Is locums worth it compared with an employed job?
Compare net income and hours, not gross. At $330,000 for 32 weeks, the model nets about $190,000 after tax and out-of-pocket benefits — roughly $63,000 less than a $320,000 employed year, for about 25 hours a week instead of 55. Whether that trade is worth it is yours to make; the arithmetic should be explicit.
All answers · Independence · checked October 21, 2026
1099 pay carries costs an employed salary hides: the employer half of Social Security and Medicare, health coverage, malpractice tail, licensing, retirement match, and weeks without a contract. The gross rate is not comparable to a W-2 salary until those are subtracted.
Locums also has income gaps and administrative load: credentialing between assignments, state licenses, housing, and invoicing. A cash buffer of three to six months is the practical requirement, not a luxury.
The non-financial trade is real: schedule control and time off versus stability, benefits, and colleagues. The career model lets you put your own numbers on both sides and name the priority that decides it.
The numbers
- Locums model
- ≈$189,700 net
- $330,000 gross, 32 weeks, $28,000 benefits cost, 1099 FICA
- Employed comparison
- $320,000 gross
- 55 hours/week, 48 weeks, employer benefits
- Difference
- ≈−$63,000 net
- For about 25 hours/week instead of 55
Actions that follow from the numbers
- Price health coverage, tail and the lost retirement match before accepting a rate. Career model
- Confirm the contract is 1099 and that you control your schedule.
- Keep three to six months of expenses liquid before the first assignment.
What could change this
Each condition below would change the conclusion above. If one applies, re-run the numbers before acting on this answer.
- Your gross rate or weeks worked differ from the model's $330,000 over 32 weeks — at higher rates the gap can reverse.
- You can get equivalent coverage more cheaply, through a spouse's plan or a marketplace — the out-of-pocket benefits line shrinks.
- You weigh schedule control and time off more than the income gap — that trade is a preference, not arithmetic.
When the numbers aren't enough
- You are choosing an entity or tax election for the first time.
- You will work in multiple states and need licensing and credentialing coordination.
- Your first contract has cancellation or tail terms you do not understand.