Built for the $400K–$2M physician. The strategies your peers are already using.
Most CPAs treat a physician’s return like any other 1040 — and leave $30K–$150K a year on the table. We build the medical-specific stack: defined benefit plans, accountable plans, entity layering, §199A optimization, and the practice-level moves that compound across a career.
Built for a specific client.
This is for the physician, dentist, or healthcare practice owner whose income has outgrown the SEP-IRA and whose CPA has stopped suggesting new moves. If you’re a high-earning W-2 doctor, a 1099 contractor, or a practice owner, the right tax stack is worth six figures over a career — usually more.
- Physicians and specialists earning $400K–$2M+, W-2 or 1099
- Dental, optometry, and veterinary practice owners
- Group practice partners with K-1 income and partnership distributions
- Locum tenens and travel physicians with multi-state 1099 income
- Late-career physicians 10–15 years from retirement maximizing tax-advantaged savings
Everything in the engagement.
- Defined benefit and cash balance plan design — $150K–$300K+ in annual deductible contributions for the high-income solo or practice owner
- Practice entity optimization — PA, PLLC, S-Corp, or management-company layering, including the MSO structure
- §199A SSTB analysis and workaround — phase-out modeling and entity strategies for specified service trades
- Accountable plan setup (§1.62-2) — home office, vehicle, CME, scrubs, malpractice — reimbursed pre-tax through the practice
- §280A Augusta rule documentation — up to 14 days of practice-paid home rental, tax-free to you
- Solo 401(k) and mega backdoor Roth — stacked on top of the DB plan for after-tax growth
- Locum tenens and 1099 structure — S-Corp election, reasonable comp, and multi-state allocation handled
Four steps. No mystery.
Practice and personal review
Current entity, retirement plans, accountable plan, and last two returns audited.
Stack design
Written plan layering DB plan, 401(k), entity comp, and accountable-plan reimbursements.
Implementation
Plan documents drafted, payroll adjusted, accountable plan rolled out, S-Corp elected if needed.
Ongoing quarterly review
Contributions tracked, comp re-tuned, and year-end optimization executed.
A typical $600K-earning physician saves $40K–$120K in year one once the DB plan, accountable plan, and entity structure are aligned. Practice owners with W-2 staff regularly clear $150K+ with the full stack.
Questions we get most often.
For most physicians over 40 earning $500K+, yes. The 401(k) caps at roughly $70K combined; a properly designed DB or cash balance plan layers another $150K–$300K of deductible contributions on top. The cash flow trade-off pays back in three to five years for almost every high-earner who qualifies.
The DB plan and accountable plan strategies don’t apply to pure W-2 income — but most employed physicians have at least some 1099 work (call, moonlighting, expert witness, speaking) that can support an S-Corp and a layered retirement plan. We size the structure to the 1099 side.
For W-2 income, mostly true post-TCJA. But the moment you have 1099 income — or your practice runs an accountable plan — those expenses become deductible on the business side. The fix is the structure, not the receipts.
Ready to put this to work?
Book a 30-minute practice review — we’ll quantify your DB plan capacity and accountable-plan savings before you hang up.
Book a Free 30-Min Call