The Cost of the Middle in Anesthesia Staffing

Anesthesia staffing is expensive.

That is not a secret to facilities, anesthesia groups, CRNAs, or anyone who has had to keep an OR schedule moving while short-staffed.

But the most frustrating part is not always that anesthesia coverage costs money. It should cost money. CRNAs provide skilled clinical care, take call, cover rooms, manage risk, and carry real responsibility. They should be paid well for that work.

The bigger problem is how much money can disappear between the facility paying for coverage and the CRNA actually providing it.

That is the part of anesthesia staffing that needs to be questioned.

I have seen this from the CRNA side. It is frustrating to know that a facility may be paying a high rate for anesthesia coverage while the CRNA doing the work may only be seeing part of that cost. Some coordination has value, but when too much of the money sits between the facility and the CRNA, the system starts to feel like it is serving the middle more than the people actually involved in the care.

Staffing problems are real

Recruiters and staffing agencies did not appear for no reason.

Anesthesia staffing is hard. Vacancies happen. People retire. CRNAs move. Family situations change. Facilities grow. Surgical volume changes. OB coverage still has to be staffed. Call schedules still have to be covered. The OR does not stop needing anesthesia because a facility is short.

There are situations where a facility needs help quickly. There are situations where a recruiter or staffing agency can provide a real service. Finding available CRNAs, helping coordinate coverage, assisting with credentialing, arranging travel, and moving quickly when a facility is in a bind all have value.

The problem is not that someone gets paid to help solve a staffing problem.

The problem is when the middle becomes so expensive, aggressive, opaque, or self-serving that it starts to hurt both sides.

Facilities feel trapped because they need coverage. CRNAs feel used because they are the ones doing the clinical work while someone else takes a large piece of the transaction. Over time, both sides lose trust.

The middle can become too expensive

Permanent placement recruiting fees are often structured as a percentage of a candidate's first-year salary. Depending on the contract, industry, role, and arrangement, those fees can become a very large number quickly.

For a CRNA position, the math is not hard to understand.

A $250,000 salary with a 20% recruiting fee is a $50,000 placement fee.

A $300,000 salary with a 25% recruiting fee is a $75,000 placement fee.

That is before the CRNA has worked a shift.

Locum staffing can be even harder to see clearly because the cost is usually built into an hourly bill rate. The facility pays one rate. The CRNA receives another. The difference may cover recruiting, credentialing support, travel coordination, malpractice coordination, payroll, administration, and company margin.

Some spread is understandable.

But the size of the spread matters.

A small difference per hour becomes a very large number when multiplied across weeks or months of coverage.

That is just one example using one hourly rate.

Look at it another way:

Again, this does not mean every spread is unfair. Agencies may be doing real work.

But facilities and CRNAs should understand how much money is sitting in the middle.

Because when the spread becomes large enough, it changes the entire staffing conversation.

A small difference per hour becomes a very large number when multiplied across weeks or months of coverage.

Lower facility cost should come from lower overhead

This point matters.

When I talk about lowering the cost of locum coverage for facilities, I am not talking about asking CRNAs to accept less for the actual clinical work.

CRNAs are the ones providing anesthesia care. They are the ones taking call, covering the room, making decisions, managing risk, and doing the work the facility needs done. They should be paid well for that.

The issue is that a facility can pay a very high hourly bill rate while a large portion of that money never reaches the CRNA. It gets absorbed by the recruiting layer.

That is where a different model can help.

If the total facility cost is lower because unnecessary overhead is lower, that does not automatically mean the CRNA rate has to be lower. In the right model, the facility can spend less overall while the CRNA can still receive a strong rate.

That is the point.

The savings should come from reducing the cost of the middle, not from reducing the value of the person doing the anesthesia.

The trust problem for CRNAs

For CRNAs, the frustration is not only about money.

It is also about trust.

Many CRNAs have dealt with recruiter calls, texts, emails, vague job descriptions, unclear rates, pressure tactics, repeated follow-ups, and opportunities that do not actually match what they said they wanted.

A CRNA may say they are only interested in certain states, schedules, settings, or rates, and still get contacted about jobs that are nowhere close. A recruiter may soften details to keep someone interested. A job may sound different on the phone than it does once the CRNA starts asking harder questions.

That wears people down.

CRNAs are not inventory. They are not leads.

They are professionals with licenses, families, schedules, preferences, and limits. If a staffing model depends on spamming enough CRNAs until someone responds, that is not a model built on trust.

HART has to be different there, or it should not exist.

If CRNAs join a HART locum interest list, they should be able to trust that their information will be handled carefully. They should not be spammed with assignments they already said they do not want. They should not feel like their name is being passed around just so someone else can close a deal.

Trust has to be built into the system from the beginning.

The locum list should be built through trust, not spam.

The facility problem

Facilities are not the enemy in this.

Most facilities are trying to solve a real coverage problem. They have ORs to run, patients to care for, surgeons expecting access, OB units needing coverage, administrators watching budgets, and anesthesia teams trying to avoid burnout.

When a facility has a vacancy, doing nothing is not always an option.

That pressure can force facilities into expensive recruiting and locum arrangements because they need help and do not have a better direct option. The cost may be painful, but the alternative may be uncovered rooms, delayed cases, overworked staff, or cancelled services.

Facilities can also be hurt by the way recruiting is handled.

If a CRNA's first exposure to a facility comes through a recruiter who is vague, pushy, misleading, or constantly spamming them, that CRNA may associate the bad experience with the job itself. A facility may have a reasonable opportunity, but the way it is presented can make it look worse.

That is bad for everyone.

Facilities need ways to reach CRNAs directly and clearly without defaulting to the most expensive layer available.

Free job postings are part of the mission

HART's free job posting option is not just a marketing gimmick.

It is part of the point.

There are job sites that are free for CRNAs to browse, but facilities often have to pay to post. That may not seem like a big deal for a large system, but it matters for smaller hospitals, rural facilities, critical access hospitals, independent groups, ASCs, and facilities that are already trying to control staffing costs.

Some facilities may not post widely because every additional posting site costs money.

Free job postings are one thing HART can give to the profession right now.

That matters to me.

HART was not built first as a paid recruiting product. I put my own time and money into building a free posting platform because I believe facilities and CRNAs need a better starting point than expensive job boards and recruiter-heavy staffing by default.

Anyone can say they want to be different.

But the first version of HART was built around giving facilities a free way to post CRNA jobs. That is not the easiest way to make money. It is, however, the clearest way to show what HART is trying to become.

What HART wants to do differently

HART is not trying to become another expensive staffing layer with different branding.

The goal is to build something more useful than self-serving.

That starts with free CRNA and anesthesia job postings for facilities. Outside recruiters are not allowed to post jobs on the site. Listings should focus on the details CRNAs actually care about: schedule, call, compensation, practice setting, employment type, autonomy, and how the role is structured.

For facilities, HART should make it easier to present a job clearly and receive interested CRNAs directly.

For CRNAs, HART should make it easier to find clearer job information and raise a hand for future career destinations without being treated like a sales lead.

Over time, the locum model should follow the same philosophy.

That means a lower, transparent markup. A fixed percentage on top of the CRNA assignment rate. No buyout fee if a CRNA transitions into a full-time role at a facility. A minimal non-circumvention period that protects HART from being bypassed immediately but does not handcuff CRNAs or facilities longer than necessary.

It also means building tools that actually help both sides: credentialing-readiness support, PRN shift notification lists with CRNA opt-in, clearer facility workflows, and better ways to connect CRNAs with opportunities they actually want.

The locum list should be built through trust, not spam.

If CRNAs trust HART enough to say what locum assignments they are open to, then facilities can eventually come to HART and get real candidates quickly without paying the kind of markup that has become normal in the industry.

That is the model I want to build.

Why being a working CRNA matters

I am not building HART because I am trying to retire from the OR by becoming another middleman in anesthesia staffing.

My identity is anesthesia.

That matters because the wrong incentives can change a company quickly. If a business becomes dependent on extracting as much as possible from staffing, it becomes very easy to justify higher rates, longer restrictions, bigger spreads, more aggressive recruiting, and the same behavior it originally claimed to dislike.

I do not want HART to become that.

I do not want HART to be a company that starts with the right message, grows, raises rates, loses its identity, and becomes another expensive option that CRNAs and facilities complain about.

HART should always allow facilities to post jobs for free.

HART should always be a low-overhead locum option.

HART should always be built around the idea that helping facilities can help CRNAs, helping CRNAs can help facilities, and both ultimately matter because patients still need anesthesia care.

If HART grows into just another expensive recruiting layer, then it failed at the thing it was created to fix.

What success should look like

HART succeeds if facilities can post CRNA jobs without paying to be seen.

It succeeds if CRNAs can find clearer job information.

It succeeds if a CRNA can join a locum interest list without worrying that their information will be abused.

It succeeds if a facility can find locum help without feeling trapped by excessive markup.

It succeeds if CRNAs can receive strong rates while facilities reduce unnecessary staffing costs.

It succeeds if direct connection becomes easier.

It succeeds if HART grows without losing the reason it was built.

If HART grows into just another expensive recruiting layer, then it failed at the thing it was created to fix.

Where this goes from here

HART is still early.

It needs CRNAs to use it, facilities to post jobs, and both sides to believe that a better model is possible.

For CRNAs, that may mean joining the HART locum interest list if you want to hear about future locum assignments that actually match what you are open to. It may mean checking HART when you are looking for a permanent job. It may mean sharing HART with a chief CRNA, anesthesia director, facility recruiter, or administrator who is tired of paying too much just to get a CRNA opening seen.

For facilities, it may mean posting a CRNA or anesthesia job for free. It may mean sending an existing job description to HART and letting us help turn it into a clearer CRNA-focused listing. It may mean reaching out when locum coverage is needed and asking whether a lower-overhead option is available.

HART exists to change the game in anesthesia staffing.

Not by becoming another expensive layer.

Not by treating CRNAs like leads.

Not by making facilities feel trapped.

But by building a more direct, transparent, and financially conscious option for the people actually living with anesthesia staffing decisions.