CRNA Trends: Overcoming Recruitment Challenges Amid Rising Demand

Certified Registered Nurse Anesthetists (CRNAs) administer approximately 49 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists. CRNAs provide compassionate, evidence-based care to patients across a spectrum of settings.

CRNAs are highly skilled in their field, administering and managing anesthesia before, during, and after medical procedures. Their expertise extends to all types of surgeries and obstetric or trauma stabilization cases. In our recent whitepaper, CRNA Supply, Demand, and Recruitment Trends, we investigate the various factors affecting the CRNA job market and offer insights into the recruitment challenges faced by healthcare organizations.  

Key Factors Driving CRNA Demand

AMN Healthcare has observed a growing demand among our clients for CRNAs over the last several years that reflects an overall growth in the need for anesthesiology and other forms of specialty care nationwide.

The Association of American Medical Colleges (AAMC) echoed this in a recent report on physician supply and demand, projected a shortage of up to 124,000 physicians by 2034. This includes a shortage of up to 48,000 primary care physicians, but an even greater shortage of up to 78,000 medical specialists, including anesthesiologists.

The shortage of specialists is driven largely by population aging. Approximately 10,000 Americans turn 65 every day, and this age cohort utilizes medical services at a considerably higher rate than younger age groups. People 65 and older visit a physician at three times the rate of those 30 and younger, according to the CDC. 

While seniors represent only 14% of the population, they generate 37.4% of diagnostic tests and treatments and 34% of inpatient procedures, many of which require anesthesia, the CDC reports. The U.S. Census Bureau reports that in 2035, there will be 78 million seniors and 77 million children 17 or under, projecting that for the first time in U.S. history senior citizens will outnumber children.

AMN Healthcare’s search engagements reflect the growing need for specialty care. Our 2023 Review of Physician and Advanced Practitioner Recruiting Incentives reported that 64% of our search engagements over the previous 12 months were for specialists, while 17% were for primary care physicians. An additional 19% were for nurse practitioners, physician
assistants and CRNAs.

More Elective Procedures Meet Rising Operational Costs

Utilization of specialty services, including anesthesia, also has been driven upward by years of economic growth following the 2007-08 recession, which has given patients the option of undergoing more elective procedures requiring anesthesia. 

The proliferation of sites of service providing consumer convenience, such as urgent care centers, and the rise of hospital outpatient services, also drives the utilization of procedures requiring anesthesia. Demand for CRNA services is further driven by the lack of anesthesia providers in rural areas, which are often entirely reliant on CRNAs.

The continual effort of healthcare facilities to cope with rising costs and flat or declining reimbursement also stimulates demand for CRNAs, who are paid considerably less than anesthesiologists (see the section on CRNA Compensation below) while providing many of the same services. 

Outcomes data generally are positive for CRNAs indicating they are a fit for emerging quality and value-based reimbursement models. Some hospital systems and other healthcare facilities have determined that having CRNAs work multiple operating rooms under the supervision of an anesthesiologist can be a cost-effective staffing model that does not detract from quality of care.

CRNA Recruiting Recommendations

The recruiting process for CRNAs closely mirrors the recruiting process for physicians in terms of strategies, time, and resource allocation. Considerable effort may be required to recruit candidates who are an enduring match for the healthcare facilities seeking them. 

Front end preparation, appropriate candidate parameters, clear lines of communication among stakeholders, a positive working environment, responsiveness, and a sense of urgency are all essential elements common to physician and CRNA searches. The following are several factors to consider specific to CRNA recruitment.

• Recruit CRNAs with the same aggressiveness and commitment you would when recruiting physicians. Like physicians, CRNAs have many options to choose from today. Bring your opportunity to the market as quickly as possible and be just as responsive to candidates.
• Keep in mind that CRNA recruiting is made more difficult by the fact that CRNAs have many locum tenens/1099 opportunities to choose from, and many CRNAs have a mindset like that of emergency medicine physicians in that they are seeking the most positive shift schedules for the highest compensation. You may have to make clear why a permanent position is a more attractive option for them.
• Offer clinical autonomy. Allow CRNAs to practice to the highest extent of their licensure and have broad practices. Practice autonomy may be the single most important factor CRNAs consider when evaluating practice opportunities. Independent practice opportunities are attractive options.
• Offer flexibility. Schedule flexibility is of growing importance to physicians and CRNAs, 60% of whom are women who may be in their child-rearing years and require a family-friendly schedule.
• Offer many types of shifts. Call, providing it is reasonable, is acceptable to most candidates. Fewer hours and less call may not be a requirement if there is flexibility for CRNAs to have time off when needed.
• Be competitive. CRNAs rarely relocate for an average salary, particularly if they are being recruited from locum tenens work to a permanent practice. In today’s market, even opportunities located in major metro areas must be reasonably competitive.
• Offer independent practice settings. Given the fact that many CRNAs were furloughed in the early stages of the COVID-19 pandemic, many are no longer embracing the employee model but prefer the independent contractor (e.g., I-99) practice model, where they feel they have more practice autonomy and financial potential.

To these guidelines should be added others that are common to physician recruiting, such as have a clear time frame for when a decision on candidates will be made (avoid “comparison shopping”), have a contract or offer letter ready, involve the spouse/ significant other in the process and the interview, and keep lines of communication open post-interview to ensure a timely resolution to the search.

About AMN Healthcare Physician Solutions

AMN Healthcare Physician Solutions was originally established in 1987 as Merritt Hawkins. AMN Healthcare provides permanent physician, locum tenens, advanced practitioner, plus, leadership, language services, nursing, and allied staffing and search services to hospitals, medical groups, community health centers, telehealth providers and many other types of entities nationwide.

As a thought leader in our industry, AMN Healthcare produces a series of surveys, white papers, books, and webinar presentations internally and produces research and thought leadership for third parties.