Physicians are the most-overpaid bucket on the tax-code curve. High W-2, often with 1099 moonlighting or locums, sometimes a private practice S-corp, complex retirement options, and almost never anyone running the math across the whole picture. The savings range we model on physician engagements is the widest of any segment we serve.
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The pain at physician income levels isn't about the work itself. It's that nobody owns the strategy. The compensation team handles your W-2, the locums billing service handles your 1099, the hospital benefits portal handles the 401(k), and your tax preparer just sums it up at year-end.
"I'm a hospitalist clearing $420K plus locums on the side. My preparer files my return. He's never once mentioned S-corp, retirement stacking, or what to do about my 1099 income."
Hospitalist · $420K W-2 + $80K 1099 · Apr 2026
"We're both attendings. Two W-2s, two 1099s, dual incomes. April hits and we owe another $40K we didn't plan for. There has to be a better way."
Dual-physician household · ~$720K HHI · Mar 2026
"I have a Cash Balance plan I don't fully understand. The fees are eating me alive. Nobody can tell me whether I should keep contributing or close it out."
Specialist · $1.1M HHI · Feb 2026
Physician engagements run wider than typical because the income streams are wider. Here's the standard playbook — refined per specialty during the Discovery call.
Once your 1099 / locums clears $80K+ net, S-corp election typically saves $8K–$15K/yr in SE tax. We model your reasonable comp benchmark against medical-specialty data so the position is defensible. The election can usually be filed retroactive to January.
Most physicians load the 401(k) and stop. You can stack Solo 401(k) (on the 1099 entity), Cash Balance, mega-backdoor Roth, HSA + LPHSA, after-tax 401(k), and NQDC. Done correctly the deferred-tax shelter runs $40K–$80K/yr in the high-earner case.
Home office, CME, vehicle, scrubs, malpractice, licensing, conference travel. Most physician S-corps run without one and lose deductions every year. We give you the template and the documentation chain.
RSU vesting from large hospital networks bumps you into higher brackets quietly. We model the vesting calendar against the bracket math and write the sell plan — including which lots to hold for LT cap gains vs. sell at vest.
Locums physicians filing in 4+ states get hit twice without source-state allocation. We handle the residency analysis, the credit-for-tax-paid-to-other-states math, and the throwback rules. Multi-state income, one clean return.
Physicians are the highest-leverage candidates for the STR loophole and cost seg. One Airbnb with material participation + a cost seg study can offset $30K–$60K of W-2 income in year one. We model whether real estate is the right counter-balance to your W-2 / 1099 income mix.
Anonymized. Numbers are modeled year-one savings from recent physician Tax Analyses + retainer engagements.
Late S-corp election on the 1099 entity, Solo 401(k) profit-share maxed, accountable plan built for the moonlighting trips. Year-one savings $34K, plus a clean structure for the next 10 years of practice.
Mega-backdoor Roth opened on both 401(k)s, Cash Balance plan re-modeled (kept), one Airbnb purchased and cost seg'd in year one. STR loophole offset $42K of W-2 income — first April with zero surprise.
Reasonable comp on the S-corp was set too high (overpaying payroll tax). Re-modeled against AMA specialty benchmarks, rebuilt accountable plan, surfaced QSBS planning on an investment in a med-device startup. Year-one savings $71K.
Multi-source income, retirement vehicle stacking, and possibly a practice entity put you above Standard. If you have an established practice + RE + RSUs + locums (4+ moving pieces), Strategic is the right call.
3-year scope · multi-source income · retirement stacking modeling · S-corp election analysis for 1099 / locums · multi-state allocation · accountable plan · ranked next-step list.
If you're an established practice owner with 3+ entities or $1M+ HHI, we'll route you to Strategic ($10K) on the Discovery call. If you're a resident or fellow finishing training, Standard ($2.5K) is the right entry point.
Bring the W-2, the 1099 totals, the 401(k) statement, and (if applicable) the practice P&L. We'll model the year-one savings range and quote the engagement before any work begins.
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