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CRNAs need to understand what is happening here.

People outside our profession are helping build a larger CRNA labor supply, and they have every financial incentive to do it.

USAP (already in anti-trust lawsuits) is helping fund, train, mentor, and recruit through Nova’s anesthesia education pipeline. NAPA, owned by private equity, is paying SRNAs while they are still in school and recruiting them directly into its groups. These companies are employers. Labor is one of their biggest costs.

They do not need to announce “we want to saturate CRNAs and lower wages.” If you are an anesthesia corporation, more graduates means more applicants, easier staffing, less dependence on travelers, and eventually less leverage for individual CRNAs.
That is the problem.

We are letting organizations whose economic interests are directly opposed to strong CRNA bargaining power help shape the size of our training pipeline.

The COA should be raising standards, limiting low-quality expansion, and aggressively protecting clinical training quality. And PE-backed anesthesia groups should have no role in driving how many CRNAs we produce.

If the profession waits until the labor market is flooded to care, the damage will already be done.

Private equity anesthesia groups should have far less influence over CRNA education.

If we wait until wages, leverage, and training quality deteriorate to care about this, we waited too long.

The CRNA profession is looking at the wrong labor market. Everyone points to today’s vacancies, $300k offers, sign-on bonuses, and locums rates and says, “Where is the oversaturation?” Of course you cannot see it yet. The people who may oversaturate the market are still sitting in classrooms. NBCRNA reported approximately 4,258 newly enrolled nurse anesthesia students in 2025, while 3,235 newly certified CRNAs entered the profession that same year. Those are not the same cohort, but the direction is obvious: the front end of the pipeline is becoming substantially larger than the number currently coming out.

That matters because CRNA programs take roughly three years. The 4,258 students who entered in 2025 mostly do not reach the labor market until around 2028 or 2029, and the classes entering in 2026, 2027, and 2028 come behind them. Today’s CRNA shortage was created by yesterday’s enrollment numbers. Tomorrow’s CRNA labor market is being created right now. By the time oversaturation becomes obvious in job postings and salaries, several more graduating classes will already be committed to the pipeline.

HRSA’s workforce projections make this more concerning than it initially appears. HRSA currently projects 79,540 CRNA FTEs in 2038 against modeled demand of only 70,400, which is already 113 percent supply adequacy. But the important detail is that HRSA’s model assumes only about 2,866 newly trained CRNAs entering the workforce each year, based on older certification levels. We already exceeded that assumption with 3,235 newly certified CRNAs in 2025, and the 4,258 students entering behind them suggest annual certifications could eventually move into the 3,600 to 3,800 range if roughly 85 to 90 percent of matriculants ultimately enter practice.

That difference compounds quickly. If HRSA is effectively modeling 2,866 new entrants per year but the real pipeline produces closer to 3,700 or 3,800, that is roughly 800 to 1,000 additional CRNAs entering practice every year beyond the model’s assumption. Allowing for ordinary attrition, a reasonable pipeline-adjusted estimate puts the CRNA workforce somewhere around 87,000 to 90,000 FTEs by 2037 to 2038, with roughly 88,000 as a reasonable midpoint. That is not an official HRSA forecast, but it shows how sensitive the workforce projection is to an entrant assumption that already appears outdated.

Could anesthesia demand absorb 88,000 CRNAs? Absolutely. HRSA also projects a major anesthesiologist shortage. NORA is expanding, ASCs are growing, the population is aging, and GI, EP, interventional radiology, cath labs, office anesthesia, outpatient surgery, and rural hospitals all create additional anesthesia demand. Hospitals also make enormous downstream revenue from procedural care, so adding an anesthesia provider can allow another room to open rather than simply dividing a fixed number of cases among more clinicians. There is a real possibility that the system needs far more CRNAs than current demand models assume.

But that is now the bet we are making. We are expanding the workforce rapidly and assuming future procedural growth, physician substitution, rural redistribution, and new anesthesia locations will absorb it. At the same time, CRNA education itself has expanded dramatically. There were roughly 124 nurse anesthesia programs around 2020 and about 155 by 2026, an increase of roughly 25 percent in six years, before even accounting for existing schools increasing cohort sizes.

CAA education is expanding even faster. Accredited CAA programs went from roughly 11 in 2020 to 20 by 2024, with 23 programs being surveyed by late 2025. The CAA workforce itself grew from roughly 2,900 in 2020 to more than 4,300 by 2025. Anesthesiology residency positions have also expanded. So this is not just a CRNA school expansion story. We are in the middle of a broad anesthesia workforce buildout from multiple directions at the same time.

That matters because every one of these training pathways ultimately competes for the same scarce educational resource: real anesthesia cases. There are not unlimited pediatric cases, OB cases, cardiac cases, blocks, difficult airways, invasive lines, thoracic cases, high-acuity rooms, or willing preceptors. ARC-AA reported that more than half of surveyed CAA programs had experienced decreased access to clinical facilities. If CRNA, CAA, and physician anesthesia training all continue expanding simultaneously, clinical capacity eventually becomes the limiting factor whether universities want it to or not.

This is why I think COA should raise clinical standards now rather than waiting for an obvious workforce problem. The minimum case requirement has already increased to 700 cases for newer cohorts, with 750 preferred. That is a good start, but I would rather see the profession move toward 750 truly diverse cases as a minimum than watch programs continue expanding while students compete for the same specialty experiences. The focus should not simply be raw case count. It should include more high-acuity patients, more regional anesthesia, more pediatrics, more OB, more invasive monitoring, more difficult airways, and more exposure to broad and autonomous practice.

If a program wants to grow from 25 students to 35, there is nothing inherently wrong with that. But it should have to demonstrate where the additional clinical capacity is coming from. Show the pediatric cases, the blocks, the OB volume, the acuity, the procedures, the clinical sites, and the preceptors. Show what happened to median student case volume and case diversity after the previous class expansion. The number of ICU nurses willing to borrow $200,000 should not determine how many CRNAs a university trains. Clinical capacity should.

COA should also require far more public transparency. Applicants should be able to see median cases per graduate, high-acuity case counts, regional blocks, pediatrics, OB, arterial and central lines, first-time NCE pass rates, ultimate pass rates, attrition, class-size growth, and how far students must travel to obtain specialty rotations. If one program graduates students with 1,100 diverse cases while another rapidly expands and barely gets its class across the 700-case minimum, applicants and employers should know that.

This is not an argument that COA should manipulate supply to protect CRNA salaries. It should not, and COA explicitly says workforce supply and demand cannot be the basis for accreditation decisions. This is an argument that rapid expansion should require progressively stronger proof of educational capacity. If tougher standards make unlimited expansion harder, that is not artificial supply restriction. It is quality control.

Maybe 88,000 CRNA FTEs in the late 2030s will be exactly what America needs. Maybe CRNAs absorb much of the anesthesiologist shortage. Maybe NORA and ASCs grow faster than expected, rural hospitals become better staffed, independent practice expands, and hospitals open thousands of additional anesthetizing locations. I hope that happens. But “demand will probably grow” is not enough reason to ignore how quickly supply is being built.

The lesson from pharmacy is not that CRNA equals pharmacy. CRNA has much stronger barriers to entry, requires real clinical training, cannot be outsourced, directly enables revenue-generating procedures, and has meaningful independent-practice opportunities. The lesson is simpler: a shortage can be real and training capacity can still eventually overshoot it. Once programs, faculty, clinical affiliations, and large cohorts are already in place, correcting the pipeline takes years.

That is why I think anesthesia oversaturation may already be here, just not in the form people expect. It is not yet visible in today’s salaries or job postings. It may be visible in the number of students already moving through the training system. HRSA already projects 79,540 CRNA FTEs in 2038 while assuming only about 2,866 new entrants per year. We just certified 3,235 in one year and enrolled another 4,258 behind them. If those enrollment levels persist, something closer to 88,000 CRNA FTEs by the late 2030s is entirely plausible.

Maybe anesthesia demand absorbs every one of them. If so, great. But if we are going to run that experiment, every additional CRNA seat should be backed by enough real clinical experience to justify its existence. Raise the standards, make programs prove the capacity exists, publish the clinical data, and then let actual anesthesia demand determine how large this profession becomes.