Doctor's Tax Guide > 자유게시판

Doctors frequently juggle two separate income streams: a steady salary from a hospital or academic setting, and revenue from a private practice or consulting engagements.

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.

Grasping the Two Income Streams

Employed Income

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

These deductions include federal income tax, Social Security tax, Medicare tax, and, if applicable, state and local taxes.

Your employer usually withholds the appropriate amount regularly, and you receive a W‑2 by year‑end.

Practice Income

Contrarily, revenue from a private practice, consulting, or other self‑employment endeavors is reported on Schedule C (or a partnership return if the practice is a partnership) and faces self‑employment tax along with 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.

Key Distinctions to Remember

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

Deductions: Practice income offers more opportunities for business deductions (office rent, equipment, supplies, mileage, professional liability insurance, 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: You may be able to claim a health‑insurance deduction on your personal return if you pay premiums out of pocket for practice income.

Self‑Employment Tax: Only practice income is subject to self‑employment tax, but you can recover part of it via deductions.

Planning for Quarterly Estimated Taxes

As salary taxes are withheld, you usually need less attention to quarterly payments unless significant practice income escapes full withholding.

Estimate your total tax liability for the year by adding your expected salary and practice income, then subtracting any deductions and credits.

Should your practice income be substantial enough that you expect to owe over $1,000 in tax at year‑end, quarterly payments will probably be necessary.

IRS offers a worksheet (Form 1040‑ES) to assist in computing these payments.

Maximizing Deductions on Practice Income

Office Space
• Rent, utilities, and office supplies can be fully deductible if the space is used exclusively for business.
• If you work from home, a suitable part 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
• CME courses, conferences, and certifications are deductible.
• Keep receipts and confirm that the courses are needed or useful for your practice.

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

Insurance
• Professional liability (malpractice) insurance premiums are fully deductible.
• Health insurance premiums related to practice for 確定申告 節税方法 問い合わせ yourself and employees can be deducted as a business expense.

Employee Compensation
• Hiring staff (nurses, medical assistants, billing clerks) makes their salaries 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+).
• Employer matches add benefit and are untaxed.

Practice Portion
• A solo 401(k) or SEP‑IRA can be established for your practice, letting you contribute 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 feature high state income taxes and additional physician taxes. Confirm if your state levies a separate tax on medical professionals.
• Some states grant a deduction for out‑of‑state physicians meeting 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
• Maintain detailed records of every business expense. Digital receipts, a separate bank account, and regular reconciliation prevent audit problems.

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
• Laws shift annually. Conduct an annual review of your tax strategy, particularly after changes in income, expenses, or life events (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 knows the medical field is invaluable; they can spot opportunities and pitfalls that might otherwise slip through the cracks.

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