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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.
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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.
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Doc Wealth provides proactive, year round tax planning built exclusively for physicians, from your first attending paycheck to the year you sell your practice. Our tax team of Tax Attorneys, CPAs, and Enrolled Agents works with you throughout the year to reduce your tax burden legally, proactively, and measurably.
In This Guide
01
The Tax Planning Gap Costing Physicians Every Year
Why Bookkeeping Matters for Physician Tax Savings
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.
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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.
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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 understands your world, not just a generalist who files forms.
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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. Every year that goes by without a proactive plan is money you can never recover.
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
What Physician Tax Planning Actually Is
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.
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.
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When your tax team is doing all of this proactively, the savings compound year after year. That's the kind of result physicians working with Doc Wealth experience consistently.
Which One Are You?
Who Physician Tax Planning Is For
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're paying 15.3% in self employment tax on top of income tax. 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.
Owner
Dual Physician Households
Combined high income means higher brackets, NIIT exposure, and coordination challenges between two employers. Filing status alone can swing your liability by tens of thousands.
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.
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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.
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 have access through daily office hours, live Q&A sessions, and our education platform covering 50+ physician tax topics.
4
Prompt, dependable communication.
When you have a tax question, you get an answer. Not a voicemail and a two week wait. Our dedicated team model means someone who knows your file is always accessible.
What We Evaluate For Every Client
Core Tax Planning Areas
Every physician's plan is customized, but here are the core areas our tax team evaluates for every client:
01
S-Corp Election
For 1099 physicians, electing S-Corp status can significantly reduce self employment tax. We handle the entity setup, reasonable compensation analysis, and ongoing payroll compliance.
02
Retirement Plan Stacking
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)
PTET elections allow your S-Corp or partnership to pay state income tax at the entity level, effectively bypassing the $10,000 SALT deduction cap. For physicians in high tax states, this can make a meaningful difference in your annual tax burden.
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
Rent your home to your business for up to 14 days per year and receive that income tax free. When implemented correctly, this can shift taxable business income to tax free personal income.
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're already donating to charity, 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
Many physicians invest in real estate for income and appreciation. What they often miss is the tax planning dimension: 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.
Proof
Results Physicians Trust
Thousands of physicians nationwide trust Doc Wealth for their tax planning. Here's why:
50
States served
Trusted by the physician finance community
Doc Wealth is recommended by leading voices in the physician finance community for our tax services. These are the people physicians turn to for vetted recommendations, and they stand behind Doc Wealth because of the tax results their audiences have experienced.
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.
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
Needs To Be Hidden
Outcome
The combined effect reshaped their entire annual tax picture.
How It Works
The Doc Wealth Process
01
Step 1
Book a free discovery call.
We'll review your current tax situation, income sources, and goals in a 30 minute conversation. No pressure, no obligation, just a straightforward discussion about what proactive tax planning could look like for you and a preliminary assessment of where the biggest opportunities are.
02
Step 2
Your tax team builds your plan.
Your dedicated team analyzes your complete tax picture, including income, entities, retirement accounts, deductions, state exposure, and long term goals, and develops a customized tax plan with projected savings. This isn't a generic template. It's a plan built around your specific income, your specific career stage, and your specific situation.
03
Step 3
We implement and manage year round.
Your tax team handles the execution: entity formation, payroll setup, retirement plan establishment, quarterly projections, and year end positioning. Throughout the year, you'll receive proactive updates when action is needed. You stay informed and in control through daily office hours, live Q&A sessions, and our education platform. Because your tax team has been managing your plan all year, tax preparation is a natural conclusion, not a scramble. Returns are filed accurately, on time, and reflecting every dollar of savings your plan captured.
04
Step 4
You keep more of what you earn, every year.
The savings from proactive tax planning compound into substantial wealth over the course of a career. Money for investments, for your family, for earlier retirement, or for the charitable causes you care about.
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 at midnight, because your team is available during daily office hours to answer them.
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
Frequently Asked Questions
Doc Wealth's tax planning engagements vary based on the complexity of your tax situation, including income level, number of entities, state filings, and planning areas involved. See our pricing page for current details. The key question isn't cost, it's return on investment. Most physicians save multiples of their planning fee in the first year.
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. Every year without a plan is money you won't get back.
That's common. Most physicians who come to Doc Wealth have an existing CPA. The question is: is your CPA doing proactive planning, or just filing your return? If you can't answer that question confidently, a free discovery call will give you clarity. We make the transition seamless.
Three things set us apart: we're physician founded (we understand your world), our team composition includes Tax Attorneys, CPAs, and Enrolled Agents (not a solo CPA), and we provide year round engagement including daily office hours, live Q&A, and 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.
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.