Locum Tenens vs Permanent Jobs: Which Is Right for a CRNA?

You’re a CRNA deciding between contract work and a staff job, and you want a straight answer.

Locum tenens means temporary contract coverage at a facility. A permanent job is salaried employment with one employer. Locum tenens suits you if you want control of your schedule, a way to try different settings, or extra income. A permanent job suits you if you want benefits, stability and a long-term team.

Many CRNAs combine the two, so the choice is rarely final.

What each option means

Locum tenens is Latin for “to hold the place.” It means a temporary clinical position where a physician, advanced practice provider or other clinician fills a staffing gap. Assignments can run from a few shifts to several months, or even over a year. The model began in the late 1970s to cover rural facilities that struggled to recruit.

Locum clinicians work as independent contractors. A staffing partner usually manages the contracts, licensing, privileging, housing, malpractice insurance and travel, at no cost to the clinician. You pick assignments that fit your interests, location and availability.

A permanent job is a salaried position with a health system, group practice or academic center. You trade freedom for benefits: fixed schedules, call obligations and limited geographic mobility come with the employer’s benefits package. Because the employer sponsors those benefits, you aren’t arranging them yourself.

Most of the published detail on both models is written about physicians, but the same structure applies to advanced practice providers such as CRNAs.

Locum tenens and permanent at a glance

Read across each row to compare how you get paid, who controls your calendar, and what benefits come with the work. The table gives the short version, and the sections after it explain the reasoning.

Option	Pay structure	Schedule	Benefits
locum tenens	Hourly, daily or per diem rate	Self-built, assignment by assignment	Self-arranged; agency covers malpractice
permanent	Salary, sometimes productivity-based	Employer-set, with call obligations	Employer health, retirement, PTO, CME

How we chose the comparison points

The comparison covers six points a CRNA weighs before committing:

• Demand for CRNAs
• Pay and benefits
• Schedule
• Licensing and credentialing
• Security and income stability
• Continuity and career growth

The facts come from a staffing-industry report (CHG Healthcare’s State of Locum Tenens), a peer-reviewed review of locum tenens work, an emergency-medicine productivity study, and guides from staffing vendors. Vendor guides have an interest in locum work, so their claims are used for how the models are structured rather than for outcomes.

Most outcome studies cover physicians, not CRNAs. Where a figure describes physicians, the text says so.

Demand and leverage for CRNAs

CRNAs are in a strong position under either model, so the choice is about fit, not about finding work. CRNA demand in Locumsmart has made it the most requested specialty there, and CHG Healthcare’s report estimates CRNA locums demand will grow by 25% this year. That is more than double the rate for NPs and PAs.

The supply side tells the same story. An estimated 31.0% of CRNAs practiced as locums in 2024, a far bigger share than for NPs or PAs, whose rates are under 2.1%. Facilities lean on advanced practice providers because they offer faster availability and lower cost, especially in anesthesia, where physician shortages are hard to fill.

For you, that means a locum assignment is rarely hard to find, and a permanent offer shouldn’t feel like your only chance at a steady role. A CRNA with a staff job can negotiate from a position of strength, and one working locums can be choosy about assignments.

Going locum doesn’t close the permanent door either. CHG’s survey found 85% of physicians who worked locums returned to permanent work. That figure covers physicians rather than CRNAs, but it shows how often people move back and forth.

So don’t pick a model out of worry about demand. Pick it by what you want from your schedule, income and team.

Pay and benefits

Locum work often wins on gross rate, but permanent work wins once you price in benefits. Locum pay is structured as per diem or hourly rates, with the agency covering travel, housing and malpractice insurance. Permanent pay is a salary or a productivity-based model, plus health insurance, retirement contributions and paid time off.

The tax picture also differs. Independent contractor status opens deductions that salaried staff don’t get, but you file your own taxes and arrange the fringe benefits an employer would normally provide: health, life and disability insurance and retirement plans.

Benefits carry real weight. The Bureau of Labor Statistics reports that benefits make up 37% of total compensation for employed workers in the ninetieth wage percentile. A high locum hourly rate with no benefits has to clear that gap before it beats a staff package.

Locum work also has no paid vacation, sick, personal or holiday leave. Every week off is unpaid, so your yearly income depends on how many weeks you choose to work.

A fair comparison looks like this:

• Take the locum rate and subtract the benefits you’d have to buy yourself.
• Add back the value of paid time off you’d lose.
• Account for the tax deductions contractor status allows.
• Set the result against the permanent salary plus its benefits package.

Pitfall: Don’t compare a locum hourly rate to a salary divided by hours. The locum figure leaves out benefits, paid leave and self-employment taxes, so it looks bigger than it is.

Schedule and flexibility

Locum work gives you the calendar, and a permanent job gives you stability. In a permanent role the employer determines your schedule, including call. In locum tenens you build your schedule around your life: work hard for months, then take a long stretch off.

That control is a main reason people go locum. Among physicians, 29% work locums to control their own schedule. Flexibility also doesn’t have to mean travel. 58% of locum assignments are local, so you can fill your calendar close to home.

A locum CRNA might work seven days on and seven days off, take seasonal blocks, or decline a contract that clashes with family plans. Those same choices are harder in a staff job, where vacation requests depend on department coverage.

There’s also a hybrid route. One example is a permanent role on a week-on, week-off rotation, with the off weeks filled by locum assignments. You keep the salary and benefits, and you get extra income and variety on your own time.

Choose the hybrid if you want some of both. Choose pure locums if schedule control matters most, and a pure permanent job if you’d rather have a predictable, employer-managed routine.

Licensing and credentialing

A permanent job does credentialing once, while locum work repeats it with every placement. For locums, you need hospital credentials at each facility, and a state license for any assignment outside your home state. Credentialing for privileges can also ask for a detailed work history and references, so the paper trail grows with the number of assignments.

A staffing agency can handle much of the paperwork. Even so, you should expect licensing, facility credentialing and privileging each time you start somewhere new, and plan the lead time before your first shift.

Don’t assume the shortcuts you read about apply to you. The Interstate Medical Licensure Compact covers 42 states plus Washington D.C. and Guam, and it lets qualified physicians get new licenses in an average of 19 days. That compact is a physician program, so a CRNA shouldn’t count on that speed. Check your own state boards for the rules that govern nurse anesthetists before you accept an out-of-state assignment.

For a CRNA weighing the two models, the practical difference is timing. A staff role means one credentialing process, then you work. Locums means building each start date around a licensing and privileging timeline, and a gap between contracts can be a gap in pay.

Job security and income stability

A permanent role gives steady pay and protects you from gaps. Locum income depends on assignments, and assignments can end early, be canceled at the last minute, or leave gaps between contracts if demand slows. Permanent roles offer stable, predictable paychecks even when patient volumes fluctuate.

The risk is real but manageable. Some physicians who started locums during COVID found themselves unemployed when staffing needs dropped, facing long stretches of unplanned, unpaid time off. A locum CRNA needs a buffer for that.

A workable buffer includes:

• An emergency fund sized to cover your fixed obligations
• Overlapping or backup contracts
• Willingness to follow demand to other regions

If you have a mortgage, tuition or dependents who rely on your income, a permanent role takes less planning. If your fixed costs are low, locum gaps hurt less.

Stability is better than many assume, though. CHG’s survey of physicians found an average of six years of locums experience and a median of three, and it found 63% had worked locums in addition to an employed or private practice role. Many people use locums as a second income stream rather than their only one, which is its own way to keep income steady.

Continuity and career growth

Locum work builds variety and a network, and a permanent job builds team ties and a route into leadership. A locum CRNA sees different healthcare systems, EHR platforms and patient populations, and that breadth can sharpen your adaptability. A staff CRNA gets continuity with the same surgeons and nurses, and a say in department culture.

Growth paths differ too. Permanent employment opens routes such as medical director, section chief, department chair and program director. These roles are less accessible to strictly locum clinicians, so a leadership goal points toward a permanent job.

What about quality of care? The evidence is thin and mostly about physicians. In a Medicare study of internists’ hospitalized patients, 30-day mortality was 8.83% with locums versus 8.70% without, no significant difference. In an emergency-physician study, locums’ productivity was lower than staff in their first 100 shifts at a site, though the differences were small against a mean of 1.8 patients per hour.

For you, the lesson is about onboarding. Familiarity with local teams, processes and guidelines takes time, so a locum CRNA should expect a ramp-up at each new site. None of this shows that locum care is worse, only that continuity takes time to build.

Locum Tenens

Locum tenens fits a CRNA who wants control, variety or extra income, and who can handle uneven work. The estimated 19,220 CRNAs working locums in 2024 show it’s a well-worn path for the specialty.

People use it for different reasons. Among physicians, 26% work locums while looking for a full-time position, and 11% use it as a bridge between training and a job. It can also relieve burnout: 43% of physicians report improved burnout symptoms after working locums.

In practice, you’re an independent contractor paid per diem or hourly, with the agency covering travel, housing and malpractice insurance. You’re responsible for your own taxes and fringe benefits, so budget for them before you compare rates.

Liability coverage deserves a closer look. It’s traditionally the locum company’s responsibility, but tail coverage can become costly, so ask what your contract says about it before you sign.

Before signing any contract, check:

• Start and end dates, call duties and shift structure
• Who pays for tail coverage and under what terms
• Credentialing and licensing lead time for the facility’s state
• How you’ll cover health insurance and retirement while contracting

The strain shows up in the transitions. Every assignment means a new EMR, different workflows and new policies, and that suits some people better than others.

Permanent

A permanent role fits a CRNA who wants a predictable paycheck, a package of benefits and a team that stays put. It’s especially useful if you support a family, are committed to one area, or carry large long-term expenses.

The benefits package is the draw. It typically includes subsidized insurance, employer-contributed retirement, paid time off, CME time and a stipend, and disability insurance. Malpractice coverage often includes tail. Those items are the pieces a locum CRNA has to buy or negotiate separately.

Team ties matter too. A stable team is described as a protective factor against burnout, and it gives you colleagues you know well. A permanent job also offers routes to clinical leadership and administrative roles, plus time for research and teaching.

The cost is freedom. Schedules are fixed and come with call obligations. It’s hard to take an extended unpaid sabbatical, and the job ties you to one region. Vacation requests may depend on department coverage.

Staff also take on committee work, performance reviews and departmental meetings. And if you thrive on novelty, a purely permanent role can start to feel repetitive.

Which should a CRNA choose

Use locums to test settings or add income, and choose permanent when benefits, security or leadership matter most. The hybrid sits between them. The data below is about physicians, but the pattern applies to CRNAs.

• Choose locum tenens if you want to build your own calendar, explore settings and regions before committing, or earn extra income. 14.9% of physicians took their first locum assignment right after residency, and 35.9% first worked locums after retiring from permanent practice, so the model fits both ends of a career.
• Choose permanent if you rely on employer health insurance, retirement contributions and paid time off, or you want a stable team and a route to leadership. The benefits, a steady paycheck and growth paths are the deciding facts.
• Choose the hybrid if you want the security of a staff role plus locum shifts in your time off. If you’re unsure which way you lean, try occasional locum shifts while employed before leaving your full-time job.
• Choose locum-to-perm if you’re unsure about a facility’s culture. You start as a locum and convert to a permanent offer once both sides confirm the fit.

You don’t have to decide once and for all. A trial often tells you more than abstract analysis.

Common questions

Is care by locum clinicians lower quality?

Evidence is limited and mixed. A Medicare study of hospitalized patients found no significant difference in 30-day mortality, 8.83% versus 8.70%. Most studies cover physicians, not CRNAs, and the authors call for more research.

How long does a locum assignment last?

Assignments range from a few shifts to several months, or even over a year. Terms vary by contract, so check the start and end dates, call duties and shift structure before committing.

What is locum-to-perm?

It means working first as a temporary contractor with the option to convert to a permanent offer. It suits anyone unsure about a facility’s culture or practice style who wants a trial period before a full employment package.

Where did locum tenens come from?

It began in the 1970s to give rural physicians time away, with Robert Wood Johnson Foundation funding at the University of Utah. The model has since spread across specialties and settings.

Next steps

Start by listing what matters most to you: schedule control, benefits, security, leadership or extra income. Then price a permanent benefits package against a locum rate, and check the licensing your target states would require for a CRNA.

If you’re still unsure, try a few locum shifts or a locum-to-perm role before you commit. If you’d like help finding either kind of role, Medical Associates Consulting places CRNAs in permanent and locum tenens positions, and its job board can be searched by state and job type.