The 2026 increase to the $15 million federal estate and gift tax exemption removed a major deadline, but it didn’t eliminate estate planning risk—especially for surgeons in high‑tax states. New York’s estate tax “cliff,” low state exemptions in places like Massachusetts and Oregon, and legacy gifting strategies using irrevocable trusts can all create avoidable tax bills and missed basis step‑ups. In this article, we walk through why “under the federal line” doesn’t mean safe, what changed in the law, and the key conversations surgeons should have now with their estate planning attorney, tax professional, and financial advisor.