Navigating 1099 Contracting: Which Employers Are Hiring Physicians?

The landscape of physician employment is rapidly evolving, with more of you than ever embracing the flexibility and autonomy of 1099 contracting work. This shift isn’t just a trend; it’s a significant change in how you are approaching your career and professional identity. While traditional W-2 employment remains prevalent, an increasing number of you are seeking—or supplementing your income with—1099 contracting roles. Whether you're a seasoned physician or just beginning your career, understanding the dynamics of 1099 contracting can open up new avenues for professional growth and personal fulfillment.

The Rise of 1099 Contracting in Medicine

Recent data from Medscape suggest that nearly 50% of physicians in the 40’s have side gigs and are currently working as independent contractors, receiving 1099 income on top of their primary job. This shift is not driven by a desire to work more but by the changing dynamics of the physician labor market. Many of you today are increasingly drawn to the autonomy, flexibility, and financial benefits that 1099 contracting offers. These arrangements allow you to structure your work in a way that aligns with your lifestyle and career goals.

The trend of prioritizing lifestyle-oriented career choices is becoming increasingly prevalent among younger physicians. This shift in professional approach reflects a broader generational change in work-life balance expectations. Many newly qualified doctors are strategically selecting and combining multiple positions, a practice known as "job stacking," to create a work schedule that aligns more closely with their personal preferences and life goals. This approach allows you to diversify your professional experiences while maintaining greater control over your time allocation. By carefully selecting a combination of part-time roles, locum positions, or telemedicine opportunities, you can craft a career path that offers flexibility, varied clinical exposure, and potentially higher overall compensation. This strategy often enables them to pursue personal interests, engage in continued education, or dedicate more time to family and personal well-being alongside their medical practice. The rise of this trend underscores a significant evolution in the medical profession, where traditional full-time, single-institution career paths are being reimagined to accommodate changing priorities and lifestyle preferences of the newer generation of healthcare professionals.

In my opinion this is a great approach, because of the diversified income channels, the preservation of your professional autonomy associated with independent contracting, and the tax efficiency of 1099 income over W-2 income.

Types of 1099 Contracting Work for Physicians

1099 contracting in medicine is diverse, offering various opportunities for you across different specialties and stages of your career. The types of positions and roles is constantly growing but include the following non-exhaustive list, and for kicks I’ll place a check mark by the ones that I have done:

• Telemedicine ✅

• Medical Writer/Editor✅

• Medical Legal Consultant/Expert Witness✅

• Locum Tenens✅

• Health and Wellness Coaching/Lifestyle Medicine✅

• Independent Medical Examiner/Chart Review for Insurance Companies

• Medical Director for Assisted Living/Nursing Homes/Home Health/Hospice✅

• Clinical Research Investigator

• Concierge Medicine/Direct Primary Care/Precision Medicine/Cash Only Practice

• Medical Education (CME) Instructor✅

• Health IT Consultant

• Medical Spa Provider

• Collaborating APP’s✅

• Occupational Medicine Consultant

• Sports Medicine Consultant✅

• Health Content Creator/Online Influencer:✅

• Medical App Developer/Healthtech Start Up✅

• Disability/Workers’ Compensation Evaluator

Now let’s take a deeper dive into the more common types of 1099 work:

• Locum Tenens: Locums are the classic form of 1099 contracting, providing short-term coverage for hospitals or clinics. This type of work is ideal for those of you seeking flexibility, travel opportunities, or those in transition between jobs. Locums work is particularly common among early-career physicians looking to gain diverse experiences or seasoned doctors seeking a change of pace.

• Telehealth: The rise of telemedicine has created a new frontier for 1099 contractors. Telehealth allows physicians to provide care remotely, offering a flexible and often location-independent work option. This is particularly appealing for those of you who want to balance work with family life or those living in areas with limited local job opportunities.

• Hospitalist, ER, Anesthesia and other specialties: Long-term contracting work is increasingly common in roles like hospitalist, emergency room, and anesthesia physician positions. These contracts offer stability while still providing the autonomy that comes with being a 1099 contractor. Doctors who contract in this way often have more control over their schedules and work conditions and it’s not uncommon to see their work considered “shift” work whereby they provide a set number of labor force shifts/month.

• Employment Lite: This model allows physicians of any specialty to work as long-term contractors within a practice or healthcare system. While it may resemble traditional employment in structure, it differs in that it preserves the physician’s independence by establishing a business-to-business relationship through the doctor's professional micro-corporation. This is how I transitioned from traditional W-2 employment into the independent contracting world. I am a big fan of this structure being a superior option to traditional employment. You can read the long version of my story in my best selling book “Doctor Incorporated: Stop The Insanity of Traditional Employment and Preserve Your Professional Autonomy”

Where Are These Jobs?

A common question that I get from our SimpliMD community is who is most likely to hire doctors as long term independent contractors?

Of course, this preference stems from the innate human desire for predictable and consistent work and income that doesn't necessitate relocation or significant lifestyle changes. This inclination is deeply rooted in our psychological need for stability and security. Although it's not insurmountable to manage, frequent moving and traveling can indeed be quite disruptive to the quality of life for individuals and their families. Such disruptions can affect various aspects of life, including children's education, social connections, and overall sense of belonging.

One of the notable elements of modern medical 1099 work that has significantly alleviated this tension is the emergence of location-independent work opportunities. This shift in the work paradigm has been facilitated by advancements in technology and changes in organizational structures. Location-independent work allows you to maintain your practice and income stream without the need for physical relocation, thereby addressing many of the traditional challenges associated with career mobility in the medical field. You can read more about this in my post: Location Independence for Working Doctors.

As example, I have spoken to a few doctors in our SimpliMD community who live in Southern California (lifestyle and family preferences) but do specialty driven telehealth jobs in the Midwest 1-2 weeks a month. This is pretty cool because the they get to have the proverbial “cake and eat it too”—getting to live a great location while taking advantage of geographic arbitrage related to the demands of their specialty.

Employers Most Likely to Hire 1099 Contractors

While not all healthcare organizations are open to 1099 contracting, several types of employers are more likely to embrace this model. These employers recognize the value of flexibility and independence in their physician workforce:

1. Telemedicine Companies: Given their reliance on remote care, telemedicine companies are often structured around 1099 contracts. They typically view physicians as independent contractors, providing care through their platform on a flexible basis.

2. Medical Groups or Practices: Some medical groups, particularly those that specialize in areas like urgent care or specialty services, are open to 1099 contracting. These groups value the ability to scale their services through independent contractors who bring specialized skills and flexibility.

3. Rural or Underserved Areas: Healthcare organizations in rural or underserved areas may use 1099 contracts as a strategy to attract physicians. These contracts can make positions in less desirable locations more appealing by offering flexibility and autonomy.

4. Startups and Innovative Healthcare Ventures: Emerging companies in the healthcare space, especially those focused on disruptive innovation, are often open to non-traditional employment arrangements. They may use 1099 contracts to attract physicians who are entrepreneurial and eager to be part of something new.

5. Hospitalist, ER Services, Anesthesia, etc…: Hospitals looking for flexible staffing solutions for their hospitalist, emergency room, and anesthesia services may opt for 1099 contractors. This allows them to meet fluctuating patient demands while providing doctors with the autonomy they desire.

Employers Least Likely to Hire 1099 Contractors

On the other hand, some healthcare employers are less inclined to engage physicians as 1099 contractors. These organizations tend to prefer traditional employment models that offer them more control over their physician workforce as they inflexibly offer boilerplate W-2 contracts.

1. Large Urban Hospital Systems: In metropolitan areas where the physician labor market is saturated, large hospital systems are less likely to offer 1099 contracts. These systems prioritize control and consistency in their workforce, which they achieve through standardized W-2 employment agreements.

2. Academic Medical Centers: Academic institutions often seek to maximize control over their physician staff, ensuring alignment with their educational and research missions. These centers typically offer salaried positions with little room for the flexibility that 1099 contracting provides.

3. Integrated Health Systems: These systems, which combine hospitals, outpatient services, and insurance plans, often favor traditional employment to maintain tight control over their operations and ensure uniformity in care delivery.

Take Control of Your Career

My best advice is to start out your career with the mindset that you want to work as an independent contractor, whose income flows through your micro-corporation. This is why I wrote the post 20 Reasons Every Resident Should Form A Micro-Corporation. In my opinion, every resident should make starting their own micro-corporation the capstone to their medical training so that they can enter the marketplace ready to thrive as a micro-business.

Sadly, I speak to too doctors every week who jumped right into traditional employment and now, 5-10 years later, feel trapped in forced into co-dependence on a single employer. I spoke to a doctor this week in that exact situation—she was paralyzed with fear about jumping into self-employment and independent contracting but knew she had to make a change due to burnout. She has a great job-stacking plan that includes a cash-only obesity clinic, telehealth, medical-legal consulting, and locum tenens work within her existing urban hospital system. She just needed a little support and coaching to help her say “yes, I going for it”, and now she is ready to regain her professional autonomy and thrive as a self-employed 1099 doctor. I am helping her take the important step of creating a micro-corporation through our SimpliMD professional network.

Perhaps you would benefit from a similar one-time micro-business consultation to provide you with advice and coaching. For less than the cost of a dinner, I can help you overcome the fear of change and begin to thrive the way you were meant to. I would love to help you. Just go here to sign up.

If you’re considering stepping into the world of 1099 contracting, it’s crucial to understand the landscape and identify the types of employers that align with your career goals. Whether you’re looking to diversify your income, gain more control over your work-life balance, or simply explore new opportunities, 1099 contracting offers a pathway to achieving those goals.

To take the first step toward building a career that aligns with your professional autonomy, consider enrolling in my new course, "Creating a Practice Without Walls." This course will guide you through the process of setting up your professional micro-corporation and teach you how to navigate the complexities of 1099 contracting in today’s healthcare environment.

Special Offer: For a limited time, I’m offering a 50% discount on the course using the coupon code "EARLYBIRD." Don’t miss this opportunity to redefine your career and take control of your professional destiny.

Enroll today and start your journey towards a more flexible, fulfilling, and financially rewarding medical career!