For years, “just do the backdoor Roth” was default advice for high‑earning surgeons. But after 2025’s OBBBA changes, that rule of thumb can quietly cost you money. This article walks through a simple three‑branch framework to decide when Roth still wins, when traditional and cash balance contributions create more value, and how your state‑to‑state tax trajectory can flip the answer. Before you fund another backdoor Roth on autopilot, model both paths and let the math—not the calendar—drive the decision.

Most surgeons never read their tax return the way they read an MRI. This article shows you four diagnostic markers—effective tax rate, QBI, retirement funding, and state tax—that reveal whether your financial structure is working or leaking.

Most surgeons track collections, not what they actually keep per clinical hour. In this article, I walk through a real‑world style example of a 2.4M orthopedic practice and show how overhead, tax structure, retirement plan design, and debt service combine to create a much lower effective hourly rate than most surgeons expect—and how targeted structural changes can raise that rate without adding a single additional case.

Many S-Corp owners are told to “keep your salary as low as possible” to save on payroll taxes—but at higher income levels, that advice can quietly cost you six figures in lost retirement wealth. This article shows Orthopedic Surgeons how to align salary, QBI, and 401(k)/cash balance contributions so their tax strategy actually builds wealth.

High-earning orthopedic surgeons aren’t overtaxed—they’re understructured. Learn how S-Corp salary tuning, cash balance plans, and cost segregation can plug $80K–$130K+ in annual tax leaks and build long-term wealth.