What Are CRNA-Only Groups?
CRNA-only anesthesia groups operate without anesthesiologists on staff. These practices provide full-scope anesthesia services with CRNAs as the sole anesthesia providers, typically in states with full practice authority.
Where CRNA-Only Groups Exist
Most Common Settings
| Setting | Prevalence | Notes |
|---|---|---|
| **Rural hospitals** | Very common | Often the only option |
| **Critical access hospitals** | Very common | CRNAs fill essential role |
| **Surgery centers (ASCs)** | Common | Cost-effective model |
| **Office-based surgery** | Common | Dental, plastic surgery |
| **GI/Endoscopy centers** | Moderate | Propofol-based sedation |
| **Community hospitals** | Moderate | Growing in FPA states |
States with Most CRNA-Only Practices
| State | Practice Model | CRNA-Only Prevalence |
|---|---|---|
| Iowa | Full independence | Very high |
| Montana | Full independence | Very high |
| Wyoming | Full independence | Very high |
| North Dakota | Full independence | High |
| South Dakota | Full independence | High |
| Kansas | Full independence | High |
| Nebraska | Full independence | High |
| Maine | Full independence | Moderate-high |
Advantages of CRNA-Only Practice
Professional Benefits
✅ Complete autonomy — You make all anesthesia decisions ✅ Full scope of practice — No artificial limitations ✅ Direct patient relationships — Own the entire encounter ✅ Professional respect — Recognized as the expert ✅ Efficient workflow — No supervision bottlenecks
Financial Benefits
✅ Higher compensation — No revenue sharing with MDAs ✅ Partnership opportunities — Equity ownership possible ✅ Direct contracting — Better negotiating position ✅ Profit sharing — In group practices ✅ Productivity bonuses — Often available
Challenges to Consider
Professional Challenges
❌ Full responsibility — No backup for difficult decisions ❌ Isolation — May be the only anesthesia provider ❌ Continuous learning — Must stay current independently ❌ Call burden — Small groups mean more call ❌ Coverage gaps — Vacation requires locum coordination
Practice Challenges
❌ Business responsibilities — If owner/partner ❌ Credentialing complexity — Navigating hospital politics ❌ Insurance negotiations — Especially for owned practices ❌ Staffing issues — Recruiting other CRNAs
Finding CRNA-Only Opportunities
Search Strategies
- Filter by state — Focus on full practice authority states
- Target rural areas — Higher concentration of CRNA-only
- Search "independent CRNA" — Often signals CRNA-only
- Look at ASC networks — Many operate CRNA-only
- Network at AANA — Connect with autonomous practitioners
Key Job Posting Signals
- "Independent practice"
- "Full practice authority"
- "Autonomous practice"
- "CRNA-led anesthesia"
- Located in rural/critical access
- "Care team model"
- "ACT environment"
- "Physician-led"
- "Collaborate with anesthesiologists"
Evaluating CRNA-Only Positions
Questions to Ask
- How many CRNAs in the group?
- Is there MDA consultation available if needed?
- Who handles complex case decisions?
- What's the call structure?
- What specialists are available?
- What's the transfer protocol?
- What equipment is available?
- What's the surgical team experience level?
- Is this hospital-employed or group practice?
- Are there partnership/ownership opportunities?
- How are profits distributed?
- What's the business stability?
Skills Needed for CRNA-Only Practice
Essential Competencies
| Skill | Why It Matters |
|---|---|
| **Regional anesthesia** | No backup for blocks |
| **OB anesthesia** | If facility does deliveries |
| **Pediatrics** | Some level in most settings |
| **Emergency management** | Difficult airway, codes |
| **Clinical judgment** | Independent decisions |
| **Communication** | Leading the team |
Experience Recommendations
| Experience Level | Readiness |
|---|---|
| New grad | Not recommended |
| 1-2 years | Possible with strong mentorship |
| 3-5 years | Typically ready |
| 5+ years | Ideal fit |
Compensation in CRNA-Only Settings
Salary Comparison
| Setting | CRNA-Only | ACT Model | Difference |
|---|---|---|---|
| Rural hospital | $255,000 | $230,000 | +11% |
| Community hospital | $235,000 | $210,000 | +12% |
| ASC | $215,000 | $200,000 | +8% |
Partnership/Ownership Potential
| Structure | Potential Income |
|---|---|
| **Employed** | $200,000-$260,000 |
| **Production-based** | $220,000-$300,000 |
| **Partner (small group)** | $250,000-$350,000 |
| **Owner** | $300,000-$500,000+ |
Starting Your Own CRNA Practice
Steps to Consider
- Gain experience — 5+ years recommended
- Choose location — FPA state, underserved area
- Develop business plan — Financial projections
- Secure contracts — Facility agreements
- Handle logistics — Billing, malpractice, licensing
- Build team — Other CRNAs, support staff
Resources Needed
| Item | Typical Cost |
|---|---|
| Legal setup | $5,000-15,000 |
| Malpractice (first year) | $8,000-20,000 |
| Billing system | $500-2,000/month |
| Insurance | Variable |
| Working capital | $50,000-100,000 |
Transitioning to CRNA-Only Practice
From ACT Environment
- Build confidence — Take on complex cases
- Develop independence — Minimize reliance on MDA
- Expand skills — Regional, OB, pediatrics
- Network — Connect with independent CRNAs
- Target locum opportunities — Test independence
Common Concerns Addressed
- Surgeon consultation available
- Telemedicine options exist
- Transfer protocols in place
- Experience builds confidence
- CRNA-only groups are still teams
- OR staff provides collaboration
- Professional networks available
- Many find it more collaborative
Conclusion
CRNA-only practice offers the highest level of professional autonomy, often with premium compensation. Success requires solid clinical experience, confidence in independent decision-making, and the right practice setting. For CRNAs who value autonomy and are ready for full responsibility, these positions offer exceptional career satisfaction.
Practice information based on Anesearch network data, January 2025.