The Locum CRNA Life

Pay benchmarks (2026)

Locum CRNA rates shifted meaningfully after the post-pandemic staffing crunch normalized. The ballpark ranges you can use as a negotiating floor:

• General OR / hospital: $180–$240/hr as 1099. Major metros skew lower because supply is deeper; rural and small-town crisis coverage skews higher.
• Cardiac / trauma / peds: +$15–$40/hr premium over general rates depending on acuity and market.
• Weekend / call shifts: typically 1.25–1.5× base. Overnight call assignments can push effective hourly into $300+/hr when census is low.
• Crisis / gap coverage: short-notice 30-day placements in rural or safety-net hospitals often pay $250+/hr plus travel and housing.

Don't confuse advertised hourly with take-home. You're 1099, which means ~15.3% self-employment tax, your own retirement, your own health insurance, and your own CME. Budget ~60% of gross as take-home before state tax, and run the math in our 1099 vs W2 calculator before you commit.

Tax home — the thing that wrecks locum CRNAs

If you have no tax home, the IRS considers you an “itinerant” worker and every reimbursed travel expense (housing, meals, airfare) becomes taxable income. This is the single biggest tax trap in locum practice.

A valid tax home requires all three:

1. A regular place of business, or a home in the area where you work regularly.
2. You maintain living expenses at that home (mortgage, rent, utilities, not just a PO box).
3. You have a personal connection — family, voter registration, driver's license.

The safest pattern: keep a permanent residence in one state, work assignments in others, return home between placements for at least some portion of the year, and maintain genuine personal ties. One week home between assignments is usually sufficient — but documentation matters. Keep travel receipts, a calendar, and utility bills.

Per diem deductions: IRS publishes standard per diem rates (see Publication 463) for meals and incidentals. Track your away-from-home days; this can be $60–$80/day in deductions.

Housing math

Three common models, ranked by how providers actually prefer them:

1. Agency-provided housing.Low friction. You show up, keys are waiting. Downside: you can't control quality, and in competitive markets it's often a corporate apartment 20+ minutes from the hospital. Negotiate hotel upgrades for short assignments.
2. Housing stipend. Agency pays you a set amount ($2,000–$3,500/month typical) and you book your own. Vrbo/Airbnb monthly rates, extended-stay hotels, and corporate apartments all work. Leftover stipend is tax-free only if you have a valid tax home (see above).
3. Hotel per diem. Agency pays for nightly hotels. Fine for 2–4 week assignments; wearying for longer stints. Ask for suite-style hotels with kitchenettes.

Protect yourself: confirm housing address, distance to the hospital, parking, and contract cancellation terms before you sign. Assignments get canceled with 7–30 days' notice by the facility fairly often — read the cancellation clause.

Credentialing timelines

The number one locum complaint: “They said it would take 4 weeks. It took 12.” Planning reality:

• State licensure: NLC compact states — instant if your home state is compact. Non-compact states — 4–12 weeks typical; some (NY, CA) longer.
• Facility credentialing:typically 60–90 days after complete file submission. Some large systems (HCA, Ascension) have centralized credentialing that's faster on the second assignment.
• DEA: federal registration, plus state CSR where required. Plan 4–8 weeks; expedite if within 30 days of assignment start.
• Hospital privileges: the last step. Cannot start clinical work without it, regardless of license status.

Start credentialing for your next assignment the day you accept it. A dropped case due to paperwork is a lost month of income and a relationship burn with the agency.

Agency selection

Good agencies operate in volume and work for you; bad ones treat you as a commodity. Signs of a good agency:

• Recruiter who's been at the firm 3+ years and remembers your preferences.
• Transparent rate sheets — tell you what the facility is paying versus what you're getting.
• Offers malpractice with tail coverage and no consent-to-settle gotchas.
• Handles credentialing aggressively and keeps you posted on delays.
• Doesn't push assignments that don't fit your stated preferences.

Work with 2–3 agencies simultaneously. Loyalty to one agency never pays — you're a 1099 contractor, not an employee.

Best locum markets in 2026

• Rural Montana, Wyoming, the Dakotas, Alaska:highest rates, hardest travel, often crisis coverage.
• Pacific Northwest (OR, WA rural): strong rates, beautiful scenery, full practice authority in many facilities.
• Rural Texas: high volume of independent practice settings, good pay, short assignments commonly offered.
• Northeast (ME, NH, VT): call-heavy but consistent, full practice authority environment.
• California coast: lower effective rate after state income tax; high cost of housing offsets stipend in many cases. Run the numbers.

The honest downsides

• Isolation.You're the new provider every 2–8 weeks. Harder to build clinical relationships, mentorship, or the feedback loops that sharpen skills over time.
• No benefits. No PTO, no paid CME, no retirement match. Self-funded with pre-tax vehicles only works if you set up your own Solo 401(k) or SEP IRA.
• Credentialing burnout. Constantly filing the same forms with minor variations. A credential vault helps (Pro+ feature).
• Unpredictable income. Canceled assignments, hospital census swings, and late paychecks from overwhelmed AP departments are real. Keep 3+ months expenses as a buffer.