More certified registered nurse anesthetists are walking out of traditional W-2 positions, and the market they’re walking into is paying them more to do it.
Of approximately 57,000 actively practicing CRNAs in the United States, about 18% practice as independent contractors rather than traditional employees, reflecting a growing preference for 1099 or locum arrangements. That number is growing. As of 2025, roughly 2,800 CRNAs had worked locum tenens, either in tandem with their permanent roles or as a standalone career, according to a report from global advisory firm Stout.
Money is a primary driver. According to the report, experienced CRNAs opting for locum tenens can earn $250,000 or more per year, with annualized pay exceeding $300,000 in premium-pay markets. Some hospitals offered rates of $275 to $325 per hour, or higher, to fill urgent assignments.
Where they’re going:
1. Locum and contract work is the fastest-growing destination. Hospitals continue to experience persistent CRNA shortages, particularly in rural markets, independent-practice states and ASC-heavy regions, with elevated vacancy rates and intensified competition for available clinicians.
2. The procedural volume shift outpatient is pulling CRNAs out of hospital ORs and into ASCs, where schedules are more predictable and on-call demands are lower. The 2025 Somnia Labor Market Study found that more clinicians are seeking 1099 arrangements for flexibility and autonomy, while others continue to prefer the stability of traditional W-2 employment.
3. Legislative expansion of CRNA scope is accelerating the migration to independent practice states. Ohio became the 45th state to update its laws governing CRNAs in 2025, replacing physician supervision requirements with a collaborative framework. In rural areas, 75% of CRNAs already report practicing independently.
Why hospitals can’t retain them:
In 2024, 56% of CRNAs reported feeling very or somewhat burned out. Hospital models, with call requirements, overnight coverage and heavy patient volumes, are accelerating that. Around 31% of CRNAs are age 55 or older, meaning nearly one-third of the workforce could retire in the next 10 to 15 years. The departure of older CRNAs from permanent hospital roles, combined with younger CRNAs entering the field with a preference for flexibility, is redrawing the workforce map.
What this means for ASCs:
The shift is not cost-neutral for facilities on the receiving end. The share of ASCs expecting to pay anesthesia stipends jumped from 28% in 2024 to 44% in 2025, according to VMG Health, and 67% of respondents cited anesthesia coverage in their top three financial challenges for 2026.
The shift isn’t always a strategic choice. Dan Zahumensky, administrator of Seattle-based Proliance Surgeons’ ENT service line, told Becker’s his ASC’s move to CRNA-only coverage wasn’t optional. Its physician anesthesia group struggled to provide consistent staffing through the summer of 2024 due to a shortage of anesthesiologists and rising pay demands, and by late fall of that year, the group opted not to renew its contract. For ASCs in markets with thinner provider pools, that sequence — shortage, then departure, then forced model change — is increasingly the path.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.