Payroll
Use a payroll provider (Gusto, ADP, Paychex, or your PEO) from the first hire; manual payroll is where tax penalties come from. Setup needs your EIN, state withholding and unemployment accounts (registrations), workers’ comp policy, and each hire’s I-9 and W-4. If you took the S-corp election, your own reasonable salary runs through payroll too. Multi-entity structures run payroll per entity: clinical staff in the PC, business staff in the MSO (why).Benefits
In a tight clinical labor market, benefits are recruiting. Rough order of impact: health insurance (small-group plan or an ICHRA reimbursing individual plans), retirement with a match, PTO policy in writing, then dental/vision and the rest. For clinicians, CE allowance, license and DEA fees, and malpractice with clear tail terms are expected parts of the package.Retirement
Deadlines matter: a new 401(k) generally must exist by year-end (safe harbor
setups have fall deadlines) to shelter that year’s income. Put the decision
on the calendar in Q3, not December.