This analysis synthesizes 7 sources published the week ending Nov 14, 2026. Editorial analysis by the PhysEmp Editorial Team.
At a physician-owned surgery center in Springfield, Illinois, CRNA applicants are flying in from Florida. The reason, according to the center’s director of operations, is that they will make almost double what they earn back home. That remark, from a Becker’s ASC panel on what surgery centers get wrong about anesthesia, is the clearest description this week of how nurse anesthetist pay actually works: it is set by local bidding between employers, and the spread between markets is wide enough to justify a cross-country move. For readers tracking Physician & Advanced Practice Jobs, three developments since our Oct. 31 look at CRNA job structures sharpen that picture: a free job board that estimates pay where employers won’t post it, the first certified anesthesiologist assistants (CAAs) working in Tennessee, and a final 2027 Medicare anesthesia rate that came in lower than proposed.
Paying a premium to keep the schedule covered
Kaitlynn Miller runs operations at Springfield Clinic Ambulatory Surgery Center, which has 16 procedure rooms and about 19 CRNAs. She called the local CRNA market “a very challenging market.” Her center’s answer is to outbid the hospitals nearby. “We pay more than our local hospitals because we want stability,” she said. The structure matters as much as the rate. Each CRNA who comes in is guaranteed nine hours of pay, whether the schedule produces two hours of cases or 12.
That guarantee is the detail worth noticing. Surgery centers run on variable schedules, and a CRNA weighing an ASC offer against a hospital job is really comparing two income risks. A guaranteed daily minimum moves that risk onto the employer. The same Becker’s panel noted that ASCs compete with hospitals and locums firms for a limited pool of anesthesia clinicians, and David Mackey, MD, of MD Anderson argued that competitive salary, benefits, working conditions and job security are what solve recruiting. He also said he doesn’t like the word “stipend,” and that inside a health system or university, the money “means a salary and not a stipend.”
A guaranteed nine-hour day is a pay term, not a perk. For a CRNA comparing a surgery center to a hospital, the useful question is what the job pays on a light day, because that number shows who carries the scheduling risk.
Posted pay has been the missing number
CRNAs moving across state lines for pay need to know the pay first. On Nov. 9, a practicing CRNA near Myrtle Beach, Aubrey Shaner, DNAP, CRNA, launched ClearPay CRNA, a free job board that pulls listings from staffing agencies, hospitals and anesthesia groups nationwide. When a recruiter leaves pay off a posting, the site shows a labeled estimate for that location. Contract 1099 pay is converted to an hourly rate and W-2 pay to an annual salary, and users can search by state or ZIP code, sort by pay, and filter by schedule, call and case mix.
The company’s release adds an offer checker and a weekly email flagging “hot areas or large increases in offers.” This is a company announcement, and neither the release nor Becker’s report published any of the board’s actual pay figures, so its estimates can’t be judged yet. What the launch does show is that a working CRNA thought posted pay was missing often enough to build a product around filling it in.
Coverage of CRNA pay usually starts with national medians and Medicare rates. Neither tells a candidate in Florida what a center in Illinois will pay, or whether a 1099 hourly offer beats a W-2 salary once guaranteed hours are counted. The real price of a CRNA is set offer by offer, and until recently most of those offers were private.
A second clinician type enters the bidding
Tennessee added a new variable this fall. CAAs have been managing cases in Tennessee operating rooms since Oct. 20, and the state faces a projected shortfall of 550 anesthesiologists by 2036, according to federal projections cited by Becker’s. CAAs work under physician supervision, up to four per anesthesiologist, a ratio tied to state licensure and medical-supervision billing rules.
Surgery center leaders’ main worry, Becker’s reported, is how hiring CAAs affects their CRNA staff. Todd Christian, who directs Lipscomb University’s CAA program and was one of the first two CAAs to practice in the state, says that fear hasn’t played out: “So far, we haven’t seen that largely in Florida or across the country in other practices where CAAs have started.” He also said that recruiting CAAs can push employers to compete “for salaries and all the rest.” His colleague Joseph Parrish estimated that 99% of surgery centers and hospitals would say they are not fully staffed in anesthesia.
For CRNAs, the CAA question is less about direct replacement than about which staffing model an employer builds. CAAs only work inside a physician-supervised care team. A center that adds them is committing to anesthesiologist supervision, while CRNA-only staffing depends on the federal supervision rule CMS is now reviewing. That review, a request for information on Medicare’s physician supervision requirement, drew opposite responses this week: AANA welcomed it, and the ASA urged CMS to keep the requirement. Whatever CMS decides will shape how many CRNA-only jobs exist in states that have not opted out.
Tennessee’s CAAs are a test of whether a new supervised clinician eases anesthesia hiring or simply adds another bidder for the same scarce coverage. Christian’s own prediction, competition over salaries, points to the second.
The revenue side keeps shrinking
Employers are bidding with less Medicare revenue per case. CMS finalized a 1.91% cut to the anesthesia conversion factor for 2027, to $20.1056 from $20.4976, deeper than the 1.38% reduction proposed in July. Most of the drop comes from the expiration of Congress’s one-year 2.5% increase for 2026. In dollars, a total knee replacement falls from $307.46 to $301.58, and a colonoscopy from $122.99 to $120.63. The cut applies to the full allowance when a CRNA or anesthesiologist works alone, and is split when the case is medically directed.
A few dollars a case doesn’t set any CRNA’s rate. It does narrow the margin an employer has for the guarantees and premiums Springfield uses to keep its staff. The panel’s point that an ASC can produce a case for 50% to 60% of what the same case costs in a hospital is the reason surgery centers can keep outbidding hospitals for now. As Medicare’s per-case payment falls, though, more of that edge goes to covering anesthesia labor.
What to watch
The number to watch is the one ClearPay says it will publish every Monday: the highest new 1099 and W-2 CRNA postings nationally. If those figures stay well above what local hospitals pay while Medicare’s anesthesia rate falls, more surgery centers will have to choose between guaranteed-pay contracts like Springfield’s and the supervised CAA model Tennessee just opened. Both choices raise the cost of anesthesia coverage, and in a year of shrinking reimbursement, CRNAs willing to relocate will hold more of the bargaining power than their employers.
Sources
‘Take that target off our back’: What ASCs get wrong about anesthesia – Becker’s ASC Review
ClearPay CRNA launches job board with location-specific pay estimates – Becker’s ASC Review
ClearPay CRNA Launches Job Board With Location-Specific Pay Estimates for Nurse Anesthetists – PRLog
Will CAAs disrupt the CRNA workforce? – Becker’s ASC Review
Trump administration weighs CRNA supervision rule – Becker’s ASC Review
ASA urges CMS to keep physician supervision of CRNAs – Becker’s Hospital Review
Medicare’s anesthesia cut gets deeper for 2027 – Becker’s ASC Review
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<p><em>This analysis synthesizes 7 sources published the week ending Nov 14, 2026. Editorial analysis by the PhysEmp Editorial Team.</em></p>
<p>At a physician-owned surgery center in Springfield, Illinois, CRNA applicants are flying in from Florida. The reason, according to the center’s director of operations, is that they will make almost double what they earn back home. That remark, from a <a href=”https://www.beckersasc.com/anesthesia/take-that-target-off-our-back-what-ascs-get-wrong-about-anesthesia/”>Becker’s ASC panel on what surgery centers get wrong about anesthesia</a>, is the clearest description this week of how nurse anesthetist pay actually works: it is set by local bidding between employers, and the spread between markets is wide enough to justify a cross-country move. For readers tracking <a href=”https://www.physemp.com/advanced-practice-jobs/”>Physician & Advanced Practice Jobs</a>, three developments since our Oct. 31 look at CRNA job structures sharpen that picture: a free job board that estimates pay where employers won’t post it, the first certified anesthesiologist assistants (CAAs) working in Tennessee, and a final 2027 Medicare anesthesia rate that came in lower than proposed.</p>
<h2>Paying a premium to keep the schedule covered</h2>
<p>Kaitlynn Miller runs operations at Springfield Clinic Ambulatory Surgery Center, which has 16 procedure rooms and about 19 CRNAs. She called the local CRNA market “a very challenging market.” Her center’s answer is to outbid the hospitals nearby. “We pay more than our local hospitals because we want stability,” she said. The structure matters as much as the rate. Each CRNA who comes in is guaranteed nine hours of pay, whether the schedule produces two hours of cases or 12.</p>
<p>That guarantee is the detail worth noticing. Surgery centers run on variable schedules, and a CRNA weighing an ASC offer against a hospital job is really comparing two income risks. A guaranteed daily minimum moves that risk onto the employer. The same Becker’s panel noted that ASCs compete with hospitals and locums firms for a limited pool of anesthesia clinicians, and David Mackey, MD, of MD Anderson argued that competitive salary, benefits, working conditions and job security are what solve recruiting. He also said he doesn’t like the word “stipend,” and that inside a health system or university, the money “means a salary and not a stipend.”</p>
<p><em><strong>A guaranteed nine-hour day is a pay term, not a perk. For a CRNA comparing a surgery center to a hospital, the useful question is what the job pays on a light day, because that number shows who carries the scheduling risk.</strong></em></p>
<h2>Posted pay has been the missing number</h2>
<p>CRNAs moving across state lines for pay need to know the pay first. On Nov. 9, a practicing CRNA near Myrtle Beach, Aubrey Shaner, DNAP, CRNA, launched ClearPay CRNA, a free job board that <a href=”https://www.beckersasc.com/anesthesia/clearpay-crna-launches-job-board-with-location-specific-pay-estimates/”>pulls listings from staffing agencies, hospitals and anesthesia groups nationwide</a>. When a recruiter leaves pay off a posting, the site shows a labeled estimate for that location. Contract 1099 pay is converted to an hourly rate and W-2 pay to an annual salary, and users can search by state or ZIP code, sort by pay, and filter by schedule, call and case mix.</p>
<p>The <a href=”https://www.prlog.org/13182053-clearpay-crna-launches-job-board-with-location-specific-pay-estimates-for-nurse-anesthetists.html”>company’s release</a> adds an offer checker and a weekly email flagging “hot areas or large increases in offers.” This is a company announcement, and neither the release nor Becker’s report published any of the board’s actual pay figures, so its estimates can’t be judged yet. What the launch does show is that a working CRNA thought posted pay was missing often enough to build a product around filling it in.</p>
<p>Coverage of CRNA pay usually starts with national medians and Medicare rates. Neither tells a candidate in Florida what a center in Illinois will pay, or whether a 1099 hourly offer beats a W-2 salary once guaranteed hours are counted. The real price of a CRNA is set offer by offer, and until recently most of those offers were private.</p>
<h2>A second clinician type enters the bidding</h2>
<p>Tennessee added a new variable this fall. CAAs have been <a href=”https://www.beckersasc.com/anesthesia/are-you-fully-staffed-in-anesthesia-tennessees-1st-caas-make-their-case-to-asc-leaders/”>managing cases in Tennessee operating rooms since Oct. 20</a>, and the state faces a projected shortfall of 550 anesthesiologists by 2036, according to federal projections cited by Becker’s. CAAs work under physician supervision, up to four per anesthesiologist, a ratio tied to state licensure and medical-supervision billing rules.</p>
<p>Surgery center leaders’ main worry, Becker’s reported, is how hiring CAAs affects their CRNA staff. Todd Christian, who directs Lipscomb University’s CAA program and was one of the first two CAAs to practice in the state, says that fear hasn’t played out: “So far, we haven’t seen that largely in Florida or across the country in other practices where CAAs have started.” He also said that recruiting CAAs can push employers to compete “for salaries and all the rest.” His colleague Joseph Parrish estimated that 99% of surgery centers and hospitals would say they are not fully staffed in anesthesia.</p>
<p>For CRNAs, the CAA question is less about direct replacement than about which staffing model an employer builds. CAAs only work inside a physician-supervised care team. A center that adds them is committing to anesthesiologist supervision, while CRNA-only staffing depends on the federal supervision rule CMS is now reviewing. That review, a <a href=”https://www.beckersasc.com/anesthesia/trump-administration-weighs-crna-supervision-rule/”>request for information on Medicare’s physician supervision requirement</a>, drew opposite responses this week: AANA welcomed it, and the ASA <a href=”https://www.beckershospitalreview.com/anesthesia/asa-urges-cms-to-keep-physician-supervision-of-crnas/”>urged CMS to keep the requirement</a>. Whatever CMS decides will shape how many CRNA-only jobs exist in states that have not opted out.</p>
<p><em><strong>Tennessee’s CAAs are a test of whether a new supervised clinician eases anesthesia hiring or simply adds another bidder for the same scarce coverage. Christian’s own prediction, competition over salaries, points to the second.</strong></em></p>
<h2>The revenue side keeps shrinking</h2>
<p>Employers are bidding with less Medicare revenue per case. CMS finalized a <a href=”https://www.beckersasc.com/anesthesia/medicares-anesthesia-cut-gets-deeper-for-2027/”>1.91% cut to the anesthesia conversion factor for 2027</a>, to $20.1056 from $20.4976, deeper than the 1.38% reduction proposed in July. Most of the drop comes from the expiration of Congress’s one-year 2.5% increase for 2026. In dollars, a total knee replacement falls from $307.46 to $301.58, and a colonoscopy from $122.99 to $120.63. The cut applies to the full allowance when a CRNA or anesthesiologist works alone, and is split when the case is medically directed.</p>
<p>A few dollars a case doesn’t set any CRNA’s rate. It does narrow the margin an employer has for the guarantees and premiums Springfield uses to keep its staff. The panel’s point that an ASC can produce a case for 50% to 60% of what the same case costs in a hospital is the reason surgery centers can keep outbidding hospitals for now. As Medicare’s per-case payment falls, though, more of that edge goes to covering anesthesia labor.</p>
<h2>What to watch</h2>
<p>The number to watch is the one ClearPay says it will publish every Monday: the highest new 1099 and W-2 CRNA postings nationally. If those figures stay well above what local hospitals pay while Medicare’s anesthesia rate falls, more surgery centers will have to choose between guaranteed-pay contracts like Springfield’s and the supervised CAA model Tennessee just opened. Both choices raise the cost of anesthesia coverage, and in a year of shrinking reimbursement, CRNAs willing to relocate will hold more of the bargaining power than their employers.</p>
<h2>Sources</h2>
<a href=”https://www.beckersasc.com/anesthesia/take-that-target-off-our-back-what-ascs-get-wrong-about-anesthesia/”>’Take that target off our back’: What ASCs get wrong about anesthesia – Becker’s ASC Review</a><br>
<a href=”https://www.beckersasc.com/anesthesia/clearpay-crna-launches-job-board-with-location-specific-pay-estimates/”>ClearPay CRNA launches job board with location-specific pay estimates – Becker’s ASC Review</a><br>
<a href=”https://www.prlog.org/13182053-clearpay-crna-launches-job-board-with-location-specific-pay-estimates-for-nurse-anesthetists.html”>ClearPay CRNA Launches Job Board With Location-Specific Pay Estimates for Nurse Anesthetists – PRLog</a><br>
<a href=”https://www.beckersasc.com/anesthesia/are-you-fully-staffed-in-anesthesia-tennessees-1st-caas-make-their-case-to-asc-leaders/”>Will CAAs disrupt the CRNA workforce? – Becker’s ASC Review</a><br>
<a href=”https://www.beckersasc.com/anesthesia/trump-administration-weighs-crna-supervision-rule/”>Trump administration weighs CRNA supervision rule – Becker’s ASC Review</a><br>
<a href=”https://www.beckershospitalreview.com/anesthesia/asa-urges-cms-to-keep-physician-supervision-of-crnas/”>ASA urges CMS to keep physician supervision of CRNAs – Becker’s Hospital Review</a><br>
<a href=”https://www.beckersasc.com/anesthesia/medicares-anesthesia-cut-gets-deeper-for-2027/”>Medicare’s anesthesia cut gets deeper for 2027 – Becker’s ASC Review</a><br>