the pitfalls in between! Learn the ropes in this 2 part series!

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The Business of Anesthesia Part 1 Mar 27, 2021

Please join me for this discussion with Joe Rodriguez MSN CRNA where we talk about the trials and tribulations of building an anesthesia company, being successful at it and all the pitfalls in between! Learn the ropes in this 2 part series!

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Chronic Pain Management & CRNAs Dec 07, 2020

Meet Nurse Anesthesiologist Scott Rigdon DNAP, CRNA who owns a full time chronic pain practice and trains other CRNAs to do so as well.

On this podcast we talk to Dr. Rigdon about what it is like to be a chronic pain practitioner. What the training is like and how to get it as well as what he does day to day in his clinic. We learn about the process of attaining competence in chronic pain and how different it is from clinical anesthesiology.

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The Federal Trade Commission, Medicine, APRNs & Anti-Trust Jun 24, 2020

Meet Daniel Gilman Phd JD an Attorney Advisor in the FTC’s Office of Policy Planning, where he works on competition issues in health care and technology, and on the impact of regulation. He has received the He co-authored the FTC staff policy paper, Competition and the Regulation of Advanced Practice Nurses, helped draft the FTC Staff Report, Broadband Connectivity Competition Policy, and has published in journals such as the Georgetown Law Journal, Health Matrix, Oregon Law Review, American Journal of Law & Medicine, the Journal of Health Care Law & Policy, Behavioral and Brain Sciences, and the British Journal for the Philosophy of Science.
On this episode we discuss the role of the FTC, the FTC staff report on competition and regulation of APRNs and some of the interesting cases Dr. Gilman has been apart of!

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You Have a Complaint Against Your License: Understand, Defend and Navigate May 28, 2020

Have you ever had a complaint filed to the board of medicine or board of nursing against your license? It is a process that providers are unprepared to navigate and unaware of the risks and pitfalls which could permanently impact their license and ability to work. What may appear as a frivolous complaint you feel you do not need legal help with could easily become a year(s) long process which consumes you.
Do not underestimate being targeted by a weaponized complaint!
Meet lawyer Teresa M. Sanzio JD who has specialized in administrative law for over 22 years representing APRNs, RNs, Physicians and other healthcare professionals defend against license complaints. Sanzio does a great job of explaining the process, the dangers of going it alone, the possible outcomes and the best way to proceed. She relays this all in addition to stories about what NOT to do!
Do not miss this one, Sanzio's advice could save you license!

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Dr Cameron Kyle-Sidell MD: ER/CCM on Covid 19 in Brooklyn NYC, Experiences, Theories & Treatments Apr 21, 2020

Meet Emergency Medicine & Critical Care Physician Dr Cameron Kyle-Sidell. He has been on the front lines in one of the epicenters of Covid 19 in the US, Maimonides Medical Center in Brooklyn New York City.
On this podcast we talk to Dr. Kyle-Sidell about how the virus has evolved from a clinical perspective, past and current theories on treatment and current understanding of the pathophysiology. He shares with us his experiences treating these patients, both young and old and the personal connection he has had with them. Dr Kyle-Sidell talks about how some theories are falling out of favor and proposes one of his own, diffusion hypoxemia. He suggests that rather than primarily V/Q mismatch or shunt physiology, could COVID19 be a DIFFUSION hypoxemia triggering maladaptive pulmonary vasoconstrictive responses?
An amazing critical thinker, an amazing physician and a great human trying to contribute to solving the Covid 19 problem. Dr. Kyle-Sidell can be found on twitter at @cameronks where he regularly posts important insights, questions and videos about Covid 19.

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Anesthesia on the Front Lines of Covid 19 in Detroit Michigan Apr 16, 2020

On this podcast we talk to Nurse Anesthesiologist Joshua Olson MS, CRNA about what it is like on the front lines of Covid 19 in the country, Detroit Michigan. Mr Olson talks about the emotional toll this takes on everyone involved, the heroic level clinical work done at his facility to save patients lives and the ever changing face of this new pandemic. We also discuss the socioeconomic factors which have made Detroit a hotspot and how Nurse Anesthesiologists have stepped up to make a difference outside of the operating room.

From experimental treatments to what we think we know about Covid 19, Mr Olson guides us through how he and his colleagues are doing everything they can to save lives. We end with a positive survival story which reminds everyone in healthcare that this does not just strike the elderly but those we work with everyday.

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Covid 19: What Anesthesia Providers Need to Know Mar 27, 2020

On this episode we talk about Covid 19, what anesthesia professionals need to know about N95 Masks and PPE, testing, epidemiology and symptomatology, as well as utilizing 2 ventilators, expanding CRNA role into the ICU as "force multiplier" as opposed to limiting their positive impact as an ICU RN, what resources are out there and more.

We also provide a Covid19 resource document now circulating all over the globe with daily updates at this link: https://tinyurl.com/rt9xxja

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AANA CEO Dr. Randall Moore and the future of healthcare Feb 12, 2020

On this podcast we talk with Dr Randall Moore the CEO of the American Association of Nurse Anesthetists (AANA) about the future of healthcare. We discuss President Trumps executive order, specifically section 5 as it relates to APRNs and how that will change practice nationally. The format is an open conversation about not just where healthcare is headed for CRNAs but as a country. Many great insights and a realistic glimpse into the future!

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Meet Dr Sophia Thomas American Assoc. of Nurse Practitioners President Jan 08, 2020

On this podcast we talk about how Dr Thomas became and NP and how she progressed through being professionally involved all the way to President of the AANP. We talk about the future for APRNs in an evolving healthcare world. Additionally, we discuss President Trumps executive order, specifically section 5 as it relates to APRNs and how that will change practice nationally. Lastly, we talk about the relationship between Nurse Practitioners and Physicians Assistants as well as the two organizations and future goals. A great discussion about where we are, where we are headed and how APRNs are in demand and will continue to be in the foreseeable future!

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Meet Scott Becker JD CPA of Beckers Healthcare Dec 11, 2019

On this podcast we talk about how Mr Becker decided to get into law, healthcare law and his journey to Harvard law school. We talk about how important family support is and how his was there for him. Additionally, we discuss physicians and allied healthcare providers roles as we continue dealing with the challenge of access to healthcare in a fiscally responsible manner. Lastly, we talk about ASCs, HOPDs and where Mr Becker sees healthcare headed in the future. This is an amazing man with great insight into the future of our industry and you do NOT want to miss this one!

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Physician Anesthesiologist Dr Matthew Mazurek On CRNA history, politics, titles and surgeon supervision Nov 06, 2019

Dr Matthew Mazurek talks about his article on CRNA history, his views on why friction between the CRNA and MD professions originated, a possible solution, why CRNAs should be working to the top of their license, why surgeon supervision is antiquated and how titles do not matter! An amazing discussion with a true advocate for the best patient care and our shared profession of Anesthesiology!
Article Found Here: https://www.linkedin.com/pulse/crnas-short-history-nurse-anesthesia-future-care-matthew-mazurek-md/

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Erik Kramer CRNA FNP Mission Trips Mexico, Mosul and The Congo Oct 09, 2019

Many healthcare providers talk about going on medical mission trips but few ever take the time out of their lives to actually do so. Erik Kramer CRNA FNP not only served humanity on a mission trip but he has done many! Erik and his family spent 5 years in a small rural hospital in Mexico where he provided anesthesia, emergency and critical care service as well as encountered the Sicario Cartel daily. He went to Mosul where he took care of victims of war from both sides and witnessed some horrific cases. Finally he went to the Congo where he and one other FNP ran an ebola clinic which acted as a triage center in which they identified, treated and saved patients with ebola! Listen in as you hear a man who feels a calling to help those in need through love and service. It is an amazing story you do not want to miss!

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CRNA Recertification, the NBCRNA and the CPC with Dr. Terry Wicks Sep 19, 2019

The entire medical industry has seen significant controversy when it comes to recertification and certification and the CRNA world has been no different. This episode I talk to Dr Terry Wicks the incoming President of the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) about the new CPC program and recertification in general.

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