Pocket‑More, Tax‑Less: Fast Wins for High‑Earning Medical Professionals Under OBBBA

You spent years in training, sacrificed weekends, holidays, and sleep for your career. Now you’re earning what you’ve worked so hard for. But with rising taxes, student loans, and the pressure to plan for retirement and your kids' college at the same time, it can feel like your income is slipping through your fingers.

Trump’s One Big Beautiful Bill (OBBBA), signed on July 4th, 2025, just gave medical professionals like you a powerful, limited-time opportunity to legally pocket more of your hard-earned money.

Download “The OBBBA Comparison Guide” to see how the new law stacks up against previous rules - and where you can find your biggest savings.

Many of these opportunities expire as soon as 2029 - or even earlier.

Let’s unpack the smart moves high-earning nurse practitioners, dentists, and other medical professionals can make right now to save serious money and take advantage of OBBBA before the window closes

🔥 The SALT Cap Quadruples  -  But Only for a While

For years, you’ve been capped at deducting just $10,000 of state and local taxes (SALT) - a frustrating limit for medical professionals in high-tax states like Illinois, Wisconsin, and Michigan.

Under OBBBA, that cap jumps to $40,000 from 2025 to 2029.

What this means for you:
If you’re a homeowner paying high property and state income taxes, you can finally deduct a much larger portion - potentially saving thousands per year.

But here’s the kicker:
In 2030, the cap snaps back to $10k. If you delay, you’ll lose your chance to fully deduct large expenses like:

• Property taxes on your primary and/or second home

• State estimated income tax payments

• Pass-through entity tax (PTET) elections (which are still allowed!)

• Charitable contributions

Tax-Savvy Move:
Consider  "Bunching" your itemized deductions, such as property and state tax payments. Evaluate prepaying 2026 taxes in 2025 (where allowed) to increase your deductions while the $40k cap is in play.

And if your Adjusted Gross Income (AGI) falls in the $500k–$600k range, beware: you’ll face a phasedown of this SALT benefit with a painful 45.5% effective marginal tax rate within the phaseout range.

🏥 Practice Owners: Remodel, Deduct, and Win

If you own your practice or have self-employed income and have plans to expand or remodel, 2025 is your year.

Here’s why:

• 100% Bonus Depreciation is still here
  You can fully deduct the cost of qualifying equipment or property upgrades in the year you place them in service.

• Section 199A Pass‑Through Deduction is Permanent
  That’s a 20% deduction on qualified business income (QBI), still available for most practice owners below the phaseout thresholds:

• $197,300 (Single/HOH)

• $394,600 (Married Filing Jointly)
  
  
  

These thresholds are staying - for now - but starting in 2026, high-income earners face a more complex phaseout with stricter active business rules and even a minimum deduction requirement.

Self-Employed - Pro Tip:
If you’re planning an imaging suite upgrade, ASC build-out, or office remodel, consider the tax effects of doing it now. Not only do you reduce your tax burden, but you also reinvest in your patient experience and operational efficiency.

What qualifies?
Think MRI machines, dental chairs, HVAC improvements, even software systems - if it’s for the business, it likely counts.

💸 “No Tax on Overtime” and “No Tax on Tips”  -  What Shift Workers Need to Know

If you're a hospitalist, ER doc, CRNA, or any clinician receiving overtime pay, you’re in for a rare break.

Under OBBBA, you can now deduct the “bonus portion” of your overtime pay - that’s the amount you earn above your normal hourly rate. For example:

• Normal rate: $80/hour

• Overtime rate: $120/hour

• Deductible amount: $40/hour

You can deduct up to $25,000 (Married Filing Jointly) or $12,500 (Single/Head of Household) from 2025–2028.

The same goes for tips, if you’re in a tip-eligible healthcare setting (think concierge medicine, massage therapy, or cosmetic procedures).

⚠️ These deductions are below-the-line - meaning you don’t need to itemize to claim them.

However, they phase out at incomes over $300k (MFJ) or $150k (Single/HOH). If you’re near these levels, now’s the time to rethink your pay structure or shift scheduling to lock in these savings.

📊 Charitable Contributions Just Got Trickier

Giving back is second nature for many healthcare professionals. But starting in 2026, you’ll need to navigate a new rule: the 0.5% AGI floor.

In short, you must subtract 0.5% of your AGI from your charitable contributions before you even hit the usual 20–60% limits.

Example:

• AGI: $300,000

• You donate $30,000 of stock to a public charity

• First, subtract $1,500 (0.5% of AGI)

• Now, your starting deductible amount is $28,500

• But the 30% AGI limit may still reduce it to $90,000

Plan ahead:
If you’re considering a major gift or Donor Advised Fund contribution, consider doing so in 2025 before these floors apply.

👶 Thinking Long-Term? Trump Accounts and Expanded 529 Rules

OBBBA introduced the Trump Account, a new vehicle designed to give kids a $1,000 boost at birth and provide potential growth like a hybrid between a 529 account and Roth IRA.

But it comes with strings:

• Only index-fund investments are allowed

• Contributions until age 18

• Strict distribution rules

• Only $5,000/year allowed (with a $2,500 employer cap)
  
  
  

It’s a promising tool - especially for parents or grandparents looking to give their child a financial head start - but it’s no silver bullet yet.

Meanwhile, 529 plans are more flexible than ever:

• You can now use them for credentialing courses, exam prep, homeschool expenses, and even certain therapies for children with disabilities.

• Aggregate annual limits: $10k in 2025, $20k from 2026

If you’ve been putting off opening or funding a 529, this is your green light.

👀 What to Watch Out For

OBBBA’s hidden costs are real, especially for high earners.

• AMT creep is back: The phaseout thresholds for the Alternative Minimum Tax have dropped, with marginal tax  rates jumping to 42% in the “bump zone.”

• Itemized Deduction Cap: Starting in 2026, itemized deductions may be capped at 35% of benefit for those earning over $626k (MFJ) or $751k (S).

• "Permanent" Isn’t Permanent: Even provisions labeled as permanent can be reversed with the next tax bill.

🛠️ Your Next Steps (Start Now, Not Later)

Here’s what smart medical professionals are doing today:

1. Meeting with their CFP® to run projections for 2025–2029 tax years

2. Running cost-benefit analyses on practice upgrades or remodeling

3. Reassessing shift schedules or overtime plans to maximize deductions

4. Optimizing charitable giving before the 0.5% AGI floor hits

5. Refactoring AGI to avoid phaseouts - Roth conversions, HSAs, and more

6. Pre-funding SALT-heavy years while the $40k cap lasts

7. Opening 529s and Trump Accounts strategically for their children

Final Thoughts: Your Financial Health Deserves the Same Care You Give Your Patients

You already know how to diagnose and treat complex cases. Your financial life deserves that same level of precision and care.

The One Big Beautiful Bill offers a rare - and temporary - window of opportunity. It’s not flawless, and it won’t last. But for high-earning medical professionals, it’s packed with strategic moves that could significantly reduce taxes and accelerate long-term wealth.

The medical professionals who take action now will gain more control, keep more of what they earn, and build a stronger financial future.

Those who wait? They’ll be looking back in 2030, wondering why they didn’t act when the window was open.

At Outside The Box Financial Planning, LLC, we specialize in helping high-income medical professionals navigate complex tax law with clarity, strategy, and purpose.

Ready to pocket more and tax less - without the guesswork?

Schedule an introductory “Fit” meeting below and let’s find out if we’re the right partner for your financial journey.