Money Talk For ER Docs™

Most financial advice talks about what to add to your life to feel better — more income, more investing, more optimization. But what if the bigger issue isn't what you're missing… it's what's quietly stacking against you? In this episode, we take a step back and look at the less obvious forces shaping an ER doc's financial reality over time. Not with fear, not with rules — just a clearer lens on how today's decisions echo into future flexibility.

Emergency medicine can generate incredible income — but income alone doesn't create wealth. In today's episode, we're looking at wealth planning through a more structured lens, breaking it into four distinct stages that every ER doctor moves through, whether they realize it or not. If you've ever felt like you're working nonstop, earning well, but not quite building long-term security, this conversation will change how you think about money, career, and freedom.

If you're a 1099-earning ER physician, the Qualified Business Income deduction—or QBI—can be a meaningful tax opportunity, but it comes with some very specific rules you need to understand. One of the biggest factors is whether your income is considered a Specified Service Trade or Business, or SSTB, which directly impacts whether the deduction is available at higher income levels. In this episode, we'll break down how QBI works, why ER physicians almost always fall into the SSTB category, and because of this, what the most effective planning strategies are to get around this obstacle. We'll also walk through real examples to show how these rules play out in practice.

There's been a lot of discussion lately around federal health care policy and potential budget cuts, especially related to Medicaid. Rather than speculate or react emotionally, we wanted to step back and look at this through a financial lens specific to emergency physicians. More importantly, we want to talk about how these kinds of changes tend to show up slowly over time — and what that means for how you plan and position yourself.

For high-earning ER physicians, capital gains aren't just about investments—they're about control. The way gains stack on top of earned income can change tax outcomes, portfolio risk, and even career decisions in ways that aren't obvious at first glance. Today, we're unpacking how capital gains actually work in the context of ER income, and why small strategic choices can make a disproportionate difference over time.

As we've entered a new year, we wanted to pause and reflect on what's actually resonated most with you over time. After five years of producing this podcast, the data tells an interesting story about which topics consistently draw attention — and which ones quietly don't. This episode is less about specific advice and more about patterns, preferences, and how that shapes what we focus on moving forward. It's a look behind the scenes as we set the direction for the year ahead.

At some point, almost everyone faces a financial decision that looks simple on the surface but carries consequences that stretch decades into the future. These are the choices where intuition feels comforting, guarantees sound appealing, and the real tradeoffs aren't immediately obvious. Today's episode uses a seemingly straightforward scenario to explore how those decisions actually work under the hood. And more importantly, why the framework you use to think about them matters far more than the specific outcome.

There's been a surge in interest around self-directed IRAs (SDIRAs), especially for real estate investments. With younger investors seeking alternatives to traditional markets, and social media amplifying the success stories, it can seem like a compelling option. But while the idea of using an SDIRA to invest in real estate sounds attractive, the reality is more complex—and, for most people, it's far riskier than it appears. In this episode, we'll dive into why this strategy might be more trouble than it's worth, and how it introduces unnecessary risks and challenges for those looking to build long-term wealth.

The new year is coming up fast, and 2026 is bringing some major updates to retirement saving rules. These aren't small tweaks—many limits are jumping in ways we haven't seen in a long time. That's great news if you're intentional about your planning because more room to save means more room to reduce taxes and grow wealth. Let's walk through the biggest changes and what they mean for you.

As we head into the final stretch of the year, this episode is about the conversation many ER docs end up having with us in April — when it's too late to change the outcome for the prior year. The goal today is to shift that conversation into the present, while you still have time to make meaningful adjustments. There are several strategies that simply don't exist once the calendar flips, and we want to make sure you're not one of the physicians who finds out in February or March how much they could have saved. So before another year slips by, let's walk through what can still be done right now.

Here we are again — the final stretch of the year. Whether you're visiting family, traveling, or squeezing in some much-needed R&R, the end of the year naturally creates a pause — the kind that invites you to take inventory of your financial life, not just the numbers, but the behaviors behind them. So in today's episode, we're going to talk about reflection — what to review, what to evaluate, and how to think about your financial life heading into a new year. And then we'll wrap up with the key year-end deadlines you need to know before the calendar flips.

Economic chatter has been getting louder, and whether it's on the news, on podcasts, or in group chats, the word "recession" gets thrown around a lot. But for ER docs, economic shifts don't just show up in the stock market—they eventually show up on shift, in your paycheck, and in the way hospitals operate. That means it's worth understanding what we're actually talking about when we talk about a recession. Before we look at indicators and how they affect emergency medicine, let's start with the basics.

There's a version of this job that would be a lot simpler. The kind where you manage portfolios, check performance once a quarter, and call it a day. No tax forms, no life events, no late-night texts — just markets and models. It sounds peaceful, almost efficient… until you realize that real people don't live their lives in neat, quarterly increments. That's why today we're talking about what it really means to do this work — the human side of financial advising that no spreadsheet or benchmark can ever capture.

We've officially entered open enrollment season — that short window when everyone from W-2 employees to business owners and locums physicians has to lock in their 2026 health coverage. And this year feels a little different. Between rising premiums and ongoing debate in Washington over healthcare subsidies — one of the major sticking points behind the government shutdown — a lot of people are finding themselves rethinking what "good coverage" actually means. So in today's episode, we're unpacking what to look for, what to avoid, and how to make sure your plan fits both your health and your wallet going into 2026.

It's been over three weeks since the government shutdown began — now one of the longest in U.S. history. By the time this episode airs, Congress may have reached a deal, but the uncertainty surrounding it mirrors the broader unease in today's markets. Inflation, rate policy, and concentrated stock performance have investors questioning what comes next. So rather than dive into politics, we'll focus on how markets have historically handled government shutdowns — and what that might tell us about navigating uncertainty today.

You’d be surprised how often people have an “oops” moment at tax time — realizing they’ve contributed too much to a retirement or HSA account. It’s more common than you’d think, and the rules for fixing it depend entirely on when you catch the mistake. While these situations can cause some frustrating tax complications, the good news is they’re almost always fixable with the right approach. In today’s episode, we’ll walk through the different account types, what to do depending on timing, and even discuss an interesting i401(k) scenario that might actually work out in your favor.

Every year, thousands of new attendings experience the same shock: the overnight jump from residency income to real money. The excitement is real — but so are the risks of complacency, overspending, or simply drifting without a plan. What you do in that first year sets the tone for everything that follows. So today, we’re breaking down the four things every new attending should focus on to build wealth with intention.

The Federal Reserve’s recent decision to cut interest rates has made headlines, and while it may seem like something that mostly affects Wall Street, the truth is these moves ripple through every household and profession. From mortgages and student loans to savings yields and the stock market, Fed policy plays a quiet but powerful role in your personal financial planning. With inflation still above target and unemployment ticking upward, the Fed’s shift signals both opportunity and caution. On today’s episode, we’ll look at what this environment means for you as an ER physician and the most relevant financial strategies to consider.

Artificial intelligence is everywhere in the headlines, and many are calling it the biggest boom since the internet revolution. Some compare it to the dot-com bubble, while others see it as a lasting shift that will reshape how businesses, investors, and individuals operate. What’s clear is that the ripple effects go far beyond tech companies — they reach into borrowing costs, retirement accounts, and even the everyday tools we use. The question is: how do we separate hype from reality, and what does that mean for us as investors and participants in this new economy?

We get asked all the time by ER doctors: “How much do I need to retire?” Surprisingly, the answer to that is actually, “You’re asking the wrong question.” The real question is: How do you build a career and financial structure that doesn’t just pay you—but frees you? Assets are only half the equation; the other half is designing a life and financial plan that isn’t entirely dependent on you showing up for shifts, scales beyond your hours in the hospital, and ultimately lets you choose when—and how—you step away.