Tax Planning for Physicians in St. Louis (2026)
The City of St. Louis, which is separate from St. Louis County, levies a 1% earnings tax. Physicians who work at hospitals inside city limits pay it even if they live in the county or across the river in Illinois.
2026 at a glance
| City earnings tax | 1% (residents and nonresidents working in the city) |
|---|---|
| Missouri top rate | 4.7% |
| Illinois rate (Metro East residents) | 4.95% flat |
Planning priorities
- St. Louis County is not part of the city, so suburban clinics in the county are not subject to the city earnings tax.
- Illinois residents who work in St. Louis pay Missouri tax on that income and claim a credit in Illinois.
- Practices with offices in the city pay the earnings tax on net profits attributable to the city.
See the full Missouri physician tax guide.
More physician tax guides
- Other Missouri cities: Kansas City, Springfield, Columbia.
- State rules: Missouri physician tax guide and all 50 state guides.
- By specialty: Hospitalists, Radiologists, Dermatologists, Neurosurgeons 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.
Frequently asked questions
Is St. Louis County subject to the earnings tax?
No. Only the City of St. Louis levies the 1% earnings tax.
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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.