Locum Tenens for CRNAs: The No-BS Guide

By Cory Kleinschmidt

2026-07-23

Certified registered nurse anesthetists are among the most sought-after locum tenens clinicians in the country, and they earn some of the highest hourly rates in the field. A locum CRNA takes temporary anesthesia opportunities, usually as a 1099 contractor, covering gaps at hospitals, surgery centers and pain clinics.

What you earn, and whether you work with or without a physician in the room, swings hard on the state you land in. Understanding those differences takes more than a salary range. This guide looks at the real numbers, named sources, and the parts the rate sheet leaves off.

The Model, Minus the Sales Pitch

Locum tenens is temporary contract work. A facility is short on anesthesia coverage, you take the opportunity for a defined stretch, and you move on when it ends. The phrase is Latin for “holding the place,” which is exactly the job. You hold the place while a hospital covers a vacancy, a parental leave, a sabbatical or a winter surge in a resort town that doubles in size every January.

One small detail shapes everything else. Most locum CRNAs are independent contractors paid on a 1099, not W-2 employees. That single line is why your pay looks bigger, why your taxes look different, and why the question of who carries your malpractice suddenly becomes yours to ask. We come back to each, because they’re where the money gets made or lost.

The Pay, and the Part the Rate Sheet Skips

Start with the number that sets the benchmark. Employed CRNAs earned a median wage of $236,590 in May 2025, per the U.S. Bureau of Labor Statistics (Occupational Outlook Handbook). That’s the middle of the field, not the top of it. It also lands CRNAs well above the nurse practitioner median of $132,300 in the very same release.

Locum work pays more by the hour, because it strips out everything an employer normally folds into a salary. Published staffing figures put locum CRNA rates in a wide band, roughly $125 to $325 an hour, with the top reserved for cardiac and OB coverage, independent-practice states and short-notice or crisis assignments (Barton Associates, CRNA Salary Guide, 2026). That’s one agency’s self-reported data, so read the ceiling as what’s possible, not what’s promised.

Then the part the rate sheet skips. That hourly figure isn’t take-home. No health plan, no retirement match, no paid time off, and self-employment taxes to account for. A $200-an-hour rate is a good rate. It’s not equivalent to $200 an hour as a salaried employee, and treating the two as the same can lead to some unpleasant financial surprises. The real comparison is total value, and we run that math properly in our rates guide.

Supervision and Opt-Out States: Two Rules, Not One

Whether a CRNA can practice without a physician overseeing the case is governed by two separate rules that people constantly blend into one. Understanding the distinction matters because it can affect where you can take an opportunity and on what terms.

The first rule is federal. Medicare’s conditions of participation require physician supervision of CRNA anesthesia services (42 CFR 482.52). A CMS rule from November 13, 2001 lets a state opt out, but only when the governor formally attests to CMS that they consulted the state boards of medicine and nursing, that opting out serves the state’s interest, and that it fits state law. As of July 2026, 27 states plus Guam have opted out, per the AANA (opt-out fact sheet), the two most recent being Vermont and Ohio in 2026.

The second rule is your state’s own scope-of-practice law, and it doesn’t move just because the federal rule did. A state can opt out of the Medicare condition and still keep supervision or collaboration requirements on the books for licensure.

Why the Demand Isn’t Cooling Off

Demand for CRNAs is expected to remain strong. The Bureau of Labor Statistics projects nurse anesthetist employment to grow 10 percent from 2025 to 2035, adding roughly 5,300 jobs (Occupational Outlook Handbook). That projected growth points to continued need for CRNAs over the coming decade.

For locum CRNAs, staffing needs can create opportunities when facilities need temporary anesthesia coverage, whether for vacancies, leaves, or other coverage gaps. The availability, length, and rates for those opportunities vary by facility, location, and market conditions.

What It Takes to Land an Opportunity

The credential bar to become a CRNA has moved up. The Council on Accreditation of Nurse Anesthesia Educational Programs requires that students accepted into accredited programs on or after January 1, 2022 graduate with a doctoral degree, a DNP or DNAP (accreditation manual, rev. January 2026). New CRNAs come out of school doctorally prepared. If you were certified before that, you’re not expected to go back for the degree, so this changes who’s entering the field, not who’s already in it.

Certification runs through the National Board of Certification and Recertification for Nurse Anesthetists. But the credential is rarely what delays a locum start. What holds it up is state licensure and facility credentialing. They run on their own timelines and can eat weeks before your first case. Getting them moving early is the difference between starting next month and starting next quarter.

The 1099 Realities: Taxes, Malpractice and Who Pays for Tail

Going 1099 is where locum CRNAs make good money and, occasionally, expensive mistakes. You owe self-employment tax. You pay estimated taxes quarterly instead of having them withheld. And you need to know exactly whose malpractice policy covers you on every opportunity, and whether anyone is paying for tail when it ends. None of this is hard once it’s set up. All of it is painful when it’s ignored.

Because these questions are identical for CRNAs, nurse practitioners, PAs and physicians, we cover them once, in depth:

• Locum 1099 taxes: deductions, entity choice and what actually changes when you leave a W-2.
• Quarterly estimated taxes: how much to set aside and when it’s due.
• Malpractice and tail coverage: occurrence vs. claims-made, and who’s on the hook for tail.
• Reviewing a locum contract, clause by clause.

On the tax pages, we anchor the hard numbers and deadlines to the IRS, then bring in our tax partner The Doctor’s CPA, a firm founded by Prithi Daswani, CPA (meet the team), specifically to serve 1099 locum clinicians, alongside other independent sources. It’s a partnership, and we say so.

“Independent practice” in a job post is a claim, not a guarantee. Check it against the actual state rule before you sign.

The Honest Ledger

Locum tenens is worth it if you want higher pay by the hour, control over your schedule and variety in where you work, and if you’re willing to run the business side: your own taxes, your own insurance, your own benefits. It’s the wrong call if what you want is a steady salary, an employer covering your benefits and one credentialing process you never think about again.

Most CRNAs land somewhere in between. Plenty run locum work alongside a permanent job rather than instead of one, and that’s a real strategy, not a fence-sit. What we can do is show you CRNA locum jobs across competing agencies in one neutral place, with the numbers and the rules attached. Whether it fits your life is your call. This guide exists to make it an informed one.

Related Guides

• Go deeper: Locum tenens pay rates, what the numbers really look like.
• Shared for every locum clinician: 1099 taxes · Quarterly estimated taxes · Malpractice and tail · Contract review · Travel and housing
• Other clinician guides: Locum tenens for nurse practitioners · Physician assistant locum tenens

Up: The No-BS Guide to locum tenens.