The Anesthesia Brief · Issue #3

The whole landscape,
in five minutes.

By Marc Smith, DNP, CRNA & Shantall Ruiz Cummins, DNP, CRNA · June 2026

If you're thinking it, we're talking about it.

Five things worth knowing before Monday's first case.

Let's get into it.

This Week's Top Story

The loan cap just went to court

A couple of issues back, we told you Washington decided a future nurse anesthesiologist can borrow a fraction of what a future physician can, after a rule reclassified nursing as something other than a "professional degree." Last month the major nursing organizations stopped sending letters and filed suit to block it. On its face the case is about money; underneath, it's about whose doctorate the government is willing to count.

Our take is at the bottom of this issue ↓

⏱ Act This Week

If you practice in Ohio, your rules changed. House Bill 52 is law, and it replaces physician supervision with a collaborative anesthesia care model. Pull your facility's anesthesia policy and your updated state practice act this week; the framework you trained under may not be the one you're working under now.

This Month's Number

Roughly what Medicare pays per anesthesia "unit" in 2026. Your pay on a case is base units plus time units, times that one figure, and it is the floor every commercial payer negotiates down from. It is also why Arizona moving on a bill to bar insurers from paying nurse anesthetists less than physicians matters more than it sounds.

Board Watch

This one is worth saying plainly, because it is the part nobody warns you about. What ends a career in this field is almost never the clinical error. It is the diversion, the note written after the fact, the self-report that never got made. Substance use disorder is an occupational hazard of this profession, the disease is treatable, and confidential help exists; the cover-up is the part that takes the license. If something feels off, with you or with someone you work with, reaching out is how a career gets saved instead of lost. (AANA Peer Assistance Helpline, 800-654-5167, free and 24/7.)

Scope, Moving

Four states moved this session. Ohio is the headline: HB 52 trades physician supervision for a collaborative care model, signed into law and effective this month. Arizona (HB 2447) advanced a bill barring insurers from paying nurse anesthetists less than physicians for the same work. Rhode Island (S 3184 and H 7740) cleared both chambers clarifying who can run deep sedation and general anesthesia. And New York (S 5727 / A 98) would let dental hygienists give block anesthesia for the first time, but only under a dentist's direct supervision.

Drug Shortage Flash

Still on the FDA shortage list as of late June: hydromorphone, ropivacaine, and lorazepam injection. Etomidate is the one to watch, some presentations are available and others are not, so confirm it before you plan around a case. Status from FDA shortage data; always verify at the source before you reroute.

Coming to Your OR

The ASA flagged the boom in ketamine clinics and at-home ketamine delivery as a growing patient-safety concern. If you are picking up clinic work, or just fielding patient questions about it, that is the trend to keep an eye on.

A couple of issues ago we told you the government decided a future nurse anesthesiologist could borrow a fraction of what a future physician can, because someone decided our doctorate is not a "professional degree." Last month the nursing world stopped writing letters about it and went to court. The number on a loan form is never really about the loan; it is a statement about whose training counts, and this time they put it in writing.

Here is what we keep coming back to. Nobody is claiming a CRNA and a physician are the same thing. We are claiming the work is real, the doctorate is real, and the debt it takes to get there should be treated like it is real too. You cannot tell a whole profession to go earn a DNP and then act surprised when it asks to be financed like one. We will watch this one and tell you what the court actually does, not what the headline says it did.

The Anesthesia Brief is free. Built by two CRNAs who wanted one place to find everything.

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Legislative data, LegiScan & OpenStates (CC BY 4.0). Drug shortage data, ASHP / openFDA. Federal regulatory data, FederalRegister.gov (public domain). Compensation, Marit Health (market feed), BLS, AANA.