You already know the basics. Locum is 1099, a full-time role is W-2, and the hourly rate on a locum contract almost always looks bigger than an equivalent full-time salary. That part isn’t news to anyone who’s worked a season of assignments.
What’s worth a second look is the part of the math that’s easy to miss even when you know exactly what you’re doing, especially if you’re picking up work on both sides of the Washington-Oregon border. Instead, this is about what the comparison actually looks like once you run your own numbers past year one.
This article isn’t meant as tax or legal advice. Tax rules vary by individual situation and change over time, so talk to a CPA or tax attorney familiar with locum income before making structural decisions.
Your Effective Rate Isn’t the Number on the Contract
The rate on a locum contract assumes every scheduled hour gets worked and paid. In practice, credentialing delays between assignments, travel days, and gaps spent waiting for the next contract to start all eat into the year without showing up anywhere on the rate sheet.
The number that actually matters is your total annual take-home divided by every week you were unavailable for other work, not just the weeks you billed for. A CRNA who nets $280,000 across nine months of assignments but has three unpaid months of gaps and credentialing in between is earning less per actual year of availability than the hourly rate suggests, even before taxes enter the picture. Pull your last twelve months of settlement statements and run that division. Most locums have never actually done it.
The Washington-Oregon Tax Stack That Catches Locums Off Guard
Here’s where it gets specific to our region. Washington has no personal income tax, which every locum here already knows. What’s less commonly factored in is that independent contractors operating in Washington are subject to the state’s Business and Occupation tax on gross receipts, with no deduction for expenses since it isn’t an income tax at all. A W-2 employee’s wages are never subject to this tax because it’s the facility’s own business revenue that gets taxed on their end.
Crossing into Oregon changes the math entirely. Oregon taxes income earned within the state regardless of where you live, so a Washington-based locum working an Oregon assignment owes Oregon’s state income tax on those earnings, a rate that climbs to 9.9% above roughly $125,000 for a single filer. If that assignment happens to be inside Multnomah County or Metro’s district, which includes most of the Portland metro area, you can also add Metro’s Supportive Housing Services tax and Multnomah County’s Preschool for All tax on top, both of which explicitly apply to non-residents with income sourced from that jurisdiction, not just people who live there.
It shows up at reconciliation, and locums splitting time between WA and OR assignments are effectively running two tax systems that don’t offset each other. A full-time CRNA anchored to one facility in one state deals with this once, if at all.
Structuring for the Tax You Actually Owe
Some locums operating as sole proprietors leave money on the table by not revisiting their business structure. Electing S-corp status and paying yourself a documented, reasonable W-2 salary, with the remaining profit taken as distribution, can reduce the portion of income exposed to self-employment tax.
The IRS requires that salary reflect what the market would actually pay for the work, so this is a structure that needs a CPA familiar with locum income, not a shortcut. A W-2 employee never has to think about any of this, since their employer’s entity structure has zero bearing on how their paycheck gets taxed.
What Full-Time Still Buys: Guaranteed Hours
The deeper risk in locum work usually isn’t tax structure. It’s the contract itself. A day-rate or block-based assignment can shrink or disappear if a facility cancels a surgical block or census drops, and that risk sits entirely with you. A full-time position guarantees the hours regardless of what the OR schedule looks like that week, and total compensation in this region increasingly reflects that stability.
Running Your Own Comparison
If you’re trying to decide whether your locum situation still makes sense, the comparison that matters isn’t hourly rate to hourly rate. It’s total annual take-home, after both states’ tax exposure, business structure, and unpaid gaps, weighed against what a full-time offer would put into your account over the same twelve months.
For CRNAs who’ve run that math and found the gap smaller than expected, here’s a closer look at how full-time positions build long-term financial security that’s worth reading before your next contract decision.
Where AANW Fits Into the Decision
At AANW, we work with CRNAs on both sides of this decision every day, in locum roles and full-time positions. If you’ve never run the full-time math against what you’re making now, including what Washington and Oregon actually take out, it’s worth doing so before you sign your next assignment. It’s not a quick napkin calculation. It’s the difference between choosing locum because the math genuinely works for your life, and staying in it because the hourly number looked good on paper.
Our full-time openings across the Pacific Northwest are built around the tradeoffs we’ve covered in this piece. Guaranteed hours instead of a day rate, retirement matching and malpractice coverage you don’t have to price out and fund yourself, and one clean tax picture instead of reconciling two states that don’t offset each other. Some CRNAs run this math and decide locum still makes sense for where they are in their lives and career right now, and that’s a legitimate answer too. Others find the full-time picture is stronger than they assumed, especially once the Washington-Oregon tax stack and unpaid gaps get factored in honestly. Either way, you shouldn’t be guessing.
Check out our current openings or reach out to our team, and we’ll discuss your actual numbers, not the headline rate, to help you see exactly where you stand.
