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Many physicians are married to spouses with well paying careers and its easier to hit that bracket than you think.Few doctors make more than $406,000 (single) or $457,000 (married) to pay into the 39.6% tax bracket. Even fewer doctors make significantly more than $500,000 so if their income does make them qualify for the 39.6% bracket than very little of their income will actually be taxed at 39.6%. California's 13.3% bracket does not kick in until the income is greater than $1,000,000, which few doctors make. I would assume that most doctors pay an effective federal tax rate of around 30% (probably a little lower) and in California you can add around 9.5% for state income taxes.
Of course being too upset about paying an extra few percent on your income over $500k is a bit out of touch with the reality of the majority of the citizens.