The One Big Beautiful Bill: What It Means for My Tax Bill (and Probably Yours)
I'm a physician. I spent many years in training, and approximately zero hours of it learning how to keep more of my own money. So when a thousand-page tax bill lands in my lap, my first instinct is to order a consult.
Here's what my CPA told me, translated into plain English.
The good news: my marginal rate stays at 37%. Painful, yes. But it could have climbed higher without this bill, so I'll take the win. The SALT deduction cap jumps from $10,000 to $40,000 for married filers, which helps those of us writing large checks to states that treat our income like an all-you-can-eat buffet. Bonus depreciation is back at 100% for practice equipment, the estate tax exemption climbed to $15 million per person, and HSAs got more accessible. If you haven't been maxing your HSA and investing those funds, we need to talk. That's financial malpractice.
The QBI deduction is now permanent at 20%, but medicine is still classified as a specified service trade or business. Translation: most of us get phased out before we see a dime of it. Classic.
Now the part that genuinely bothers me. Federal student loans for medical school are capped at $200,000 lifetime, with Grad PLUS eliminated for new borrowers in 2026. The median medical school debt already exceeds that. Future physicians will be taking out private loans at higher rates with fewer protections. We're already facing a physician shortage. This isn't helping.
My honest advice? Call your CPA now. Not in April, when they're drowning in returns and giving everyone the same answer. The physicians who benefit most from legislation like this are the ones who move early.
And while you're at it, keep reading. At Physician on Fire, we break down exactly these kinds of opportunities in plain language built for physicians. Whether you're a W-2 employee collecting a hospital paycheck or a 1099 contractor running your own show, the tax implications are different and the stakes are high either way. No jargon, no generic advice designed for someone with a simple return. We write for people who trained as long as we did and deserve to understand where their money is going. The tax code changed. Your financial education should too.
Jorge Sanchez, MD
Naples, Florida
