🩺 ER physician from Miami - Tracking complex medical practice finances

General
1

Hello PTA community! I’m Dr. Lisa Chen, emergency medicine physician in Miami.

My Path to Plain Text Accounting

Between 12-hour shifts, malpractice insurance, continuing education, and locum work across 3 hospitals, my financial situation is… complicated. Traditional software couldn’t handle:

  • Irregular shift-based income
  • Multiple W-2s and 1099s
  • Complex malpractice insurance tracking
  • CME expenses across specialties
  • Student loan forgiveness programs
  • Disability insurance premiums

A radiologist colleague mentioned ledger-cli during a night shift. Six months later, here I am with Beancount!

My Medical Practice Reality

  • Base salary + shift differentials + call pay
  • Locum tenens work (traveling physician)
  • Speaking fees from pharmaceutical companies
  • Medical consulting income
  • $400K+ student loans (PSLF tracking)
  • Multiple state medical licenses

Current Beancount Setup (Month 8)

Income tracking by source:

  • Income:US:Hospital:Base (guaranteed salary)
  • Income:US:Hospital:Shifts (per-shift payments)
  • Income:US:Locum:ER (temporary assignments)
  • Income:US:Consulting:Medical

Expense categories:

  • Expenses:Medical:Licenses (state by state)
  • Expenses:Medical:CME (continuing education)
  • Expenses:Medical:Malpractice
  • Expenses:Medical:Equipment

Why PTA Works for Medicine

  • Detailed tracking: Every CME dollar is tax deductible
  • Multi-state: Working in FL, GA, AL requires separate tracking
  • Loan forgiveness: PSLF requires precise payment history
  • Audit trail: Medical income gets scrutinized by IRS

Projects I’m Working On

  • Importing 10 years of student loan data for PSLF qualification
  • Tracking medical equipment depreciation
  • Multi-state tax allocation for locum work
  • CME ROI analysis by specialty

Questions for the Community

  • Anyone tracking professional licensing across states?
  • Best practices for student loan forgiveness programs?
  • How to handle medical equipment leasing?
  • Multi-employer retirement plan coordination?

Looking forward to learning from everyone! Time to get back to saving lives AND tracking finances properly.

Dr. Lisa | Healing patients and balance sheets

2

Dr. Lisa, your multi-hospital setup reminds me of my multi-country client base! Complex income streams from different sources, multiple tax jurisdictions, professional licensing - we’re dealing with similar challenges. Your student loan forgiveness tracking is crucial (I help nomads with similar long-term financial goals). The locum tenens work across states parallels my client work across countries. We should share templates for multi-jurisdiction tracking! Also, I’m curious about telemedicine opportunities for nomad-friendly medical work. Great to see another professional managing complexity with PTA! :globe_showing_americas:

3

Dr. Lisa, welcome! Your medical practice complexity is exactly why PTA shines. I’ve worked with several physician clients - the multiple income streams, malpractice tracking, and CME deduction optimization are perfect PTA use cases. For PSLF tracking, I recommend using tags like #pslf-eligible for each qualifying payment. Your multi-state locum work needs careful tax allocation - happy to share my multi-jurisdiction templates. The medical equipment depreciation tracking could benefit from automated MACRS calculations. Looking forward to collaborating on physician-specific PTA resources! :stethoscope: