How we help Medical Practice
Business owners
How physicians, surgeons, dentists, specialists, and private practice owners can protect, grow, and exit their practice—profitably and strategically.
Orthopedic Surgeon, age 45
Net Worth: $750,000
Annual Income: $950,000
Primary Goals:
Reduce taxes, accumulate wealth more aggressively, and build passive income sources
Background:
Dr. Patterson entered orthopedic surgery after years of training. Although he had been practicing for almost a decade, most of his financial growth had been hindered by medical school debt, buying a home, and the pressures of raising three children. With high income came high taxes — nearly 42% of his income was absorbed by federal and state obligations, leaving him frustrated despite earning nearly $1M per year.
He had a 401(k) through his practice but contributed only enough to receive a match. Savings remained inconsistent. Investments were scattered across a few brokerage accounts recommended by colleagues, with no unified strategy.
Planning Strategy:
The financial planning process revealed that taxes were his single largest expense — greater than mortgage, children’s education, or lifestyle spending combined.
The advisory plan implemented:
- 401(k) with profit-sharing and a new cash balance pension plan (estimated $275,000 annual deductible contribution)
- Backdoor Roth IRA + mega backdoor Roth for future tax-free growth
- Strategic investment allocation:
- 60% globally diversified equity ETFs
- 20% private real estate credit & debt
- 20% tax-advantaged municipal bond ladder
- 60% globally diversified equity ETFs
- Annual tax-loss harvesting playbook
- Umbrella liability + LLC structure for rental real estate holdings
- 529 plans structured for long-term compounding
- Automated cash flow and savings system
Outcome:
Within the first year, Dr. Patterson reduced taxable income by approximately $115,000 and redirected funds into long-term accounts. With continued contributions and historical performance assumptions, his net worth is projected to reach $6.2M by age 60.
More importantly, he transitioned from saving inconsistently to saving intentionally, aligned with goals for lifestyle, retirement, and legacy.
Vascular Surgeon, age 52
Net Worth: $3.5M
Income: $1.1M
Goal:
Retire from clinical practice in 10–12 years and transition practice to younger partners
Background:
After two decades in vascular surgery, Dr. Alvarez had established a profitable group practice. Revenue was strong, but the partnership lacked a formal succession plan, and turnover among younger associates jeopardized long-term practice stability.
Most of his net worth was tied up in the practice value and real estate ownership — leaving him asset-rich but income-fragile.
Planning Strategy:
The plan included:
- Re-structuring into an S-corporation with payroll optimization for QBI deduction eligibility
- Implementing nonqualified deferred compensation to retain and reward future partners
- Beginning staged ownership transfer pricing based on adjusted EBITDA
- Investing profits into diversified sources:
- Industrial real estate syndications
- Healthcare private equity fund focused on device innovation
- Tax-efficient ETF portfolio
- Industrial real estate syndications
- Intentionally Defective Grantor Trust (IDGT) to remove future appreciation from estate tax exposure
- Disability buyout insurance + updated buy-sell agreement
Outcome:
Projected practice sale valuation increased by $1.8M due to reduced turnover and recurring revenue enhancements. Estate tax exposure was reduced by nearly $600,000, and Dr. Alvarez began pivoting into an advisory role while forming income streams not dependent on surgical volume.