3 Keys to CRNA/Nurse Anesthesiologist Contract Negotiation

The last five years have seen a sharp increase in CRNA/nurse anesthesiologist compensation. Organizations looking to decrease costs have realized they can staff multiple ORs with CRNAs without the expense of multiple physician anesthesiologists. This has driven up demand for CRNAs, allowing them to command higher and higher rates. While the spike may be leveling out, CRNAs are still typically the highest-earning advanced practice providers. That’s not to say, CRNAs can simply “name their price.” As is the case with all healthcare providers, CRNA contract negotiations involve both parties coming to an agreement on base compensation, bonuses, benefits, time off, scheduling, non-compete clauses, and more.

Several factors influence the terms of a CRNA’s contract–the practice setting, the location, and the CRNA’s level of experience, among other things, but the principles of a CRNA contract negotiation remain the same. CRNAs entering a contract negotiation must go into the process with a clearly defined goal. What is it that you want out of the negotiation and what is most important? CRNAs should also be clear on their best alternative to the negotiated agreement (commonly known as BATNA). That is, if you walk away from the negotiation, what is your best alternative? The high demand for CRNAs typically provides a strong BATNA which means more leverage in the negotiation. Lastly, CRNAs must be ready to deal with objections. Even with the high demand for CRNAs, employers rarely say “yes” to all contract requests. So, you must consider how you will respond to objections.

Negotiating a CRNA contract is a complex process, so before you simply say, “Show me the money!” you’ll want to consider these three keys to CRNA contract negotiation.  

Defining Your Goal as a CRNA

It’s one thing to know how much you want to make, but the amount you ask for must be based on market data. CRNAs should research CRNA compensation nationally and regionally to gain an understanding of their value in the marketplace. They should have a clear goal in mind, but also know where they are willing to compromise. This means understanding the various aspects of a contract. Negotiations don’t begin and end with the salary. There are recruitment incentives, productivity bonuses, health benefits, retirement contributions, paid time off, schedule flexibility, non-compete clauses, and more. All of these things may be potential “asks” or “trade-offs” in the negotiating process, so know what you want – and where you are willing to compromise.

Knowing Your Best Alternative

“BATNA” refers to each party’s best alternative if they walk away from the negotiation. In negotiations between CRNAs and healthcare organizations, the CRNA typically has the stronger BATNA. In fact, this is largely what has driven up salaries for employed CRNAs. During the pandemic years, contract rates for CRNAs shot up to levels near those of an employed physician anesthesiologist. This meant CRNAs negotiating a permanent employment contract had the alternative of working for higher rates as a contractor. Organizations were forced to offer higher salaries to employ CRNAs since their best alternative was to pay even higher rates for contractors.

Of course, the severity of the specific organization’s hiring needs will influence the strength of the BATNA, but generally, there are more CRNA jobs than there are CRNAs to fill them. Starting the process over isn’t ideal for either party, but the one who can more easily find a similar alternative has more leverage. One look at AANA Motion, the map-based career exploration tool from AANA, reveals an abundance of opportunities for CRNAs, meaning your leverage is strong.

That’s not to say the organization you are negotiating with may not have another candidate waiting in the wings if they decide your ask is too high. Knowing whether or not they have a back-up candidate may influence how hard of a line you hold in the negotiating table. So, it’s not only important to establish your own BATNA, but you should aim to understand the other party’s BATNA as well.

Handling Objections

Even with the high demand for CRNAs, it is unlikely the employer will be able to say “yes” to everything. Occasionally, it does happen though, and in those rare cases, you can’t go back and ask for more. More often, the employer will say “no” to certain things or come back with an offer that’s closer but not quite everything you want. How do you handle those objections?

This is where your research pays off. Be ready to present the national median compensation for CRNAs and a metric for factoring in years of experience. Have documentation that shows how much time off or schedule flexibility CRNAs at other organizations have. This research will help you make your case, however, the best market data you can provide is another offer.

Even if you’ve made your case well, there may be things the employer simply can’t do–for a variety of reasons. Try to see where they are coming from and find a plausible alternative. If they can’t provide a higher salary, perhaps you ask for more PTO.

Negotiating your CRNA employment contract is a nuanced process that encompasses far more than the salary. Understanding your goals, knowing your BATNA, and preparing to handle objections with concrete data are crucial steps. The increasing demand for CRNAs provides significant leverage, but effective negotiation requires more than just recognizing this advantage. It demands thorough preparation, clear communication, and strategic flexibility. By approaching contract negotiation with a well-defined strategy, CRNAs can secure contracts that not only meet their financial expectations but also align with their professional and personal goals.

If you are seeking a new CRNA job, AANA Motion is the official career platform of the American Association of Nurse Anesthesiology. It allows you to see all the relevant practices in your preferred area, so you can target your job search. If you prefer a more personalized recruitment assistance, reach out to the team at Jackson Physician Search–the only recruitment firm endorsed by the AANA.