CPA for Dentists and Medical Practices
Practice accounting, equipment strategy, and owner wealth planning under one roof.
Shetland Financial works with dental and medical practice owners across the Lehigh Valley and Upper Bucks. We are a fee-only CPA firm and registered investment advisor, which means the tax planning for your practice and the investment planning for your household are done by the same people, in the same conversation. You work directly with Kevin Dodgson, CPA, CFA, CFP®.
Practice owners carry two balance sheets that are constantly pulling at each other: the practice and the household. Decisions about equipment, staffing, buying the building, or taking on an associate all move both. Handled separately, they tend to work against each other.
Equipment and build-out are timing decisions, not just purchases. Chairs, imaging, lasers, sterilization, operatory build-outs. There are several ways to write these off and they produce very different results depending on your income in the year of purchase and the years around it. Accelerating everything into one year feels satisfying and is often the wrong answer, particularly if it drops your income below the level where other planning opportunities live. We plan the purchase and the deduction together.
Buying, selling, or buying in. How a practice transition is structured determines the tax outcome for years. Asset versus entity purchase, how the price is allocated across equipment, goodwill, and a restrictive covenant, whether seller financing makes sense, how an associate buy-in is staged. If you are being approached by a DSO, the structure of the offer usually matters more than the headline number, and it is worth modelling before you are emotionally committed.
Retirement plan design is the most underused lever in a profitable practice. Once a practice is throwing off real income, a well-designed plan can shelter a great deal more than a standard 401(k), while still meeting the coverage and nondiscrimination rules that apply when you have staff. Plan design of this kind depends heavily on the age and pay profile of your team, so it needs actual census data rather than a rule of thumb.
If you own the building, look at it properly. Practices that own their real estate frequently hold it in a separate entity and rent to the practice. Whether that structure is set up correctly, and whether the building has ever been studied for component depreciation, are two questions that often turn up meaningful money.
We also handle the Pennsylvania and municipal detail: local Earned Income Tax and Local Services Tax filings for practices with staff across multiple townships, and the state and local registrations that come with adding a second location.
What happens to the money the practice generates. A profitable practice creates a second problem: what to do with the proceeds. Practice owners are frequently over-concentrated in the practice itself and under-invested outside it. Our wealth management page covers how we invest it, and as a fee-only fiduciary we are not paid commissions on anything we recommend.
What you get
Practice and household planned together. One team sees the practice P&L and your personal balance sheet, so decisions are not made in isolation.
Transitions modelled before you commit. Buy-ins, buy-outs, and DSO approaches run through the numbers while you can still negotiate.
Fee-only, flat-fee, no commissions. No product sales, no revenue share, no incentive to steer you anywhere.