You Take Care of Patients. We'll Take Care of the Numbers.
Medical practices are high-income, high-complexity businesses — and your accountant should reflect that. Most general firms file your return and call it a year. The right firm builds you a tax strategy, designs a retirement plan that actually moves the needle for a physician's income, and treats your books like the engine of a professional practice. We've been doing exactly that for IL and WI physicians for over 40 years.
The Accounting Challenges Medical Practices Actually Face
The tax bill keeps climbing — and nobody's actively planning
You're in the top bracket. Federal, state, Medicare surtax, NIIT — it adds up fast. But your accountant only talks to you in March, and by then the strategies that would have saved real money are already off the table.
Your retirement plan isn't sized for a physician's income
A standard SEP or solo 401(k) caps out around $70K. For a physician earning $400K+, that's a fraction of what's possible. A properly designed defined benefit or cash balance plan can shelter $200K–$300K+ per year — and most general firms never even raise it.
Owner compensation isn't structured strategically
How you pay yourself — W-2 salary, S-corp distributions, retirement contributions, fringe benefits — has six-figure tax implications. Without intentional structure, you're leaving money on the table every payroll cycle.
Equipment and buildout deductions get left on the table
Medical practices spend heavily on equipment, technology, and office buildouts. Section 179, bonus depreciation, and cost segregation strategy can save tens of thousands — but only when somebody is actually thinking about it before you sign the lease or the PO.
What Goes Wrong When Medical Practices Use a General Accountant
Most general accounting firms are competent — for general businesses. But medical practices have economic dynamics that don't show up in retail or trades. Here's what we typically see when physicians switch to us from a non-specialist firm.
Tax planning happens once a year — too late
For a high-income physician, tax strategy needs to happen quarterly at minimum — not in April. Bonus depreciation timing, entity structure, retirement contributions, charitable strategy. By the time most general firms look at your return, the planning year is closed.
Retirement plan design defaults to the simplest option
Most general firms set up a SEP-IRA or a basic 401(k) and call it done. For a physician earning $400K+, that's malpractice. Defined benefit plans, cash balance plans, and 401(k)/profit-sharing combinations can shelter 3x to 5x more — but they require active design.
Owner compensation isn't optimized
S-corp salary vs. distribution split, fringe benefit structure, retirement contribution coordination — all of these affect what hits your personal return. A general firm files what's in front of them. A specialist firm tells you what it should look like before the year starts.
Depreciation strategy is mechanical, not strategic
Imaging equipment, exam room buildouts, leasehold improvements, technology — medical practices have meaningful fixed asset activity. Section 179, bonus depreciation, and (for larger buildouts) cost segregation studies can compress deductions into the years they help most. Most firms default to straight-line.
Payroll is run, not coordinated
For a physician-owned practice, payroll isn't just a compliance task — it's the input that drives retirement contributions, S-corp reasonable compensation, and personal tax planning. When payroll and accounting and tax planning are three separate vendors, the coordination breaks down.
Accounting Services Built for Medical Practices
Everything your practice needs — handled by one team that understands physician economics.
Monthly Bookkeeping
Clean books every month, reconciled accounts, and P&L statements structured around how a medical practice actually performs.
Proactive Tax Planning
Multi-touch tax planning throughout the year — not just at filing. Entity strategy, quarterly check-ins, year-end optimization, and coordinated personal returns.
Retirement Plan Design
SEP-IRA, Solo 401(k), 401(k)/profit-sharing, cash balance, and defined benefit plans — sized for physician income, designed to shelter real money.
Owner Compensation Strategy
S-corp salary vs. distribution, fringe benefits, retirement coordination — structured to optimize your total compensation and tax position.
Equipment & Depreciation Planning
Section 179, bonus depreciation, and cost segregation strategy for imaging, buildouts, and technology — planned before you sign, not after.
Payroll Services
Practice payroll through Payroll Freedom — coordinated with retirement contributions, S-corp comp, and your books in real time.
We Work With Solo, Small Group, and Specialty Medical Practices
From solo physicians to mid-size groups across every specialty — if you're a physician-owned practice in Illinois or Wisconsin, we know your economics.
What to Look For in a Medical Practice Accountant
Not every CPA firm is set up to serve physicians well. If you're evaluating accountants — whether or not you end up choosing us — these are the five things worth checking before you sign anything.
Real experience with physician-owned practices
Ask how many medical or healthcare practices they currently serve, and at what size. A firm with one or two casual medical clients won't have the depth to design a cash balance plan or coordinate an S-corp comp strategy at the income levels physicians operate at.
Active retirement plan design — not just plan administration
Ask: "What retirement plan structures do you currently use for your physician clients?" If the answer is just "SEP-IRA" or "401(k)," they're not designing for physician income. The right answer mentions defined benefit, cash balance, or 401(k)/profit-sharing combinations.
Quarterly (at minimum) tax planning — not just annual filing
A high-income physician needs tax strategy touched multiple times a year. Ask what their typical client communication cadence is. If the answer is "we do your return" and not much else, they're an accountant, not an advisor.
Accounting, payroll, and tax under one roof
Owner comp, retirement contributions, and reasonable compensation all depend on three things talking to each other — books, payroll, and tax planning. When those are three different vendors, the coordination breaks down. Look for a firm that handles all three internally.
Transparent pricing
You shouldn't have to wait through three discovery calls to find out what something costs. A firm that publishes its pricing structure (or at least gives you a clear estimate after one conversation) respects your time and is confident in its value.
How Accounting Freedom Stacks Up Against That Checklist
We've been working with medical practices in Illinois and Wisconsin for over 40 years. Here's how we score on the five-point checklist above — judge for yourself.
Decades of physician practice experience
Medical practices have been a core client base since we opened in 1981. We understand physician economics, S-corp structure for professional practices, and the planning cadence high-income physicians actually need.
Real retirement plan design
We work across the full spectrum — SEP, Solo 401(k), 401(k)/profit-sharing, cash balance, and defined benefit. We start with your income and goals, then design the structure that shelters the most. Not the other way around.
Year-round, not just March–April
You're assigned a dedicated Client Advisor who knows your practice. Quarterly tax planning touches, mid-year strategy reviews, and proactive outreach when something needs your attention.
One firm for accounting, tax, payroll & planning
Through Accounting Freedom and Payroll Freedom, you get every back-office service under one roof — coordinated by one team, with no dropped handoffs.
What Does Medical Practice Accounting Cost?
We believe you should be able to estimate what working with us costs without filling out a form or waiting for a sales call. Here's how our pricing works for medical practices.
Three tiers — Core, Core+, and CorePro
Medical practices typically fit into our Core+ or CorePro packages because the planning load is heavier than most small businesses. Core covers monthly accounting and business tax compliance. Core+ adds quarterly tax planning, retirement plan design, owner compensation review, and proactive advisory — where most solo and small-group practices land. CorePro adds 90-day cash flow forecasting, KPI dashboards, full annual business review, and deeper planning — typical for mid-size groups and concierge practices.
Your final price depends on practice size, number of physicians and partners, transaction volume, payroll complexity, and the depth of planning you need. Solo physicians typically land in Core+; group and specialty practices typically land in Core+ or CorePro, plus complexity adjustments based on your specific setup.
The fastest way to get a real number for your practice is the Pricing Calculator — it walks through the same questions we'd ask on a discovery call and gives you a customized estimate in under three minutes.
Medical Practice Accounting Questions We Hear Often
Let's Talk About Your Practice.
Schedule a free consultation. We'll walk you through how we can take the accounting and tax planning burden off your plate — so you can stop reacting in April and start managing your tax position year-round.
Illinois: 847-949-8373 | Wisconsin: 262-375-2440