A physician tax practice on the Philadelphia Main Line
Your taxes deserve a specialist, not a general practitioner.
Oakmont Tax Consulting serves physicians across the country, with deep roots on the Philadelphia Main Line. From residents to practice owners, we help doctors keep more of what they earn.
Serving Philadelphia Main Line physicians · Nationwide virtual practice
The problem
You didn't spend 11 years in training to give a third of your income to the IRS.
Most physicians work with generalist CPAs who prepare their returns compliantly. The math is right and the filing is on time. What generalists routinely miss are the physician-specific strategies, and missing them costs real money year after year. Here is what that looks like in practice.
Missed S-corp election savings
Physicians running 1099 income through a single-member LLC or sole proprietorship often overpay self-employment tax year after year. The S-corp election is one of the most powerful and most overlooked tools available to physicians with independent income.
No cash balance plan analysis
High-earning physicians can shelter substantial income each year through cash balance pension plans, but most CPAs never model one. If you are an established attending or a practice owner, this conversation should have already happened.
Backdoor Roth execution errors
Incorrect execution of the backdoor Roth IRA strategy can trigger the pro-rata rule, creating an unexpected tax bill on money you thought was tax-free. It is a common and costly mistake with a straightforward fix, if your CPA knows to look for it.
Student loan filing strategy mistakes
Filing status decisions can saddle physicians in income-driven repayment plans with unnecessary payments, or set up a painful tax bill at forgiveness. A married-filing-separately versus jointly analysis is essential for any physician carrying federal student loans.
The free guide
Free guide: The Physician's Tax Checkup.
Seven costly mistakes your CPA might be missing, and how to fix them.
This guide was written specifically for physicians, not small business owners or generic W-2 employees. Inside is a plain-English breakdown of the seven most common and most expensive tax mistakes we see physicians make, with a self-assessment question for each so you can tell whether it applies to your situation.
If you check three or more boxes, your current tax strategy has room for improvement, and the fix is usually straightforward once you can see it.
- You're still a sole proprietor when an S-corp election could lower your bill
- You're not executing a backdoor Roth IRA, or you're triggering the pro-rata rule
- Your CPA hasn't modeled a cash balance or defined benefit plan
- You're not maximizing your HSA as a stealth retirement account
- Your tax filing status is working against your student loan repayment
- You're leaving QBI / Section 199A deductions on the table
- Your investments aren't tax-coordinated with your CPA
Oakmont Tax Consulting
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How we work
How we work with physicians.
A three-step process built around your career stage, your income structure, and your long-term financial goals.
Diagnostic review
We start with a comprehensive review of your current tax return, identifying missed strategies and sizing the opportunity. Think of it as a second opinion on your tax health.
Custom strategy, implemented
We build a personalized plan from our library of physician-specific strategies, covering entity structure, retirement design, real estate, charitable giving, and state-level planning. Then we actually implement it.
Year-round monitoring
Tax planning is not a once-a-year event. We monitor your situation through the year, adjust projections, and capture opportunities as your career evolves, from residency through practice ownership.
Across the arc of a career
Different stage, different tax picture.
The foundation years
Income is modest but climbing, and the decisions you make now compound for decades. We help you start clean and avoid the early missteps.
- ◆Student loan interest and education credits
- ◆Multi-state moves for training
- ◆First moonlighting 1099 income
- ◆Roth groundwork while rates are low
The high-earning years
A hospital W-2, locums or moonlighting 1099s, and a tax bill that suddenly demands a plan. This is where good structure earns its keep.
- ◆W-2 and 1099 income in one year
- ◆Quarterly estimated payments
- ◆Multi-state and locums filings (SALT)
- ◆Deductions that actually apply to you
The practice years
Owning or buying into a practice changes everything about your return. We help you choose the structure and keep it compliant as you grow.
- ◆Entity selection and S-corp election
- ◆Reasonable-compensation analysis
- ◆Partnership and group K-1s
- ◆SALT across multiple locations
The real value of proactive strategy
Tax savings don't just save. They compound.
A dollar of tax you never pay is worth more than a dollar. Reinvested in the practice or the portfolio, it earns returns of its own, and next year's savings stack on top of this year's. Repeat that every year of a long career and the gap between a proactive strategy and the status quo stops looking like a line item and starts looking like an asset.
That is why we treat planning as an annual discipline rather than an April errand. The strategies themselves, entity structure, retirement design, filing status, are repeatable. The advantage comes from running them every single year, early enough to act.
Service plans
Plans built for every career stage.
Flat-fee service plans designed for physicians at every stage of their career. You will know the fee structure before any work begins, and there are no surprise invoices.
The Foundation
Base Compliance
- Federal + state return preparation
- Backdoor Roth IRA guidance
- Retirement account contribution optimization
- W-2 withholding review and adjustment
- Annual Physician Tax Blueprint document
- 3-business-day email + portal message response
The Strategist
Priority Prep
- Everything in Base Compliance
- Mid-year tax check and withholding review
- Moonlighting / 1099 income integration
- Student loan filing strategy optimization
- Multi-state income allocation
- HSA strategy and coordination
- Annual Physician Tax Blueprint document
- 2-business-day response via email + portal messaging
- Live Zoom walkthrough of your completed return
- Notice representation included
The Physician's Tax Advisor
Premium Advisory
- Everything in Priority Prep
- 24-hour response + direct line access to Ryan
- Quarterly estimated tax preparation
- Fall tax planning session
- S-corp evaluation + reasonable comp analysis
- Cash balance / defined benefit plan modeling
- Practice buy-in / buy-out scenario planning
- Real estate and depreciation strategy
- Charitable giving and DAF planning
- Annual Physician Tax Blueprint document
Practice-level services for S-corp and partnership medical practices are quoted individually based on your situation.
FAQ
Common questions from physicians.
Do you only work with physicians?
No, but physicians and medical practice owners are our primary focus. Our physician tax playbook and deep familiarity with physician compensation, student loan implications, and practice-level planning set Oakmont apart from generalist CPAs. Clients in other fields get that same depth on their own situations.
I'm a resident or fellow. Is it too early to work with a tax advisor?
Not at all. Getting your tax strategy right during training, especially your student loan filing strategy and retirement account setup, pays off for decades. The Foundation plan is designed for early-career physicians who want to build good habits from the start.
Can we work together virtually?
Yes, and that is how the majority of our physician clients work with us. Oakmont is a virtual-first practice: secure document sharing, video calls, and phone. Physicians across the country work with us without ever stepping into an office, which fits a demanding schedule far better than in-person appointments.
How is Oakmont different from my current CPA?
Most generalist CPAs prepare your return compliantly: the math is right and it is filed on time. What they typically miss are the physician-specific planning strategies, from entity structure to retirement design to filing status. We focus on proactive planning alongside compliance, and we speak the language of physician compensation, practice structure, and student debt.
What does the first meeting look like?
It is a free 30-minute call spent understanding your situation: how you earn, how you are structured today, and what is changing. We do not diagnose on the spot. Within a few days you receive a follow-up with our proposed plan, what it would involve, and what working together would look like. If we do not believe we can add real value, we will say that instead.
Do you handle medical practice tax returns too?
Yes. We prepare S-corporation (1120-S) and partnership (1065) returns for medical practices, including reasonable compensation analysis, retirement plan coordination, and multi-state filing. Practice engagements are quoted individually once we understand the scope.
Ready for a tax second opinion?
Download the free Physician's Tax Checkup, or tell us about your situation through the contact form. Either way, you'll know exactly where you stand.