How many states do not have physician 'supervision or direction' requirement for CRNAs?

• A. 23
• B. 33
• C. 40
• D. 10

Answer: (B)

The main idea is that the regulation of CRNA practice varies by state, with many states permitting independent anesthesia care without mandatory physician supervision or direction. In about 33 states, CRNAs can administer anesthesia under state rules that do not require a physician to supervise or direct the case. They still follow hospital policies and standardized anesthesia care plans, monitor patients, titrate medications, and handle emergencies. Physician involvement may occur through on-call availability, consultation when needed, or broader medical direction structures, but the physician’s physical presence or direct supervision for every case isn’t required in these states. The remaining states maintain some form of required physician supervision or direction, whether on-site, through medical direction agreements, or other collaborative arrangements.