The Current Landscape of 1099 CRNAs

Higher earning potential. The appeal of being your own boss. Better work-life balance. Controlling your professional future. No matter the reason, pursuing work as a 1099 CRNA/nurse anesthesiologist independent contractor is increasingly common. In 2023, for example, 20% of AANA members surveyed reported this type of employment.

If you’re a CRNA/nurse anesthesiologist considering making the switch to 1099 employment, you’re doing so at a good time. Demand for independent contractors is high, albeit to a slightly lesser degree than in years past. Still, industry experts Sharon Pearce, former AANA president, Jeremy Stanley, founder and CFO of CRNA Tax Associates; and Tracy Young, AANA vice president, say the window of opportunity is still wide open for 1099 CRNAs/nurse anesthesiologists.

In this article, the three discuss the landscape for independent contractors, including demand, compensation, and employment hot spots.

State of the 1099 CRNA Market

Demand and Outlook

Each year, CRNAs/nurse anesthesiologists safely administer over 58 million anesthetics to patients in the United States — and the need for anesthesia is growing as an aging population and advances in medical technology drive an increase in surgeries, among numerous other factors. That trend is reflected across the country.

Although the demand for 1099 CRNAs/nurse anesthesiologists is high and even rising in many areas, the overall rate of increase has been slowing. Some markets are even nearing a point of stabilization, albeit at high-demand levels. In our organization, “We’re still needing 1099 CRNAs,” Young said. “We’re just not needing to add as many and as frequently as we have in the past.”

Some of this plateauing of demand relates to new graduates entering the profession and choosing to begin their careers as an independent contractor. Each year, more than 2,400 resident registered nurse anesthetists (RRNAs) graduate from nurse anesthesia educational programs. Typically, new graduates choose full-time W2 positions over 1099 work.

That’s changing — and so is the perception of what it means to be a 1099 CRNA/nurse anesthesiologist. More new graduates are considering 1099 employment, although that number is still just about 10% of all graduates, Young estimated. Many of these 1099 opportunities are long-term positions in single locations, not the traveling locum tenens work often associated with independent practice.

Compensation Trends

Mirroring demand, compensation for 1099 CRNAs/nurse anesthesiologists has been rising in recent years. According to the AANA Benefits & Compensation Survey of members, those compensation increases have been about 5% in the past year, Young said.

Like demand, that rate of increase is slowing — and even stabilizing in some areas around the country. In the 1099 market, Stanley noted that current 1099 compensation averages $200-$250 per hour.

Part of this leveling off can be attributed to hospitals being less likely to change their anesthesia providers due to the high costs of transitioning to new anesthesia groups.

“When a hospital changes anesthesia groups, usually the new group that comes in raises pay rates to recruit, to retain the CRNAs that are there, and to be able to attract the talent that those hospitals need,” Young said. “When a hospital raises those pay rates through this transition, what do the other hospitals in the area have to do? Six months later, they have to raise theirs to be able to make sure they continue to meet their needs and their demands.”

Practice Settings and Hot Spots

CRNAs/nurse anesthesiologists working as 1099 contractors can be found in a wide variety of practice settings. The following have emerged as especially active areas:

Common Practice Settings:

• Hospitals
• Dental and oral surgery offices
• Plastic surgery centers
• Gastroenterology centers
• Ambulatory surgery centers (ASCs)

Additional Hot Spots:

• Facilities struggling with recruitment and retention, often due to:
• Out-migration of CRNAs/nurse anesthesiologists
• Limited scope of practice
• Unfavorable workplace culture
• Low appeal to new graduates

“You may have a geographic area where the shortage may not be terrible, but there may be one or two hospitals in that area that have a bad reputation, maybe a bad culture,” Young explained. “Maybe the scope is more restricted than some of the others, and when they can’t recruit and retain, the only answer is to go to the 1099 market if they’re not going to fix their issues. So those are hot spots.”

“There’s been no study to pinpoint precisely where demand is the hottest at the moment.”

Impact of QZ Billing

QZ is a billing anesthesia code modifier used on a claim form indicating non-medically directed CRNA/nurse anesthesiologist services. In general, QZ and the anesthesia code modifiers used to indicate medical direction  typically reimburse the same total amount for a case but that is changing in commercial payer markets. It might sound mundane, but the use of CRNA non-medically directed services (QZ) billing could affect the demand for 1099 employees.

In simple terms, cutting QZ reimbursement is attractive to commercial insurers because they can pay less for non-medically directed CRNA/nurse anesthesiologist services. A hospital that bills CRNAs/nurse anesthesiologists under the QZ modifier might be reimbursed 15% less than if they had used medically directed anesthesia services modifier codes with a physician anesthesiologist medically directing 1 to 4 CRNAs. Since the contracted 1099 CRNA/nurse anesthesiologist likely isn’t taking a 15% pay cut, the hospitals are footing the bill for the difference. The bottom line is: QZ billing could incentivize hospitals to use a more physician-anesthesiologist-centric model over non-medically directed 1099 CRNAs/nurse anesthesiologists.

This hasn’t impacted demand for 1099 CRNAs/nurse anesthesiologists yet, but it could in the future if the economics don’t work out for hospitals or health systems.

Factors Shaping the Future of 1099 CRNAs

Looking ahead, several factors will play a vital role in the 1099 CRNA/nurse anesthesiologist market.

Impact of state opt-outs: The Medicare opt-out option grants states the ability to waive the federal requirement for physician supervision of CRNAs as part of facility requirements for payment. This would remove barriers to CRNA/nurse anesthesiologist practice, increase cost effectiveness, and address the shortage of physician anesthesiologists, making 1099 arrangements attractive for healthcare facilities and independent CRNAs/nurse anesthesiologists. In some cases, opt-out policies can reinforce that CRNAs/nurse anesthesiologists are responsible for their own practice, potentially alleviating facility and surgeon concerns about liability.

Supply and demand dynamics: A host of factors will influence the supply and demand of CRNAs/nurse anesthesiologists in the coming years and when those two will reach equilibrium.

• New graduates + retirements: More than 2,400 CRNAs/nurse anesthesiologists enter the workforce annually — a relatively steady figure based on program cohort sizes, school counts, and admissions trends. The workforce in general is aging; baby boomers are nearing retirement — some are already there. But more fluid factors like the stock market affect the age of retirement, too, Young said. For example, a huge increase or decrease in the stock market can greatly impact retirement accounts. A CRNAs/nurse anesthesiologist who is considering retirement but suddenly loses a significant portion of their savings might delay retirement. On the other hand, a considerable increase in retirement savings — reaching the “magic number,” as Young described it — could push fence-sitters into retirement sooner than expected.
• Aging population: As noted, the aging of America means an increase in demand for healthcare services, including sedation, anesthesia, and pain management. Older adults often require more surgical procedures and other medical interventions that necessitate anesthesia care, fueling the need for CRNAs/nurse anesthesiologists.
• Healthcare trends: The growing emphasis on minimally invasive procedures and outpatient surgery centers has increased surgical volume — and with it, demand for CRNAs/nurse anesthesiologists in these settings. An increase in chronic diseases also contributes to the need for more CRNAs/nurse anesthesiologists, as these conditions lead to more surgeries and procedures requiring anesthesia services and pain management.
• Scope of practice regulations: These vary by state, but regulations for CRNAs/nurse anesthesiologists play a vital role in determining demand. States that allow greater CRNA/nurse anesthesiologist autonomy often see higher demand, particularly for 1099s offering independent care. “If you had CRNAs/nurse anesthesiologists working to the full extent of their education, license, and scope of practice, we’d have enough supply,” Stanley said.

Healthcare policy and regulation: With a new presidential administration putting its stamp on healthcare, this impact is the hardest to predict. Healthcare reimbursement changes, funding cuts to Medicare and Medicaid, and a general dissatisfaction with healthcare delivery could add up to industry changes in the short term that could impact 1099 CRNAs/nurse anesthesiologists demand. Young offered a prediction: “Medical direction is the least efficient model to deliver anesthesia care,” he said. “The whole reason medical direction was created was for the government to figure out a way to pay someone to not do anesthesia. It’s an inefficient model. My hunch is there’s going to be some changes there.” That could open the door to more 1099 CRNA/nurse anesthesiologist opportunities.

Navigating the Future With the 1099 CRNA Institute

“Right now, you can go anywhere and everywhere, but I do think there will always be a 1099 market,” Pearce said. “There has been in the last 35 years that I’ve been giving anesthesia.”

To take advantage, plan your career, and enjoy the benefits of 1099 work, CRNAs/nurse anesthesiologists need to understand all these dynamics. The AANA 1099 CRNA Institute can be a valuable resource for staying up-to-date and making informed decisions.

References

1. AANA. 2025 CRNA Compensation & Benefits Survey. Retrieved from
   https://store.aana.com/Products/ProductDetails/S-ANA-062/2025-CRNA-Compensation-!26-Benefits-Survey
2. AANA. 1099 CRNA Institute. Retrieved from
   https://1099crnainstitute.aana.com 
3. AANA. Full Practice Authority for CRNAs in the Veterans Health Administration. Retrieved from
   https://www.aana.com/news/aana-champions-full-practice-authority-for-crnas-in-the-veterans-health-administration 
4. AANA. Flexibility vs. Stability: Choosing the Right CRNA Path. Retrieved from
   https://www.aana.com/news/flexibility-vs-stability 
5. AANA. Transitioning from RN to CRNA. Retrieved from
   https://www.aana.com/news/transitioning-from-an-rn-to-a-crna 
6. AANA. Becoming a CRNA. Retrieved from
   https://www.aana.com/about-us/about-crnas/become-a-crna 
7. U.S. Bureau of Labor Statistics. Statistics. Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners: Job Outlook. (2025).
   Retrieved from https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-1
   
8. Anesthesia Facts. 2022 SGA04 At a Glance. Retrieved from
   https://www.anesthesiafacts.com/wp-content/uploads/2022/11/2022_SGA04_At_a_Glance_FNL.pdf 
9. Recorded Webinar: The Current Landscape of 1099 CRNAs. Retrieved from
   https://share.hsforms.com/1BsT4uHqeRcaaKGouNIjfFw4rpz6 

Updated October 2025