Tax Planning for Doctors, Run by Physician Tax Strategists
Tax planning for doctors is the work that happens before the return: choosing the entity, the retirement plan, the state elections and the timing so the return you file next April is smaller. Doc Wealth does that work for physicians, then prepares and files the return it produces.
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The Overview
Most physicians overpay on taxes every single year.
Not because they aren't smart enough to handle their taxes, but because their current CPA does nothing beyond filing a return. Physician tax planning is the difference between handing the IRS more than you owe and keeping that money where it belongs: building your wealth.
If your CPA only calls you in March, you don't have a tax plan. You have a tax filing service. And that gap is costing you real money every year it goes unaddressed.
Doc Wealth provides proactive, year round tax planning for physicians, from your first attending paycheck to the year you sell your practice. Your tax team of Tax Attorneys, CPAs, and Enrolled Agents works with you throughout the year as your physician tax strategists, so the return reflects a plan rather than a surprise.
In This Guide
The Problem
The Tax Planning Gap Costing Physicians Every Year
The two complaints we hear most from physicians coming to Doc Wealth for the first time: their CPA never communicates, and their CPA does nothing beyond filing a return.
That means most physician CPAs are doing the bare minimum. They file accurate returns while leaving significant money on the table every year in missed planning opportunities.
Consider what "nothing beyond filing" actually means. No one is evaluating whether your entity structure is optimized. No one is running quarterly projections to adjust your estimated payments. No one is analyzing whether an S-Corp election, cash balance plan, or PTET election could meaningfully reduce your annual tax burden. Your CPA receives your documents in February, files your return in March, and disappears until the following year.
This isn't your fault. Medical school, residency, and fellowship don't include a single hour on tax law. You spent a decade learning to save lives, and the CPA industry never evolved to serve the complexity of physician taxes. The generalist CPA you hired was never trained to handle multi entity structures, retirement plan stacking, or the 30+ deduction categories that apply specifically to your career. What you need is a physician tax advisor who plans ahead, not a generalist who files forms. That is what tax planning services for physicians are supposed to be.
The result? You're paying a tax bill that's significantly higher than it needs to be. At physician income levels, even one missed planning opportunity costs thousands. Compound that over a career, and the gap between what you're paying and what you should be paying grows substantially.
What "Filing Only" Actually Costs You
Six things your CPA is probably skipping.
No quarterly projections
Entity structure never reviewed
S-Corp / PTET elections missed
30+ deduction categories unchecked
Retirement stacking left on the table
Zero mid-year communication
Planning vs. Preparation
Tax planning vs. tax preparation: what a tax strategist does that a CPA may not
Tax planning is not the same as tax preparation. Tax preparation looks backward. It reports what already happened. Tax planning looks forward. It shapes what happens next.
Tax Preparation
Looks backward
Last April
Reports what already happened.
Tax Planning
Looks forward
Next 12 months
Shapes what happens next.
A tax strategist and a CPA are not the same job. A CPA prepares and files an accurate return. A tax strategist decides, before the year is over, what that return should contain: the entity, the retirement plan, the state elections, the timing. Some CPAs do both. Many do not. Doc Wealth does both, in that order, which is why physicians looking for tax advice for doctors end up here rather than with a filing service.
Proactive physician tax planning involves:
01
Entity structuring
Determining whether an LLC, PLLC, S-Corp, or combination makes sense from a tax perspective
02
Retirement plan optimization
Stacking Solo 401(k), cash balance plans, and backdoor Roth contributions to shelter income legally
03
Real estate tax integration
Using cost segregation, depreciation, and REPS status to offset clinical income
04
Quarterly projections
Adjusting estimated payments and withholdings throughout the year based on actual earnings
05
Mid-year adjustments
Responding to income changes, new contracts, or life events before December 31
06
Year end positioning
Making moves in Q4 to minimize your current year liability
Here's what this looks like in practice. A physician with significant 1099 income and no proactive tax plan is likely paying far more than necessary in federal and state taxes. That same physician, with an S-Corp election reducing self employment tax, retirement plan stacking sheltering substantial income, a PTET election bypassing the SALT cap, and optimized deductions capturing every legitimate write off, can see a dramatically different tax picture. The difference isn't theoretical. It's the result of having a tax team that plans proactively throughout the year instead of filing a return once in March.
When your tax team is doing all of this proactively, the savings compound year after year.
Which One Are You?
Tax planning for W-2, 1099 and practice-owner physicians
Proactive tax planning benefits physicians at every stage and every employment type, but the specifics look different depending on your situation.
1099 Physicians
If you're working as an independent contractor, you are paying self-employment tax on top of income tax, up to 15.3 percent on earnings below the Social Security wage base. Entity formation, S-Corp election, and retirement plan stacking can reduce your total burden significantly.
1099
Locum Tenens Physicians
Multi-state filing, travel deductions, tax home rules, and variable income create a uniquely complex situation. One misstep on tax home status can cost you every travel deduction for the year.
Locums
Practice Owners
Running a medical practice adds layers of complexity: payroll, entity structure, employee benefits, equipment depreciation, and cash balance plans. The opportunities are significant, but so are the compliance requirements.
See how medical practice accounting should run for physician owners.
Owner
Dual Physician Households
Combined high income means higher brackets, NIIT exposure, and coordination challenges between two employers. Filing status and benefit coordination alone can change your liability materially.
Dual
W-2 Physicians
Employed physicians often think tax planning is only for business owners. That's not true. At your income level, backdoor Roth IRAs, HSA optimization, additional backdoor Roth contributions through your employer plan, and charitable giving planning can save you meaningfully every year.
W-2
Our Approach
The Doc Wealth Approach
We built Doc Wealth because physicians deserve more than once a year tax filing from a CPA who treats them like every other client. You deserve a physician tax advisor who works proactively on your behalf, every month of the year.
Here's what makes our approach different:
1
Physician founded.
Our co-founder, Dr. Mark Applegate, is a practicing physician who built Doc Wealth after experiencing the same CPA frustrations you have. We understand the complexity of physician taxes because our founder lives it.
2
An elite tax team, not a solo practitioner.
Your dedicated tax team includes Tax Attorneys for complex structuring, CPAs for compliance and filing, and Enrolled Agents who can represent you before the IRS. This is not one person handling your return between fifty other clients. You have a tax team, not a solo CPA. See what a CPA for physicians looks like at Doc Wealth.
3
Year round engagement.
We don't disappear after April 15. Your tax team provides quarterly projections, mid-year adjustments, and year end positioning. You receive year round communication with your CPA, Enrolled Agent, or Accountant, along with access to our education platform covering 50+ physician tax topics.
4
Prompt, dependable communication.
You receive year round communication with your CPA, Enrolled Agent, or Accountant. Our dedicated team knows your file and works with you as tax questions arise throughout the year.
Last updated September 2026
What We Evaluate For Every Client
Physician Tax Strategies We Evaluate for Every Client
Every plan is built around your facts. Each of these applies only when the condition attached to it is true, so here is the condition as well as the move.
01
S-Corp Election
If you have 1099 income above the level where the payroll cost is worth it, electing S-Corp status can reduce self-employment tax. We handle the reasonable compensation analysis and payroll; entity formation is coordinated with our partners.
02
Retirement Plan Stacking
For 1099 physicians and practice owners, a Solo 401(k) alone can shelter a substantial portion of your income (subject to annual IRS adjustments). Add a cash balance plan on top, and physicians can defer even more, legally reducing taxable income in peak earning years.
03
Pass Through Entity Tax (PTET)
In states that offer a PTET election, your S-Corp or partnership can pay state income tax at the entity level and deduct it federally, which matters if your state and local taxes exceed the federal SALT deduction cap.
04
Tax Deductions Optimization
From home office and mileage to CME, malpractice insurance, and professional dues, most physicians miss deductions because no one told them what qualifies. Our team ensures every legitimate deduction is captured and documented.
05
Augusta Rule
If you own a business entity and a home, you can rent the home to the business for up to 14 days a year for legitimate business use and exclude that rental income. Documentation and a market rate are what make it hold up.
06
Hiring Your Children
If you have working age children and own a medical practice, employing them can shift income from your top tax bracket to their lower bracket.
07
Charitable Giving Optimization
If you already give, the question isn't whether to give. It's how to give in the most tax efficient way. Donor Advised Funds let you contribute appreciated stock (avoiding capital gains tax entirely), take an immediate deduction, and distribute the funds to charities over time. Bunching two years of charitable contributions into a single year can push you above the standard deduction threshold, capturing tax savings that would otherwise be lost.
08
Real Estate Tax Planning
If you own investment property, consider the tax planning dimension as well as income and appreciation: cost segregation studies that accelerate depreciation, Real Estate Professional Status (REPS) that allows losses to offset clinical income, and 1031 exchanges that defer capital gains on property sales. When real estate is integrated into your overall tax plan, it becomes one of the most powerful wealth building tools available to high income physicians.
09
Multi-State and Locums Planning
If you earn in more than one state, or work locums, the questions are which states you owe, how income is allocated between them, and where your tax home is for travel and lodging deductions. Getting this wrong is the most common compliance problem we see on physician returns.
Proof
Results physicians have seen
Thousands of physicians nationwide trust Doc Wealth for their tax planning.
Serving physicians in all 50 states.
Trusted by the physician finance community
Doc Wealth is listed in the White Coat Investor tax strategist directory and appears with the physician finance voices shown above. These are the people physicians turn to for vetted recommendations.
Real results, documented
Our physician clients consistently see meaningful tax reductions through proactive planning, depending on income level, practice structure, and which planning areas apply to their situation. The savings come from a combination of entity optimization, retirement plan stacking, deduction capture, and state tax planning. Not from a single silver bullet, but from a comprehensive approach that compounds across every area. When we opened 500 physician tax returns prepared elsewhere, the most common gaps were a missing or underfunded Solo 401(k), no S-Corp election on 1099 income, locums with states missing from their filings, and no PTET election where one was available.
Case Studies
01
Case Study 01
Texas
1099 Emergency Medicine Physician
Before
Came to Doc Wealth ready to get more strategic about taxes. They were filing as a sole proprietor, the same setup most physicians default to coming out of training, without an entity structure or retirement plan beyond a simple IRA.
What We Did
S-Corp election implemented
Retirement plan stacking built out
Every eligible deduction captured
Quarterly projections established
Outcome
The difference in their tax burden was immediate, and the plan continues to compound year over year.
02
Case Study 02
Pennsylvania
W-2 Hospitalist with Moonlighting Income
Before
Came to Doc Wealth looking to get ahead of a growing tax burden. They had 1099 consulting income flowing through without an entity, and their employer retirement plan had untapped opportunities.
What We Did
S-Corp set up for moonlighting work
Additional backdoor Roth identified through employer's 403(b)
Charitable giving implemented through a Donor Advised Fund
Outcome
The combined effect reshaped their entire annual tax picture.
These are representative engagements. What applies to you depends on your income, entities and states.
How It Works
What a year of tax planning with Doc Wealth looks like
01
Step 1
Discovery call.
Fifteen minutes on your income, entities, states and last two returns. No prep needed.
02
Step 2
Your Tax Planning Roadmap.
Within the first weeks, a written plan of what applies to you, what does not, and when each move happens.
03
Step 3
Implementation.
S-Corp election and payroll set up by your tax team; entity formation and EIN coordinated with our partners with us walking you through each step; retirement plans established with the providers you choose.
04
Step 4
Quarterly reviews and estimated payments.
Every quarter, numbers updated to your actual income so April is not a surprise.
05
Step 5
Year end moves.
Retirement contributions, charitable timing, equipment and anything else with a December 31 deadline, decided in the fall.
06
Step 6
Preparation and filing.
Federal and every state you touched, prepared by the same team that built the plan.
07
Step 7
Post filing review.
What worked, what changes next year, and the roadmap updated for the year ahead.
The Price
What physician tax planning costs
The Payoff
What Life Looks Like With a Tax Plan
When your tax planning is handled by a dedicated team that works on your behalf year round, the change is measurable and immediate.
You stop wondering
whether you're overpaying, because you know your plan is optimized.
You stop scrambling
in March, because your tax team has been managing your situation since January.
You stop Googling
tax questions on your own, because year round communication with your CPA, Enrolled Agent, or Accountant helps you understand how tax decisions apply to your situation.
The impact compounds: meaningful savings year after year means substantially more wealth over the course of your career. That's money available for investments, for your family, for earlier retirement, or for the charitable causes you care about.
The part of your tax situation that used to keep you up at night becomes the most handled area of your life.
Answers
Tax planning questions physicians ask
Doc Wealth's planning and preparation packages start at $3,799 a year for W-2 physicians, $4,799 a year for 1099 physicians and $11,400 a year for practice owners, quoted up front as a flat fee. The pricing page has the full breakdown.
Now. Tax planning is most effective when your tax team has a full year to implement planning areas. Starting in January gives you twelve months of optimization. Starting in October limits your options. That said, it's never too late to start.
Three things set us apart: we're physician founded (we understand your world), our team composition includes Tax Attorneys, CPAs, or Enrolled Agents (not a solo CPA), and we provide year round engagement. This includes communication with your CPA, Enrolled Agent, or Accountant and access to an education platform covering 50+ topics.
Yes. Doc Wealth serves physicians in all 50 states, including complex multi-state filing situations for locum tenens and telemedicine physicians. For more answers, see our complete FAQ.
It depends on how you are paid. Employed physicians do not have business deductions, but more room in retirement plans, HSAs and charitable timing. 1099 physicians and practice owners can deduct ordinary and necessary business expenses: malpractice premiums, licenses and CME, a home office that meets the rules, business travel and the retirement plans that only exist for the self-employed. Our deductions guide walks through each with its conditions.
The ones we see missed most often are retirement plan contributions that were never made, the S-Corp election on 1099 income, deductions for licenses, CME and malpractice paid out of pocket, and state elections like PTET where they exist. We wrote up eleven of them.
For 1099 physicians, the S-Corp election and a Solo 401(k) usually come first. For practice owners, entity structure, reasonable compensation and the Pass Through Entity Tax election in states that offer one. For W-2 physicians, retirement plan stacking, HSA contributions if you are on a high deductible health plan, and charitable timing. Each has a condition that makes it apply, which is what the strategies section above sorts out.
A CPA is a licensed credential; a tax strategist is a role. A CPA prepares and files returns and may or may not plan ahead. A tax strategist decides, during the year, which entity, retirement plan, state election and timing the return should reflect. Doc Wealth's tax team does both, planning first, and includes CPAs, Enrolled Agents, or Tax Attorneys.
Yes, though the moves are different. A W-2 physician cannot elect S-Corp status on wages, but at physician income levels retirement plan stacking, backdoor Roth contributions, HSA contributions on a high deductible health plan, charitable bunching and coordinating two employers' benefits in a dual physician household all add up. A single state W-2 physician with no side income has the least to plan, and we will say so on the first call.
This material is intended for educational and informational purposes only and does not constitute tax, legal, accounting, or financial advice. The content is general in nature and may not apply to your specific circumstances. Tax laws and financial regulations are subject to change and interpretation, and the application of these laws can vary based on individual situations. Before making any decisions, you should consult with a qualified tax advisor, legal counsel, or financial professional.