AI tools for pulmonology: PE triage, lung nodule, and CDS

May 6, 2026 · Pouyan Golshani, MD, Interventional Radiologist

Pulmonology AI has clinical evidence weight in PE triage and lung nodule management. Here’s the working directory. We’re seeing algorithms that can flag an incidental PE on a chest CT or characterize a lung nodule with increasing accuracy. These tools are about leverage—applying technology to high-stakes decisions to improve outcomes and efficiency. This is a critical development, and you can find a curated list in the physician AI tools directory.

But what if we applied the same strategic, evidence-based mindset to our own financial and operational lives? Most of us are W-2 employees in large health systems. We see high patient volumes, and our compensation, while solid, isn’t in the same tier as procedural subspecialties. This puts us in a unique financial position. The standard-issue advice often misses the mark. The real leverage isn’t in chasing high-risk investments; it’s in mastering a set of specific, powerful tax and savings rules that are practically designed for our income bracket. Just as we have clinical tools, we have financial tools. This is the working directory for your financial life. For a broader overview, see the complete list of pulmonology AI tools and resources on GigHz.

The 199A QBI Deduction: Your Most Valuable, and Fragile, Tax Break

Most physicians hear about the Section 199A Qualified Business Income (QBI) deduction and immediately tune out. They’ve been told it doesn’t apply to them because medicine is a “Specified Service Trade or Business” (SSTB), and their income is too high. For many specialists, that’s true. For many pulmonologists, it’s a costly mistake to assume so.

The 199A deduction allows owners of pass-through businesses (like an S-corp or a 1099 side gig) to deduct up to 20% of their qualified business income. The catch for SSTBs is the income phase-out. For 2026, this phase-out begins at a taxable income of approximately $394,000 for single filers and $787,000 for those married filing jointly. Many hospital-employed pulmonologists, especially earlier in their careers or those in lower cost-of-living areas, have taxable incomes that fall right into this window, or just below it.

Here’s the strategy: If your income is near or slightly above these thresholds, you must actively manage your Adjusted Gross Income (AGI) down to preserve the deduction. This isn’t about evasion; it’s about using the tax code as it’s written.

Max out pre-tax retirement accounts: This is the first and most powerful lever. Your contributions to a 401(k) or 403(b) directly reduce your AGI.
Max out your Health Savings Account (HSA): An HSA contribution is an above-the-line deduction, meaning it lowers your AGI. We’ll cover this in more detail below.
Charitable Bunching: If you make regular charitable donations, consider “bunching” two or three years’ worth of giving into a single year using a Donor-Advised Fund (DAF). This can create a large enough deduction to significantly lower your AGI in the year you contribute, potentially dropping you below the 199A phase-out threshold.

The Trap: The most common trap is passive acceptance. You see your W-2 income, assume you’re phased out, and leave tens of thousands of dollars on the table. A $50,000 1099 side income could yield a $10,000 deduction if your overall AGI is managed correctly. Don’t assume you’re disqualified. Model it out. Just as a PE triage calculator helps stratify clinical risk, a tax projection helps stratify your financial opportunities.

Rescue Your Lost Deductions: The W-2 Employee’s Schedule C Fix

Remember when you could deduct unreimbursed professional expenses? Your CME travel, board exam fees, medical licenses, DEA registration, scrubs, and home office computer? The Tax Cuts and Jobs Act of 2018 (TCJA) eliminated the miscellaneous itemized deduction for W-2 employees, wiping out these write-offs for most of us.

There is a powerful, and entirely legitimate, solution: generate any amount of 1099 independent contractor income. This creates a Schedule C (Profit or Loss from Business) on your tax return. A Schedule C is a business, and businesses are allowed to deduct all ordinary and necessary expenses incurred to generate that income. Suddenly, those “non-deductible” professional expenses become deductible again, but against your 1099 income.

Here’s how it works:

Establish a side gig: This can be anything from telemedicine shifts, expert witness reviews, chart reviews, or a medical directorship. Even a few thousand dollars of 1099 income is enough to open the door.
Track your expenses: Keep meticulous records of all your professional expenses—the ones your W-2 employer doesn’t reimburse. This includes the portion of your cell phone and internet used for work, your license and DEA fees, society memberships, journal subscriptions, and CME costs.
Deduct against 1099 income: On your Schedule C, you list your 1099 income and then deduct these professional expenses. The effect can be dramatic. If you have $5,000 in 1099 income and $4,000 in professional expenses, you only pay tax on the net $1,000 of profit. You’ve effectively “rescued” $4,000 worth of deductions that would have otherwise been lost.

The Trap: The trap is thinking small. Most physicians see a $2,000 telemedicine gig and think it’s not worth the hassle. They’re missing the point. That $2,000 isn’t just income; it’s the key that unlocks the ability to deduct $5,000, $8,000, or even $10,000 in professional expenses you’re already paying for out-of-pocket. The side gig itself doesn’t have to be a massive moneymaker to be incredibly valuable from a tax perspective.

The Solo 401(k): Your 1099 Income Supercharger

Once you have that Schedule C from your 1099 side income, you unlock another major wealth-building tool: the Solo 401(k), also known as an individual 401(k). This is a retirement plan for self-employed individuals, and it allows you to save far more than a traditional IRA.

A Solo 401(k) has two components for contributions:

The “Employee” Contribution: As the “employee” of your own side business, you can contribute up to 100% of your self-employment compensation, up to the annual limit ($23,000 in 2024, plus catch-up contributions if over 50). This is the same limit as your hospital 401(k)/403(b), but it’s a separate bucket.
The “Employer” Contribution: As the “employer,” your business can contribute up to 20% of your net self-employment income.

The total combined contributions can be substantial (up to $69,000 in 2024). For a pulmonologist with a W-2 job who is already maxing out their hospital 401(k), the Solo 401(k) provides a massive, additional pre-tax savings vehicle. If you have $50,000 in net 1099 income, you could potentially contribute your employee max (if you haven’t hit it at your main job) plus the employer portion of roughly $9,293 (20% of net adjusted self-employment income). This is a direct reduction of your taxable income.

The Trap: The biggest trap is the setup deadline. You must establish the Solo 401(k) plan by December 31st of the tax year you want to make contributions for. Many physicians wait until they are doing their taxes in March or April and discover it’s too late to open a plan for the prior year. You can still make *contributions* up until the tax filing deadline, but the *plan itself* must exist before the year ends. Setting one up with a major brokerage is free and takes less than an hour. Do it in the fall, even if you’re not sure how much you’ll contribute.

The HSA Triple-Stack: Your Best Long-Term Investment Vehicle

The Health Savings Account (HSA) is the most misunderstood and underutilized benefit available to physicians. Most see it as a simple checking account for medical bills. This is a fundamental error. An HSA is a retirement account disguised as a health account, and it’s the only vehicle with a triple tax advantage:

Tax-Deductible Contributions: The money you put in is tax-deductible, lowering your AGI (which, as we saw, helps with things like the 199A deduction). For 2026, the family contribution limit is projected to be around $8,750.
Tax-Free Growth: Unlike a 401(k) or IRA, the money inside your HSA can be invested and grows completely tax-free.
Tax-Free Withdrawals: You can withdraw the money tax-free at any time for qualified medical expenses.

Here is the “triple-stack” strategy that turns it into a powerhouse:

Step 1: Contribute the Maximum. Every single year, contribute the family maximum to your HSA, even if you are healthy and have low medical costs.
Step 2: Do NOT Spend It. Pay for your current medical expenses out-of-pocket with post-tax dollars. This feels counterintuitive, but it’s the most important step. You want to leave the money in the HSA untouched.
Step 3: Invest the Entire Balance. Immediately invest your HSA funds in low-cost, broad-market index funds. Let it compound, tax-free, for decades.
Step 4: Save All Your Receipts. Keep a digital folder of every single qualified medical expense you pay out-of-pocket, forever. This includes co-pays, prescriptions, dental work, glasses, etc.

Decades later, in retirement, you will have a massive, tax-free investment account. You can then “reimburse” yourself from the HSA for all those receipts you’ve saved over the years, pulling out tens or even hundreds of thousands of dollars completely tax-free. Or, after age 65, you can withdraw from it for any reason, and it’s simply taxed as ordinary income, just like a traditional 401(k). It’s a “super Roth” for medical expenses and a traditional IRA for everything else. This is the kind of long-term strategic thinking that builds real wealth, much like how a platform like the Pogosh CDS API can be integrated into an EMR to provide long-term, systematic clinical value.

The Trap: The trap is using the HSA like a Flexible Spending Account (FSA). People use their HSA debit card for every co-pay, depleting the balance and losing out on decades of tax-free investment growth. You must have the discipline to pay for current medical costs with other funds to let the HSA grow.