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Physicians regularly balance two different income sources: a regular salary from a hospital or academic institution, and income from a private practice or consulting gigs.

Although each stream faces different tax treatments, the combined tax landscape can be intricate, particularly when considering self‑employment tax, health‑insurance premiums, retirement contributions, and state‑specific regulations.

Here we dissect the main tax factors for balancing salary and practice income and present practical tactics to keep your tax liability low while maximizing net income.

Understanding the Two Income Streams

Salary

As an employed physician—whether in a hospital, clinic, or university—you earn a salary that undergoes payroll deductions.

The deductions encompass federal income tax, Social Security tax, Medicare tax, and, when relevant, state and local taxes.

The employer generally withholds the right amount consistently, and you obtain a W‑2 at the end of the year.

Private Practice Income

Alternatively, earnings from a private practice, consulting, or other self‑employment pursuits are filed on Schedule C (or a partnership return if the practice is a partnership) and are subject to self‑employment tax plus income tax.

Self‑employment tax includes both employee and employer shares of Social Security and Medicare, amounting to roughly 15.3% of net earnings.

You can offset the employer portion (7.65%) when determining your adjusted gross income, reducing the amount of taxable income.

Important Differences to Note

Tax Withholding: Salary income has taxes automatically withheld; practice income may require quarterly estimated tax payments.

Deductions: Practice income allows for more business deductions—office rent, equipment, supplies, mileage, professional liability insurance, and continuing education.

Retirement Contributions: Salary income can be directed into employer‑sponsored accounts (403(b), 401(k), etc.), while practice income can be rolled into a solo 401(k), SEP‑IRA, or SIMPLE IRA.

Health Insurance: For premiums paid out of practice income, you might be able to deduct health insurance on your personal return.

Self‑Employment Tax: Practice income alone faces self‑employment tax, but deductions can recover a portion.

Planning for Quarterly Estimated Taxes

Because salary taxes are withheld, you typically need to worry less about quarterly tax payments unless you have significant practice income that isn’t fully withheld.

Calculate your overall tax liability for the year by summing expected salary and practice income, 法人 税金対策 問い合わせ and then deducting any deductions and credits.

If your practice income is large enough that you anticipate owing more than $1,000 in tax at year‑end, you’ll likely need to file quarterly payments.

The IRS supplies a worksheet (Form 1040‑ES) to aid in calculating these payments.

Maximizing Deductions on Practice Income

Office Space
• Rent, utilities, and office supplies are fully deductible when the space is used solely for business.
• If you work from home, a reasonable share of your home expenses (mortgage interest, property taxes, utilities, internet) can be deducted as a home office.

Mileage and Transportation
• Keep a logbook or app for all business mileage. The IRS standard mileage rate is $0.655 per mile for 2025.
• Alternatively, deduct actual expenses (gas, maintenance, depreciation) if they exceed the standard rate.

Professional Development
• Continuing medical education (CME) courses, conferences, and certifications are deductible.
• Maintain receipts and verify that the courses are required or beneficial for your practice.

Equipment and Technology
• Computers, medical devices, software licenses, and even mobile phones used for patient communication are deductible.
• For sizable purchases, think about depreciation (MACRS) or Section 179 expensing.

Insurance
• Malpractice insurance premiums are fully deductible.
• Practice‑related health insurance premiums for yourself and employees can be deducted as a business expense.

Employee Compensation
• If you hire staff, such as nurses, medical assistants, or billing clerks, their salaries are deductible.
• Payroll taxes paid by the practice are also deductible.

Retirement Planning for Dual Income

Salary Portion
• If your employer offers a retirement plan, you can contribute up to the maximum allowed ($22,500 for 2025, plus $7,500 catch‑up if 50+).
• The employer’s matching contributions are an added benefit with no tax penalty.

Practice Portion
• You can create a solo 401(k) or SEP‑IRA for practice income, contributing up to 25% of net self‑employment income, up to $66,000 (or $73,500 if 50+).
• With a solo 401(k), you can draw a salary from your practice, reducing self‑employment tax since the salary portion is taxed only as employee payroll tax.

Health Insurance Deductions
• Self‑employed individuals may deduct 100% of health‑insurance premiums on their personal return (Form 1040, Schedule 1).
• The deduction isn’t capped by income percentage and can notably reduce your adjusted gross income.

State‑Specific Considerations
• New York and California have high state income taxes and additional physician taxes. Check whether your state imposes a separate tax on medical professionals.
• Some states allow a deduction for out‑of‑state practicing physicians if they meet residency requirements.
• State‑level health‑insurance requirements may demand additional filings (e.g., California’s SDI for self‑employed).

Avoiding Common Pitfalls

Under‑Withholding
• Avoid depending only on salary withholding for practice income. Use the IRS’s Tax Withholding Estimator to tweak your W‑4 or make quarterly payments.

Improper Tracking
• Keep thorough records of all business expenses. Digital receipts, a dedicated bank account, and routine reconciliation avert audit issues.

Overlooking Deductions
• Many doctors miss deductions for student loan interest, continuing‑education tuition, or charitable contributions linked to their practice.

Ignoring Tax Credits
• The Qualified Business Income (QBI) deduction can provide up to a 20% reduction on qualified income. Ensure you qualify and claim it.

Failing to Update Your Tax Strategy
• Tax statutes evolve yearly. Review your tax strategy annually, especially after income, expense, or life changes (marriage, children, etc.).

Putting It All Together: A Sample Planning Scenario

Dr. Lee earns $300,000 in salary from a teaching hospital and runs a private practice that nets $200,000 after expenses. Here’s how the tax picture might look:
• Salary: $300,000 subject to payroll withholding. No self‑employment tax.
• Practice: $200,000 net income. Self‑employment tax on $200,000 (15.3% = $30,600). Deduct employer portion (7.65% of $200,000 = $15,300) from AGI.
• Total taxable income before deductions: $300,000 + $200,000 – $15,300 = $484,700.
• After standard deduction ($14,600 for married filing jointly), taxable income: $470,100.
• Federal tax: Approximately $120,000 (using 2025 brackets).
• Self‑employment tax: $30,600.
• Total tax: $150,600.

To reduce this burden, Dr. Lee could:
• Contribute $22,500 to a 403(b) from salary.
• Max out a solo 401(k) with $66,000 from practice income.
• Deduct $15,300 employer portion of SE tax.
• Deduct health‑insurance premiums.
• Use Section 179 to expense new imaging equipment ($40,000) in the first year.

After these adjustments, the taxable income shrinks, and the overall tax bill could drop by tens of thousands of dollars.

Final Thoughts

Balancing salary and practice income is a delicate dance of taxation, deduction maximization, and financial planning.

Treating each stream per its distinct tax rules, keeping meticulous records, and using retirement and health‑insurance options helps physicians lower tax liability while maintaining healthy cash flow for both employment and entrepreneurial ventures.

Regular consultation with a tax professional who understands the medical field is also invaluable; they can spot opportunities and pitfalls that might otherwise slip through the cracks.

With the right strategy, you can retain more of what you earn and focus on what matters most—providing excellent patient care.