Physician-Led. Finance-Backed. Built for Doctors.

The 1099 Physician
Infrastructure Framework

Not generic tax advice. A structured wealth-building system for high-income independent physicians who want the infrastructure of a W-2 job, without the W-2. Get W-2 stability with your 1099 income. S-Corp formation, automated payroll, health insurance navigation, 401(k) setup, and complete tax compliance, all handled for you. Specialized for locum tenens and independent contractor physicians.

Built exclusively for 1099 physicians earning $300K+ annually

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Same-day response | 30-day onboarding | Year-round support

Every Situation Is Different

We've Seen Your Situation Before.

No two 1099 physicians are alike. Here's how we approach three common scenarios and what we'd typically build for each.

1

"I just finished residency and I'm going 1099 for the first time."

The Situation

A physician finishing residency, heading into their first 1099 contract. No entity, no payroll system, no idea what "reasonable compensation" means, with a contract starting in 60 days.

The Complexity
  • ● Form 2553 must be filed within 75 days of incorporation
  • ● First payroll must run before any distributions are taken
  • ● Health insurance setup must be coordinated through the S-Corp for full deductibility
  • ● Student loans and QBI threshold interaction requires early planning
What We Build
S-Corp Formation EIN + Form 2553 Payroll Setup Solo 401(k) Setup Health Insurance Coordination Bookkeeping Quarterly Tax Planning Form 1120-S Corporate Tax Return

A physician earning $250K in year one could typically expect $15,000–$22,000 in annual tax savings from S-Corp structure alone.

This Is My Situation →
2

"I live in one state but work contracts in two or three others."

The Situation

An established independent contractor physician based in one state, taking contracts in two or three others. Has an S-Corp or LLC already, but multi-state income is creating compliance gaps and missed deductions.

The Complexity
  • ● Non-resident state tax returns required for each income-producing state
  • ● Foreign qualification filings needed if S-Corp does business across state lines
  • ● PTET elections must be evaluated state-by-state. Benefit varies significantly
  • ● Income apportionment between states affects both federal and state taxable income
What We Build
Multi-State Compliance Review Foreign Qualification Filings Non-Resident State Returns PTET Analysis by State Income Apportionment Strategy Ongoing Bookkeeping Quarterly Planning Form 1120-S Corporate Tax Return

A physician in this situation earning $350K–$400K typically sees $25,000–$40,000 in combined annual benefit: S-Corp payroll tax savings plus recovery from incorrect apportionment and missed multi-state deductions.

This Is My Situation →
3

"I have a W-2 job and 1099 income."

The Situation

A physician earning a W-2 salary from a hospital or group practice, while also taking independent contracts on the side. Combined income exceeds $500K but the two income streams have never been coordinated. Most assume the W-2 makes an S-Corp impossible. It doesn't.

The Complexity
  • ● W-2 income counts toward the QBI phase-out threshold even though it generates no QBI
  • ● The 401(k) employee deferral limit is shared across both employers and must be coordinated
  • ● W-2 FICA already paid allows the S-Corp salary to be set more conservatively, preserving more distributions
  • ● Cash Balance Plan eligibility still applies to 1099 income and can shelter $175K–$300K+ depending on age
What We Build
S-Corp for 1099 Income W-2 and 1099 Income Coordination 401(k) Deferral Optimization Cash Balance Plan Salary Optimization Modeling QBI Threshold Management Roth Optimization Strategy Charitable Giving Strategy Form 1120-S Corporate Tax Return

A physician in this situation with $500K+ in combined income and the full strategy stack deployed can typically shelter $250,000–$350,000 of gross income annually from federal and state taxation.

This Is My Situation →

These are illustrative scenarios based on common physician situations. Your actual engagement scope and fees are determined during your free consultation based on your specific circumstances.

Not sure which scenario fits, or want to see the numbers before you book? Run your estimate below →

Free Estimate

Calculate Your Tax Savings

See exactly how much you could save by switching to an S-Corp

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2026 Tax Strategy Map

Your Income Level Determines Your Strategy

The post-OBBBA tax landscape rewards precision. Standard compliance isn't enough. What works at $280K actively fails at $520K. Here's what your level demands.

Tier 1
$200K – $350K
The Efficiency Foundation
Estimated Annual Impact
$5,000 – $12,000

At this level, you are likely overpaying into a system that gives you nothing back.

Primary Lever
Medicare/FICA Arbitrage via S-Corp Election
The Play
Optimize Reasonable Compensation to convert SE tax into profit-sharing

The Goal: Make your S-Corp pay for its own overhead in month one. The S-Corp structure alone generates immediate, recurring payroll tax savings, before we touch a single deduction.

See real examples for this tier →
Tier 2
$350K – $500K
The QBI Red Zone
Estimated Annual Impact
$15,000 – $25,000

You are entering the most dangerous tax bracket for physicians. As an SSTB, you hit the $383,900 MFJ phase-out, and every dollar over that line erodes your 20% QBI deduction.

Primary Lever
SSTB Threshold Management: The $383,900 Cliff
The Play
Expanded $40K SALT Cap + $72K 401(k) to pull taxable income under the phase-out line

The Goal: Protect your 20% federal discount before it permanently vanishes. This is the tier where a generic CPA costs you the most, and where precise threshold management pays the highest dividend.

See real examples for this tier →
Tier 3
$500K+
The Wealth Shield
Estimated Annual Impact
$60,000 – $150,000+

You've outgrown "deductions." You now need to build private wealth with dollars the IRS can't touch, and the SALT cap just snapped back to $10K, making your prior strategy obsolete.

Primary Lever
Cash Balance Plan Layering + PTET Election Restoration
The Play
Max $72K Solo 401(k) + Cash Balance overlay. PTET elections become essential as SALT cap snaps to $10K.

The Goal: Shift your focus from "tax savings" to seven-figure wealth accumulation. The Cash Balance Plan is the single highest-leverage tool available to a physician at this income level.

At $750K+: A Cash Balance Plan contribution alone can exceed $300,000 annually depending on age, making it the single highest-leverage tax tool available to any physician in the country. Every year without one at this income level is a six-figure decision.

See real examples for this tier →

Tax savings estimates are based on individual income, state of residence, and filing status. All strategies are subject to individual circumstances and IRS compliance. Consult with a qualified tax professional before implementation.

Oh, And You'll Save Serious Money

This Service Pays for Itself
Every Single Year

While building your W-2 infrastructure, we also optimize your tax structure. Depending on your income and age, most clients save $15,000 to $100,000+ annually.

Investment That Pays for Itself

Your typical tax savings? $15,000 to $100,000+ annually, depending on income, age, and state.

$15K–$100K+ Annual Tax Savings
120+ hrs Time Saved Annually
100% Done For You

S-Corp Payroll Tax Savings

S-Corp structure eliminates self-employment tax on distributions. On a $300K income with a 50/50 salary split, you stop paying 2.9% Medicare tax on $150K of distributions, plus avoid the 0.9% Medicare surtax on the overage.

Save $8,000–$18,000/yr

QBI Deduction

For physicians under the 2026 SSTB phase-out threshold of $383,900 (MFJ), you can deduct up to 20% of qualified business income from federal taxable income. Above it, strategic income suppression is required to preserve it.

Save $5,000–$12,000/yr

Solo 401(k): 2026 Limits

As both employee and employer inside your S-Corp, you can contribute up to $72,000 in 2026 in pre-tax deferrals. Physicians aged 60–63 can add an additional $11,250 Roth catch-up contribution on top of that cap.

Shield up to $72,000/yr

Cash Balance Plan

Layered on top of the Solo 401(k), a Cash Balance Plan can shelter an additional $100,000–$300,000+ of income annually depending on age. Available only through a corporate structure. This is the highest-leverage tool for physicians earning $400K+.

Shield $100K–$300K+/yr

PTET Election & SALT Savings

The 2026 OBBBA expanded the personal SALT cap to $40,400 for physicians earning under $505,000. Above that, it phases back to $10,000, making the Pass-Through Entity Tax election the only way to deduct state taxes at the federal level for high earners in CA, NY, NJ, OR, and MN.

Save $5,000–$25,000/yr

Business Deductions & Accountable Plan

CME courses, medical licenses, malpractice insurance, home office, vehicle mileage, and health insurance premiums, run through an accountable plan inside your S-Corp to maximize deductibility and reduce both federal and state taxable income.

Save $3,000–$8,000/yr

Important: Tax savings estimates are based on typical client scenarios and are provided for illustrative purposes only. Actual tax savings will vary based on your individual income, deductions, filing status, state of residence, and other factors. These estimates do not constitute a guarantee of specific results.

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We're confident you'll love working with us. If at any point you're not completely satisfied with our services, we'll refund the unused portion of your annual package. No questions asked.

What This Means for You:

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Zero risk to try our services

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Pro-rated refund for unused months

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