The Ortho Money Show
Money, business, and life strategies for orthopedic surgeons who want to build wealth beyond the operating room
Ep #127: Roth Conversions & The IRMAA Warning That Doesn’t Apply To You
Quick question: when's the last time someone actually checked whether you're already at the top of the Medicare IRMAA scale, before warning you that a Roth conversion might push you into it? For most surgeons, the answer is never, and the warning doesn't apply to them anyway.
In this episode, Jared walks through why the standard Roth conversion advice breaks down at surgeon income. The IRMAA surcharge tops out around $750,000 in household income for a married couple. If you're earning $1.1 million, your regular income already put you at the ceiling years ago, a conversion adds nothing further on top of it. Once that's off the table as a deciding factor, Jared lays out the three-branch framework that actually applies: when conversion helps, when deferral wins, and when a partial conversion timed to a low-income window beats both.
He works two side-by-side examples, same age, same income, same $150,000 conversion, opposite answers, because the underlying goals were different, to show the framework produces a personal answer, not a universal rule.
Ep #126: The Cliff Nobody Tells You About
Here's a number that should bother you: $773,000. That's what a surgeon in New York can owe in state estate tax on an $8 million estate, even while sitting $7 million under the new federal exemption.
In this episode, Jared unpacks what the "permanent exemption" headline leaves out. The One Big Beautiful Bill Act set the federal estate and gift tax exemption at $15 million per person with no scheduled sunset, real and welcome news for most surgeons. But federal exemption and total exposure aren't the same thing. Jared walks through New York's estate tax cliff, where crossing the state exemption by more than 5% doesn't just reduce the exemption, it erases it, and the state taxes the entire estate from dollar one. He maps the twelve states plus Washington, D.C. that still run their own estate tax, and explains why a surgeon who owns a second property in one of them can have exposure they've never considered.
Then he covers the trap some surgeons already walked into: irrevocable trusts built to dodge the old exemption sunset that may now be costing more in lost step-up basis than the estate tax they were built to avoid.
Ep #125: Life Beyond the OR - What the Best Practice Transitions Have in Common
The happiest surgeons two years after a practice transition aren't the ones who got the highest multiple, and they aren't the ones who negotiated the most aggressive earn-out. They're the ones who knew what they were transitioning to.
In this episode, Jared walks through the question that almost never shows up in transition planning: who are you when you're not a surgeon? He lays out what happens when that question goes unanswered, using a scenario where a surgeon nets $2.9 million from a practice sale, has no next-chapter plan, and watches the balance fall to $1.7 million within three years through a series of individually reasonable, collectively costly decisions. Then he runs the same $2.9 million exit with a plan in place: a structured budget, a waiting period on large purchases, and identity work done before the sale closed. Same starting number, $1.5 million apart three years later.
Jared closes with the three elements that make the difference: identity work, purpose architecture, and financial guardrails, and why they matter as much at a $2 million exit as a $10 million one.
Ep #124: Why I Recommend A Financial Second Opinion, And What To Look For
You've ordered hundreds of second opinions in your career. Have you ever gotten one on your financial plan?
In Episode 3, Jared makes the case for a financial second opinion. Financial services are built in silos: your CPA handles compliance, your advisor handles investments, your attorney handles the estate plan. Each does their piece well. Nobody's looking at how the pieces interact, and that's where the money leaks.
Jared walks through the four areas a real second opinion should cover (entity structure, retirement plan design, tax strategy, and investment allocation), and works through a scenario where an $850,000 surgeon's second-opinion review surfaces a cash balance plan opportunity, a SEP restructuring, and uncoordinated tax-loss harvesting worth $50,000 to $80,000 in year one, and over $400,000 across a decade.
Then he gives you three questions to ask before you sit down with anyone offering a "second opinion": what's their motive, will the findings be specific, and will they respect your existing team.
Ep #123: Practice Valuation 101: What Buyers See That You Don’t
Two numbers, same practice, same year: $4.4 million and $5.5 million. The difference comes down to one concept most surgeons never encounter until an LOI is already on the table: normalized EBITDA.
In this episode, Jared walks through what normalized EBITDA actually is and why a buyer's number is almost always higher than the one on your tax return. He breaks down the five adjustments that create the gap: owner compensation above market, family employment at above-market pay, personal expenses running through the business, one-time non-recurring costs, and lease terms on owner-held real estate. On a practice reporting $1.1 million in net income, those five adjustments can add over $1.1 million to the valuation.