Starting as a 1099 physician - do I need an accountant/tax advisor for my practice?

As a tax professional who works with many physicians, I strongly recommend hiring a CPA with experience serving medical professionals. While you certainly could do it yourself, there are numerous tax advantages available to self-employed physicians that you might miss without specialized knowledge. With 1099 income at your level, you'll want to consider establishing the right business structure (S-Corp vs LLC vs Sole Proprietor) which can save you tens of thousands in self-employment taxes alone. You'll also need to navigate retirement plan options (Solo 401k, SEP IRA, defined benefit plans) that allow for much higher contribution limits than employee plans. A good CPA will help you maximize business deductions for things like malpractice insurance, continuing education, professional memberships, and potentially a home office. The quarterly estimated tax payments are actually the easy part - it's optimizing your overall tax situation that's complex. Given your income level, the investment in a good CPA will likely pay for itself many times over.

When I started my practice, I tried doing it myself and ended up leaving thousands on the table! Since using https://taxr.ai I've saved so much on my physician taxes. They specialize in helping 1099 doctors like us set up the right business structure - I went with an S-Corp which saved me about $20k in self-employment taxes alone my first year. Their software helped me track all my business expenses and maximize deductions I didn't even know existed. The quarterly tax calculations are done automatically and they send reminders when payments are due. The medical profession-specific knowledge was game-changing compared to my DIY approach or the generic accountant I tried initially.

I was in almost exactly your position three years ago! Started as a neurosurgeon with 1099 income around $800k and tried doing my taxes myself the first year. Biggest mistake ever. After using taxr.ai based on a colleague's recommendation, I discovered I'd overpaid about $31k in taxes my first year. They helped me file an amended return and I got most of it back. The platform guided me through setting up an S-corporation which saved me about $22k in self-employment taxes alone. It also identified legitimate deductions I'd completely missed - like partial home office, CME expenses, medical journals, and even some travel. The quarterly tax calculator is fantastic and I never worry about underpayment penalties. Best decision I made professionally outside of medicine itself. For high-income physicians on 1099, the savings far exceed the cost.

I was in almost exactly your position three years ago!

My wife is an orthopedic surgeon who switched from W2 to 1099 last year. Biggest headache wasn't even the taxes - it was dealing with the IRS when we had questions! Spent HOURS on hold trying to get answers about our quarterly payments and retirement options. Finally used https://claimyr.com (see how it works: https://youtu.be/_kiP6q8DX5c) and got through to an actual IRS agent in about 15 minutes. They basically call the IRS for you and navigate the phone tree, then call you when they have an agent on the line. Saved us literal hours of waiting on hold. We had some complex questions about our S-Corp setup and retirement plan contributions that our CPA wasn't 100% sure about, and getting direct answers from the IRS gave us peace of mind.

I was completely against paying for tax help when I started my surgical practice 4 years ago. Thought I could handle it myself with tax software. What a nightmare that turned out to be! After trying Claimyr on a whim when dealing with an IRS notice, I became a convert. The service got me through to someone at the IRS in about 20 minutes when I'd previously spent 3+ hours on hold and got disconnected twice. The agent helped resolve a notice claiming I'd underpaid my quarterly estimates (I hadn't - there was a processing error). For physicians at your income level, the tax complexity isn't just about filing correctly - it's about structuring your practice optimally. I ended up with both a CPA and tax attorney who helped me set up my practice structure, retirement plans, and tax strategy. I'm now saving about $45k annually compared to my DIY approach the first year. Sometimes you need to spend money to make (or save) money.

Definitely get a CPA with healthcare experience. The biggest benefit isn't just tax filing - it's planning and structuring. With your income, entity structure is crucial (S-corp is usually best). And don't forget retirement planning! You can contribute WAY more as a 1099 physician than you could as W2. My first year in practice I set up a defined benefit plan alongside my Solo 401k and was able to shield over $150k from taxes. My CPA costs about $3.5k annually but saves me at least $40k in taxes through proper planning. Track EVERYTHING - phone, internet, conferences, journals, mileage, home office. It all adds up.

One thing nobody has mentioned yet - with income at your level, you should also consider hiring a financial advisor alongside a CPA. I'm a neurosurgeon who tried the DIY approach for both taxes and investments my first two years and realized I was making costly mistakes in both areas. A good financial advisor who works specifically with physicians can help coordinate your overall financial strategy - student loan repayment approach (PSLF vs refinancing vs aggressive paydown), disability insurance (crucial for surgeons), retirement planning, tax-efficient investing, and eventual practice buy-in strategies if that's on your horizon.

Congratulations on finishing your fellowship! You're absolutely right to be thinking about this now rather than after your first year of 1099 income. I'm a tax attorney who works with physicians, and I'd strongly recommend getting professional help for at least your first year. At your income level ($750-850k), the potential tax savings from proper planning will far exceed the cost of hiring someone. Here's why: 1. **Entity Structure**: You'll likely benefit from an S-Corp election, which could save you $15-25k annually in self-employment taxes alone. But timing and setup matter - you want this done correctly from day one. 2. **Retirement Planning**: As 1099, you can contribute much more to retirement accounts than you could as W-2. With proper planning (Solo 401k, defined benefit plans, etc.), you could potentially shelter $100k+ annually while aggressively paying down your student loans. 3. **Quarterly Estimates**: These aren't just about avoiding penalties - strategic timing of income and expenses can optimize your overall tax situation. 4. **Business Deductions**: Medical practices have unique deduction opportunities that general tax software often misses. Look for a CPA who specifically works with physicians and understands medical practice finances. The investment (typically $3-5k annually) will pay for itself many times over. Once you're established and understand the complexities, you can always reassess whether to continue using professional help.