1099 physicians, CRNAs, and locum tenens doctors often ask whether they need a CPA and how much tax prep and planning will cost. The answer depends on how complex your situation is and what you want handled. This blog explains when self-preparation is often enough, when CPA involvement typically makes sense, and what drives the cost so you can decide whether and when to hire.
There isn’t a single rule that determines when a 1099 healthcare professional needs a CPA. Many handle their own taxes when the work is limited to one state and a straightforward return. CPA involvement typically becomes useful when added complexity increases the risk of mistakes or missed planning, and cost is driven by that complexity rather than income alone.
If your income is reported on a single Form 1099-NEC, you work in one state, have no entity (or a simple sole proprietorship), and are comfortable with Schedule C and Schedule SE, you can often handle your own return. The IRS treats net profit from your trade or business as self-employment income once it reaches $400. Schedule C reports income and expenses, and Schedule SE calculates self-employment tax. Many 1099 healthcare professionals in that situation do their own return.
Doing your own taxes is often reasonable when all of the following are true:
If those conditions apply, many 1099 healthcare professionals handle their own returns without issues.
A CPA does not track mileage or collect receipts. The value is in reviewing how those records are used, categorized, and reported on the return.
In our experience working with locum tenens professionals, complexity tends to increase once additional factors are involved, such as working in multiple states, setting up an LLC or S-corp, contributing to retirement plans, or planning around the QBI deduction or health insurance deductions. That’s often when people decide to bring in a CPA.
For many physicians, CRNAs, and anesthesiologists, the decision comes down to time and focus. Their training and day-to-day work are demanding, and keeping up with tax rules that change regularly and vary by state can become another ongoing responsibility. CPA involvement often makes sense when managing that complexity competes with time better spent on clinical work or running the business side of their practice.
Complexity usually increases when one or more of the following apply: multiple 1099 payers or assignments, an S-corp or LLC with payroll and reasonable-compensation questions, multi-state work (common for locum tenens), retirement plan setup or optimization (solo 401(k), SEP), or planning for the QBI deduction or self-employed health insurance (Form 7206).
Estimated taxes are another trigger. When income varies by quarter or by state, underpayment penalties can add up. A CPA can help you set withholding or estimated amounts and keep payments on track.
There isn’t a specific income level where hiring a CPA suddenly becomes necessary. It describes situations where the cost of mistakes or missed planning often outweighs the cost of having someone handle it.
The cost of tax planning varies from client to client because the work does. What actually drives it:
Return complexity. A single Schedule C and Schedule SE is one level of effort. Add an S-corp (payroll, Form 1120-S, reasonable salary), multiple states, or multiple entities, and the time and fee go up.
Planning vs. preparation. Tax preparation is one line item. Tax planning—entity choice, retirement strategy, estimated tax strategy, multi-state or per diem guidance—is another. Firms that do both may quote separately for preparation and planning/advisory.
Audience and specialization. Some firms focus on 1099 healthcare (CRNAs, locum tenens, physicians). They are used to Schedule C, SE, Form 7206, Form 8995, and state filings; that familiarity can mean fewer surprises and a clearer scope. A generalist may charge less per return but take longer to get up to speed on your situation.
When you budget, focus on what is in scope (one return vs. multiple states/entities; prep-only vs. planning) and on how the firm prices (per return, by entity, or by engagement).
When a CPA is involved, a few things often shift. Consistency from year to year is easier: depreciation, deductions, and entity reporting can align with prior returns and with how you keep your books. Estimated tax timing and amounts can be planned rather than guessed. Coordination between your recordkeeping and the return reduces last-minute cleanup and missing deductions.
That does not guarantee a refund or a specific outcome. It describes what typically changes when someone familiar with 1099 healthcare is handling the filing and planning.
Accolade Accounting works with 1099 healthcare professionals, including CRNAs and locum tenens physicians. The firm handles tax preparation, planning, and related work for individuals and entities in this space; the scope varies by client. That is a statement of the type of work the firm does, not a guarantee of results.
Here are a few additional articles that address common IRS rules, expense areas, and planning decisions for 1099 healthcare professionals.
Disclaimer: This article is for informational purposes only and is not intended as tax advice. Tax situations vary, and IRS rules can change. Always consult with a qualified tax professional regarding your specific circumstances.
