When Higher Rates Attract Lower Value
A Hard Truth About Talent, Culture, and Compensation
In healthcare (especially in anesthesia services) we spend an enormous amount of time thinking about compensation. What’s competitive? What’s sustainable? What attracts talent? What retains it?
But over the past few years, I’ve noticed a trend that is counterintuitive, and honestly, a little uncomfortable to say out loud:
Often, the most skilled providers are the most reasonable and flexible about rates.
And surprisingly often, the least skilled are the most demanding.
This isn’t a universal truth, of course. But it’s a pattern that emerges repeatedly if you hire enough people, lead enough teams, and observe enough behaviors across different facilities, markets, and organizational cultures.
Let’s break down why.
How I Define “Skilled” — It’s Not Just Technical Ability
When I talk about “skilled providers,” I’m not just talking about clinical expertise or speed in the OR. Skill, at its highest levels, is multidimensional:
1. Technical Skill
The provider is clinically strong, safe, efficient, and can handle complexity without drama or ego.
2. Deep Knowledge Base
They don’t just do the work—they understand it. They’re curious, engaged, and always improving.
3. Emotional Intelligence
This is the differentiator.
High-skill providers tend to:
Be self-aware
Thrive in group dynamics
Communicate well
Show respect for the entire care team
Make others better
It’s the EI component that shifts a clinician from “competent” to “culture-enhancing.”
Why High-Skill Providers Are Often More Reasonable on Rates
Here’s the paradox:
The more well-rounded and skilled the clinician, the less likely they are to chase the highest rates.
Why?
They value the whole experience and look for internal fulfillment rather than paycheck-to-paycheck gratification.
Top-tier clinicians choose roles based on:
Strong culture
Team satisfaction
Autonomy
Stability
Leadership support
Work-life balance
Respect and partnership
Compensation matters, of course, but it’s not the only axis.
They don’t need to chase dollars.
Because their skill and reputation give them real options, they select roles based on fit and purpose. They are not interested in only short-term quick wins.
They see themselves as part of a system, not above it.
They want to uplift the group, not extract from it.
Why Lower-Skill Providers Tend to Chase Higher Rates
This part is delicate, but honest.
They sometimes lack the skill or EI to differentiate themselves otherwise.
If you don’t have relational capital or clinical excellence to stand on, rate becomes your only leverage point.
They look for what they can get, not what they can build.
Transactional, not relational.
They misjudge their value.
Without self-awareness, there’s a tendency to equate market urgency with personal worth.
They may destabilize culture.
High rates can attract individuals who are:
Less team-oriented
Less flexible
More entitled
More likely to create friction
More likely to leave when the next high number appears
And, unfortunately, just one of these hires can do cultural damage that takes months to repair.
Rates Can Get People in the Door — But They Don’t Keep Them
I’ve seen this again and again:
High achievers may be attracted by a higher rate initially, but they stay because of the environment, relationships, and opportunity to practice at the top of their training.
Rate-chasers show up for the money, and often leave for the money.
Their loyalty is to the number, not to the mission or the team.
This distinction is critical for leaders:
Compensation strategy should attract the providers you actually want, not the ones who chase whatever offer is highest this month.
The Broader Leadership Lesson
If we want:
Strong culture
Stable teams
High reliability
Low drama
Better patient care
Sustainable financial models
…then we need to think about compensation not just as an economic lever, but a cultural filter.
Rates should be competitive, fair, and respectful. But when they become the only attraction mechanism, you end up attracting exactly the people who are not aligned with long-term success.
Or said differently:
Money alone tends to attract mercenaries, not mission-driven professionals.
Fair wages along with purpose, partnership, and culture attract the best clinicians.
Final Thought
This is, of course, a generalization. Not every highly paid provider struggles with teamwork, and not every lower-paid provider is less skilled. But trends matter and this is one I’ve seen across states and systems in recent years.
If we want to build organizations that last, not just survive, we have to invest in the providers who elevate the team, not the ones who extract from it.
And sometimes, the simplest indicator is how they talk about compensation.
15 years into practice and I’ve watched private equity and for profit systems swoop in, buy out contracts, and squeeze them for every penny. The new “leadership” couldn’t care less about their clinicians and show it at every turn. They say things like “team” and “culture” when the real focus is on the immediate quarter’s profit margins and whatever it takes to roll into the next quarter in the black with rooms staffed. It doesn’t take long for the stronger clinicians to throw up their hands and either move on or jade out. To be fair, I agree on many of your points. I would love to work in an environment with strong culture, team satisfaction, be a respected partner, enjoy some autonomy and stability, and strive for work-life balance all the while being supported by leaders. However, I must submit to you that very little of what you write is based on reality in my experience. Must we strive to do better? Of course and at every opportunity. I simply haven’t been a part of the type of environment you are describing. In addition, I think your excerpt on valuing emotional intelligence is accurate but you may be seeing it backwards. Those that have it will wake up to the fact that they are being taken advantage of in most W2 situations simply because they are trying to be team players. Those clinicians are looking left and right at the locums providers making more per hour with way less skin in the game and are justifiably upset. Match that up with “leaders” that can’t give a lunch safely, communicate poorly if at all, and will gladly throw staff under the bus at the first sign of trouble. The truly emotionally intelligent won’t suffer that for long and will either change their situation or drop out. To finally land on a hypothesis that paying less per hour will somehow get you better clinicians? No sir. The comp package will only get someone interested enough to start a conversation and in the current market that number needs to be high. It is up to you as the hiring entity to figure out who will and won’t fit the culture you are trying to create. Add that to the fact that we are facing a shortage that is only worsening? Most places are only worried about getting enough clinicians to cover rooms. The time for wholesale culture change is when you have the good fortune of a full complement of solid staff. Now is not that time. Pay up or lose.
I couldn’t agree more. Example: I own a business and have one employee that has been a CRNA for 40+ years and has retired from the VA and a teaching university. Never complains, loves people, patients and work. Just happy to be able to do something. Doesn’t complain about compensation and it’s more than fair. Doesn’t chase the extra $15/hr bc he knows there’s more joy right where he is.
CRNAs really need to know what they actually generate in revenue then maybe the demands will decrease and they will be happy that they make what they do. Stipends are weakening our story.