Should Your Hospital or PMG Build an Internal CRNA Locums Agency?
What Forward-Thinking Groups Are Learning the Hard Way
The landscape of healthcare staffing is more challenging than ever, especially when it comes to securing highly skilled Certified Registered Nurse Anesthetists (CRNAs). If you’re part of a hospital system or a Practice Management Group (PMG), you’re likely feeling the immense pressure. CRNA demand continues to soar, traditional locum tenens agencies are charging escalating fees, and every unstaffed shift translates directly into lost revenue and increased operational risk.
It’s no wonder that a compelling question has emerged for many healthcare leaders: Should we just build our own internal locums agency?
The allure of this strategy is undeniable. On paper, the benefits seem clear and compelling:
- Reduce external broker fees: Cut out the middleman and reclaim significant budget allocations.
- Control the talent pool: Directly manage your own roster of trusted CRNA professionals.
- Move faster on coverage gaps: Respond to urgent staffing needs with greater agility.
These theoretical advantages paint an attractive picture of cost savings and operational efficiency. However, as many groups are discovering, what looks good in a strategic planning meeting often proves to be far more complex and resource-intensive in practice. Crucially, it also doesn’t necessarily mean the provider talent pool will “buy what you’re selling.”
The Rising Temptation: Why Groups Explore Internal CRNA Locums Models
Before delving into the pitfalls, it’s important to acknowledge the legitimate motivations driving national PMGs and hospitals to consider an internal locums agency. These aren’t naive decisions but rather attempts to address very real pain points within CRNA staffing.
The primary drivers behind this strategic exploration typically include:
- Cost Control: This is often the paramount motivator. The escalating fees charged by third-party CRNA locum tenens agencies can be astronomical, eating into already tight budgets. The idea of reining in these expenditures by bringing CRNA sourcing in-house is incredibly attractive.
- Ownership and Control: Many groups desire greater direct management over their CRNA provider pool. This includes everything from setting specific hiring criteria to fostering a more integrated sense of team amongst temporary staff. The goal is to build a reliable, familiar contingent workforce (and potentially to impose non-competes that favor the employer, though this often backfires).
- Perceived Speed and Efficiency: The assumption is that by having an internal locums agency, a hospital or PMG can react more quickly to sudden call-offs, unexpected patient surges, or long-term vacancies without the lead times associated with external agencies.
If you’ve been down this path or are currently contemplating it, these motivations likely resonate deeply. They represent a genuine effort to optimize anesthesia recruitment and improve CRNA staffing resilience.
Where Internal CRNA Locums Models Fall Short: Lessons Learned the Hard Way
Despite the well-intentioned objectives, the reality of operating an internal CRNA locums agency often diverges sharply from initial expectations. We’re consistently hearing from organizations who have ventured down this road, only to encounter significant hurdles that lead them to reconsider their approach.
Here are the critical areas where internal locums models frequently falter:
1. The Hidden Complexity and Astronomical Overhead
The most significant miscalculation often lies in underestimating the sheer operational complexity involved in running a truly effective internal locums operation. It’s far more than just hiring a recruiter or pivoting someone from your internal recruiting team to your new locums team. Building an internal locums agency demands the creation of an entirely new, specialized infrastructure, which includes:
A Dedicated Recruiting Function:
This isn’t just one person. It requires a team of experienced recruiters specifically skilled in identifying, vetting, and engaging CRNAs for temporary positions. This team needs access to specialized databases, marketing tools, and industry networks – all of which come with substantial costs.
A Robust Database of Flexible Providers:
You need a dynamic, constantly updated pool of available CRNAs who are interested in locum tenens work with your organization. Building this pool from scratch and keeping it consistently populated requires continuous effort and investment.
Specialized Systems for Temporary Staff Management:
Unlike permanent hires, locum tenens CRNAs require distinct processes for:
- Credentialing and Compliance: Ensuring every temporary CRNA meets all state and federal regulations, facility-specific requirements, and undergoes thorough background checks is a time-consuming and meticulous process.
- Scheduling: Managing the ever-changing availability and assignments of a flexible workforce demands sophisticated scheduling software and dedicated administrative support.
- Payroll and Benefits (for temporary staff): While existing payroll systems can handle the financial transactions, the specific tax implications, hourly rate calculations, and lack of traditional benefits for locums CRNAs add layers of complexity.
What often begins as a cost-saving initiative can quickly balloon into an expensive new department, complete with its own overhead, personnel costs, technology investments, and administrative burdens. The perceived savings from cutting agency fees are frequently offset, and sometimes even exceeded, by these unforeseen internal expenditures.
2. The Flexibility Paradox: Alienating the CRNAs You Need
CRNAs who choose locum tenens work do so for a fundamental reason: flexibility. They value autonomy, variety in their assignments, and control over their schedules. They are often looking to avoid the rigidities associated with permanent employment.
Many internal locums models, in an attempt to exert control and minimize perceived risks, inadvertently undermine this core value proposition. Tactics such as:
- Adding Restrictive Non-Competes: Demanding that locum CRNAs not work for other facilities within a certain radius or timeframe can severely limit their opportunities and make your internal pool less attractive.
- Rigid Scheduling Demands: Expecting locum CRNAs to adhere to inflexible schedules that mirror permanent staff, rather than accommodating their preferences, can quickly lead to disengagement.
- Inflexible Contract Terms: Offering one-size-fits-all contracts that don’t allow for negotiation or adaptation to individual CRNA needs can deter top talent.
When an internal locums agency attempts to impose too much control, it often alienates the very CRNA professionals it seeks to engage. CRNAs choose locums for flexibility; models that overlook this crucial aspect typically struggle to build and retain a robust, engaged talent pool. The most sought-after locum tenens CRNAs will simply choose opportunities that truly respect their desire for autonomy. We’ve seen outright refusals to work with these groups increase.
3. Persistent Coverage Gaps and the Return to External Agencies
Despite the significant investment and effort, most internal CRNA locums pools remain inherently too small and specialized to adequately cover every single need. Healthcare demand is unpredictable, and specialized CRNA needs can arise suddenly.
When an unexpected surge in demand occurs, or a specific sub-specialty CRNA is urgently required that isn’t available in the internal pool, PMGs and hospitals often find themselves in a familiar, uncomfortable position: going back to external locum tenens brokers.
The irony here is painful: after investing heavily in an internal agency to avoid external fees, groups often end up paying even higher rates to third parties for contingent placements. This is because the urgency leaves little room for negotiation, and external agencies are well aware of the client’s desperate need. This defeats the primary purpose of building an internal locums model in the first place.
A Smarter Alternative: Leverage What Works, Strengthen What Doesn’t
Here’s the promising news: You don’t have to choose between exorbitant external agency fees and the hidden costs of building a full-blown internal locums agency from scratch. The solution lies in a more strategic approach that leverages your existing strengths while intelligently addressing your weaknesses.
Most PMGs and hospitals already possess robust internal infrastructures capable of supporting a flexible CRNA workforce. You likely have:
- Established Credentialing and Compliance Processes: Your teams are already experts at vetting healthcare professionals, ensuring licenses are current, and verifying qualifications. These processes are essential and already in place.
- Reliable Payroll Systems: You have the mechanisms to pay your employees accurately and efficiently, handling all the necessary tax and financial regulations.
- Comprehensive Malpractice Coverage: Your existing insurance frameworks likely cover the professionals working under your facility’s umbrella.
What’s often missing isn’t the fundamental backend infrastructure. Instead, the critical gap is the sourcing layer – the ability to efficiently connect with a broad, qualified, and flexible pool of CRNAs who are actively seeking locum tenens opportunities.
That’s precisely where Lokum App comes in.
Real-World Success: How One Anesthesia PMG Uses Lokum App to Build a Better Model
Consider the experience of a major anesthesia PMG we’ve partnered with. This group, like many others, initially explored the internal agency path. Their journey quickly revealed the challenges:
- Their internal CRNA provider pool wasn’t wide or deep enough to consistently meet fluctuating demand.
- Their internal recruiters couldn’t keep pace with the sheer volume and urgency of staffing needs, or struggled when standing up new programs in unfamiliar geographic regions.
- Despite their efforts, they still had to engage third-party agencies to fill critical, high-priority gaps, negating much of their intended cost savings.
Recognizing these inefficiencies, they wisely shifted their strategy. Instead of abandoning their existing strengths, they decided to augment them with a smarter CRNA sourcing solution. Now, their approach involves:
- Using Lokum App as a primary sourcing engine: Lokum App functions as an intelligent matchmaking engine for CRNA jobs. It seamlessly bridges the gap between talent and opportunity, providing them with immediate access to a vast and diverse pool of pre-vetted CRNAs actively seeking flexible CRNA jobs.
- Leveraging their internal payroll, malpractice, and credentialing teams for onboarding: This ensures that while they’re sourcing externally, the crucial backend processes remain firmly within their established, efficient internal systems.
- Tapping into a broader pool of CRNAs without rebuilding the wheel: They benefit from the expansive reach of Lokum App without incurring the immense costs and complexities of developing their own recruitment infrastructure.
The results have been transformative for this PMG. They’ve achieved:
- More consistent CRNA coverage: Critical shifts are filled reliably, reducing operational stress and ensuring patient care continuity.
- Fewer last-minute panic hires: Proactive CRNA staffing for new programs through Lokum App has minimized the need for expensive, urgent external placements.
- A better experience for CRNAs: CRNAs feel respected and empowered, as they can find appealing opportunities with PMGs that understand and accommodate their desire for flexibility – a testament to the effectiveness of a dedicated CRNA job platform and matchmaking engine designed for their needs. This enhances the PMG’s reputation as an employer of choice for flexible CRNA jobs.
The Bottom Line for Your Anesthesia Recruitment Strategy
If your hospital or PMG is currently weighing the pros and cons of building an internal CRNA locums agency, it’s crucial to ask yourself some critical questions:
- Do we truly want to take on the significant upfront costs and ongoing operational complexity of building and maintaining an entirely new, specialized department?
- Are we confident we can offer CRNAs the genuine flexibility and autonomy they expect from locum tenens work, or will our internal model inadvertently alienate them?
- Can we achieve our CRNA staffing goals faster, more cost-effectively, and with greater success by partnering with a smarter, dedicated CRNA sourcing platform and matchmaking engine?
The evidence from groups who have tried and pivoted suggests that the answer often points towards an integrated approach. By leveraging the strengths of your existing internal infrastructure and empowering it with a cutting-edge CRNA job platform like Lokum App, you can achieve superior CRNA staffing outcomes.
Let Lokum App be the intelligent CRNA sourcing layer and matchmaking engine that empowers your internal team to do what it does best: provide exceptional care.