Hey I have long since stated that because of the difficulty recruiting crna to urban areas that it is wise to have AA able to practice in that setting or any setting with an MDA around. That being said it is the independent practice that seems to annoy so many anesthesia providers. The simple truth is the economics of small towns does not allow to have an MDA when they can hire 2 crna to do the job understanding we have limitations in independent practice as well.