Is W2 or 1099 better as a hospitalist?

Neither, until you price the whole job. The W2 salary and the 1099 rate are not the same kind of number: one arrives with a layer of employer spending attached, and the other arrives bare. The 1099 rate has to run about 25 to 30 percent above the W2 offer before the two are even the same pay. That premium is not a bonus for flexibility. It replaces the employer half of payroll tax and the benefits the W2 job was buying for you, and a 1099 offer priced near the W2 salary is a pay cut wearing a contractor costume.

Part of the internal medicine hub.

Price what the W2 job pays that never reaches your paycheck

Start with the tax layer. An employer pays half of the 15.3 percent payroll tax on your wages before you see a dollar; as a contractor you pay the whole 15.3 percent yourself as self employment tax, 12.4 percent for Social Security up to the annual wage base and 2.9 percent for Medicare on everything, and your hospitalist income will pass the wage base. Then price the benefits, because when the bases are close, benefits decide: the retirement match formula, the disability definition and its monthly cap, who pays the tail, and your CME dollars and days. A 4 percent match on a 300,000 dollar salary is 12,000 dollars a year that a 1099 rate has to replace before it starts winning. Add the coverage the group was carrying for you, malpractice with tail, health premiums, and licenses, plus any paid time off or CME days the W2 offer actually lists. On a seven on seven off rotation the off weeks are built into both versions, so read the W2 offer for what it pays beyond them, because on a 1099 any shift you give up is income gone. The internal medicine contracts page prices the shift count and the differential the same way, and the 25 to 30 percent premium is the number that keeps surviving the math. If forgiveness is part of your loan plan, confirm who your legal employer is under each offer before you compare anything, because that one line can be worth more than the premium.

Where the 1099 version honestly wins

The contractor side has real weapons, and they are worth naming. A solo 401(k) lets you contribute in both capacities, as the employee making elective deferrals and as the employer adding nonelective contributions, which for a self employed contractor works out to about 20 percent of net self employment earnings, which can shelter more than many group plans allow once a match formula caps out. You choose your own disability and life coverage instead of accepting a group definition, you can work more than one site, and the schedule control is yours in a way no employed job matches. Those weapons pay when the premium is real and when you will actually run the business side: the entity, the quarterly estimates, the separate accounts, the coverage bought on purpose. They do not pay when the rate is thin and the administration lands on a hospitalist who wanted the employed job's simplicity at a contractor's risk. So the answer is arithmetic, not identity. If the 1099 premium clears the band and you want the control, take it and run it like a business from day one. If the premium is inside the band, the W2 job is the better instrument: same work, more of the cost carried by the employer, and a benefits stack you did not have to build yourself. Either way, compare totals: the internal medicine retirement page lays out the solo 401(k) menu the contractor version builds from.