The hourly rate on a locum contract looks great on paper. That’s essentially the whole pitch. Higher number, more freedom, no strings.
But the rate isn’t the compensation. It’s just the part you can see. And for CRNAs carrying six figures of graduate debt, the stuff you can’t see on a rate sheet often matters more than the rate itself.
Permanent, full-time positions come with financial machinery attached. Loan forgiveness eligibility, employer retirement contributions, tax-free loan assistance. A payroll tax bill that’s roughly half what a contractor would pay. None of that shows up in an hourly number, and all of it compounds.
Here’s what’s actually at stake.
Loan Forgiveness Only Opens for Employees
Start with Public Service Loan Forgiveness, because it’s the biggest single lever most CRNAs have.
PSLF wipes out your remaining federal Direct Loan balance after 120 qualifying payments. That’s roughly ten years and the thing most people get wrong about it is this: eligibility hangs on who employs you, not what you do. Your job title is irrelevant. What matters is whether your employer is a government entity or a 501(c)(3) nonprofit, and whether you’re working there full time.
The last part is the trap. Full-time employment is a hard requirement. Independent contractors generally can’t qualify at all, which means a CRNA running 1099 locum contracts is usually locked out of the program entirely, no matter how many hours they’re logging or how much they’re earning. Ten years of that work can leave you with a great income and zero progress toward forgiveness. Ten years of permanent full-time work at a qualifying facility can leave you with a balance of zero..
One caution worth taking seriously. Not every permanent employer qualifies. For-profit facilities don’t. Before you count on PSLF, run your employer’s EIN through the PSLF Help Tool and get it confirmed. Don’t assume.
Your Employer Can Pay Down Your Loans, Tax-Free
This one is newer and a lot of CRNAs haven’t caught up to it yet.
Under Section 127 of the tax code, an employer can put up to $5,250 a year straight toward your student loans, and it doesn’t count as taxable income to you. No federal income tax, no payroll tax, it all just goes to the loan.
That provision used to have an expiration date hanging over it. Employers were hesitant to build programs around something Congress kept renewing at the last minute. Then the One Big Beautiful Bill Act, signed in July 2025, made the student loan piece permanent and set the cap to rise with inflation.
Which means more employers are building real programs around it now. And it’s an employee benefit. You can’t collect it as a contractor working through your own LLC without setting up and administering a compliant plan yourself, which most solo CRNAs never bother to do.
Over five thousand a year, tax-free, aimed just at your principal. Over a few years that’s real money against a balance that’s otherwise just sitting there compounding..
Retirement: The Part Locums Quietly Lose
Here’s the math that gets people.
As a W-2 employee, your employer typically contributes to your 401(k) or 403(b). That match is compensation. It’s money that only exists because someone else is putting it in on your behalf.
As a 1099 contractor, you can absolutely open a solo 401(k) or a SEP-IRA. Good options, generous limits, but there’s no match. Every dollar in that account came from your own pocket. An employer match isn’t your own money moving around. It’s extra money, and it only exists if someone else is putting it in.
Run that gap across a career and it isn’t small. It’s one of the biggest hidden costs of chasing a higher hourly rate, and it shows up decades later, quietly, in a number you can’t do anything about anymore.
There’s also a newer wrinkle worth knowing about. Under section 110 of the SECURE 2.0 Act, employers can now match your student loan payments with retirement contributions. You pay the loan, they drop money in your 401(k) as if you’d contributed it yourself. It’s optional for employers, so not everyone offers it. But if you’re the CRNA who’s been skipping retirement contributions to kill the debt faster, this changes the whole calculus. And it only exists inside an employer plan.
The Tax Bill Nobody Warns You About
Payroll taxes split cleanly along the W-2 line, and most people don’t think about it until they file.
Social Security and Medicare taxes run 15.3% combined. As an employee, you pay half and your employer pays the remaining half. As a self-employed contractor, you pay both halves yourself. That’s self-employment tax, and it’s a real chunk of that attractive hourly rate you negotiated.
We’ve written more about how W-2 and 1099 classification plays out for CRNAs in the Pacific Northwest, because the differences run deeper than most people expect.
And the Rest of It
Malpractice coverage is the one that keeps CRNAs up at night, and rightly so. Permanent positions typically include it. Contractors are often on the hook for their own policy, and if it’s claims-made, there’s tail coverage waiting for you when you leave. This can have a brutal effect on your finances.
Then there’s health insurance, disability, life coverage, PTO, CME allowances and the days off to use them. Every one of those is either free to you as an employee or something you buy retail as a contractor.
We broke the whole thing down in more detail in our post on CRNA benefits packages, full-time versus locum, if you want a more complete comparison.
“The hourly rate is the easiest number to compare and the least useful one. Run the whole thing and most people land somewhere different than where they started.”
–Greg White, CRNA, Owner
Do the Actual Math
None of this is an argument that choosing locum contracts is a mistake. For some CRNAs, at some points in a career, it can be the perfect choice.
But compare the whole package, not the headline number. Employer retirement contributions. Loan forgiveness eligibility. Tax-free loan assistance. Half payroll tax. Covered malpractice. Add it up honestly and the permanent role often wins by a margin that surprises people.
AANW places CRNAs in permanent positions with hospitals, surgery centers, and clinics across Washington and Oregon. We’re clinician-led, so when you ask us about call structure or benefits or what a role actually pays out over five years, you’re talking to people who’ve been in the room before.
Take a look at our current openings, or reach out if you’d rather just talk through what your options actually look like.
