Understanding Practice Models
The way CRNAs work varies significantly based on practice model. Understanding these differences is crucial for career decisions.
The Two Primary Models
Anesthesia Care Team (ACT)
- MDA present or immediately available
- Case decisions may involve MDA input
- MDA handles complex issues
- Team-based approach
Independent/Autonomous Practice
- Full decision-making authority
- No MDA supervision required
- Complete responsibility for cases
- Common in FPA states and rural areas
Side-by-Side Comparison
| Factor | ACT Model | Independent |
|---|---|---|
| **Autonomy** | Moderate | Full |
| **Decision authority** | Shared | Complete |
| **Backup available** | Yes | Limited |
| **Stress level** | Lower | Higher |
| **Compensation** | Market rate | Often premium |
| **Case complexity** | All levels | All levels |
| **Settings** | Urban, academic | Rural, ASCs |
Day-to-Day Differences
In ACT Practice
- Check in with MDA at case start
- May discuss anesthetic plan
- MDA available for problems
- Shared sign-out responsibility
- Team rounds/meetings
In Independent Practice
- Develop own anesthetic plan
- Direct communication with surgeon
- Handle all complications
- Full documentation responsibility
- Autonomous scheduling
Compensation Comparison
| Setting | ACT Salary | Independent Salary |
|---|---|---|
| Urban hospital | $210,000 | N/A (usually ACT) |
| Community hospital | $215,000 | $230,000 |
| Rural hospital | N/A | $250,000+ |
| ASC | $200,000 | $215,000 |
Who Prefers Each Model
ACT Model Suits:
✅ Those valuing backup/support ✅ New graduates building skills ✅ CRNAs preferring team environment ✅ Those in specialties needing MDA (cardiac) ✅ Academic/teaching-oriented
Independent Practice Suits:
✅ Experienced, confident practitioners ✅ Those valuing complete autonomy ✅ CRNAs seeking highest compensation ✅ Those comfortable with responsibility ✅ Rural/underserved area workers
Transitioning Between Models
ACT → Independent
| Step | Purpose |
|---|---|
| Build experience | 5+ years recommended |
| Develop confidence | Handle complex cases |
| Broaden skills | Regional, OB, peds |
| Target FPA states | Where independent is standard |
| Consider locum first | Test independence |
Independent → ACT
- Better work-life balance
- Less stress
- Urban lifestyle
- Subspecialty practice
Making Your Choice
Consider Questions
- How comfortable am I with sole responsibility?
- Do I prefer backup available?
- Is autonomy or support more important?
- What settings am I targeting?
- Where do I want to live?
Conclusion
Neither model is inherently better—they suit different personalities, career stages, and priorities. ACT offers support and specialization; independent practice offers autonomy and often premium compensation. Match the model to your preferences and career goals.
Practice model information from Anesearch, January 2025.