Tax planning for physicians, NPs, PAs & other clinicians
A W-2 salary, a moonlighting 1099, and a schedule that never repeats — one plan for all of it.
Between hospital wages, locum shifts, medical directorships, and retirement contributions that phase out faster than anyone tells you, high-earning clinicians need a return built for the whole picture, not just the W-2.
Where physician returns usually leave money on the table
High W-2 income plus irregular side work is exactly the profile the tax code makes the most complicated — and the most rewarding to plan around properly.
Backdoor Roth, done wrong
High earners are locked out of direct Roth contributions, but the backdoor route has a pro-rata trap if you have other pre-tax IRA balances. We check this before, not after, the contribution.
HSA eligibility gets missed
If you're on a qualifying high-deductible plan, HSA contributions are triple-tax-advantaged — deductible going in, tax-free growth, tax-free for medical costs. It's often underused simply because no one flagged it.
Moonlighting income needs its own plan
Locum shifts and medical directorships paid on a 1099 carry self-employment tax and their own quarterly estimate schedule — separate from what's already being withheld at your main job.
Why physician side income phases out of the QBI deduction
Health services are named directly in the tax code
Unlike a lot of side businesses, income from the performance of medical services is explicitly classified as a Specified Service Trade or Business. Past a certain income level, that phases out the 20% Qualified Business Income deduction on your 1099 side income entirely — it isn't a gray area the way it is for some other professions.
IRC §199A(d)(2) — the Specified Service Trade or Business rules, which name "health" directly.How it works
Book a call
A short conversation about your W-2 income, any 1099 shifts or directorships, and your retirement accounts.
Upload through your portal
W-2s, 1099s, HSA and retirement statements go into a secure client portal on whatever schedule works for you.
Review, sign, and plan ahead
We walk through the return and flag what to set up before next year — backdoor Roth timing, HSA contributions, quarterly estimates.
Straightforward pricing
One flat starting rate for a W-2 return — more only if 1099 or entity income is involved.
Individual return
- W-2 income, HSA & backdoor Roth review
- Multi-state review for split-year moves
- Secure portal, remote e-signature
1099 / entity return
- Locum, directorship, or side-practice income
- Self-employment tax & QBI phase-out review
- Quarterly estimate planning
Questions clinicians ask most
Not a problem — it's common. It just means the return has two income streams with different tax treatment, and the 1099 side needs its own quarterly estimate plan so you're not surprised in April.