What Is Office-Based Anesthesia?
Office-based anesthesia (OBA) refers to anesthesia services provided in physician offices, clinics, and freestanding surgical suites rather than hospitals or licensed ASCs.
Common OBA Settings
| Setting | Case Types | Volume |
|---|---|---|
| **Dental surgery** | Extractions, implants, sedation | High |
| **Plastic surgery** | Facelifts, liposuction, body contouring | Moderate |
| **Oral/maxillofacial** | TMJ, reconstructive, trauma | Moderate |
| **GI/endoscopy** | Colonoscopy, EGD | Very high |
| **Pain management** | Injections, RFA, implants | Moderate |
| **Dermatology** | MOHS, large excisions | Low |
| **Fertility** | Egg retrieval, embryo transfer | Moderate |
Compensation in OBA
Salary Ranges
| Setting | Typical Range | Notes |
|---|---|---|
| **Dental surgery** | $180,000 - $240,000 | Often per diem or contract |
| **Plastic surgery** | $190,000 - $260,000 | Variable based on volume |
| **GI centers** | $195,000 - $230,000 | High volume, steady |
| **Pain clinics** | $175,000 - $220,000 | Regular hours |
| **Multi-specialty** | $185,000 - $250,000 | Varied case mix |
Per Diem Rates
| Setting | Per Case | Daily Rate |
|---|---|---|
| **Dental surgery** | $150-300/case | $1,500-2,500 |
| **Plastic surgery** | $200-400/case | $2,000-3,500 |
| **GI center** | $100-175/case | $1,200-2,000 |
Advantages of OBA Practice
Lifestyle Benefits
✅ No call — Daytime hours only ✅ Predictable schedule — Regular start/end times ✅ Limited complexity — Generally healthy patients ✅ Short cases — High turnover, minimal downtime ✅ Weekends off — Most offices Saturday/Sunday closed ✅ Holidays off — Offices close for holidays
Professional Benefits
✅ Autonomy — Often sole anesthesia provider ✅ Efficiency — Streamlined processes ✅ Team stability — Same staff daily ✅ Lower stress — Planned cases, stable patients
Challenges and Considerations
Practice Limitations
❌ Limited case variety — Same procedures repeatedly ❌ Skills atrophy — Complex cases not seen ❌ Emergency resources — Limited compared to hospital ❌ Solo responsibility — You're the only backup
Practical Concerns
| Concern | Reality |
|---|---|
| **Emergency preparedness** | You must maintain protocols |
| **Equipment limitations** | May not have full OR capability |
| **Transfer logistics** | Distance to hospital matters |
| **Accreditation variability** | Some offices less rigorous |
| **Scheduling inconsistency** | Volume can fluctuate |
Scope of Practice in OBA
Typical Case Characteristics
| Factor | OBA Norm | Hospital Norm |
|---|---|---|
| **ASA status** | I-II | I-IV+ |
| **Case length** | 30-180 min | Variable |
| **Anesthesia type** | MAC/GA | All types |
| **Age range** | Adults (usually) | All ages |
| **Complexity** | Low-moderate | All levels |
Red Lines to Consider
- ASA III-IV patients without hospital backup
- Cases that regularly exceed capability
- Patients with uncontrolled comorbidities
- Procedures with high complication rates
Getting OBA Credentials
Requirements Vary By State
| Requirement | Common Standard |
|---|---|
| **State license** | Active CRNA license |
| **ACLS** | Required |
| **BLS** | Required |
| **Additional certifications** | Sometimes (PALS, sedation) |
| **Office-specific privileging** | Usually required |
Dental Anesthesia Specifics
- Dental board permit
- Additional certification
- Specific training hours
- Periodic re-credentialing
Check your state's dental board requirements.
Evaluating OBA Opportunities
Questions to Ask
- What emergency equipment is available?
- Where is the nearest hospital?
- Who manages emergencies with me?
- What's the transfer protocol?
- What's the typical daily case volume?
- What patient population do you serve?
- Who owns the practice?
- How is scheduling handled?
- Employee or independent contractor?
- What malpractice is provided?
- How is compensation structured?
- Are there volume expectations?
Safety Red Flags
⚠️ No emergency equipment — CPR equipment essential ⚠️ No hospital relationship — Transfer plan needed ⚠️ No protocols — Documentation required ⚠️ Pressure to sedate inappropriate patients — ASA limits exist ⚠️ No accreditation — Increases liability risk
Transitioning to OBA
From Hospital Practice
- Shadow first — Understand the environment
- Start part-time — Maintain hospital skills
- Build protocols — Create safety systems
- Maintain certifications — Stay current on emergencies
- Network — Connect with OBA colleagues
Maintaining Skills
| Strategy | Purpose |
|---|---|
| PRN hospital work | Complex case exposure |
| Simulation training | Emergency management |
| Peer networks | Case discussion |
| Continuing education | Current knowledge |
Market Outlook for OBA
Growing Demand
- More procedures moving to office setting
- Cost pressures driving shift
- Patient preference for convenience
- Surgeon preference for control
Opportunities
| Specialty | Growth Trend |
|---|---|
| **Dental surgery** | Strong |
| **Plastic surgery** | Strong |
| **GI/endoscopy** | Very strong |
| **Pain management** | Growing |
| **Fertility** | Moderate |
Who Thrives in OBA?
Good Fit For:
- CRNAs prioritizing work-life balance
- Those comfortable with autonomy
- Experienced providers (5+ years recommended)
- CRNAs who enjoy routine and efficiency
- Those who don't need case variety
Less Ideal For:
- New graduates (limited complexity)
- CRNAs who love variety
- Those uncomfortable with solo practice
- CRNAs wanting academic connection
Conclusion
Office-based anesthesia offers CRNAs excellent lifestyle benefits—predictable hours, no call, and lower stress—with competitive compensation. Success requires understanding the limitations, ensuring proper safety protocols, and maintaining emergency management skills. For experienced CRNAs prioritizing work-life balance, OBA represents a rewarding career path with growing demand.
Practice information based on Anesearch network data, January 2025.