Tax Planning for Physicians in Sacramento, CA (2026)

Physicians in Sacramento pay federal tax at up to 37% plus California income tax (a top rate of 13.3%). Here is how the 2026 rules apply to doctors, dentists and practice owners in Sacramento, CA.

2026 at a glance for Sacramento, CA physicians

State tax figures apply California's 2026 brackets to state taxable income and ignore credits, deductions and local taxes.

Local taxes in Sacramento

California has no city income tax, but wages above the federal Social Security base remain subject to State Disability Insurance (SDI) with no wage cap, and some cities (for example San Francisco and Los Angeles) impose business taxes on practices.

We have not identified a separate Sacramento income tax beyond the California rules above; confirm with the city if your practice or employer is located there.

State rules that apply in Sacramento

Yes. The state has an elective pass-through entity tax (PTET) that partnerships and S corporations can use to deduct state income tax at the entity level.

• California's top rate is 13.3% on income over $1 million (including the 1% Mental Health Services surcharge), and SDI applies to every dollar of wages, so a high-earning W-2 physician's marginal state cost can exceed 14%.
• California does not conform to federal bonus depreciation or many federal retirement and HSA rules (HSA contributions are taxable for California), so a strategy that saves federal tax may save little at the state level.
• Physicians generally cannot practice through an LLC in California; medical practices use a professional medical corporation, which can then elect S corporation status (California charges a 1.5% franchise tax on S corporation income).
• California's elective pass-through entity tax has been extended through tax years beginning before January 1, 2031, which makes it one of the most valuable SALT workarounds for practice owners.

Where the savings usually come from

For most Sacramento physicians, federal planning drives the largest results: W-2 strategies such as 401(k)/403(b), 457(b) and the backdoor Roth; 1099 and locum planning; entity and cash balance plan design for practice owners; and real estate strategies for physicians with time to participate.

More physician tax guides

• Other California cities: Long Beach, Los Angeles, San Francisco, San Diego, San Jose, Orange County.
• State rules: California physician tax guide and all 50 state guides.
• By specialty: Radiologists, Dermatologists, Neurosurgeons, Pain Management Physicians and every specialty.
• Core strategy: tax planning for physicians, tax planning for medical practice owners, advanced strategies for high-income physicians and S corporation tax planning for physicians, plus the physician tax glossary.

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.