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Physician Cents

Physician Cents

By: Chad Chubb & Tyler Olson
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 Welcome to the Physician Cents Podcast! A podcast designed specifically for physicians, offering a breakdown of complex financial topics to help you develop your financial IQ, further your financial journey, and improve your well-being. Whether you're a medical student, resident, fellow, or attending physician, you're sure to learn something new that will benefit your journey.2024 Economics Hygiene & Healthy Living Personal Finance Physical Illness & Disease
Episodes
  • 18 Common Tax Mistakes Physicians Make (Part 3): The Quiet Errors That Create Massive Tax Bills Ep #50

    18 Common Tax Mistakes Physicians Make (Part 3): The Quiet Errors That Create Massive Tax Bills Ep #50
    Apr 1 2026
    Welcome to a milestone episode of the Physician Sense Podcast! In this 50th edition, we cap off our three-part miniseries on tax planning with actionable, nuanced strategies tailored specifically for physicians. Whether you're a medical student, attending, or anywhere in between, you'll find value in our tips on navigating real estate tax advantages and maximizing the power of Health Savings Accounts HSAs. We're also helping you understand the intricacies of W-4 updates, evaluate Roth contributions versus pre-tax options, and recognize the importance of year-round tax coordination and impeccable documentation. Blending real-world stories with our expert insight, this episode is packed with the kind of practical advice that will help you minimize headaches, avoid unexpected tax bills, and keep your financial journey on track. Looking for help with Disability Insurance, Physician Banking, Student Loan Refinancing, Physician Mortgages, Contract Reviews, and more? Check out our "Best of the Best" sponsors page to find a list of the professionals Chad & Tyler team up with for their clients. You will want to hear this episode if you are interested in... [06:20] Real estate tax benefits explained [10:08] Understanding HSA plans and trade-offs [11:08] High deductible plans and HSAs [16:49] Managing taxes with life changes [21:04] Retirement tax planning options [23:33] Comparing pre-tax and Roth options [31:05] Organizing tax documents [33:25] Balancing tax planning efforts Real Estate Professional Status is Not as Simple as it Seems Investing in real estate is often touted as a path to financial freedom and tax deductions, but achieving Real Estate Professional (REP) status is rarely straightforward. Most physicians can't deduct passive losses unless they or their spouse qualify for REP. This requires meticulous documentation and significant time spent actively managing properties. Record-keeping is paramount, and physicians should understand the rigorous standards—casual efforts, like buying an air filter, don't count. For married couples, there's some flexibility if one partner can take on the real estate workload, but many physicians jump in without researching the bones of the rules—sometimes after costly educational programs that yield little benefit. Learning the requirements before investing money and time is crucial. Triple Tax Benefits with a Caveat Health Savings Accounts (HSAs) are the only "triple tax-free account", yet many doctors use them like checking accounts, missing out on compounding growth for future healthcare costs. Before committing to an HSA, it's important to first assess your family's healthcare needs. High-deductible health plans are not right for everyone—especially those with ongoing medical expenses. For those who can manage high deductibles, investing HSA funds and keeping receipts for big medical expenses can yield powerful tax-free withdrawals later. There's little urgency to reimburse minor expenses—think of HSAs as a possible long-term care fund rather than an emergency account. Roth vs. Pre-Tax: Tax Bracket Matters Roth accounts get a lot of love, but the decision isn't always clear-cut. For doctors in the highest tax brackets, pre-tax contributions may be more beneficial. State taxes also play a role. Maximizing pre-tax tools is key for high-earning physicians; Roth is often best when pre-tax options are "maxed out." Tax diversification is more important than Roth obsession. Future tax rates are unpredictable, so having a mix of pre-tax and Roth accounts provides flexibility for future strategies, such as Roth conversions during lower-income years. Don't blindly follow internet advice—consult a professional for tailored guidance. Tax Planning vs. Tax Filing Tax filing is reactive; tax planning is proactive. Most CPAs focus on filing, not planning, unless you pay for that service. For complicated situations—business ownership, side work, etc.—planning ahead can save thousands. Proactive strategies—W-4 changes, retirement contributions, entity selection—are best addressed earlier, ideally with the help of a planner who understands physician finances. The IRS isn't interested in your busy schedule—they want proof. Saving lives won't excuse missing receipts. Audit defense requires organized documentation: physical or digital folders for each year and category. Even rare audits are stressful; good records bring peace of mind. Always err towards simplicity—understand the basics, seek guidance, and choose strategies that fit your life. The best of the best list is a paid sponsorship, but these are professionals/companies that Tyler and Chad collaborate with within their own practices or have been vetted to earn a spot on this list. By supporting our sponsors, it allows Chad & Tyler to dedicate more time to you and the Physician Cents community. If you ever have a question (or not a great experience, which we don't expect!) ...
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    35 mins
  • 18 Common Tax Mistakes Physicians Make (Part 2): The Quiet Errors That Create Massive Tax Bills Ep. #49

    18 Common Tax Mistakes Physicians Make (Part 2): The Quiet Errors That Create Massive Tax Bills Ep. #49
    Mar 15 2026
    This week, we dive into the second part of our three-part series on the most common tax mistakes doctors make. Today, we pick up where we left off last week, tackling mistakes 6 through 12—ranging from Roth IRA contribution blunders and retirement account coordination errors to the complexities of state taxes for locums and practice owners. You'll hear practical tips on avoiding the pitfalls of direct Roth IRA contributions when you're ineligible, understanding how to juggle multiple retirement plans without overcontributing, and the essential—but often overlooked—benefits of cash balance plans for high earners. Looking for help with Disability Insurance, Physician Banking, Student Loan Refinancing, Physician Mortgages, Contract Reviews, and more? Check out our "Best of the Best" sponsors page to find a list of the professionals Chad & Tyler team up with for their clients. You will want to hear this episode if you are interested in... 04:05 Backdoor Roth IRA contributions tips 08:44 401(k) vs. 403(b) Limits 15:08 Pensions for academics vs. private practice physicians 19:55 Income consistency and sustainability 25:35 Tax efficiency in bond investing 28:58 Married filing status & student loans 31:23 1099 tax strategies for doctors 34:31 Cross-border tax challenges Don't Trip on Income Limits for Direct Roth IRA Contributions Many doctors—especially those transitioning from training to attending roles—get caught by contributing directly to a Roth IRA even when their income makes them ineligible. Moving from trainee income to an attending salary can put you over the Roth IRA limits without realizing it. This triggers a 6% annual penalty, which can add up quickly if not caught. If you're close to the income threshold or anticipate a big jump in pay, default to the Backdoor Roth IRA process. Yes, this introduces an extra 5-year hold period for accessing converted funds, but it's a safer bet than risking penalties. And if you file as married, filing separately, something sometimes used for student loan optimization, you need to pay extra attention. If you're unclear, run the numbers with an advisor or accountant. Retirement Plan Coordination Physicians often juggle work at multiple employers, leading to multiple retirement accounts. For 2026, the combined employee contribution limit is $24,500, regardless of how many plans you have (excluding 457(b)s, which operate independently). Missing the nuances can lead to over-contributions or missed opportunities. Know the types of plans you have and their coordination rules. For side-gig/1099 income, solo 401(k)s are powerful—but you can't "double-dip" on the employee limit if you're also contributing to a work plan. Cash Balance & Defined Benefit Plans Cash balance plans (a type of defined benefit plan) can help high-earning doctors shelter over $100,000 per year. Most docs have never heard of these vehicles—or, if they have, write them off as too complex or niche. But they're a goldmine for established physicians, practices, or those with significant 1099 income—so long as you expect consistent high earnings for several years. Setup and administration involve actuaries, costs, and (often) "boring" bond-heavy investment choices. But saving $200k+ from high state and federal taxes can be a game-changer, especially in places like California. Evaluate this with your advisor; if you're close to the $200,000+ threshold and plan to keep earnings high, it may be time to explore. Tax-Efficient Investing: The Importance of Asset Location You might be maxing your retirement plans, but as your taxable brokerage account grows, tax-aware investment choices pay off big. Tyler recommends housing bonds inside tax-sheltered accounts and using municipal bonds in taxable accounts to blunt tax drag. High-turnover mutual funds in taxable accounts are a relic. Prefer tax-efficient index ETFs, and periodically review your investment "location" as your situation evolves. Remember, after a few decades of saving, this optimization can mean tens of thousands in net after-tax wealth. The best of the best list is a paid sponsorship, but these are professionals/companies that Tyler and Chad collaborate with within their own practices or have been vetted to earn a spot on this list. By supporting our sponsors, it allows Chad & Tyler to dedicate more time to you and the Physician Cents community. If you ever have a question (or not a great experience, which we don't expect!) about a sponsor, please let us know. We call it the "best of the best" for a reason, and we will maintain that standard for our listeners & viewers. Resources & People Mentioned The White Coat Investor Connect With Physician Cents WealthKeel LLC Olson Consulting LLC Tyler Olson on Twitter Chad Chubb, CFP®, CSLP® on Twitter Subscribe to Physician Cents Apple Podcasts Audio Production and Show Notes by - PODCAST FAST TRACK
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    39 mins
  • 18 Common Tax Mistakes Physicians Make (Part 1): The Quiet Errors That Create Massive Tax Bills, Ep #048

    18 Common Tax Mistakes Physicians Make (Part 1): The Quiet Errors That Create Massive Tax Bills, Ep #048
    Mar 1 2026
    Physicians are some of the highest earners in the country—and often some of the biggest overpayers in taxes. Not because they lack intelligence or discipline, but because the tax code punishes complexity. Multiple income streams, inconsistent withholding, overlooked deductions, and misunderstood retirement strategies quietly create five-figure mistakes that compound over time. This episode kicks off a three-part series based on Tyler Olson's widely shared thread outlining 18 of the most common tax mistakes physicians make each year. Part 1 tackles five of the most frequent and costly errors—many of which stem from coordination problems rather than aggressive tax planning. Looking for help with Disability Insurance, Physician Banking, Student Loan Refinancing, Physician Mortgages, Contract Reviews, and more? Check out our "Best of the Best" sponsors page to find a list of the professionals Chad & Tyler team up with for their clients. You will want to hear this episode if you are interested in... [05:00] Not planning for multiple income types (W2 + 1099 + bonuses) [12:45] When an S-Corp election makes sense—and when it doesn't [19:30] Missing easy 1099 deductions like CME, licenses, and travel [27:10] Quarterly payments and how underpayment penalties really work [36:20] The Pro Rata rule and why it ruins so many Backdoor Roth IRAs Multi-Income Physicians: Where Withholding Breaks Down One of the most common physician tax mistakes is assuming payroll withholding is "handling it." Each income source calculates withholding independently. A university paycheck does not account for income from a physician group. Neither accounts for 1099 consulting. And 1099 income itself has no withholding at all. Bonuses create an additional trap. Productivity bonuses are often withheld at a flat 22%, which may be significantly lower than a physician's actual marginal rate. The result is a surprise balance due—even when it feels like plenty has already been paid throughout the year. The solution is coordination: projecting income early, reviewing pay stubs, and adjusting W4 elections or adding additional withholding before year-end. Without proactive adjustments, physicians can face large balances due along with unnecessary penalties. S-Corps: A Strategy That Requires Math, Not Hype The S-Corp conversation has become increasingly popular online, often framed as a guaranteed tax win once 1099 income reaches a certain threshold. The reality is more nuanced. Yes, S-Corps can reduce self-employment taxes under the right circumstances. But those savings must exceed the added costs of payroll services, separate business tax filings, and ongoing administrative work. In some states, additional business taxes materially reduce the benefit. This is not a default move—it is a numbers-driven decision. Physicians should evaluate projected tax savings against professional fees and state-level implications before electing S-Corp status. Without that analysis, complexity can increase without meaningful benefit. Quarterly Taxes and the Backdoor Roth Trap Physicians earning locums or moonlighting income frequently miss quarterly estimated payments. The IRS expects taxes to be paid throughout the year, not in a single lump sum at filing. Even if the full balance is eventually paid, penalties can apply if payments were not made on time. Quarterly estimated payments—due in April, June, September, and January—help prevent underpayment penalties. In some cases, increasing W2 withholding can simplify the process and reduce the need to manage separate payments. The final major mistake covered in Part 1 involves the Backdoor Roth IRA. High-income physicians often attempt this strategy while holding pre-tax balances in traditional IRAs, rollover IRAs, SEP IRAs, or SIMPLE IRAs. When those balances exist, the Pro Rata rule applies, causing part of the Roth conversion to become taxable. Before executing a Backdoor Roth, pre-tax IRA balances should typically be moved into a 401(k), 403(b), or Solo 401(k) if eligible. Skipping that step can create unnecessary taxes and undermine the intended benefit of the strategy. These five mistakes share a common theme: the fundamentals matter. When income streams are coordinated, elections are evaluated carefully, and compliance is respected, physicians retain more of what they earn. Resources Mentioned IRS Direct Pay – https://www.irs.gov/payments/direct-pay Connect with Tyler and Chad WealthKeel LLCOlson Consulting LLCTyler Olson on XChad Chubb X Subscribe to Physician Cents Apple Podcasts Audio Production and Show Notes by - PODCAST FAST TRACK
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    41 mins
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