Money Talk For ER Docs™

Ever wonder why some people obsess over every financial detail while others just want someone to handle it all for them? Money isn't just about math — it's deeply tied to how we're wired.  In this episode, we're diving into how your personality shapes your financial decisions — and why knowing yourself might be the key to getting (and staying) ahead. It's less about spreadsheets and more about self-awareness.

You ever scroll through the list of emergency department visits by sport? It's more surprising than you'd expect. The activities racking up the most injuries aren't necessarily the most extreme or dangerous—they're just the ones people do the most.  Which got us thinking… what if we looked at ER doctor personal finance through the same lens? Not just what's flashy or dramatic—but the everyday stuff that quietly causes the most long-term damage.

The House officially passed the One Big Beautiful Bill Act—so today, we're diving into what actually made it into the bill. If you listened to our earlier episode, you know we were taking some educated guesses, but now we've got real answers.  This bill is packed with changes—some extensions, some brand-new provisions—and while it's not law yet (it still needs to clear the Senate), it's already shaping major tax and financial planning conversations. So let's break down what passed and what it could mean for your bottom line.

When it comes to passing on wealth, the traditional approach has been to wait—save everything, then hand it off through a will. But what if the most meaningful impact happens before that moment?  Giving while you're still here—intentionally, strategically—lets you see the effect of your support, guide the outcomes, and build deeper alignment with your values. In this episode, we explore why earlier is often better, and how giving now doesn't just transfer wealth—it multiplies its purpose.

We all know the Roth IRA is a powerful tool for setting our kids up financially, especially when they're earning early and you can stash away a few thousand dollars for decades of tax-free growth. But what happens when your child hits that in-between stage—say, age 19 to 25—still on your health insurance but no longer a tax dependent?  That's where the HSA strategy kicks in, offering a surprisingly overlooked second phase of long-term wealth building. In this episode, we explore how to leverage this window to give your child a tax-free healthcare fund that could quietly grow into hundreds of thousands by retirement.

If you've been hearing rumblings about tax changes in 2026, you're not imagining things — we're heading toward one of the biggest tax shifts in decades. The Tax Cuts and Jobs Act of 2017, which shaped much of our current tax system, is set to expire unless Congress takes action.  But right now, lawmakers are locked in a high-stakes budget battle, and no one knows exactly how it'll end. This episode breaks down why that matters not just politically — but for your wallet, your financial plan, and the decisions you might want to make before the rules change.

Today, we're going to dive into a mindset shift that every high-earning professional needs to hear, especially our ER doc families making strong incomes. It's tempting to think that a $400K household is financially invincible. But the truth is: the system isn't designed to make you wealthy. It's designed to keep you comfortable.  And comfortable, if you're not careful, is the enemy of wealthy. We're going to walk through a real-world hypothetical of a $400K-earning ER doc, a stay-at-home parent, two kids, and all the common expenses that come with the lifestyle to show you exactly how easy it is to spin your wheels and not actually build wealth.

This episode is going to get technical — so if you're not ready to get lost in the math and mechanics of debt, investments, and balance sheet risk, you've been warned. But for high earners like ER docs, these seemingly small decisions — like whether to pay down a mortgage early or redirect that cash flow into investments — can have six- or even seven-figure implications over time.   With today's higher mortgage rates and more volatile markets, the old rules don't necessarily apply, and what once was considered conservative might now be the riskiest choice of all. We're going to break down how to analyze these trade-offs, with real numbers and real behavioral considerations that go way beyond “just do what feels right.”

Markets just experienced one of the most dramatic intraday reversals in history — and at the center of it all? Tariffs. In this episode, we dive into how sudden trade policy shifts, particularly around President Trump's tariff announcements, are sending shockwaves through investor sentiment and market pricing. We'll break down what tariffs actually are, who really pays for them, and why reacting to market drops after the fact can be more harmful than helpful. If you've been feeling whiplashed by the headlines, this one's for you.

Today is what most people call the “tax deadline” — but that term is more misleading than helpful. In reality, April 15 is less of a final cutoff and more of a decision point: you either file your return or file for an extension.  In this episode, we'll walk through why the panic surrounding this date is often unnecessary, especially for those with more complex tax situations. Whether you're already squared away or haven't even started, there's still something smart you can do today — and we're here to help you make tax season uneventful on purpose.

Match Day is an unforgettable milestone—the moment your medical journey becomes real, and the future you've worked so hard for finally starts to take shape. But what often gets overlooked is how your match decision can deeply impact your financial path.   From student loans and cost of living to career opportunities and long-term goals, your choice matters more than you may know. In this episode, we'll help you look at your match not just as a career move—but as the first step in a financial strategy designed to match your life.

Student loans — especially under income-driven repayment (IDR) plans — continue to be one of the most asked-about topics among ER docs. With all the recent changes, pauses, and legal uncertainty, figuring out what to do next has become increasingly difficult. We're recording this episode to help break down the latest updates, including the major change as of February 21st that halted all IDR applications, and to answer some of the most common questions we've been hearing. If you're pursuing PSLF, on SAVE, PAYE, or just trying to make sense of it all — this episode's for you.

The market is down, volatility is everywhere, and if you're feeling uneasy about investing right now—you're not alone. It can be terrifying to watch your portfolio drop or to commit new money when uncertainty is high.   But history has shown that those who stay the course and follow key investing principles come out ahead in the long run. Today, we're breaking down how to navigate the fear, stay invested, and set yourself up for long-term success—even when the market feels like a horror story.

Big changes are happening at the IRS—thousands of employees are being laid off, and that could mean longer wait times, delayed refunds, and even fewer audits… for now. But does this mean you're in the clear to take more risks on your taxes? On today's episode, we're diving into what these IRS cuts really mean for you, how to stay out of trouble, and why playing it smart now could save you from a nightmare audit years down the road. Let's talk all things IRS and how to keep your taxes stress-free.

Many underestimate how much their assets can grow—or how much they'll need for retirement. A $5M goal today could mean $12M+ in 30 years due to inflation, making financial targets seem daunting. By understanding compounding, inflation, and strategic adjustments, you can make smarter decisions today that have a massive impact tomorrow. We'll break down key numbers, risks like sequence of returns, and why financial planning is an evolving process.

Whether you're selling stocks, real estate, or a business, capital gains taxes can take a huge bite out of your profits. But here's the good news—you have control over when and how you sell assets, and with the right strategies, you can significantly reduce your tax bill. From understanding short-term vs. long-term capital gains rates, to tax-loss harvesting, tax-gain harvesting, donor-advised funds, and Qualified Opportunity Zones—this episode is packed with the insights you need to keep more of what you earn.

Think you're getting your full 401(k) employer match? You may need to think again. Even if you max out your contributions every year, the way you elect to defer your paycheck could be quietly costing you thousands in free money. In this episode, we break down the hidden flaw in many employer match structures, why high earners—like ER doctors—are especially at risk, and how a simple adjustment could mean an extra $800,000+ in retirement savings over your career.

Today, we're talking about what every kid and teen should know about personal finance—starting with the basics: What is money? Why should you save? And how can just $100 grow into thousands over time?   Today, kids are flooded with flashy social media influencers pushing get-rich-quick schemes—so how do we convince them that slow, steady investing is actually the best path to wealth? We'll break it all down, plus share real strategies for saving, investing, and setting up accounts like Roth IRAs and custodial investments to make money work for you.

On today's episode, we'll be diving into the unpredictable world of markets, investing, and economics. With the start of a new year and a new president, the market is full of mixed forecasts—half the experts are optimistic, while the other half are... not so much. But what's the reality?  We'll look at past market performances, including the surprising results from 2024 and Trump's first term, and evaluate why forecasts often miss the mark. Plus, we'll discuss the importance of diversification and how to stay calm in the face of uncertainty.

With the inauguration of President Trump behind us, a wave of changes is already in motion—executive orders reshaping policies, and bold tax proposals that could have significant implications for your bottom line. While not everything in a campaign becomes reality, understanding these potential shifts is key to staying ahead. In this episode, we're diving into Trump's new tax agenda, including how a C corporation instead of an S corporation could be the new norm for 1099 earning ER docs.

When it comes to taxes, income tax often takes center stage in our minds. But for high-income earners, like ER doctors, the tax landscape is much broader and more complex.  Beyond federal and state income taxes, there are hidden and often overlooked taxes that can quietly accumulate into a substantial burden. Let's dive into how you can take control of your tax strategy and maximize your wealth.

This year brings new challenges for ER physicians—rising patient volumes, increasing administrative burdens, and the ever-present risk of burnout. In this episode, we'll explore how these factors are reshaping careers and discuss practical strategies for maintaining balance, prioritizing mental health, and aligning your work with your personal and financial goals.  Whether you're an experienced EP or just starting out, we're here to help you navigate these shifts and build a sustainable path forward.

As the new year begins, it's the perfect time for ER doctors to hit the reset button on their finances. In this episode, we'll explore how to create a financial game plan that works for your unique career and lifestyle. From setting achievable money goals to tackling student debt and maximizing investments, this episode will help you start the year on the right foot. Let's turn your financial resolutions into reality.

Today we're diving deep into a retirement strategy that's gaining traction—we'll call it "phased retirement." Instead of the traditional abrupt transition from full-time work to complete leisure, phased retirement allows Emergency Physicians to gradually wind down their careers by transitioning to locum tenens positions.  This approach offers a multitude of benefits, both financial and psychological, which we will discuss.

Today, we're revisiting a topic that keeps coming up in our conversations with clients and listeners—how to best approach your retirement contributions, specifically when it comes to choosing between pre-tax retirement accounts and post-tax brokerage accounts.  We'll get into the math involved with the decisions and when it may be appropriate to lean towards one over the other.

As we close out the year, it's the perfect time for a financial checkup. While we often focus on our savings rate during our working years, once we transition into retirement, the spotlight shifts to something equally, if not more, important: our spending rate.   Today, we're diving into how the way we spend impacts our long-term financial security, and why taking a step back to reflect on our spending habits at the end of the year is essential for making sure we're on track.

As the year wraps up, it's time to turn our attention to the essential financial tasks that need to be checked off before January 1st, 2025. In today's episode, we'll walk you through the key deadlines and action items for your year-end financial checklist—everything from maxing out retirement contributions to taking care of your RMDs. Whether you're a W-2 employee or a 1099 contractor, there are some critical moves to make before the clock runs out. So, let's dive in and make sure you're ending the year on a strong financial note.

Today, we'll break down the latest updates on 401(k), IRA, and HSA limits for 2025, and forecast the tax landscape under the new administration. We'll also look at the possible extension and expansion of the TCJA, the SALT cap, and tax credits—and even provide a few things you may want to do before year-end and things you may want to wait to do until after the new year kicks off.

We're diving into a topic that many people overlook when it comes to their finances—the importance of working with a unified financial team. We recently received a question from an investment manager of a client we only handle tax services for, and it sparked an important discussion about the need for clear communication between financial professionals. Specifically, we're looking at how IRA conversions can be impacted when tax planning and investment advice aren't fully coordinated. We'll also explore why splitting your financial advisors could actually lead to more confusion and missed opportunities. So, let's break it all down and see why having one cohesive team in place is so crucial for making the best decisions for your financial future.

So today, we're diving into our post-election world, with a focus on student loans. Trump, plus a Republican majority in the Senate, means there's, at minimum, uncertainty on the horizon as it pertains to loan programs - income-driven, PSLF, SAVE, and anything in between. If you've got student loans or you've been planning your path to forgiveness, we'll try to unpack what you may want to do now before things change and it's too late.

In this episode, we explore the Roth vs. Traditional retirement account decision specifically for ER docs. With high income, fluctuating tax brackets, and the potential for major tax changes in the future, choosing the right account can significantly impact your long-term financial strategy. We break down the pros and cons of each account type, discuss how to leverage tax planning opportunities during your career and retirement, and help you navigate the complexities of saving for the future while balancing the unique financial challenges of being an ER doctor.

With the market performing well recently, many of you may find yourselves sitting on sizable gains in your portfolios. But how do you navigate these gains effectively to optimize your tax situation?  On today's episode, we'll break down the mechanics of tax-gain harvesting—what it is, when to use it, and how it can potentially save you money—alongside the more familiar tax-loss harvesting strategies.

With so much perceived to be at stake and tensions running high, it's easy to get caught up in the political drama. However, as a finance-focused podcast, our aim is to shift the conversation toward how financial markets have historically reacted to election outcomes. We'll explore the trends, debunk some myths about market behavior during elections, and offer our perspective on not only the market and economy, but personal finance as a whole whether we're led by a Republican or Democrat come November.

Disability can be one of the most significant financial threats to your career and income. 1 in 7 people will suffer from a disability that will last at least 5 years. That's fairly decent odds for a potentially severe financial outcome. On today's episode, we'll explore why having the right amount of coverage is vital, how to calculate your needs, and which riders you should consider to tailor your policy. This is a must-listen episode if you are in residency or under-covered with your current DI policy.

Finance can be complex. It's very easy to focus on the bells and whistles instead of the tried and true. So today, we're stepping back to explore the core financial principles that every emergency physician should know. Understanding what areas to focus on, and which to avoid, is just as important whether you're fresh out of residency or a seasoned pro.

Over the past 14 years, we've seen a major shift in interest rates that's changed how we handle cash. Starting back in 2008 during the financial crisis, rates were so low that many people kept minimal cash because it just wasn't earning anything. But after the pandemic, rates climbed, making it easier to earn decent returns on savings.   Now, as we expect more rate cuts, it's a good time to rethink how we manage our cash and consider smarter investment strategies.

How do you perceive your future self? How you answer that may matter when it comes to your finances. Research shows we may have a particular POV when it comes to looking forward at our lives, which can lead to challenges in saving for retirement. On today's episode, we'll explore how this disconnect, along with concepts like temporal discounting and loss aversion, can impact your spending habits now and in retirement.

We'll kick today's episode off with a surprising New York Times article that challenges the validity of supercentenarians and those so-called Blue Zones we discussed before. From there, we'll explore the current economic landscape, where conflicting predictions are the name of the game. With a heated presidential race and fluctuating markets, it's time to unpack the chaos, debunk some myths, and find out what really matters for your financial future. Let's get started!

We're excited to feature our first client on the Money Talk for ER Docs podcast! We've planned to do this for some time now and couldn't be more thrilled to have Dr. Brian Laakaniemi as a guest as he discusses his path to EM as well as his finances. We love the idea of continuing to host existing clients on the podcast and we hope you, as a listener, not only enjoy hearing the perspective of a fellow emergency medicine practitioner, but also find value in their experience and insights. For legal purposes, we are required to disclose that Brian's experience as a client may not be reflective of the experience of all clients and he did not receive any compensation for speaking with Scott. Hope you enjoy!

Identity theft is a real concern for ER docs due to high patient interaction volume. Consider the reality that accessing an EP's signature can open up opportunities to obtain medications or allow for other financially-driven motives. Combine this with other variables, such as higher income and thus higher credit limits and a busy lifestyle that may prevent them from noticing identity theft schemes, it's no mystery as to why ER docs as a subset of professionals are prime targets. On today's episode, we'll discuss a large data breach that impacted most Americans and lay out the things you can do today to prevent fraud happening tomorrow.

We are constantly inundated with clickbait-y headlines and concepts that are hard to ignore. A once-a-day pill to shed fat, increase alertness, get wealthy, grow your hair back – whatever it may be, even the biggest skeptics can begin questioning their skepticism when painted a convincing enough picture. But what about velocity banking? Is it another fad or an exception? Can you really use this as a method to not only shave years off your mortgage, but also save hundreds of thousands of dollars in interest over the life of your loan?  On today's episode, we'll discuss the ins and outs of velocity banking and also revisit the math behind amortization schedules for refinancing.

From white water rafting to taking a trip to the grocery store, there's always some level of practical analysis and mapping that can, and probably should, be performed. Doing so helps us make more informed decisions, capitalize on strengths, address weaknesses, seize opportunities, and mitigate threats to enhance overall well-being and productivity.  On today's episode, we perform a SWOT Analysis of the personal finances of emergency physicians to really evaluate all of the ways EPs can find success (and failures) within their working career.

We all have experienced a pretty rapid run-up in mortgage rates since 2020-2021. Of course, no one knows where the top (or bottom) will be moving forward. But at least over recent history, rates have dropped a good amount to the point where there are mortgage opportunities for many to explore. On today's episode, we'll discuss the decision-making process of refinancing and get into other forms of equity lines of credit that can be appealing even for those with low-interest rate primary mortgages.

The market and its behavior, though it may not feel like it, is predictable. It's like a broken record:  there will be ups and downs; some bigger than others. Despite this, in the moment, it can feel very serious or dire. But if we let history be our guide, there are plenty of lessons to draw from that show how to react and what to do to get through those stressful moments. On today's episode, we'll talk about the market's recent movement and also discuss the surge in small cap value stocks that will leave those who jumped on the large cap stock trend feeling a bit left out.

Happiness can come in so many forms. When it comes to the relationship between work and happiness, whether we care to admit it or not, they tend to be pretty intertwined. But what if they weren't? How would you structure your life if you were optimizing for happiness over money?  On today's episode, we'll get a bit psychological and look at the science behind happiness and how much things like your job and spending money play a role.

Many ER docs may not be aware of cash balance pensions. These are a type of retirement plan that can really supercharge retirement savings and minimize tax liability. But buyer beware: these aren't a DIY solution. That's one of several reasons why they are underutilized despite being an extremely attractive option for saving large sums of money.  On today's episode, we'll discuss these relatively complex plans and how they may be the best tool to help guide ER docs to their retirement goals. 

Conventional wisdom would suggest that becoming more educated should result in earning more money. And when you combine that sentiment with ambitions of change either within or outside of emergency medicine, seeking an Executive MBA may be an appealing option, especially for an ER doc looking to reduce clinical hours. But when it comes to EM, more money and a better opportunity may not be as matter of fact as it is with other careers. On today's episode, we'll discuss our experience with clients who have pursued and obtained their Executive MBA and what changes it led to personally, professionally, and of course, financially.

It's no surprise EM has experienced volatility over the past decade. Whether it's in the form of general healthcare structure, insurance, government programs, private equity, and, importantly, compensation, it's clear things may not be running as efficiently as they should be. This has led to talks of unionization growing in popularity as a means to make long-desired improvements. On today's episode, we'll discuss the history of unions, review a study recently issued on this topic, and of course relay the messages and sentiments we've received from clients.

The majority of ER docs will earn contractor pay at some point in their career, which opens the door to new types of retirement accounts. One highly praised type is the individual 401(k). With all the great potential it brings, it also comes with additional responsibilities that can easily be overlooked if not careful, especially when considering the sheer number of tax deadlines and responsibilities an ER doc has.  On today's episode, we'll discuss the upcoming Form 5500 deadline, go over the scary consequences of not filing it, and conclude with what can be done if you realize you haven't filed in the past when you were liable to.

Maslow's Hierarchy of Needs is a psychology theory that details our motivations as humans. Within that model, things like food, water, and health are all vital. But so, too, are employment status and property – actually within the same tier as health and safety. That shouldn't be a surprise; our ability to fund our survival goes hand-in-hand with surviving itself. Yet, it's almost like our brains can't wrap around the concept that we will not work at some point in the future, whether we care to or not. That means the planning we do with our money today serves as the replacement for the work we won't be able to do in the future.   On today's episode, we'll remind listeners of the importance of making incremental progress toward financial goals and adhering to a plan.

What does the termination of a deferred compensation plan actually mean for employees? In the case of Envision, it appears to mean receiving a windfall of money upfront that was likely earmarked for retirement purposes. And if that wasn't challenging enough, there's inevitably going to be a tax hit that may not be fully realized until over a year after the funds are received. That's a lot of responsibility and will definitely test the discipline and planning system of these affected ER docs.  So in today's episode, we'll discuss the specifics of Envision's deferred comp plan termination (dates, distributions, and of course the tax impacts you should be aware of), but also give our insight into these plans in general when it comes to a savings option for ER docs.