Tax Guide for Doctors (2025)
Physicians earn a median salary of $229,300. High income means exposure to the top tax brackets, AMT, NIIT, and phase-outs of deductions and credits. The typical salary of $229,300 results in an estimated $169,394 take-home pay after federal income tax and FICA.
Quick Tax Snapshot
Gross Salary
$229,300
Median for doctors
Federal Income Tax
$45,399
Single filer, standard deduction
FICA Taxes
$14,507
Social Security + Medicare
Estimated Take-Home
$169,394
After federal tax + FICA
Key Tax Deductions for Doctors
Student loan interest deduction (income limits apply)
Continuing medical education
Professional liability insurance
Retirement contributions (401(k), 457(b), backdoor Roth)
What to know at this income level
Above $200,000 you trigger the Additional Medicare Tax (0.9% on earnings over $200,000) and may owe the Net Investment Income Tax (NIIT) of 3.8% on investment income. You are in the 32% bracket ($197,300-$250,525 taxable) or 35% bracket above that. At this level, tax planning has outsized impact — the difference between strategic and unplanned taxes can be $10,000-$30,000 per year. State taxes also become a major factor, with high-tax states like California and New York adding 9-13% on top.
Additional Medicare Tax
The 0.9% Additional Medicare Tax applies to wages over $200,000 (single) or $250,000 (MFJ). On $300,000, that is $900 in extra Medicare tax. Unlike regular Medicare, this is not matched by your employer. Your employer withholds it once your wages exceed $200,000 regardless of filing status. Use calculator →
Net Investment Income Tax (NIIT)
If your MAGI exceeds $200,000 (single) or $250,000 (MFJ), you may owe 3.8% NIIT on investment income — capital gains, dividends, rental income, and interest. Tax-loss harvesting and tax-efficient fund placement become important strategies at this level. Use calculator →
State tax impact
At $300,000, state income tax ranges from $0 (Texas, Florida, Nevada) to over $30,000 (California, New York, New Jersey). Under OBBBA (2025+) the SALT deduction cap is $40,000 ($20,000 MFS) and phases out $1-for-$1 above $500,000 MAGI ($250,000 MFS) toward a $10,000 floor — a $300K earner still gets the full $40K cap. For remote workers, state residency remains a significant financial decision. Use calculator →
Estimated quarterly taxes
If you have significant income beyond wages (investments, self-employment, rental), you likely need to make quarterly estimated tax payments to avoid underpayment penalties. The safe harbor is paying 110% of last year's tax liability. Use calculator →
Typical roles at this level: Senior directors and VPs, attending physicians, senior partners at law and accounting firms, tech staff engineers, experienced consultants, and business owners with established revenue.
Frequently asked questions
Are doctors affected by the Alternative Minimum Tax?
Physicians with high incomes, large state tax deductions, or incentive stock options may be subject to AMT. The 2025 AMT exemption is $88,100 for single filers and $137,000 for married filing jointly, phasing out at higher incomes.
How should doctors handle student loan repayment for taxes?
Doctors can deduct up to $2,500 of student loan interest if their MAGI is below $80,000 (single) or $165,000 (MFJ). For those on Income-Driven Repayment plans, forgiven balances may be taxable income. Public Service Loan Forgiveness is tax-free.
What retirement strategies work best for high-income doctors?
Max out 401(k)/403(b) contributions ($23,500 in 2025), consider a backdoor Roth IRA, and look into cash-balance pension plans or defined-benefit plans for practice owners. Mega backdoor Roth conversions can shelter additional income if your plan allows after-tax contributions.
How does the SALT deduction cap affect me?
Under OBBBA (2025+), the State and Local Tax (SALT) deduction is capped at $40,000 per return ($20,000 if MFS). The cap phases out $1-for-$1 for MAGI above $500,000 ($250,000 MFS), reverting toward a $10,000 ($5,000 MFS) floor for very high earners. Pre-OBBBA (2018–2024) the cap was $10,000 flat. If you live in a high-tax state and pay more than the cap in state/local income and property taxes, you lose the deduction on the excess — so low- or no-tax states remain significantly more attractive for ultra-high earners hitting the phaseout.
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Federal Income Tax Calculator →Best states for doctors →
As a doctors, your state choice can save you thousands. Compare all 50 states at your $229,300 income.