The short answer
A locum (1099) contract almost always shows a bigger gross number than a staff (W-2) job — often substantially higher per hour. But you keep less of each dollar. As an independent contractor you pay the full self-employment tax, buy your own health insurance, fund your own retirement, and earn nothing on the weeks you don’t work.
Once you net it all out, locum usually still comes out ahead on cash — frequently by tens of thousands of dollars a year for a CRNA working a full schedule — but the gap is smaller than the hourly rates suggest, and you’re trading a salary’s worth of stability and benefits to get there. Whether that trade is worth it depends less on the math than on how steadily you want to work and how much financial admin you’re willing to take on.
If you just want your own number, the CRNA locum pay calculator compares 1099 and W-2 take-home side by side for any state. The rest of this post explains what’s moving underneath those numbers.
How locum (1099) pay works
As a locum, you’re typically paid as a 1099 independent contractor: a flat hourly rate, no withholding, and no benefits. That high rate is doing a lot of work that an employer would otherwise handle for you.
- Self-employment tax. A W-2 employee and their employer split Social Security and Medicare (FICA) roughly down the middle. As a 1099 contractor you pay both halves — about 15.3% on most of your net earnings, on top of income tax. Half of it is deductible, which softens the blow, but it’s the single biggest reason a locum dollar is worth less than a staff dollar.
- No benefits. No employer health insurance, no 401(k) match, no paid time off, no CME allowance. You either buy these yourself or go without.
- Quarterly estimated taxes. Nobody withholds for you. You’re expected to send the IRS estimated payments four times a year (April, June, September, January), and you’ll owe penalties if you underpay. Setting the money aside is on you.
- Deductions in your favor. Legitimate business expenses — licensing, travel, a home office, professional dues — reduce your taxable income. Some contractors also qualify for the 20% qualified business income (QBI) deduction, though it phases out at higher incomes for clinical work.
Locum agencies often provide malpractice coverage as part of the contract, but confirm whether it’s occurrence-based or claims-made, and who pays for tail coverage when the assignment ends.
How staff (W-2) pay works
A staff job pays a lower gross, but a chunk of your real compensation is hidden in things that never show up on the rate:
- The employer pays half your FICA. That’s roughly 7.65% of your pay the locum version comes out of your own pocket.
- Benefits have real cash value. Health insurance alone is a big one: in 2025 the average employer-sponsored family plan cost about $27,000, of which the employer paid roughly $20,000 (about $7,900 for single coverage), per KFF. Add a retirement match, paid time off, CME money, and licensure reimbursement and the package can easily clear $25,000–$40,000+ a year — and you don’t pay income tax on most of it.
- Predictability. Taxes are withheld automatically, income is steady, and you get paid when you’re sick or on vacation. There’s no quarterly-tax discipline to maintain and no gap between assignments.
The tradeoff is a lower ceiling and less flexibility: you’re trading upside for stability.
A worked example
Here’s a same-person comparison in Texas (no state income tax), filing single: a locum contract at $180/hr worked roughly full-time (40 hours a week, 48 weeks), versus a staff job at a $225,000 salary. The numbers below are computed live by the same engine that powers our locum pay calculator, so you can reproduce them exactly with your own contract.
| Locum (1099) | Staff (W-2) | |
|---|---|---|
| Pay basis | $180/hr × 40h × 48wk | $225,000 salary |
| Gross income | $345,600 | $225,000 |
| Taxes (federal + FICA/SE) | −$111,686 | −$58,231 |
| Effective tax rate | 32.3% | 25.9% |
| Net take-home | $233,914 | $166,770 |
These are two separate runs through the calculator — the locum contract as 1099 and the staff salary as W-2, both in Texas, filing single. On cash alone, the locum nets roughly $67,000 more. (Note the locum gets no QBI deduction here: clinical work is a "specified service" trade, so the deduction fully phases out at this income.)
But the staff job quietly includes benefits the locum has to self-fund — health insurance, a retirement match, and CME — worth roughly $25,000 a year. Net that out and the locum's real edge is closer to $42,000: still a meaningful lead, but a different story than "$180/hr versus a salary" first suggests. And it assumes a full year of work — every unworked week is about $7,200 of billings ($4,900 after tax) you don't earn, so a locum who takes several weeks off lands much closer to the staff number.
Two things drive the locum’s higher rate of tax in the table: progressive brackets (more income is taxed at higher rates) and that full self-employment tax. Both are working against the bigger gross, which is exactly why the net gap is narrower than the gross gap.
When locum makes more sense
- You can keep your schedule full and don’t need the weeks off a salary pays for.
- You want geographic flexibility, or you’re testing markets before settling down.
- You’re a disciplined saver who’ll actually set aside quarterly taxes and fund your own retirement — where the higher 1099 contribution limits can work in your favor.
- You’re optimizing for cash now: paying down loans, building savings, front- loading earnings.
When W-2 makes more sense
- You value stability, steady income, and getting paid when you’re off.
- You need family health coverage or want an employer retirement match.
- You’d rather not run quarterly taxes, track deductions, or carry the risk of a slow stretch between assignments.
- You’re building tenure somewhere you want to stay.
The bottom line
Locum usually wins on raw take-home for a CRNA working a full schedule, but by less than the hourly rate implies — and only if you stay busy and self-fund the benefits a staff job includes. W-2 trades that upside for predictability, coverage, and a lot less financial admin. Neither is “the smart move” in the abstract; it depends on how steadily you want to work and how much risk and paperwork you’re willing to carry.
The most useful next step is to stop comparing rates and compare net. Put your real contract into the locum pay calculator to see your 1099 and W-2 take-home side by side, then browse open locum CRNA roles to check the math against what’s actually being offered in your state.