Your First Attending Tax Bill: Withholding and Quarterly Estimates
Yohance Harrison
June 27, 2026
Your first attending tax bill is high for a predictable reason. Withholding rarely keeps pace with an income that climbed in the middle of the year, and any 1099 income arrives with nothing withheld at all.
Payroll withholding estimates your full-year income from your current paycheck. Start attending pay partway through the year and the system often assumes a lower annual figure, so it withholds too little. The true number catches up in April. Add a new top bracket and the gap widens.
Look at your W-4 in your first attending year. Adjusting it so withholding reflects your new income closes most of the gap before it becomes a surprise. A short update now prevents a large balance later.
Contractor income has no withholding, so you pay quarterly estimated taxes directly. Missing them invites penalties on top of the bill. The fix is a habit rather than a heroic effort.
Move 25% to 30% of every untaxed payment into a separate account the day it lands. Pay your quarterly estimates from that account. When April arrives, the money is already waiting, and the bill stops being a shock.
Present bias is the culprit. The full deposit feels like income you can spend, and the tax owed stays invisible until the deadline. A separate account makes the obligation visible and removes the monthly temptation.
If you want a set-aside rate and a quarterly schedule built around your situation, book a 15-minute complimentary discovery call.
Withholding from a mid-year pay increase usually assumes a lower full-year income, so too little is withheld. 1099 income has no withholding at all, which adds to the balance due.
If you have 1099 income, you pay estimated taxes to the IRS four times a year. Setting aside 25% to 30% of each payment funds those estimates and your final bill.
W-2 attendings should update their W-4 to reflect the new income. 1099 attendings should set aside 25% to 30% per payment and pay quarterly estimates.