Independent CRNA (1099) vs Hospital W-2

The hospital W-2 CRNA earns $210-260K. The 1099 independent/locum CRNA earns $280-400K. The dollar gap looks huge but the after-tax, after-benefits math is more nuanced.

Gross-to-net comparison

The 1099 path typically nets 10-20% more than W-2 at similar work volume — not as dramatic as gross numbers suggest but still meaningful.

S-corp election: the hidden lever

A 1099 CRNA electing S-corp taxation splits income between W-2 (subject to FICA) and distributions (not subject to FICA). Example: $330K gross → $150K reasonable W-2 comp + $180K distributions. FICA savings: $180K × 15.3% = $27K annually.

With S-corp: net income closer to $227K vs. $200K straight 1099. Most working independent CRNAs should elect S-corp.

Retirement space

Huge advantage for 1099 CRNAs via Solo 401(k):

• Employee deferral: $23K
• Employer profit-sharing: up to 25% of W-2 comp (if S-corp)
• Total: up to $70K annual tax-advantaged

W-2 CRNAs typically cap at 403(b) $23K + maybe 457(b) $23K + employer match. $50-60K total depending on employer.

What you give up going 1099

• Income smoothing. 1099 income is lumpy — gaps between contracts, no paid time off, variable demand.
• Benefits continuity. Health insurance, disability, retirement match all gone or self-funded.
• PSLF path. 1099 work never qualifies for PSLF — game over if you were on that track.
• Administrative overhead. Entity setup, quarterly estimated taxes, accounting, multi-state filing if you travel. 15-30 hours/year of admin.
• Credentialing transitions. Each new facility requires credentialing (60-90 days). Income gaps real.

Hybrid strategies

Many CRNAs do 80% W-2 + 20% 1099 side work. Get the benefits stability from W-2 plus the high-rate flex income from weekend locum. Optimal of both in many cases.

When each wins