The PEA-SimpliMD Digest: This Week in Micro-Business

Week of April 28 — May 3, 2026

A Note from Tod

This week felt like it had a thread running through all three posts, even though I didn't plan it that way. Monday we talked about a physician who had never run the numbers on her own compensation. Wednesday we talked about the structural decision you have to make before you can even start building the business. And Friday we talked about how to actually pay yourself once that structure is in place.

Taken together, this week is really about one thing: most physicians are operating inside systems they don't fully understand, and the cost of that gap is significant. Not dramatic. Just steady. Year after year of leaving money on the table, missing deductions, accepting compensation that doesn't reflect fair market value, and deferring decisions that compound over time.

The good news is that none of this is complicated once someone walks you through it. That's what PEA is for. That's what these posts are for. I hope something this week clicked for you.

Let's get into it.

Quote of the Week

"The most powerful moment in a PEA consultation is not when the physician sees the tax savings projection. It's when they see what they have been leaving on the table for years, and realize they had no idea it was there."

— Dr. Tod Stillson, from Monday's post

Monday's Post — The Entrepreneur's Life

She Didn't Know What She Was Worth — Until We Ran the Numbers

Dr. Maya is a family medicine physician with OB who has spent years serving a rural community she loves. She came into a PEA consultation thinking her base salary was the number that mattered. It is not. When I built out her complete employer cost picture, the total came to nearly $490,000 per year — a figure that includes malpractice insurance topping $41,000, employer payroll taxes, over 200 hours of compensated PTO, and a retirement match capped by ERISA rules that allowed her to save a fraction of what a Solo 401(k) inside a Professional Corporation would permit.

Then we opened her employment contract. There was a job stacking ban she didn't know existed. Uncompensated call coverage a colleague at the same facility was getting paid for. A revenue assignment clause that meant every dollar of clinical production she generated flowed directly to her employer. None of it was unique. All of it was fixable. But none of it was fixable until she knew it was there.

Read the full post here.

Wednesday's Post — Think Like an Owner-Entrepreneur

PC or PLLC? The Structural Decision Every Physician Micro-Business Owner Must Make

Before you can build a physician micro-business, you have to choose a legal structure. The two main options for licensed professionals are the Professional Corporation (PC) and the Professional Limited Liability Company (PLLC). Wednesday's post walked through the differences clearly and honestly.

The short version: for most single-physician micro-corporations, the tax outcome is nearly identical between a PC taxed as an S-Corp and a PLLC taxed as an S-Corp. The S-Corp election is where the financial benefit actually lives, not the entity label. What actually drives the decision is your state's law (some states don't allow PLLCs for physicians at all), your attorney's recommendation based on your specific situation, and how much governance flexibility you want going forward. The entity choice matters. But how you run the business matters more.

Read the full post here.

Friday's Post — Micro-Business Tips for Clinicians

How to Pay Yourself as a Self-Employed Doctor: The Salary Framework You Actually Need

Once your entity is formed, the question every self-employed physician faces is: how do I actually pay myself? Friday's post answered that with a framework built around three anchoring variables and a simple structural rule I call the 60/40 approach.

The core insight is that your household income as a micro-business owner comes from four channels, not one: salary, distributions, tax-advantaged household expenses, and tax-deferred retirement contributions. Your salary floor is your annual household expenses. Your ceiling is the lower end of the IRS-compliant reasonable salary range for your specialty. And the 60/40 rule — at least 60% of corporate income as W-2 salary, no more than 40% through the other channels — keeps you compliant while giving you real flexibility on the tax-advantaged side. For a physician earning $600,000, applying this framework correctly can produce a meaningful five-figure annual tax savings compared to traditional W-2 employment at the same income.

Read the full post here.

Tool of the Week

TaxElm Small Business Tax Savings Blueprint

This week's posts covered salary structure, entity formation, and total compensation analysis — all topics that connect directly to your tax strategy as a physician micro-business owner. TaxElm's small business blueprint is a solid tool for any physician who wants to understand the major tax categories before sitting down with a CPA. It helps you go into those professional conversations already knowing the right questions to ask, which makes the whole process faster and more productive.

Explore TaxElm's Blueprint

Affiliate Highlight

Contract Diagnostics — Compensation Analysis ($297)

Monday's post made it clear that most employed physicians have no idea what their total compensation package actually looks like. Contract Diagnostics' Compensation Analysis is exactly the tool that fixes that. For $297 they will build you a verified, documented picture of your total W-2 value — the same kind of analysis that stopped Dr. Maya cold when she saw the real number for the first time. If you are approaching a contract renewal or thinking about a transition to independent practice, this is one of the most practical things you can do before you sit down at the negotiating table.

Get Your Compensation Analysis

Free eBook This Week

This week's posts all touched on the foundation of building a physician micro-corporation, so I want to point you toward two free resources that go deeper on the structural and mindset side:

• Should I Create a Professional Micro-Corporation? — the decision framework, start here

• Professional Business Entity Formation Guide by State: PLLC vs. PC or PA — which structure is available in your state

Both are free. Both are built specifically for physicians. Grab them, read them, and if you have questions bring them to a Business Strategy Session.

PEA Membership

Everything we covered this week — compensation analysis, entity structure, salary frameworks, tax strategy — is the kind of content the Physician Entrepreneur Academy exists to deliver, week after week, in a format built for clinicians who are serious about building a sustainable independent professional life.

If you are not yet a member, here is where to start:

• Explorer — $99/yr: Full access to the resource library, free eBooks, and community

• Builder — $499/yr: Deeper content, courses, and expanded tools

• Pro — $999/yr: Direct access to coaching and the full PEA experience

Join the Physician Entrepreneur Academy

Exit Charge

This week's theme kept coming back to the same uncomfortable truth: the gap between what most physicians know about their own financial situation and what is actually true is wide. It's not their fault. Nobody taught this in medical school. Nobody sat them down in residency and walked through compensation structure, entity formation, or salary design. The system wasn't built to make this easy to understand.

But that gap has a cost. And the longer it stays open, the more it compounds.

You don't need to fix everything this week. But if one post, one tool, or one resource from this week moved something for you — follow that thread. Reach out. Book a session. Ask the question you've been sitting on.

That's what this community is here for.

See you next week,

Tod

P.S. Ready to map out your own micro-business structure? A $500 Business Strategy Session is the fastest way to go from questions to a clear plan. One conversation. Real answers.