Understanding Professional Jurisdiction Changes in the Field of Anesthesiology.

We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists' (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs. We show that higher levels of incumbent physician power makes it less likely that a state will change jurisdictional boundaries, while increasing relative power among challenging CRNAs and the past successes of other challenging health professionals increase the likelihood. State labor deficiency and proximity to other adopting states also positively influenced the expansion of CRNAs' autonomy. Implications for the professions and health services literature are discussed.