Would love to hear everybody's plan for those of you doing PSLF. Are you just staying in Save and investing for now or switching out to start accruing payments and counting towards PSLF? Would love to get a discussion going.
I joined a PE-backed medical practice group. During recruiting in 2023, their CEO told me via email that the practice "maxes out" 401(k) contributions through a combination of profit sharing and safe harbor, totaling $66K per year (of course $22.5K is my own deferral).
Fast forward to today — I've received roughly $9K/year in employer contributions, nowhere close to the ~$43.5K I was told to expect. When I asked CEO about the gap, they told me their policy has changed and that the full match only applies to partners.
However, the job listing for my exact position is still publicly advertised today, and it still says "Maximum employer contributions for MDs in a 401(k) plan" — with no mention that this only applies to partners.
I'm planning to leave this practice soon. Before I go, I want to know if there a reasonable chance I could recover any of this shortfall — either through direct negotiation, a labor/benefits dispute, or would this realistically require litigation?
Edit to add
My contract just said "Physician is entitled to participate in any pension plan, 401(k) plan, profit-sharing plan, or similar benefit plan, available generally to similarly situated physicians employed by the Company to the extent permitted by such plans and the applicable statutes and regulations".
My 401 plan document DID separate partner and employee MDs.
Have you thought about a 530A for your kids? The idea is to contribute while they’re young, then convert the account to an IRA and eventually a Roth IRA around age 24, giving them a strong head start on tax-free retirement growth. There’s also discussion that 530A contributions could potentially become pre-tax in the future, which could make the strategy even more attractive. It could be a powerful way to build long-term wealth for your kids.
5k from ages 0-18 is about 12 million tax free (in a roth) by the time they're 65. (Assuming S&P continues its average rate over the long run).
Hi friends,
Throwaway account for obvious reasons.
In summary, I work as a PCP within a federal institution (to put it one way). My salary is nothing to brag about, especially on this subreddit. However, I see about 16 patients per day and work 4 days / week (with 3 day weekends), no call, no evening clinic, no other duties. My panel is still relatively small (about 50% of total capacity).
Now, recently, I was offered a leadership position within this institution where I would basically oversee several dozen physicians and "put out fires" as the current boss put it. I'd be working under him -- would effectively be in the #2 or #3 position within this sector of the institution.
The positives: it would come with roughly a $50k increase to salary and reduce my patient facing time to seeing about 10-12 patients per week (down from 64). The drawbacks: I'd have to work 5 days / week (no more 3 day weekends), steep learning curve, no prior administrative experience.
On one end, I want to pursue this so I can "get out of" patient-facing care (I'm burnt out as a relatively fresh physician already). On the other end, I want my 3 day weekends (gives me tremendous flexibility), but I'm not sure when an opportunity like this will present itself again.
Curious what you would do? Any thoughts would be helpful, I don't know who else to ask!
My kids are soon to be starting high school and the target investment strategies my 529s use are soon to be converting to more conservative funds. I am hesitant move the money and miss out on more years of potential gains. I understand the market could go in the other direction and I could lose money.
I have about $150,000 for each child in the 529 accounts. I have the means to pay any and all future tuition without needing the 529 so I am not afraid of dips in the market requiring me to pull money at bad times. I would like to use the 529s though for the tax savings and to use the other money for other things. Should I just keep the investment strategy fairly aggressive or just follow the target investment strategy? Anyone just keep investing throughout the time their kids are in high school and college?
I figure I can always use the funds towards potential grad school, kid's roth IRAs, or transfer the money to grandkids if I have money left after my kids finish college and any potential post graduate school.
Here's my situation. I am a pure 1099 (no W2 income) under the age of 50 and have a PLLC that I recently changed to S-corp this year. For tax purposes I am in Nevada (no state income tax). My wife is a W2 earning ~100k/yr. I earn ~90k/month (~$1mil/yr) as a 1099. With the start of being a S-corp I am doing payroll via Gusto and paying myself $200k/yr.
I am trying to maximize my tax strategy, and my colleagues keep mentioning that I should look into a Solo 401k and potentially "mega back door roth" (MBDR). I already have a small Roth IRA from my early days before hitting the income limit with Fidelity.
It is my understanding that I cannot open up a Solo 401k directly with Fidelity and convert it into my existing Roth and that I would need a 3rd party. There doesn't seem to be many options out there and the only option I keep seeing mentioned is "mysolo401k".
Their website seems antiquated (I think this has been beaten to do death) but their fees seem reasonable. Am I correct in thinking this is the best option to allow MBDR? I still don't understand why I need this 3rd party to open up another fidelity account. And will it allow me to rollover into my existing Roth IRA?
For 2026, maximum contribution limit is $72k with a max employee contribution of $24.5k that I plan to make. This would leave the "business" or employer/PLLC contribution at $47.5k.
Is my math checking out correctly? My CPA hasn't been much help and keeps pushing this CFP on me. My colleagues have very mixed responses and generally say a CFP isn't worth their expense. I believe I will have to file form 5500EZ or face a large penalty.
Hi all, I need some help with what to do with my next car. For context, I’m currently in fellowship and will be earning an attending salary in about 12-13 months. I currently lease my car but that lease ends in a few months. The reason I originally leased and sold my used car was because I needed to ensure I would have a reliable car during residency without the hassle of potential breakdowns and worrying about finding a ride for work.
Long story short, I’ve posted on multiple car threads to see what people thought about some current lease deals and the overwhelming majority of responses are basically “if you’re looking at a lease it sounds like you can’t afford the car and you should be buying used”. Well the used car market is outrageous right now so a car that’s 3-5 years old with reasonable miles and features still has a higher monthly payment than the lease!
The thing these commenters don’t understand is that I can afford the lease payment currently, and will be able to afford it even more comfortably in a year with my attending salary. So my question for you all is… is leasing really that bad of an idea? I am having a hard time understanding how having a lower monthly payment now is a “waste of money” when in 3 years when the lease is done, my attending salary will most certainly be able to buy a new or used car comfortably.
I appreciate any insight or thoughts!
I'm a new fellowship grad, new associate in a surgical specialty that heavily relies on lasers and imaging technologies in the office. It's not the most desirable city, but my wife's family is from here and we want to make this work. I joined a 3-doctor private practice, 1 of whom I knew was going to retire and who I'll replace. Another one seems to one foot out the door more than I realized, and the last one is still mid-career but might think about slowing down soon.
The issue is that I'm the first person they've hired in 20 years. All of the lasers and imaging machines are way out of date, some even older than me. They don't have a imaging machine that is considered the gold standard for our specialty. At our satellite office, the machine software can't even be serviced anymore, so if it goes down we're screwed. Before I signed, they did say they were looking into buying one of the machines but never did. One of these machines would cost ~100k+ so I understand there's a financial side to running a business, but they have not stayed up to date for the last decade+.
The clinic manager has brought up these concerns before with the docs who have always brushed it off. Not to mention staffing issues, refusing to hire qualified people with certificates and instead hiring young grads with no experience leading to high turnover rates
At what point of my 2-year associate contract should I bring up my concerns? I was thinking ASAP to see how they respond, and to give them time to actually pull the trigger. But I'm not sure how much I can push as an associate. I'm definitely their retirement plan as it would be hard to recruit to this area, so they have a big reason to keep me around and keep me happy.
Any advice would be appreciated
In a bit of a spiral.
I am about a year max from PSLF forgiveness, potentially much less. Spiraling because I’m considering walking away from PSLF and what that might look like financially.
I work a mix of W2/1099 jobs, but I unexpectedly lost my PSLF W2 job this summer when my hospital abruptly closed my department.
It is appearing unlikely I will find another PSLF eligible job without moving out-of-state. The options are not palatable. I am single and cannot fathom moving somewhere undesirable for a job I’m not excited about, even if I can switch jobs & move again after achieving PSLF forgiveness. I don’t want to waste the next couple of years trying to find a partner & build a family by moving around.
I make about 300k and have 392k in federal loans at a ~5.2% interest rate, with what feels like a minimal amount in retirement and no real estate. I feel like a horse that’s finally been broken tbh, I completely regret my fellowship choice and financial compromises I’ve made in my career path. If I sellout and successfully generalize, my income could potentially increase substantially. I’m okay with selling out to build a better life outside of medicine.
I find contemplating giving up on PSLF completely overwhelming emotionally since that has been my plan for so long. Where do I start? Is there a calculator to roughly estimate what I need to earn & payoff without destroying my financial future? Am I being dumb and instead should stick with PSLF despite the personal cost? I have a lot to learn & read to properly make this decision.
37, married, one young kid under 2. Solo surgical subspecialty practice. S corp, four staff, mostly cash-pay with some insurance work. Wife works part time at an outside W2 job and part time as the practice administrator, so she’s on both payrolls.
This is the first year of any meaningful income after training. Still remember having -$18 after rent and food was paid in med school. Residency was nearly break even. So started essentially from zero: before starting a practice, about $30K in retirement accounts and no taxable investments. Still renting because I can’t get a conventional mortgage until I have enough self-employment history as a solo owner.
Where things stand right now this far in the year: down payment for a house is fully saved and sitting in cash, $100K into taxable ETFs, and the 2026 tax bill is set aside. So the near-term obligations are covered and everything from here is incremental.
First full calendar year numbers
• Practice revenue: ~$1.5M
• Overhead: ~36%
• My W2: $185K
• Wife’s W2 from the practice: $78K
• K1 to me: ~$675K
• Household gross: ~$965K
• Net after tax and retirement contributions: ~$540K
The plan
Target retirement at 49 to 50. Family budget of $220K/yr while working, $180K/yr after. Both are on top of housing, and both assume no consumer or student debt, which should be true within a few years. The house will be on a 15-year note and pays off around age 53. I know health insurance from 50 to 65 isn’t in the $180K and needs its own line. Wife will drop the outside job in the next year or two and go full time at the practice.
Annual stack once fully built, roughly $322K/yr:
• Cash balance plan, both of us: $225K
• 401k deferrals, both: $53K
• Profit sharing and match, capped at 6% because of the CB plan: $19K
• Backdoor Roth, both: $16K
• HSA once we move to an HDHP: $9.5K
• Taxable ETFs: whatever is left, and the only thing funding the gap to 59.5
Other moving pieces over the next 3 years
• $1.3M house next spring, 15-year note, once I clear the self-employment seasoning requirement
• Cash balance plan launches next year
• $300K student loans at 6%, on RAP now
• Practice loan paid off (150k at 5.2%) within about three years
• Two short-term rentals, cost seg on both, STR loophole with real material participation logs. First one this fall, second one two years out
• Wife off the outside job, full time at the practice
• Switch to an HDHP and start the HSA
• 529 on track to $100K
Longer term: sell one rental at retirement, carry the mortgage on the other until 59.5, then pay it off and keep it as a cabin.
Questions
My friend Peds and I OB/GYN planning to start private practice together. We have some capital saved, target location is Tampa, FL.. for those who've done this, what should we consider? Startup costs, staffing, EMR, billing, insurance, cash reserves, etc.
Permission to post mods, tysm!
When do you guys think of retiring? How much you invest / save each month to achieve your financial freedom and at what age/ time frame
My annual income is roughly 350k
Haven’t saved anything residency
Currently 31 yo and just started my attending job
Few questions:
- at what number $ you would feel comfortable to FIRE, similarly at what $ you would feel comfortable going part time.
Physicians often assume that if Medicare pays only 50% for the second procedure, their employer should also credit only 50% of the wRVUs. That isn’t necessarily true. How does your institution handle multiple-procedure wRVU credit?
Our current condo is getting too small for our growing family and we’re hoping to buy a house in late 2027 early 2028. I’m a hospitalist and my wife just transitioned to being stay at home with our newborn. We’re looking in a HCOL area where homes are easily $1 million plus. We currently have enough to put a down payment of 20% and excellent credit but want to wait a little bit longer to make some more money to have in preparation for renovations and other major savings. I know there’s also physician loans too in case I don’t want to pour all our money into a down payment.
Anyway, I was talking with my friend who is not a physician but has experience in real estate and he was highly recommending I talk to at least one lender now just to get preapproval and see more concretely how much loan and home I could theoretically get now, and if it’s not enough then I could better plan the next year how to optimize my finances.
Caveats to this obviously being this is gonna do a credit pull but I can’t imagine that’s that devastating with my credit, and that I have no intention to use it yet so it will expire in 90 days.
Has anyone else here ever done this? If or if not, what would you recommend?
33 male. Married. No student loan debt. 270k cash in a ETF, 30k emergency fund - HYSA. 170k in a 401k. 670k left on mortgage. Gross income: 410k, sub-specialty.W2. Car paid off. What could I do better? How am I doing? Taxes are killing me but then again, not sure if I can do much with a W2…
We are a dual income but single physician income family. Looking at jobs in the bay in my speciality, I expect our combined take home to be somewhere in the range of 550-650k pretax. Current income is around 250-270k depending on how much moonlight. I am currently a fellow. We have no student debt. We are renting and maxing out our 403bs, IRA and contributing to a 529. Looking at homes in the area, even a basic starter home is anywhere from 1.5-3 million depending on location. It seems much more financially sensible to just rent indefinitely. Is anyone else just planning on renting indefinitely? Did anyone purchase a home in the Bay Area recently on a single physician salary income?
Hello everyone. I'm looking for feedback on a business idea I've been considering: becoming a non-clinical operating partner to a physician starting or scaling an independent practice.
I'm 27 and relatively early in my career, so I'm not presenting myself as someone who has already figured this out. I'm trying to determine whether this is a skillset and career path worth deliberately developing over the next several years.
I'm not a physician, but my background is heavily focused on the operational and technology side of healthcare. I have a bachelor's degree in Health Informatics and Health Information Management and have worked for several years as an EHR/System Administrator. Most of my experience has been in smaller practices, including an organization with 10+ locations and roughly 40–60 providers.
Working in the systems role has given me a pretty good understanding of how practices operate behind the scenes. I've worked closely with operations, supported providers and staff, participated in implementations, and dealt with the EHR, workflows, technology, and administrative processes that keep the practice running. Being responsible for the systems side has given me an "under the hood" perspective that I don't think I would have gotten from simply working in healthcare IT at a large health system.
I've also encountered several physicians who have talked about wanting to open their own practice but were hesitant because of everything required on the business and administrative side: selecting and implementing systems, hiring, workflows, vendor management, compliance, operations, etc. That's what initially made me think there might be an opportunity here.
My biggest weakness currently is probably revenue cycle, since I haven't worked in that area day-to-day. I also don't have clinical experience and don't intend to become a clinician. My interest is specifically in the business and operational side.
The concept I'm considering is somewhat different from simply becoming a practice administrator. I'd like to eventually develop enough expertise to become an operating/business partner to a physician who wants to start or expand a practice. The physician would focus on medicine and clinical leadership while I would focus on building and operating the business around them.
From a financial perspective, what interests me is whether there is a viable ownership/economic model here. A physician could hire an administrator or outsource many of these functions, but perhaps there is a case for bringing someone in earlier who is willing to take on some of the operational risk and build the infrastructure alongside the physician. In return, the non-clinical partner would need some form of economic participation that makes taking on that risk worthwhile.
I'm considering pursuing an MBA and deliberately filling in the gaps in my knowledge, particularly around finance, revenue cycle, practice economics, contracting, and healthcare business operations.
I'm not committed to this idea yet. I'm trying to figure out whether I'm identifying a legitimate business opportunity or simply overestimating the value of my current experience.
For physicians who have started independent practices: how did you approach the business/administrative side in the early stages? Would you see value in an operating partner who had strong healthcare IT and operational experience but wasn't a clinician? And from a financial perspective, is there enough upside for both the physician and non-clinical partner to make an ownership/economic arrangement worthwhile?
I'd particularly appreciate perspectives from physicians who have actually started practices and people who have worked on the business side of physician-owned practices.
Thanks!
Edit: I should have mentioned I’d want to put my own capital. This isn’t just me trying to be a leach but I get how it sounds that way.
I am 19 years old and i am new to investing. I have saved up around 4000€. A month ago i put all of my money in a penny stock and earned 500€ and two weeks later i managed to earn another 200€. After that i invested in 4 companies: ASTS,PL,MRVL and NOK. After that the big dip came because Spacex came to the market i guess… I didn’t panic sell three of them and i am still holding them till now. But i sold NOK where i invested 1000€ and decided to sell on a loss for 600€ where i had the stupid idea to invest my money in a penny stock. Firstly, i made 250€ and then the next day i tried again and was -500€.
For a few days I couldn’t sleep because of that loss. I know that’s not that much money but for me there were a big amount. Could you give me advice what to do? (I will wait for the other three companies to come back because i believe in them and i am there for the long-term.)
My husband and I have been very heavily focused on FIRE. So we dabbled on RE very early on our career as well as stocks on too of building our careers. We are 36 and already have 5m NW but we are the most boring people. We were too focused on building wealth so we didn’t pick up any hobbies. . We have kids on top of full time work so that is my excuse being boring .
But I want to make my life interesting.
What do you guys do as a hobby? What do you recommend what we can do as couples?
29M new attending, ~$268k base. My 401(k) (w employee 6% match) has these index options:
S&P 500 Index — 0.01% fee
S&P Extended Market — 0.025%
International (SS GACEQ EXUS IDX II) — 0.055%
T. Rowe Price Retirement Blend 2060 — 0.17%
I’m maxing out my 401k and currently in 100% TRP 2060, but I’m considering moving to:
55% S&P 500 / 15% Extended Market / 30% International
I’m comfortable with high equity risk, have a 30+ year horizon, and am willing to review/rebalance annually.
Does this allocation make sense, or would you use a different split? Would you personally prefer the target-date fund despite the higher 0.17% fee?