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NYC Medical Startup Needs an Accountant!!

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  • NYC Medical Startup Needs an Accountant!!

    Hello WCI team,

    I am new to posting however a longtime follower of the white coat investor podcast and forum. Along with a buddy of mine from residency, we are in the process of starting a new medical practice in NYC. We have both been practicing as attendings for 4 years and feel it is the right time to take the leap into private practice. We have been making some solid headway on our own and assembling our core team of advisors, however I am not pleased with our current business accountant.

    Currently, when asking financial questions regarding business tax savings, structuring equipment purchasing (rent vs lease vs buy vs lease to buy, section 179 tax deductions, etc) his advice is unclear and often in the form of additional questions - not helpful. His current fees are as follows:

    Initial Set up fee $500
    Consulting Hourly Rate PRN ​$250/hr
    Monthly Flat Fee: $500/month
    Tax Prep for Business and Owner’s Personal Returns: $1,500

    Does this seem reasonable from a fee perspective? So far, we've paid the first $500, but are coming up on the first monthly fee of $500 at the start of December.

    I want to have an open candid relationship with our accountant and I already feel that with the few/"simple" questions I am asking, we are getting pushback and poor guidance. Ideally, I would like someone I can quickly reach out with questions and who can offer sound explanations back without that feeling that I am bothering them with dumb questions. We are a medical startup after all.

    My ask of you all is whether you have any recommendations for an accountant who can not just help with "setting up the books" but offer sound financial advice. Ideally we would like someone well versed with NJ/NYC tax laws as I know there are several city/state specific nuances as well (a friendly fee schedule would be a nice perk too haha)

    Any help would be greatly appreciated. Thank you in advance!!

  • #2
    •Fee schedule is reasonable
    •There is no such thing as a “dumb question”. You have a new business relationship and you CPA has an extremely new relationship as well.
    • Quickly reach out and offer sound explanations back” is your source of dissatisfaction. Sounds like solving that is your goal. Was that discussion of the “need” and the process defined? Phone call, email, scheduling and response times?
    •I will give you and example regarding equipment. From an accounting perspective, equipment leases are Operating or Capitalized.
    Specific criteria. From a business owner perspective, it is a lease/purchase financial analysis that the equipment itself (obsolescence and financing capabilities) have a large impact.
    Two different questions and a source of miscommunication.
    •Get clarification of what falls in the monthly fee and what falls under consulting. You need to get the answers and service you desire. This CPA may or may not be a fit. It sounds like your expectations are out of sync. Clarify them. It’s worth a conversation.
    • You sound reasonable and realize startups take more support. Good luck.


    • #3
      Hi Tim!

      Thank you for your help. We did have discussions regarding startup advice on our initial phone call, however I'm not really happy with the execution of the advice we're getting. Good to know regarding operating vs capitalized criteria. Do you happen to have any recommendations for CPA's whether in NYC or virtual?