Locum vs. Permanent CRNA:
Which Is Right
for Your Facility?

When a CRNA position opens at your facility — whether through a retirement, a resignation, or new volume growth — you face an immediate decision: do you bring in a locum to cover the gap, launch a permanent search, or both? It sounds straightforward. In practice, it's one of the most consequential staffing decisions a facility leader makes, with real implications for budget, continuity of care, and team morale.

Here's a clear-eyed breakdown of both options, when each makes sense, and why the right answer is almost never one or the other.

Understanding the Real Cost of Each

The sticker price of locum tenens is high — typically $250–$350+ per hour for a CRNA, depending on specialty, location, and urgency. When you add housing, travel, and agency fees, the all-in cost of a locum CRNA can run $20,000–$35,000 per week. That number creates real sticker shock for finance departments.

But the comparison isn't locum rate vs. permanent salary. It's locum rate vs. the total cost of an unstaffed OR. Cancelled cases, delayed procedures, diverted patients, and overtime for remaining staff all carry their own costs — and they hit your revenue line directly. A fair financial model has to account for both sides of that equation.

When Locum Makes Clear Sense

Immediate coverage needs

If a CRNA gives two weeks notice on a Monday, you cannot fill that position permanently by the following Monday. Credentialing alone takes 4–8 weeks at most facilities, and a thorough permanent search typically runs 6–9 months from kickoff to start date. Locum tenens exists precisely for this gap — it keeps your ORs running while you conduct a thoughtful permanent search rather than a panicked one.

Seasonal or variable volume

Some facilities have genuinely predictable volume surges — orthopedic surgery centers that spike in spring and fall, or hospitals that see volume increases in certain quarters. Locum CRNAs are a legitimate, cost-effective tool for managing variable demand without overstaffing your permanent roster.

Evaluating fit before committing

A locum engagement can serve as an extended working interview. Some of the best permanent hires start as locum placements — both sides have the opportunity to evaluate chemistry, clinical style, and cultural fit before making a long-term commitment.

When Permanent Placement Should Be the Priority

Predictable, ongoing volume

If you have consistent case volume that requires a dedicated CRNA, permanent placement is almost always the better long-term investment. The math is straightforward: at the cost differential between a locum and a permanent hire, a permanent CRNA pays for their own recruiting fee within months — and the long-term savings compound significantly over a full-time tenure.

Building a cohesive anesthesia team

CRNAs who work together consistently develop communication patterns, clinical rhythms, and institutional knowledge that translate directly into better patient outcomes and smoother OR workflow. High locum turnover disrupts this. If team culture and continuity matter at your facility — and they should — permanent placement is worth prioritizing.

Rural and critical access settings

In rural facilities where CRNAs often function as the sole or primary anesthesia provider, continuity is not just a preference — it's a patient safety imperative. Finding a permanent provider who is committed to the community is worth a longer, more deliberate search than defaulting to a revolving door of locums.

The Decision Framework

The Hybrid Approach: How Most Facilities Should Think About This

The most effective strategy for most facilities isn't a binary choice — it's running both tracks simultaneously. Engage a locum to cover immediate clinical needs, while running a focused permanent search in parallel. Set a clear internal deadline (typically 60–90 days) for the permanent search, and hold to it.

This approach keeps your ORs running, avoids the panic that leads to poor permanent hiring decisions, and creates genuine cost discipline — because you know the locum clock is running while the permanent search progresses.

What it requires is a recruiting partner who can move quickly on both tracks, understands the difference between locum and permanent CRNA candidates, and knows how to close offers in a competitive market.