This analysis synthesizes 6 sources published the week ending Oct 31, 2026. Editorial analysis by the PhysEmp Editorial Team.
Medicare pays the same anesthesia fee for a case whether a CRNA or an anesthesiologist delivers it alone. That one rule, laid out this week in a Becker’s ASC breakdown of anesthesiologist and CRNA Medicare pay, explains more about the nurse anesthetist job market than most of the shortage coverage around it. The fee is fixed. What changes is how many people split it and who controls the split. For CRNAs comparing offers across our Physician & Advanced Practice Jobs listings, the billing arrangement behind a role now says as much about its future as the salary line does.
One fee, split four ways or not at all
The formula is mechanical: base units for the procedure, plus one time unit for every 15 minutes, multiplied by a conversion factor that sits at $20.4976 nationally for 2026. When an anesthesiologist medically directs two to four concurrent rooms, each case’s allowance splits 50/50 between the physician and the CRNA in the room. A CRNA working without medical direction collects 100%.
Becker’s illustrative total knee replacement shows the consequence. The full 2026 allowance comes to $307.46. Under medical direction, the CRNA’s share is $153.73, while an anesthesiologist directing four such rooms collects $614.93, twice what one personally performed case pays. Medicare’s outlay per case doesn’t move. What moves is who captures the margin from concurrency.
That makes the CRNA the variable in the employer’s equation. A care-team group earns its economics by stretching each anesthesiologist across rooms; a CRNA-only group earns them by putting the whole fee behind the nurse anesthetist. The same clinician generates very different value depending on which model hires them, and both models are under strain. The 2026 conversion factor rose only 0.88% from 2025, CMS has proposed cutting it to $20.2143 for 2027, and average professional anesthesia reimbursement fell 5.5% between 2019 and 2023.
A CRNA offer from a medical-direction group and one from a CRNA-only group can show similar base pay while resting on opposite economics. In the first, the CRNA is half of a split fee. In the second, the CRNA is the fee, and that difference surfaces later in ratios, case mix and job security.
Pay growth has tilted back toward physicians
The salary story most CRNAs know is the long climb: Bureau of Labor Statistics data cited by Becker’s put average CRNA pay at $181,040 in 2019 and $231,700 in 2024. The newest survey runs the other way. SullivanCotter’s 2026 Physician Compensation and Productivity Survey, covering 575 organizations and about 235,000 physicians, found total cash compensation for general, cardiac and pediatric anesthesiologists up 14% to 16% since 2024, while CRNA compensation grew almost 12%, according to Becker’s.
The gap matters because of what SullivanCotter says rising anesthesia pay is doing to employers: it has “markedly shifted employment models and driven consolidation among private practice groups,” because private-practice reimbursement hasn’t kept up with what new recruits expect. Independent groups that can’t fund those packages sell or merge, and a CRNA who signed with a local group can wake up employed by a regional or national platform.
Those platforms are growing. NorthStar Anesthesia has added 17 ASC partnerships so far in 2026, from Norfolk, Va., to Toledo, Ohio, and its CEO told Becker’s that 80% of ASCs in its network now require anesthesia stipends, up from 10% to 15% before the pandemic, according to this week’s roundup of anesthesia’s changing economics. Consolidation and subsidy travel together. The national groups are the ones with balance sheets big enough to take on a facility that can’t cover its own anesthesia costs.
Leadership seats become part of the offer
The more telling signal this week came from the top of an org chart. Sound Anesthesia, the anesthesia division of Sound Physicians, named cardiac anesthesiologist Emil Engels, MD, chief physician officer and paired him with Noele Morse, DNP, CRNA, its chief anesthetist officer. “Our physician anesthesiologists and CRNAs care for patients together every day, and our leadership should reflect that,” CEO David Leachman, MD, said in Becker’s coverage of the appointment. Sound Physicians employs more than 4,000 clinicians across 45 states, so a CRNA title at that level carries weight with recruits.
Management companies are selling hospitals a version of the same idea. In a contributed piece for Becker’s, a CCI Anesthesia executive argued that hospitals should expect anesthesia programs to provide operational leadership rather than coverage alone, judged on OR efficiency, retention and surgeon relationships. The pitch is self-interested, but it describes where the better-paid roles are heading: clinical work bundled with accountability for throughput.
Where CRNAs lack a formal voice, the risk lands on their employment. In California, the state’s nurse anesthesiology association has sued the Department of Public Health over rules it says let CRNAs hold clinical privileges while keeping them off hospital medical staffs, and out of decisions on credentialing, peer review and policy, Nurse.org reported. The association alleges that after a 2024 state inspection, a Modesto hospital pulled all of its CRNAs from practice for about six weeks, disrupting more than 1,000 surgical cases. Those claims are unproven, and the legal question belongs to the courts. The employment point stands on its own: privileges without governance leave a CRNA’s job exposed to decisions made in meetings they don’t attend.
Most coverage frames the anesthesiologist-CRNA relationship as a scope-of-practice war. The billing rules point somewhere less dramatic. Both sides are paid from one fixed fee, and the argument over who supervises whom is also an argument over who keeps the concurrency margin.
Questions a CRNA offer should answer
The practical move for CRNAs is to ask what a posting rarely says. Does the group bill under medical direction, and at what ratio? A wider ratio doesn’t change the CRNA’s half of each case, but it changes the employer’s margin and the pace of the day. Is the employer a local group or a consolidator, and if local, how is it funding the raises recruits now expect? Are CRNAs part of the organization’s governance or only its schedule? Twenty-seven states have opted out of Medicare’s physician-supervision requirement, so across much of the country a CRNA-only model is a live option, and Proliance Surgeons’ ENT centers near Seattle moved to a CRNA group after their physician group couldn’t staff consistently.
Employers face the mirror image. Anesthesiologist pay is again outrunning CRNA pay, reimbursement is flat to falling, and team configuration is one of the few cost levers left. Groups that can show CRNAs a path into leadership, as Sound now does, have something to offer beyond a matching raise.
The number to watch is $20.2143, CMS’s proposed 2027 anesthesia conversion factor. If it is finalized, every case pays less in January while this year’s compensation commitments stay put. Medical-direction groups will feel that as pressure to stretch each anesthesiologist across more rooms; CRNA-only groups will feel it in the single fee that covers their whole cost. Whichever model absorbs the cut better is where the next round of CRNA openings will come from.
Sources
Anesthesiologist vs. CRNA Medicare pay – Becker’s ASC Review
Anesthesia pay climbs 16% as private groups consolidate – Becker’s ASC Review
Anesthesia’s changing economics: 5 ASC updates – Becker’s ASC Review
Sound Anesthesia expands leadership with physician-CRNA partnership – Becker’s ASC Review
The Future of Hospital Anesthesia Isn’t Staffing – It’s Operational Leadership – Becker’s ASC Review
Nurse Anesthetists Sue California Over Rules Keeping Them Off Hospital Medical Staff – Nurse.org