PART 10 — Your Final Pre-2026 Year-End Checklist: The Physician’s Last Chance to Lock In Tax Savings

December 23, 2025

From the series: Are You Ready for 2026? The Top 20 Year-End Tax Tips to Maximize Your 2025 Deductions & Credits

This is it.
The final part of the series.
The one that pulls everything together.

If you’re like most physicians, December shows up fast.
You’re juggling call shifts, family events, holiday travel, and the final push of the year.
You’re tired.
Your email is full.
Your accountant keeps asking you for numbers you haven’t gathered yet.

And somewhere in the background is that quiet voice saying:
“I really should do something about taxes before the year ends.”

This checklist is how you silence that voice — and go into 2026 prepared.

It’s your final pre-2026 action plan.
Simple.
Direct.
No fluff.
No wasted moves.

Let’s walk through it together.

1. Max Out Every Retirement Account You Have

Start with the basics:

  • W-2 401(k) or 403(b)

  • Hospital match

  • Profit-sharing

  • Solo 401(k) for 1099 income

  • Cash balance plan (if eligible)

  • HSA — if you have a high-deductible plan

Retirement contributions hit harder in the final pre-2026 year.
They push down taxable income and give you a cleaner runway before brackets rise.

If you want to revisit the details, check Part 2 of this series again.

2. Run Your Roth Strategy Before the Window Closes

Ask yourself one question:

“Will I regret not converting now when tax rates go up?”

For many physicians, the answer is yes.

Your income is high.
Your retirement accounts are large.
Your future RMDs are huge.
And 2026 brings higher tax brackets.

So before December 31:

  • Clean up pre-tax IRA balances

  • Set up your Roth conversion amount

  • Pair with tax-loss harvesting

  • Pair with 1099 deductions

  • Pair with retirement contributions

Revisit the full explanation in Part 3 if needed.

3. Finalize All 1099 and Business Deductions

This is your last chance to use:

  • CME

  • Travel

  • Telehealth equipment

  • Software

  • Section 179 purchases

  • Home office deduction

  • Phone/internet allocation

  • S-corp accountable plan reimbursements

  • Business meals

  • Supplies

  • Licensing fees

Physicians lose the most here because you’re busy.
But these deductions add up fast.

Parts 6 and 7 cover this in depth.

4. Time Your Income and Expenses Intentionally

Don’t let income “happen to you.”
Control it.

Before December 31, decide whether to:

Accelerate income (if this is a lower year)
or
Push income into January (if this is a higher year)

And pair that decision with your expenses.

This is your best pre-2026 bracket-control tool.

Part 4 explains the timing strategy step-by-step.

5. Use Loss Harvesting to Offset Gains and Conversions

If you have any investments sitting at a loss, now is the time.

Sell the loss.
Capture it.
Reinvest in something similar.
Stay invested.
Avoid wash-sale rules.
Document the trade.

Then use the loss to offset:

  • Capital gains

  • Roth conversions

  • K-1 gains

  • Stock vesting

  • Real estate gains

Part 5 walks through this more deeply.

6. Knock Out Your Energy and Clean Vehicle Credits Before Rules Shift

Energy credits are still strong, but some provisions may shift by 2026.

So if you’re planning:

  • Heat pump

  • Windows

  • Doors

  • Solar

  • Battery storage

  • Home insulation

  • EV purchase

  • Used EV purchase

…this may be your best timing.

Part 8 explains all the credit ceiling amounts clearly.

7. Review Your State Tax Exposure

High-tax states get more painful in 2026.

Especially:

  • California

  • New York

  • New Jersey

  • Minnesota

  • Oregon

If you’re considering relocating, splitting residency, telehealth income, or practicing across state lines, this is a good year to map the strategy.

To frame state-level planning, revisit:
High state income taxes for physicians.

8. Confirm Your Business or Practice Structure Is Correct

A strong tax plan starts with the right structure:

  • S-corp

  • Sole prop

  • LLC

  • Multi-member LLC

  • Partnership

  • Hybrid setups

  • Rental entity planning

  • Real estate LLC leasing to practice

If your structure is wrong, everything else becomes harder.

Review the full structural guide here:
Best tax structure for doctors.

9. Plan Your Charitable Strategy Before Brackets Rise

Your charitable planning becomes more valuable when paired with rising tax rates.

Consider:

  • Donor-advised funds

  • Appreciated stock donations

  • Charitable “bunching”

  • QCDs (if age-eligible)

A small move now can set up years of flexibility.

10. Look Ahead — Don’t Wait for 2026 to Arrive

The biggest mistake physicians make is waiting.

Waiting until January.
Waiting for tax season.
Waiting to “get around to it.”
Waiting until after call ends.
Waiting until a lighter rotation.

But the window closes on December 31.

Everything you do now affects:

  • Your 2025 return

  • Your 2026 bracket exposure

  • Your Roth conversion cost

  • Your estate planning timeline

  • Your long-term retirement withdrawals

  • Your practice tax strategy

This is your last clean year.
Use it.

Your Final Pre-2026 Year-End Checklist (Print This One)

Retirement

  • Max employee 401(k)/403(b)

  • Add employer profit-sharing

  • Fund HSA

  • Add Solo 401(k) contributions

  • Open cash balance plan (if eligible)

Roth

  • Clean up IRA balances

  • Complete Roth conversion

  • Pair with loss harvesting

1099/Business

  • Log miles

  • Document travel

  • Confirm CME

  • Reimburse through accountable plan

  • Buy equipment before December 31

  • Deduct software, subscriptions, tools

Timing

  • Decide income acceleration or deferral

  • Accelerate deductible expenses

  • Delay large expenses strategically

Investments

  • Harvest losses

  • Rebalance

  • Check gains for offset

Energy/Credits

  • Review heat pump eligibility

  • Check EV credits

  • Consider solar

  • Complete home upgrades

State Planning

  • Review multi-state income

  • Evaluate relocation timeline

  • Reassess residency

Practice/Entity

  • Review S-corp salary

  • Review distribution strategy

  • Update bookkeeping

  • Close accountable plan reimbursements

Charity

  • Consider donor-advised fund

  • Donate appreciated stock

You don’t have to do all of these.
But doing some of them will significantly reduce your tax bill before the rules change.

FAQ — Final Year-End Physician Tax Planning

1. What’s the most important move to complete before December 31?

For most physicians:
A combination of retirement contributions, Roth conversions, and business deductions.

2. Can I still open a Solo 401(k) this year?

Yes — as long as you open it by December 31.

3. Is 2025 really the “last cheap year” for Roth conversions?

Yes.
Conversions cost more in 2026 due to higher tax brackets.

4. Should W-2 doctors still follow this checklist?

Yes.
Retirement moves, Roth planning, and energy credits still apply.

5. How do I know which moves matter most for me?

Use the checklist above.
Circle the areas where you have income or deductions.
Start with the ones that reduce your taxable income the most.

Yes.
Income timing, Roth planning, and charitable strategies still matter.

Ready to talk strategy? Start here.

Visit contact physiciantaxsolutions.com to schedule a consultation and learn how we can help you take control of your tax strategy today.

This post serves solely for informational purposes and should not be construed as legal, business, or tax advice. Individuals should seek guidance from their attorney, business advisor, or tax advisor regarding the matters discussed herein. physiciantaxsolutions.com assumes no responsibility for actions taken based on the information provided in this post.

 

Posted in Tax tips and tagged , , , , , , , , , , , ,

Leave a Comment