2026 was the year a lot of things happened to orthopedic surgeons, very few of which anyone got a vote on. Tax rules were rewritten. Medicare took another swing at procedural payments. Consolidation kept moving. The Fed raised rates for the first time in more than three years.

In this reflective episode, Jared walks through the four biggest forces that shaped a surgeon's finances in 2026 (the tax law's permanent provisions and where the headline SALT cap actually lands at surgeon income, the steady pressure on procedural payments, the shifting consolidation landscape, and what rising rates mean for variable-rate practice debt), then ties them together with a comparison of two surgeons who lived through the identical year with very different results, a gap worth roughly $16,000 in federal tax for 2026 alone, built entirely from decisions rather than luck.

He closes with a twenty-minute exercise: split a page in two, write down what happened to you financially in 2026 on one side, and what you decided about it on the other, then look at the ratio.