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TuneIn Office Hours: Peak CRNA Locums? Is MD Supervision a Convenience? 1099 vs W2, Hospital Execs Who Shrug
Key Takeaways
- Host Joe Rodriguez explains that locum rates move on a predictable curve that is currently correcting, and falling rates do not automatically translate to fatter margins for anesthesia groups.
- New graduates entering straight into locums miss out on crucial mentorship during the most dangerous years of their careers, as locum assignments only fill schedule gaps rather than develop clinicians.
- The internet claims a 50% conversion rate for 1099 vs W2 CRNA models, but real conversions actually land between 16% and 35%, with the biggest advantage coming from tax savings.
- Disappearing supervision models on nights and weekends reflect convenience and financial bets rather than patient acuity.
- Joe Rodriguez details how anesthesia RFPs are ultimately won on the denominator through small margins by deeply understanding service requirements and labor costs.
CRNA locums pay has been on a steep curve, and curves correct. The internet says 1099 vs W2 CRNA conversion is 50%. Real conversions land at 20 to 25%. And some CRNAs are supervised all week, then trusted to run solo every weekend.
Host Joe Rodriguez, CRNA and anesthesia group co-founder, answers your questions in the first About the Rest Office Hours.
Locums and new grads. Joe breaks down the three curves that set locum rates (education, locums, and anesthesia group economics) and explains why falling rates don't mean fatter margins for groups. He also makes the case that new grads going straight into locums are entering the most dangerous years of their careers alone.
1099 vs W2 CRNA. The real conversion range, the tax factor everyone misses, and why most CRNAs who go 1099 never go back.
Supervision when convenient. A listener asks why the care team model flips from ACT to independent on nights and weekends. Joe explains the two bets behind it.
Hospital contracts. Joe covers what happens when contract volume comes in 20% short and the hospital shrugs, and who should control anesthesia contracts. He also walks through how anesthesia RFPs are actually won: on the denominator, by small margins.
Plus: the $40K-per-CRNA misclassification trap, and why Joe's own group nearly failed in 2021.
Takeaways:
- Locum rates move on a curve, and curves correct. When the correction comes, anesthesia groups don't keep the difference: revenue guarantees cap their margin, and a competitor underbids at renewal.
- New grads need two to three years of mentorship, and locum work doesn't provide it. A locum assignment is built to fill a gap on the schedule, not to develop the clinician filling it.
- 1099 vs W2 CRNA comes down to conversion, tax savings, and risk. Conversion ranges from 16 to 35%. The bigger advantage is tax treatment, conservatively about 10% more of every dollar kept. The risk is misclassification, which has cost groups about $40K per CRNA.
- Supervision that disappears on nights and weekends reflects convenience, not acuity. The model bets that no one will check and no one will put the contract at risk.
- Anesthesia RFPs are won on the denominator. Everyone models payer mix and volume; the winner understands service requirements and labor cost, and the margin between winning and losing is small.
- Every group needs a mission beyond money and an operating margin to protect it. A mission without margin nearly failed in 2021. Change is how the mission survives.
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Want more Dr. Joe Rodriguez?
Tik Tok: @jrodcrna21
Instagram: @jrod.crna & @abouttherestpod
YouTube: @AboutTheRest
Thanks for my co-hosts:
Randy Moore (EVP & National Chief CRNA, NorthStar Anesthesia)
Gary Keeling (VP of Anesthesia Services, Coronis RCM)
To Learn More about Human Content Visit: http://www.human-content.com
To Learn More about About The Rest Visit: www.abouttherest.com
Got a Question? hello@abouttherest.com
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Frequently Asked Questions
Are CRNA locum rates dropping?
Yes, CRNA locum pay has been on a steep curve that is currently correcting, though falling rates do not mean increased margins for anesthesia groups due to revenue guarantees and competitive underbidding.
What is the real 1099 vs W2 CRNA conversion rate?
While online sources often cite a 50% conversion rate, real-world 1099 vs W2 CRNA conversions actually land between 16% and 25% (or up to 35%), with tax savings providing the most significant financial advantage.
Why do care team models change to independent CRNAs on nights and weekends?
When supervision disappears outside of normal business hours, it typically reflects convenience and a calculated bet by facilities that acuity is lower and no one will challenge the model.
How are anesthesia RFPs actually won?
Anesthesia RFPs are won on the denominator by small margins, requiring groups to master service requirements and labor costs rather than just modeling payer mix and basic volume.