At some point in most certified registered nurse anesthetists (CRNAs) careers, questions about independent practice come up. Sometimes it is tied to a potential move. Other times, it comes from wanting a different kind of professional rhythm or responsibility. However it comes up, understanding how practice differs from state to state is part of making informed choices about where and how you work.

The Expanding Role of CRNAs

CRNAs already play a central role in anesthesia delivery, particularly in rural areas. Each year, CRNAs safely administer more than 58 million anesthetics in the United States, and approximately one-third of hospitals and more than two-thirds of rural hospitals rely exclusively on CRNAs for anesthesia services. In some areas, states have responded to rural access challenges by adjusting how CRNA practice authority applies in specific clinical settings. For example, Utah and Wyoming have partial opt-outs for anesthesiologist supervision requirements in rural and critical access hospitals, allowing CRNAs to practice independently in those facilities.

Looking ahead, reliance on CRNAs to support timely anesthesia services is likely to continue. The U.S. Bureau of Labor Statistics projects 9% job growth for CRNAs from 2024 to 2034, reflecting sustained demand across the job market. At the same time, the National Center for Health Workforce Analysis (NCHWA) estimates that the U.S. could face a shortage of 10,660 anesthesiologists by 2038, which may further reliance on CRNAs to sustain anesthesia coverage across care settings.

How CRNA Practice Authority is Determined

The scope of practice for CRNAs is not defined by a single set of rules but rather by a mix of federal and state laws. At the federal level, a key inflection point came in 2001, when the Centers for Medicare & Medicaid Services (CMS) allowed governors to opt out of the federal physician supervision requirement for CRNAs. The intent was to help preserve and expand access to anesthesia care, particularly in rural and underserved communities.

However, even in opt-out states, the opt-out itself does not mean full independent practice. The opt-out affects the federal supervision condition tied to Medicare participation, but each state still defines what CRNAs can do through its nurse practice act and related regulations. Because of that, states generally land in one of three categories:

  1. Independent Practice: The governor has opted out of the CMS supervision requirement, and state law treats CRNAs as independent providers.
  2. Opt-out with Restrictions: The CMS supervision requirement is waived, but state law may include guardrails, such as collaboration requirements, protocol expectations, or restrictions tied to certain settings or facility policies.
  3. Physician Supervision Required: Regardless of any CMS opt-outs, state law maintains a physician-supervision requirement, meaning CRNAs practice under defined medical oversight.

For CRNAs seeking independent practice, it is important to understand how each state defines CRNAs' scope of practice. That clarity helps you focus on states and roles that support autonomy and set realistic expectations before you commit to an opportunity.

States Where CRNAs Can Practice Independently

State law ultimately determines whether physician supervision is required for CRNA practice. The states listed below are those where CRNAs can practice independently without physician supervision.

As of January 2026, the following states and Washington, D.C., allow CRNAs to practice independently:

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Vermont, Washington, West Virginia, and Wisconsin.

States Where CRNAs Can Practice Independently

  • =Independent
  • =Not Independent

While independent practice means a CRNA is not required to work under physician supervision, collaboration requirements, facility bylaws, credentialing standards, and payer policies may still apply. Additionally, some states and facilities may set additional expectations related to education, certifications, and clinical experience.

Important to Note: This information is provided for general educational purposes. Regulations and interpretations are subject to change as laws evolve, so it is important to always review current state and facility requirements.

Why CRNAs Choose Independent Practice

Independent practice can be professionally rewarding, but it also asks for comfort with clinical ownership and decision-making across a wider range of scenarios. Many tenured CRNAs thrive in this environment because the variety in case types and increased responsibility can sharpen judgment and expand skills over time. New graduates may look for structured supervision early on while they build experience. Either path can be the right fit. The key is aligning the practice model with where you are in your career and the kind of responsibility you want day to day.

Here's a perspective from a Medicus locum tenens CRNA who practices independently:

"Working in an independent practice as a CRNA allows me to practice to the full extent of my training, which in turn helps me become a well-rounded provider. I enjoy doing regional anesthesia, including spinal, epidurals, and peripheral nerve blocks. They offer quick pain relief, better pain control, and also decrease opioid use. There is an immense feeling of satisfaction when you are the one performing the pre-op evaluation, deciding and carrying out the anesthetic plan, and continuing to manage the postoperative phase." - Kelsey, CRNA.

Interested in Working as a Locum Tenens CRNA with Medicus?

If independent practice is on your radar, locum tenens can be a practical way to experience it firsthand before making a longer-term commitment. Locum tenens CRNA jobs allow you to step into an independent practice setting, learn what the day-to-day responsibility feels like, and decide whether it is a model you want to pursue long term, either by continuing as a locum tenens CRNA or transitioning into a permanent role. Along the way, many CRNAs also pursue locum tenens to explore opportunities in different states, broaden their clinical experience, and maintain control over their schedule.

At Medicus, we help make that exploration more straightforward. We take time to understand what you are looking for in an independent practice experience, then share locum tenens CRNA jobs that align with your goals around location, practice setting, and schedule. Whether you are seeking independence, professional variety, or work-life balance, CRNA locum tenens roles provide a dynamic solution to meet your career goals.

Interested in working as a CRNA locum tenens? View our open CRNA locum jobs here, or complete the short form below to connect with a Medicus Recruiter today.