09/08/2026
For physicians, saving for retirement is only half the battle and the order in which you draw down your accounts can drastically impact how much income you actually keep after taxes.
Juggling a mix of 401(a), 403(b), governmental/non-governmental 457(b), and Cash Balance plans creates distinct opportunities alongside hidden tax traps:
- The 457(b) Bridge vs. Trap: A governmental 457(b) offers penalty-free withdrawals before age 59½, serving as a flexible bridge for early retirement. A non-governmental 457(b), however, often defaults to a forced lump-sum payout at separation, which can spike your taxable income into the top marginal bracket.
- Cash Balance Plan Timing: Practice owners transitioning out or selling a practice face critical decisions between IRA rollovers and cash payouts to prevent massive single-year tax liabilities.
- The IRMAA Surcharge Cliff: Concentrating withdrawals into a single tax year can trigger maximum Medicare Part B and D premium surcharges two years later.
- The Roth Conversion Window: The gap years between clinical retirement and required minimum distributions (RMDs) offer a low-income window for strategic Roth conversions.
Tax efficiency isn't just about how much you've saved, it's about coordinating your withdrawal sequence long before you step away from medicine.
Read the full guide to sequencing physician retirement plan withdrawals:
https://www.oreadwealth.com/blog/physician-retirement-withdrawal-sequencing