Rural health care and the nurse anesthetist.

As they work in all types of practice arrangements and settings with and without anesthesiologists, certified registered nurse anesthetists have been and continue to be the principle anesthesia providers in rural hospitals in the United States. As such, they are responsible for providing anesthesia services to about 1 quarter of the US population that resides in rural and frontier areas of this country. Rural health care is characterized by its necessity to provide a broad array of services with lesser resources than are typically available in metropolitan or urban areas. The rural population is characterized as having a higher proportion of elderly people and children under the age of 18, a higher incidence of chronic diseases, a lower mortality rate (albeit a slightly higher infant mortality rate), and a 40% higher mortality rate resulting from accidents. Rural residents are poorer and less likely to have job-related health insurance benefits or Medicare supplemental insurance. Despite the significant rise in the number of anesthesiologists in the past 10 to 15 years, there is no evidence that they are attracted to practice in these areas. As sole anesthesia providers in many of these rural hospitals, rural CRNAs have both common and unique problems and issues that confront them. However, from available reports, their communities are satisfied with their services, providing evidence of the capability of CRNAs to function satisfactorily without the anesthesiologist.