The question from the CRNA was both specific and universal: "I have an opportunity to take over providing anesthesia services for a plastics practice. I'm currently working part-time 1099 there, and I LOVE it. Where do I even start?" This isn’t just a question of logistics; it points to a broader change unfolding in the profession. What was once a career path almost exclusively defined by W-2 employment is now being deliberately chosen and shaped by a new generation of practitioners who are embracing entrepreneurship.
A Growing Trend: From W-2 to 1099
While a large number of CRNAs remain W-2 employees, a significant and growing segment has transitioned to independent practice, favoring 1099 tax status. Two powerful forces are driving this shift. The first is an evolving legal landscape at the state level. As of 2024, nearly half of US states allow CRNAs to practice without direct physician supervision. This expanded scope of practice elevates the value of CRNAs, particularly in rural and underserved areas where they often serve as the sole anesthesia providers. This legal autonomy is the bedrock of the independent practice model.
The second force is a change in the professional mindset itself, one that is being cultivated at the very beginning of a CRNA’s career. A review of CRNA programs shows a clear emphasis on concepts like "independence", "autonomy", and “business of anesthesia” during interviews and in curricula. In fact, one program reports that over 80% of its clinical sites are either “CRNA only” or “CRNA autonomous”. This educational shift is creating a new cohort of graduates who are entering the workforce already primed with the skills and, more importantly, the mindset to be an entrepreneur.
Overcoming the Learning Curve: From LLCs to Billing
Tthe path from clinician to business owner is filled with challenges. As demonstrated by the question from the CRNA at the start of the blog post, one of the most common gaps for CRNAs looking to embark on the entrepenurial path is around business administration, including things like how to form an LLC, how to find clients, and, perhaps most critically, how to handle billing and negotiate with insurers. This is where the narrative shifts from one of professional ambition to the critical need for mentorship and communal knowledge. The logistical hurdles are substantial and are not taught in standard clinical programs, underscoring the need for CRNAs to come together and share expertise to navigate the business side of practice.
Help us bring transparency to medicine
Why More CRNAs Are Choosing 1099
Despite these formidable difficulties, the advantages of the 1099 model are reshaping the profession from the ground up. The most obvious benefit is financial. Independent CRNAs can command significantly higher hourly rates, often ranging from $130 to $200, which translates to a substantial annual income premium over a traditional W-2 positions.
Beyond the paycheck, some of the most valuable benefits are enhanced autonomy and better work-life balance. The high-stress, on-call nature of anesthesia can quickly lead to burnout. By gaining control of their schedules, independent CRNAs can mitigate these stressors by choosing their cases, setting their hours, and negotiating for more time away from practice. A CRNA who can take 13 weeks off a year while earning a six-figure salary is not just succeeding financially, they're taking a strategic approach to building a more sustainable and fulfilling career.
The financial rewards are amplified by the tax advantages of self-employment. As a 1099 contractor, a CRNA is now a business owner. This means they are responsible for their own payroll and self-employment taxes, a flat 15.3% of their net earnings that covers both the employer and employee portions of Social Security and Medicare. This is a new administrative burden, but it also unlocks a wide range of business deductions that are not available to a W-2 employee. These can include everything from malpractice insurance premiums and licensing fees to travel and a portion of home office expenses. While the complexity of taxes requires careful planning, it is one of the most powerful tools for a CRNA to retain more of their hard-earned income. The full potential of these tax strategies, including how business structures can fundamentally change the tax framework, is a conversation for another day.
Concluding Thoughts
Ultimately, the CRNA seeking advice at the start of our blog post reflects a profession at a crossroads. Going down the entrepreneurship path is not for everyone, as it demands discipline and business management skills as much it does clinical excellence. But for those who are willing to navigate the complexities and build their own practice, the rewards of a truly independent and self-directed career are redefining what it means to be a Certified Registered Nurse Anesthetist.
