The RMD Checklist: What Surgeons Over 73 Need to Do Before December 31
Consider a surgeon who turned 73 this spring, still operating three days a week and consulting two more, who opens an October account statement and sees that her IRA custodian has calculated a required minimum distribution, or RMD.
If this is not her first RMD year, the distribution generally must be completed by December 31. If 2026 is her first RMD year, she generally may delay that initial RMD until April 1, 2027—but doing so generally means taking two taxable distributions during 2027.
The RMD rules do not change because someone is still generating substantial practice income. For surgeons who remain active in practice into their 70s, an RMD can add ordinary income during years when earnings may already place them in higher federal and state tax brackets.
The RMD amount and deadline may be set by law, but several planning decisions remain available. Here is a practical checklist.
Step 1: Confirm Your Deadline and Exact RMD
For individuals who reach age 73 in 2026, the first RMD is generally required for 2026. The first distribution may generally be taken by December 31, 2026, or delayed until April 1, 2027. Every RMD after the first year must generally be taken by December 31 of the applicable year. Delaying the first RMD may result in two RMDs being included in income in 2027.
Confirm the RMD calculation before creating a tax or charitable-giving strategy around it. The calculation generally begins with the account’s December 31 balance from the prior year and divides it by the applicable IRS life-expectancy factor.
The Uniform Lifetime Table generally applies. However, a different IRS table may apply when the IRA owner’s sole beneficiary is a spouse who is more than 10 years younger. If you own multiple traditional IRAs, the RMD is generally calculated separately for each IRA, although IRA RMDs may generally be aggregated and withdrawn from one or more IRAs.
Step 2: Consider a Qualified Charitable Distribution
For an IRA owner who is at least age 70½ at the time of the distribution and who already intends to make charitable gifts, a qualified charitable distribution, or QCD, may be worth evaluating.
For 2026, the annual QCD exclusion limit is $111,000 per eligible IRA owner. A properly completed QCD is made directly by the IRA trustee to an eligible public charity. The amount can count toward the owner’s RMD and is generally excluded from gross income rather than claimed later as an itemized charitable deduction. A taxpayer cannot also claim a charitable deduction for the same QCD.
A QCD does not work for every charitable vehicle. Donor-advised funds, private foundations, and most supporting organizations are generally not eligible QCD recipients. A donor-advised fund may still be useful for some charitable-planning goals, such as consolidating charitable assets or making grants over time, but it cannot receive a QCD.
The distribution must be made directly by the IRA trustee to the eligible charity. A custodian check payable directly to the charity may generally qualify even if the IRA owner delivers the check. A distribution payable to the IRA owner and later contributed to charity does not qualify as a QCD.
This distinction may be particularly relevant in 2026. Under changes applicable to charitable giving beginning in 2026, itemized charitable deductions are generally subject to a 0.5% of AGI floor, and taxpayers in the top federal marginal bracket generally receive a deduction benefit limited to 35 percent. Because a QCD is generally excluded from gross income rather than treated as an itemized deduction, it is not subject to those itemized-deduction mechanics.
Example
Assume a 73-year-old surgeon has a $2.4 million traditional IRA balance as of December 31 of the prior year. Under the Uniform Lifetime Table, the applicable age-73 divisor is 26.5:
$2,400,000 ÷ 26.5 = $90,566
Her approximate RMD would be $90,566, assuming the Uniform Lifetime Table applies and no adjustment is required for an eligible spouse beneficiary.
If she takes the entire RMD personally, it will generally be included in her ordinary income. Depending on filing status, deductions, other income, state tax law, and the amount of taxable income already in each bracket, some or all of the RMD may be taxed at relatively high marginal rates.
If she already intends to give $90,566 to eligible public charities and properly completes that amount as QCDs, the QCD amount can generally satisfy the RMD while being excluded from gross income. She gives up control of those dollars permanently in favor of charitable recipients, so this is a charitable-planning decision—not merely a tax technique.
Step 3: Evaluate Roth Conversions Before RMD Years
A Roth conversion can reduce future pre-tax IRA balances and therefore may reduce future RMDs. But the timing matters.
Once RMDs begin, the RMD for the year must generally be taken first and cannot be converted to a Roth IRA. Any additional eligible IRA amount converted after satisfying the RMD is generally taxable in the conversion year.
Roth conversions may be worth modeling before RMDs begin or during a lower-income year, such as a partial practice wind-down, a sabbatical, a year with lower business income, or a year with unusually high deductible expenses. The analysis should compare the tax cost of converting today with projected future federal and state tax rates, Medicare IRMAA thresholds, Net Investment Income Tax exposure where applicable, charitable intentions, estate-planning goals, investment time horizon, and the availability of non-IRA assets to pay conversion taxes.
There is no universal “right” conversion amount. A surgeon who expects to remain in a high marginal bracket for several years may reach a different conclusion than one approaching retirement or a reduced work schedule.
Step 4: Coordinate With Your CPA and Plan Team
The RMD deadline itself generally cannot be moved for an ongoing RMD year, but certain business, compensation, and retirement-plan decisions may sometimes affect the broader tax picture.
For example, where permitted by employment agreements, entity documents, established payroll practices, qualified-plan documents, and applicable tax rules, a physician may be able to discuss the timing of discretionary compensation, bonuses, or qualified retirement-plan contributions with the CPA and plan administrator.
Those decisions require care. Deferring compensation can raise constructive-receipt and reasonable-compensation issues. Cash balance and other qualified-plan contributions are governed by plan documents, funding rules, deduction limits, and administrative deadlines. They should not be treated as last-minute RMD offsets without coordinated advice from the CPA, third-party administrator, and, where applicable, ERISA counsel.
Start these discussions well before year-end.
Step 5: Complete QCDs Early
If you plan to use a QCD to satisfy all or part of an RMD, do not wait until the last week of December.
The IRA trustee must complete the distribution to the eligible charity by the relevant deadline. Custodian processing times can increase during year-end. Keep the charity’s acknowledgment letter and the custodian’s distribution records, and report the distribution correctly on the federal income tax return.
For someone who intends to make qualifying charitable gifts, an early QCD review can help coordinate the RMD amount, the charity’s eligibility, the transfer process, and tax-return reporting.
The Planning Question
An RMD may be required, but the tax and charitable consequences depend on the choices surrounding it.
For surgeons who remain in practice well into their 70s, the most useful starting point is to confirm the correct RMD calculation, assess whether charitable giving is already part of the plan, model future Roth-conversion opportunities, and coordinate compensation and retirement-plan decisions early with the appropriate professionals.
Important disclosure: This article is for general educational purposes only and is not individualized investment, tax, legal, or accounting advice. RMD, QCD, Roth-conversion, charitable-giving, compensation-timing, and retirement-plan decisions depend on individual facts and circumstances, including account type, beneficiary designations, filing status, state law, plan documents, and changes in tax law. Consult a qualified tax professional, attorney, plan administrator, and financial adviser before acting. Charitable organizations should be independently confirmed as eligible QCD recipients.
Capably Yours,
Jared
DISCLAIMER
This article is for informational and educational purposes only and does not constitute investment, tax, or legal advice. It does not take into account the specific objectives, financial situation, or needs of any particular person. You should consult your own tax, legal, and investment professionals before acting on any information contained herein. Capable Wealth, a New York registered investment adviser, provides advisory services only where properly licensed or exempt from licensing.