About ten weeks remain in 2026. Here is every dated move for W-2, 1099 and locum tenens physicians, in deadline order, with the 2026 limits and the paperwork each one needs.
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Tax planning slots are limited before year-end.
Most physician year-end planning comes down to four things: max every workplace deferral before your last 2026 paycheck, shelter 1099 or locums income with a solo 401(k), clean up pre-tax IRA balances by December 31 so a backdoor Roth stays tax-free, and close any withholding gap before the January 15, 2027 estimate.
The deadlines are not all December 31. A 457(b) increase usually has to be elected before the month it applies to, open enrollment choices lock in your 2027 HSA and dependent care options, and some moves (IRA, HSA, solo 401(k) employer money) stay open into 2027.
Worked example (illustrative)
A hospitalist earns $420,000 on a W-2 and already maxes the hospital 403(b). She also netted $90,000 from 1099 locums shifts in 2026. Her spouse has no earned income. They file jointly and take the standard deduction.
| Net 1099 locums income | $90,000 |
|---|---|
| SE tax (Medicare only, wages already past the $184,500 wage base) | $2,410 |
| Half of SE tax, deductible | $1,205 |
| Solo 401(k) employer contribution: 20% x ($90,000 minus $1,205) | $17,759 |
| Federal marginal bracket (MFJ taxable income about $476,600) | 32% |
| Federal income tax effect of the contribution | about $5,683 |
| Safe harbor: 110% of an assumed $118,000 of 2025 tax | $129,800 |
| Projected 2026 W-2 withholding | $98,000 |
| Withholding gap to close | $31,800 |
Her 403(b) used the full $24,500 employee deferral, and that limit is shared across every plan she joins, so the solo 401(k) can only take the employer contribution. That money can go in as late as the extended 2026 return due date, but the plan has to be adopted by then.
The withholding gap is the urgent part. Because W-2 withholding counts as paid evenly through the year, asking payroll for an extra $31,800 from December paychecks clears the safe harbor. A single January 15 estimate would not fix the earlier quarters.
The example ignores state tax and the QBI deduction. As a physician (a specified service business) her QBI deduction is already phasing out at this income, and the contribution changes both numbers.
Illustrative composite with simplified assumptions, not a client result and not a projection of what you will save. Your numbers depend on your full return.
Dated moves in deadline order. Check items off as you go, or print it.
Taxstra 2026 year-end tax checklist: Physicians
taxstra.com/year-end-tax-planning-checklist/physicians/ · Last reviewed October 20, 2026 · Educational, not individualized tax advice.
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Moves that need lead time with payroll or HR
Must happen in calendar 2026, usually through your last paycheck
Rule changes that move this year's year-end math
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Tax planning slots are limited before year-end.
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Tax planning slots are limited before year-end.
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Under-withholding after adding 1099 or locums income. The W-2 job withholds on the salary only, so the side income arrives with no tax taken out. Once AGI is above $150,000, avoiding the penalty requires paying 110% of last year's tax through withholding and timely estimates. Extra withholding from December paychecks is the cleanest fix because it counts as paid evenly through the year.
Yes, but usually only the employer piece. The $24,500 employee deferral limit is shared across all your plans, so if the 403(b) used it, the solo 401(k) can take the 20% employer contribution on net self-employment earnings. A 403(b) is also combined with a solo plan you control for the $72,000 total limit.
Under current law a plan can be adopted as late as the 2026 return due date, including extensions, for employer contributions. If you want to make employee deferrals from 2026 self-employment income, the simplest path is to adopt the plan and document your deferral election before December 31.
The contribution for 2026 can be made until April 15, 2027. The December 31 date matters for the cleanup: the pro-rata rule looks at your pre-tax IRA balances at the end of the year in which you convert, so roll those balances into a workplace plan before December 31 if you plan to convert.
No. The free 30-minute call is with our team and covers your needs, our services and whether we are a fit. Reviewing your projections, documents or plan choices is part of a paid engagement.
Want the general version? See the year-end tax planning checklist and the full list of 2026 and 2027 tax due dates.
Book a free 30-minute consultation with our team. Tell us what you need, learn how Taxstra can help, and explore whether our services are a good fit. Tax advice, document reviews, and analysis require a paid engagement.Your tax plan and specific advice come after you engage. The call is about fit and next steps.
Tax planning slots are limited before year-end.
