Locum CRNA Income Case Study
At The Financial Cocktail, we do some financial coaching. One CRNA was agreeable to share their income as a case study on how CRNAs can break the financial norm. The CRNA will remain anonymous, numbers will be rounded for ease of reading, and I’ll keep this short. W-2 comparison at the end.
CRNA is a locum who worked in 3 Midwest states throughout 2025. CRNA uses an LLC and files as an S-Corp. CRNA and spouse are employed by the LLC.
Gross Income from Anesthesia: $775,000
Woo!
CRNA worked 260 days in 2025. They worked a standard 40 hour week for 47 weeks. Contracts were a mix of 5x8s and 4x10s. CRNA worked 17 weekends of call from “home.” They estimate a total of 100-125 nights of light-ish call (including those 17weekends).
LLC Expenses: $325,000
CRNA’s contracts were a mix of “all-inclusive”, “paid travel and lodging”, and hospital supplied housing. I broke out the big expenses. The “other expenses” are the typical locum expenses including housing, travel, health insurance premiums, meals, malpractice, and licensure.
EmployEE Salaries: $200,000
EmployER 401(k) Match: $50,000
Other Expenses: $75,000
The LLC shows $450,000 remaining after $325,000 of expenses. This $450,000 passes through to CRNA personally. This was done via quarterly distributions.
CRNA’s personal taxes show $450,000 plus $150,000 in W-2 income (after solo401(k) contributions) bringing the total to $600,000.
A bit more information…
CRNA runs monthly payroll for them and their spouse. Taxes are withheld from this paycheck like any other W-2 job. Every quarter CRNA makes estimated federal and state payments, then takes a distribution.
On the personal side, CRNA utilizes a mix of traditional and Roth investments via a Solo401(k), IRA, and HSA. Add the standard deduction and that’s about where the deductions end.
There is so much hype around deductions and tax credits that don’t help out much when earning this kind of money. The utility of QBI deductions fades when begins to taper or no longer applies based on your income. We could get into the “spend $1 to save $0.40” conversation, but I’ll save that for another time.
Time for everyone’s favorite part about making money — Paying the taxes.
Household income is adjusted for their traditional tax-advantaged contributions and the standard deduction.
CRNA has a bit of income outside of anesthesia dollars, but it’s negligible to the gross $775,000 brought in by the LLC. I attempted to factor out any taxes owed for capital gains. Close enough to get the idea.
CRNAs tax bill is $175,000
State Tax: $35,000
CRNA owes state taxes where the money is earned. All three states have different state taxes.
Federal Tax: $140,000
If I assume $600,000 of income (after expenses) created a $175,000 tax bill, that would indicate an effective tax rate of 29.12%
State taxation represents 5.83% and Federal taxation represents 23.33%.
Bonus: The $50,000 employer match is an expense to the business counting against income, but neither the employEE nor employER pay taxes on that money YET as it is a traditional Solo401(k) contribution.
TFC Overlay
CRNA essentially earns $775,000, spends $75,000 on overhead, and pays $175,000 in taxes leaving $525,000 to live, invest, play, donate, and enjoy.
Split it this way…invest $225,000 and live off $300,000. Most cities allow a solid quality of life for $300,000 annually.
Investing $225,000 annually wipes out your student loans and probably makes you a millionaire within 5 years and a multimillionaire within 10.
Plus a $25,000 monthly living allowance gives you a $1M+ home, a lake cabin, and new vehicles. Tilt these ratios to fit your goals.
What you didn’t get in this case study was the UNrealized gains from CRNA’s current investments. These don’t show up as income. A multiple six-figure unrealized gain amplifies wealth building. All done in the background.
If you want to turbocharge your financial situation and shave years off your retirement timeline, consider it – even if it’s a couple years. This case study displays an amazing income, not just for CRNAs, but anyone. It’s a blessing to have this earning potential as a locum CRNA.
This case study isn’t a hidden gem. These contracts are out there. I’m in the Midwest and this is repeatable. The need for CRNAs is strong in the current marketplace.
Seriously, earn $3M over 4 years. Pay $1M in taxes and walk with $2M. Set yourself up for the fast track to financial independence.
For as much as I feel I should end there, here me out.
Back of the Napkin Math Time…
Let’s assume this was a W-2 situation with a W-2 CRNA earning $775,000 and a state income tax rate of 5%.
Firstly, CRNA’s income would be $700,000 without T&L reimbursement. Secondly, CRNA’s salary would be $650,000 with $50,000 in benefits. The monthly income profile would look something like this…
Gross Earnings: $54,166
Taxes: $22,476
Net Income: $31,690
W-2 status brings a tax bill of $270,000 with an effective rate of 41.5%. Bit higher than the 1099 version at 29.12%. Might be worth the expenses and BS of contracting.
If we consider tax-advantaged accounts and a standard deduction, taxable income will be around $590,000. This reduces the tax bill to $240,000 with an effective rate of 40.9%.
This doesn’t call for a 1099 course explaining how to deduct your cellphone and use the Augusta Rule; it calls for a macro finance play. How to increase income, increase investments, and increase net worth. The decision to chase the dollars for a while and what to do with those dollars when they show up.
Thanks for reading!
