Roth conversion advice is usually written for retirees near the IRMAA threshold, not for surgeons earning seven figures. At your income level, Medicare surcharges are often already maxed out, which means IRMAA isn’t the variable that should drive your decision. Instead, the real leverage comes from understanding where today’s 37% tax bracket meets your expected retirement tax rate and how the SECURE Act’s 10‑year rule changes what your heirs inherit. In this article, we walk through a practical framework—and a worked example—for deciding when conversion, deferral, or partial conversion makes the most sense for high‑income physicians.

Many orthopedic surgeons have the income to build generational wealth, but not the structure to capture it. This article breaks down the “raccoon trap” of lifestyle inflation, shows how small shifts in spending and saving create six‑figure differences over a decade, and explains how tools like cash balance plans and intentional S‑Corp design can redirect more of your income toward long‑term freedom instead of the parking lot.

Most surgeons start year-end tax planning too late—and leave tens of thousands of dollars on the table. This article outlines a five-month protocol for surgeon practice owners, detailing how donor-advised funds, equipment purchases under Section 179, retirement plan amendments, Roth conversions, and installment sale planning must be sequenced from July through December to maximize 2026 tax savings.