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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.

Even though the two income streams are taxed differently, the overall tax picture can be complicated, especially when including self‑employment tax, health‑insurance premiums, retirement contributions, and state‑specific rules.

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

Salary

When you work as an employed physician—whether at a hospital, clinic, or university—you receive a salary that is subject to 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.

Self‑Employment 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.

The self‑employment tax accounts for both employee and employer contributions to Social Security and Medicare, totaling around 15.3% of net earnings.

Nonetheless, you may deduct the employer portion (7.65%) in computing your adjusted gross income, thereby lowering 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 may be funneled into employer‑sponsored plans (403(b), 401(k), etc.), whereas practice income can be channeled 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 taxed for self‑employment, yet deductions help offset some of it.

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.

Calculate your overall tax liability for the year by summing expected salary and practice income, 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 provides a worksheet (Form 1040‑ES) to help calculate 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
• Track all business mileage in a logbook or use an app. 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.
• Keep receipts and confirm that the courses are needed or useful for your practice.

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

Insurance
• Professional liability (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 (nurses, medical assistants, billing clerks), their salaries are deductible.
• Payroll taxes paid by the practice are also deductible.

Retirement Planning for Dual Income

Salary Portion
• Should your employer provide a retirement plan, 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
• 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+).
• A solo 401(k) also allows a salary from your practice, potentially lowering self‑employment tax as the salary portion faces only employee payroll taxes.

Health Insurance Deductions
• If you’re self‑employed, you can deduct 100% of your health‑insurance premiums on your personal return (Form 1040, Schedule 1).
• This deduction isn’t restricted to a percentage of income and can substantially lower your AGI.

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 mandates may require you to file additional forms (e.g., California’s SDI for self‑employed individuals).

Avoiding Common Pitfalls

Under‑Withholding
• Don’t depend solely on salary withholding for practice income; use the IRS’s Tax Withholding Estimator to adjust 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
• Physicians often overlook deductions for student loan interest, continuing‑education tuition, or charitable contributions tied to their practice.

Ignoring Tax Credits
• QBI deduction offers up to a 20% cut on qualified income. Verify eligibility and claim it.

Failing to Update Your Tax Strategy
• Tax laws change every year. Perform an annual review of your tax strategy, especially if you’ve had 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: About $120,000 (using 2025 brackets).
• Self‑employment tax: $30,600.
• Total tax: $150,600.

To reduce this burden, 節税対策 無料相談 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 fine balance of taxation, deduction maximization, and financial planning.

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

Regular consultation with a tax professional familiar with 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.