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  • White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Benign_user, join the club… Paying too much taxes is a good problem to have in comparison with other people’s problems.  And consider that you likely have it easy, as it appears you live in a low tax state.  I pay a combined marginal tax rate of 46% and that applies to the majority of my income, as in 41% effective.

    You should be looking to see if you can do a cash balance pension plan.  It depends on how many employees there are and the requirements to meet the fairness testing whether or not this type of plan would make sense for you, but clearly you should be exploring all your options.

    If future tax rates remain the same, you can never have too much in tax deferred.  If instead you assume tax rates will skyrocket, then just pay your taxes now and invest in taxable, but don’t forget that future capital gains rates may go up as well, and the step up for heirs could also disappear.

    So…. spend and save in a balanced fashion, enjoy your good fortune, consider sharing some of that good fortune with others, and try not to sweat the unanswerable questions too much.

    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    My combined state/federal marginal rate is almost there, but once the rate gets much above 50%, it starts to feel much less rewarding to hustle to earn more.  Even though we are financially independent, it remains in my DNA to work hard and earn money.  These days, you will often find us playing hard, but in between playing hard I still like to work hard.  Yes, I enjoy the work and it makes me feel needed and useful, but honestly I also like the money.

    In thinking about shift work for docs, the hardest shifts to fill are the undesirable ones.  Once you get to onerous marginal tax rates it will get a lot tougher to cover those open weekend and night shifts when the net take home pay is low.

    In contrast, if I am not earning from the sweat of my brow, but rather have the opportunity as a business owner to make large profits and have to pay lots of tax, high marginal rates likely would not change my behavior much because the income is passive.  That is in contrast to working in the hospital on a Saturday night.

    If someone is going to pay $2400 for an overnight shift on the weekend, there are currently docs willing to take it for the pay.  If, however, you were to take most of the money away in taxes with only $800 take home left, good luck finding volunteers to get out of bed to care for the sick on a Saturday night overnight shift.

    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    The working environments in various academic medical centers are as different as they are numerable.  Some are very collegial and a pleasure to work in, others are toxic where people claw over one another to gain power and position.  It will typically vary quite a bit even between departments at the same institution.

    Your question cannot be answered on a forum, but talking to people who are already working where you are considering a position could yield lots of helpful information.  I would ask to meet some of the rank and file in the department you are considering joining.

    “This is a big move for me at this stage of my career.  I am excited about this opportunity but would love to meet some of my future colleagues before finalizing my decision.”

    Even the response you receive to this type of request could be telling about the culture of the department.

    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    2019 accomplishments:

    Youngest child now fully launched and making 6 figure salary on his own.  Yippee!!!

    Retired the last bit of debt related to real estate investments.  As in zip, zero, zilch for debt.  Yippee!!!

    Loosened the purse strings more, multiple great trips to far flung places already this year with more to come.  Yippee!!!

     

    The stuff you younger folks are talking about, fortunately for us is old hat and simply routine at this point.  I am thankful for maintaining good financial habits for quite a while, including maxing the retirement space each year, investing in taxable each month on autopilot, and retiring debt early.  We are now the fortunate beneficiaries of those good habits.  From this vantage point, life is great with good health and control over our choices.

    in reply to: Financial accomplishments 2018-2019 #245685 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    If you have insufficient staff, leading to a need to have an electronic sitter with a patient, what leads you to believe that a busy nurse will be able to stop while in the middle of caring for another patient to rush into the room quickly enough to prevent a line from being pulled out?

    in reply to: Tele-sitter? #245213 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Looking ahead, I think you could potentially be in good shape to retire, if you pay off your mortgage, and if you are able to finish paying tuition for your kids.  Those things still sound a bit off in the future for you.

    Until then, given your net worth at your age and income level, in your shoes I would attempt to avoid any major financial mistakes.  Adding a vacation home far away to your current personal and financial responsibilities could be a modest financial hit, or a big financial hit.  And it could be a big hassle.  Would the positives of ownership of that far away vacation home that sometimes sits empty, compensate for the pain of a leaking water heater that is discovered several weeks later and leads to a house filled with mold? (A retired family member that maintains 2 homes just went through 8 months of mold remediation, renovations, and insurance company negotiations at one home, fortunately just in time to go back to their winter home.  Ouch!)

    And this inheritance that you plan to receive in the future, do you even know when that will be coming?  Sounds a bit morbid thinking about it.

    in reply to: 600K Inheritance: Hawaii vacation condo vs rental property #245210 Reply
    Liked by OldSoul
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Normally the payment should come with a 1099 to you at the end of the year.  You would declare the income and deduct any expenses, so you need a system for that if this is an ongoing thing.  An easy way to do that is to deposit the check into your business account as business income from your practice of medicine as a medical expert giving a deposition.

    If it is a one time deal, then it is less of a concern, but even if you deposit it into your personal account, you are required to declare the income on your annual tax return.

    in reply to: Re: Deposition Deposits #245099 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Looking to buy my first residential rental in the Orlando area to start forming a nice stream of cash flow(hopefully) out side my job.  Are residential home values to high right now?

    Click to expand…

    To answer your own question, learn how to value a real estate investment before pulling the trigger.  Learn about things like:

    positive cash flow

    cash on cash return

    cap rate

    IRR, or internal rate of return

    Once you learn about how to calculate all of these things, you can then analyze a potential real estate investment to see if it “pencils out”.  Bigger pockets is a web site about all things real estate investing.  You could start there and learn about how to analyze the particular investment in question.

    in reply to: Real Estate Investing #244761 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Currently all days are spent trying to keep a newborn alive.

    Click to expand…

    Your statement is hanging alone without any context.

    I hope you don’t have a new child in the family who is sick.  If you do, I am sending you some hope and prayers for better days ahead.

    in reply to: Saturdays #244628 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    In answer to your question, yes, malpractice expenses including a tail can be paid by an employer if the employer is willing to pay. And yes, this is clearly a valid deductible business expense.  If you were to offer to reduce your pay by the amount of the malpractice tail, and if your employer is willing and nimble enough to do this for you, then it will save you a lot on taxes.  Another option is to negotiate this with your new employer, assuming you are transitioning to a new job.  They can also pay it to make it deductible.

    Are you taking a new job?  What are the details of the old job and the new job? W2? 1099? New solo practice?  Those details matter as far as the potential options for how to set this up to pay the tail with pre-tax dollars.

    We recently had a doc join our group in a high risk specialty.  The director of practice management made arrangements to pay the new docs large tail with pre-tax dollars.  The new doc funded it by accepting reduced income.

    in reply to: Malpractice Tail Insurance #244404 Reply
    Liked by Zaphod, jfoxcpacfp
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Once things get more complicated, general CPAs are not able to handle the complex pension rules.  You need a TPA who specializes in retirement plans.

    Back when I had a solo tax deferred plan for my outside business and the other tax deferrals at my W2 job, the regular CPA handled it.  Once I started having multiple employees joining the plan, the CPA said I needed to use the pension folks at an outside firm to avoid any compliance issues embedded in the complex rules.  Our CPA recommended a firm and they have been our TPA for many years.

    in reply to: Establishing mega back door roth #244402 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    It’s fascinating to me that despite all the resources and cheap labor that are usually present at large academic centers, they still need to turn to paying a remote physician to screen patients.

    Click to expand…

    There is zero need for this particular hospital to use telemedicine.  The academic medical center involved is ranked among the top handful of hospitals in the country.

    They are doing all things telemedicine in myriad areas not because of need, but because one of their goals is to explore and lead in the application of telehealth and new technology in medicine.  They are also hiring physician data scientists to advance AI use in health care, again because they want to stay on the bleeding edge of medical data science/AI applications.

    in reply to: Emergency Medicine Telemedicine Job #244401 Reply
    Liked by jfoxcpacfp
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Has anyone gone for a test drive?  Are they even in showrooms yet?

    Please report back if/when you have driven one.

    in reply to: Porsche Taycan #244374 Reply
    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Going part time in medicine can be a real issue in some specialties.  You have to ask yourself, “What is the minimal monthly clinical experience I need to stay on top of my game?”

    White.Beard.Doc White.Beard.Doc 
    Participant
    Status: Physician
    Posts: 937
    Joined: 02/06/2016

    Your friend needs to be advised that this may not meet EMTALA screening since he/she cannot perform a physical exam on the patient.

     

    How would this be an EMTALA violation? The patient gets seen by an on-site provider after this initial brief preliminary evaluation by the telemedicine provider in triage.

    Furthermore, unless you have specific insurance for telemedicine or your current carrier specifically authorizes it, then it’s not covered.  Most insurers hate telemedicine because it’s new and untested.  Therefore, they cannot accurate assess risk.

    Click to expand…

    As far as my understanding goes, the facility where this telemedicine occurs is a large academic hospital that provides the telemedicine doc with full malpractice coverage.

    in reply to: Emergency Medicine Telemedicine Job #244370 Reply
    Liked by wonka31
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