CRNA Locum Pay Guide 2026: Rates, Independent Practice, and What to Negotiate

Certified Registered Nurse Anesthetists occupy a unique position in the locum tenens market. Their compensation regularly exceeds that of most physician specialties on an hourly basis, their workforce shortage is documented and deepening, and their scope of practice varies by state in ways that directly affect where they work and what facilities will pay. For CRNAs evaluating locum tenens, the economics are genuinely favorable — but the contract variables that determine actual take-home pay are more complex than the headline rate suggests.

CRNA Locum Pay in 2026: The Market Overview

The CRNA locum market in 2026 is still strong but less overheated than it was during the 2022-2023 peak. SullivanCotter’s 2025 CRNA compensation analysis shows median total cash compensation has risen 22.9% since 2022, with year-over-year growth slowing to 5.2% from 2024 to 2025. That trajectory — meaningful growth, moderating pace — describes a market that has repriced upward and is holding, not a bubble deflating.

AANA’s 2025 job market outlook notes that locum CRNAs with consistent assignments can reach $250,000 or more annually, and its Benefits and Compensation Survey showed approximately 5% compensation growth over the past year for 1099 CRNAs. The on-file hub figure of $200-$325/hr reflects the full market band; the setting and acuity breakdown below shows where within that range most assignments actually land.

A note on how to read the rural row: the 15-25% premium is additive, not a separate lower tier. A CRNA taking a rural critical access assignment at the general OR baseline rate of $220/hr would expect a rural-adjusted rate of approximately $253-$275/hr before call premium. Rural assignments with significant call burden will push further above that.

Why CRNA Economics Parallel Physician Locum Experience

CRNAs are categorized as advanced practice providers, but their locum tenens economics are structurally closer to physician locum experience than to most NP or PA locum work. Three factors drive this:

Scope and substitutability: In 23 states plus Washington DC, CRNAs practice independently without physician supervision. In these markets, a locum CRNA is not supplementing a physician anesthesiologist — they are the anesthesia provider of record. That scope, and the liability that accompanies it, is reflected in the rate.

Facility dependency: Hospitals and surgery centers cannot operate OR services without anesthesia coverage. A CRNA vacancy does not reduce capacity — it eliminates it. That operational dependency creates the same kind of leverage that makes physician locum coverage expensive in shortage specialties.

1099 overhead structure: Like physician locum tenens, CRNA locum work typically comes with the full 1099 cost burden: self-employment tax, malpractice, health insurance, retirement contributions. The gross hourly rate needs to be evaluated against that overhead in the same way physician locum income is evaluated. See our compensation structure guide and S-Corp election guide — the mechanics apply directly to CRNA locum income at these rate levels.

Independent Practice States: Real Premium, Modest Effect

One of the most frequently cited variables in CRNA locum discussions is state practice model — specifically whether independent practice states command meaningfully higher rates than supervision-required states. The current data gives a nuanced answer: yes, but not primarily because of state law.

One 2026 salary guide places independent-CRNA states in rural settings at $190-$230+/hr — a range that overlaps substantially with the broader national market of $200-$250/hr for general OR coverage. The pattern that emerges from current postings is that higher rates appear when independent practice aligns with rural coverage, overnight or weekend call, and hard-to-fill service lines. State practice model alone does not move the rate dramatically. The convergence of independent practice, rural geography, and call burden does.

The practical implication: if you are evaluating assignments based on state practice model as a primary rate driver, the data does not fully support that framework. Evaluate acuity, call structure, and geography first. Practice model is a secondary variable that amplifies those primary drivers rather than operating independently.

The Medicare Supervision Opt-Out: What It Means for Locum Placement

Separate from state practice law, 25 states plus Washington DC and Guam have opted out of the Medicare condition of participation requiring physician supervision of CRNAs. This opt-out is a facility-level operational decision enabled by CMS, distinct from state scope of practice law — and the two do not always align.

For locum CRNAs, the Medicare opt-out matters because it determines whether a facility can deploy a CRNA independently for Medicare patients without a supervising anesthesiologist on record. In opt-out states, the facility has more flexibility to use locum CRNAs as standalone anesthesia coverage — which is the model that produces the highest locum demand and the most favorable rate conditions. In non-opt-out states, the facility’s anesthesia model may require physician oversight even if state law permits independent CRNA practice, which affects how locum CRNA coverage is structured and valued.

When evaluating a locum assignment, confirm both the state practice model and the facility’s Medicare opt-out status. They are not the same variable.

The Workforce Shortage: Why Demand Is Not Cyclical

CRNA locum demand is structural, not cyclical, and the shortage data supports that framing clearly.

AANA’s job market outlook projects a potential anesthesiology workforce shortage of approximately 12,500 by 2033 — roughly 22% of the current workforce — with rural communities expected to absorb the most severe impact. That projection reflects a combination of retirement-driven attrition, training pipeline constraints, and geographic maldistribution that is not responsive to short-term market signals.

A compounding supply-side factor: 2025 marked the entry-to-practice transition deadline requiring all newly credentialed CRNAs to hold a Doctor of Nursing Practice (DNP) degree rather than a master’s degree. The longer training timeline for doctoral preparation creates a near-term constraint on new graduate supply entering the locum market — a pipeline effect that reinforces the shortage trajectory AANA projects through 2033.

The rural dimension is particularly acute. Becker’s Hospital Review reported that 78% of rural facilities were experiencing CRNA staffing gaps by late 2022, up from 35% in 2020. CRNAs provide more than 80% of anesthesia services in rural counties — meaning rural facilities are not supplementing physician anesthesiologists with CRNAs, they are dependent on CRNAs as the primary anesthesia workforce. When that workforce has gaps, locum coverage is the operational response.

What Drives Rate in CRNA Locum Assignments

How CRNA Locum Pay Compares Across the Market

CRNA locum pay sits above most physician cognitive specialties and well above the typical NP and PA locum range. The overlap with emergency medicine and general surgery at the top end reflects the acuity and call premium in high-demand CRNA assignments. The comparison with physician anesthesiology is the most relevant benchmark for CRNAs evaluating whether the locum model makes financial sense — the gap between CRNA and anesthesiologist locum rates reflects the credential differential, not a difference in operational value at facilities where CRNAs are the sole anesthesia provider.

What to Negotiate

Call structure and OB call specifically: OB call is its own category in CRNA contracts. Confirm whether it is included in the base rate, structured as a separate call stipend, or billed on activation. Overnight OB call at a busy labor and delivery unit is a materially different assignment than daytime elective OR coverage, and the rate should reflect that.

Acuity disclosure: Ask for the case mix before agreeing to a rate. A contract priced for general OR coverage that includes regular cardiac or high-acuity pediatric cases is underpriced if the rate does not reflect that complexity. Get the case mix in writing.

Supervision requirements: Confirm the facility’s supervision model and Medicare opt-out status before accepting. In supervision-required arrangements, clarify whether the supervising anesthesiologist is reliably available and what happens when they are not — that is a scope and liability question, not just an administrative one.

Malpractice coverage: CRNA malpractice exposure in independent practice is significant. Confirm occurrence versus claims-made coverage, tail responsibility, and coverage limits. See our malpractice coverage guide for detail on evaluating coverage structures.

Travel and housing: CRNA locum assignments frequently include travel and housing stipends, particularly for rural placements. These are negotiable and materially affect total compensation. Confirm what is included before evaluating the hourly rate in isolation.

Agency bill rate context: As with all locum assignments, the rate offered reflects what remains after the agency margin from the facility bill rate. See our bill rate breakdown guide for the full picture on how that margin is structured and what it implies about negotiating room.

The 1099 and Tax Structure Question

CRNA locum income at these rate levels — particularly for high-acuity or rural call-heavy assignments — will frequently put annual 1099 income in ranges where tax structure matters significantly. The S-Corp election analysis that applies to physician locum income applies equally here. A CRNA generating $200,000-$300,000+ annually in 1099 locum income should evaluate the reasonable salary and self-employment tax implications before the next contract year.

The mechanics are covered in our S-Corp Election guide. The guide is written for physicians but the underlying tax structure is identical for CRNAs operating as independent contractors.

Data Transparency Statement

Rate figures in this article are drawn from AANA’s Benefits and Compensation Survey (2025 references), SullivanCotter’s 2025 CRNA compensation insights, publicly available agency postings, and current locum market references. Becker’s Hospital Review shortage figures are cited as a secondary source reflecting data originally from facility surveys. The pain management rate figure from public salary aggregators was excluded as a mixed employment signal not representative of locum anesthesia rates. Rural rate figures are expressed as a percentage premium above baseline rather than a fixed range, reflecting the additive nature of the geographic premium. All figures are pre-tax gross hourly rates and do not account for 1099 benefit and overhead costs.