CRNA Call Pay Explained
Beeper, callback, and in-house — what fair rates look like and how to negotiate them.
The Three Types of Call
Call compensation varies dramatically based on what's actually being asked of you. Understanding the three tiers — and making sure you're paid appropriately for each — is one of the biggest levers in total compensation.
You carry the pager and must respond within a set window (usually 30 min), but you're free to be at home, sleep, and live your life. This is the baseline — you're selling availability, not labor.
You've been called in and are now actively working a case. Standard is 2-hour minimum per callback, with 1-hour minimums being below market. Some contracts pay time-and-a-half or the regular hourly rate.
You must remain on-site for the entire shift, awake or asleep. This should pay 3–5x beeper rates — you can't leave, can't sleep reliably, can't live your life. If a facility is paying beeper rates for in-house call, that's a red flag.
Fair Market Rates in 2026
Call pay benchmarks have shifted upward as facilities compete for coverage. Here's where the market sits:
These are market rates — what you can reasonably negotiate. Below these benchmarks, you're leaving money on the table. Significantly above them, and the facility probably has a serious staffing problem (which may be worth knowing before you commit).
The Call Index: Measuring Call's Real Impact
One useful metric for evaluating how call-heavy a position is: the Call Index. It's calculated as the ratio of total on-duty hours (including call) to regular worked hours, minus 1. A Call Index of 0 means no call at all. A Call Index of 0.5 means you're spending 50% more time on-duty than you're actually working — that's significant.
A high Call Index isn't inherently bad — if the call pay is fair, it can be a significant income boost. But if your Call Index is 0.5+ and you're only getting $50/night beeper pay, you're massively undervaluing your time.
How to Negotiate Call Pay
Call pay is often the most negotiable part of a locum contract because facilities know it's the hardest role to fill. Start by asking for the call breakdown separately from the base rate — many contracts bundle call into the hourly rate, which makes it impossible to evaluate whether it's fair.
Know your benchmarks. If a facility offers $300/night beeper for a weeknight, you have data showing market rate is $500–$900. Ask for a 2-hour callback minimum if they're offering 1 hour. Negotiate holiday multipliers explicitly — don't assume they're included.
The strongest negotiating position: “I'm happy to take call, but I need the compensation to reflect what I'm giving up.” Frame it as fair exchange, not a demand.
When to Walk Away
Some call arrangements aren't worth any amount of money. Red flags include in-house call paid at beeper rates, mandatory call with no additional compensation beyond base rate, no callback minimum (meaning you can get called in for a 20-minute case and only get paid for 20 minutes), and call expectations that weren't disclosed during the interview process.
Your time has value even when you're not in the OR. A facility that doesn't recognize that is telling you something about how they value their CRNAs.
See how call shifts affect your bottom line
Rebel Forecaster tracks call income separately — beeper pay, callbacks, and your Call Index — so you can see whether your call shifts are actually worth it.