Orthopedic Surgeon Take-Home Pay Calculator

At $700K–$1.5M gross, orthopedic surgeons face a tax picture few financial advisors model correctly: W-2 vs K-1 vs 1099 income, Additional Medicare Tax, massive pre-tax savings opportunities through cash balance plans, and state taxes that can add 0–13.3% on top. Enter your numbers to see the full breakdown — what you owe, what you keep, and where the levers are.

How ortho surgeon taxes actually work

W-2 hospital employed: you pay more FICA than you think

At $875K W-2, your FICA burden is $11,439 (Social Security cap¹) + $12,688 (Medicare 1.45%) + $5,625 (Additional Medicare Tax 0.9% on wages above $250K MFJ²) = $29,752 in FICA on top of federal and state income taxes. Your employer matches the $11,439 SS + $12,688 Medicare, but that never shows in your paycheck — it's an invisible cost of employment you don't see. For a hospital-employed spine surgeon at $875K, total taxes (federal + FICA + 5% state) typically run 36–42% of gross depending on deductions, leaving $500–560K take-home.

Private practice S-Corp: FICA only on your W-2 salary

The main tax advantage of running your practice through an S-Corp or PC isn't the § 199A QBI deduction — at orthopedic surgeon incomes, QBI phases out completely for SSTBs above $544,600 MFJ (post-OBBBA)³. The real benefit is FICA arbitrage. By paying yourself a "reasonable compensation" W-2 (typically $300–400K for a full-time orthopedic surgeon) and taking the rest as K-1 distributions, you avoid FICA on the distribution portion. At $350K W-2 vs $875K W-2, the FICA savings is roughly $10,000–$12,000/year. Small relative to income, but real. The more important planning lever is what you contribute to the plan side: a solo 401(k) + cash balance plan can shelter $200–400K/year pretax from that same income base.

The retirement stack is where ortho surgeons really reduce taxes

At $900K gross, your first-dollar federal marginal rate once deductions are exhausted is 37%. Every $1 you shelter in a cash balance plan saves $0.37 federal + your state rate. A 55-year-old spine surgeon in a 5% state who contributes $155K to a cash balance plan saves approximately $65,100 in combined federal/state taxes vs. taking it as income. The after-tax cost of the $155K contribution is only $89,900. The calculator above models this directly: try increasing the cash balance contribution and watch the net take-home change less than you'd expect.

1099 / Sole proprietor: SE tax adds 14.1% before income taxes

Orthopedic surgeons who work as independent contractors — common in locum tenens engagements, expert witness income, and device consulting — pay self-employment tax at 15.3% on the first $184,500 of net earnings and 2.9% above that (plus 0.9% AMT)². The one offset: 50% of SE tax is deductible above-the-line, reducing AGI and therefore federal and state tax. The calculator models this automatically. For a full-time locum at $550K net 1099 income, SE tax runs approximately $22,000–$25,000 after the 50% deduction benefit, on top of federal income taxes. The mitigation strategy: establish a solo 401(k) plan (employer contributions up to 25% of net SE income, $72,000 total limit)⁴ and a cash balance plan if volume justifies it — both reduce SE-eligible income and AGI simultaneously.

Related calculators and guides

Sources

Tax values verified June 2026 against IRS and SSA authoritative publications.

1. SSA.gov — Contribution and Benefit Base: $184,500 for 2026
2. IRS Topic 751 — Social Security and Medicare Withholding Rates (FICA and SE tax rates)
3. IRS 2026 Tax Inflation Adjustments (Rev. Proc. 2025-32) — brackets, standard deduction, § 199A phaseouts
4. IRS Rev. Proc. 2025-67 — 2026 retirement plan limits: 401(k) $24,500, § 415(c) $72,000, HSA $8,750 family
5. IRS.gov — Federal Income Tax Rates and Brackets (2026)