Retirement accounts and taxes for physicians — filling the right accounts in the right order, backdoor Roths, and keeping more of a high income.
31 articles in retirement & taxes
Rebalancing controls risk; it does not reliably add return. The two triggers that work, where to execute without a tax bill, and the behavioral reason to write the rule down.
The claiming decision reduces to a handful of computations — the reduction and credit percentages, a breakeven age, a survivor rule, and a tax tier — and physicians should run all of them before picking a date.
Between your last paycheck and your first required distribution sits the cheapest tax capacity of your life — here is how to fill it deliberately, and when to leave it alone.
The withdrawal-rate literature, read properly — what Bengen and Trinity tested, what came after, and why a physician's ability to work part-time changes the whole calculation.
The verified arithmetic of missing the rebound, why the best and worst days arrive together, the professional track record, and the protocol that replaces forecasting.
Ranked by career cost, with the arithmetic shown: starting late, complexity-seeking, unpriced advice, panic selling, careless asset location, and the confidence that does not transfer.
One US stock fund, one international fund, one bond fund — why the simplest credible portfolio is also the hardest one to beat, and how to build it inside a hospital 403(b).
The Medicare-tax math is real but small, and the social-media math is not — a worked, honest analysis at $400,000 of 1099 income.
The conversion takes ten minutes; the form is where physicians get double-taxed. A line-by-line walk for a clean $7,500 backdoor in 2026.
Section 199A hands pass-through physicians a 20 percent deduction, then phases it out across bands that only taxable income — not practice structure — can move.
The January-to-April protocol: every form by income stream, the five items physicians miss, the CPA handoff package, and what an extension actually buys.
The safe harbors, the 2026 deadlines, the December withholding cure, and the set-aside system that keeps moonlighting income from ruining April.
The 2026 brackets worked at real attending incomes, the deferral stack, the rewritten OBBBA deduction landscape, and the calendar that runs it all.
Generic age-based tables grade physicians as failures until 40 — the honest benchmark starts the clock at your first attending year, not your birthday.
Five findings — match formula, vesting, deferral size, the Roth toggle, and the beneficiary form — settle your retirement elections before orientation ends.
The complete starter protocol for physicians taking moonlighting, locums, or contract income on a 1099 — taxes, retirement, insurance, and records, in the order they will hurt you if skipped.
The aggregation arithmetic that turns a tax-free maneuver into taxable income, a worked $95,000 example, and the three fixes ranked from best to last resort.
The right answer depends on return complexity, not income. W-2-only attendings in one state usually do fine with software; 1099 income, multi-state work, and practice ownership change the math fast.
Academic and government-employed physicians often have a 457(b) alongside the 403(b) — a separate $24,500 deferral limit. The governmental vs non-governmental distinction determines whether that money is protected and portable, or exposed to your employer's creditors.
Nothing is withheld from 1099 income, and the IRS charges for paying late even if you pay in full. Here are the safe-harbor rules, the deadlines, and the math.
The 2026 federal brackets, the marginal vs effective rate distinction, and a $300,000 single attending worked line by line. Plus the arithmetic that kills the myth that a raise can shrink your take-home pay.
Standard retirement benchmarks fail physicians, who start earning at 32 with negative net worth. Here are benchmarks by years since training, built from an explicit worked model, plus the catch-up math that makes attending income close the gap.
Physicians are the favorite target of aggressive tax-scheme salesmen. Here is the real list — retirement accounts, HSA, backdoor Roth, charitable bunching, 1099 deductions, state awareness — each quantified with 2026 numbers for a $400,000 household.
The HSA is the only account with a triple tax advantage. At a 35% marginal rate, the 2026 family limit of $8,750 saves over $3,000 in federal tax this year — and the long game is better.
Every attending is over the 2026 Roth IRA income limit, and the backdoor Roth is the lawful workaround. The steps take 20 minutes. The pro-rata rule is where physicians get burned — here is how to get it right.
Both accounts shelter 1099 income, but at moonlighting-level earnings the solo 401k allows far larger contributions and never breaks your backdoor Roth. A worked example at $40,000 of 1099 income shows the gap.
A cash balance defined benefit plan is the largest deduction available to a physician-owner — and a costly mistake for the wrong practice. The fit comes down to age, income stability, and headcount.
Tax loss harvesting offsets gains and up to $3,000 of ordinary income per year, but most of the benefit is deferral, not elimination. Here is the actual math and the cases where it is not worth the effort.
The mega backdoor Roth can move $30,000+ per year into Roth accounts — but only if your plan allows after-tax contributions and in-service conversions. Most hospital 403(b) plans allow neither. Here is how to check yours.
You can finish residency without anyone telling you what an ETF is — then a 403(b) form lands with thirty fund names on it. Here is the whole vocabulary, and the fee math that quietly costs physicians six figures.
A $350,000 attending with the right employer plans can shelter more than $115,000 in tax-advantaged accounts in 2026. Here is every account, every limit, and the order to fill them.