Tax Planning for Surgeons (2026)

Surgeons are among the highest-earning physicians and often combine hospital employment, call pay, group partnership income and ownership in ambulatory surgery centers (ASCs). That mix creates more planning opportunities, and more ways to overpay, than a single paycheck.

Tax planning priorities for surgeons

ASC and facility ownership

Distributions from ASC partnerships are generally reported on a K-1. They may be passive or non-passive depending on your participation, which affects net investment income tax and whether losses can offset other income. Track hours and roles carefully.

Call pay and stipends

Call stipends paid on a 1099 open a solo 401(k) and business deductions, even if your main salary is W-2.

Asset protection

High malpractice exposure makes retirement plans (with strong creditor protection), umbrella coverage and proper titling of assets more important for surgeons than for most professionals.

Cash balance plans

Surgeons who own a practice or have large 1099 income are often good candidates for a cash balance plan layered on a 401(k).

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.