Tax Planning for Orthopedic Surgeons (2026)

Orthopedic surgeons frequently own interests in ASCs, imaging and physical therapy, and sometimes receive royalty or consulting income from device companies. Each income stream is taxed differently.

Tax planning priorities for orthopedic surgeons

Ancillary ownership

ASC, imaging and therapy income may be passive or non-passive depending on participation, which affects the 3.8% net investment income tax.

Royalties and consulting

Device royalties are generally ordinary income; consulting fees are self-employment income that can fund a solo 401(k).

Real estate

Many orthopedic groups own their clinic and ASC buildings, which can be held separately and depreciated, including through cost segregation.

Exit planning

Private equity interest in orthopedic platforms makes early sale planning important.

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.

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.