Remote Tax Planning For
Physicians Nationwide.
You started earning late. You have massive student loans. You work 60+ hours a week. We are your dedicated financial team, helping you navigate the complex transition from "Resident" to "High-Net-Worth Attending." Start with our Tax Planning Playbook, explore our locum tenens tax guide or real estate for physicians, and see our services to learn how we work with doctors nationwide.
Written by Bryan Martin, CPA, Managing Partner and Founder of Taxstra. Last updated June 10, 2026.
Quick answer
Physician tax planning depends on how you are paid. W-2 attendings lean on retirement account stacking, HSAs, and real estate strategies. 1099 and locum physicians add entity structure, business deductions, and self-employed retirement plans. Practice owners layer on cash balance plans and compensation design. The right mix follows your career stage and income type.
Where Are You On The Curve?
Most physicians we work with fall into one of these specific career stages. Select yours to see your specific tax playbook.
Residents & Fellows
Low income now, high income later. The perfect time for Roth Conversions and PSLF filing strategy.
Employed Attending
Trap: High W-2 taxes. Solution: Spousal REPS, Short-Term Rentals, and "buying" deductions. See our W-2 planning guide.
Side Gigs (1099)
Surveys, expert witness, consulting. Turn "hobby money" into a Solo 401(k) shelter.
Locum Tenens
Full-time traveler? We handle multi-state taxes and S-Corp structuring. Read our tax home guide.
Practice Owner
You own the equity. We optimize entity structure, Cash Balance Plans, and partnership buy-ins/outs.
Student Loans Meet Tax Math
Most tax preparers ignore your student loans. We integrate them into your tax plan. The decision to file Married Filing Jointly vs. Separately can swing your loan payments by thousands of dollars a month.
Filing Status Analysis
We run the MFS vs MFJ math every year and make sure your filing status lowers your monthly loan obligation without costing more in taxes than you save in payments.
AGI & Payment Math
Income-driven payments are calculated from your Adjusted Gross Income (AGI). We model how pre-tax retirement contributions, HSA funding, and filing status change that calculation.
The "Marriage Penalty" Logic
Loan payment based on combined household income.
Loan payment based on YOUR income only, ignoring high-earning spouse.
*We calculate if the tax savings of filing jointly outweigh the $16,800/year savings in loan payments. (Hint: Often, they don't.)
The Power of 1099 Income
Even a small amount of 1099 income (Moonlighting, Expert Witness work, Medical Surveys) changes the game. It opens the door to business deductions that W-2 employees can't touch. See our complete physician tax deductions guide for the full list.
- Solo 401(k) / SEP IRAShelter up to $72,000+ (2026 limits) of income, creating a massive tax deduction. Compare options in our retirement plans guide.
- "Augmented" Business TravelCombine a CME conference with a family trip? If structured correctly as a business trip, substantial costs become deductible. Read the business travel guide.
- Home Office DeductionUse a dedicated space for charting or telemedicine? You might deduct a portion of your mortgage interest, utilities, and repairs. See the full home office guide.
*Simplified example. Try our full calculator for personalized results.
W-2 vs 1099: Which Tax Levers Do You Have?
The single biggest factor in a physician's tax plan is not specialty or income level. It is how you are paid. Here is how the available levers compare:
| Tax Lever | W-2 Physician | 1099 / Locum Physician |
|---|---|---|
| Business expense deductions | Not available on federal returns | Fully deductible against 1099 income |
| Retirement plans | Employer 401(k)/403(b), sometimes a 457(b) | Solo 401(k), SEP IRA, cash balance plans |
| Entity structure / S-Corp | Not applicable to wages | Available once income justifies the overhead |
| Home office deduction | Not available | Available with a dedicated workspace |
| Backdoor Roth IRA | Available | Available |
| HSA (with a qualifying plan) | Available | Available |
| Real estate strategies (STR, REPS) | Available | Available |
| Tax withholding | Automatic through payroll | None; quarterly estimated payments required |
"Physicians don't overpay because they're careless. They overpay because their tax plan was built for an average employee, not for how physician income actually works."
Bryan Martin, CPA
Private Practice Optimization
Ownership changes the rules completely. You are no longer just an employee; you are a business. This unlocks the most powerful tax strategies available in the code. Our entity structure guide walks through every option.
Entity Selection (S-Corp vs LLC)
We analyze the tax savings of an S-Corp election versus the administrative cost. For many practices netting over $100k, an S-Corp can save thousands in Medicare/Social Security taxes.
Cash Balance Plans
Ideally suited for partners in profitable groups. This "Pension Plan" allows you to contribute $200k-$300k+ annually PRE-TAX, on top of your 401(k) max. Compare all options in our retirement plans guide.
The "Augusta Rule"
Rent your personal home to your medical practice for board meetings or staff retreats for up to 14 days a year. The business gets a deduction, and you receive the rental income tax-free. Set up a proper accountable plan to make it airtight.
Dual-Physician W-2 Household
Cardiologist & Pediatrician
Challenge: $800k combined W-2 income. Zero time to manage active businesses. Massive tax bill.
Solution: We identified one spouse was cutting back to 0.6 FTE. We structured a "Spousal REPS" strategy where the part-time spouse managed a portfolio of 3 short-term rentals. This unlocked $250k in paper losses to offset their clinical W-2 income. Read more about physician real estate investing.
Locums with 6 States
Emergency Medicine Doc
Challenge: Working in TX, CA, NY, and FL. Getting double-taxed and missing deductions.
Solution: We centralized billing through a Wyoming S-Corp. We implemented an Accountable Plan to reimburse travel/meals tax-free. We properly apportioned income to avoid double taxation on the NY/CA returns. See our locum tenens tax home guide.
Physician Tax Playbooks
Detailed guides for every physician career stage and financial situation.
Physician Tax Guide
18 in-depth guides covering every aspect of physician tax planning. From deductions and business structure to retirement planning and audit protection.
Tax Deductions & Write-Offs
Maximize every deduction available to physicians
Business Structure
Choose the right entity and employment structures
Retirement & Wealth Building
Shelter income and build long-term wealth
Real Estate Strategies
Use real estate to offset physician W-2 income
Compliance & Planning
Stay compliant and plan proactively
Tools & Resources
Interactive calculators and planning tools
1099 & Side Income
Tax strategy for independent contractor and moonlighting income
Career Stage Guides
Targeted playbooks for every stage of a physician's career
Full-Service Physician Accounting
Done-for-you tax and accounting services for physicians
Not Sure Where to Start?
Download our Physician Tax Planning Playbook for a step-by-step framework, or use the Physician Tax Calculator to estimate your savings. Then book a call to put it into action.
Book a Free Initial ConsultationPhysician Tax FAQ
Common questions about W-2s, 1099s, and student loans. For deeper answers, explore our tax deductions guide or S-Corp election guide.
Have another question?Support Your Tax Strategy
Tax planning is most effective with monthly accounting and accurate bookkeeping.
Monthly Bookkeeping
Stay audit-ready with monthly reconciliation and financial statements. Clean books support every tax strategy.
Learn moreTax Planning
Proactive strategies to complement your W-2 or 1099 income and maximize physician-specific deductions.
Learn moreTax Preparation
CPA-reviewed returns that document your strategies and withstand IRS scrutiny for high-income physicians.
Learn moreStop Overpaying The IRS.
You worked hard for your license. You work hard for your patients. Let us work hard for your wealth.