Cover: Relationship Between State Policy and Anesthesia Provider Supply in Rural Communities

Relationship Between State Policy and Anesthesia Provider Supply in Rural Communities

Published in: Medical Care (2019). doi: 10.1097/MLR.0000000000001106

Posted on Apr 11, 2019

by Grant R. Martsolf, Matthew D. Baird, Catherine C. Cohen, Nirabh Koirala


There is a significant geographic variation in anesthesia provider supply. Lower supply in rural communities raises concerns about access to procedures that require anesthesia in rural areas. State policies related to certified registered nurse anesthetist (CRNA) practice may help to alleviate rural supply concerns.


To estimate the association between state CRNA policy and anesthesia provider supply especially in rural communities.

Research Design

Repeated cross-sectional design using ordinary least squares and 2-stage least squares regressions.


All counties in the United States from 2010 to 2015. Measures: Dependent variables include anesthesia provider counts per 100,000 people, calculated separately for anesthesiologists, CRNAs, and their sum. Key variables of interest include state-level CRNA policy based on scope of practice (SOP) regulations and Medicare opt-out status.


Opt-out status and less restrictive SOP regulations were consistently correlated with a greater supply of CRNAs, especially in rural counties. Furthermore, we found that anesthesiologists and CRNAs tend to be complements to each other, but less restrictive SOP and opt-out status tend to weaken the importance of this relationship.


State regulations may lead to increased supply of CRNAs in rural communities. However, the design of our study makes causality difficult to assert. So, it is also possible that states set CRNA policy as a response to counts of anesthesia providers in rural areas. Furthermore, given supply of anesthesiologists and CRNAs are complementary to one another, improving access to anesthesia services may require addressing issues pertaining to the supply of all anesthesia provider types.

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