Advocacy, Influence, and the Future of CRNAs: A Conversation with CEO Bill Bruce

In this candid and wide-ranging episode, we sit down with Bill Bruce — CEO of the AANA, representing over 65,000 CRNAs and SRNAs nationwide — to pull back the curtain on what it really takes to lead the profession’s largest and most influential organization.

From balancing the competing demands of members, boards, and limited resources, to navigating constant political, clinical, and industry noise, Bill explains how the CEO’s role is equal parts strategist, mediator, and pressure point. We explore how the AANA sets priorities, allocates resources, and adapts to both internal ambitions and external threats — and why the organization’s absence would have an almost immediate impact on CRNAs across the country.

Bill also shares his perspective on maintaining focus in an environment of relentless change, the leadership qualities that matter most in high-stakes healthcare advocacy, and how the AANA is positioning the profession for the future.

Whether you’re a CRNA, SRNA, or simply curious about the forces shaping nurse anesthesia, this conversation offers a rare inside look at the operational, strategic, and political realities of leading at the top.

Keywords:

Anesthesia, CRNA Leadership, Healthcare Advocacy, Professional Associations, Strategic Planning, Workforce Advocacy, Organizational Leadership, AANA, Healthcare Policy, Nursing Leadership

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Transcript

Joseph Rodriguez (00:00)
Bill Bruce, the one and only chief executive officer. us what the CEO does for the ANA. I am, I'm the fulcrum between what an organization wants to do and what an organization can't do. In any of those prior roles, was there anything like the interprofessional or inter industry tension? The noise is, it's constant. know, there's always, there's always some amount of

of attention that we have to get to it. long do you think it would be until, know, CRNAs had a significantly negative impact if the ANA did not exist? Almost immediate. It'd be very quick. Thanos snap,

Joseph Rodriguez (00:47)
Hey everyone, real quick. If you're listening to this, you're probably the kind of anesthesia provider who wants to understand more than just how to push drugs. This podcast is about understanding what's really going on, whether it's legally,

clinically or financially and the often small but powerful ways you can protect and advance your career outside of the OR. Anesthesia Deconstructed is already one of the top podcasts, at least in anesthesia. Out there we get a few thousand listens per episode, but subscribing helps us keep that momentum and it helps us bring on more compelling guests that are commentary and the kind of insight that actually moves our careers forward.

Subscribing is free. helps us keep doing what we're trying to do and it means you'll stay sharp, connected and stay a step ahead. So please hit the subscribe button and enjoy the show.

Joseph Rodriguez (01:41)
All right, Bill Bruce, the one and only chief executive officer of the ANA, a organization that represents 60,000 CRNAs and neurosanitary residents across the country.

The largest, the most influential body for CRNAs in the country. You are the CEO. Why don't you

your role for us? Tell us what the CEO does for the ANA.

and ultimately the value that that role is providing to those 60,000 people and of course no pressure since we're putting this in the very first part of the podcast and thank you for being on.

Bill Bruce (02:21)
Thank you, Joe. Always happy to be here. think, well, first, currently, we are just over 65,000 members. And this is the month in the year that we define that for the annual cycle.

And it's not going to be 65,000.

sharing.

I am

fulcrum between what an organization wants to do and what an organization can do. I balance the resources that we have to do different things, our staff, our investments, all of our programs, with the hopes

desires and dreams of ⁓

what

the members of the organization want us to be. ⁓ so that expresses itself to me through the board. ⁓ That's the main way that work comes. ⁓ So sometimes I get to play a consultative role with the board to help them focus and lens their strategy in the right directions and highlight where we could be stronger or where there's opportunities. And at other times I get to

reallocate the resources and distribution of things that we have in place in order to affect that strategy or that goal as expressed. so, ⁓ yeah, the role of the CEO is in many ways ⁓ a balance point or a pressure point of these different sides of the organization of what it can currently be versus what it wants to be.

Joseph Rodriguez (03:55)
And just for the sake of context, remind, can you just remind the audience what your role was prior, immediately prior? I know you have military leadership experience, so on and so forth, but what was the role immediately prior to this one?

Bill Bruce (04:04)
sure.

So right before coming to the AA &A, I was the CEO at the American College of Occupational and Environmental Medicine, which is a small physician organization that,

interesting area of healthcare. They had four or 5,000 members total over

years. yeah, they were small. before, I was...

Joseph Rodriguez (04:30)
or 5,000 you said? A little different.

Bill Bruce (04:35)
They were an interesting organization. That was my first role as a chief executive. ⁓ And it was a good place for me to have that role. And ⁓ you learn a lot any time it's your first time doing a thing. You learn things that you do well and you learn things that you need to improve on. ⁓ I learned both of those things at that organization. But before that, worked with the American Academy of Orthopedic Surgeons.

as their Chief Technology Officer, which there was not just, it was an IT and a business position also had some internal capacity. Yeah, you have your foot, right. And then before that, I was the Chief Information Officer for the American Psychiatric Association. And now we're getting back to March of 2000. So, you know, that's 25 years of, yeah.

Joseph Rodriguez (05:04)
Mm-hmm.

Yeah, you had your foot in both capacities.

March of 2000.

Yeah, that's a lot of CRNAs weren't even born then. I'm sorry, I'm dating, I was in high school. That's great, I love it.

Bill Bruce (05:35)
Right.

You're a nice, well, if

you consider born the date you complete your program or your initial credential, then yeah, you're right.

Joseph Rodriguez (05:46)
Yeah, that's

definitely true. That's definitely true. ⁓ I want to talk a little bit about so obviously, a lot of those there's going to be elements of all of those organizations which are similar right that

standard board structure, i.e. members elect board, board sets endpoints, high level items, and effectively you're the control point that says, yes, that's realistic or no, that's not realistic or it could be realistic, but you need to go and get me another 10 or 20 million dollars, something like that. Is that a fair description? You know, just as a follow-up.

Bill Bruce (06:20)
That is fair.

Joseph Rodriguez (06:27)
unique to the ANA, unique to CRNAs is that there's so much scope overlap, obviously with physician anesthesiologists and obviously we wanna be very respectful in the conversation for anyone who's listening. ⁓ There's obviously scope overlap. I don't think anyone's gonna debate that. In any of those prior roles, was there anything like?

the interprofessional or inter industry tension that you've seen in anesthesia. You have a view that others don't, right? Because you came to anesthesia effectively fresh, right? You have the CEO skills, that vision, that ⁓ operational capability. The tensions in anesthesia were new. I'm curious on your perspective there.

Bill Bruce (07:11)
Yeah, so there are, ⁓ you know, in other areas of healthcare, there are aspects where you see a similar dynamic, ⁓ not exactly the same. And in my experience, I've run into two different versions of this before the AA &A. ⁓ And at the end, I'll come around to why I think the AA &A is uniquely different

than those other two, at least in magnitude, if not specifics. ⁓

My last organization is interesting, ask about that. My last organization was, ⁓ it's an area of healthcare that is in contraction

particularly from the physician side. They're not turning out enough new physicians to meet the demand every year for the work that is done. The organization had spent a long time not really supporting the creation of new programs or advocating for the creations of new programs. And so there are.

totally getting bitten by the reality that the best time to plant a tree is 20 years ago and the second best time is right now. And you didn't plant them 20 years ago. So you don't have a crop of people coming in to keep the profession looking the way it is. ⁓ At the same time that that was happening, you saw a lot more nursing coming in, nurse practitioners, ⁓ in particular, but also some physician assistants that were getting their chops up because the market would demand.

that more people could do what they did to provide care in occupational medicine. And so that organization was grappling with the confluence of physicians and nurses that could do similar things. So it was interesting to see the lens and how the priority dynamic within one organization plays out for that. So you have a physician's organization, you have nursing that is trying to be recognized differently and struggling against the cultural

Joseph Rodriguez (08:47)
Sure.

Bill Bruce (09:01)
histories of the physician apparatus of power. ⁓ And now from my perspective, in my role, part of why, some of what I learned there was that sometimes it's just very hard for people to hear things that seem to be very obvious to somebody who is one step removed. And that's an organization that I believe math has determined the outcome. And it's now everybody just needs to accept the outcome. ⁓

Joseph Rodriguez (09:06)
Yeah.

Mm.

Bill Bruce (09:28)
you know, with their median age at the time, I want to say it was in the low 60s to mid 60s for the physicians. There's zero chance that the physicians were going to be the majority in the profession for very much longer. And if the organization that represents the profession was to continue, ⁓ it definitely would need to welcome nursing and the care that nursing could. Yeah, and it would need to change what it was. But that was hard for them.

Joseph Rodriguez (09:34)
Wow.

Right.

and kind of have a joint society in that way. ⁓

Bill Bruce (09:56)
Separately, see a similar kind of friction ⁓ with podiatry and foot and ankle surgeons. They run orthopods or podiatry. They run into each other a bit and they have, ⁓ I don't think anyone listening is going to be surprised to know that there are emotions involved with what they do with each other.

Joseph Rodriguez (10:04)
Sure, the orthopods, yeah.

Whatever do you

mean? I've never experienced that. ⁓ Could you put it in qualitative terms? Like maybe a metaphor or analogy for

Bill Bruce (10:20)
⁓ But what's this?

Joseph Rodriguez (10:30)
level of overlap and that tension and what you see in anesthesia?

Bill Bruce (10:35)
say,

well for those who so for the orthopedic example, ⁓ it's, you know, you're camping and you've been camping, right? Everybody's been camp. Awesome. So you spent a lot of time setting up your tent and figuring out where you want to sleep on the ground and you get everybody like sort of

Joseph Rodriguez (10:48)
Yes, I have been camping. Scout, all my honor. I will do my duty to God of my country. I can keep going, but yes.

Bill Bruce (11:01)
And specifically in a group camp, you're looking for the best spot, right? You want the softest ground. You want to avoid these midge roots. No matter what, you're going to find that thing is annoying. It's going to wake you up two or three times a night and you're going to have to move around and shift around it and deal with it. ⁓ know, to me, it's ⁓ the level of attention is kind of like that for the pituitary, the orthosis, right? There's an irritation. There's clearly some friction going on.

Joseph Rodriguez (11:13)
Of

Okay.

Bill Bruce (11:32)
and, ⁓ you know, it was.

Joseph Rodriguez (11:36)
interested to see how you complete this metaphor. This is going to be interesting. ⁓

Bill Bruce (11:41)
Well, in some regards, ⁓ I kind of think on our side of the fence now, it seems like we set up camp next to a train station. The noise is constant. There's always some amount of attention that we have to get to it, which is what makes it ⁓ very different, I think, than my previous experience. So what the ANA deals with and what CRNAs deal with is ⁓

much more consistent ⁓ and bona fide overlap with another with another profession practicing the same thing, you know, one practicing medicine, one practicing nursing. And those are different manifestations. But from from the health system standpoint, if you take a step back, you do have

two bona fide separate professions, each with their own certification tracks, their own education track and their own philosophy of care that effectively do the same thing. And the outcomes are the same, the qualities is the same. We look at those constantly, because we're constantly looking for an edge or something that can help protect our profession, your profession. And what we can get to is that care

care can be provided by both models, by both professions ⁓ equally well. And then you get into, you now have a stage where you can have competing professions and competing organizations. And the fact is that neither organization or profession has enough people to meet the demand in the first place. So both have to exist.

Joseph Rodriguez (13:23)
Indeed.

Yeah, and there's a lot of conversations on the ground every day, not just in terms of what is right from a policy standpoint, but also what is right from a or what is appropriate from a modeling standpoint, right? I was saying all amc practitioners are certified. They're not all the same, right? Some are dumber than a bag of hammers. I won't mention them by name on the podcast. That would be inappropriate, but that's good perspective.

You also, I know you are connected with IFNA, the International Federation of Nurse Anesthetists, or at least you're aware of it. And I think for the benefit of the audience, you already know this, but I want to frame this appropriately. Canada, the United Kingdom, i.e. Ireland, England, Wales, Scotland, France, Spain, Australia, New Zealand.

Bill Bruce (13:57)
Yes.

Joseph Rodriguez (14:15)
Effectively any healthcare economy or any society any westernized economy that the United States has anything in common with?

is effectively I would characterize it as effectively do not exist there might be some sort of you know assistant role, but it's very limited and not only is it very limited but

In terms of market share, it's a fraction.

We're talking, I would imagine, less than 5%. Whereas here, CRNAs are involved in something like 60%, 70%. Just an entirely different environment. So with that

long do you think it would be until, you know, CRNA has had a significantly negative impact if the ANA did not exist?

Bill Bruce (14:59)
I think it would be almost immediate. It'd be very quick. ⁓ the thing, if we assume, know, Thanos snap, right? Tomorrow there's no ANA. You know, the organization just stops existing. ⁓ That's going to create a

And ⁓ all vacuums seek to be filled by something. And ⁓ the thing that you would see, I would guess, is other interests rushing to try to influence that vacuum and to pivot ⁓ the collective psyche of the profession into a different direction, to change the makeup of it. They would see an opportunity. ⁓

are not being here, we create opportunities for others to ⁓ take money off the table, ⁓ frankly. since we live in a society that ⁓ strives for efficiency and is largely defined by financial efficiency from certain perspectives, that's gonna tell you who would be interested in removing things from the menu of options for people practicing nurse anesthesiology. So I think...

Joseph Rodriguez (15:52)
Sure.

Of course.

Bill Bruce (16:12)
it would be very fast that you would see people seeking to fill the void And if, for example, a lot of those other countries, even the ones that are on the path to maybe having something like what we would recognize as a CRNA, ⁓ eventually emerge. Those professions don't.

They don't have the same power of self-determination that we do. And we have that here because of the AANA. We set those boundaries. We're kind of the boundary guards of the profession. And if an organization is not in place to look to, here's what we do. We advocate for these people.

we make sure that this group of professionals is as good as they can be and holds themselves to a standard to do what they promised to society, but also protects

those people from encroachments of other organizations and other interests in that society.

people will start to nibble away at those borders. They'll encroach in on our space. I think it would happen very quickly. It might take a long time for it to...

Joseph Rodriguez (17:16)
Yeah.

Bill Bruce (17:25)
come to whatever the next state is, but it would be fast that people would see the opportunity. would there still be, getting to the earlier part of the conversation, would there still be ⁓ non-physicians ⁓ administering anesthesia? Yeah, for sure. ⁓ Because there aren't enough physicians to do it, and the economics don't support that. ⁓ But would they look like what we have today? Not remotely, I think, in the long term.

Joseph Rodriguez (17:29)
Mm-hmm.

What?

Yeah, indeed. Yeah, I totally agree and I'm certainly not auditioning for a job but I think, well actually let me ask you this question before reflecting on your answer there. Do you know your counterpart at the American Society of Anesthesiologists? You have a good report?

Bill Bruce (18:09)
I do.

So we're developing, this might be news to folks listening, to the audience. Historically, there's been off and on interactions between the AANA CEO and the ASA CEO. The previous ASA CEO, Paul Pomerantz, is something, because I'm not a practitioner or a clinician, I work within a group of professionals who work in professional associations. Paul Pomerantz was one of those people. I've known Paul.

Joseph Rodriguez (18:17)
The audience here, yeah.

Bill Bruce (18:42)
Probably going back 2002, 2003, first time I met Paul, we've been sort of a friendly acquaintance over the years since then. Yeah, we run in the same circles. We share a profession and interest even sometimes, even when they're not aligned. However, so that's pretty common that people who work in associations know people who work at other associations.

Joseph Rodriguez (18:49)
We're running the same circles a little bit.

Mm-hmm.

Bill Bruce (19:06)
And

we'll have some amount of engagement with them. Now, the ASA and AANA's leadership has, off and on over the years, had different periods where there was some amount of frequency in their interactions. ⁓ That, for whatever reason, did not survive the dual changeovers between our organizations. So when Paul retired, ⁓ the tradition of meeting with the AANA CEO did not continue, nor did it survive the

Joseph Rodriguez (19:26)
Mm.

Bill Bruce (19:34)
transition from Randy Moore to the interim CEO to me. And this thing sort of by the wayside. So it's something that... ⁓

Joseph Rodriguez (19:41)
Do you want to go on record now and say you'd like to begin that conversation again? We can send it over. can send this clip over to, I don't even know who it is.

Bill Bruce (19:48)
Yeah, well, his name is Brian Riley. ⁓ Yeah, I know his name. I know him. We've had some conversations. ⁓ And ⁓ I think it could be. you know, right now.

Joseph Rodriguez (19:51)
Okay.

Good. Seems like a good thing.

Bill Bruce (20:06)
The thing about inter-organizational relationships is, if you don't have a conversation, you tend to always assume the worst and you have no perspective of what the psyche of the other organization is. And without going into details and things, could say, I can say that there are elements of each of our organizations that will consistently think the worst of the other. And for some people, I'm sure those

Joseph Rodriguez (20:17)
Indeed.

Bill Bruce (20:35)
extreme views are completely valid and justified. ⁓ But we know that not everybody in these professions shares those views. We've had those conversations. So right now, the organizational positions are what they are. ⁓ But having a conversation is something that can be done to ⁓ hopefully help avoid miscommunications. It gives an opportunity for

Joseph Rodriguez (20:44)
Of Of course.

Bill Bruce (21:04)
one or the other of us to say, you know, did you guys really mean that? ⁓ You know, did you intend for this? Because in our organizations, and this has not happened, but having a dialogue can allow for this to happen if it was over relevant. ⁓ You know, we could be a little bit more intelligent in how we do or don't engage or react to or not react to what our alternative or what the other organizations do. So that can happen. ⁓

Joseph Rodriguez (21:27)
Hmm.

Yeah, well said. think this is very wise on your part. I'm hosting, but I'm sharing my opinion. I think this is very wise to start those conversations. think going back to our previous question, I think one of the keys to professional success generally is a superpower of not taking things personally.

Right. Realizing most things that people do is about them. It's not really about you. You don't have to pick that up, so to speak. If a physician says that, you know, an anesthesiologist says that, you know, they're the best thing ever. Right. That doesn't necessarily diminish your position and vice versa. I try to have these conversations because our group is interprofessional, but you know where I actually work. ⁓ But, know, if the A &A didn't exist and I'm not auditioning for a job here.

But if they didn't exist and the ASA didn't do everything in their power to advance the cause of their members, that is their duty. That is their fiduciary duty. They need to be faithful to the interests of their members and they certainly should be. And I try to encourage people on both sides. There's nothing wrong with that. I think largely your comment on we can be more intelligent is well taken. I often encourage folks to think about things locally.

Like just let people work things out locally rather than trying to get the United States government or a state government to figure it all out for us. Cause you know, they're, they're working super well lately, which is, I almost can't even make that joke anymore. It's so bad. Okay. I appreciate it. It's bad. It's bad right now. I appreciate your input on that. I know it's a touchy subject. Let's switch gears a little bit.

ANA CEO, you're gonna be walking around with your little badge that says CEO on it, or you can be all humble, hi, I'm Bill, right? Bill Bruce, someone's gonna make a joke about Braveheart if they're as old as I am. know, every Gen Z-er on here is like, you know, probably thinks it's a terrible movie or they don't know what it is. But you're gonna be there, you'll be pressing the flesh.

Shaking hands so on and so

gonna meet a lot of everyday members gonna meet a lot of future members a lot of people in their training program from your point of view, what is the most common myth most common misunderstanding about what the a &a is doing well or just a misunderstanding about our professional association in general that you're correcting with the everyday member something that sticks out in your mind that is coming up regularly

Bill Bruce (24:12)
Yeah, so the biggest myth and misunderstanding, and I'll add to that ⁓ something else I think you might be interested to, the biggest myth is, we're more than advocacy and ⁓ credit transfers. Those are the things that we see the most. Well, I mean, and that kind of gets to the real answer, the most underutilized part of the organization, which is something that ⁓ people at Congress will know about. ⁓

Joseph Rodriguez (24:25)
Tell me more about that.

Bill Bruce (24:42)
you know, the secret, the thing that I want us to be, to continue to grow is our attendance at our events. ⁓ Our events are of enormous value, they are changing. You we've been experimenting with different things ⁓ in recent years.

Joseph Rodriguez (24:56)
they

are changing in what way?

Bill Bruce (24:59)
⁓

So we get a lot of feedback from attendees about the sometimes repetitiveness of the things that show up in the program and maybe the lack of creativity. so we've been for the past couple of years and will continue for the next several years to see ⁓ what we hope are perceived as improvements to our events. We're going to be doing more to make them a little bit more engaging.

You know, if you could kill things with both metrics if you go too far, of course, and evaluations are one way that you could generate those metrics. So when we ask people, when you look at event evaluations, one of the things that they'll say, and this is true for all associations, by the way, not just the ANA, I go to events for the education. Okay, that's a very common refrain. I go for the education. And I think that's because a lot of people are reimbursed because of the education.

Joseph Rodriguez (25:58)
Of course. ⁓

Bill Bruce (25:59)
And so that's the obvious

answer.

second thing is I go for the networking. And then maybe it's I go to meet some exhibitors, depending on the reasons. I think the way those questions get asked, they might support some answers that aren't the actual reality. ⁓ Because what we see in the data is that half of the people who attend at most claim half of the

credit.

Joseph Rodriguez (26:25)
They're not there primarily. True

or false statement, they're there somewhat for the education and mostly for the experience.

Bill Bruce (26:32)
Yes.

There's other reasons for it. And so if we pay attention to the other things that could be there, the connections, making it much more of a social event, a fun meeting, engaging, lots of things to do that are not the same format of session, changing things up. think one of the things that the younger generation is demanding more of organizations like us is that we have

creativity and more flexibility in the way we think about delivering knowledge. ⁓ Personally, my whole life I've struggled with the concept of I go and I sit in a room and I listen to somebody talk at me for 45 to 50 minutes and somehow I magically have absorbed things ⁓ because I'm an autodidact. I teach myself almost everything I need to have my hands on and read things on my own. then a 15 to 20 minute lecture is a great way for me to reinforce and clarify some of what I've

taught myself or what I've learned elsewhere. in ⁓ traditional education, that's not a delivery model that is as ⁓ well, you see

Joseph Rodriguez (27:31)
Sure.

never been

asked to give a 20 minute talk. I would love that as a speaker, frankly, because people's attention really drops off after about 20 minutes. You have to really ramp it up in the second half to keep their attention.

Bill Bruce (27:42)
Yeah.

It does. and again, I I'm just I'm more speaking about, you know, my approach to learning, which is not what we're projecting onto the event.

Joseph Rodriguez (27:57)
course. mean you're not

inviting me to a 20 minute? This is not an official invite. ⁓ okay. Okay.

Bill Bruce (28:02)
This is not an official invite yet, though I hope in the future it could be. would love to see us do

more rapid fire stuff than we are. And we're moving in that direction. We're bringing some things that are differently engaging. And this year, we have a hackathon this year where we actually have a facilitator who's coming in. We're to have room for, I could be wrong on this, 75 or 100 people that will be able to participate in this and pick a problem and chew on it. Yeah, absolutely. Yeah.

Joseph Rodriguez (28:10)
Yes, indeed.

Good.

That's awesome. That's awesome. You Sharon Pierce hosting, right?

Bill Bruce (28:32)
Share into the... Yeah, I'm sure she will.

Joseph Rodriguez (28:32)
You chose a great host. She'll do a great job. She's got that Southern charm.

Bill Bruce (28:37)
Yes, she will. So we're doing that. We've changed some of the fun side of the event to kind of re-envision the whole party with a purpose. Last year we had a real smash with the aircraft carrier. I think ⁓ it's a rooftop series of bars downtown. Yeah, there's like three different venues that are all connected.

Joseph Rodriguez (28:48)
What is it going to be this year? It's going to isn't a rooftop or something.

series of rooftops.

Okay,

Bill Bruce (29:01)
Yeah,

Joseph Rodriguez (29:02)
awesome, awesome.

Bill Bruce (29:03)
we have the capacity for it to be an outstanding event. And we're going to need it because in spite of the fact that I wish more people would come to our meetings, we actually are going to have our largest Congress ever this year. Well, so far we are 3,963, which is...

Joseph Rodriguez (29:18)
Really? How many people are going to be there?

Wow.

Bill Bruce (29:28)
about 300 or so more than the 75 year anniversary year, which was the record. That is 2006, 2008. Thank you.

Joseph Rodriguez (29:36)
Congratulations.

That's impressive. 4,000 person conferences, that's no small thing.

Bill Bruce (29:43)
I'm pretty sure we're holding our breath. We think we're gonna pass 4,000 once we get through some of the onsights. It's gonna be fun. But even so, ⁓ that spells an opportunity for us and that's something that I hope people do listen to. I there's more to the event than just education or there's education, there's networking, there's peer mentoring, there's... ⁓

Joseph Rodriguez (29:49)
Sure. Okay, awesome.

Bill Bruce (30:11)
all of those things and we're trying to be more creative in how we deliver these things so more people will drive value because if you think about 65,000 people and you have a 4,000 person conference that leaves 61,000 people that aren't at the conference this year. take away the people that are hyper engaged that come all the time and the people who come every other year when there's a good chunk of those and you're down to, you know, there's about 1,500 people that are

Joseph Rodriguez (30:27)
Sure.

Bill Bruce (30:41)
You know, this is going to be the one they're giving a shot. And mouse suggests that, that we might never see any of those 1500 again, because out of 65,000, their career is over by the time they're going to loop back in. Whereas most professional associations, your annual conference is going to get people about every three years. You know, you're going to get roughly a third of your membership is showing up to your annual conference. And there's a lot of things that change that for CRNAs, but I think, I think we, we,

Joseph Rodriguez (30:52)
they might only come once or twice in their career. ⁓

Mm-hmm.

Bill Bruce (31:11)
should see more utilization of our events than we do even factoring that in. And so I think there's an opportunity here for us to do better and do more. And so we're more than just credits. We're more than just advocacy. And I think the most value that we have potentially is in our events. I hope more people decide to give it a try.

Joseph Rodriguez (31:37)
Yeah, can shameless plug. All right, obviously I'm a member of the association. I'm playing host today. people ask them the question I get asked the most, which is, tell me about the business. Tell me about the business. And then I tell them two things. The first, which is anesthesia reimbursement is a fraction of what we get paid. So it gets very complex very quickly. The second thing I tell them is most of what I learned, I learned at meetings.

Right. I talk to people constantly, just meet people. There's a certain power. You just kind of bump off opportunity in these places. And that's what most people don't get, which you can never do right here. Right. You can't do that through a camera. All right. I want to I want to ask one more question right before we wrap up. It's a busy week. Thank you for making the time. We started the conversation talking about your experience with all of these non anesthesia organizations. And I think there's significant value in some of those things. I know.

you a little bit on a personal level. I know you've experienced significant, you you've had personal challenges. Every leader brings something to the table, something that drives them, something from their childhood, some sort of almost traumatic experience. What's

from your background that you're still pulling in to your professional life, your career, your leadership, something that maybe people don't know about currently?

Bill Bruce (32:59)
This one's tough. ⁓

You know, yeah, I've had an interesting path. ⁓ I think of all people as ⁓ not just the sum of their experiences, but the sum of their choices. ⁓ You know, every time you make a hard, particularly if you make a hard choice, that has ⁓ some incremental effect on defining you.

And those choices and those experiences have always interplayed. so without going into the details, I'll say that I grew up with a very strong affinity for a lack of hypocrisy and an awareness that each of us can have an impact on the well-being of those around us, ⁓ even if small.

And so ⁓ one thing that I try very hard to do is to ⁓ be consistent in doing the things that I say that I'm going to do or doing my best to do them. ⁓ because I grew up ⁓ in situations where I couldn't always depend on things that should have been constant,

I try very hard and I get value from when I'm successful at being constant and being something that can be counted on in that way for the people around me. And right now, of the things that, one of the most rewarding things that I get to do is do that for this organization and its staff. ⁓ And that means, you know, being consistent and the advice that I give to our board in terms of what kind of culture is a good board.

and what kinds of philosophies and sort of how to be a stronger future. Because if you're strong today, you'll be stronger tomorrow. And to be strong today, you have to trust yourself tomorrow. So always trust a future version of you to make the right choice at the time and get out of your way, get out of your own way. And I could do the same thing for staff. The staff have responded very well.

to this consistency and this kind of there are some things when we talk to the people who put on this ⁓ survey that drives that award or that series of awards, there are some aspects of the engagement survey they use for which we were the benchmark. We set the standard nationwide, not just in associations.

but of all organizations. There are a few metrics where ⁓ we've been interviewed to talk about what is it that you do at the ANA that is working as well, because we don't see these results very typically. So we've become a leader in the association workspace because of, I think, having a very positive and consistent and value-driven culture.

Joseph Rodriguez (35:56)
Hmm.

Bill Bruce (36:09)
There have been times in my life where I've lacked that and there have been times where I've had that. And I bring a need to create that for other people. I'm never gonna work in healthcare. I'm never gonna be able to improve people's lives directly

way. So the work I do here and the environment that I set up, it should give people a small amount of peace and sense of being rewarded because

If they do that, they will do better work, which means we can collectively help the profession do better work. ⁓ You know, all of this builds on itself. And it's a way that it's a way that I could contribute something to society that I wouldn't have a better way to do somewhere else.

Joseph Rodriguez (36:43)
Indeed.

I love it. We're going to leave it right there. Bruce, thank you so much.

Bill Bruce (36:58)
Pleasure to respond anytime Joe.