Cost Implications of Internal Versus External Recruitment of Certified Registered Nurse Anesthetists in a Hospital System

Anesthesia services contribute materially to hospital revenue, yet recruitment of qualified providers can strain budgets. The objective of this study was to evaluate anesthesia care models, billing structures, and the financial impact of internal (program-trained graduates) versus external recruitment of Certified Registered Nurse Anesthetists (CRNAs) within a single hospital system. A retrospective cost analysis using the 2019 institutional budget compared orientation length, recruiter costs, event and candidate travel expenses, and mentor time for external hires versus hospital-trained graduates. In 2019, 27 CRNAs were hired, 4 internally and 23 externally. External hires incurred approximately $22,961 more per hire, yielding a total annual differential of $528,109. System-based recruitment and retention of hospital-trained nurse anesthesia graduates is associated with substantial cost savings and may help stabilize staffing and maintain quality.