Practice Models
Solo Office-Based Anesthesia
You contract directly with surgeons (plastics, dental, GI) to provide anesthesia in their office-based facilities.
Pros
- Highest hourly rates ($150-$200+/hr)
- No hospital bureaucracy
- Flexible schedule
- Direct surgeon relationships
Cons
- You're the only safety net — no code team
- Higher medicolegal risk
- Equipment and emergency prep is your responsibility
- Revenue depends on surgeon volume
Multi-CRNA Group Practice
You build a group of 3-10+ CRNAs contracting with hospitals and surgery centers. You manage the business; they provide the clinical care.
Pros
- Scalable — revenue grows with each CRNA added
- Facility contracts provide stable income
- Build equity in a real business
- Can eventually sell the practice
Cons
- HR complexity — hiring, scheduling, managing providers
- Must maintain facility relationships
- Billing and collections overhead
- Higher liability as a business owner
Pain Management Practice
Independent pain clinic in a full practice authority state. Interventional procedures, medication management, follow-up visits.
Pros
- No call
- Predictable schedule
- High per-patient revenue
- Growing demand (aging population)
Cons
- Highest startup cost
- Complex billing (insurance credentialing)
- State regulatory requirements vary
- DEA requirements for controlled substances
The Business Checklist
Form your business entity
PLLC or LLC with S-Corp election in most states. Work with a healthcare attorney for your state's specific requirements for professional practice entities.
Get credentialed with payers
Apply for Medicare, Medicaid, and commercial insurance credentialing. This takes 3-6 months — start immediately. Without payer credentials, you can't bill insurance.
Obtain a National Provider Identifier (NPI)
Type 1 (individual) and Type 2 (organization) NPI numbers. Required for all insurance billing.
Secure malpractice insurance
Occurrence-based, $1M/$3M minimum. Higher limits for office-based or independent practice. Budget $5K-$10K/year.
Set up billing infrastructure
Hire a medical billing company or use a platform (Kareo, AdvancedMD, athenahealth). Anesthesia billing is complex — time-based units, modifiers, multiple payer rules. Don't DIY this.
Establish facility contracts
Negotiate contracts with surgery centers, hospitals, or physician offices. Key terms: case volume guarantees, payment terms, credentialing requirements, call expectations, exclusive vs non-exclusive.
Build your clinical team
If hiring other CRNAs: employment contracts, malpractice coverage, credentialing support, scheduling system, payroll. Start with 1099 contractors to minimize overhead, then convert to W2 as volume stabilizes.
Compliance and quality
Quality assurance program, peer review, incident reporting, HIPAA compliance, OSHA requirements, controlled substance tracking (DEA). These aren't optional — they're legal requirements.
Financial Reality
Year 1 Projection (Solo Office-Based)
Year 1 is typically part-time as you build facility relationships and patient volume. By Year 2-3 at full capacity (1,600+ hours), gross revenue reaches $280K-$350K+ with $200K-$250K net after expenses.