What is Per Diem CRNA Work?
Per diem (PRN) CRNAs work on an as-needed basis without guaranteed hours. This arrangement offers flexibility while typically paying premium hourly rates compared to full-time positions.
Current Per Diem Rates by Region
2025 Market Rates
| Region | Standard Rate | Premium Rate |
|---|
| **Northeast** | $120-145/hr | $150-180/hr |
| **Southeast** | $110-135/hr | $140-165/hr |
| **Midwest** | $115-140/hr | $145-175/hr |
| **Southwest** | $115-140/hr | $145-170/hr |
| **West Coast** | $125-150/hr | $155-185/hr |
| **Rural/Remote** | $140-175/hr | $180-225/hr |
Rates by Setting
| Setting | Typical Range | Notes |
|---|
| **Hospital (Level I/II)** | $115-145/hr | Complex cases |
| **Community hospital** | $120-150/hr | Varied case mix |
| **ASC** | $110-135/hr | Limited scope |
| **GI center** | $100-125/hr | Propofol only |
| **Office-based** | $120-150/hr | Specialized |
Per Diem vs Full-Time Comparison
Financial Analysis
| Factor | Per Diem | Full-Time |
|---|
| **Hourly rate** | $130-160 | $100-115 |
| **Annual (40 hrs/wk)** | $270,000-330,000 | $208,000-240,000 |
| **Benefits** | None | $40,000+ value |
| **Taxes** | Self-employment | W-2 |
| **Flexibility** | High | Low |
Break-Even Analysis
- Health insurance ($15,000-25,000/year)
- Retirement contributions (no match)
- Self-employment taxes (+15.3%)
- Paid time off (no compensation)
Premium Rate Situations
When to Command Top Dollar
| Situation | Rate Increase |
|---|
| **Weekend shifts** | +15-25% |
| **Holiday coverage** | +30-50% |
| **Same-day/last minute** | +20-40% |
| **Night shift** | +20-30% |
| **Call coverage** | +Additional per call |
| **Specialized cases** | +10-20% |
Holiday Premium Examples
| Holiday | Typical Premium |
|---|
| Christmas Day | +50-75% |
| Thanksgiving | +40-60% |
| New Year's Eve/Day | +40-60% |
| July 4th | +30-40% |
| Weekend holidays | +35-50% |
Finding Per Diem Positions
Best Sources
- Direct facility contact — Highest rates, no middleman
- Local hospital HR — PRN pools always needed
- ASC networks — Growing per diem demand
- Colleague referrals — Word of mouth effective
- Locum agencies — For regional opportunities
Building Your Per Diem Network
| Strategy | Benefit |
|---|
| Work at multiple facilities | More shift options |
| Maintain credentials broadly | Faster scheduling |
| Provide reliable service | First-call status |
| Be flexible on timing | More opportunities |
| Network with schedulers | Inside track on shifts |
Rate Negotiation Strategies
Know Your Leverage
- Specialty skills (cardiac, OB, peds)
- Flexible availability
- Excellent references
- Credentialed at multiple sites
- Clean record
Negotiation Scripts
For new facilities:
> "My current per diem rate at [comparable facility] is $X. Can you match that rate?"
For premium situations:
> "For last-minute weekend coverage, my rate is $X. Would that work for this shift?"
For ongoing relationships:
> "I've been providing reliable coverage for 18 months. I'd like to discuss a rate adjustment to $X to reflect current market rates."
Maximizing Per Diem Income
Strategy 1: Facility Diversification
- Fill calendar when one is slow
- Compare rates
- Reduce dependency
- Maintain skills variety
Strategy 2: Premium Shift Focus
- Weekend call coverage
- Holiday coverage
- Last-minute fills
- Specialty cases
Strategy 3: Strategic Scheduling
| Approach | Income Impact |
|---|
| 4 premium shifts/month | +$3,000-5,000 |
| Holiday coverage | +$2,000-4,000/holiday |
| Last-minute fills | +$100-200/shift |
Credentialing for Per Diem
Best Practice
| Action | Why It Matters |
|---|
| Credential at 3-5 facilities | Options for shifts |
| Keep licenses current | No lapse in options |
| Maintain certifications | Required everywhere |
| Complete annual competencies | Stay credentialed |
Timeline Expectations
| Step | Typical Duration |
|---|
| Application | 1-2 weeks |
| Verification | 2-4 weeks |
| Committee review | 2-4 weeks |
| Approval | 1-2 weeks |
| **Total** | **6-12 weeks** |
Tax Considerations
As 1099 Contractor
- Quarterly estimated taxes
- Self-employment tax (15.3%)
- Track deductible expenses
- Maintain tax records
- Malpractice insurance
- License fees
- CME costs
- Professional dues
- Work-related travel
- Home office (if applicable)
As W-2 Per Diem
- Taxes withheld
- May include some benefits
- Often lower gross rate
- Simpler administration
Combining Per Diem with Full-Time
Supplement Strategy
| Arrangement | Additional Income |
|---|
| 2 shifts/month | $2,500-4,000/mo |
| 4 shifts/month | $5,000-8,000/mo |
| Holidays only | $3,000-5,000/yr |
Considerations
- Check full-time contract for restrictions
- Manage fatigue appropriately
- Maintain malpractice coverage
- Consider tax implications
Per Diem Pitfalls to Avoid
Common Mistakes
❌ Underpricing yourself — Know market rates
❌ Over-committing — Burnout risk
❌ Poor credentialing — Limits options
❌ Ignoring taxes — Plan for 30-35% set-aside
❌ Reliability issues — Reputation matters
❌ Benefit gaps — Health insurance essential
Conclusion
Per diem CRNA work offers excellent earning potential with unmatched flexibility. Current market rates of $120-160/hour (higher for premium shifts) make this an attractive option for supplementing income or building a flexible practice. Success requires maintaining credentials at multiple facilities, providing reliable service, and negotiating rates that account for the lack of benefits.
Rate data from Anesearch network, January 2025.