The Hospital vs ASC Question
More CRNAs are weighing this choice as ambulatory surgery centers expand. Here's a data-driven comparison to help you decide.
Compensation Comparison
Base Salary
| Setting | Average Salary | Range |
|---|---|---|
| **Hospital** | $218,000 | $190,000 - $260,000 |
| **ASC** | $205,000 | $180,000 - $240,000 |
| **Difference** | +$13,000 hospital | +6% |
Total Compensation (Including Call)
| Setting | Base | Call Pay | Benefits | Total |
|---|---|---|---|---|
| **Hospital** | $218,000 | $18,000 | $45,000 | $281,000 |
| **ASC** | $205,000 | $0 | $42,000 | $247,000 |
Hospital appears to pay more—but there's more to the story.
Hourly Rate Reality
Actual Hours Worked
| Setting | Scheduled | Call Hours | Total/Year |
|---|---|---|---|
| Hospital | 2,080 | 600 | 2,680 |
| ASC | 2,000 | 0 | 2,000 |
Effective Hourly Rate
| Setting | Total Comp | Hours | $/Hour |
|---|---|---|---|
| Hospital | $281,000 | 2,680 | $104.85 |
| ASC | $247,000 | 2,000 | $123.50 |
ASCs pay 18% more per hour worked.
Work Schedule Comparison
Typical Hospital Schedule
- Hours: 6:30 AM - 3:00 PM + call
- Call frequency: 1 in 4 to 1 in 6
- Weekends: Required rotation
- Holidays: Required rotation
- Late cases: Frequent
- Unpredictability: High
Typical ASC Schedule
- Hours: 6:30 AM - 3:00 PM
- Call: None or rare
- Weekends: Off
- Holidays: Off
- Late cases: Rare (no overnight admits)
- Unpredictability: Low
Case Complexity and Skills
Hospital Environment
- Complex, challenging cases
- Trauma and emergencies
- Full specialty exposure
- Skills stay sharp
- Teaching opportunities
- Higher stress
- Unpredictable workflow
- More administrative burden
- Burnout risk
ASC Environment
- Predictable case mix
- Lower stress
- Higher throughput
- Streamlined processes
- Team consistency
- Less variety
- Skills may narrow
- Fewer complex cases
- Limited teaching
Benefits Comparison
| Benefit | Hospital | ASC |
|---|---|---|
| **Health insurance** | Typically stronger | Variable |
| **Retirement match** | 4-6% common | 3-5% typical |
| **PTO** | 4-5 weeks | 3-4 weeks |
| **CME allowance** | $2,000-5,000 | $1,500-3,000 |
| **Malpractice** | Always covered | Usually covered |
| **Tuition assistance** | Sometimes | Rare |
Career Trajectory
Hospital Career Path
- Staff CRNA → Lead CRNA → Manager → Director
- Teaching/precepting opportunities
- Research possibilities
- Broader network for references
- Skills transferable anywhere
ASC Career Path
- Staff CRNA → Lead CRNA → Center Manager
- Less hierarchy, faster advancement
- Ownership/partnership opportunities
- Specialized network
- May need to "catch up" if returning to hospital
Who Thrives in Each Setting?
Hospital is Best For:
✅ CRNAs who value case variety ✅ Those building careers (first 3-5 years) ✅ People who handle stress well ✅ Those seeking leadership roles in large systems ✅ CRNAs wanting academic connections
ASC is Best For:
✅ CRNAs prioritizing work-life balance ✅ Parents with childcare constraints ✅ Experienced providers seeking sustainability ✅ Those approaching retirement ✅ CRNAs burned out on call
Financial Modeling: 5-Year Analysis
Hospital Path (Age 35-40)
| Year | Salary | Call | Total |
|---|---|---|---|
| 1 | $205,000 | $15,000 | $220,000 |
| 2 | $210,000 | $18,000 | $228,000 |
| 3 | $218,000 | $20,000 | $238,000 |
| 4 | $225,000 | $20,000 | $245,000 |
| 5 | $232,000 | $22,000 | $254,000 |
| **5-Year Total** | **$1,185,000** |
ASC Path (Same Period)
| Year | Salary | Call | Total |
|---|---|---|---|
| 1 | $195,000 | $0 | $195,000 |
| 2 | $200,000 | $0 | $200,000 |
| 3 | $205,000 | $0 | $205,000 |
| 4 | $210,000 | $0 | $210,000 |
| 5 | $215,000 | $0 | $215,000 |
| **5-Year Total** | **$1,025,000** |
Hospital: +$160,000 over 5 years
BUT: Hospital CRNA worked 3,000 more hours (equivalent of 1.5 years of extra work).
Hybrid Strategies
Best of Both Worlds
- Full-time ASC position (lifestyle)
- PRN hospital shifts when desired
- Control your call exposure
- Maintain acute care skills
- Build skills in hospital (years 1-5)
- Transition to ASC for lifestyle (years 6+)
- Maintain hospital PRN for variety
- Work at multiple ASCs
- Varied case types
- Still no call
- Higher income potential
Market Trends
Growing ASC Sector
- 7% annual growth in ASC construction
- Payers pushing outpatient procedures
- More complex cases moving to ASC
- CRNA-friendly ownership structures
Hospital Challenges
- Staffing pressures increasing call
- Burnout driving experienced CRNAs out
- Salary compression frustrating tenure
- More reliance on locum coverage
Questions to Ask
Before Accepting Hospital Position
- What's the actual call frequency?
- How is call compensated?
- What's the late case policy?
- Is there a no-call track available?
- What's the turnover rate?
Before Accepting ASC Position
- What's the typical end time?
- Are benefits equivalent to hospital?
- What's the ownership structure?
- Is there room for growth?
- What happens if volume drops?
Conclusion
Hospitals pay more in total dollars but demand significantly more time. ASCs pay more per hour with vastly better lifestyle. The right choice depends on your career stage, financial needs, and personal priorities. Many CRNAs find the optimal path includes both settings at different career phases—hospital early for skill building, ASC later for sustainability.
Compensation data from Anesearch market research, January 2025.