Whether you're a new locum or a seasoned provider, understanding the dynamic between anesthesiologists and CRNAs is key to thriving on assignment. Some facilities follow a strict 1:4 supervision model. Others expect anesthesiologists to manage their own cases or take a hybrid approach.
Knowing what to expect — and where — can help you find the right locum tenens fit for your skills, style, and preferences.
Supervision Basics: What It Means
“Supervision” means you're responsible for overseeing one or more CRNAs delivering anesthesia care. This typically involves:
- Evaluating the patient preoperatively
- Approving the anesthesia plan
- Being available for consultation or emergencies
- Documenting involvement at key points in the case
In the most common model (1:4), anesthesiologists supervise up to four CRNAs concurrently. Some facilities expect hands-on participation; others prioritize documentation and oversight.
Independent CRNA Practice
In states where CRNAs have full practice authority, anesthesiologists may serve a different function — focusing on medically complex patients, cardiac cases, or team leadership.
States that allow independent CRNA practice include:
- Arizona
- Iowa
- Montana
- New Hampshire
- Oregon
- Alaska
- Kansas
In these states, you may be called in for high-risk cases or emergencies, but you’re not required to supervise every anesthetic.
Facility Culture Matters
Even in supervision-required states, how facilities implement oversight varies. Questions to ask:
- What’s the average number of ORs per attending?
- How are breaks and lunch relief handled?
- Is there a chief CRNA? How is collaboration structured?
- Do anesthesiologists perform their own blocks or are they shared?
Knowing the OR flow and expectations helps avoid surprises — especially on your first shift.
Solo vs. Supervisory Assignments
Some assignments expect you to perform your own cases from start to finish. These often include:
- Outpatient surgical centers
- Rural hospitals
- Short-staffed facilities
These roles may offer higher pay, but also demand more physical and clinical bandwidth — especially during call. If you’re more comfortable supervising than staying in the OR all day, let your recruiter know upfront.
Legal and Billing Implications
Facilities must meet certain Medicare requirements when billing under medical direction. That means documentation is essential. Be sure you understand:
- Which tasks you must personally perform or be present for
- What needs to be documented and when
- How the anesthesia record is split between CRNA and MD
Your recruiter or facility contact should clarify these billing expectations before your first day.
Choosing the Right Assignments
To find the best locum jobs for your comfort level:
- Ask about the care model in every opportunity
- Clarify your supervision preferences early
- Know your state’s practice rules — especially in IMLC states
- Be upfront about whether you want to supervise, do your own cases, or a mix
Tip: Some anesthesiologists enjoy solo practice for variety. Others prefer larger centers with full CRNA teams. There’s no wrong answer — just the right match.
Conclusion
Supervising CRNAs vs. working independently can dramatically change your role on a locum tenens assignment. By understanding state laws, facility expectations, and your own preferences, you can find positions that support your style and maximize your impact in the OR.