How Medical Practice Owners Can Get More From Their CPA Relationship

By Brian Giesecke, CPA/EA | Giesecke Advisory

Are you getting the most out of your relationship with your CPA or accountant?

For a lot of medical practice owners, the answer is probably not.

Not because the accountant is bad. But because the relationship isn't set up for proactive tax planning — just compliance.

What Does a Typical CPA Relationship Look Like?

Here's what typical looks like:

Once a year, around February or March, you gather documents. Send them over. Few weeks later, you get a return. Sign it, pay the bill, done until next year.

This is fine for tax compliance — filing your return accurately and on time. But it's not tax planning. It's not proactive. And the difference between compliance and planning can easily be $10,000-$50,000+ per year for a practice doing $300,000+ in profit.

If you want more than compliance, the relationship has to change.

What Should Practice Owners Look For in a CPA?

Industry focus. Do they work with other medical practices? Do they understand your world?

Proactive communication. Do they reach out during the year, or only when you call?

Willingness to explain. Can they explain strategies in plain language?

Availability. Can you get them when you need to?

If your current accountant doesn't fit these criteria, it might be time to evaluate.

How to Get More Value From Your Accountant

Ask questions. Don't just accept the return. Ask: "Is there anything we could be doing better?"

Schedule planning meetings. Don't wait for them to suggest it. Request a pre-year-end call.

Bring them information early. Don't wait until March to mention big changes.

Be responsive. When they ask for documents, reply quickly.

Ask for recommendations. They probably know other professionals you might need.

When Should You Push Back on Your CPA?

You're allowed to push back.

If they say "you're all set" and never suggest improvements — ask why.

If they dismiss strategies without explanation — ask for the explanation.

If they're never available — say something. Or find someone else.

You're paying for advice, not just data entry.

The CPA Partnership Mindset That Saves Practice Owners Money

The best accountant relationships feel like partnerships.

You bring the information. They bring the expertise. Together, you make better decisions.

That requires effort on both sides.

Frequently Asked Questions

How much should a CPA charge for tax planning vs. just tax preparation? Tax preparation fees for a medical practice typically range from $1,500-$5,000 depending on complexity (S-corp, multiple states, etc.). Proactive tax planning is a separate service, usually $3,000-$10,000+ annually, but should pay for itself many times over. If your accountant only charges for prep, you're likely only getting compliance.

How often should a practice owner meet with their CPA? At minimum, twice a year: a mid-year check-in (June-July) to review projections and adjust estimated payments, and a year-end planning meeting (October-November) to execute strategies before December 31st. Quarterly touchpoints are ideal for practices with $500,000+ in revenue.

Key Takeaways

• Tax compliance and tax planning are different services — compliance is filing accurately, planning is proactively reducing what you owe. The gap between the two can cost practice owners $10,000-$50,000+ per year
• Industry-specific experience matters — a CPA who works with medical practices understands reasonable compensation benchmarks, practice-specific deductions, and healthcare entity structures
• Proactive communication is the #1 differentiator — your CPA should reach out before year-end, not just process your return in March
• You should meet with your CPA at least twice per year — mid-year projection review and pre-year-end planning session
• Push back if you're not getting value — if your accountant never suggests improvements, it's a sign you're paying for data entry, not advice

Your Next Step

When was the last time you talked to your accountant outside of tax season?

If it's been more than six months, consider reaching out.

Even just to say: "I'd love a quick check-in. Are there any opportunities I should be thinking about?"

You might be surprised what comes up.