New surgeon wondering if I need an accountant/tax advisor for 1099 income?

I'm wrapping up my residency training this summer and transitioning to an attending surgeon position. My financial situation includes about $430k in student loans ($340k mine, $90k my wife's), and we're planning to continue renting for a few years until we make significant progress on paying down this debt. My new position will be entirely 1099 income with a private surgical group, projecting roughly $750k-$900k annually depending on case volume and complexity. I'm joining an established practice but will be paid as an independent contractor. I've always handled my own taxes during residency, but that was straightforward W-2 income. With 1099 status, I understand I'll need to make quarterly estimated tax payments to federal and state authorities and handle my own FICA contributions. None of this seems particularly difficult, and I feel like I could manage it myself without much trouble. However, I've noticed all the senior surgeons in the group use accountants and tax advisors. I'm wondering if I'm missing something important here. Should I follow their example and hire someone? If so, what type of professional would be appropriate - is a CPA sufficient for my situation? My instinct is to just calculate my quarterly tax liability and make the payments myself, but I don't want to overlook something critical.

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19 comments

Ella Cofer

•8M

Having worked with physicians transitioning to attending roles for over a decade, I'd strongly recommend getting a CPA, especially with your income level and 1099 status. This isn't just about filing taxes - it's about strategic tax planning that could save you tens of thousands annually. First, you'll want to consider a business structure (LLC, S-Corp, etc.) that could potentially save significant FICA taxes. As a 1099 contractor making $750k+, you'll pay self-employment tax on that entire amount without proper structuring. Second, you'll need to maximize retirement vehicles. Standard 401(k) contributions aren't enough at your income level - you might benefit from defined benefit plans, cash balance plans, or other strategies. Third, quarterly estimated payments need careful calculation. Underpay and you'll face penalties; overpay and you're giving an interest-free loan to the government. Lastly, you'll want to consider deductions specific to medical practitioners that you might miss handling things yourself.

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Ella Cofer

•8M

S-Corps typically make financial sense when you're earning enough that the SE tax savings outweigh the additional costs of running the corporation (payroll services, additional tax forms, etc.). For most physicians, that threshold is around $150-200k, so at your projected $750k+, it would almost certainly be beneficial. S-Corps actually enhance retirement planning options rather than complicating them. As an employee of your own S-Corp, you can establish a Solo 401(k) with both employer and employee contributions, potentially putting away much more than you could as a sole proprietor. You could even explore setting up a Cash Balance Plan alongside the 401(k) to shelter significantly more income from taxes.

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Savannah Glover

•8M

After finishing my surgical fellowship and jumping into private practice with similar 1099 income, I tried doing taxes myself for the first year. BIG mistake. I missed so many deductions and ended up paying way more than necessary. The second year I found an incredible resource - https://taxr.ai - that completely changed my approach. It specifically analyzes the tax documents of healthcare professionals and helped me identify legitimate deductions I never knew existed. You'd be surprised how many medical-specific tax advantages are out there that standard tax software doesn't catch. For instance, I was able to properly document a portion of my continuing education as a business expense and set up a more tax-efficient retirement contribution strategy. The time I saved was worth it alone, but the tax savings were substantial - far more than the cost of the service.

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Savannah Glover

•8M

The service works alongside a CPA or independently - many users do both. It analyzes your specific situation as a physician and identifies deductions and strategies that general accountants might miss if they don't specialize in medical professionals. The platform is secure with bank-level encryption, which addressed my initial concerns about data protection. For quarterly payments, it provides calculator tools specifically for 1099 physician income that account for the unique aspects of medical practice income. Many local CPAs are excellent but might only have a handful of physician clients, whereas these specialized tools are built specifically for our profession's unique situations.

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Felicity Bud

•8M

Just wanted to follow up - I decided to try out taxr.ai after asking about it here, and I'm genuinely impressed. As a new attending with similar 1099 situation to yours, it walked me through setting up an S-Corp structure that my previous accountant never suggested. The interface specifically addressed physician-specific deductions related to medical licenses, continuing education, and even partial home office usage that I was eligible for. The most valuable part was structuring my retirement contributions between different vehicles to maximize tax advantages. I'm projecting about $22k in tax savings this year compared to my previous approach, which more than justified trying something new. Definitely worth checking out if you're in the same boat.

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Max Reyes

•8M

After dealing with 1099 income for years as a physician, the worst part isn't even filing taxes - it's trying to get answers from the IRS when inevitable questions come up. I wasted DAYS on hold trying to verify some specific deductions related to my medical practice. Then a colleague told me about https://claimyr.com - they get you through to an actual human at the IRS without the endless hold times. You can see how it works here: https://youtu.be/_kiP6q8DX5c It was a game-changer when I needed to sort out an issue with my quarterly payments. Instead of the typical 2+ hour wait, I got through in about 15 minutes. As a busy surgeon, that time savings alone is invaluable.

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Max Reyes

•8M

It's not someone sitting on hold for you - it's technology that navigates the IRS phone tree and holds your place in line. When an agent picks up, you get an immediate call connecting you directly to that agent. They use an automated system that continuously redials and navigates the IRS phone system, essentially waiting in line for you. I had the same skepticism initially. The IRS made a mistake calculating my quarterly payment penalty, and I needed to speak to someone to get it fixed. What would have been a half-day project turned into a 15-minute call. The technology is similar to what call centers use, but repurposed to benefit individuals trying to reach government agencies.

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Adrian Connor

•8M

I have to eat my words and follow up on my skeptical comment. After another frustrating attempt to reach the IRS about a notice I received regarding my quarterly payments, I broke down and tried Claimyr. I got through to an actual IRS agent in about 20 minutes while I continued seeing patients. The system called me when an agent was on the line, and I stepped out to take the call. Got my issue resolved in one conversation instead of the multiple attempts it would have normally taken. For any physician dealing with 1099 income and quarterly payments, having this tool available is worth keeping in your back pocket. Especially during tax season when wait times are even worse. Time is the one thing we can't bill for, and this saved me hours.

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Aisha Jackson

•8M

Congrats on the new position! Beyond just hiring a CPA (which I agree with), make sure you have adequate disability insurance ASAP with that 1099 income. As a surgeon, your income potential is massive but entirely dependent on your ability to perform procedures. Standard employer plans won't exist with 1099 status. Also, don't necessarily rush to pay off those student loans if they're at a favorable interest rate. With your income, you might be better off maximizing retirement accounts first, especially with the tax advantages.

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Aisha Jackson

•8M

For disability insurance, most financial advisors recommend covering 60-70% of your income, but as a surgeon, you should look for specialty-specific coverage with true "own-occupation" definition of disability. This means you get paid if you can't perform surgery specifically, even if you could still work in medicine in other capacities. Regarding retirement vs. loans, it depends on the interest rates, but generally yes - max out tax-advantaged accounts first, especially if your loans are under 6-7%. The tax advantages of retirement accounts (particularly when combined with the right business structure) almost always outperform the guaranteed return of paying off low or moderate interest debt. With your income level, you should be able to make significant progress on both simultaneously.

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