I absolutely agree about the need to practice, however even in 100% ACT, there are lots of ways to practice "the monkey skills." These are still your cases and I'll often talk to the CRNA beforehand (to maintain good will) and do an entire induction or a wake up/emergence. Come in a little early and set up a machine for one of your rooms, stock once in a while so you become familiar with the storage room. Be humble - ask your partners for help, ask the CRNAs if you don't know where something is. You don't need to do solo cases regularly to stay sharp, but you need to take some effort daily (literally 5-10 min) to relearn and maintain sharpness on these skills, I consider it CME.
If we want to "take back" our specialty, especially in ACT, this is where the rubber meets the road IMHO and I don't think saying, "well I'd be dangerous" or "scrutiny is too much" or "we run lean" (just out of curiosity, if you're so lean, what happens if someone gets hurt or injured? Apply that same solution to illness or injury to a case request). My point is, there are solutions to all of these excuses and we need to step up our game. If you're so rusty that you can't figure these things out in a few days, you might need to look for a different career.
These statements should instead be motivation to maintain and practice your skills. Of all the things that are "bringing down" our specialty in the end we are doing it to ourselves and statements like the above are more scary to me for the specialty than any CRNA comment on twitter. I'm not trying to be confrontational, I'm simply pointing out what should be obvious to any reader of this thread from any other medical specialty.
