A Certified Registered Nurse Anesthetist (CRNA) can build their career in two very different ways: as a W-2 employee or a 1099 independent contractor. The right choice depends largely on what you value most—stability, freedom, or financial control.

Download Infographic

W-2 CRNA: Stability & Benefits (with Current Context)

A W-2 CRNA works directly for a hospital, clinic, or anesthesia group and receives a W-2 form at tax time, meaning they’re classified as an employee rather than a contractor. This path emphasizes dependable income and built-in security—employer-sponsored health and malpractice insurance, retirement plan contributions, and automatic tax withholdings that simplify financial management. The trade-off is less schedule flexibility, typically lower hourly pay (before benefits) than contractor roles, and limited opportunities to deduct business expenses. For many, it’s the predictable, benefits-rich route that favors long-term consistency over autonomy.

Advantages of W-2 Employment

• Dependable income & payroll simplicity: Regular paycheck with employer handling federal income tax, Social Security, and Medicare withholdings.
• Employer-sponsored benefits: Common packages include health, dental/vision, malpractice coverage, PTO, and often CE reimbursement.
• Retirement contributions: Access to employer plans (e.g., 401(k)/403(b)) and in many cases employer matching or contributions.
• Administrative ease: Less personal burden compared with running a solo business (insurance shopping, quarterly tax estimates, etc.).

Trade-Offs to Consider

• Less flexibility: Schedules and assignments are typically set by the employer; fewer options to choose locations/cases compared with contracting.
• Typically lower hourly rate (pre-benefits): Nominal hourly pay often trails contractor/1099 rates designed to offset lack of benefits.
• Fewer deductions: Because many costs are covered by the employer, there are fewer business expenses to write off at tax time.

Recent Data Points

• National pay context: Industry summaries for 2024–2025 report W-2 CRNA compensation commonly in the $170,000–$425,000 annual range (roughly $81–$204/hour), varying by region, experience, and case mix.
• W-2 vs. 1099 pay differential: Contractor/1099 CRNAs often earn a ~20–30% higher hourly rate than comparable W-2 roles to compensate for self-funded benefits and added administrative responsibilities.
• Total compensation matters: Professional guidance (including AANA commentary) emphasizes evaluating salary + benefits + taxes + admin time, not just the headline hourly rate.

Why It Matters

• Benefits are real dollars: Employer-paid health/malpractice coverage and retirement matches materially increase total comp.
• Predictability helps planning: Consistent pay and reduced admin work simplify budgeting and long-term financial goals.
• Fit your priorities: W-2 suits CRNAs prioritizing stability and institutional support over maximum flexibility and rate-shopping.

1099 CRNA: Independence & Earning Power (with Current Context)

A 1099 CRNA operates as an independent business, contracting directly with facilities or via staffing agencies. Contractors typically command higher hourly or daily rates to offset the lack of employer-provided benefits, and they enjoy greater control over schedules and case selection. In exchange, they assume responsibility for self-employment taxes, purchasing insurance (including malpractice and often tail coverage), retirement planning, quarterly estimated taxes, and meticulous recordkeeping. Income can vary between assignments, so cash-flow management matters.

Advantages of 1099 Contracting

• Higher top-line pay potential: Facilities often pay a premium over W-2 rates to compensate for self-funded benefits and flexibility demands.
• Business deductions: Travel/lodging, professional liability insurance, continuing education, equipment, licensing/credentialing, and certain home-office and communications costs can often be deducted when ordinary and necessary for the work.
• Lifestyle flexibility: More control over schedules, locations, and case mix (e.g., short-term locums, seasonal coverage, high-need markets).

Trade-Offs to Consider

• Self-employment tax & complexity: You pay both the employee and employer share of Social Security and Medicare via the self-employment tax, plus federal/state income taxes. You’ll also handle quarterly estimates and bookkeeping.
• Benefits are DIY: Health, disability, retirement, and malpractice (including tail if needed) are typically out-of-pocket.
• Variable income: Gaps between contracts or cancellations can create volatility; an emergency fund is crucial.

Recent Data Points

• Hourly pay ranges: Many agencies/facilities list 1099 CRNA rates in the $180–$250/hour range (annualized ≈ $347k–$482k assuming full-time hours), with significant variation by region, case complexity, and urgency. Other national snapshots peg recent averages around $125/hour, reflecting wide spread by market and assignment type.
• Premium over W-2: Illustrative comparisons show facilities offering ~20–40% higher hourly for 1099 than the W-2 equivalent when benefits are not provided.
• Self-employment tax (2025): The SE tax rate is 15.3% (12.4% Social Security + 2.9% Medicare). Social Security applies up to the $176,100 wage base in 2025; Medicare has no base cap, and an extra 0.9% Medicare surtax can apply at higher incomes. Only 92.35% of net SE income is subject to SE tax, and the “employer” half is deductible when computing income tax.
• Malpractice coverage: 1099s commonly purchase their own policies and should understand claims-made vs. occurrence coverage and when a tail is required. Claims can surface long after an incident; tail protects against post-assignment filings.
• Demand picture: AANA reports strong and in many areas rising demand for 1099 CRNAs, with some markets stabilizing at high levels rather than continuing to accelerate.

Why It Matters

• Total comp, not rate alone: Compare the net after taxes, healthcare, retirement funding, malpractice (and tail), CME, licensing, travel, and unpaid downtime.
• Plan like a business: Build reserves for gaps, set aside quarterly tax payments, and formalize bookkeeping to maximize deductions and reduce surprises.
• Protect the downside: Confirm contract terms (cancellation, guaranteed hours, travel reimbursements), and align coverage type (occurrence vs. claims-made) with your assignment pattern.

When deciding between these two models, it’s crucial to look beyond the hourly rate and calculate the true financial picture—benefits, taxes, deductions, and stability all included. W-2 employment appeals to CRNAs who prefer predictability and institutional support. The 1099 route attracts those who thrive on independence, variety, and the potential for higher earnings despite the administrative load of running a business.

According to data from the American Association of Nurse Anesthesiology (AANA), roughly one in five CRNAs now work as 1099 contractors, a number that continues to climb, while about 40% remain hospital employees.

Both paths allow CRNAs to practice across diverse settings and specialties. The decision ultimately comes down to career goals, lifestyle priorities, and comfort with the financial and legal responsibilities that come with self-employment. For most, partnering with a CPA or financial advisor familiar with CRNA work can provide the clarity needed to choose the structure that best supports both professional growth and personal peace of mind.