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Cover Focus | July/Aug '21

Six Tools to Build Retirement Wealth

A review of retirement planning tools for physicians and an outline of the rules that govern their use.

Getting to a comfortable retirement is a leading financial goal for most physicians, even for younger ophthalmologists who may continue to practice for many years. To reach this goal, physicians may use several different planning tools throughout their careers. This article examines six leading retirement planning tools most often utilized by physicians and outlines the basic rules that govern their use.

1. Qualified Retirement Plans for Employed Physicians

Ophthalmologists who are employed and receive a W-2 can often participate in their employer’s retirement plan, which allows them to defer income by contributing to the plan.

For example, 401(k) plans are one type of qualified retirement plan (QRP) and are the most common option offered to physician employees of for-profit entities. The 403(b) plans work the same as 401(k)plans, but they are offered by government and nonprofit health care organizations.

Government-sponsored 457(b) plans are offered by state and local government health care organizations. Physicians can defer funds into the plan on a pretax basis in addition to the money they contribute to a 403(b) plan.

Nongovernment organization 457(b) plans, or NGO 457 plans, present a special risk for unwary physicians saving for retirement. Although these plans also allow for pretax contributions and tax-deferred growth, they only gain these tax benefits due to a “substantial risk of forfeiture” imposed by the Internal Revenue Service. Physicians who hold these plans can lose everything if the sponsoring employer goes bankrupt. Although account balances from one nongovernment 457(b) can usually be rolled over to another nongovernment 457(b) plan, they cannot be rolled over to an IRA or any other type of plan.

A 401(a) plan is a QRP normally offered by government agencies, educational institutions, and nonprofit organizations, rather than by corporations. These plans are usually custom-designed and can be offered to key employees as an added incentive to stay with the organization. The employee contribution amounts are normally set by the employer, and contributions can be pre- or posttax. The employer has a mandate to contribute to the plan as well.

2. Qualified Retirement Plans for Physicians in Private Practice

A QRP for a private practice may be in the form of a defined benefit plan, profit sharing plan, money purchase plan, or 401(k). Properly structured plans offer a variety of benefits: You can fully deduct contributions to a QRP, funds within the QRP grow tax-deferred, and (if nonowner employees participate) the funds within a QRP enjoy superior asset protection.

In our experience, we find that nearly all physicians in private practice participate in QRPs. The tax deduction is hard to resist. For many physician practice owners, however, the cost of contributions for employees, potential liability for mismanagement of employee funds, and the ultimate tax costs on distributions at least suggest that it would make sense to investigate another type of plan (that hedges the QRP) as an additional savings vehicle. For many, tool number three provides that tax hedge.

3. Nonqualified Plans for Physicians in Private Practice

Many private practice physicians want to save significantly for retirement but are limited by the funding rules of QRPs. Others, per above, are interested in a plan that hedges against their QRP and can be accessed tax-free in retirement. Nonqualified plans can be the solution for many ophthalmologists. Because these plans are not subject to QRP rules, nonqualified plans do not have to be offered to any employees. Further, even among the physician owners, there is total flexibility. For example, one doctor can contribute a maximum amount, the next partner could contribute much less, and a third physician could opt out completely.

The main drawback to nonqualified plans is that contributions are never tax deductible. However, like a Roth IRA, they can be structured for tax-free growth and tax-free access in retirement. As such, nonqualified plans can be an ideal long-term tax hedge against a QRP. Beyond these general ground rules, there is tremendous flexibility and variation with nonqualified plan designs.

4. Benefit Plans for Self-Employed Physicians or Outside Businesses

Physicians who receive income reported on Form 1099 (including doctors who “moonlight,” work locum tenens, or consult/speak in the health care industry) and self-employed physicians have other options to help save for retirement.

A SEP-IRA is a traditional IRA established under a Self-Employed Pension Plan document (often the Form 5305-SEP). Under the 2021 limits, physicians can contribute the lesser of $58,000 or 25% of compensation. In addition, physicians with a SEP may still be able to contribute to a separate traditional IRA or Roth IRA. Like other traditional IRAs, account balances can grow tax-deferred and are taxed at ordinary income rates when distributed.

5. After-Tax IRAs

A traditional IRA allows doctors to defer up to $6,000 per year ($7,000 per year if over age 50) into the account, under the 2021 limits. Physicians who are not covered by a workplace retirement plan may deduct pretax contributions while those covered at work can make nondeductible or partially deductible contributions, depending on their earned income and filing status.

Many physicians implement a backdoor Roth IRA by first contributing to a traditional IRA and then converting the traditional IRA to a Roth IRA. (Note: This tactic requires careful planning to avoid unnecessary taxation. Work with an experienced advisor on this.)

6. Life Insurance as a Retirement Plan

Above, we explained that Roth IRA contributions are made after tax, but then the balances grow tax free and can be accessed tax free in the future. Would you be surprised to learn that, if managed properly, a permanent life insurance policy can act the same way? “Permanent” life insurance includes whole life, universal life, variable life, and equity-indexed life insurance policies. Regardless of the type of insurance product, the cash value of such policies grows tax-free and can be accessed tax-free during the insured’s life.

For more coverage of money matters, check out the Wealth Planning for the Modern Physician podcast, hosted by David B. Mandell, JD, MBA.


The number-one financial goal of nearly all physicians is a retirement on their terms, and the six retirement tools discussed in this article can play significant roles in achieving this goal. If building your retirement wealth is important goal to you, an experienced advisor can help you investigate retirement planning alternatives and determine the best option(s) for you, your family, and your practice. The authors welcome your questions.

SPECIAL OFFER: To receive free print copies or e-book downloads of Wealth Planning for the Modern Physician or Wealth Management Made Simple, text MILEYE to 47177, or visit www.ojmbookstore.com and enter promotional code MILEYE at checkout.

Disclosure: OJM Group, LLC (“OJM”), is an SEC-registered investment adviser with its principal place of business in the State of Ohio. SEC registration does not constitute an endorsement of OJM by the SEC nor does it indicate that OJM has attained a particular level of skill or ability. OJM and its representatives are in compliance with the current notice filing and registration requirements imposed upon registered investment advisers by those states in which OJM maintains clients. OJM may only transact business in those states in which it is registered or qualifies for an exemption or exclusion from registration requirements. For information pertaining to the registration status of OJM, please contact OJM or refer to the Investment Adviser Public Disclosure web site www.adviserinfo.sec.gov.

For additional information about OJM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein. Please read the disclosure statement carefully before you invest or send money.

This article contains general information that is not suitable for everyone. The information contained herein should not be construed as personalized legal or tax advice. There is no guarantee that the views and opinions expressed in this article will be appropriate for your particular circumstances. Tax law changes frequently; accordingly, information presented herein is subject to change without notice. You should seek professional tax and legal advice before implementing any strategy discussed herein.

David B. Mandell, JD, MBA
  • Partner, OJM Group, Cincinnati
  • mandell@ojmgroup.com; 877-656-4362
  • Financial disclosure: Employee (OJM Group)
Jason O’Dell, MS, CWM
  • Partner, OJM Group, Cincinnati
  • odell@ojmgroup.com
  • Financial disclosure: Employee (OJM Group)