LOCUM TENENS PAYROLL · 1099 PHYSICIANS, W-2 STAFF & CREDENTIALS

Physicians on 1099, recruiters on W-2. WageTime pays both in the same run.

WageTime is payroll for locum tenens staffing agencies: the 1099 physicians you place and the W-2 recruiters who placed them settle on one payday, with fee-for-time pay and credential files on the same roster.

Built on infrastructure processing $35B+ in payroll & taxes · 4.3M+ W-2s & 1099s filed

WageTime provides payroll mechanics, not tax or legal advice. Whether a provider is a 1099 contractor or a W-2 employee is a classification decision for you and your counsel; 1099 income is paid without tax withholding, and the provider handles their own estimated taxes. Sample screens use a demonstration environment.

SOUND FAMILIAR?

A physician on a 1099, a recruiter on a W-2, a DEA card that expires mid-assignment, and a rule that says how you can pay. Generic payroll models none of it.

Locum tenens payroll is not the warehouse-staffing treadmill. It is a smaller roster of credentialed clinicians, most of them independent contractors, paid a per-diem or hourly fee for time worked, plus a back office of W-2 recruiters who found them the assignment. Miss the classification, misread the pay basis, let a credential lapse, or withhold in the wrong state, and the fix is slow and costs real money.

THE 1099 QUESTION

Your physicians aren’t on your W-2

Short locum assignments usually pay the physician as a 1099 independent contractor, not a W-2 employee: no tax withholding, no benefits, and a higher headline rate to offset the self-employment cost. Longer or agency-employed engagements sometimes flip to W-2. Either way the classification is your call with counsel, and payroll still has to pay both kinds of people correctly on the same Friday.

FEE FOR TIME, NOT A SALARY

How you pay a locum is constrained

Under Medicare’s fee-for-time rules, a substitute provider is paid on a per-diem or hourly basis for time worked, not a salary and not a productivity split. Facilities bill those services under the regular physician’s NPI with the Q6 modifier, for up to sixty continuous days. Your payroll therefore runs on day rates and hourly fees, not an annual salary divided by twenty-six.

NO COMPLETE FILE, NO START

License, DEA, board, malpractice

Before a locum sees a patient the file has to be complete: an active state medical license for the assignment state, DEA registration, board certification, and malpractice coverage with tail. Credentialing proves the provider is qualified; privileging is the facility saying which procedures they may perform. If any of it expires mid-assignment, the provider stops and your billing stops with them.

TWO PAYROLLS, ONE SHOP

Contractors and staff in one place

The clinicians are 1099. The recruiters, credentialing coordinators, and branch staff who placed them are W-2, often on base plus a placement bonus. Agencies typically end up with a contractor-payment tool bolted onto a separate employee payroll, reconciled by hand every single period.

THE 1099 TAX SPLIT

One roster, two tax treatments

A locum physician can cover four states in a year. For a W-2 locum that means multi-state withholding that follows the worksite. For a 1099 contractor there is no withholding at all, but the year-end 1099-NEC still has to reflect exactly what you paid. One roster, two completely different tax treatments, running at the same time.

Every screen below is built for a desk that pays physicians by the day and staff by the pay period.
01 · 1099 AND W-2, ONE PAYDAY

How do you pay 1099 physicians and W-2 staff in the same payroll?

In the same run: WageTime pays locum physicians engaged as independent contractors their contract rate without withholding, while W-2 recruiters and coordinators are withheld and filed, and both settle on one payday.

  • 1099 contractors and W-2 employees in one payroll run.
  • Year-end 1099-NEC and W-2 forms both produced.
  • Base-plus-placement-bonus recruiters on the same register.
  • Classification stays your decision with counsel.
app.wagetime.com/payroll/mixed-run

Weekly Run · Locum Desk · Week of Mar 9

1099 + W-2 in one runYear-end forms included
$24,750.001099 and W-2 gross
2Contractors on 1099
2Employees on W-2
Dr. Alan M.1099$12,950.00
Hospitalist · 7 days at $1,850/day
Priya S., CRNA1099$7,560.00
36 hrs at $210/hr
Marcus B., RecruiterW-2$3,120.00
Base plus placement bonus
Lena K., CoordinatorW-2$1,120.00
Credentialing · 40 hrs at $28.00
One run, two worker typesW-2s and 1099s at year-end

Replaces the contractor-payment app bolted onto a separate W-2 payroll, reconciled by hand every period.

02 · FEE FOR TIME, ON THE CLOCK

How do you pay a locum per-diem or hourly, plus call?

Fee-for-time pay runs as WageTime pay codes, not a salary: a day rate for a per-diem shift, an hourly rate for coverage, and call pay alongside, itemized by day, hour, and call on one statement.

  • Day rates and hourly fee-for-time rates as pay codes.
  • On-call, standby, and call-back pay as their own codes.
  • Sign-on and completion bonuses in-cycle or off-cycle, no extra cost.
  • A day rate and an hourly cross-cover in the same week, itemized.
  • Weekly or biweekly cadence, unlimited runs.
app.wagetime.com/payroll/fee-for-time

Fee-for-Time · Dr. Alan M. · Week of Mar 9

Per-diem and hourly in one weekCall pay as pay codes
Dr. Alan M., Hospitalist
5 per-diem days × $1,850$9,250.00
12 ED hrs × $190.00$2,280.00
3 call nights × $400$1,200.00
Completion bonus$1,500.00
Gross this week$14,230.00
Per-diem, hourly, and call in one weekeach basis runs as its own pay code

Replaces the salary field a locum’s pay does not fit, and the spreadsheet where call and completion pay get added by hand.

03 · THE FILE THAT CLEARS A START

How do we track a physician’s licenses, DEA, board, and malpractice?

The whole credential file lives on the provider’s record: every state medical license, DEA registration, board certification, and the malpractice certificate the agency carries, each with its own expiration date and the document attached.

  • Every state medical license a provider holds, tracked separately in WageTime.
  • DEA registration, board certification, and malpractice tail on file.
  • Alerts that escalate as an expiration date approaches.
  • Flags credentials that lapse inside the current assignment window.
  • Credentialing dates you own; privileging stays the facility’s call.
app.wagetime.com/hr/provider-file

Provider Credential File · Locum Desk

License, DEA, board, malpractice2 lapses before next start
ProviderCredentialExpires
Dr. Alan M., HospitalistTX, NM, OK · 61 days outState medical licenseAug 14
Priya S., CRNAFederal · expires Apr 2DEA registration18 days
Dr. Alan M., HospitalistCarried by agency · Apr 11Malpractice, tail27 days
Dr. Omar R., RadiologyNational · 150 days outABR board certificationNov 20
96 providers on file2 credentials lapse in 18 and 27 days · documents attached

Replaces the shared drive of scanned licenses nobody reconciled, and the assignment that fell through when a DEA registration quietly expired.

04 · FOUR STATES, TWO TAX TREATMENTS

Which taxes apply when a locum works several states, on 1099 and W-2?

Two ways, split by how each provider is engaged: a 1099 locum has no income tax withheld and gets a year-end 1099-NEC, while W-2 withholding follows the work address, state by state.

  • The physician handles their own estimated taxes with their advisor.
  • W-2 withholding geolocated to rooftop level, 11,000+ locals, 50 states plus Puerto Rico.
  • Reciprocity, overrides, and effective-dated setup for mid-year moves.
  • Every W-2 filing and deposit automatic; each EIN on its own account.
  • Contractors and employees kept on one WageTime roster, one login.
app.wagetime.com/people/tax-treatment

Tax Treatment by Provider · Q2

1099 vs W-2 handled3 states this quarter
4People this quarter
2Paid on 1099-NEC
2Paid on W-2
PersonTypeTax handling
Dr. Alan M., HospitalistTX assignment1099No withholding, 1099-NEC
Priya S., CRNACO assignment1099No withholding, 1099-NEC
Marcus B., RecruiterIL (HQ)W-2IL withholding, filed
Dr. Sara L., PsychiatryOH assignmentW-2OH plus Columbus municipal
1099 and W-2 on one roster2 contractors on 1099-NEC · 2 employees withheld and filed

Replaces the January guess about whether a provider gets a 1099 or a W-2, made at year-end instead of at setup.

PRICING

Simple payroll pricing. No surprises.

Full-service payroll is $10 a month per person paid that month, plus $50 a month per company, with unlimited runs. No long-term contracts, no per-run charges.

  • Full-service payroll, unlimited runs
  • Federal, state & local tax filing
  • Year-end W-2s & 1099s
  • Direct deposit, checks & pay cards
  • Contractor payments & filings
  • Off-cycle runs & bonuses, no extra fee
  • Employee paystubs & W-2 access
  • QuickBooks integration
$10/mo per person paid
+ $50/mo per company

Off-cycle runs and bonuses cost nothing extra. No long-term contracts; cancel anytime.

Example: 50 people paid × $10 + $50 company = $550 for the month

HR & hiring, onboarding, PTO, time tracking, benefits, and workers’ comp are optional add-ons, priced separately when you’re ready.

See a demo
THE INFRASTRUCTURE BEHIND WAGETIME
$35B+
in payroll & taxes paid
2.8M+
employees paid
4.3M+
W-2s & 1099s filed
100%
of tax filings automated

Locum tenens payroll FAQ

Are locum tenens physicians paid on a 1099 or a W-2?

Both models exist, and it depends on the assignment. Short locum engagements are usually paid as 1099 independent contractors, while some longer or agency-employed arrangements are W-2. The classification is a legal decision for the agency and its counsel, not a payroll setting. WageTime pays each provider the way you classify them and issues the matching 1099 or W-2 at year-end.

Can WageTime pay 1099 physicians and W-2 internal staff in the same payroll?

Yes. WageTime runs 1099 contractors and W-2 employees in one payroll, so your locum physicians and your recruiters and coordinators settle on the same payday. Contractors are paid without tax withholding and receive a 1099-NEC; W-2 staff have taxes withheld and filed and receive a W-2. Both sets of year-end forms are included.

How do you pay a locum physician, salary or per diem?

On a fee-for-time basis. Locum physicians are typically paid a per-diem day rate or an hourly rate for time worked, not an annual salary. In WageTime those run as pay codes, with on-call, standby, and call-back pay and any sign-on or completion bonus as their own codes, so a week that mixes a day rate and hourly cross-cover comes out itemized and correct.

What do the Q6 modifier and the 60-day rule mean for how we pay locums?

The Q6 modifier and 60-day rule are Medicare billing rules for the facility, not payroll settings. A regular physician can bill a substitute’s services under their own NPI with the Q6 modifier for up to sixty continuous days, and Medicare expects the locum paid on a fee-for-time, per-diem or hourly, basis. WageTime pays that fee as a pay code; how your client bills Medicare stays with the facility.

Can WageTime track physician licenses, DEA registration, and board certifications?

Yes. A locum physician usually carries medical licenses in several states at once, plus a DEA registration, board certification, and the malpractice certificate your agency provides. WageTime stores each of those on the provider’s record with its own renewal date and document, and escalating alerts surface a credential that is about to expire so you can renew it before it stops an assignment.

What does payroll cost for a locum tenens agency?

$50 a month for the company plus $10 for each person paid that month, with unlimited runs. A 1099 physician and a W-2 recruiter each count as one person paid, and weekly pay costs the same as biweekly. An agency paying 20 physicians and 5 internal staff in a month is $300, and a slow month costs less because you pay only for people paid.

Bring one week of your locum desk.

One physician’s per-diem week with call pay, one recruiter on base plus bonus, and your credential list. Twenty minutes with a payroll specialist on a live demo company: you’ll see 1099 physicians and W-2 staff run together, fee-for-time and call pay as pay codes, the credential-expiration file, and the split between contractor and employee tax treatment.

Book a 20-minute demo