You’re pretty sure your practice is thriving, but sometimes, it’s hard to tell.

With everything else you’re juggling, you’re a few months behind on reconciling your business account, and your bookkeeping system hinges around a shoebox full of receipts. You want to invest in new equipment or bring on more staff… but you’re not sure if you can afford it.

If that all sounds familiar, you’re not alone. Between managing payroll, tracking expenses, and the rest of the nitty-gritty that comes with running a practice, the back-office tasks can pile up fast. And when tax season rolls around, that mess gets expensive even faster.

Choosing the right accountant isn't just about filing taxes once a year. It's about having someone who keeps your books clean and helps you get the context you need to make the right decisions for your practice.

Let's break down what to look for, what to avoid, and how to find an accountant who won't leave you flying blind.

Why Accountants for Doctors Require Specialized Expertise

Before we explore the key considerations to bear in mind when choosing an accountant, let’s kick off with the basics. Doctors and medical practices have unique accounting needs that not just any old accountant can manage properly.

First and foremost, let’s consider your income. You’ll have multiple sources of income from a W-2 salary to K-1 partnership distributions. Your expenses are just as unique, with industry-specific costs, such as malpractice insurance, CME costs, and maybe even home office deductions if you’re offering telemedicine.

Worst of all, individuals earning over $200k per year are 4x more likely to get audited by the IRS than folks under that threshold, so you need to keep your books clean if you want to keep your stress levels under control.

Then there's the life-stage stuff: transitioning from residency to attending, buying into a practice, bringing on partners, or planning your exit strategy. Each phase has unique financial implications that a generic accountant might completely miss.

Add in Michigan's state tax considerations and the realities of practicing in the Detroit metro area, and you need someone who actually gets it. The problem is that there's a massive shortage of quality CPAs right now, and even fewer who specialize in working with healthcare providers.

Key Considerations When Choosing Accountants for Doctors

Not all accountants are created equal, and you need more than a once-a-year tax preparer. You also don’t want to shell out good money for a service that doesn’t benefit you. Here's what separates the “worth it” from the "why am I paying you again?"

Credentials and Expertise Level

Like the medical field, accounting is one of those industries where credentials actually matter. There are two main types of certifications you’ll want to consider:

A CPA (Certified Public Accountant) has passed rigorous exams, met experience requirements, and completes ongoing education.
An EA (Enrolled Agent) specializes in taxes and can represent you before the IRS.

In most states, you can work with an unlicensed tax preparer, but even if they manage to get your books right, you’re still at a disadvantage. If the IRS comes knocking, only CPAs and EAs can legally represent you. And if your finances are complicated enough that you're paying someone to handle them, you should probably hire someone who's proven they know what they're doing.

You can verify a CPA's license on CPAverify.org and check if they belong to professional organizations like AICPA or NATP.

But credentials are just the starting point. You also need to understand what level of service you're actually getting.

Tax preparers will file your return, but may ignore your calls the rest of the year.
Tax planners will help you make strategic moves throughout the year to lower what you owe.
Bookkeepers will help you track and manage expenses, reconcile your books, and keep your financial records healthy all year long.

Finally, be sure to look for accountants with experience working with healthcare providers. You’ll want to work with someone who understands practice partnerships, provider compensation models, and medical-specific deductions.

Service Model and Responsiveness

One of the most common complaints I hear about accountants is related to a lack of responsiveness. I meet doctors and other professionals all the time who emailed their accountant three weeks ago and still haven’t heard back.

Chances are, you’re going to want to work with someone a little more responsive than that.

When you’re considering accountants for doctors, ask about response times. A 1-2 business-day standard is reasonable for most questions. You’ll also want to clarify how they accept communications from clients. If they require a phone call every time you have a small issue, that might not work for your already overbooked schedule.

Finally, if you're only getting help during tax season, you're missing out. The best accountants offer year-round advisory relationships. If your accountant is ghosting you between tax seasons or making you feel like a nuisance if you have questions throughout the year, it’s time to move on and find a new partner.

Pricing Structure and Transparency

Next, you’ll want to consider your accountant's pricing structure. Some use hourly billing, which can add up fast (especially if they’re inefficient). We prefer a flat monthly fee or fixed-price agreement, since it makes our clients feel less like they’re getting nickel-and-dimed any time they have a simple question. Either model can work, though, as long as your accountant is transparent.

During your consideration phase, be sure to ask clarifying questions about pricing and add-ons. Some accountants have a seemingly flat fee, but will add on costs for amended returns, audit support, or other services. These add-ons can turn a $500 tax prep bill into a $3,000 surprise real quick.

For reference, a simple W-2 return typically costs $200-$300. Add a Schedule C for side income, and you're looking at a few hundred more. If you're running a practice with partnerships, multiple entities, real estate investments, and active tax planning, expect to pay several thousand.

If you practice near state lines (hello, Michigan doctors working in Ohio or Indiana), make sure your accountant understands multi-state filing requirements. That's where things get expensive if they're not handled correctly.

Tax Philosophy Alignment

What is your tax philosophy? You’ll want to choose an accountant with the same approach.

Some accountants are conservative, meaning they won't touch a deduction unless it's bulletproof. Others are more aggressive and willing to push boundaries. Neither is inherently wrong, but you need to know where your accountant stands and make sure it lines up with your comfort level.

More importantly, you want someone who's proactive, not reactive. The right partner should be thinking about elections, optimization, and strategies that can help keep your finances smooth and make tax time easier throughout the year, not just when March rolls around.

Similarly, you want an accounting partner who is collaborative. If you work with a financial planner or estate attorney, your accountant should be willing to coordinate with them. Your financial team should actually talk to each other rather than forcing you to play telephone every time something comes up.

Technology and Systems

If your accountant is still using QuickBooks Desktop and mailing you paper copies of your tax return, it’s probably time for an upgrade.

Look for an accountant who uses a cloud-based accounting software solution, such as QuickBooks Online. These solutions are more secure than desktop or manual-entry systems and make collaboration easier between you and your financial team.

Other modern tools the right accountant will use:

Secure client portals for remote document sharing
Video conferencing tools
E-filing systems
Digital signature tools

The short version of this section is that you’re too busy to waste time digging through filing cabinets or running to the post office to mail off documents. Be sure you find an accountant who uses the tools you need to manage your books remotely and collaborate asynchronously.

Michigan-Specific Considerations

Finally, if you're practicing in Michigan, you need someone who actually understands the local landscape. You’ll want an accountant with familiarity with Michigan state tax filing requirements, knowledge of the Detroit metro healthcare market, and ideally, connections to local resources like business attorneys and financial advisors who specialize in working with physicians.

Michigan has its own quirks, especially if you're working across state lines or dealing with partnership structures common in the area. An accountant who's navigated these issues before will save you headaches (and money) down the road.

Finding the Right Accountant for Doctors in Michigan: Taking the Next Step

The right accountant can save you hundreds of thousands of dollars over the course of your career. The wrong one will cost you in overpaid taxes, missed opportunities, and frustration.

At Primary Care Financial, we work with health and wellness professionals across Metro Detroit who want modern, responsive, tech-forward support without the outdated billing models or radio silence.

We specialize in solopreneurs and small practices (think occupational therapists, chiropractors, and other service-based businesses) that need clean books, proactive tax planning, and someone who actually answers their emails.

Not sure if your current accountant is the right fit? Let's talk. Set up a free 15-minute Q&A with my team, and we’ll talk through your current challenges and help you build a plan for future financial success.

Accountants for Doctors: 5 Considerations & Top Options for Michigan-Based Practices