How much do you make in a year as a psychiatrist?

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How much do you make in a year as a psychiatrist (total comp including call and bonuses)

  • <100k

  • 100-200k

  • 200-300k

  • 300-400k

  • 400-500k

  • 500-600k

  • 600-700k

  • 700k+


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magdellan

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Total comp, including call and bonuses.
Let's see how psychiatry is doing in 2024! All votes are anonymous.

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Total comp, including call and bonuses.
Let's see how psychiatry is doing in 2024! All votes are anonymous.

Yes let's post the data for CMS, private insurers galore to try and cut our falling rates outside of cash practices in HCOL areas.
Inflation adjusted I am making less than I was a few years ago and sadly that trend will continue. Why hire an md psych when you can get 2-3 psych NPs at the same price.
 
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Yes let's post the data for CMS, private insurers galore to try and cut our falling rates outside of cash practices in HCOL areas.
Inflation adjusted I am making less than I was a few years ago and sadly that trend will continue. Why hire an md psych when you can get 2-3 psych NPs at the same price.
Valid point. I have a part time cash private practice and an employed role, the private practice pay per hour worked is far better.
 
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Yes let's post the data for CMS, private insurers galore to try and cut our falling rates outside of cash practices in HCOL areas.
Inflation adjusted I am making less than I was a few years ago and sadly that trend will continue. Why hire an md psych when you can get 2-3 psych NPs at the same price.
I’m sure CMS and private groups already have that data (ie MGMA) but most of us don’t so crowdsourcing it is lol
 
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yeah so mgma is fairly accurate. For a full time psych 36-40 hours clinical work it is somewhere in the 250-350 range for most employed positions outside of Cali.

Can you make more... sure by stacking multiple gigs, wknd locums, nights etc. Or if your self employed and want multiple providers and assume a lot of risk and slow initial build up years that may or may not be the right role for most people.

Point is psych pays middle of the road but has a great lifestyle with no wknds, nights, calls for a lot of folks and maybe work from home set up.

But my sibling is about to be a gas attending and even academics are in the 450k range for a snail pace work environment and easily into the 600-700 range in the private sector for NEWBIE grads starting out just from ONE JOB on DAY ONE. If that's not enough they can do some locums and touch into the low 7 fig's if they desire. I didn't really believe it till they sent me the crazy contracts her colleagues are signing in locums for 300-400/hrs.
 
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Our society is never going to value preventative medicine or even worse something as nebulous as mental health
 
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Our society is never going to value preventative medicine or even worse something as nebulous as mental health
I feel like people are pretty obsessed with it. If anything our remit is too great, and we are tasked with too much.
 
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I feel like people are pretty obsessed with it. If anything our remit is too great, and we are tasked with too much.
News outlets throwing out "mental health" as a core issue at every topic, does not mean that people are obsessed with it in my opinion. Patients complain about having to pay small copayments for their appointments which shows how much they truly value "mental health"
 
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It's hard to estimate accurately calculate the cost of benefits paid by the employer, like say PTO. I'm guessing the $200-300k are non-correctional salaried and the $300k-$400k are self employed. Under $200k are part time and over $400k are probably corrections.
 
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The inpatient jobs in my area are in the 290-310 range for 8-12 patients per day.
 
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2023:
Private Practice Insurance based
very few medicare, capped the number. Basically just aging in my existing patients.
~8 clinical patient care hours per week
143K Gross, 50K overhead, 93K Net
-18.6K for SEP-IRA
-20.8K for likely taxes
58K truly in pocket


*goal for 2024, is 12 clinical hours per week, which would yield:
214K gross, 50k overhead, 164K Net
-32K for SEP-IRA
-37K for taxes
95K truly in pocket. Who knows. We'll see.
 
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2023:
Private Practice Insurance based
very few medicare, capped the number. Basically just aging in my existing patients.
~8 clinical patient care hours
143K Gross, 50K overhead, 93K Net
-18.6K for SEP-IRA
-20.8K for likely taxes
58K truly in pocket


*goal for 2024, is 12 clinical hours, which would yield:
214K gross, 50k overhead, 164K Net
-32K for SEP-IRA
-37K for taxes
95K truly in pocket. Who knows. We'll see.
Love the transparency!! Is that 12 hrs/week? Amazing!!
 
Last year was 8 patient clinical hours average per week, and that's with vacation weeks counting as 0. So a true 52 week average.

I hope to get to 12 hours over 2024. We'll see.
 
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Last year was 8 patient clinical hours average per week, and that's with vacation weeks counting as 0. So a true 52 week average.

I hope to get to 12 hours over 2024. We'll see.

really hope you can explode soon. Sounds like the new area is much better. Are you seeing 2-3 pts/hr right now so close to 20-24/pts per week?
 
I estimate my total comp (employed) right now to be about 360k. It's probably a slight overestimate, as I used $20k as the value of the health insurance. That figure would be the cost of a high-tier marketplace plan and the likely out of pocket differential I'd pay due to being on an expensive medication. (Almost all of the marketplace plans in this state are high deductible. There are some that aren't HD but still have a high MOOP and poor coverage for nonpreferred/specialty tier treatments.)
 
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News outlets throwing out "mental health" as a core issue at every topic, does not mean that people are obsessed with it in my opinion. Patients complain about having to pay small copayments for their appointments which shows how much they truly value "mental health"

People with good insurance are willing to pay cash $$$$$ for ketamine infusions, vitamin infusions, coffee enemas, gas for their giant SUVs, the latest iPhone, designer handbags. But $20 copay? Get outta here doc! Poor people are willing to pay cash $$$$$ for meth, weed, crack, the latest iPhone and Jordans. But take a free $3000 monthly injection? Get outta here doc!

I feel like people are pretty obsessed with it. If anything our remit is too great, and we are tasked with too much.

When society refers to "mental health," they mostly mean treating issues other than actual psychiatric diseases: crime, school shootings, homelessness, emotional support animals, adult ADHD, making an annoying family member not annoying, stupidity, etc.

To answer OP's question, I get paid a decent amount, but at the same time, not enough to do this.
 
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Truer words have not been spoken
 
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Also a better metric would have been $/hr worked. The poll has part timers doing sub 15-20 hrs to work horses doing 60-80.
Like in residency we had this PP doc who had a 5 day wk office then would do overnight calls and go straight into ect mornings and rounding. I never understood why he did nights at the later part in his career. Probably in the 7 figs but that work ethic was nowhere to be found when his adult children (late 20s) were working in the office and complaining about minor things while this 60+ year old was sleeping maybe 4-5 hrs at most per night.

edit: the guy was 67 at the time and now 75 and going strong.
 
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2023:
Private Practice Insurance based
very few medicare, capped the number. Basically just aging in my existing patients.
~8 clinical patient care hours per week
143K Gross, 50K overhead, 93K Net
-18.6K for SEP-IRA
-20.8K for likely taxes
58K truly in pocket


*goal for 2024, is 12 clinical hours per week, which would yield:
214K gross, 50k overhead, 164K Net
-32K for SEP-IRA
-37K for taxes
95K truly in pocket. Who knows. We'll see.

How many patients do you see a week for only working 8 clinical hours per week?
 
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So the data in this poll is roughly 70% in psych make less than 400k.

As for the 30 percent above this they are working over 40hrs with some combo of an additional side gig, calls, moonlighting etc. Im not considering those in cali, PP, or lucrative jail work but your just not going to find in most areas a 40 hours w2 job outside of the 250-400 range counting all bells and whistles. A great salary nonetheless and lifestyle that can't be beat. MGMA is pretty much spot on with the employed folks range.
 
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2023:
Private Practice Insurance based
very few medicare, capped the number. Basically just aging in my existing patients.
~8 clinical patient care hours per week
143K Gross, 50K overhead, 93K Net
-18.6K for SEP-IRA
-20.8K for likely taxes
58K truly in pocket


*goal for 2024, is 12 clinical hours per week, which would yield:
214K gross, 50k overhead, 164K Net
-32K for SEP-IRA
-37K for taxes
95K truly in pocket. Who knows. We'll see.
I'm confused, do you have a partner with an income or are you somehow in a state with higher income tax? You were taking home 75k in 2023 but had 21k in taxes?
 
yeah so mgma is fairly accurate. For a full time psych 36-40 hours clinical work it is somewhere in the 250-350 range for most employed positions outside of Cali.

Can you make more... sure by stacking multiple gigs, wknd locums, nights etc. Or if your self employed and want multiple providers and assume a lot of risk and slow initial build up years that may or may not be the right role for most people.

Point is psych pays middle of the road but has a great lifestyle with no wknds, nights, calls for a lot of folks and maybe work from home set up.

But my sibling is about to be a gas attending and even academics are in the 450k range for a snail pace work environment and easily into the 600-700 range in the private sector for NEWBIE grads starting out just from ONE JOB on DAY ONE. If that's not enough they can do some locums and touch into the low 7 fig's if they desire. I didn't really believe it till they sent me the crazy contracts her colleagues are signing in locums for 300-400/hrs.
Couldn't pay me enough to listen to surgeons all day
 
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Were you wanting to add in PTO, health insurance, 401k match, equity etc? Or just straight cash including call/bonuses?. The later is what is usually reported by the the big salary collectors but the former is what some people seem to be listing.
Total comp, including call and bonuses.
Let's see how psychiatry is doing in 2024! All votes are anonymous.
 
really hope you can explode soon. Sounds like the new area is much better. Are you seeing 2-3 pts/hr right now so close to 20-24/pts per week?
30 min follow ups, 90 min consults. 8 clinical hours =16 follow ups? or 10 follow ups, 2 consults, etc

I'm confused, do you have a partner with an income or are you somehow in a state with higher income tax? You were taking home 75k in 2023 but had 21k in taxes?
I am married / dual income. But the bigger tax is with being in PP, I have to pay all the SS and Medicare and income tax my self. I usually use 22% as my surrogate for calculations. Positively, the SEP-IRA (or 401k for others, gets deducted first, pre taxation).
 
30 min follow ups, 90 min consults. 8 clinical hours =16 follow ups? or 10 follow ups, 2 consults, etc


I am married / dual income. But the bigger tax is with being in PP, I have to pay all the SS and Medicare and income tax my self. I usually use 22% as my surrogate for calculations. Positively, the SEP-IRA (or 401k for others, gets deducted first, pre taxation).

lol um yeah you need to start making more than 168K where SS phases out, otherwise yes you get royally screwed paying both sides of the payroll tax on all of your income.
 
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30 min follow ups, 90 min consults. 8 clinical hours =16 follow ups? or 10 follow ups, 2 consults, etc


I am married / dual income. But the bigger tax is with being in PP, I have to pay all the SS and Medicare and income tax my self. I usually use 22% as my surrogate for calculations. Positively, the SEP-IRA (or 401k for others, gets deducted first, pre taxation).
I would think with income values that low your deductions could really drive it down further. Depending on if you have home office, car for commuting, home office, internet, conferences, etc, I would be surprised if you came out at 22% at such limited hours. It does depend of course on how much your spouse makes and what bracket that puts you in.
 
Not side track this thread too much but home office and car deductions are very sketchy and hard to justify if one follows the IRS rules. I have a brick/mortar office, so home office won't work. My job doesn't have any extra reason why I need a vehicle so a car deduction won't work either.

If I did conferences, yes those would fall under overhead. CME falls under overhead. Internet for the office falls under overhead. etc. These days I choose cheap CME to keep money as income. Some day I might do the whole vacation CME thing. Not now.
 
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Working in the Northeast and including all cash-equivalent benefits (incentive pay, 403b+457 match, etc) I make around 344k, 39k of which is for different types of weekend coverage in an academic position.
 
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Not side track this thread too much but home office and car deductions are very sketchy and hard to justify if one follows the IRS rules. I have a brick/mortar office, so home office won't work. My job doesn't have any extra reason why I need a vehicle so a car deduction won't work either.

If I did conferences, yes those would fall under overhead. CME falls under overhead. Internet for the office falls under overhead. etc. These days I choose cheap CME to keep money as income. Some day I might do the whole vacation CME thing. Not now.
That's fair, I really respect you for going that route. I will say that some relatively conservative CPAs have made it pretty clear that there is good support for doctors who have a home office where they work (especially if you see patient's remotely at times), review charts, put in meds, etc and then drive to an office can have that count for a vehicle deduction. But not going that route and paying your fair share of taxes is really baller and I wish our narrative was more around how patriotic it is to pay taxes rather than avoiding them at all costs being a trendy thing.
 
That's fair, I really respect you for going that route. I will say that some relatively conservative CPAs have made it pretty clear that there is good support for doctors who have a home office where they work (especially if you see patient's remotely at times), review charts, put in meds, etc and then drive to an office can have that count for a vehicle deduction. But not going that route and paying your fair share of taxes is really baller and I wish our narrative was more around how patriotic it is to pay taxes rather than avoiding them at all costs being a trendy thing.

So yeah I would expect "overhead" to basically include all the deductible expenses so the net after retirement contributions would end up being the taxable income. As above, the SS tax really kills you below the phase out threshold.

The home office deduction actually doesn't save you THAT much unless you have a crazy huge mortgage. Even if you have an office thats like 10% of your square footage for your entire house (which is a pretty big office). Maybe a few thousand bucks a year at best in actual taxes unless your home expenses are really high.

The transportation expenses are pretty clear that you must be commuting from your primary office to a secondary office for it to be deductible. For that to be the case, when the IRS comes knocking you for an audit you better have your DEA and NPI registered to your home address if that's your "primary office" for that to make sense and be able to prove that's where you spend most of your week (ex. if you do telepsych the majority of the time from there) I suspect many people aren't doing this.
 
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So yeah I would expect "overhead" to basically include all the deductible expenses so the net after retirement contributions would end up being the taxable income. As above, the SS tax really kills you below the phase out threshold.

The home office deduction actually doesn't save you THAT much unless you have a crazy huge mortgage. Even if you have an office thats like 10% of your square footage for your entire house (which is a pretty big office). Maybe a few thousand bucks a year at best in actual taxes unless your home expenses are really high.

The transportation expenses are pretty clear that you must be commuting from your primary office to a secondary office for it to be deductible. For that to be the case, when the IRS comes knocking you for an audit you better have your DEA and NPI registered to your home address if that's your "primary office" for that to make sense and be able to prove that's where you spend most of your week (ex. if you do telepsych the majority of the time from there) I suspect many people aren't doing this.
This was just discussed on the latest WCI podcast with a very experienced CPA. My wife's partners have been doing this for some time (all surgeons who do exactly as they note below). They do not have their DEA/NPI registered to their primary home and it would be very easy to argue why someone wouldn't do that for privacy reasons. There absolutely will be metadata to support their use of the computer from home on a daily basis. My colleague does televisits on a daily basis (although also has a seperate office) and does this as well.

Dr. Jim Dahle:
Can you explain to the doctors out there listening that their drive from their house to the hospital is not business use?

Alexis Galati:
Well, sometimes it can be. If you have your home office, and it's a legitimate home office, a lot of times I have some physicians that they're on call, they come home and they're using it to look at images, etc. They have a legitimate home office. You actually can take your mileage from your home to your other place of business, and that is legitimate mileage. However, if you don't have that legitimate home office established, then yeah, you can't do your commuting miles.
 
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And then if you establish your home in any was as home office then that might open it up as an asset of the business/practice that could be gone after in a horrible lawsuit. One only needs to look at current news articles to see the goat rodeo of the judicial system. For me, just isn't worth the risk, all the way around, even if I did jump through those extra hoops to justify it.
 
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I'm not exactly sure how to answer regarding pay + benefits. Do I add in the 7 weeks of PTO?, What about the paid malpractice and other insurances, my employer's payments into our pension?
 
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independent contractor - 8hrs/day for 3 days a week , 6 -8 weeks vacation anytime i want( i dont get paid). I have a 4 day weekend every week.$202k/year (before tax).

Screenshot_20240212_121022.png
 
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This was just discussed on the latest WCI podcast with a very experienced CPA. My wife's partners have been doing this for some time (all surgeons who do exactly as they note below). They do not have their DEA/NPI registered to their primary home and it would be very easy to argue why someone wouldn't do that for privacy reasons. There absolutely will be metadata to support their use of the computer from home on a daily basis. My colleague does televisits on a daily basis (although also has a seperate office) and does this as well.

Dr. Jim Dahle:
Can you explain to the doctors out there listening that their drive from their house to the hospital is not business use?

Alexis Galati:
Well, sometimes it can be. If you have your home office, and it's a legitimate home office, a lot of times I have some physicians that they're on call, they come home and they're using it to look at images, etc. They have a legitimate home office. You actually can take your mileage from your home to your other place of business, and that is legitimate mileage. However, if you don't have that legitimate home office established, then yeah, you can't do your commuting miles.

As you can see from that example, the CPA is saying in these "sometimes it can be" and the example he gives is limited circumstances when you're coming home (in this case Office #2) from the hospital (what would be considered Office #1 or "principle place of business").

It's pretty clear that to be deductible trips have to be from your "principle place of business" to either other offices, meeting with clients, other business related trips, etc. Having a home office does NOT necessarily mean that this is your "principle place of business" (although it certainly can be), what you're claiming on Form 8829 is whatever "expenses for business use of your home" you're claiming.
You would need to establish with the IRS that this is your "principle place of business" even though you seem to be commuting to another office every day where you actually do your work. So someone who is driving to a brick and mortar office every day from their house where they claim a home office would be pretty hard pressed to show that their home was actually the "principle place of business"...when they were driving to a completely separate office to work out of most of the day every day.

This stuff sounds all fine and dandy with the CPAs until you actually get audited and realize that your CPA or tax accountant or whatever isn't actually responsible for any back taxes you have to pay the IRS and goes "whoops sorry I thought this was good". You don't actually have much recourse if a CPA screws up with your taxes or if they deduct stuff inappropriately unless you're planning on suing them. They really base this on the fact that being audited is overall a very low risk and they have to "prove" their worth over Turbotax by pointing out all these "aggressive" deductions people can take.

This is actually on WCI website as well if we're referencing that.

They do talk about home offices generally needing to be a "principle place of business" (if you actually look at Form 8829 instructions there are exceptions to this) but right in the middle there about mileage deductions:

"Lots of doctors get into a gray area with this. They reason that since they check their email or do some charts at home they can then deduct their drive to the clinic or hospital. Keep careful records and realize this may or may not hold up in an audit. The key is really to avoid having some other place that is the principal place of business. If you're a hospitalist working shifts at 4 different hospitals, that is going to be a lot easier to argue than if you are an internist who always works in the same clinic."
 
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As you can see from that example, the CPA is saying in these "sometimes it can be" and the example he gives is limited circumstances when you're coming home (in this case Office #2) from the hospital (what would be considered Office #1 or "principle place of business").

It's pretty clear that to be deductible trips have to be from your "principle place of business" to either other offices, meeting with clients, other business related trips, etc. Having a home office does NOT necessarily mean that this is your "principle place of business" (although it certainly can be), what you're claiming on Form 8829 is whatever "expenses for business use of your home" you're claiming.
You would need to establish with the IRS that this is your "principle place of business" even though you seem to be commuting to another office every day where you actually do your work. So someone who is driving to a brick and mortar office every day from their house where they claim a home office would be pretty hard pressed to show that their home was actually the "principle place of business"...when they were driving to a completely separate office to work out of most of the day every day.

This stuff sounds all fine and dandy with the CPAs until you actually get audited and realize that your CPA or tax accountant or whatever isn't actually responsible for any back taxes you have to pay the IRS and goes "whoops sorry I thought this was good". You don't actually have much recourse if a CPA screws up with your taxes or if they deduct stuff inappropriately unless you're planning on suing them. They really base this on the fact that being audited is overall a very low risk and they have to "prove" their worth over Turbotax by pointing out all these "aggressive" deductions people can take.

This is actually on WCI website as well if we're referencing that:

They do talk about home offices generally needing to be a "principle place of business" (if you actually look at Form 8829 instructions there are exceptions to this) but right in the middle there about mileage deductions:

"Lots of doctors get into a gray area with this. They reason that since they check their email or do some charts at home they can then deduct their drive to the clinic or hospital. Keep careful records and realize this may or may not hold up in an audit. The key is really to avoid having some other place that is the principal place of business. If you're a hospitalist working shifts at 4 different hospitals, that is going to be a lot easier to argue than if you are an internist who always works in the same clinic."
I think you are misunderstanding (it's harder with a transcript than hearing the podcast), the CPA is saying that if you have a home office, than driving to your various offices/hospitals is deductible mileage. If you have a legitimate home office than travel to any of your other sites are business miles. Not a return home from a hospital. Thus 100% of your driving to work sites is business miles for deduction if you have a legitimate home office.

I am very weary around most deductions, but I have spoken to multiple CPAs and a tax attorney and feel very comfortable with my wife doing this. As with a lot of tax planning strategies it's worth talking to professionals and deciding for yourself. I found conservation easements disgusting and I can't believe the actually codified those to be allowable (although now they are capped and don't provide any savings). Backdoor roth IRAs are clearly a loophole but they are now 100% acceptable loopholes. We have a really bizarre tax code that is intentionally obtuse, I think it's just good for people to get as many perspectives as possible in those situations.
 
I think you are misunderstanding (it's harder with a transcript than hearing the podcast), the CPA is saying that if you have a home office, than driving to your various offices/hospitals is deductible mileage. If you have a legitimate home office than travel to any of your other sites are business miles. Not a return home from a hospital. Thus 100% of your driving to work sites is business miles for deduction if you have a legitimate home office.

I am very weary around most deductions, but I have spoken to multiple CPAs and a tax attorney and feel very comfortable with my wife doing this. As with a lot of tax planning strategies it's worth talking to professionals and deciding for yourself. I found conservation easements disgusting and I can't believe the actually codified those to be allowable (although now they are capped and don't provide any savings). Backdoor roth IRAs are clearly a loophole but they are now 100% acceptable loopholes. We have a really bizarre tax code that is intentionally obtuse, I think it's just good for people to get as many perspectives as possible in those situations.

Hey again if you feel comfortable proving the IRS that the home office is the "principle place of business" when they come and ask how this is any different than a commute, which is not deductible, then for sure go for it, I deduct all kinds of stuff.

Again, it's going to depend on the setup. One outpatient doc going back and forth to the same 1 or 2 outpatient offices every day where they spend most of the business day for years is likely to look a lot more like a "commute" than "business trips". Which is what Sushi or most of us outpatient would be saying with this deduction.
 
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So you're saying it's easier to deduct the home office and the mileage when you are, for example, working virtually from home Monday, Wednesday, and Friday and you head into your office on Tuesday and Thursday for seeing people in person? Especially when you finish off the lion's share of the charts from the home office and / or have metadata showing a substantial portion of the work is done at home?
 
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I'm not exactly sure how to answer regarding pay + benefits. Do I add in the 7 weeks of PTO?, What about the paid malpractice and other insurances, my employer's payments into our pension?
Salary + any bonuses from like from RVUs + any extra call shifts
 
If you're just including salary, bonuses and overtime...you're discounting at least 25% of the benefits of being an employed physician, possibly much more.
 
Southeast. Inpatient. 5 days a week + 1 weekend/month. 4 weeks vacation + 1 week CME ($4500/CME). Salary + wRVU bonus. Commonly see between 11-14 pts/day, some weeks more if a colleague is on vacation but never usually more than 16-17/day even on the worst days. Weekends 18-23 pts depending on census. Being "on call" during a weekday is taking home call until early evening.

Before-tax 550-600k. Only leaving this job if they fire me.
 
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Southeast. Inpatient. 5 days a week + 1 weekend/month. 4 weeks vacation + 1 week CME ($4500/CME). Salary + wRVU bonus. Commonly see between 11-14 pts/day, some weeks more if a colleague is on vacation but never usually more than 16-17/day even on the worst days. Weekends 18-23 pts depending on census. Being "on call" during a weekday is taking home call until early evening.

Before-tax 550-600k. Only leaving this job if they fire me.
Florida?
 
That's fair, I really respect you for going that route. I will say that some relatively conservative CPAs have made it pretty clear that there is good support for doctors who have a home office where they work (especially if you see patient's remotely at times), review charts, put in meds, etc and then drive to an office can have that count for a vehicle deduction. But not going that route and paying your fair share of taxes is really baller and I wish our narrative was more around how patriotic it is to pay taxes rather than avoiding them at all costs being a trendy thing.
um, what? This is like satire right?
 
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Southeast. Inpatient. 5 days a week + 1 weekend/month. 4 weeks vacation + 1 week CME ($4500/CME). Salary + wRVU bonus. Commonly see between 11-14 pts/day, some weeks more if a colleague is on vacation but never usually more than 16-17/day even on the worst days. Weekends 18-23 pts depending on census. Being "on call" during a weekday is taking home call until early evening.

Before-tax 550-600k. Only leaving this job if they fire me.
is this RVU, salary, mix?
 
um, what? This is like satire right?
Not at all. Doctors are the most overtaxed group in the US (as percentage of take home, at least for W2 docs), so it's not exactly the right group for the message. The way we glorify avoiding taxes, using crazy armies of tax lawyers, lobbyists, and CPAs to ensure the top 0.001% pay comically low tax rates is actually one of the biggest problems impacting the daily lives of our citizenry. Wealth inequality is directly tied to a number of mental health indices and one of the best ways to address it is a true progressive income tax that does not have 1000 loopholes. Ironically, if this was actually implemented (and it has occurred in the last century of US history so there is at least precedent for it), doctor's taxes would likely be similar if not lower. At this point I think everyone has completely given up on the actual elites ever paying their fair share, so I guess it feels like satire?
 
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So you're saying it's easier to deduct the home office and the mileage when you are, for example, working virtually from home Monday, Wednesday, and Friday and you head into your office on Tuesday and Thursday for seeing people in person? Especially when you finish off the lion's share of the charts from the home office and / or have metadata showing a substantial portion of the work is done at home?
Yes in this case any mileage into/back from the office on Tues/Thur would count as business expense and if the percent of driving is >50% percent of the vehicle's total mileage then that % becomes deductible (highly recommend using an app to track). In my wife's case as a surgeon, she travels to 4 different hospitals/surgery centers and 4 different clinics (wild how different surgery is) so a ridiculous percent of her overall mileage is work which means the car is nearly paid for on a pretax basis. So if you see surgeons drive ridiculous vehicles it's not only because they make more money and have larger egos, most are using pretax money on the car.

I work at one office and see 2% of my patient's remotely, so I would not be eligible for any vehicle or home office deduction.
 
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So you're saying it's easier to deduct the home office and the mileage when you are, for example, working virtually from home Monday, Wednesday, and Friday and you head into your office on Tuesday and Thursday for seeing people in person? Especially when you finish off the lion's share of the charts from the home office and / or have metadata showing a substantial portion of the work is done at home?

Yes, or as @Merovinge pointed out if you're going to many different offices/clinics during the week so you can say your "principle place of business" is actually your home office, you're essentially going out to different satellites or clinicsfrom your home office. Basically you have to be able to prove that you do most of your business out of your home office or it's your "hub" for different trips to do other work. Other businesses do this all the time when the person has a home office but has to go out to meet with clients regularly in different locations or something.

A typical PP outpatient setup (aside from a primarily virtual setup) where you go to one office outside the home 4-5 days a week for most of the day has the risk of looking more like a commute than different business trips. But, if for instance you cover an IOP, an inpatient unit and another clinic for various days of the week, that has the potential to look more like multiple different business trips.
 
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My private practice is 50% in person and 50% telehealth although in the end, I probably do more admin work at home than in my physical office. I would try to justify the miles or the car as a business deduction, but I did the analysis on it and it would save me a whopping $500-600 per year in mileage deduction with a paid off car. Not worth my time tracking the miles and figuring this out. Now, if I wanted to do a section 179 and deduct the car payments, it would be much more worth it although increasingly less so as this is being phased out.

The bigger business deductions are the 199A deduction, small business pension plans (defined benefit cash balance plan), incorporation if you make enough money and want to spend the time learning how to do that (I posted about this in another thread), a home office, the Augusta rule, going out for networking meals with therapists and other psychiatrists, and business travel for CME. Outside of that, pre-tax deductions on both the employee and employer will take you far. If you really want to get advanced and deduct investments as part of your active wages, you can look into short-term vacation rentals (less than 7 days) and doing a cost segregation analysis for forced depreciation or becoming a real estate professional status if you work part time in PP or if your spouse can do it.
 
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