How to Evaluate a Locums Agency as a CRNA: What to Ask and What to Watch For
There are dozens of locums agencies actively recruiting CRNAs at any given time. Some are excellent. Some will waste your time, lowball your rate, and disappear the moment you ask a hard question about a contract. The difference between a good agency and a bad one is not always obvious from the outside. Here is how to tell them apart before you commit to anything.
Understand What an Agency Actually Does
A locums agency is a middleman. They have relationships with facilities that need anesthesia coverage, and they have a database of CRNAs available to fill those gaps. When they place you, they bill the facility at a rate higher than what they pay you and keep the margin. That margin is typically 20 to 35 percent of the total billing rate, though agencies don't disclose this and won't confirm it if asked.
This is not inherently a problem. Agencies add real value by handling credentialing coordination, contracting, malpractice insurance, and housing logistics. The best ones also have genuine relationships with facilities and can get you access to assignments you wouldn't find independently. The question is whether a specific agency is actually providing that value or just collecting margin while doing as little as possible to close the placement.
Most experienced locums CRNAs work with two to four agencies simultaneously, not just one. No single agency has access to every facility, and diversifying your relationships gives you more options, more negotiating leverage, and protection against any one recruiter going quiet. Exclusivity agreements with agencies are a red flag, not a perk.
The Recruiter Is the Agency
Agency quality at the operational level comes down to your individual recruiter, not the company name. A large national agency can have excellent recruiters and mediocre ones working under the same brand. A smaller regional agency can be exceptional if the person handling your account is responsive, knowledgeable, and honest.
This means you're evaluating a person as much as a company. The first few interactions tell you a lot. A recruiter who listens to what you're actually looking for, asks specific questions about your experience and preferences, and presents options that match your criteria is worth your time. A recruiter who sends you a mass email blast of generic positions and calls you twice a day about an assignment you already said no to is not.
Questions that tell you who you're dealing with
Ask these early. The answers separate recruiters who know what they're doing from ones who are just working a numbers game.
- QHow long have you been placing CRNAs specifically, and how many do you currently represent?
- QCan you tell me the billing rate to the facility, not just my take-home rate?
- QWho handles credentialing and what is the typical timeline for the facilities you work with?
- QWhat happens if the facility cancels my assignment after I've relocated?
- QWho is my point of contact if something goes wrong on-site and it's a weekend?
- QCan you connect me with a CRNA you've placed at this facility in the last year?
Most of these have no perfect answer. What you're looking for is whether the recruiter engages with the question honestly or deflects. A recruiter who says "I can't share the billing rate but I can tell you our margin is competitive" is being more straight with you than one who changes the subject entirely. A recruiter who can't tell you the credentialing timeline is not close enough to the actual process to be useful.
Red Flags That Tell You to Walk Away
Pressure to sign quickly before "the position fills"
Urgency is a sales tactic. Some positions do fill fast, that's real. But a recruiter who can't give you 48 hours to review a contract before signing, or who calls multiple times a day to push a decision, is prioritizing their close rate over your interests. A contract you sign under pressure is a contract you didn't read carefully enough. Good recruiters understand that you need time to review what you're signing.
Vague or evasive answers about malpractice coverage
Any agency placing CRNAs should be able to tell you immediately whether coverage is occurrence-based or claims-made, who carries the policy, and what the tail arrangement is. If your recruiter has to "check on that" or gives you a non-answer, that's a sign they either don't know the details of their own contracts or don't think you'll ask follow-up questions. Either way it's a problem you'll deal with later.
Contracts with broad exclusivity or non-solicitation language
Some agency contracts include language preventing you from working with other agencies or taking assignments at facilities where you've previously worked through them. Read the fine print before you register with any agency. A clause that limits your ability to work independently or through competing agencies is not standard and not in your interest.
No real support once you're on-site
Ask directly: if something goes wrong at the facility after hours, who do you call? A good agency has an on-call support line or a direct contact who can actually help with credentialing issues, contract disputes, or facility problems. An agency that connects you to a general voicemail or says "the facility handles that" has done their job and collected their margin. You're on your own from there.
Consistent communication gaps before placement
If a recruiter takes two days to return calls during the placement process, when they're motivated to close the deal, they will be harder to reach once you're in the field and they've already been paid. Responsiveness before placement is a preview of responsiveness after. Weight it accordingly.
Reluctance to put anything in writing
Every meaningful commitment should be confirmed in writing, whether that's the rate, the call schedule, the housing stipend, or the tail coverage arrangement. A recruiter who prefers to handle things verbally or "trusts you'll work it out" is either not organized enough to document their own commitments or doesn't want a paper trail. Neither is a reason to continue the relationship.
Signs You Have Found a Good One
They ask about your clinical experience in detail
A recruiter who asks specifically about your case mix, your comfort with OB or pediatric anesthesia, your experience with regional techniques, and your preferences around supervision structure is trying to match you appropriately. One who sends you any open CRNA position regardless of fit is treating you like a warm body to fill a slot.
They push back on facilities on your behalf
The best recruiters negotiate with the facility for you, not just with you for the facility. If you raise a concern about a contract clause and your recruiter goes back to the client to address it, that tells you they see the relationship as ongoing, not transactional. A recruiter who says "that's just how the contract is" without making any attempt to negotiate is not actually representing your interests.
They can provide references from other CRNAs
Any agency worth working with should be able to connect you with a CRNA they've placed who is willing to speak to the experience. Not a testimonial on their website. An actual person you can call and ask direct questions. If they can't or won't provide that, ask yourself why.
They are honest about what they don't know
No recruiter knows every detail about every facility in their network. A good one says "I don't know that but I'll find out" and then actually finds out. That's more useful than a confident non-answer, and it tells you the recruiter is more interested in placing you well than in closing fast.
Working With Multiple Agencies
The standard advice among experienced locums CRNAs is to register with several agencies at once, typically three to five, and let them compete for your time. This gives you broader access to assignments, more leverage in rate negotiations, and a fallback if one recruiter goes dark or a placement falls through.
A few things to manage carefully when working with multiple agencies:
- Track which agency submitted you to which facility. If two agencies submit you to the same facility, it creates a billing dispute that can cost you the placement entirely. Tell each agency which facilities you've already been submitted to.
- Be consistent about your rate requirements. If Agency A knows you'll take $175/hour and Agency B is negotiating for $190, that inconsistency will eventually surface and undermine both relationships.
- Don't let urgency from one agency push you into a bad decision with another. Recruiters sometimes manufacture time pressure to prevent you from shopping the opportunity. Take the time you need regardless of what any single agency tells you.
When you first enter the locums market, register with two or three agencies you've researched or been referred to. Give each one a genuine chance to present opportunities over 30 to 60 days. After that, you'll have a clear sense of which recruiters are responsive, which have the facility relationships that match your preferences, and which ones you want to continue working with. Cut the ones that aren't performing and add new ones as your network grows.
The Bottom Line
There is no definitive ranked list of locums agencies that applies to every CRNA in every market. Agency quality is too dependent on the individual recruiter, the region, and the specific facility relationships they've built to make blanket recommendations. What you can control is how thoroughly you evaluate any agency before you trust them with your livelihood.
Ask hard questions early. Watch how they respond under pressure. Get everything in writing. Work with more than one. The agencies worth keeping will prove it over time. The ones that aren't will tell you quickly.