Locum Tenens Anesthesia: What It Costs and When It Beats Hiring

The short answer: in anesthesia job postings over the past year, locum tenens and other contract work offered CRNAs a median of about $225 an hour and anesthesiologists about $333 an hour. Those are the rates offered to the clinician. A hospital or group booking through an agency pays more: the agency’s margin, travel, lodging and malpractice coverage come on top. One public federal order in 2026 paid $497.87 an hour for locum anesthesiologists. At that bill rate a locum anesthesiologist costs about 1.7 times an employed one per shift; for CRNAs, the clinician’s rate alone is already 1.4 times the employed cost, before any agency margin. Locums are the cheaper choice for short gaps, while a permanent hire is found or volume settles, and an expensive one as a standing part of the schedule.

What locums anesthesia pays

In the 12 months to September 2026, our index of publicly posted anesthesia job listings from national job boards held 705 contract CRNA postings and 289 contract anesthesiologist postings (locum tenens, 1099 and other contract work) that stated an hourly rate. They came from 162 and 93 different employers and agencies. Counting each employer’s rate once per state:

Rates did not rise over the year: the CRNA median was $230 in postings from October 2025 to March 2026 and $225 from April to September 2026. State medians for contract CRNAs ran from about $190 an hour (Georgia) to $260 (South Carolina), with Minnesota, Washington, Arizona, Wisconsin and Iowa around $250. For anesthesiologists, the states with enough postings ran from $300 (North Carolina) to $350 (Texas and Illinois). CHG’s Locumstory, an agency publication, puts what locum anesthesiologists earn in 2026 at $300–$425 an hour.

Contract work is not a niche. Among anesthesia postings in the same 12 months that said how the job pays, hourly and locums work made up about 84% of CRNA postings and about 68% of anesthesiologist postings.

What the hospital actually pays

The clinician’s rate is the floor. An agency’s bill rate covers the clinician’s pay plus its own costs and margin, and usually travel, lodging, licensing, credentialing and malpractice coverage. Agencies do not publish their markups, and no independent survey of them exists. Public contracts give a glimpse: in March 2026 the Department of Veterans Affairs in New Mexico ordered six months of coverage by three locum anesthesiologists at an estimated $1.55 million, at $497.87 an hour, and noted that the contractor already on site was being paid $511 an hour.

Set against an employed clinician, at September 2026 median salaries plus 20% for benefits, taxes and malpractice, and 220 shifts a year:

Travel and lodging are extra unless the contract includes them. For CRNAs, the clinician’s rate alone is already about 40% above employed cost, which is likely part of why so many CRNAs have moved to contract work. A national recruiting firm reported in 2026 that hospitals and groups cannot compete with locums and 1099 pay for CRNAs.

The costs that do not show up in the rate

• Credentialing time. Every locum needs a license in the state and privileges at the hospital before the first shift, and often payer enrollment. The VA order noted that local recruiting could take up to 90 days after award before credentialing could even begin.
• Billing limits. Under Medicare’s rules an absent physician can bill for a covering physician’s services for at most 60 continuous days. The statute that allows it covers physicians (and physical therapists in some areas), not CRNAs, so longer assignments, and contract CRNAs, need the clinician enrolled in their own name.
• Malpractice coverage. Agencies describe their coverage differently; some policies are occurrence-based and some claims-made, which leaves a tail to cover. Ask for the policy form.
• Conversion fees. Hiring a locum permanently usually triggers a buyout fee negotiated in the agency contract. There is no public schedule; read the clause before signing.
• Continuity. Rotating locums do not know the surgeons, the protocols or the building, which shows up in turnover times, first-case starts and cancellations.

When locums beats hiring

A vacancy has a cost too. A staffed location at the subsidy calculator’s default inputs collects about $2,000 a day in anesthesia fees alone, and the hospital’s own revenue from the surgery is larger: one Florida hospital told a court that procedures requiring anesthesia brought it about $75 million in contribution margin in 2023. Physician searches take months: filling a physician vacancy took about 129 days in 2023, according to the recruiters’ association AAPPR.

A 2024 study in Cureus that modeled the choice for anesthesiologists found locums cheaper than hiring for engagements shorter than about 665 hours of coverage, once the upfront cost of recruiting and onboarding a permanent hire is counted. Its inputs used the locum’s pay rate rather than an agency bill rate, so the break-even point for a hospital paying agency rates comes sooner.

In practice, locums are the right answer for:

• bridging a vacancy while a permanent hire is recruited and credentialed;
• seasonal or temporary volume, such as a surgeon’s block that may not last;
• opening a new location before its volume is proven;
• covering leave, without overloading the permanent team.

They are the wrong answer when the same rooms are filled with locums month after month. Then the premium is part of the cost of every case, and it usually arrives at the hospital as a larger subsidy request.

Questions to ask before approving locums spend

1. What share of last quarter’s shifts were covered by locums or contract clinicians, at which locations?
2. What is the bill rate per hour or day, and what does it include?
3. Who is paying for it: the hospital directly, or the group, passing it through in the subsidy?
4. What is the plan, and the date, for replacing those shifts with permanent staff?
5. What do the agency contract’s conversion and notice terms say?

Our 2026 pay data covers salaried pay by state, and what care team ratios cost covers the staffing model the locums are filling in for.

Sources

• AOC index of publicly posted anesthesia job listings from national job boards: contract postings stating an hourly rate, October 2025 to September 2026, each employer’s rate counted once per state.
• Department of Veterans Affairs, order 36C26226F0177 for locum anesthesiology services, New Mexico VA Health Care System (March 2026), as published on SAM.gov.
• Locumstory (CHG Healthcare), locum tenens compensation trends (September 2026).
• Cross et al., cost of locum tenens versus permanent anesthesiologists, Cureus 2024, doi:10.7759/cureus.58853.
• CHG Healthcare, State of Locum Tenens report (2025), citing AAPPR’s 2024 benchmarking report on 2023 searches.
• CMS, Medicare Claims Processing Manual, chapter 1, sections 30.2.10 and 30.2.11 (reciprocal and fee-for-time billing, formerly locum tenens).
• Holy Cross Hospital’s complaint against North American Partners in Anesthesia, S.D. Fla. No. 0:24-cv-60315 (February 26, 2024).
• AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives.