Year-End Tax Moves for Doctors: Q4 Playbook 2025

As 2025 wraps up, many physicians are reviewing their earnings, deductions, and retirement goals. Q4 is the window where good planning can still make a major difference. It’s the season to reduce your taxable income, protect your assets, and prepare for 2026’s potential tax shifts.

Why Q4 Tax Planning Matters for Doctors

Your fourth quarter decisions can set the tone for the entire year’s outcome. Smart physician tax planning helps you determine how much to defer, where to contribute, and how to avoid last-minute tax stress.

In these final months, you can still:

• Defer income or accelerate deductible expenses.

• Fund retirement accounts to lower taxable income.

• Recheck your quarterly estimated taxes for physicians.

• Review reimbursements and deductions within your practice.

Doctors in high-tax states may also benefit from strategic relocation or retirement planning to preserve more income.

If you want a broad overview of opportunities that still apply in 2025, revisit these doctor tax-saving strategies to align your Q4 plan with next year’s tax goals.

Estimated Taxes, Safe Harbor, and Avoiding IRS Penalties

If you receive both W-2 and 1099 income, you already know how easy it is to underpay estimated taxes. The safe harbor rule for doctors protects you from IRS penalties if you:

• Pay 100% of your prior year’s tax liability (110% if income exceeded $150,000), or

• Pay 90% of your current year’s total tax.

Before the October 15 tax deadline for doctors, confirm your numbers match your actual income and withholdings. Locum tenens professionals and independent contractors should double-check their figures using this 1099 contractor tax guide for physicians.

You can also review the IRS Tax Tips for up-to-date guidance on estimated tax payment schedules and calculation methods.

Getting your estimates right now means no surprises later—and no unnecessary penalties.

Retirement Contributions That Still Count for 2025

Q4 is your last chance to make meaningful retirement moves before the year closes.

• Solo 401(k) for 1099 physicians: Contribute up to $69,000 for 2025 ($76,500 if age 50+).

• Cash balance plan for physicians: Great for high-income earners seeking six-figure deductions while saving aggressively for retirement.

• Mega backdoor Roth 401(k) strategy: For physicians looking to grow tax-free wealth beyond standard IRA limits.

• HSA for doctors with family coverage: Contribute up to $8,550 ($9,550 if 55+).

Choosing between S-corp, LLC, or C-corp ownership can affect your deduction strategy. To see which fits best, review the best tax structure for doctors in 2025 before filing.

These contributions don’t just save on taxes—they build long-term flexibility for your financial future.

Deduction Planning and Practice Expenses

Doctors often leave thousands on the table each year simply because deductions aren’t tracked or categorized properly. Before December 31, review your deductible expenses:

• Medical equipment and software purchases: Section 179 allows deduction of up to $1.22 million in 2025.

• Business travel and CME: See how to structure deductible business vacations legally and efficiently.

• Accountable plan reimbursements: If you have an S-corp, ensure your expense reimbursements follow an accountable plan. Learn more from tax-free travel reimbursements for C- and S-corps.

• Market losses: Review your portfolio for tax-saving opportunities from investment losses before December 31.

If you’ve started or expanded a side business, consider how non-clinical income can offset expenses. Many physicians are now increasing income through non-clinical side businesses—with proper structure and documentation, those ventures can create new deduction layers.

Advanced Year-End Strategies

High-income physicians can go beyond the basics in Q4:

• Charitable bunching: Combine multiple years of giving to exceed the standard deduction.

• Donor-advised funds: Pre-fund your charitable contributions for future years while claiming the full deduction now.

• Roth conversions: Convert part of your pre-tax IRA or 401(k) to Roth while income levels and rates are favorable.

• Entity review: If you’ve grown your practice or changed income streams, a business structure review can realign your entity type with your tax goals.

Physicians who follow this year-end tax checklist tend to see the biggest gains in cash flow and long-term savings.

Your Q4 Physician Tax Checklist

Before December 31:

• Recalculate estimated taxes using the safe harbor rule.

• Confirm 401(k), HSA, or cash balance contributions.

• Record all accountable plan reimbursements.

• Review Section 179 purchases and depreciation.

• Log charitable donations and Roth conversions.

• Assess your entity structure and payroll setup.

A quick review now prevents a scramble later—and positions your practice for stronger results in 2026.

Partner with Experts Who Know Physician Taxes

When the goal is saving on taxes while staying compliant, guidance matters. Physician Tax Solutions and Provident CPAs specialize in helping doctors cut through complexity and capture every available deduction.

Whether you’re planning for retirement, managing multiple income streams, or preparing to sell your practice, strategic Q4 planning can make the difference between paying the IRS—or paying yourself.

Schedule a session with Physician Tax Solutions today and finish 2025 with clarity and confidence.

FAQ: Year-End Tax Moves for Doctors

1. Why is Q4 tax planning important for physicians?
It’s your final chance to make deductible contributions, adjust estimated taxes, and reduce liability before December 31. Waiting until tax season means losing flexibility.

2. What are the best year-end deductions for doctors?
Common deductions include medical equipment (Section 179), travel, CME, charitable contributions, and business reimbursements under an accountable plan.

3. Can I still make 401(k) or cash balance contributions for 2025?
Yes, but the plan must be established before year-end. Contributions can be funded up to your filing deadline, including extensions.

4. What’s the difference between a Solo 401(k) and a cash balance plan for physicians?
A Solo 401(k) is flexible and ideal for 1099 income, while a cash balance plan offers higher contribution limits for physicians with strong earnings.

5. How do Roth conversions fit into year-end tax planning?
A Roth conversion moves pre-tax funds into tax-free growth. Performing it in Q4 allows you to estimate your total income and select an optimal conversion amount.

6. Should doctors worry about underpayment penalties?
Yes, especially those with both W-2 and 1099 income. Use the safe harbor rule to determine your required payments and avoid IRS penalties.

7. How can a CPA help with year-end tax strategy?
A specialized physician CPA service ensures you capture every available deduction, optimize your structure, and stay compliant under evolving 2025 tax laws.

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.