A 1099 rate has to clear roughly 21 percent above an equivalent W-2 base just to replace payroll taxes, health coverage, retirement match, malpractice and CME — before a single unpaid day off. On a $145,000 salaried job with 26 paid days off, true break-even is about $94 an hour. Two hosts run the real math, explain why most PMHNPs should target $103 to $108 to absorb unbilled time, and cover what self-employment tax does to whatever is left. Work the numbers yourself: https://psychnpfellowship.com/pmhnp-1099-vs-w2-contract-offer-math-2026/