Locum Anesthesiology vs Permanent Anesthesiology in North Carolina
Real numbers, state-adjusted. See what permanent doesn't show you — and what locum doesn't get.
Direct Answer
Locum anesthesiology in North Carolina earn $385–$495/hr (annualized $813,120–$1,045,440 at 44 working weeks). Permanent anesthesiology in North Carolina earn $462,000–$572,000 base salary plus benefits worth ~$83,160–$102,960. Locum total comp tops permanent by $138,160–$500,280 in 2026.
Pay rates per LocumOS Physician Freedom Project 2026, AMN Healthcare 2026, and NALTO benchmarks. Physician take-home, 1099. Updated May 2026.
Side-by-Side: Locum vs Permanent Anesthesiology
| Factor | Locum (1099) | Permanent (W-2) |
|---|---|---|
| Annual Compensation | $813,120–$1,045,440 (gross, 1099) | $545,160–$674,960 (salary + benefits) |
| Hourly Equivalent | $385–$495/hr | $222–$275/hr equivalent |
| Benefits | Malpractice, travel, lodging bundled. Solo 401(k) to $69K. No employer match. | Health insurance, 401(k) match (~3–6%), PTO, CME stipend. Tail usually not included. |
| Schedule Control | Pick OR days, avoid committees, no call after assignment ends | Fixed schedule, call obligations, committee duties, admin meetings. |
| Tax Structure | 1099 S-Corp typical. Deduct travel, lodging, equipment. Solo 401(k) + backdoor Roth stack. | W-2. Standard deductions only. FICA split with employer. Limited retirement options. |
| Lifestyle | Block schedule: work 2–4 weeks, take 1–2 off. No hospital politics, no partner track anxiety. | 2–4 weeks PTO per year. Call obligations. EMR inbox. Hospital politics. |
| Career Risk | Partnership buy-in is $0. No golden handcuffs. But no guaranteed income floor either. | Partnership track or employment model. Non-compete clauses. Golden handcuffs. |
What Permanent Doesn't Show You
FICA/SS Hidden Cost
Employer pays 7.65% FICA match (~$35,770) that never hits your W-2. As 1099, you pay both halves — but deduct the employer half.
Malpractice Tail
When you leave perm, tail coverage costs $25,000+. Locums One includes tail in every assignment.
Vacation Buy-In
4 weeks PTO = $40,000 in deferred earnings. Locum: take time off between assignments, no unpaid gap.
License & CME Fees
~$7,000/year in license renewals, DEA, board fees, CME travel. Often out-of-pocket even with "CME stipend."
What Locum Doesn't Get
Employer Health Insurance
No default group health plan. You buy on the marketplace or through a spouse. Cost: $8K–$18K/year for family coverage.
Retirement Match
No employer 401(k) match (~$25,200 value). You max Solo 401(k) to $69K — but it's all your money.
Annualized Math for North Carolina Anesthesiology
Locum 1099
Permanent W-2
Locum net tops permanent net by:
$138,160–$500,280
At 44 working weeks. Work 8 weeks off per year.
Your Locum Career, Managed End-to-End
The biggest objection to switching from permanent to locum is career management. Who handles your next assignment? Your licensing? Your tax strategy?
Locums One does. Same recruiter every assignment. State licensing handled. Malpractice verified. Travel booked. We do not just place you — we manage your locum career so you can focus on medicine.