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4275 Executive Square Suite 200
La Jolla, CA 92037
(858) 754-8277
NATALIE C. PAPAGNI, CPA
Tax, Planning & Advisory Services
A Different Kind of CPA Firm
Serving
High-Income Earners, Physicians, Entrepreneurs & Privately-Held Companies
That Expect & Deserve More.
PHYSICIANS & HEALTHCARE PROFESSIONALS
Expertise in Areas that Matter Most
Transforming Complexity into Clarity - from Residency-to-Retirement
CPA & Tax Strategist
for Physicians & Healthcare Professionals
La Jolla, Greater San Diego and throughout California
Natalie C. Papagni, CPA - Tax, Planning & Advisory Services specializes in providing strategic tax planning, tax preparation and advisory services catering to the unique needs and lifestyle interest of physicians & healthcare professionals - from residency-to-retirement.
Physicians & healthcare professionals we work with typically have multiple income streams, including W-2, 1099 locums, private practice, investment, and real estate income, come to us with years of overpaying taxes, and looking for a multi-year tax strategy and plan to minimize tax liabilities, increase financial efficiencies, plan for independence, and take control of their financial future.
As your CPA and tax strategist, we provide our strategic tax planning clients with unlimited direct access throughout the year for decisions requiring professional guidance and decision support, updating tax projections and run scenario analysis on new ideas and initiatives.
We encourage clear communications and frequent discussions. Conversations and collaboration provide us the opportunity to add enhanced value, leading to optimal tax outcomes, avoid year-end surprises, enhanced clarity and peace of mind.
We also advise where it matters most: student loan repayment strategy, launching an S-corporation or side business, real estate and investments, quarterbacking your relationships with wealth advisors, attorneys, and real estate professionals, planning for independence, retirement, and legacy.
At year-end, we efficiently coordinate and file your individual, business, and trust tax returns in full compliance with federal and state law — capturing every deduction planned for, earned, and deserved.
Specialized Services for Physicians & Healthcare Professionals
S-Corp Tax Architecture
Working directly with shareholders, we evaluate professional corporation entity selection and implement post-formation activities — financial design, accounting and payroll, reasonable compensation, QBI optimization, the PTET election, accountable plans, bonus depreciation and Sec. 179, home office, retirement plan layering, and business vehicle lease-versus-purchase and personal-auto business use. We then provide year-round access for guidance on S-corporation shareholder basis and distribution planning, multi-state filings, late S-corp elections, and more.
California PTET Optimization
We run scenarios modeling the California Pass-Through Entity Tax (PTET) (AB 150) election to maximize the entity-level deduction and advise clients on the benefit of opting in to election, when advisable
Integrated Shareholder & S-Corporation Tax Planning & Quarterly Tax Management
We align corporate (Forms 1120-S and 100S) and personal (Forms 1040 and 540) tax elements to target optimal outcomes year after year, coordinating W-2 earnings, 1099 locums, K-1s, investment, rental real estate, and retirement income to minimize liabilities and effective tax rates.
Individual, Business & Trust Tax Preparation
We prepare federal and single- and multi-state returns in full compliance with federal and state law — capturing the deductions, savings, and credits planned for, earned, and deserved.
Challenges & Opportunities Physician & Healthcare Professional Face
Challenges
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High federal and California tax exposure
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Complex compensation models
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Multiple income streams — clinical and academic W-2s, 1099, K-1, private practice, real estate, and investments
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MAGI exceeding key phase-out limits
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Lifestyle creep
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High audit-risk categories
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Student loan repayment
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Limited time to manage financial affairs
Opportunities
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MAGI management to preserve phase-out-sensitive deductions and credits
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NIIT minimization across investment and rental income
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Multi–income-stream offset — pairing losses and deductions against clinical, K-1, and portfolio income
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Strategic Roth conversions in lower-income windows
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Income deferral and timing across tax years
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Retirement plan layering — 401(k), 403(b), 457(b), Solo 401(k), Cash Balance, and Backdoor Roth
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PTET election
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S-corporation election for 1099 and practice income
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Multi-entity structuring for clinical and non-clinical income
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QBI §199A planning
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Extensive business tax deductions
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Maximizing ownership benefits
Services for Physicians & Healthcare Professionals
Strategic Tax Planning
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Mult-year tax planning, projections & analysis
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Integrating practice K-1 results into your personal 1040/540 tax plan — so entity and individual decisions move together, not in isolation
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Multi-state tax planning
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Managing MAGI phase-out limits
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Controlling the Net Investment Income Tax (NIIT)
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Optimizing 401(k), 403(b), 457(b), and 401(a) contributions
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Capital gains offsets
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Rental real estate optimization
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2025 OBBBA planning
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Planning for independence
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Transitioning to retirement
Tax Preparation
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Personal tax returns (Forms 1040 / 540) and multi-state returns
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Trust and estate tax returns
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Professional medical corporation tax returns
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S-corporation tax returns (Forms 1120-S / 100S)
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Limited liability company (LLC) returns
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Partnership tax returns
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Late S-corporation elections
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FBAR filings (FinCEN Form 114)
Practice Advisory
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Entity selection and S-corporation elections
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S-corporation foundation setup package
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Multi-entity layering
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Reasonable compensation guidance
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Shareholder benefits
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QBI and PTET planning
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Multi-layered retirement plans
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Accountable plans
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Maximizing the benefits of business ownership
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Business vehicle purchase-versus-lease analysis
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Shareholder basis management
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Distribution planning
Should Your Practice Elect S-Corporation Status?
A Physician's Decision Framework→
The Physician's Retirement Stack:
How to Shelter Far More Than the 401(k) Limit→
From Resident to Attending:
The Tax Shift No One Warns You About →
Understanding Your K-1
A Line-By-Line Guide to Form K-1 →
Frequently Asked Questions (FAQs)
Why does physician income require different tax planning than other high earners?
Physician income is often high, layered, and payroll-driven—base comp plus call pay, productivity bonuses, stipends, signing/retention bonuses, and sometimes multiple employers—so withholding rarely matches true liability. Many physicians also have “lumpy” additions like moonlighting (1099), partnership/K-1 income, ASC/surgery center investments, or a spouse’s equity compensation, which creates timing problems that normal W-2 planning doesn’t solve. The result is predictable underpayment risk and cash-flow surprises unless you run a projection and build a payment plan around when income hits, not just how much.
Physicians also face career-stage transitions that change tax structure overnight—resident to attending, W-2 to partner, employee to owner—where the wrong first move can lock in penalties, poor entity choices, or missed retirement opportunities for years. Finally, California physicians are hit by a uniquely high combined marginal stack, so decisions that feel “small” elsewhere can create five-figure differences here, especially when surtaxes and itemizing limitations interact.
Do you help physicians with W-2s, or only physicians with W-2s + 1099 + practice income?
We treat W-2 physicians as planning clients because high W-2 income still creates predictable failure points—bonus withholding, multi-job withholding, spouse income interactions, and surtax thresholds—so the first deliverable is a full-year projection that includes all household income, not just your paycheck.
Next, we convert the projection into an implementation plan: adjust W-4 withholding (often the cleanest solution), add targeted estimated payments when needed, and build a calendar that matches tax payments to bonus and vesting dates so April is not a surprise. We then optimize within what W-2 allows: retirement contributions and sequencing, charitable strategy (including bunching/appreciated asset giving when appropriate), and investment tax coordination to avoid accidental surtax spikes.
We also manage “hidden complexity” that still hits W-2 physicians—multi-state issues, moving mid-year, backdoor Roth execution errors, HSA eligibility mistakes, RSUs via spouse, or investment K-1s—so the return is accurate and the plan is coherent.
What Are the best physician retirement tax planning strategies mid-career?
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A Solo 401(k) combined with a defined benefit or cash balance plan can shelter $150,000 to $300,000 or more from current-year taxation. Every dollar contributed reduces taxable income at the physician's current marginal rate — which at California incomes above $300,000 often exceeds 47% combined federal and state.
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Hospital plan maximization. 403(b), 457(b), and pension contributions should be maximized before adding side-income retirement plans. Each plan has its own limits — stacking them legally requires knowing the rules.
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Backdoor and Mega Backdoor Roth. Building Roth balances during high-income years seeds a tax-free bucket that will be available in retirement with no required minimum distributions and no California income tax on withdrawals.
What are the best physician retirement tax planning strategies in the transition-to-retirement phase?
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This is often the most valuable planning window in a physician's financial life. Income drops significantly before RMDs begin. Tax brackets compress. The window for Roth conversions at favorable rates opens.
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Converting pre-tax IRA and 401(k) balances to Roth in this window — filling up the 22% or 24% federal bracket — can reduce lifetime RMD exposure and protect heirs from inherited IRA tax consequences.
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California exit planning opportunities: Physicians who plan to leave California in retirement often materially benefit from deferring conversions until after establishing residency in a no-income-tax state.
What is a tax efficient physician retirement funds withdrawal sequence?
In general, the order is often taxable accounts first, followed by tax-deferred and then then Roth, This sequence is efficient for most physicians, however the right answer depends on Social Security timing, RMD projections, state residency, and estate planning goals.
Should a 1099 physician or healthcare professional form an S-corporation?
Often yes, once net 1099 income consistently exceeds roughly $ 100,000 +/-. An S corporation allows a physician to pay themselves a reasonable W-2 salary and take remaining profits as distributions not subject to self-employment tax. In California, an S corporation also unlocks the Pass-Through Entity Tax (PTET) election, which restores a federal deduction for state taxes. The analysis is fact-specific — payroll costs, the 1.5% California franchise tax, and retirement plan goals all factor in.
What is the California Pass-Through Entity Tax (PTET) and how does it help physicians?
The California PTET election lets an S corporation or partnership pay state tax at the entity level — 9.3% of qualified net income — which is fully deductible on the federal return, bypassing the SALT deduction cap. The owner then claims a dollar-for-dollar credit on their California return. For a high-income physician, PTET can generate meaningful federal savings each year, but the June 15 prepayment deadline is strict and easy to miss without proactive planning.
Why do physicians need quarterly tax projections?
Physician income is rarely level — bonuses, RVU true-ups, locums work, and distributions arrive unevenly. Quarterly projections keep estimated payments accurate, prevent April surprises and underpayment penalties, and create planning checkpoints for retirement contributions, PTET payments, and entity-level decisions while there's still time to act. This is the core of proactive tax planning versus once-a-year compliance.
How is locum tenens and moonlighting income taxed?
Locum tenens and moonlighting income is typically paid on Form 1099 and taxed as self-employment income, subject to both income tax and 15.3% self-employment tax. No taxes are withheld, so quarterly estimated payments are required. The upside: 1099 income opens the door to business deductions, a solo 401(k), and — at higher income levels — an S corporation structure.
Natalie C. Papagni, CPA
Tax, Planning & Advisory Services
4275 Executive Square
Suite 200
La Jolla, CA 92037
(858) 754-8277
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Natalie C. Papagni, CPA - Tax, Planning & Advisory Services
Who We Serve
Natalie C. Papagni, CPA - Tax, Planning & Advisory Services is a modern, forward-focused CPA firm serving high-income earners and businesses that expect and deserve more. Nominated as a Best of La Jolla accounting firm for 2026, the practice is built for clients who want the technical depth found at leading firms coupled with the responsiveness, personalized service and unhurried attention found at boutique firms - without the elevated fees.
Tax Planning, Preparation & Advisory Services
Physician tax planning requires coordinating multiple income streams, calibrating withholdings, calculating estimated tax payments, evaluating reasonable compensation, tracking shareholder basis, distributions planning, CA PTET and QBI planning, layered retirement plan guidance, retirement planning, planning for independence, coordinating investments and residential real estate portfolios, preparing individual, trust and business tax returns, and more.
Serving La Jolla, Greater San Diego & California
An experienced tax CPA firm in San Diego serving clients in La Jolla, greater San Diego and throughout California, Natalie C. Papagni, CPA - Tax, Planning & Advisory Services offers the personalized service, responsiveness and unhurried attention found at boutique firms coupled with the technical depth found at leading firms - without the elevated fees. Whether you found the firm searching for a tax CPA near me or you are in La Jolla, greater San Diego, or elsewhere in the state, you work directly with the principal — a licensed California CPA and AICPA member — through secure, technology-forward service.