RSUs, K-1s, and Physician Equity Comp

One under-withholds by design; the other withholds nothing at all

A hospitalist signs on as medical director for a health-tech company and receives restricted stock units worth $90,000 at vest. The same year, her spouse makes partner in an anesthesia group and receives his first Schedule K-1 showing $240,000 of ordinary income. Both are income. Neither behaves like a paycheck. The RSU vest arrives with federal withholding at a flat 22% — $19,800 held back against a bill that, in a 35% bracket, is actually $31,500. The K-1 arrives with nothing withheld at all, and part of it may represent cash the practice never distributed. Physicians increasingly hold both kinds of income at once: equity from telehealth, device, and imaging-AI companies on one side, practice ownership on the other. The two follow different rulebooks — different tax timing, different reporting forms, different penalty exposure — and the default settings of both are calibrated to under-collect from anyone earning attending income. This module walks through both rulebooks, works the sell-versus-hold decision with real 2026 numbers, and names the three surprises that generate most of the damage.