From the invoice to the tax return.

1. What is fee-based work?

You work on a self-employed basis for a limited period – on a research project, say, or for an industrial client – not as an employee, but against an invoice. Activities around medicine such as trial reads, medical consulting or software testing generally count as freelance work for tax purposes; curative treatment of patients is usually not involved.

2. How does the fee reach you?

You issue an invoice once the work is complete. It states:

• your name and address
• the service you provided
• the amount
• VAT where applicable (see point 5)

We are happy to provide an invoice template.

3. Do you have to register a trade?

No. Medical work generally counts as freelance – no trade registration, no trade tax (Gewerbesteuer). If you are working on a fee basis for the first time, you do register once with the tax office: via the tax registration questionnaire (Fragebogen zur steuerlichen Erfassung), submitted electronically through the ELSTER portal. A tax adviser will take care of this for you; we can put you in touch if you need a contact.

4. What do you need to bear in mind for tax?

Income tax is due on the fee and is settled through your annual tax return. If you work on a fee basis regularly, the tax office may set quarterly advance payments. As a rule of thumb: set aside roughly 30 to 40 per cent of your income for tax and insurance.

5. Is VAT payable?

Often not. Medical treatment is exempt from VAT. Expert reports, research services or consulting, by contrast, may be subject to VAT. If in doubt, settle the question with your tax adviser in advance – or talk to us and we will work through the specific activity with you.

6. How are you insured?

Many of the colleagues in our network work in a hospital as their main occupation and take on fee-based work alongside it. In that case your health, pension and long-term care insurance continue through your main employment; as a rule nothing changes in your social insurance.

If you work exclusively on a fee basis, insurance and provision are your own responsibility. Get in touch and we will explain what matters here.

Some clients require proof of your own professional indemnity insurance – even where you are additionally employed by a hospital. Clarify early with the client whether proof is needed, and if in doubt speak to your existing liability insurer.

7. Do you need a tax adviser?

Not strictly, but it helps a great deal at the start. A tax adviser supports you in getting set up, shows you how to record income and expenses cleanly, and handles the tax return.

8. And what about bogus self-employment?

This becomes an issue above all where someone works permanently for a single client and the work resembles employment. As long as you work for a range of clients, organise your own time and decide independently how you work, the arrangement is customary and unproblematic. If in doubt: ask your tax adviser, or talk to us.

9. What is left at the end?

That depends on the fee, your personal tax situation and your insurance. As a rough guide: of every 100 euros in fees, plan on around 30 to 40 euros for tax and insurance.

For comparison: in employment, too, more than 40 per cent of gross salary goes on tax and social contributions – with no room to manoeuvre. With fee-based work you have more control over your expenditure, can deduct costs (training, travel, professional literature) and stay more flexible in how you provide for the future. The overall burden is therefore comparable or lower.

10. If questions remain

We are board-certified radiologists ourselves and have been through the move into fee-based work. From us you get templates for invoices and contracts, guidance on insurance, contacts for tax advisers – and projects that match your profile.

This overview is intended as orientation and does not constitute tax or legal advice. It reflects our own experience in practice and refers to the law in Germany. For binding information, please consult a tax adviser or a specialist legal adviser.