You spent a decade learning medicine. Nobody taught you the tax code is written against you.
Published IRS data shows physicians pay 35-40% effective tax rates when structures exist to bring that to 28-32%. The gap isn't intelligence — it's architecture. Most practices are structured for compliance, not optimization.
Based on typical client scenarios. Individual results vary depending on your specific situation.
Where healthcare & medical firms typically have gaps.
Patterns we see most often in this industry.
You're Auto-Renewing Malpractice and Overpaying Every Year
Most practices auto-renew malpractice without shopping it. Carriers count on this inertia. Published industry data from medical professional liability associations shows that re-quoting every 2-3 years typically saves 15-25% — with equal or better coverage. Your claims history, practice size, and specialty all change. Carrier appetites change too.
Your Practice and Your Building Are in the Same Entity
If your practice owns the building it operates in, a malpractice judgment can reach both. The American Bar Association and every asset protection attorney will tell you the same thing: the building should be in a separate entity. This protects the real estate from practice liability, creates rental income flexibility, and makes a cleaner exit path when you're ready to sell the practice but keep the property.
Your Benefits Package Is Losing You Staff — or Costing You Too Much
Healthcare staff turnover costs $5-15K per position in recruiting and training, according to the Medical Group Management Association. Right-sizing your benefits package — ICHRA instead of traditional group, HSA optimization, strategic retirement matching — is almost always cheaper than constant recruiting. Most practices are either overspending on benefits or underspending on the ones that matter.
The Foundation Review is a 60-minute working session at no cost.
Book Foundation Review →Frequent missteps in healthcare & medical.
Keeping practice ownership and real estate in the same entity +
Auto-renewing malpractice insurance without shopping it +
Under-utilizing health savings accounts and defined benefit plans +
Common areas of recovery.
Opportunities we typically identify for healthcare & medical firms.
What a Foundation Review actually looks like.
An anonymized engagement from our work with healthcare & medical businesses.
Multi-Provider Medical Practice
$6.2M annual revenueA five-physician practice had been focused on clinical growth but had neglected the financial infrastructure underneath. The two founding physicians — who generated 60% of revenue — had no disability insurance. The group's retirement plan was an off-the-shelf 401(k) that wasn't optimized for high-earning owners. Malpractice was up for renewal.
- No disability insurance on the two highest-revenue providers — if either was injured or ill, the practice would lose 30% of revenue with no income replacement and no way to cover their overhead
- 401(k) plan was leaving $180K+ per year on the table: a cash balance plan layered on top would shelter significantly more for the senior physicians while still offering competitive benefits to staff
- Malpractice re-quoting across three carriers showed potential savings of $45K annually — consistent with published MGMA benchmarks for practices that haven't shopped coverage in 3+ years
- Also identified: entity restructuring opportunity (separating real estate from practice for asset protection) referred to their attorney
The Foundation Review placed own-occupation disability policies on both founding physicians (through Ash Brokerage), restructured the retirement plan to include a cash balance component, and re-quoted malpractice at renewal. The disability coverage alone closed a $2.4M income protection gap. Retirement plan optimization added $180K/year in tax-advantaged savings for the owners.
Details anonymized and modified. Individual results vary — your Foundation Review will be specific to your situation.
An integrated alternative.
One firm. Investments, tax, insurance, business advisory.
Good Deals consolidates investment management, tax strategy, insurance planning, and business advisory into one CFA-led practice. Operator background spans dozens of companies and many industries.
For your industry specifically: we coordinate with your existing CPA and attorney rather than replacing them.
- CFA-led investment analysis and portfolio management.
- Operator background across multiple industries.
- Registered fiduciary — legally obligated to act in your interest.
- Investments at Altruist; insurance through BackNine when an audit identifies a need.
- 90-day money-back on every V-CFO engagement.
- Austin, TX.
Book a Foundation Review.
A 60-minute working session focused on healthcare & medical. No cost.