A cash balance plan can be one of the most powerful tax‑deferred tools available to a practice‑owning surgeon—but only if it’s funded on schedule. This article walks you through a simple mid‑year pacing check, explains what chronic underfunding can cost in taxes and penalties, and shows how to coordinate your cash balance plan with your 401(k) and profit‑sharing strategy so you stay within IRS limits and keep your largest tax shelter on track.