Nationally, pay for certified registered nurse anesthetists has climbed sharply over the last several years.
CRNAs in Alaska earned the highest average annual salary in the country, as of the most recent data — $311,110 a year — while California CRNAs averaged $283,780, according to a May Becker’s analysis of 2026 Bureau of Labor Statistics data.
Wages have risen across nearly every market as demand for anesthesia providers outpaces the supply of clinicians willing to fill the role. For ASCs competing with hospital systems for a shrinking pool of CRNAs, that wage growth lands directly on the bottom line.
Ben Childers, MD, a plastic surgeon and president of Premier Outpatient Surgery Center in Colton, Calif., said the pressure has intensified sharply over roughly the last year. The center relies heavily on CRNAs, who can practice independently in California, with one anesthesiologist covering a handful of shifts each month. Nearby hospital systems, including Kaiser Permanente, can outbid Premier for the same small pool of providers.
“It’s supply and demand,” Dr. Childers said. “The price of nurse anesthetists has gone up because they can demand it — because there’s not as many.”
“We can get $1,600 down the street. So you’ve got to raise your rate,” Dr. Childers continued, describing the near-daily back-and-forth from anesthesia providers citing better offers elsewhere.
That leaves ASCs like Premier absorbing costs that insurers and Medicaid haven’t kept pace with, according to Dr. Childers. About 30% of the center’s volume comes through Inland Empire Health Plan, a Medicaid managed care plan covering roughly 2 million people in his region. IHP pays Premier a reasonable facility fee, Dr. Childers said, but reimburses anesthesia providers lower for the same cases — a gap he said has widened as more commercial-insurance patients have shifted onto Medicaid managed care plans in the years since the Affordable Care Act.
“What’s happened is they’re now putting it on the hospitals, and they’re putting it on the surgery centers, to subsidize their payments,” Dr. Childers said.
He doesn’t see the underlying shortage easing on its own, either. Dr. Childers said he expects the problem to worsen as the population ages and demand for procedures grows faster than the anesthesia workforce can expand. He said the fix needs to come from outside any single ASC.
“It would be really nice if we could find some better answers,” Dr. Childers said. “I think it needs to be more on a national level, trying to get insurance companies to pay us or pay the providers what they’re worth.”
Short of a national reimbursement fix, Dr. Childers said Premier’s approach has been to compete on culture rather than try to out-bid hospitals dollar for dollar.
“I think it’s having a really good partnership with the nurse anesthetists,” Dr. Childers said. “We treat them just like family.”
Part of that pitch is the work-life balance that ASCs can offer, while another part of it is caseload. Premier’s outpatient volume skews toward lower-acuity procedures — plastic surgery, hand surgery, pain management — rather than the traumas and medically complex cases anesthesia providers might see in a hospital.
“They’re not at a hospital doing traumas, with some horribly sick patient, or somebody who’s got a lot of medical problems and is trying to do a hip replacement,” Dr. Childers said. “I think the acuity is a little bit lower, and I think that’s attractive to people.”
Then there are the smaller gestures. Premier feeds its anesthesia staff lunch every day, an expense Dr. Childers acknowledged adds up but said pays off in retention. “We do offer lunches, which sounds small, and it does cost quite a bit, but we feed our anesthesia providers well,” Dr. Childers said. He said the combination has kept turnover manageable even as competitors raise their rates.
“Premier’s a great place. We like working there,” Dr. Childers said, describing feedback he’s heard from providers who’ve worked elsewhere. He has been told by CRNAs that “other facilities just don’t treat us as well.”
Whether that’s enough to offset a wage spiral he expects to continue is a separate question — one Dr. Childers said he’d like to see addressed well beyond his own operating rooms.
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.