Hospital vs. Anesthesia Group vs. 1099: Where Should a New CRNA or Anesthesiologist Work?
Many anesthesia clinicians work for a group of some kind, either a private practice or an anesthesia management group that holds contracts at many facilities. Close to half of anesthesiologists were in private practice in 2024, one of the highest shares of any specialty.
Across all of medicine, only about 12% of physicians were directly employed by a hospital. Others go 1099 and contract on their own. The specific site usually matters more than the model, so it pays to know how each one works.
Hospital vs. anesthesia group vs. 1099 at a glance
Model | Who you work for | What it tends to mean |
Private anesthesia group | A clinician-owned group tied to one or a few facilities | Deep roots in one place; partnership tracks at some groups |
Anesthesia management group | A company holding contracts at many facilities | More locations to choose from and room to move between sites |
Hospital-employed | The hospital or health system itself | One employer and one HR system; anesthesia sits inside a much larger budget |
1099 independent contractor | Yourself, contracting directly with groups or agencies | Higher hourly rates and schedule control; you cover your own benefits and taxes |
None of these is right for everyone. Residents and SRNAs often don't learn the differences until their first contract is in front of them, which is late to start asking.
What an anesthesia group does behind the scenes
• Recruiting and credentialing so new hires can start on time
• Scheduling and call across every site it covers
• Billing and collections for anesthesia services
• Negotiating with the facility over staffing levels and financial support
• Clinical standards and quality work shared across sites
Most of this is invisible on a normal day. You notice it when it's missing, such as when credentialing takes four months or a staffing concern goes nowhere.
How anesthesia departments are funded
At most hospitals, anesthesia billing alone doesn't cover the cost of staffing the department. The facility makes up the difference with a subsidy, often called a stipend. Hospitals usually choose their anesthesia partner through a request for proposal (RFP), and many weigh price heavily.
The lowest bid can look like savings on paper. When it underfunds the staffing model, the department ends up with open shifts and locums bills, and the hospital goes back out to bid a few years later. That cycle is worth knowing about, because it's the department you'd be walking into.
Should you go 1099?
Going 1099 gives you control of your schedule and usually a higher hourly rate. In exchange, you handle your own taxes and benefits, and work can dry up when a contract changes.
Many new grads start W2 for the support during their first year. Our 1099 vs. W2 CRNA guide walks through the math.
What to ask before you join an anesthesia group
1. How long have you held the contract at this site?
2. Who is my site leader, and who do they answer to?
3. Can I move to another site later if my life changes?
4. Is malpractice and tail coverage included, for both W2 and 1099 roles?
5. Are clinical decisions made by people who practice anesthesia?
How Essential works
Essential is clinician-led. The company was founded and is run by anesthesiologists and CRNAs, and we partner with hospitals and surgery centers across [confirm current state count] states. We provide malpractice and tail coverage for W2 employees and 1099 contractors. When we bid on a contract, we price it for a staffing model that can hold up, which means we're rarely the lowest number in the room.
Curious what that looks like in practice? See where we're hiring.
FAQ
Is it better to work for a hospital or an anesthesia group? It depends on what you value. Hospital employment offers one employer and one system. A larger anesthesia group usually offers more locations and the option to move between them. Compare the specific site and its leadership before you compare models.
What is an anesthesia stipend? It's the financial support a hospital pays its anesthesia provider to cover the gap between what anesthesia services bill and what it costs to staff them.
Do anesthesia groups hire new grads? Many do, including new CRNAs and anesthesiologists straight out of residency. Ask about orientation length and who you can call during your first months.
Do anesthesia groups pay less than hospitals? Not as a rule. Pay depends on the site's workload and how much the facility invests in anesthesia.
Can a new grad CRNA work 1099? Some do. Many new CRNAs start W2 to get benefits and day-to-day support during their first year, then revisit 1099 once they're established.
