A medical practice is a small business with specific tax and operational dynamics. Most generalist CPAs do not see enough of them to catch what matters.
Most practice owners end up in an S-corp because someone told them to. The real question is owner compensation, distribution mix, and retirement plan optimization.
Major equipment purchases carry tax implications — § 179 expensing, bonus depreciation, financing-vs-cash tradeoffs — that materially change after-tax cost.
Multi-physician practices accumulate complexity in their partnership agreements — buy-ins, buy-outs, capital accounts, distribution waterfalls.
Acquiring or selling a practice has tax implications that need modeling years before the transaction. Goodwill allocation, § 197 amortization, seller financing all change the math.
We work with Bay Area physicians on the financial side of running and growing a medical practice.
S-corp vs. C-corp analysis, owner compensation modeling, distribution strategy, and integration with personal tax planning.
Section 179 and bonus depreciation modeling for major equipment, build-out cost segregation, and financing-structure analysis.
Solo-401(k), cash balance, and defined benefit plan analysis for sole-physician practices; cross-tested plans for multi-physician groups.
Buy-in and buy-out structuring, capital account maintenance, distribution waterfall design, and partner-departure modeling.
Acquisition financial diligence, allocation of purchase price, goodwill treatment, seller financing analysis, and sale-side tax modeling.
Practice-specific bookkeeping, payroll oversight, monthly KPI reporting, and tax-ready year-end coordination.
A medical practice has financial dynamics no other small business shares — collections cycles tied to insurance, physician compensation that affects retirement plans, equipment financing that drives multi-year tax strategy. The CPA who sees only one or two practice clients a year does not develop the pattern recognition that makes the work valuable.
A complimentary 30-minute consultation. We review your situation and tell you honestly whether Milestone is the right firm.
