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For Independent 1099 Physicians Earning $400K–$1M+

You earn $400K–$1M+ as a 1099 physician.
Is your financial structure actually optimized?

You make enough. The problem is coordinating it.

Book a 1099 Physician Financial Diagnostic

One conversation. You'll leave knowing the financial priorities that deserve your attention first — whether or not you work with us.

You make enough. The problem is coordinating it.

By the time you're earning $400K or more as a 1099 physician, you usually have several professionals in the picture:

Any of them may be good at their piece. But no one is responsible for whether all of those decisions make sense together. The result is often a collection of individually reasonable decisions that produce a suboptimal household outcome.

A New Category

A Physician CFO

Your CPA is responsible for the return. Your advisor is responsible for the portfolio. Your Physician CFO is responsible for making sure the decisions fit together.

Information is abundant. Judgment is scarce. The value is not knowing every strategy that exists; it is knowing which ones matter for your situation, which conflict with each other, what should happen first, and what should be left alone.

That's the role we fill. We coordinate the financial architecture of your 1099 practice and household, and we bring in the licensed specialists — CPA, attorney, actuary, investment advisor — to execute wherever licensing or specialized expertise is required. One person responsible for the whole picture, instead of five professionals each seeing a slice of it.

We coordinate the strategy. Licensed professionals execute the regulated work. That is what keeps the advice accountable and correct.

The Framework

Earn → Keep → Compound → Optional

Earn

Structure how your income reaches you: entity, contracts, multi-state sourcing, payroll.

Keep

Reduce unnecessary tax, financing, insurance, and structural drag so more of what you earn stays available to build wealth.

Compound

Point surplus cash at its highest-value use instead of letting it idle.

Optional

Build enough financial independence that practicing medicine becomes a choice rather than a requirement.

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

Dr. Troy Akers, MD, Emergency Medicine physician and co-founder of 1099 Physician Solutions
Your Physician Co-Founder

Dr. Troy Akers, MD

Emergency Medicine Physician · Army Combat Veteran · 20+ Years Around 1099 Medicine

“Physicians don't need more financial information. They need one person who sees the whole picture and takes responsibility for how the pieces fit together. That's what we built.”

This firm is built by a physician who has lived the 1099 problem, paired with a finance team that solves it. You are not handing your practice to a generic S-Corp mill. You are working with people who understand both medicine and money.

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 coordinate for each.

1

"I've been 1099 for years, but no one has ever looked at the whole picture."

The Situation

An established independent physician earning $450K–$600K. Already has an S-Corp, a Solo 401(k), and a CPA who files the return. Each piece was set up separately, and no one has ever coordinated them against each other.

The Complexity
  • ● Income is crossing the $403,500 QBI phase-out with no one managing it to protect the deduction
  • ● Retirement is a Solo 401(k) alone when a Cash Balance overlay could shelter far more
  • ● The salary and distribution split was set once and never revisited against reasonable-comp data
  • ● A PTET election may be going unclaimed in a state that offers it
What Needs to Be Coordinated
Entity & Compensation Review QBI Threshold Management Cash Balance Plan Evaluation PTET Election Retirement Coordination Bookkeeping Quarterly Tax Planning Form 1120-S Corporate Tax Return

A physician earning $450K–$600K with these pieces uncoordinated typically finds $20,000–$45,000 in annual improvement once the decisions are aligned.

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
  • ● Variable multi-state cash flow and quarterly estimates have to be coordinated with retirement contributions and available investment capital
What Needs to Be Coordinated
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 $450K–$650K 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
  • ● Once W-2 wages reach the Social Security wage base, additional S-Corp salary is subject only to Medicare, not the 12.4% Social Security tax, which changes the payroll-tax math
  • ● Cash Balance Plan eligibility still applies to 1099 income and can shelter $175K–$300K+ depending on age
What Needs to Be Coordinated
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. Actual recommendations, scope, and fees depend on your specific circumstances.

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

One Example of What We Evaluate

Estimate Your S-Corp Tax Savings

The S-Corp election is one lever among many. Here's a quick estimate of what that single decision is worth — one example of what a full diagnostic examines.

$
2026 Tax Strategy Map

Your Income Level Determines Your Strategy

Tax strategy scales with income, and what works at $450K fails at $900K. A snapshot of the tax competence behind the coordination.

$400K – $550K
The QBI Red Zone

Threshold management across the $403,500–$553,500 SSTB phase-out to protect the 20% QBI deduction.

$15,000 – $30,000 / yr
$550K – $750K
The Wealth Shield

Cash Balance Plan layering and PTET restoration to build private wealth as the SALT cap phases down.

$50,000 – $120,000 / yr
$750K – $1M+
Maximum Deferral

Full Cash Balance and Solo 401(k) stacking against the $350K compensation cap to defer the most the code allows.

$120,000 – $250,000+ / yr
See the full 2026 tax strategy map, with real examples by income level →

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.

Evidence, Not the Product

The Tax Work Is Real.
It Just Isn't the Whole Job.

Tax structure is one part of the system we coordinate. We evaluate whether your S-Corp, salary split, retirement contributions, and PTET elections actually improve your household's overall outcome, not just this year's return. The savings are often substantial, but they're a result of the coordination, not the reason to do it.

S-Corp Payroll Tax Savings

S-Corp structure eliminates self-employment tax on distributions. On a $500K income with a 50/50 salary split, you stop paying 2.9% Medicare tax on $250K of distributions, plus avoid the 0.9% Medicare surtax on the overage.

Save $8,000–$18,000/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. For physicians earning $400K+ with stable income, it is one of the highest-leverage tools available.

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

Important: This estimate assumes a reasonable salary equal to 50% of your 1099 income. Reasonable compensation is a facts-and-circumstances determination benchmarked to market pay for your specialty, region, and hours, so your actual figure will differ and the result moves with it. 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.

Where to Start

The 1099 Physician Financial Diagnostic

In one focused conversation, we'll identify:

You'll leave knowing the 2–4 financial priorities that deserve attention first, in order.

You don't need to become a client. You'll leave knowing what deserves attention first.

Book Your Diagnostic
Pricing

One Relationship, One Number

Annual Physician CFO engagements start at $10,000.

Scope and fee depend on your complexity, the states involved, and the services we coordinate. A typical engagement covers the decisions around your 1099 practice: bookkeeping, payroll, tax planning and compliance, retirement-plan coordination, cash-flow planning, and ongoing strategic support. Instead of managing tax, payroll, retirement, and financial decisions separately, you have one person responsible for the whole picture.

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100% Satisfaction Guarantee

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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We stand behind our work