Understanding VANA’s Department of Justice Letter and the Competitive Impacts of CRNA Supervision Mandates
On May 27, 2025, a formal letter was submitted to the U.S. Department of Justice’s Anticompetitive Regulations Task Force on behalf of the Virginia Association of Nurse Anesthetists by our legislative team. This letter makes a compelling case that Virginia’s outdated requirement that Certified Registered Nurse Anesthetists (CRNAs) be supervised by a physician isn’t just medically unnecessary, it’s bad for patients and creates anti-competitive conditions in the state’s healthcare marketplace.
Virginia is one of only six states that mandates full physician supervision of CRNAs. Despite decades of evidence, including federal recognition by the military and findings by the American Association of Nurse Anesthesiology that CRNAs are fully qualified to provide safe, independent anesthesia care, Virginia law continues to tie our hands.
This restrictive model doesn’t just limit professional autonomy, it limits access to care. The 2024 Joint Commission on Healthcare study found that lifting supervision requirements presents minimal risks while expanding access to anesthesia providers, especially in underserved rural areas. These restrictions also disincentivize providers, including surgeons and CRNAs, from practicing in Virginia, creating workforce gaps just as demand for anesthesia services is increasing.
The anticompetitive impacts are tangible: earlier this year Aetna considered requiring Virginia CRNAs to show proof of physician anesthesiologist supervision. This proof has not been required of CRNAs in most other states. These constraints drive up costs, reduce provider choice, and delay care. Rural hospitals, which are already struggling to attract specialized physicians, face added barriers because of misperceived legal liability tied to the supervision mandate.
Allowing CRNAs to practice to the full extent of their education and training without unnecessary supervision would modernize Virginia’s healthcare regulations, bring the state in line with national norms, reduce costs, and increase access, especially in rural communities. The DOJ letter urges federal action to address these barriers.
For CRNAs, policymakers, and healthcare leaders alike, this is a moment to reexamine who benefits from these mandates, and who is left behind because of them. It’s time to prioritize patients, not protectionist policies.
