Are your 2026 retirement-plan contributions on pace? Learn how surgeons and physicians can review 401(k) payroll deferrals, use the enhanced catch-up contribution available at ages 60 through 63, account for the 2026 Roth catch-up rule for certain higher earners, and coordinate year-end cash balance plan funding.

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.

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.