Tax Planning for Neurosurgeons (2026)
Neurosurgeons are among the highest earners in medicine, so the 37% bracket, the SALT phase-down and the 35% itemized deduction cap apply to nearly every neurosurgeon.
Tax planning priorities for neurosurgeons
High-income limits
At this income the SALT deduction is usually $10,000 and the QBI deduction is fully phased out; plan around both.
Retirement shelters
457(b), cash balance plans and mega backdoor Roth contributions matter more at this level.
Asset protection
High liability exposure makes protection planning essential.
Charitable planning
Appreciated stock and donor-advised funds are more efficient than cash under the 2026 rules.
Strategies that apply to every specialty
- Know your marginal rate. In 2026 the 37% federal bracket starts at $640,600 (single) and $768,700 (joint); see how much tax doctors pay.
- Fill every tax-advantaged account: 401(k)/403(b) ($24,500 in 2026), 457(b), HSA and a backdoor Roth.
- Match the plan to how you are paid: W-2, 1099 or practice owner.
- Use your state's rules; see our 50-state guides.
Frequently asked questions
What tax bracket are neurosurgeons in?
Most are in the 37% federal bracket, which starts at $640,600 (single) or $768,700 (joint) of taxable income in 2026.
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Sources
This article is for general educational purposes and is not tax, legal or investment advice. Tax law changes often and its application depends on your facts. Figures reflect 2026 rules as published by the sources listed above. Consult a qualified professional before acting. See our editorial policy.