The W2 locum question worth asking before you sign.

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"Locum" doesn't mean "no benefits." It depends entirely on whether you're working as a 1099 contractor or as a W2 employee through an employer-of-record (EOR). The difference is the difference between a real benefits package and tax season anxiety. Same clinical work. Very different financial picture.

If you're considering locum work and the recruiter you're talking to isn't being clear about which structure you're being placed under — that itself is the answer about who you're working with.

What 1099 actually means.

As a 1099 independent contractor, you are — for tax purposes — running your own business. That's a real thing with real implications:

• You handle your own taxes. No withholding. You owe federal income tax plus the full 15.3% self-employment tax (Social Security + Medicare, both halves) on your earnings, paid quarterly to the IRS.
• You handle your own benefits. Health insurance via the marketplace or a private broker. Retirement via Solo 401(k) or SEP-IRA. Disability insurance, life insurance, anything you want — you arrange and pay for it.
• You handle your own malpractice. Some assignments include facility-provided coverage; many don't. Your structure, your responsibility.
• You can deduct legitimate business expenses. Home office, CME, license fees, malpractice premiums, certain travel — properly documented, these reduce your taxable income.

None of this is bad. Many physicists and physicians prefer 1099 specifically for the flexibility, the higher gross rates, and the deduction structure. But it's a different financial life than being a W2 employee, and it requires either real bookkeeping discipline or an accountant who knows physician practices.

What W2 through an EOR means.

When you take a locum assignment as a W2 employee through an employer-of-record, the EOR is your legal employer for the duration of the assignment. The clinical work is the same. The structure is fundamentally different.

• Taxes are withheld from each paycheck. Federal, state, FICA — handled. No quarterly estimated payments.
• You qualify for the EOR's benefits package. Medical, dental, vision through real carriers. 401(k) with match. Life insurance, disability, accident coverage. Coverage that travels with you between assignments as long as you're on a W2 contract.
• Malpractice is provided. Real coverage, real terms, real liability protection — built into the EOR relationship.
• You receive a W-2 at year-end. Tax filing is straightforward. No Schedule C, no quarterly estimates, no chasing 1099s from facilities.

The trade-off is on the gross rate. W2 hourly or daily rates are typically lower than 1099 rates because the EOR is absorbing the employer-side costs (FICA matching, benefits, workers' comp, malpractice). The net comparison once benefits and taxes are factored in is much closer than the gross rates suggest — and for many clinicians, the W2 number actually wins on net.

The question to ask.

When a recruiter pitches you a locum assignment, three questions tell you almost everything:

1. "Is this 1099 or W2?" A clear answer means a clear structure. An evasive answer means run.
2. "If W2, who's the employer-of-record and what carriers do they use?" Real EOR partnerships have named carriers (Cigna, MetLife, Health Equity, Empower) and real plan documents you can review.
3. "What does the malpractice coverage actually look like?" Occurrence vs claims-made, limits, tail provisions. The recruiter should be able to answer this without checking with someone.

If the recruiter can't answer these crisply, the assignment is probably 1099 and the benefits conversation hasn't been thought through. That's not necessarily disqualifying — 1099 is a legitimate structure for many clinicians — but you should be entering the engagement with eyes open about what you're responsible for arranging on your own.

Why this matters more than it used to.

Locum work has historically been treated as a "between jobs" stopgap. That's not the reality anymore. A growing number of radiation oncologists, physicists, dosimetrists, and therapists are building career-length practices around long-term locum work. For that to be sustainable, the benefits structure has to be real — not improvised.

The right answer for any individual depends on tax bracket, family situation, risk tolerance, and how much administrative overhead you want to manage personally. But the answer to "1099 or W2 EOR" should be made deliberately, not by accident.