CRNAs get paid through five main models: W2 hospital employee, W2 employee of an anesthesia group, 1099 independent contractor, locum tenens, and owner of a group that keeps its collections. The headline rate differs across them, and so does everything underneath it: taxes, benefits, malpractice, and risk.
Comparing a $110 W2 hourly rate to a $150 1099 rate without adjusting for those differences is the most common CRNA pay mistake. Here is how the money actually flows in each model.
Key points
- Five models: hospital W2, group W2, 1099, locum, and group owner.
- Higher headline rates trade away benefits, taxes, and stability.
- Only ownership captures the full value of your cases.
- Model offers after taxes and benefits, never on headline rates.
1. W2 hospital employee
You are employed by the hospital or health system. The hospital bills payers for your cases, or funds anesthesia as a cost center, and pays you a salary or hourly rate regardless of collections.
The employer withholds taxes, pays half your Social Security and Medicare taxes, and typically provides health insurance, retirement match, paid time off, and malpractice coverage. Pay is stable and benefits are rich, and the trade is a lower headline number and less schedule control.
2. W2 employee of an anesthesia group
You are employed by a private group or a national staffing company that holds the facility contract. The group bills for your cases, collects from payers and any hospital stipend, pays its overhead, and pays you from what remains.
Day to day it feels like hospital employment, with the same W2 tax treatment. The difference is that your job security is tied to the group's contract. If the contract changes hands, your employment can too, and non-competes complicate staying at the same facility; see /crna-non-compete/.
3. 1099 independent contractor
You contract directly with a facility or group and receive gross pay with nothing withheld. You are a business. You pay both halves of Social Security and Medicare tax, about 15.3 percent self-employment tax on net earnings up to the annual wage base, file quarterly estimated taxes, and buy your own benefits and often your own malpractice.
In exchange, rates run higher than W2 and you can deduct legitimate business expenses. Whether the premium actually compensates for the lost benefits depends on the numbers. Run yours through the /crna-1099-vs-w2-calculator/ and read /1099-crna/ for the full setup, including entity and retirement options.
4. Locum tenens
Locums is short-term coverage work, usually placed through an agency, usually paid 1099 though some agencies run W2. The agency bills the facility a bill rate and pays you a lower pay rate, keeping the spread. Travel, lodging, and licensing support are often covered.
Locums pays well per hour and buys flexibility. It costs you continuity, benefits, and some control over where you land each month. See /locum-crna/ for how assignments work and /crna-staffing-agencies/ for how agencies price you.
5. Owner of a group taking collections
You own, alone or with partners, the entity that holds a facility contract. The group bills payers, collects professional fees plus any hospital stipend, pays all costs, and the owners keep the profit.
This is the only model where you capture the full value of your cases, and the only one where you carry billing risk, staffing risk, and contract risk. Income depends on payer mix, collection performance, and the stipend; see /anesthesia-collection-rate/ for what drives it. Start with /how-to-start-a-crna-group/, model income with the /crna-group-revenue-calculator/, and dig deeper at /for-crna-practice-owners/.
How the models compare
| Model | Who bills | Taxes | Benefits | Malpractice | Risk level |
|---|---|---|---|---|---|
| Hospital W2 | Hospital | Withheld, employer pays half FICA | Full | Employer-provided | Low |
| Group W2 | Group | Withheld, employer pays half FICA | Usually full | Usually provided | Low to moderate |
| 1099 contractor | Facility or group | You pay SE tax, quarterly estimates | None, buy your own | Often your own | Moderate |
| Locum | Agency or facility | Usually 1099 treatment | Rare | Varies by agency | Moderate |
| Group owner | Your entity | Business plus personal | You fund them | You buy it | High |
For context on absolute pay, BLS reported a mean of $248,320 and a median of $236,590 for nurse anesthetists in May 2025. Those figures count employees only, so 1099 and owner income sits outside them. Compare markets at /crna-salary/ and /crna-salary-by-state/, and estimate your net under any model with the /crna-take-home-pay/ calculator.
Which model pays the most?
Per hour, 1099 and locum rates usually top W2 rates, and ownership has the highest ceiling and the highest risk. After taxes, benefits, and malpractice, the gap is smaller than it looks, which is why you should model it rather than compare headline rates.
Can I mix models?
Yes. Many W2 CRNAs add 1099 side work. Check your contract and coverage first; /crna-moonlighting/ walks through the pitfalls.
Do 1099 CRNAs really pay more tax?
They pay both halves of FICA as self-employment tax, and they also gain business deductions and larger retirement contribution room. Net outcomes vary by person, so confirm with a CPA.
This page is general information, not tax, legal, or financial advice. Confirm your situation with a CPA before changing employment models.