payments as a rural practice inducement for nurse anesthetists to practice in small, underserved rural hospitals. CRNAs begin their education with a four-year Bachelor of Science degree, followed by at least one year of critical care nursing experience (most trainees enter with 3-6 years of critical care nursing experience), and completion of the CCRN certification. After 3 years of intensive didactic and clinical anesthesia training, they obtain a doctorate of nursing degree and they must then pass the NBCRNA national certification exam. CRNAs care for patients pre-, intra-, and postoperatively and practice in all facets of anesthesia care. They may care for patients independently but also work collaboratively as part of the healthcare teams. Some choose to narrow the focus of care to sub-specialize in the provision of cardiac, pediatric, pain, or obstetrical care. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all of the accepted anesthetic techniques—general, regional, local, or sedation independently without supervision of a physician anesthesiologist. As of 2022, 19 governors opted out of the CRNA supervision requirement of the Centers of Medicare and Medicaid Services (CMS). Anesthesiologist Assistants Anesthesiologist assistants are advanced non-physician anesthesia providers qualified by graduate medical education and clinical training to work under the direction of an anesthesiologist in developing and implementing the anesthesia care plan. The anesthesiologist assistant is a nonphysician anesthesist in the Anesthesia Care Team (ACT) with an identical scope of practice of certified registered nurse anesthetist (CRNA). Anesthesiologist assistants obtain pre-anesthetic health histories, perform preoperative physical exams, establish non-invasive and invasive monitors, perform all types of intubations and airway management techniques, administer medications/IV fluids/blood products, evaluate and treat life-threatening situations, and execute all forms of anesthesia including the induction, maintenance, emergence and recovery of general, local, sedation and regional anesthetic techniques. Anesthesiologist assistants generally work in the hospital setting but can work at any location including pain clinics, dental offices and surgical care centers. Anesthesiologist assistants work under the medical direction of physician anesthesiologists in surgical environments such as cardiac surgery, neurosurgery, transplant surgery, and trauma surgery centers. The incorporation of anesthesiologist assistants into ACT teams across the country is a dynamic process, and currently there are sixteen states, as well as Washington D.C. and the Veteran's Affairs Medical System. In each of these states, the anesthesiologist assistant falls under the regulatory authority of the State Board of Medicine. As of 2017 there