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A growing number of doctors add side practices such as consulting, teaching, telemedicine, or a small clinic to their primary work. While these activities can boost income, they also add layers of tax complexity. Proper planning can reduce liability, preserve cash flow, and keep you compliant with federal and state regulations. Below is a practical guide to navigating tax planning for doctors who run side practices.

The Importance of Side Practices Side practices alter the tax classification of your income. What would normally be taxed as salary is now treated as self‑employment income, subject to Social Security and Medicare taxes. A blend of W‑2 income from your primary job and 1099 income from a side practice produces a hybrid tax environment. Each income type comes with distinct deduction rules, reporting needs, and timing factors.

Essential Tax Concepts for Physicians 1. Self‑Employment Tax (SEAT) – 15.3% on net self‑employment earnings. 2. Qualified Business Income (QBI) deduction – up to 20% of qualified business income under Section 199A, subject to limitations. 3. Corporate rates – incorporating may provide lower tax rates and distinct liability. 4. State Taxes – many states tax medical income differently; some offer special exemptions or lower rates for medical professionals.

Selecting the Appropriate Entity

Schedule C

Simplest to set up; earnings are reported on Form 1040 Schedule C. All expenses are deducted on the same schedule; no separate corporate filing. SE tax is due on the net profit.

Limited Liability Company (LLC)

A single‑member LLC is treated as a disregarded entity, identical to a sole proprietorship unless corporate taxation is elected. Multi‑member LLCs file Form 1065; each member receives a K‑1. Delivers liability protection without corporate formalities.

S‑Corporation

Pay yourself a reasonable salary (W‑2) and take the remaining profits as shareholder distributions. Salary is subject to payroll taxes, but distributions are not subject to SEAT. Requires payroll setup, quarterly payroll tax filings, and compliance with IRS reasonable‑compensation rules.

C‑Corporation

Separate legal entity; profits taxed at the corporate level (21% federal) and again when distributed as dividends. Useful for larger side practices or when planning to reinvest profits. Demands detailed corporate governance and annual meetings.

Best Practice: Most physicians opt for an S‑Corp or LLC with an S‑Corp election to balance simplicity, liability protection, and tax efficiency. Nonetheless, the choice relies on revenue, number of staff, and future goals.

Tax‑Deductible Expenses

Office Rent

Utilities, Internet, and Phone services

Liability Insurance for Professionals

CME and Licensure Fees

Equipment and Supplies such as medical instruments, computers

Marketing and Advertising

Capital Asset Depreciation

Health Insurance Premiums (if self‑insured)

Business‑related Travel and Meals (50% deduction for meals)

Home Office deduction when you use a dedicated area for patient care or administrative duties.

Keep in mind: All expenses must be ordinary, necessary, and directly tied to the side practice. Document everything with detailed records, receipts, and a mileage log if you claim a home office or vehicle deduction.

Paying Self‑Employment Tax on Time

• Quarterly estimated tax payments (Form 1040‑ES) must be made if your side practice generates $1,000+ in SE tax.
  
• Employ the safe‑harbor rule: pay 90% of prior year’s tax or 100% of current year’s tax (110% if AGI exceeds $150,000).
  
• An automatic payroll setup for an S‑Corp decreases the risk of underpayment penalties.
  
  

Qualified Business Income (QBI) Deduction

• The QBI deduction allows a 20% deduction on qualified business income from a pass‑through entity.
  
• Doctors with higher incomes encounter limits: wage and capital caps, and the 20% ceiling.
  
• Analyzing total income and side practice type is vital to maximize the deduction.
  
  

Health Insurance and Retirement

• Self‑insured doctors can deduct 100% of their premiums from gross income.
  
• Set up a Solo 401(k), SEP IRA, or defined‑benefit plan to defer income and lower taxable wages.
  
• IRS limits contributions to these plans; a financial advisor can guide you to stay within limits.
  
  

Documentation and Recordkeeping

• Use distinct bank accounts for primary and side practices.
  
• Record all income and expenses in a detailed ledger.
  
• Use accounting software tailored for medical practices to track reimbursable items, write-offs, and tax documents.
  
• Retain records for at least seven years in case of audit.
  
  

State and Local Considerations

• States such as Texas, Florida, and Nevada lack state income tax, easing your compliance.
  
• Other states like California and New York levy extra taxes on medical income.
  
• Look into local licensing fees, business taxes, and health department permits that could apply.
  
  

Timing Tactics

• Defer income: Move large invoice receipts to the following year if permitted, lowering current year tax.
  
• Speed up deductions: Pay rent or acquire equipment before year‑end to raise deductions.
  
• Think about a cash‑basis entity to align income and expenses more closely.
  
  

Hiring Employees or Contractors

• Hiring employees triggers payroll taxes, benefits, and labor law compliance.
  
• Independent contractors (1099) can reduce payroll burden but increase audit risk.
  
• Hire a qualified tax professional to classify workers correctly and dodge penalties.
  
  

Collaborating with a Tax Professional

• A CPA or tax lawyer experienced in medical practice taxes can guide you in entity selection, deduction optimization, and compliance.
  
• Collaborate with a professional to handle quarterly estimates, payroll setup, and audit defense.
  
• Frequently review your tax strategy.
  
  

Common Mistakes to Avoid

• Combining personal and business expenses in one bank account.
  
• Neglecting detailed mileage logs for vehicle usage.
  
• Failing to estimate SE tax accurately, leading to missed quarterly payments.
  
• Ignoring QBI limits and not structuring the side practice for qualification.
  
• Neglecting state‑specific tax rules applicable to medical professionals.
  
  

Wrap‑Up

Operating a side practice can boost your income considerably, yet it brings a variety of tax obligations. Choosing the right entity, 節税対策 無料相談 maximizing deductions, managing SE tax, and using retirement and health‑insurance plans lets you retain more income. Regular collaboration with a qualified tax professional and meticulous recordkeeping are the cornerstones of effective tax planning for doctors with side practices. With the proper strategy, you can concentrate on high‑quality care while cutting your tax burden.