CAA vs. CRNA Work Settings: Hospitals, Surgery Centers & Practice Models

Key Takeaways

• CAAs practice in ~23 states plus Washington, D.C. and always work within the Anesthesia Care Team (ACT) model under anesthesiologist supervision — primarily in hospitals, ambulatory surgery centers (ASCs), and academic medical centers
• CRNAs practice in all 50 states across every setting where anesthesia is delivered, including independent practice in states that have opted out of federal supervision requirements
• Hospitals remain the largest employer of both roles, but ambulatory surgery centers are the fastest-growing work setting in anesthesia
• Practice model — ACT, independent CRNA, or hybrid — shapes daily workflow, autonomy, case mix, and compensation
• Both CAAs and CRNAs earn outstanding compensation: CAA national average $247,000–$253,000 (Becker’s/Marit Health, 2026); CRNA BLS median $223,210 (BLS, May 2024), advertised average $260,000 (ZipRecruiter, 2026)

Choosing where and how you’ll practice anesthesia is one of the most important decisions in your career. Whether you’re a Certified Anesthesiologist Assistant or a Certified Registered Nurse Anesthetist, CAA work settings and CRNA practice environments offer distinct advantages, case mixes, and lifestyle tradeoffs. From high-acuity academic hospitals to fast-paced ambulatory surgery centers, the setting you choose shapes your clinical experience, your daily schedule, and your earning potential. If you’re exploring opportunities as an anesthesiologist assistant, start with our CAA Jobs hub for a full overview of available positions.

This comprehensive guide compares every major work setting for CAAs and CRNAs, breaks down the practice models that govern how each role operates, and helps you evaluate which environment is the best fit for your clinical strengths and career goals. We’ll also explore how compensation varies by setting and practice model so you can make a fully informed decision. For a broader side-by-side comparison of these two roles, see our CAA vs. CRNA career guide.

Understanding the nuances of CAA work settings versus CRNA work environments matters now more than ever. With nearly 30% of anesthesiologists projected to leave the workforce by 2033 (Becker’s, 2025) and CRNA job growth at an explosive 38% through 2032 (BLS), healthcare systems are expanding their anesthesia teams — and both CAAs and CRNAs are in exceptionally high demand.

📊 Salary Data Sources & Freshness This guide cites data from multiple sources: the U.S. Bureau of Labor Statistics (BLS, May 2024 — latest government data), ZipRecruiter (2026 advertised salaries), Glassdoor, AMN Healthcare, SalaryDr, and other industry reports. Government salary surveys have a 12–18 month reporting lag. Current advertised salaries on job boards typically reflect real-time market conditions and may be higher. Anesthesia provider compensation has risen steadily over the past five years.

Anesthesia Practice Models: How CAAs and CRNAs Work

Before comparing work settings, it’s essential to understand the practice models that determine how CAAs and CRNAs function within each environment. The practice model dictates the level of supervision, autonomy, and team structure — and it’s one of the biggest differentiators between the two roles.

The Anesthesia Care Team (ACT) Model

The Anesthesia Care Team model is a collaborative approach where a physician anesthesiologist supervises one or more anesthesia providers — either CAAs, CRNAs, or both. The anesthesiologist participates in key moments of each case (pre-anesthetic evaluation, induction, emergence) and oversees multiple operating rooms simultaneously.

• CAAs always practice within the ACT model. By definition and by regulation in all practice states, CAAs work under the direct supervision of a physician anesthesiologist. This is a core feature of the CAA role, not a limitation — it means CAAs are specifically trained for, and embedded within, physician-led anesthesia teams.
• CRNAs may also practice within the ACT model, particularly at large hospitals and academic medical centers where the team-based approach is the standard operating structure.

The ACT model is most common in large hospital systems, academic medical centers, and high-acuity surgical environments where complex cases benefit from the combined expertise of the full anesthesia team.

Independent CRNA Practice

In states that have opted out of the federal Medicare supervision requirement, CRNAs can deliver anesthesia services independently — without physician oversight. This model is especially prevalent in:

• Rural hospitals where CRNAs may be the sole anesthesia provider
• Ambulatory surgery centers focused on lower-acuity, high-volume procedures
• Office-based surgery settings

Independent CRNA practice expands patient access to surgical care in communities where anesthesiologists may not be available. More than 67,000 CRNAs practice across the country (AANA, 2026), and in many rural areas, a CRNA is the only anesthesia provider in the facility.

Medical Direction Model

Under medical direction, the physician anesthesiologist takes a more hands-on supervisory role — directly involved in preoperative assessment, induction, emergence, and postoperative evaluation. This model typically features a lower CRNA-to-physician or CAA-to-physician ratio (often 1:1 to 1:2) and is common in complex subspecialty environments like cardiac surgery and pediatric anesthesia.

Hybrid and Flexible Models

Increasingly, hospitals and ASCs are adopting hybrid approaches that blend ACT, medical direction, and independent practice depending on case complexity, time of day, and staffing availability. Becker’s ASC Review (2025) reports that hybrid care teams combining anesthesiologists, CRNAs, and CAAs are becoming the norm for maintaining surgical volume and patient access.

CAA Work Settings: Where Anesthesiologist Assistants Practice

CAA work settings span a growing range of clinical environments. While CAAs always practice within physician-led teams, the types of facilities where they work are diverse and expanding — especially as more states authorize CAA licensure.

Hospitals and Large Health Systems

Hospitals remain the primary employer of CAAs. Within hospital settings, CAAs are most commonly found in:

• Large academic medical centers performing high-acuity procedures including cardiac surgery, neurosurgery, organ transplantation, and complex orthopedic cases
• Community hospitals with physician-led anesthesia departments
• Level I and Level II trauma centers where the ACT model supports rapid surgical response

CAAs are particularly valued in high-acuity hospital environments. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) notes that CAAs are “most commonly employed in larger facilities that perform procedures such as cardiac surgery, neurosurgery, transplant surgery, and complex orthopedic procedures.” This reflects the rigorous science-based training that prepares CAAs for the most demanding surgical cases.

Ambulatory Surgery Centers (ASCs)

Ambulatory surgery centers represent a rapidly growing work setting for CAAs. As ASCs expand the complexity of procedures they perform — including total joint arthroplasties, spine procedures, and cardiac catheterizations — the demand for skilled anesthesia providers in these settings has surged.

CAAs working in ASCs typically:

• Provide anesthesia for high-volume, same-day surgical procedures under anesthesiologist supervision
• Manage efficient patient throughput and rapid recovery
• Administer both general and regional anesthesia techniques

ASC leaders increasingly view CAAs as part of the solution to anesthesia staffing challenges. According to Becker’s ASC Review (2025), “Integrating CAAs under anesthesiologist supervision is viewed as a way to reinforce patient safety while providing more consistent coverage in ASCs.”

Cardiac and Subspecialty Programs

CAAs have a strong presence in cardiac anesthesia programs, where the ACT model is the standard of care. Emory University’s cardiac anesthesia program, for example, employs CAAs at compensation levels of $264,000–$328,000 (Emory, 2026) — reflecting the cardiac premium that comes with this high-acuity subspecialty.

Other subspecialty environments where CAAs work include:

• Pediatric surgery centers
• Neurosurgical suites
• Pain management clinics
• Transplant programs

Veterans Affairs (VA) Facilities

CAAs have a unique advantage at VA medical facilities: they can practice at any VA facility across all 50 states, regardless of individual state licensure laws. This opens a nationwide network of potential work settings for CAAs, including in states that have not yet authorized civilian CAA practice.

States Where CAAs Can Practice

As of 2025, CAAs can practice in approximately 23 states plus Washington, D.C. The states include Alabama, Colorado, Florida, Georgia, Indiana, Kansas, Kentucky, Michigan, Missouri, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin. Several additional states — including California — have introduced legislation to authorize CAA practice (Becker’s, 2025). For a deep dive into scope-of-practice details, see our CAA scope of practice guide.

CRNA Work Settings: Where Nurse Anesthetists Practice

CRNAs practice in every setting where anesthesia is delivered — a reflection of both the profession’s broad scope and its presence in all 50 states. With more than 67,000 CRNAs in active practice (AANA, 2026), CRNAs are the most widely distributed anesthesia providers in the United States.

Hospitals

Hospitals are the largest single employer of CRNAs. Within hospital environments, CRNAs work in:

• Operating rooms across all surgical specialties
• Obstetrical suites providing labor epidurals and anesthesia for cesarean sections
• Emergency departments and trauma centers providing airway management and resuscitation
• Cardiac catheterization labs and interventional radiology suites

CRNAs in hospital settings earn an average of $234,250 per year (BLS, May 2024). Depending on the state and facility, CRNAs may work within the ACT model or practice independently.

Ambulatory Surgery Centers

ASCs are a major and growing employer of CRNAs. The shift toward outpatient surgery continues to accelerate: lower overhead, shorter patient stays, and favorable reimbursement models make ASCs an attractive practice environment for both providers and patients.

CRNAs in outpatient care centers earn an average of $263,960 (BLS, May 2024) — a significant premium over hospital settings. In states that allow independent practice, CRNAs often serve as the sole anesthesia provider in ASCs, managing cases from pre-op assessment through post-anesthesia recovery. For more on surgery center opportunities, see our guide to surgery center CRNA jobs.

Rural and Critical Access Hospitals

CRNAs are the primary — and often only — anesthesia providers in many rural hospitals and critical access hospitals. Independent CRNA practice is essential for maintaining surgical services in underserved communities where recruiting an anesthesiologist is not feasible. This role positions CRNAs as healthcare lifelines in rural America.

Office-Based Surgery and Dental Settings

CRNAs also provide anesthesia in physician and dental offices, particularly for procedures like cosmetic surgery, oral surgery, and GI endoscopy. These settings typically feature lower acuity but high patient volume and predictable schedules.

Pain Management Clinics

Both CRNAs and CAAs may work in chronic pain management, performing interventional procedures such as epidural steroid injections, nerve blocks, and radiofrequency ablation under appropriate supervision or independent practice authority.

Hospital Work: CAA vs. CRNA Side-by-Side

Hospitals offer a rich clinical experience for both CAAs and CRNAs, but the day-to-day reality differs based on the practice model.

Both roles offer compelling hospital careers. CAAs bring focused expertise in high-acuity, physician-led teams, while CRNAs offer flexibility across all specialties and practice models.

Ambulatory Surgery Centers: Opportunities for Both Roles

The ASC sector is booming. More than 6,100 Medicare-certified ASCs operate in the United States, and the number continues to grow as procedures shift from inpatient to outpatient settings. This growth creates substantial opportunities for both CAAs and CRNAs.

CAAs in ASCs

• Work under anesthesiologist supervision within the ACT model
• Particularly valuable for ASCs affiliated with hospital systems that already employ physician-led teams
• Help maintain consistent anesthesia coverage and reduce scheduling disruptions
• Compensation aligns with the national CAA average of $247,000–$253,000 (Becker’s/Marit Health, 2026), with market hourly rates of $200–$275/hr

CRNAs in ASCs

• May practice independently in opt-out states — often as the sole anesthesia provider
• Outpatient care center CRNAs earn an average of $263,960 (BLS, May 2024), a premium over hospital-based positions
• Strong demand for regional anesthesia skills (ultrasound-guided nerve blocks, spinal anesthesia)
• Predictable schedules with fewer overnight calls compared to hospital settings
• Locum tenens CRNA rates in ASCs range from $200–$325+/hr

Key Differences in the ASC Setting

How CAA Work Settings Affect Compensation

Compensation for both CAAs and CRNAs varies significantly by practice setting, acuity level, and geographic region. Understanding how the work environment shapes your earning potential is critical for career planning.

CAA Compensation by Setting

CAAs who pursue cardiac and neurosurgical subspecialties, relocate to high-demand markets, or take locum tenens assignments typically earn at the top of the range. New graduates can expect strong starting salaries of $200,000–$250,000, with rapid growth as they build experience.

CRNA Compensation by Setting

CRNAs earn a notable premium in outpatient care centers ($263,960) compared to hospital settings ($234,250). Locum tenens CRNAs command the highest gross compensation, with annual earnings of $400,000–$550,000+.

Choosing the Right Work Setting for Your Career

The best work setting depends on your clinical interests, lifestyle priorities, and career goals. Here’s a framework for evaluating your options:

Choose a Hospital Setting If You:

• Thrive on clinical variety and high-acuity cases
• Want exposure to cardiac, trauma, neuro, and OB anesthesia
• Enjoy the structure and resources of a large healthcare system
• Are a CAA seeking the team-based environment you were trained for
• Are a CRNA who values the backup and collaboration of a full care team

Choose an Ambulatory Surgery Center If You:

• Prefer a predictable schedule with minimal overnight call
• Enjoy high-volume, efficient case flow
• Want to develop strong regional anesthesia skills
• Value work-life balance as a top priority
• Are a CRNA seeking independent practice (in opt-out states)

Choose a Subspecialty Program If You:

• Have a passion for cardiac, pediatric, or neurosurgical anesthesia
• Want to maximize compensation through subspecialty premiums
• Are a CAA interested in cardiac programs (earning $264,000–$328,000 at top centers)
• Are drawn to the intellectual challenge of complex cases

Choose Locum Tenens If You:

• Want maximum earning flexibility — CAA locum rates of $200–$275/hr; CRNA locum rates of $200–$325+/hr
• Enjoy travel and experiencing different clinical environments
• Prefer short-term assignments with the freedom to set your own schedule
• Are early-career and want to explore settings before committing long-term

Related Reading

• CAA vs. CRNA: Full Career Comparison
• CAA Scope of Practice: State-by-State Guide
• Surgery Center CRNA Jobs: Opportunities & Pay
• CAA Salary by State: Complete 2026 Guide
• CRNA Independent Practice States

CTA: Browse CAA Jobs on AnesthesiaJobs.com Browse CAA Jobs →

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Frequently Asked Questions

What are the most common CAA work settings?

CAAs work primarily in hospitals, ambulatory surgery centers (ASCs), and academic medical centers. They are most commonly employed in larger facilities that perform high-acuity procedures such as cardiac surgery, neurosurgery, and organ transplantation. CAAs always practice within the Anesthesia Care Team model under the supervision of a physician anesthesiologist. As of 2025, CAAs can practice in approximately 23 states plus Washington, D.C., and at all Veterans Affairs facilities nationwide.

Can CAAs work in ambulatory surgery centers?

Yes. CAAs are increasingly working in ASCs as these facilities expand the range and complexity of procedures they perform. In ASCs, CAAs work under anesthesiologist supervision within the ACT model. ASC leaders report that integrating CAAs into their teams helps maintain consistent anesthesia coverage and supports patient safety (Becker’s, 2025). CAA compensation in all settings averages $247,000–$253,000 nationally (Becker’s/Marit Health, 2026), with market hourly rates of $200–$275/hr.

How do CRNA work settings differ from CAA work settings?

CRNAs practice in every setting where anesthesia is delivered — including hospitals, ASCs, rural and critical access hospitals, pain clinics, dental offices, and office-based surgery suites — across all 50 states. The key difference is that CRNAs can practice independently in states that have opted out of federal supervision requirements, while CAAs always practice within physician-led anesthesia teams. CRNAs earn an average of $263,960 in outpatient care centers and $234,250 in hospitals (BLS, May 2024).

Do CAAs or CRNAs earn more in surgery centers?

Compensation is competitive for both roles in ASC settings. CRNAs in outpatient care centers earn an average of $263,960 (BLS, May 2024), while the national CAA average across all settings is $247,000–$253,000 (Becker’s/Marit Health, 2026). Locum tenens rates are similar for both: CAAs earn $200–$275/hr and CRNAs earn $200–$325+/hr. Both roles benefit from predictable ASC schedules with minimal overnight call.

What practice model do CAAs work under?

CAAs exclusively practice within the Anesthesia Care Team (ACT) model, where a physician anesthesiologist provides supervision. This means an anesthesiologist is always present or immediately available when a CAA is delivering anesthesia care. This team-based approach is standard in most hospitals and is expanding into ASCs and hybrid care environments. CRNAs, by contrast, may work within the ACT model, under collaborative agreements, or independently depending on state regulations and facility policies.