When physicians compare locum offers, the headline number is almost never the full story. Two assignments can advertise similar weekly rates yet produce meaningfully different take-home outcomes once taxes, stipends, malpractice, and cancelation rules are included.
What recruiters mean by W-2 vs. 1099
In broad strokes, W-2 arrangements often behave more like employment for tax withholding purposes, while 1099 independent contractor arrangements shift more administrative responsibility to you. Exact treatment depends on the contract, payer of record, and how expenses are structured.
- W-2: withholding may be simpler day-to-day; some deductions and business expenses may be constrained compared to contractor models.
- 1099: may offer flexibility in entity structure and expense tracking, but requires disciplined bookkeeping and a CPA who understands multi-state work.
The line items that change effective pay
- Malpractice: occurrence vs claims-made, tail coverage responsibility, and any specialty-specific riders.
- Travel and lodging: stipend caps, taxable vs non-taxable treatment, and what happens if flights are delayed.
- Cancelation policies: guaranteed hours vs at-will reductions.
- Extra shifts: premium rates, how they are approved, and documentation expectations.
- Call: stipend or hourly add-ons, post-call expectations, and whether overnight work is counted toward weekly hours.
A practical comparison checklist
Before you choose, write down assumptions for each offer: weekly hours, average census, call burden, commute from lodging, and EHR efficiency. A slightly lower rate with better support staffing can outperform a higher rate in a chaotic unit.
Use locums as market research
Short blocks can help you benchmark what your time is worth across geographies and practice models—useful context before signing a multi-year employment agreement.