What Are Critical Access Hospitals?
Critical Access Hospitals (CAHs) are small, rural hospitals designated by the federal government to reduce financial vulnerability and maintain access to healthcare in remote areas.
CAH Criteria
| Requirement | Standard |
|---|---|
| **Bed count** | ≤25 inpatient beds |
| **Distance** | 35+ miles from another hospital |
| **Stay length** | Average ≤96 hours |
| **Emergency** | 24/7 emergency services |
Why CAHs Pay Premium
Compensation Comparison
| Setting | Avg Salary | Sign-On | Total Package |
|---|---|---|---|
| **CAH** | $255,000 | $75,000 | $355,000 |
| **Community** | $215,000 | $30,000 | $260,000 |
| **Urban** | $200,000 | $20,000 | $230,000 |
Premium Drivers
- Recruitment difficulty — Remote locations
- Retention challenges — Lifestyle trade-offs
- Critical need — Often sole provider
- Autonomy requirements — Must work independently
Typical CAH Practice
Case Mix
| Case Type | Frequency |
|---|---|
| General surgery | 35% |
| Orthopedics | 25% |
| OB (if offered) | 15% |
| GI/Endoscopy | 15% |
| Emergency | 10% |
Scope of Practice
- Practice independently (FPA states) or with distant supervision
- Handle all anesthesia cases
- Manage own call coverage
- Coordinate with surgeons directly
Benefits Beyond Salary
| Benefit | CAH Typical |
|---|---|
| **Sign-on bonus** | $50,000-100,000 |
| **Relocation** | $15,000-25,000 |
| **Student loan repayment** | $30,000-50,000 |
| **Housing assistance** | Sometimes included |
| **CME budget** | $4,000-6,000 |
Loan Repayment Programs
- NHSC Loan Repayment
- State loan forgiveness
- Employer loan assistance
Reality of CAH Practice
What You'll Love
✅ Complete autonomy ✅ Premium compensation ✅ Community impact ✅ Low cost of living ✅ Broad skills utilization ✅ Meaningful work
Challenges
❌ Geographic isolation ❌ Heavy call burden (often solo) ❌ Limited resources ❌ Transfer required for complex cases ❌ Lifestyle limitations
Evaluating CAH Positions
Critical Questions
- How many CRNAs share call? (Solo coverage is exhausting)
- What's the true call volume? (Not just frequency)
- Is there OB coverage? (Major commitment)
- What's the transfer process? (Distance matters)
- Is there locum coverage for vacation?
Who Thrives at CAHs
Best Fit
- Experienced CRNAs (5+ years)
- Independent decision-makers
- Those valuing autonomy over amenities
- CRNAs comfortable with isolation
- Those seeking financial acceleration
Less Ideal
- New graduates
- Those needing urban lifestyle
- CRNAs who prefer team environments
- Those with specialty career interests
Conclusion
Critical Access Hospital positions offer CRNAs exceptional compensation with maximum autonomy. The trade-off is geographic and professional isolation. For the right candidate, CAH practice provides rapid financial growth and deeply meaningful work—but requires realistic assessment of lifestyle implications.
CAH data from Anesearch and HRSA, January 2025.