Quarterly Tax Planning for Medical Practice Owners: The 4-Meeting Rhythm That Eliminates Surprises

By Brian Giesecke, CPA/EA | Giesecke Advisory

What if you could eliminate tax surprises with just four conversations a year?

Most medical practice owners find out what they owe in April. By then, it's too late to do anything about it. Quarterly tax planning is the rhythm that keeps practice owners ahead of their tax liability — not scrambling behind it.

There's a better way.

Why Is Quarterly Tax Planning Important for Practice Owners?

Tax planning isn't about doing more work. It's about doing the right work at the right time.

A year is too long to go without checking in. Things change. Revenue fluctuates. Opportunities arise.

Quarterly rhythm means you're never surprised. You see problems coming. You can make adjustments while you still have time.

What Should You Cover in Each Quarterly Tax Planning Meeting?

Q1 (January-March): Set the Foundation

• How did last year finish?
• What's projected income for this year?
• Are estimated payments calibrated correctly?
• Retirement plan strategy set?

Key action: Make sure estimated tax payments (filed on IRS Form 1040-ES) are based on THIS year's expected income, not just last year's safe harbor amount.

Q2 (April-June): Mid-Year Check

• How does actual compare to projected?
• Any major changes coming?
• Are tax withholdings still appropriate?

Key action: Adjust if you're significantly off track.

Q3 (July-September): Pre-Year-End Planning

• Project full-year income and taxes
• Identify strategies to execute before December 31st (Section 179 purchases, retirement contributions, charitable giving)
• Retirement contributions on track? (Solo 401(k) employee deferrals for 2024: up to $23,000, or $30,500 if age 50+)
• Equipment purchases to consider?

Key action: Create a written plan for Q4.

Q4 (October-December): Execute

• Implement the plan
• Fund retirement contributions
• Make equipment purchases
• Finalize salary/distributions (S-corps)

Key action: Execute before December 31st.

How to Build the Quarterly Planning Habit

Put it on the calendar. Four times a year. Even 30 minutes with your accountant.

If your accountant doesn't do quarterly calls, you can do most of this yourself. Pull your P&L (profit and loss statement), look at projections, ask the questions.

The point isn't complexity. It's awareness.

Key Takeaways

• Quarterly tax planning replaces April surprises with year-round control — four 30-minute check-ins per year is all it takes
• IRS estimated tax payments (Form 1040-ES) are due quarterly: April 15, June 15, September 15, and January 15 — underpayment triggers penalties under IRC Section 6654
• Q3 is the most valuable planning quarter — it gives you 3+ months to execute year-end strategies (equipment purchases, retirement funding, charitable contributions)
• Most tax savings opportunities expire on December 31st — without a Q3/Q4 plan, you miss the window entirely
• Even 30 minutes per quarter with your P&L is better than the annual "how much do I owe?" panic call

FAQ

What if my accountant only meets with me once a year? That's common — and it's a problem. If your accountant won't do quarterly check-ins, you can run the first three quarters yourself using your P&L and the checklist framework above. Bring your findings to a Q4 meeting and execute. Or... find an accountant who believes in proactive planning.

What are the IRS estimated tax payment deadlines? For most practice owners, estimated taxes are due four times a year: April 15, June 15, September 15, and January 15 of the following year. These are filed using IRS Form 1040-ES. Missing a deadline can trigger an underpayment penalty, even if you pay in full by April 15.

Your Next Step

If you don't have a quarterly rhythm, start with one conversation.

Schedule a call with your accountant for sometime in the next month. Ask: "Where do I stand? What should I be thinking about?"

That's it. One conversation. See what comes out of it.