Hospitalist + locums
Late S-corp election on the 1099 entity, Solo 401(k) profit-share maxed, accountable plan built for the moonlighting trips, plus a clean structure for the next 10 years of practice.
Who we help · Physician · W-2 + 1099 + practice
Hospital W-2. Locums 1099. Private practice. Three income streams. One tax bill. Almost never planned.
Physicians are the most-overpaid bucket on the tax-code curve. High W-2, often with 1099 moonlighting or locums, sometimes a private practice S-corp, complex retirement options, and almost never anyone running the math across the whole picture. The savings range we model on physician engagements is the widest of any segment we serve.
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This is you if
Your income looks like one of these. The strategy work hasn't been done.
- Attending physician with $300K+ W-2 and weekend / locums 1099 work on the side
- Surgeon or specialist in private practice running an S-corp that's never been optimized
- Hospital employee with significant RSU / bonus comp and no equity-comp planning
- Locums physician billed 1099 across multiple states with no entity strategy
- Resident or fellow finishing training, transitioning to attending, the planning window before income explodes
- Dual-physician household at $700K+ combined, no retirement vehicle stacking done
- Recently bought a home in a high-tax state and the math feels punishing
- Moonlighting income that is large enough to cover the added S-corp costs
What you're done with
Three real physicians. Same three patterns.
The pain at physician income levels isn't about the work itself. It's that nobody owns the strategy. The compensation team handles your W-2, the locums billing service handles your 1099, the hospital benefits portal handles the 401(k), and your tax preparer just sums it up at year-end.
I'm a hospitalist clearing $420K plus locums on the side. My preparer files my return. He's never once mentioned S-corp, retirement stacking, or what to do about my 1099 income.
Hospitalist · $420K W-2 + $80K 1099 · Apr 2026
We're both attendings. Two W-2s, two 1099s, dual incomes. April hits and we owe another $40K we didn't plan for. There has to be a better way.
Dual-physician household · ~$720K HHI · Mar 2026
I have a Cash Balance plan I don't fully understand. The fees are eating me alive. Nobody can tell me whether I should keep contributing or close it out.
Specialist · $1.1M HHI · Feb 2026
The reason most physicians overpay isn't that the moves are obscure. It's that nobody has the time to coordinate across W-2, 1099, retirement, and (if applicable) practice. That coordination is the engagement.
What we'd actually do for you
Six moves. Calibrated to your specialty and income mix.
Physician engagements run wider than typical because the income streams are wider. Here's the standard playbook, refined per specialty during the Discovery call.
- 01
S-corp the 1099 / moonlighting income
If your W-2 pay is already above the Social Security wage base ($184,500 in 2026), an S-corp on side income saves only the Medicare part of the tax (2.9%, or 3.8% at high income). That is often less than the added costs. You must also pay yourself a fair salary, and the IRS checks this. We run your numbers first, and model your reasonable comp benchmark against medical-specialty data so the position is defensible. If the election is late, we can ask the IRS for relief to make it effective back to January; relief is not automatic.
- 02
Stack retirement vehicles correctly
Most physicians load the 401(k) and stop. Many physicians can use more than their hospital 401(k). Options include a Solo 401(k) employer contribution (on the 1099 entity), a cash balance plan, after-tax 401(k) money converted to Roth, and an HSA. You can only defer one $24,500 limit across all plans, so a Solo 401(k) adds only employer profit sharing once the hospital plan is maxed. The size of the savings depends on your plans and income.
- 03
Build the accountable plan for the practice
Home office, CME, vehicle, scrubs, malpractice, licensing, conference travel. Most physician S-corps run without one and lose deductions every year. We give you the template and the documentation chain.
- 04
Equity comp + RSU sell plan (hospital systems)
RSU vesting from a for-profit hospital system is taxed as pay. Withholding is often too low. We model the vesting calendar against the bracket math and write the sell plan, including which lots to hold for LT cap gains vs. sell at vest.
- 05
Multi-state allocation for locums
Locums physicians filing in 4+ states get hit twice without source-state allocation. We handle your home state, the states where you work, and the credit your home state gives for tax paid to other states. Multi-state income, one clean return.
- 06
Real estate as a counter-balance
A short-term rental can sometimes create a loss that offsets W-2 pay. The average guest stay must be 7 days or less, and you must do much of the work yourself and log your hours. Many busy physicians cannot meet that test, and the IRS checks it closely. Part of the depreciation is taxed again when you sell. We check before you buy, and model whether real estate is the right counter-balance to your W-2 / 1099 income mix.
Recent physician situations
Three real engagements. Three different problems.
Anonymized. Recent physician Tax Analyses + retainer engagements.
Dual-physician household
Mega-backdoor Roth opened on both 401(k)s, Cash Balance plan re-modeled (kept), one Airbnb purchased and cost seg'd in year one. The STR loophole offset part of their W-2 income, and April held no surprise.
Surgeon · private practice
Reasonable pay for the S-corp was set too high. We re-checked it against pay surveys for the specialty and wrote down our reasons, since the IRS can challenge pay that is too low. Rebuilt accountable plan, surfaced QSBS planning on an investment in a med-device startup.
Which tier fits
For most physicians, Comprehensive is the right tier.
Multi-source income, retirement vehicle stacking, and possibly a practice entity put you above Standard. If you have an established practice + RE + RSUs + locums (4+ moving pieces), Strategic is the right call.
Recommended for this segment
Tax Analysis · Comprehensive tier
$5,095 flat
3-year scope · multi-source income · retirement stacking modeling · S-corp election analysis for 1099 / locums · multi-state allocation · accountable plan · ranked next-step list.
If you're an established practice owner with 3+ entities or $1M+ HHI, we'll route you to Strategic ($10,095) on the Discovery call. If you're a resident or fellow finishing training, Standard ($2,595) is the right entry point.
Next step
One 20-minute call. We map the income picture and the right tier.
Bring the W-2, the 1099 totals, the 401(k) statement, and (if applicable) the practice P&L. We'll model the year-one savings range and quote the engagement before any work begins.
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