IC09 - A Bird in the Hand is Worth Two in the Bush? - Growing and Keeping your Personal Wealth

Aug 26, 2026

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Instructional course handout for ASSH’s 77th Annual Meeting outlining a stepwise approach for physicians to save and build retirement wealth. It targets barriers faced by many hand surgeons, then explains how to decide on self-managed investing, estimate savings goals using common rules (e.g., 20% savings guideline and 4% rule), and choose suitable retirement vehicles. The materials compare employed, government, nonprofit, self-employed, and account types, highlighting contribution limits, tax-deferred growth, and withdrawal tax or penalty considerations.

LanguageEnglish

CategoryExam

FormatPDF

Pages21

Reading Time53 min

AccessFree to download

Goal

Potential barriers

Stepwise path to success

Step 1 - Determine if you want to manage your own investments

Step 2 - Determine how much you should save

Step 3 - Understand what retirement vehicles are available to you

Employed physicians

403b

457b

401(a) plans

Self-employed physicians

SEP-IRA

Solo 401k

Pensions (defined benefit plans)

Tax-Advantaged Accounts

Traditional IRA

Roth IRA

Spousal IRA

IC09: A Bird in the Hand is Worth Two in the Bush? Moderator: Ines C. Lin, MD Faculty: Joshua M. Adkinson, MD, Aakash Chauhan, MD, MBA, Kalpit N. Shah, MD, David Veltre, MD and David W. Zeltser, MD Session Handouts 77TH ANNUAL MEETING OF THE ASSH SEPTEMBER 29–OCTOBER 1, 202 822 West Washington Blvd Chicago, IL 60607 Phone: (312) 880-1900 [Web:](Web: www.assh.org)[ ](Web: www.assh.org)[www.assh.org](Web: www.assh.org) [Email:](Email: meetings@assh.org)[ ](Email: meetings@assh.org)[meetings@assh.org](Email: meetings@assh.org) All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain. Instructional Course 09-HANDOUT A Bird in the Hand is Worth Two in the Bush?– Growing and Keeping your Personal Wealth When I’m 64: Preparing for Retirement Now By Joshua M. Adkinson, MD September 29, 2022 Goal • To save “enough” for a comfortable retirement Potential barriers • Despite having over a decade of post-graduate training, many hand surgeons are less knowledgeable regarding basics of managing, growing, and protecting their personal wealth • Physicians typically begin earning “real money” in their mid-30s but in the initial decade of practice-when the power of compound interest has the biggest impact on retirement accounts -doctors are saddled with student loans, mortgage payments, and childcare expenses that can make it difficult to contribute to retirement. Stepwise path to success Step 1 – Determine if you want to manage your own investments • Do you have the time and interest to do this? • Will require reading and carved out time o approx. 30-60 min/week reviewing finances and reading finance blogs/books/etc o steep learning curve Step 2 – Determine how much you should save • Usual recommendation is at least 20% of gross income • Some recommend 50/30/20 rule (net income) o 50% - living expenses (house, car, food, insurance, utilities, etc) o 30% -savings (emergency fund, savings, retirement accounts, taxable account) o 20% -discretionary (take-out, movies, vacation, gym, hobbies, credit card, etc) • Case Example-make approx. $400,000 as a new attending – allocate $80,000/yr, or $6,700/mth to savings o Caveats: married single earner, single parent, geography (higher or lower COL), other priorities (children, caring for family member/parent) • 4% rule (or 25x your current annual spending) is a rough way to estimate needs o Ex. Spend $80,00 year, need $2 million in retirement – roughly 30 yr retirement (varies depending on desired retirement age, significant other/spouse savings, spending habits, etc) Step 3 – Understand what retirement vehicles are available to you Employed Physicians • Employees of for-profit healthcare organizations and self-employed doctors • Up to $20,500 per year ($27,000 if age 50+) on a pre-tax basis • Account balances grow tax-deferred. Qualified distributions are taxed as ordinary income when withdrawn • Other withdrawals, including those made before age 59½, are subject to income taxes and a 10% penalty 403b • Same as 401k, but for government and non-profit hospital systems 457b • Offered by state and local government healthcare organizations • Up to $20,500 per year ($27,000 if age 50+) on a pre-tax basis in addition to 403(b) plan • Account balances can grow tax-deferred. Qualified distributions are taxed as ordinary income when withdrawn • Other withdrawals, including those made before age 59½ are generally subject to a 10% penalty and income taxes 401(a) plans (money purchase plans) • Offered by non-profit employers who may make contributions on behalf of physicians *Always max out accounts with an employee match (usually up to 3-5% of income up to certain limit)! Self-employed physicians ([i.e. you](i.e. you) receive a form 1099) SEP-IRA •

FAQs

What is the primary goal for physicians in this instructional course?

Save enough for a comfortable retirement, starting from the realities of early-practice financial constraints and the role of compound interest over time.

How much should physicians generally save for retirement according to the handout?

A common recommendation is at least 20% of gross income, with alternatives such as the 50/30/20 rule and the 4% rule for estimating retirement needs.

What are the key differences among major retirement vehicles discussed?

The handout compares employer-based plans (including pre-tax contribution limits), self-employed options like SEP-IRA and Solo 401k, and tax-advantaged accounts such as Traditional and Roth IRAs—emphasizing tax-deferred growth and differing withdrawal tax/penalty rules.

Aug 26, 2026

Upload by Maeve