MoneyRx for CRNAs and NPs

The age on your Social Security application shapes your retirement more than your portfolio balance or your withdrawal rate. In this episode, Brett explains why the first ten years of retirement carry outsized risk, what claiming early versus delaying does to a portfolio during a bad market, and a bridge-income option available to CRNAs and nurse practitioners that a typical retiree doesn't have. He also runs a full hypothetical, a 60-year-old CRNA with $2.1 million saved, through both claiming paths and a market downturn to show the dollar difference between the two choices.This is illustrative only and not a substitute for an individualized analysis of your own earnings record and portfolio.Key Timestamps:(0:08) The one number that decides how a market drop affects your retirement(3:23) Why the first 10 years of retirement are the most fragile(6:50) How your claiming age protects or exposes your portfolio(11:25) Why CRNAs and NPs often have a different earnings record problem(15:08) The bridge income option most retirees don't have(18:13) A $2.1 million example: two paths, one market downturn(22:06) The dollar cost of delaying, laid out plainly(24:56) So which path is right? The factors that actually decide it(28:43) Why your spouse's claiming age matters too(31:22) Your practical next step before you file(34:45) How to run this analysis with your own numbersFor more information and resources related to this episode, please visit the show notes. 

A CRNA retires at 55 with $2,800,000 saved, a paid-off house, and every account funded the way a plan is supposed to look. A few months later, that same person turns down a $6,000 family trip because they might need the money.In this episode, Brett Fellows CFP®, founder of Oak Capital Advisors, works through a composite retiree built from a pattern he sees again and again with CRNAs and NPs who saved for decades and still can't bring themselves to spend a dollar of it. He runs the withdrawal numbers on a $2,800,000 portfolio, walks through why the account a withdrawal comes from can change its tax and Medicare cost by thousands of dollars, and explains the psychological reflex that makes a completely safe expense feel like a threat. Brett closes with a simple exercise for putting your own number to use.Brett covers:Why a mathematically safe $6,000 trip can still feel dangerous to someone with $2,800,000 savedWhat a safe withdrawal rate supports on a $2,800,000 portfolio for someone who retired at 55Three specific purchases, a 529 gift, an international trip, and a home renovation, this plan could fund without putting it at riskWhy pulling the same $50,000 from a 401(k), a Roth, or a taxable brokerage account produces three different outcomes at tax timeThe Medicare and ACA subsidy cliffs that can turn a single large withdrawal into a five-figure surpriseLoss aversion, the one more year syndrome, and why the instinct to keep working can outlast the need toA simple 1% exercise for finding your own spending number and using it on purposeKey Timestamps:(0:18) Why a $2,800,000 retiree still turned down a $6,000 family trip(1:59) What this pattern is really about beneath the dollar amount(4:03) Research showing why running out of money isn't the risk for consistent savers(5:34) What a safe withdrawal rate supports on a $2,800,000 portfolio(9:11) Three specific purchases this plan could fund without putting it at risk(12:03) Why the account a withdrawal comes from changes what it costs(18:10) The psychological reason a mathematically safe expense still feels dangerous(20:54) The one more year syndrome and what it costs(21:46) Why the same reflex hits savers and spenders differently in one household(23:11) Back to the $2,800,000 example with the numbers now in view(25:47) A simple exercise for finding and using your own numberFor more information and resources related to this episode, please visit the show notes. 

Two people can retire with the same total balance, the same asset mix, the same withdrawal rate, even the same average annual return over thirty years, and still land in totally different places by the end. In this episode, Brett Fellows, CFP®, founder of Oak Capital Advisors, walks through why the order those returns show up in can carry as much weight as the returns themselves, and lays out the War Chest, a framework for setting aside three to five years of spending so a retiree is never forced to sell stocks during a downturn just to cover this month's bills.Brett covers:Why a retirement portfolio has to fund today's spending and keep growing for the next thirty years at the same timeHow a portfolio drifts from its target allocation without a single decision causing it, shown with a real dollar exampleCalendar-based vs. threshold-based rebalancing, and the tax difference between rebalancing in a 401(k)/IRA vs. a taxable brokerage accountWhat the War Chest holds, why inflation-protected securities are part of it, and how it played out for real retirees during the spring 2025 market dropSequence of return risk, the "Red Zone," and how retirement age and funding level change how much cushion a plan needsHow to size a speculative investment sleeve without putting the actual retirement plan at riskKey Timestamps:(0:18) Two retirees, same portfolio, completely different outcomes(2:16) Why a drifting plan becomes a stress problem, not just a technical one(3:10) The two jobs a retirement portfolio has to do at once(5:06) How a 60/40 portfolio drifts without a single trade being made(5:56) A dollar example of five years of portfolio drift(7:51) Calendar-based vs. threshold-based rebalancing(9:01) Tax treatment of rebalancing: retirement accounts vs. taxable accounts(9:58) Introducing the War Chest(11:04) Morningstar's findings on when retirement portfolios run out of money(12:21) What inflation-protected securities (TIPS) do inside the War Chest(13:53) Why rebalancing feels wrong even when it's working(15:10) Real example: the spring 2025 market drop and the War Chest in action(16:17) Practical habits for maintaining the War Chest and allocation(17:21) Sizing a speculative investment sleeve(19:29) Sequence of return risk explained(20:45) How retirement age and funding level change red zone exposure(22:19) Coordinating withdrawals with tax planning(24:44) The assignment: sorting your portfolio into three bucketsFor more information and resources related to this episode, please visit the show notes. 

Retirement charts inside a 403(b) can eat hours of attention. Five-year returns, ten-year returns, expense ratios, lined up side by side and compared fund by fund.Brett Fellows, CFP®, runs the numbers on what a decade of picking the single best-performing fund would add to a CRNA's account. He also shows where a bigger opportunity sits, in an oversized cash cushion earning next to nothing.Brett covers:What a decade of picking the single best-performing fund in a 403(b) lineup would add to a CRNA's account, in dollarsWhy that number translates to about $30 a month in retirement income once it's run through a conservative withdrawal rateWhy an oversized cash cushion builds up so easily on PRN and locum incomeHow redirecting unused cash into a 403(b) and backdoor Roth IRA over eighteen years can grow to roughly $180,000The 2026 contribution limits for a 403(b) and backdoor Roth IRA, and how much space typically goes unusedA bank statement exercise for finding a real emergency fund number this weekKey Timestamps:(0:18) The pull to find the "perfect" fund in your 403(b)(1:04) Running the crystal ball test on a decade of fund picks(3:10) The stable value fund vs. bond fund gap in a real 403(b)(4:09) The real number: under $9,000 difference over ten years(5:00) Turning $9,000 into actual monthly retirement income(6:27) Where fund selection still genuinely matters(7:46) The high-stakes decision most CRNAs get backwards(9:26) Why unused 403(b) and Roth IRA space is use-it-or-lose-it(10:07) 2026 contribution limits for a 403(b) and backdoor Roth IRA(12:33) Sarah's example: redirecting $450 a month into retirement(13:32) $450 a month grows to roughly $180,000 by 60(15:44) Pressure-testing the number with a more conservative return(17:27) The same math at a smaller dollar amount(20:35) The bank statement exercise to run this week(24:17) The bigger lesson: where to spend your decision-making energy(26:51) Closing thoughts and how to work with BrettFor more information and resources related to this episode, please visit the show notes. 

You retired from full-time practice, kept a couple of PRN shifts a month, and now you're looking at claiming Social Security at 62. It feels like the easy part of the plan. For most nurse practitioners and CRNAs, it isn't.In this episode, Brett Fellows, CFP®, breaks down the Social Security earnings test, the permanent benefit cut that comes with claiming at 62, the survivor benefit floor it sets for a spouse, and the ACA subsidy cliff that can turn one claiming decision into a much larger household cost.Brett covers:Why tapering into PRN work turns a simple claiming decision into a three-variable oneThe Social Security earnings test: how much you can earn before benefits get withheld, and why that money isn't gone foreverThe permanent 30% reduction tied to claiming at 62, and why it never resets once the PRN shifts stopHow a higher earner's claiming age sets the survivor benefit floor for a spouse, walked through with real numbersThe ACA subsidy cliff at 400% of the federal poverty level, and how a Social Security check can push a household over itA three-number framework to run before you file for benefitsKey Timestamps:(0:18) Retiring early, staying on with PRN shifts, and the pull toward claiming at 62(1:41) Why two-variable Social Security models fail for tapering retirees(3:05) The Social Security earnings test and the $24,480 limit for 2026(5:40) The permanent 30% reduction tied to claiming at 62(8:02) How your claiming age sets your spouse's survivor benefit floor(11:47) The ACA subsidy cliff and the 400% federal poverty line(15:06) How provisional income affects the taxation of your benefit(16:45) When claiming early can genuinely be the right call(18:51) The decision tree: three variables, not two(22:59) The three numbers to estimate before you file(24:00) Why a full scenario comparison beats a generic rule of thumb(26:02) Closing thoughts and how to schedule a conversation with BrettFor more information and resources related to this episode, please visit the show notes. 

One hundred episodes ago, Brett Fellows sat down in front of a microphone with no idea if a single person outside his own family would ever listen.For this milestone episode, there is no new strategy and no client case study. Brett goes back through ninety-nine episodes and pulls out the five questions that keep resurfacing for CRNAs and NPs, no matter how different two households look on paper. He also shares the honest reason he keeps making this show at all.Brett covers:Tax buckets: why the account a dollar sits in, pre-tax, Roth, or taxable, matters more over a whole career than any single year's tax billHow much is enough, and why the number itself is rarely the hard partSocial Security as a one-way door, and why the claiming decision changes the math on everything elseThe healthcare gap before Medicare, and the shadow tax created by a Roth conversion in the wrong yearWithdrawal order once the paycheck stops, and why the sequence matters as much as the totalThe honest reason Brett keeps making this show, a hundred episodes inNew episode of MoneyRx for CRNAs and NPs is out now.Key Timestamps:(0:18) Sitting down for 100 episodes and why today is different(2:49) Real-world impact on CRNAs and nurse practitioners over two years(6:09) Topic 1: Roth conversions and looking at taxes across your whole career(9:09) Topic 2: how much is enough and trusting the number to buy back time(11:34) Topic 3: Social Security claiming as a one-way door decision(14:03) Topic 4: understanding the healthcare gap before Medicare(16:32) Topic 5: figuring out where money comes from in retirement(18:53) Why helping the people who take care of everyone else matters(21:20) Reflecting on episode one, the book, and how the show evolved(23:45) Your action step for this week: pick one topic you have been avoiding#CRNAs #NursePractitioners #RetirementPlanning #MoneyRx #RothConversionsFor more information and resources related to this episode, please visit the show notes. 

Retire at 53, and your plan needs to survive 35 years of retirement, not 25. Most retirement calculators were never built for that math, and the gap shows up first in your health insurance bill.In this episode of MoneyRx for CRNAs and NPs, Brett Fellows, CFP®, founder of Oak Capital Advisors, breaks down why the standard retirement math quietly falls apart for anyone leaving full-time work before Medicare age, and what to do instead.Brett covers:Why the 4% rule and most retirement software were built for a 30-year retirement, not 35Medical inflation running nearly 40 points ahead of general inflation since 2000, and why that gap compounds every yearColleen's story: how a "safe" $72,000 withdrawal actually needs to support close to $109,000 a year by year tenThe ACA subsidy cliff returning for 2026, and how $1,400 of extra income can erase an entire subsidy at onceWhy pulling the same dollar from a Traditional IRA versus a Roth or brokerage account can decide whether you keep that subsidyWhat changes, and what doesn't, once Medicare starts at 65Key Timestamps:(0:18) Why retiring at 53 is the hardest stress test a retirement plan can face(1:05) The 4% rule and the 30-year model it was built around(1:34) Why that model was only ever stress tested to 30 years(2:02) Why a 35-year retirement is the realistic case, not the aggressive one(3:05) The flat inflation assumption almost every calculator makes(3:43) Medical inflation since 2000: 121% versus 86% for everything else(7:05) Meet Colleen: 53, a $1.8 million portfolio, and a calculator that says she's fine(8:51) Splitting $72,000 into two inflation buckets instead of one(10:16) The real gap: $37,000 a year, and the sequence of returns risk it creates(12:32) The ACA subsidy cliff returning for 2026(16:27) Why which account you draw from is now a health insurance decision(18:49) What changes, and what doesn't, once Medicare starts at 65(24:33) Running the plan to 90 instead of the standard 25 to 30 year horizonIf your retirement starts before Medicare eligibility, or you want your own plan stress-tested against 35 years of real, two-track inflation, schedule a free Pre-Op Retirement Assessment at https://connectwithbrett.com/ and subscribe for more information. #CRNAs #RetirementPlanning #EarlyRetirement #HealthcareCosts #MoneyRxFor more information and resources related to this episode, please visit the show notes. 

The IRS didn't reduce this tax break for high-earning nurses over 50. They took it away. Starting this year, catch-up contributions can no longer go in pre-tax if your wages cross $150,000, and most CRNAs and NPs haven't adjusted their plan for it.In this episode of MoneyRx for CRNAs, Brett Fellows, CFP, walks through the new Mandatory Roth Catch-Up Rule, what it costs the people who ignore it, and three accounts most CRNAs and NPs are not using together that can more than offset the change. He walks through a hypothetical CRNA named Dana to show what structuring it properly can mean over time.Brett Covers:Why catch-up contributions now have to go into Roth accounts for anyone whose wages cross $150,000What it actually costs this April if your plan defaults you into Roth and you don't adjust anythingWhy most CRNAs and NPs are only using one of the three tax-advantaged accounts available to themHow the 457(b) special three-year catch-up and a solo 401(k) can offset the new Roth mandateWhat structuring all three accounts properly could mean over a hypothetical 14-year periodKey Timestamps:(0:18) The retirement rule that quietly changed for nurses over 50(3:16) How the Mandatory Roth Catch-Up Rule works under Secure 2.0(5:55) What doing nothing costs you this April(8:10) Why this is an awareness mistake, not a financial one(8:40) The three accounts most CRNAs and NPs aren't using together(13:50) Case study: Dana, a 51-year-old CRNA earning $230,000(17:55) The dollar difference between reacting and structuring it right(20:41) The exact questions to ask your plan administrator(25:50) How to get help modeling your own numbersFor more information and resources related to this episode, please visit the show notes. 

Most retirement plans do an excellent job modeling the money, but almost none of them model the time. For CRNAs specifically, that missing piece changes everything about when stepping back actually becomes possible and what it looks like when you get there.In this episode, Brett Fellows, CFP®, founder of Oak Capital Advisors, shows why standard financial plans built around a flat spending model can lead high-earning nurses to stay in the OR much longer than necessary. Brett Covers:The Time vs. Money Blindspot: Why the real question isn't just how much money you have, but what kind of time you will have and when.The Three Distinct Phases: Breaking down the Go-Go, Slow-Go, and No-Go years and how capacity and discretionary spending naturally shift across them.The Flat Model Flaw: How standard inflation-adjusted spending models cause CRNAs to overestimate late-life needs and underestimate early-retirement freedom.The Locum Bridge: How picking up just 10 to 15 days of locum anesthesia per year can fill early retirement gaps on your own terms.The 73 Collision: Why ignoring transitional gap years causes pre-tax RMDs and Social Security to collide into an unnecessarily high tax bracket.The Conversion Window: How to systematically move $50,000 to $70,000 a year from your pre-tax 403(b) into a Roth IRA while your bracket is temporarily low.Sequenced Withdrawal Strategy: The optimal account order (taxable first, pre-tax second, Roth last) to extend portfolio longevity.Key Timestamps:(0:18) Most retirement plans model the money, but fail to model the time.(1:26) Why standard financial conversations ignore the realities of health and energy timelines.(4:17) Defining the three distinct phases of retirement: Go-Go, Slow-Go, and No-Go years.(6:55) How flat spending assumptions trick CRNAs into overestimating late-life financial needs.(8:19) Navigating the personal identity shift when stepping back from clinical expertise.(9:26) Case study: The 10-year window for a 58-year-old CRNA named Maria.(11:27) The Locum Bridge: How 10 to 15 days of temporary work changes the retirement math.(13:20) Introducing the conversion window to shelter your nest egg from future IRS claims.(15:32) The 73 Collision: What happens when pre-tax RMDs and Social Security stack together.(17:26) Concrete actions to evaluate your personal timeline, local locum rates, and account mix.(20:27) How to access a complimentary 30-minute Pre-Op Retirement Assessment.Find out how to structure your retirement timeline and learn more about Oak Capital Advisors at https://oakcapitaladvisor.com/.#CRNAs #RetirementPlanning #TaxPlanning #LocumTenens #MoneyRx For more information and resources related to this episode, please visit the show notes. 

Most CRNAs and NPs who want to cut back to part-time have already decided it's impossible, because they're running the wrong number. In this episode of MoneyRx for CRNAs, Brett Fellows, CFP, walks through the framework for figuring out whether cutting back is actually financially viable, using the story of a hypothetical NP named Sarah who was $130,000 away from her real number, not $920,000 away from it.Brett Covers:Why the 2026 Nurse.org State of Nursing Survey points to a math problem, not a career problemWhy modeling full retirement for a part-time decision always makes the numbers look impossibleHow to find your real healthcare cost after ACA subsidies instead of assuming the sticker priceWhy the 4% rule is the wrong tool for someone who's cutting back rather than stopping entirelyHow Roth conversion timing and account sequencing change the picture over timeIf you're 50 or older with at least $750,000 saved and you've been telling yourself you can't afford to slow down, this episode is worth your full attention.Key Timestamps:(0:18) Survey data on nursing burnout and financial necessity(1:25) Realities of dropping job satisfaction and growing career fear(2:58) Distinguishing full retirement from cutting back to part-time hours(4:34) Financial profile and baseline savings of case study subject Sarah(6:33) Accessing meaningful ACA marketplace subsidies with lower clinical income(8:38) Health insurance premium deductions within a 1099 independent contract model(9:58) Misapplying traditional investment drawdown metrics to partial retirement scenarios(11:13) Calculating the real net portfolio gap required to cover downshifted schedules(13:13) Optimal multi-bucket asset sequencing guidelines for tactical cash flow(14:28) Leveraging transitional low-tax windows for strategic Roth conversions(16:13) Chronological timeline walkthrough of Sarah's dynamic downshift plan(18:18) Navigating the professional identity shift when reducing clinical commitmentsFor more information and resources related to this episode, please visit the show notes. 

Almost every nurse walks into retirement with a short to-do list: file for Social Security, roll over the 403(b), and pull money for the things earned. On paper, it looks responsible. But in practice? Each item on that list can quietly close a door that no amount of future income can reopen.In this episode, Brett Fellows CFP®, founder of Oak Capital Advisors, walks through the story of Teresa, a CRNA who retired after 26 years and came to her first planning meeting with exactly three permanent decisions on her list. Brett explains why the fix-it-later mindset that served nurses well during their careers becomes a liability the day the paycheck stops, and introduces the Point of No Return Plan, a framework for identifying which decisions are irreversible and handling those on purpose, in sequence, before they lock.Brett covers:Why retirement mistakes feel different from working-years mistakes, and why that distinction mattersTeresa's three-item list and what each decision would have cost her householdSocial Security timing: what it locks in, what the survivor effect means for a high-earning household, and when early claiming can make senseThe gap years between retirement and RMDs: why doing nothing with a $2.1M 403(b) is itself a decisionThe two healthcare clocks and how a single $250,000 income year in 2026 creates a bill that shows up in 2028The Point of No Return Plan: how to sort every retirement decision into fixable and unfixable, and protect the unfixable few before they closeKey Timestamps:(0:18) Distinction between fixable working mistakes and irreversible retirement decisions (2:18) Household financial profile of Teresa and her retired husband Victor (4:11) Reviewing Teresa’s initial three-item retirement checklist (6:13) Hazards of applying a quick fix-it-later clinical mindset to retirement (8:08) Permanent lifestyle impacts of filing for early Social Security benefits on instinct (11:53) Risk of ignoring the low-tax gap year window for asset repositioning (13:33) How forced required distributions permanently exhaust cheap tax bracket space (15:58) Multi-clock tax triggers of pulling large lump sums from pre-tax accounts (17:08) Interaction between single-year income spikes and retroactive Medicare surcharges (21:41) Implementing the point of no return plan to safeguard irreversible choices (23:08) Maximizing gap year productivity with targeted annual Roth conversions (24:30) Pacing large capital lifestyle rewards from cash reserves over multiple years For more information and resources related to this episode, please visit the show notes. 

Almost every nurse who sits down with Brett a few years before retirement asks the same question: "What is my number, and am I there yet?" The account balance keeps growing, the calculators keep confirming the money will last, and yet something still feels off. No calculator can see what a retirement date controls.In Episode 94, Brett introduces the five planning windows and explains why the date you stop working opens or closes all five of them at once.Brett Covers:Why the 4% rule and Monte Carlo success scores are silent on the most costly retirement decisions high-earning nurses faceThe five windows your retirement date controls: the ACA bridge, the Roth conversion runway, Social Security timing, the fragile decade, and RMDs at 73How retiring at 60 versus 66 creates a $300,000 to $500,000 lifetime difference for the same nurse with the same balanceWhy "one more year" feels like buying safety and what it actually costsThe Window Map: a method for working your retirement age backward from the five windows instead of toward a numberKey Timestamps :(0:18) Portfolio readiness scores versus timeline window alignment(3:23) Case study profile of Cynthia and her retired husband, Raymond(5:18) Limitations of standard survival metrics and Monte Carlo success tools(6:53) Portfolio drawdown blind spots regarding early retirement tax structures(10:08) Window 1: Income thresholds and coverage cliffs within the ACA insurance bridge(11:33) Window 2: Utilizing early lower-income gap years for cheap Roth conversions(12:53) Window 3: Delaying Social Security benefits to protect a surviving spouse(14:23) Windows 4 and 5: Managing fragile decade market drops and forced required distributions(16:36) Interactivity between early retirement dates and Medicare look-back surcharges(18:56) Side-by-side lifetime analysis of exiting at age sixty versus age sixty-six(21:54) Reversing traditional retirement formulas by counting backward from open windows(27:24) Sequencing conversion and subsidy strategies so they do not collide over a single yearFor more information and resources related to this episode, please visit the show notes. 

Most retirement plans are built for two people. When one spouse dies, the survivor gets hit with a higher tax bill on lower income. At the same time.In this episode of MoneyRx for CRNAs and NPs, Brett Fellows, CFP, walks through the widow's tax penalty using a real CRNA household. He explains why this happens, what it costs over a lifetime, and the specific steps a married nurse can take to protect the surviving spouse before it's too late.Brett Covers:Why the survivor's tax bill goes up when household income goes downThe role of required minimum distributions in the problemHow filing as a single filer compresses tax brackets and cuts the standard deduction in halfThe IRMAA surcharge that shows up two years after the funeralThe Survivor's Window: a multi-year plan using Roth conversions, Social Security timing, and beneficiary cleanup to reduce the lifetime tax cost by tens of thousandsIf you have a large pre-tax 403(b) or IRA and a spouse, this episode is worth your full attention. The window to act is only open while both of you are still here.Key Timestamps:(0:18) Predictable financial surprises and tax penalties in retirement(1:18) The widow's penalty where survivor income drops but taxes rise(2:48) Case study introduction of Diane and Paul(5:48) Structural exposure of retirement plans built only for two people(7:29) Social Security and single-life pension changes after a spouse dies(8:43) Required minimum distribution rules for a single survivor schedule(10:03) Shrinking standard deductions and compression of single tax brackets(11:15) Impact of single filer Medicare IRMAA thresholds and surcharges(12:45) Total lifetime cost breakdown of the single filer tax penalty(15:44) Exploiting the low tax bracket window while both spouses are alive(18:41) Filling joint tax brackets with multi-year Roth conversions(19:54) Setting the survivor income floor by delaying Social SecurityFor more information and resources related to this episode, please visit the show notes. 

If you are a CRNA or nurse practitioner thinking about rental property as part of your retirement plan, watch this episode before you write the check. When you run the numbers for a high-earning nurse buying the kind of property they want at today's rates, the result often surprises people.In this episode, Brett Fellows, CFP®, walks through the story of Yvonne, a 55-year-old CRNA in the Charleston area earning $220,000 a year who wants to buy a second rental property before retiring at 62. Brett explores the problems that arise when they explore her options.Why most rental property owners never calculate the one number that tells them if the investment workedThe Cash Flow Illusion: why a property that "covers the mortgage" can still run hundreds per month in the redThe passive loss rule that suspends depreciation deductions for most CRNAs and NPs earning over $150,000What the real exit looks like after commissions, depreciation recapture, capital gains, and state taxesWhy Yvonne's 403(b) outperformed her rental property over the same six-year periodThe Capital Priority Ladder: the order in which high-earning nurses should deploy capital before buying direct propertyHow Yvonne sheltered $71,000 from taxes in year one without buying a second rentalMost CRNAs who own rental property have never run the number that tells them whether it worked: the all-in, after-tax, after-expense, after-time annualized return. #CRNAs #NursePractitioners #RealEstate #RetirementPlanning #TaxPlanningFor more information and resources related to this episode, please visit the show notes. 

Kristin Burton paid off over $160,000 in student loan debt in 16 months, became a self-made millionaire by 31, and built a platform called Millionaires in Medicine that now reaches PAs, NPs, pharmacists, and other non-physician healthcare professionals across the country. She also just published her first book, The PA Millionaire Path.In this episode, Brett Fellows, CFP®, sits down with Kristin to talk about what holds high-earning healthcare professionals back from building wealth. They cover the identity problem around income, why student loans should never be the whole money plan, the three tax buckets that create flexibility in retirement, and what it takes to make work optional. Kristin also shares the investing philosophy that built her net worth and the financial mistakes she would do differently.Key Timestamps:(0:18) Introduction of guest Kristin Burton and her personal wealth milestones(1:38) Origins and grassroots mission of Millionaires in Medicine(3:53) Failure of non-physician medical professionals to self-identify as high earners(5:13) Time management strategies for balancing clinical practice and entrepreneurship(6:18) Shift from short-form infographics to deep long-form conversations(10:23) Inspiration for publishing a tangible and enduring financial guidebook(12:05) Why behavioral choices and mindset outweigh pure financial intelligence(16:22) Reframing student loans as a career investment instead of an emotional burden(19:03) The three-pillar framework to track earnings, multiply investments, and build net worth(22:03) Long-term advantages of a boring and fully automated dollar-cost averaging approach(27:35) Spreading assets across three tax buckets to optimize retirement withdrawal strategies(30:04) Three-step process to establish and future-proof baseline lifestyle expenses For more information and resources related to this episode, please visit the show notes. 

A year ago, Amanda Kelly jumped into full 1099 independence with income goals, an S-corp, and many unknowns. Now she’s back.In this episode, Brett Fellows, CFP®, sits down with Amanda Kelly, CRNA, coach, and founder of The Mindful CRNA, to hear what happened once the theory met real life. They talk through the financial surprises that came with running an S-corp, why most CRNAs leave money on the table at tax time, how the independent market has shifted heading into 2026, and what Amanda learned from a 30-minute tax return walkthrough with Brett that changed how she thinks about her money entirely.They Cover:The honest financial case for going 1099 in your 40s or 50sWhy salary vs. distributions inside an S-corp matters more than most CRNAs realizeWhat CRNAs consistently get wrong with deductions and bookkeepingHow the 1099 market has shifted since 2024 and what to expect going forwardRunning a side coaching business, and when to spin up a second LLCThe tax return review that made her numbers finally make senseBaby Roths, HSAs, and what a "money machine" looks like in practiceThree financial moves she would tell every new CRNA to make first#CRNAs #1099CRNA #TaxPlanning #FinancialPlanning #MoneyRxKey Timestamps:(0:18) Return of guest Amanda Kay to review her first year of independent contracting (1:43) Simple bookkeeping and revenue tracking methods using basic apps (2:56) Psychological adjustments when transitioning away from W-2 employment (4:40) Spousal communication strategies for managing variable monthly income (6:50) Common first-year errors with S corp compliance and deductions (10:53) Tax efficiency benefits of prioritizing business distributions over salary (13:40) Proactive recordkeeping habits to easily track business expenses (15:56) Evaluating the financial case for switching to 1099 contracting (18:40) Choosing the right entity structures when managing multiple income streams (19:58) Projected overhead costs and platform fees for digital courses (27:13) Navigating anesthesia market shifts and establishing cancellation policies (30:04) Protecting income through continuous clinical skill diversificationFor more information and resources related to this episode, please visit the show notes. 

If you are within five years of retirement and thinking about paying off your mortgage, you are asking the right question, but… you’re probably asking it the wrong way.In this episode, Brett walks through a sample client household, Imani, a 60-year-old nurse practitioner retiring in December with $1.7 million in her 403(b) and a $228,000 mortgage. Her plan was simple: pull the money from her retirement account and walk into retirement debt-free. Brett shows why that one decision would have cost her roughly $190,000 in taxes, lost growth, and destroyed planning runway, and the three moves that got her to the same outcome for about $9,000 instead.Brett covers:Why the mortgage rate versus investment return comparison is the wrong framework for most CRNAs and NPsThe four separate tax bills hiding inside a single 403(b) withdrawal, and why almost nobody adds them upWhy January of your first retirement year is the worst possible time to make this decisionThe three-move mortgage payoff runway that keeps retirement accounts untouched and the ACA planning window intactHow Imani went from a $190,000 mistake to a $9,000 solution without changing her goal at all#CRNAs #NursePractitioners #RetirementPlanning #TaxPlanning #MortgagePlanningKey Timestamps: (0:18) Financial risks of pulling from pre-tax accounts for mortgage payoffs (1:23) Case study introduction of a nurse practitioner aiming for debt-free retirement (2:33) Breakdown of how the wrong asset source creates a major planning mistake (4:33) Failure of standard rate versus return comparisons for pre-tax accounts (6:38) Four separate financial liabilities triggered by a single lump sum withdrawal (8:13) Delayed impact of retirement account liquidations on future Medicare surcharges (10:28) Heightened compounding dangers of large early retirement lump sum distributions (11:43) Preservation of the low tax window for strategic Roth conversions (13:03) Alternative approach using accelerated principal payments from current cash flow (14:53) Structural benefits of utilizing a five to seven-year payoff runway (16:00) Mathematical guidelines for evaluating mortgage payoff choices based on interest rates (18:03) Protecting retirement accounts from accelerated debt elimination plansFor more information and resources related to this episode, please visit the show notes. 

Most nurses retiring in their early sixties think they face one decision when it comes to ACA subsidies and Roth conversions: pick one or the other. But there’s another way. In this episode, Brett walks through the story of Renata, a 60-year-old CRNA retiring after 28 years with $1.78 million in her 403(b). She spent six months researching the ACA-versus-Roth question, talked to two CFPs, and was leaning toward skipping every conversion. What she discovered in a planning meeting changed everything. The cost of the question she had been asking, run across twelve years of her household's life, came to $280,000.In this episode, Brett walks through the three reasons this mistake keeps repeating, and introduces The Conversion Calendar: a 12 to 15-year framework that lets nurse households capture ACA subsidies and do Roth conversions at the same time, by placing each type of move on the right years of the retirement runway.Brett covers:- Why the ACA-versus-Roth binary is a false choice, and why 2026 makes it far more costly as enhanced credits expire- The shadow tax that adds 10 to 19 percent on top of your federal bracket without showing up on your tax return- How a household can go $3,000 over the cliff line and lose $14,000 in subsidies while saving only $300 in federal tax- The three-step Conversion Calendar built around Renata and Ben's 13-year runway- How this household saved $420,000 in lifetime federal taxes while capturing $45,000 in ACA subsidies#CRNAs #NursePractitioners #RothConversion #RetirementPlanning #ACASubsidyKey Timestamps:(0:18) Trade-off between ACA subsidies and Roth conversions(1:39) Case study of Renata and Ben’s early retirement transition(2:54) Risks of the false binary approach in tax planning(4:26) Reappearance of the hard 400% FPL cliff in 2026(6:07) Hidden shadow tax impact on real marginal rates(7:29) Actual cost of conversions compared to federal tax brackets(8:58) Shifting the planning focus to the multi-year retirement runway(10:33) Benefits of using a conversion calendar for long-term sequencing(11:33) Visual mapping of retirement into distinct tax environments(12:53) Strategy for pairing ACA years with measured conversions(14:53) Impact of sequencing on future required minimum distributions(16:08) Lifetime tax savings achieved through strategic decision orderingFor more information and resources related to this episode, please visit the show notes. 

You've worked for decades, maxed your 403(b) every year, and built a solid balance. But what if the structure of those savings is quietly setting you up for a six-figure tax problem in retirement?This episode follows Dana, a CRNA with 22 years at the same hospital and $1.4 million saved. She did everything the articles told her to do. What she found out in the first planning meeting was that doing everything right in a single account is still a problem.Brett walks through the three reasons high-earning nurses arrive at retirement with a tax structure they can't control, and the three concrete moves any nurse can make in the next 90 days to get back on track.Brett explores:Why having 96% of savings in one pre-tax account creates a retirement tax rate the IRS sets for youThe hospital plan features most nurses never use, including a 457(b) that could have added $200,000 in contributionsThe eight-year window between retirement and Social Security that is the cheapest tax opportunity of a high-earner's lifeHow to audit your hospital plan, redirect future dollars, and draw a conversion calendarWhat the Tax Diversification Reset looked like for Dana and Marcus, and how it saved their household $190,000 in lifetime federal taxesIf you have a growing balance in your plan and no real strategy for how it gets taxed in retirement, this episode is for you.Key Timestamps:(0:18) Risks of long-term concentration in a single pre-tax account (1:23) Shift of financial control from the retiree to the IRS (2:32) Distinction between missed contributions and missed financial flexibility (3:38) Financial exposure of households with large pre-tax balances (4:54) Institutional incentives that promote the default retirement structure (6:03) Impact of Medicare IRMAA surcharges on retirement cash flow (7:38) Unlocking overlooked features in complex hospital plan documents (9:13) Identifying the low-tax planning window before required distributions hit (10:58) Gaining control through tax-aware ordering and account types (12:53) Three concrete steps to audit hospital plans for new options (14:53) Mapping the conversion runway to minimize future tax brackets (16:08) Lifetime tax savings achieved through strategic asset repositioning For more information and resources related to this episode, please visit the show notes. 

Most retirement budgets are built around a method that almost guarantees an error. You sit down with a spreadsheet, write out every category you can think of, and estimate a number for each line. Research shows people who go through that exercise estimate what they think they can live on, not what they spend. Real retiree spending can run 20 to 30% higher than those estimates. On a $75,000 target, that's $15,000 to $22,000 per year, the plan never accounted for.In this episode, Brett walks through a different approach: the Subtract-and-Replace Budget. Two halves, eight lines, and a starting point that's already in your paycheck.Brett covers:Why the line-item budget fails: The psychology behind underestimating, and what a $500 error in your monthly estimate does to your plan's success probability.The Subtract side: Four expenses that disappear the day you stop working: payroll taxes, retirement contributions, debt service, and invisible work costs.The Replace side: Four categories that expand or appear at retirement: taxes in their retirement form, healthcare, go-go lifestyle spending, and healthcare inflation.David and Karen: Two CRNAs in their late 50s who thought their line-item budget was solid, until the Subtract-and-Replace method revealed the real number.If you're within five years of retirement, this framework is worth understanding before you build the plan.#CRNAs #NursePractitioners #RetirementPlanning #RetirementIncome #FinancialPlanningKey Timestamps:(0:18) Probability of success based on retirement spending accuracy(2:03) Ineffectiveness of the traditional line item approach for future budgeting(3:08) Discrepancy between imagined discipline and real retiree spending habits(4:53) Identification of major work expenses that disappear after retirement(6:06) Determining a real lifestyle baseline using current paycheck data(7:39) Average total healthcare expenditures for retired couples over a lifetime(9:03) Impact of healthcare inflation on long-term retirement planning(10:33) Financial value of strategic tax control and withdrawal timing(11:33) Moving from guessing to financial clarity with the paycheck method For more information and resources related to this episode, please visit the show notes. 

If you retired with $2.5 million and were still afraid to spend it, you would not be alone. Many CRNAs and nurse practitioners have worked so hard for so long, but nobody ever taught them how to switch gears.In this episode, Brett walks through a sample client household, Chris and Heather, a CRNA and NP couple who retired with $2.5 million in pre-tax accounts and were only spending $6,800 a month when their plan could safely support $10,500. Brett names the three reasons that happened, and the three-part retirement spending blueprint he built to fix it, including a Roth conversion strategy on track to save them over $180,000 in lifetime taxes.Brett Covers:Why retirees spend 80% of their guaranteed income but only 50% of their portfolio assetsThe psychology behind treating savings as untouchableHow underspending creates a compounding future tax problemThe three-bucket retirement spending blueprintHow to build a monthly "retirement paycheck" from your portfolioLong-term care: the real data on who actually needs itHow to use the Roth conversion window before RMDs kick inWhy IRMAA surcharges cost some couples $18,740 a year in Medicare alone#CRNAs #NursePractitioners #RetirementPlanning #FinancialPlanning #MoneyRxKey Timestamps:(0:18) Challenges transitioning from saving to spending money(1:20) Comprehensive financial planning services for high-earning nurses(2:54) Potential tax liabilities of underspending in retirement(4:44) Psychological differences between monthly income and portfolio assets(6:36) Statistical data regarding long-term care cost risks(8:06) Benefits of using the Roth conversion window after retirement(9:08) Medicare surcharges and their relationship to required distributions(10:39) Three components of the retirement spending blueprint(12:33) Executing a Roth conversion strategy to minimize taxes(14:18) Summary takeaways and link to free retirement assessment For more information and resources related to this episode, please visit the show notes. 

Many CRNAs and nurse practitioners are already financially ready to retire… they just don’t know it. And yet, they keep working three, five, sometimes ten years longer than they need to. Not because they have to, but because no one has shown them clearly that they’re okay to stop.In this episode, Brett Fellows CFP® discusses four specific financial markers that show retirement readiness.Brett covers:Sign 1: Your portfolio can cover your income gap at a safe withdrawal rate, even if the market doesn’t cooperate.Sign 2: Your tax-deferred accounts are large enough that you’d benefit from starting Roth conversions now.Sign 3: You have, or can build, two years of living expenses in cash or short-term bonds outside of equities.Sign 4: Your plan still works under the widow’s penalty scenario, when one spouse is gone.If two or three of these apply to you, you may not be years away from retirement. You may already be there.#CRNAs #NursePractitioners #RetirementPlanning #FinancialIndependence #WealthManagementKey Timestamps:(0:18) Retirement readiness for CRNAs and nurse practitioners.(0:46) Overview of Oak Capital Advisors comprehensive planning.(1:47) Introduction to four specific financial signals.(2:14) Sign 1: Replacing your paycheck and the 4% rule.(4:39) Sign 2: Tax problems within pre-tax retirement accounts.(6:33) Power of Roth conversions during low-income years.(8:19) Sign 3: Protecting against the sequence of returns risk.(9:48) Sign 4: Stress testing for the widow's penalty.(11:28) Summary of the four markers for retirement.(12:36) Scheduling a complimentary discovery meeting.For more information and resources related to this episode, please visit the show notes. 

Making the jump from employee to business owner can feel scary for NPs and CRNAs, but it can be done successfully. In this episode, Brett Fellows sits down with Dr. Michelle Cuevas, DNP, FNP-C, a family nurse practitioner, entrepreneur, and self-described explorer who made the leap from W2 employee to 1099 business owner and has not looked back.Michelle built the NP Specialist Nursing Inc., her own clinical 1099 company, and then launched the NP Travel Specialist, a travel business that gives her flexible income and the freedom to explore the world with her family. Brett and Michelle share insights for anyone considering a similar move.In this episode, they explore:What finally pushed Michelle to leave the W2 world after nearly three decadesThe costly legal and financial mistakes she made going 1099, and what she wishes she had knownHow to evaluate a side business or second income stream as a nurse practitionerWhy the DNP did not necessarily increase her direct income, but absolutely opened doorsHer approach to managing student loan debt with intentionHow full practice authority and state-level legislation directly impact NP income and opportunityWhat a solo 401(k) looks like for a self-employed NPThe one piece of money advice she would give her younger selfWhether you are a nurse practitioner dreaming of going 1099, considering a side business, or trying to figure out what financial freedom looks like in practice, this episode is for you.#NursePractitioner #1099Life #NurseEntrepreneur #FinancialFreedom #MoneyRxKey Timestamps:(0:18) Welcome and Introduction to Dr. Michelle Cuevas(5:18) How Diverse Clinical Experience Impacted Her Earning Power(7:18) Why Michelle Chose Nursing and Pursued Her Doctorate(11:18) The Catalyst for Transitioning from W2 to 1099 Clinical Work(21:18) Lessons Learned: Legal Mistakes and Business Structure Errors in California(26:18) The Reality of Financial Complexity and Choosing Retirement Accounts(31:18) Diversifying Income: Launching "The NP Travel Specialist" Business(35:18) Evaluating the ROI of a DNP Degree(36:18) Managing Student Loans: What Nurse Practitioners Often Get Wrong(39:18) Managing a Large Family and Long-Term Financial PlanningFor more information and resources related to this episode, please visit the show notes. 

A CRNA or nurse practitioner can save consistently, build a $1.5 to $2 million portfolio, and be just a few years from retirement and STILL lose tens of thousands of dollars a year without knowing why. The answer? Because of these three specific decisions that got made quietly in the background right before retirement.In this episode, Brett Fellows walks through the story of Sandra, a 58-year-old CRNA with $1.9 million saved. Two of those decisions had already been made wrong. The third she didn't know existed. Brett covers:Why the account you pull from in early retirement can create a $12,900 per year difference in health insurance premiums for the exact same plan and coverageHow the ACA subsidy cliff works and why crossing it by $1 can wipe out more than $10,000 in subsidiesWhy Medicare looks at income from two years ago and how high-earning nurses get hit with IRMAA surcharges they never planned forThe overlap between Roth conversions, ACA premiums, and future Medicare costs that most advisors don't model togetherWhat tail coverage is, why most APRNs don't know it exists, and why the negotiation window closes the moment you give noticeThe Healthcare Retirement Clearance: three checkpoints that need to be addressed two and a half to five years before your target retirement dateIf you are within five years of retirement, these decisions are already in motion whether you have planned for them or not.Visit oakcapitaladvisor.com to schedule a call. We work specifically with CRNAs and NPs.#CRNAs #NursePractitioners #RetirementPlanning #EarlyRetirement #HealthcareCostsKey Timestamps:(0:18) Intro(1:25) Meet Sandra: CRNA, 58, $1.9M, two years from retirement(2:05) Decision 1: Which accounts fund your life before Medicare?(2:48) Two nurses, same plan, $12,000 difference in premiums(3:46) The ACA subsidy cliff and how income triggers it(5:18) Decision 2: The Medicare surcharge tied to income you no longer earn(6:16) IRMAA explained, and the appeal most nurses never file(6:55) The overlap: Roth conversions, ACA subsidies, and Medicare costs(8:28) Decision 3: The charge hiding in your exit paperwork(9:20) Tail coverage: what it costs and when you can negotiate it(11:22) The Healthcare Retirement Clearance(12:05) Sandra's corrected plan and outcomes(13:35) These decisions are already in motionFor more information and resources related to this episode, please visit the show notes. 

Where will your paycheck come from once you stop working, and which account do you pull from first? You saved well, maxed out your 403(b), and built a $2 million portfolio, but haven’t found clear answers to your retirement questions. In this episode, Brett Fellows talks through the three hidden issues that were quietly setting up a CRNA named Janie for $80,000 to $150,000 in taxes she did not have to pay, and the three-act retirement paycheck framework that changed her outcome.Brett covers:Why the 4% rule understates your real take-home by design when every dollar is pre-taxThe age 73 collision: what happens when a $2 million 403(b), Social Security, and forced RMDs all hit in the same yearWhy the window between retirement and RMDs is the highest-leverage tax planning period of a CRNA's entire financial life (and why most people waste it)How Roth conversions done at $75,000 per year from age 62 to 70 reduced Janie's 20-year federal tax bill by $170,000The three-act retirement paycheck framework: the bridge, the window, and the forced yearsWhat Janie's monthly paycheck looked like at age 70 after stopping work at 62 with a structured, tax-efficient sequenceIf your numbers raise more questions than they answer, get your retirement pre-op assessment: https://oakcapitaladvisor.com/schedule-a-call/  Click here to download the Free Retirement Checklist https://oakcapitaladvisor.com/retirement-checklist/#CRNAs #RetirementPlanning #RothConversion #TaxStrategy #RetirementPaycheckKey Timestamps:(0:18) Why retirement feels unclear with $2M(2:44) Janie: CRNA case study at age 58(4:10) The 4% rule and the age 73 collision(6:51) IRMAA and the conversion window(9:30) Filling your tax brackets on purpose(11:57) The three act retirement paycheck framework(13:06) Act 1: Funding the bridge years(15:15) Final results: Janie's $170,000 savings For more information and resources related to this episode, please visit the show notes. 

Most nurses arrive at retirement having done everything right for 30 years. The problem is not what they built. It is that nobody explained what happens when you have to start pulling money out.In this episode, Brett Fellows walks through five retirement mistakes that look responsible from the outside and only reveal their cost much later. Most nurses are making at least two of them. Some are making all five. And the window to correct them is closing.Brett covers:Why building only one tax bucket sets nurses up for forced income they never asked for at age 73The 457(b) that sits right next to the 403(b) at most hospitals and why it almost never gets usedWhy claiming Social Security early without a bridge account locks in a permanent 30% reduction worth $259,000 over 20 yearsHow a taxable brokerage account can cut healthcare premiums by $12,000 to $18,000 per year before Medicare startsWhat it means to shift from accumulation thinking to distribution architecture and why that shift changes everythingSandra's story: the same NP, same income, two completely different retirement outcomes based on six years of intentional decisionsIf you want to see what a distribution architecture looks like for your specific situation, visit oakcapitaladvisor.com to schedule a call. We work specifically with CRNAs and NPs.#CRNAs #NursePractitioners #RetirementPlanning #TaxStrategy #457bKey Timestamps:(0:18) The problem no one warned nurses about(2:24) Mistake 1: Building only one tax bucket(3:32) IRMAA explained: the cliff most nurses never see coming(4:36) Mistake 2: Not using the 457(b)(6:55) Mistake 3: Claiming Social Security too early(7:28) The $259,000 gap between 62 and 70(8:39) Mistake 4: No taxable brokerage account(9:50) Mistake 5: Staying in accumulation mode(12:22) What a well-structured retirement actually looks like(13:22) Meet Sandra: Path A vs. Path B(16:22) Same person, same income, six years of intentional decisions For more information and resources related to this episode, please visit the show notes. 

Most nurse practitioners trying to answer the retirement question are using benchmarks that were never designed for them. The 4% rule. The 80% income replacement rule. Healthcare cost estimates built on worst-case assumptions. Used together, they can make a completely achievable retirement look years out of reach.In this episode, Brett Fellows walks through an example, a 55-year-old NP named Diane with $1.2 million saved, to show exactly how three common planning beliefs were pointing her toward the wrong answer and how replacing them with the right framework changed everything.Brett covers:Why the 4% rule was designed for someone retiring at 65 with Social Security starting immediately, and why applying it to an early retirement overstates what you needHow the 80% income replacement rule nearly doubled Diane's perceived retirement cost by ignoring NP-specific work expenses that disappear at retirementWhy healthcare costs before Medicare are almost entirely a function of taxable income, not health status, and how to use that to your advantageThe account sequencing strategy that kept Diane's ACA premiums at $4,800 to $7,200 per year instead of $20,000How the years between retirement and Social Security can become the lowest-tax years of your adult life if you plan them correctlyWhy Diane retired at 60 instead of 65 with a 3.5% withdrawal rate and a portfolio still on track at age 85 and 90If you want to know whether your number actually works for your retirement, visit oakcapitaladvisor.com to schedule a call. We work specifically with CRNAs and NPs.#NursePractitioners #CRNAs #RetirementPlanning #EarlyRetirement #TaxStrategyKey Timestamps:(0:18) The question most NPs can't answer with confidence(1:10) Meet Diane: NP, 55, $1.2M saved, no debt(1:38) Why she believed she needed $2 million(2:25) The 4% rule and why it was built for someone else(4:19) The 80% income replacement myth(5:32) NP work expenses that vanish at retirement(6:07) Healthcare cost catastrophizing before Medicare(7:18) How taxable income, not health status, drives ACA premiums(8:09) Three beliefs, one wrong answer(9:15) The three questions that actually matter(10:22) The Nurse Retirement System: Step 1, map your real spend(11:00) Step 2: Income sequencing and account order(12:10) Roth conversions in the low-tax gap years(12:35) Social Security at 67 drops withdrawal to 3.5%(13:41) What the wrong benchmarks were really costing her For more information and resources related to this episode, please visit the show notes. 

Most CRNAs and nurse practitioners treat their HSA like a checking account for medical bills. They put money in, pay bills, and move on. But the HSA is the ONLY account in the U.S. tax code that gives you 3 tax benefits at the same time, and when used correctly, it translates to hundreds of thousands of dollars in tax-free wealth.In this episode, Brett Fellows walks through how to turn your HSA into a serious retirement savings tool, including the investment strategy most nurses skip, the shoebox receipt strategy for tax-free cash in retirement, and the Medicare timing mistake that triggers a penalty most people never see coming.Brett covers:Why you must be enrolled in a high deductible health plan to contribute, and what the 2026 IRS thresholds actually areThe 2026 HSA contribution limits, catch-up contributions, and the FICA tax savings W-2 employees get that most people overlookHow the triple tax advantage works and why the HSA outperforms both the traditional 401(k) and the Roth IRA for medical expensesThe key differences between an HSA, FSA, and HRAWhy investing your HSA balance instead of spending it is the move that separates a $2,000 balance from a $340,000 oneThe shoebox receipt strategy and how to use old medical receipts for tax-free withdrawals in retirementThe Medicare look-back rule and exactly when to stop contributing to avoid a 6% excise taxWhat happens to your HSA after age 65, and why it functions as a traditional IRA for non-medical expensesIf you want to see how an HSA fits into your full retirement plan, visit oakcapitaladvisor.com to schedule a call. We work specifically with CRNAs and NPs.#CRNAs #NursePractitioners #HSA #HealthSavingsAccount #RetirementPlanning #TaxStrategy Key Timestamps:(0:18) The HSA secret most nurses are missing(1:17) Lisa vs. Kevin: same income, $340,000 apart(2:35) What is an HSA, and who qualifies?(3:05) 2026 HDHP thresholds and contribution limits(4:15) The FICA tax savings most W-2 nurses overlook(04:45) The triple tax advantage explained(6:45) HSA vs. FSA: key differences (Note: HRA is not mentioned in the transcript)(07:40) How to invest your HSA and why it matters(08:25) The shoebox receipt strategy(09:55) The Medicare timing trap and the look-back rule(11:15) What happens to your HSA after age 65(12:05) Action plan and next stepsFor more information and resources related to this episode, please visit the show notes. 

Do you have a retirement tax bomb? Many CRNAs and nurse practitioners spend 30 years following traditional financial advice: max out your 403(b), live below your means, and defer taxes as long as possible. However, this strategy often leads to a "retirement tax bomb" where required minimum distributions (RMDs) and Social Security push you into a higher tax bracket than when you were working. AKA your tax bill might be jaw-dropping in your Golden Years. In this episode, Brett Fellows, CFP®, explains how to avoid this expensive mistake through strategic tax bracket filling. He shares real-world case studies of nurses who saved over $130,000 in lifetime taxes by utilizing the 0% capital gains rate and well-timed Roth conversions. See how to manage your three tax buckets and why asset location is just as important as asset allocation.Brett Covers:How RMDs and Social Security create the retirement tax bomb.The three tax buckets: tax-deferred, tax-free, and taxable.A strategy to pay 0% federal tax on capital gains during early retirement.How to execute Roth conversions without triggering Medicare surcharges.The four biggest tax mistakes nurses make.A three-phase framework for tax-efficient retirement withdrawalsWhether you are a decade away from retirement or already considering your exit date, these strategies can help ensure your savings remain in your pocket rather than going to the IRS.#CRNAs #NursePractitioners #RetirementPlanning #TaxStrategy Key Timestamps:(0:18) David and Karen’s $1.4 Million Tax Mistake(2:37) Defining the Retirement Tax Bomb(3:27) Tax Bracket Filling and the Three Buckets(4:35) Case Study: Saving $130,000 in Lifetime Taxes(5:34) How the 0% Capital Gains Rate Works(6:25) Strategic Roth Conversions and Social Security(7:20) Asset Location: Where to Put Your Investments(8:30) Managing IRMAA and Medicare Surcharges(9:10) The Three Phases of a Tax-Efficient Retirement(10:10) The Four Biggest Tax Mistakes APRNs Make(11:24) Angela’s Example: A Plan for Single Providers For more information and resources related to this episode, please visit the show notes. 

If you're a CRNA or nurse practitioner earning over the Roth IRA income limits, you're locked out of one of the best retirement accounts available. But there's a legal workaround. In this episode, Brett Fellows explains two powerful tax strategies that can save you hundreds of thousands of dollars over your career.In this episode, Brett covers:How the backdoor Roth IRA works and why it's been IRS-approved since 2010The exact step-by-step process to execute a backdoor Roth conversionWhat the pro-rata rule is and how to avoid the biggest mistake that trips people upHow the mega backdoor Roth lets you contribute up to $72,000 annually to tax-free accountsWhether your employer plan allows mega backdoor Roth contributions (and what to ask HR)Real-world examples showing how nurses can accumulate $4.5 million tax-freeCommon mistakes to avoid when executing these strategiesTax reporting requirements and which forms you need to fileHow self-employed CRNAs can maximize these strategies with a solo 401(k)Whether you're just starting out or nearing retirement, these strategies can help you build millions in tax-free savings and potentially save over $1 million in taxes throughout your career.Key Timestamps:(0:45) Why "High-Earners" Are Locked Out of Roth IRAs(2:54) The Backdoor Roth IRA: A Simple 2-Step Process(4:54) The Pro-Rata Rule: Avoiding the #1 Backdoor Mistake(7:09) Step-by-Step: How to Execute a Clean Backdoor Conversion(8:59) What is a Mega Backdoor Roth?(11:49) Two Must-Have Features Your 401(k) Plan Needs(15:44) Common Mistakes: From Missing Conversions to Paperwork Messes(17:49) The $43,000 Strategy: Can You Do Both?(21:19) Case Study: Saving $1 Million in Taxes Over a Career(24:49) What to Do if Your Plan Doesn't Allow the "Mega" Strategy#CRNA #TaxStrategies #RothIRA #NurseFor more information and resources related to this episode, please visit the show notes. 

"I've been earning $200,000 or more a year for most of my career. Social Security is going to be a drop in the bucket." If that's what you're thinking, you could be leaving hundreds of thousands of dollars on the table.In this episode, Brett Fellows walks through nine critical Social Security strategies specifically for high-earning CRNAs and nurse practitioners. Using a real-world example of David and Sarah, both age 62 CRNAs with $1.8 million saved, he explains how to maximize lifetime benefits while minimizing taxes.Brett Covers:Know your full retirement age and how early claiming permanently reduces benefitsUnderstand why delaying gives you a guaranteed 8% annual return (worth $216,000 over 20 years)Maximize Your 35-Year CalculationCoordinate spousal benefits strategically when one spouse earns significantly moreUse the bridge strategy to retire early while delaying Social Security to 70Don't forget survivor benefits (delaying can mean $162,000 more for your surviving spouse)Watch out for IRMAA surcharges that could cost $10,000+ per year in Medicare premiumsConsider Roth conversions and QCDs during your low-income "gap years"Understand the earnings test if you plan to work while claiming earlyWhether you're planning to retire at 62, 65, or 70, this episode shows you how to turn Social Security from an afterthought into a strategic anchor for your retirement income.#CRNAs #NursePractitioners #SocialSecurity #RetirementPlanning #FinancialPlanning #MoneyRxKey Timestamps:(0:18) Welcome to Money RX: Social Security for High-Earning CRNAs and NPs(1:28) Case Study: David and Sarah’s $200,000 Income Strategy(2:44) #1: Know Your Full Retirement Age(3:51) #2: Why Delaying Pays Off (The Guaranteed 8% Return)(4:17) #3: Maximize Your 35-Year Calculation(7:11) #4: Coordinate Spousal Benefits Strategically(8:13) #5: Use the Bridge Strategy(9:33) #6: Do Not Forget Survivor Benefits(11:01) #7: Watch Out for IRMAA Surcharges(12:16) #8: Consider Roth Conversions and QCDs(14:09) #9: Understand the Earnings Test(15:18) Summary: How a Strategy Adds Hundreds of Thousands in Value For more information and resources related to this episode, please visit the show notes. 

The five-year window before you stop working is the most critical period for your financial future. While many CRNAs and nurse practitioners (NPs) focus solely on saving, the transition to retirement requires a shift toward strategy. In this episode, Brett Fellows, CFP®, shares a 10-point checklist designed specifically to help both CRNAs and NPs manage health insurance gaps, mitigate IRMAA surcharges, and turn decades of savings into a sustainable retirement paycheck.Brett covers:Why strategy matters more than accumulation when you are five years outHow to calculate your true retirement spending instead of just replacing your incomeThe hidden Medicare cost shock (IRMAA) that high-earning nurses need to understandWhy your 403(b) might be a tax time bomb and how Roth conversions can helpHow to bridge the health insurance gap if you retire before age 65The guaranteed 8% return from Social Security and how to decide when to claimA smarter withdrawal strategy to stay in lower tax bracketsWhy your beneficiary designations matter more than your willYour retirement paycheck should include your hard-earned money, without the tax trap. #Retirement #NP #CRNA #RetirementPlanningKey Timestamps:(0:20) The Critical Five-Year Window(2:19) Step 1: Set Your Target Retirement Date(3:19) Step 2: Know Your True Retirement Expenses(4:44) Step 3: Take Inventory of Your Accounts(5:50) Step 4: Health Insurance Before Medicare(6:54) Step 5: Start Learning About Medicare & IRMAA(8:19) Step 6: Understand Your Social Security Options(9:33) Step 7: Consider Roth Conversions(11:11) Step 8: Create a Withdrawal Strategy(12:18) Step 9: Simplify Your Accounts(13:06) Step 10: Get Your Estate Documents in Order(13:58) Case Study: The Five-Year TransformationFor more information and resources related to this episode, please visit the show notes. 

The 4% rule is a staple of retirement planning, but for high-income CRNAs and nurse practitioners, it is often the wrong tool for the job. Relying on a rigid, one-size-fits-all percentage can lead to psychological stress, tax blindness, and the mistake of underspending during your healthiest years.In this episode, Brett Fellows, CFP®, explains why APRNs should move away from static rules of thumb in favor of a "Work Optional" guardrails plan. This approach replaces spreadsheet fantasies with a dynamic system that accounts for changing life seasons, tax sequencing, and the unique ability of clinicians to use income levers if markets get rough.Brett explains how to:- Identify the 5 core problems with the 4% rule, from linear spending assumptions to ignoring Medicare surcharges.- Build a retirement paycheck timeline that maps out income sources like Social Security and RMDs as distinct seasons.- Implement dynamic guardrails to know exactly when it is safe to increase spending or when to briefly cut back.- Leverage the "Clinician Advantage" by using PRN or consulting work as a strategic buffer against market volatility.- Master the tax window between stopping full-time work and starting forced distributions.This episode can help you avoid costly mistakes while understanding how to adjust your spending without feeling stuck. #CRNAs #NursePractitioners #RetirementPlanningKey Timestamps:(0:18) Why the 4% Rule is the Wrong Tool(3:24) What the 4% Rule Is (and Is Not)(5:19) The Comfort Trap: Why We Use Rigid Rules(7:47) 5 Core Problems with the 4% Rule(12:30) Reframing Retirement as "Work Optional"(14:30) Step 1: Your Retirement Paycheck Timeline(15:52) Step 2: Finding Your Baseline Lifestyle Number(16:48) Step 3: Using Dynamic Spending Guardrails(17:52) Step 4: The Clinician Advantage (Optional Levers)(19:54) Case Study: Alicia and Jordan’s Guardrails Plan(22:14) The Elephant in the Room: Tax Strategy & RMDs(26:14) The Truth About Annuities For more information and resources related to this episode, please visit the show notes. 

You've worked long shifts, held everything together in high-stress situations, and saved diligently for 25 years. You think you're on track for retirement. But what if investment mistakes you don't even know you're making could force you to work five to seven more years?In this episode, Brett Fellows reveals the shocking truth about a CRNA couple with nearly $2 million in their 403(b) accounts who discovered they'd need to work an extra five to seven years because of investment decisions they'd made over the years. That's five to seven more years of night shifts, five to seven more years of being on call, all because of mistakes that could have been avoided..Today's episode walks through the 10 biggest investment mistakes that cost nurses real years of their lives. Brett covers::Mistake #1: Trying to time the market (costs 3-4% annually, nearly $1M over 30 years)Mistake #2: Letting emotions drive your decisionsMistake #3: Not having proper diversificationMistake #4: Paying excessive fees and costs (a 1% fee difference costs $600,000+ over 30 years)Mistake #5: Chasing past performanceMistake #6: Not reinvesting dividendsMistake #7: Ignoring tax efficiencyMistake #8: Active stock picking instead of evidence-based investingMistake #9: Not rebalancing your portfolioMistake #10: Investing before addressing financial basicsIf you're making these mistakes, you might be adding years to your working life without even realizing it. This episode will show you exactly what to fix and how to get your retirement back on track. #CRNAs #NursePractitioners #RetirementPlanning #InvestmentMistakes Key Timestamps:(0:18) Welcome and Introduction(4:18) Mistake #1: Trying to time the market(5:50) Mistake #2: Letting emotions drive your decisions(7:20) Mistake #3: Not having proper diversification(8:55) Mistake #4: Paying excessive fees and costs(10:20) Mistake #5: Chasing past performance(11:40) Mistake #6: Not reinvesting dividends(12:41) Mistake #7: Ignoring tax efficiency(14:08) Mistake #8: Active stock picking instead of evidence-based investing(15:30) Mistake #9: Not rebalancing your portfolio(16:40) Mistake #10: Investing before addressing financial basics(18:40) Actionable steps and conclusionFor more information and resources related to this episode, please visit the show notes. 

If you are a high-earning nurse making $120,000 as NP or over $200,000 as a CRNA, you probably think Medicare will be simple and affordable because you have paid your taxes for decades. However, many nurses are shocked to receive premium notices for $649 per month instead of the standard $202. This episode breaks down the "IRMAA" surcharge and why your income from two years ago dictates what you pay for Medicare today.Brett explores:The definition of IRMAA and why it treats high-earning nurses as if they haven't paid their fair share.Why your 2026 Medicare premiums are based on your 2024 tax returns.The specific 2026 income thresholds for single and married filers.Five specific strategies to potentially reduce or eliminate these surcharges.How to use the appeals process if you have recently retired or seen a drop in income.By the end of this episode, you will have a roadmap to avoid the "tax bomb" in retirement that triggers these expensive surprises.#CRNAs #NursePractitioners #Medicare #IRMAA #RetirementPlanningKey Timestamps:(0:38) Welcome to Money RX for CRNAs and NPs(1:22) The $10,000 Medicare surprise: A real-life case study(2:25) What is IRMAA? The income-related surcharge explained(4:03) Why the two-year look back catches nurses off guard(6:10) 2026 Medicare Part B premium brackets and thresholds(7:49) Strategy 1: Appealing due to life-changing events(8:21) Strategy 2: Using Qualified Charitable Distributions (QCDs)(8:50) Strategy 3: Strategic Roth conversions in gap years(9:25) Strategy 4: Leveraging 403(b) and 457 plan contributions(9:39) Strategy 5: Donor Advised Funds for tax deductions(11:05) Conclusion: Integrating Medicare into your retirement strategy For more information and resources related to this episode, please visit the show notes. 

If you're a nurse around age 50 thinking you can do this for about 10 more years, then this episode is for you. Burnout from nursing changes the game. When you're tired, you don't want more complexity in your life. You want a plan that creates options.Today, we're talking about five money moves to make in 2026. Not theory, not vague motivation, but real moves that you can implement. Each of these moves is designed for someone who is already responsible and a saver, but feels like the finish line keeps moving away from them.Brett explores:The "qualified rich, cash poor" trap and why maxing out retirement accounts can accidentally limit your flexibilityHow to use a "match first, then flexibility funding" strategy to build options before age 59.5Why Social Security isn't just a check but longevity insurance, and how to model your claiming strategyThe five year paycheck buffer framework that protects you from sequence of returns riskAsset location strategies that give you the same risk with better tax efficiencyHow to win the tax game during your gap years with Roth conversions and capital gains harvestingBy the end of this episode, you'll have a roadmap for making work optional in the next 10 years without being too afraid to spend what you've saved.#CRNAs #RetirementPlanning #FinancialFreedom #TaxPlanning #MoneyRXKey Timestamps:(0:37) Welcome to Money RX for CRNAs and NPs(2:35) Move 1: Avoiding the "Qualified Rich, Cash Poor" trap(4:40) The Flexibility Funding Plan: Building a second bucket(7:10) Move 2: Strategic Social Security planning beyond the "vibe"(9:20) Estimating benefits at age 62, FRA, and 70(10:19) Move 3: Building your retirement paycheck first(11:15) The five-year paycheck buffer framework(14:25) Move 4: Using asset location for better tax efficiency(18:05) Move 5: Winning the tax game in your "gap years"(19:30) Selective Roth conversions and ACA healthcare planningFor more information and resources related to this episode, please visit the show notes. 

What if the biggest risk to your retirement isn't running out of money, but spending too little? When you've accumulated $3 million through decades of hard work and discipline, the fear shifts from "Can we afford to retire?" to "How much can we spend without getting this wrong?"Brett covers:Why identical portfolios can lead to completely different retirement outcomesHow to calculate your true baseline spending (hint: it's more than you think)The role Social Security plays in reducing portfolio pressureSequence of returns risk: why timing matters more than disciplineThe hidden dangers of both lifestyle inflation and accidental underspendingWhy flexibility beats precision in retirement planningHow to build a resilient plan that adapts without panicFind out why the most successful retirements aren't built on rigid withdrawal rates but on intentional decisions that align your money with your values. Your portfolio is a tool (not a limiter) for the life you want to live.#RetirementPlanning #FinancialPlanning #CRNA #PortfolioManagement Key Timestamps: (0:38) Welcome to Money RX for CRNAs(2:23) Case Study: David and Anne’s $3M Portfolio(3:38) Determining True Baseline Lifestyle Spending(5:03) How Social Security Reduces Portfolio Pressure(5:37) Reframing Retirement as an Annual Cashflow Problem(7:27) Introducing Susan: Sequence of Returns Risk(10:03) Karen’s Story: The Risk of Structural Lifestyle Inflation(12:02) Tom’s Story: The Cost of Accidental Underspending(14:22) Kevin and Laura: Building a Resilient vs. Precise Plan(15:58) Retirement as a System of Behavior and Alignment(20:13) Conclusion: $3 Million is a Tool for Choice, Not a LimitFor more information and resources related to this episode, please visit the show notes. 

"I can't retire early because of healthcare." If this is the voice holding you back, this episode changes everything.Healthcare costs terrify so many CRNAs approaching early retirement. You've saved enough money, you're burned out, and these are your good health years. But one fear keeps you working: what if healthcare costs blow up your plan?In this episode, Brett reveals why healthcare shouldn't delay your early retirement and shows you the one number that simplifies everything. Once you know how MAGI (Modified Adjusted Gross Income) works, healthcare becomes predictable math instead of an expensive mystery.We explore:The one number that controls your health insurance costs before Medicare.What counts as taxable income and what doesn't in retirement.Real-life case studies showing couples retiring before 65, spending six figures, and keeping healthcare affordable.How the healthcare subsidy cliff works and recent rule changes you need to know.Why being "qualified rich, cash poor" limits your healthcare options.The three biggest levers you can pull during the retirement gap years.A simple framework to decide if healthcare should keep you working or if you're more ready to retire than you think.Two people can spend $100,000 per year, but one pays full price for healthcare while the other receives massive subsidies. Same lifestyle, completely different premiums. The difference? Understanding MAGI and structuring withdrawals correctly.Whether you're in your late 50s or early 60s, this episode gives you the roadmap to make healthcare planning manageable and stop letting it delay the retirement you've earned.#CRNAs #EarlyRetirement #HealthcarePlanning #MAGI #AffordableCareActKey Timestamps:(0:45) Brett explains why healthcare shouldn't delay your retirement goals.(2:55) Why the ACA cares about your reported income rather than savings.(5:10) Breaking down taxable vs. tax-free money buckets for spending.(7:10) Example of maintaining a six-figure lifestyle with high subsidies.(10:35) How crossing the subsidy cliff "light switch" can cost thousands.(11:50) Stress-testing a retirement portfolio against high premium estimates.(14:15) The danger of maxing pre-tax accounts without tax diversification.(16:05) Top three levers to pull during the early retirement gap.(17:15) A practical checklist to evaluate your current retirement readiness.(20:30) Closing thoughts on taking control of your healthcare math.For more information and resources related to this episode, please visit the show notes. 

Many CRNAs hit the $1 million savings mark and assume they are automatically ready to retire.While reaching that milestone is a huge achievement, retiring well isn't just about the balance in your accounts. It is about timing, flexibility, and protecting yourself from the hidden dangers that appear in the final decade of your career.In this episode, Brett Fellows, CFP®, shares five powerful moves you should make before you retire if you have saved over $1 million. These aren't generic tips; they are strategies derived from real-life case studies and years of planning with CRNAs.Brett explores:Why two retirees with the exact same portfolio can have completely different outcomes based on "sequence of returns risk"Why the 4% rule is outdated and what to use insteadThe "Freedom Account" strategy that allows CRNAs to retire years before age 59½Why you should lock in liquidity (like a HELOC) while you still have W2 incomeHow to handle the "Fragile Decade" and guard against lifestyle inflation in your "go-go" yearsKey Timestamps:(0:37) Intro: When does work become optional? (2:00) Step 1: Run your numbers early (The Fine-Tuning Stage) (2:35) Sequence of Returns Risk explained (3:35) Why the 4% Rule is outdated (5:30) Step 2: Build a Brokerage Account (The Freedom Account) (7:30) Step 3: Lock in liquidity before you retire (9:15) Step 4: Tackle big expenses during the "Fragile Decade" (11:15) Step 5: Guard against lifestyle inflation (12:50) Creating intentional spending guardrails (13:25) Recap of the 5 stepsFor more information and resources related to this episode, please visit the show notes. 

What if you’re making a Social Security benefits mistake that could cost you 5 figures?It almost happened to a CRNA.Brett Fellows recently reviewed a retirement plan with a couple where the wife had worked full-time as a CRNA for 25 years while her husband worked part-time to raise their children. They assumed that because he had his own earnings history, he could not claim spousal benefits. That single assumption was a mistake that could have cost them tens of thousands of dollars over their lifetime.In this episode, Brett Fellows, CFP®, breaks down exactly how Social Security spousal benefits work and why they are critical for CRNA couples to understand.Brett explores:The fundamental rules of claiming 50% of a spouse's benefitWhy CRNAs with "gap years" or early retirement dates are specifically affectedThree real-world scenarios: The Traditional Family, The Dual High-Earner Couple, and The Career Gap SituationThe "Social Security Tax Tsunami" and how spousal benefits impact provisional incomeThe four biggest mistakes couples make, including claiming too early and failing to coordinate with tax planningKey Timestamps:(0:45) The costly mistake Sarah and Mark almost made (2:05) Fundamentals: How spousal benefits actually work (2:53) The 50% cap and full retirement age rules (4:05) Why the primary earner must claim first (5:35) Why this matters specifically for CRNAs (8:00) Scenario 1: The Traditional CRNA Family (9:45) Scenario 2: The Dual High-Earner Couple (10:35) Scenario 3: The Career Gap Situation (11:40) The Social Security Tax Tsunami (14:15) 4 common mistakes CRNA couples makeFor more information and resources related to this episode, please visit the show notes. 

We constantly hear headlines about how Americans are undersaving for retirement. While that is often true, there is a side of the story that rarely gets discussed. What happens if you never stop saving?For many high-income CRNAs, over-saving can quietly cost you in unexpected ways. You might find yourself with less time, fewer experiences, and missed opportunities with your family.In this episode, Brett Fellows, CFP®, shares the surprising truth about when you should stop saving for retirement. He breaks down two powerful financial principles: compound growth and opportunity cost. He also names the five clear signs that it is time to stop saving and start living.Brett explores:Why money should be viewed as a tool rather than the ultimate goalHow compound growth shifts the heavy lifting from you to your portfolioThe real opportunity cost of maxing out retirement accounts year after yearThe "moving goalpost" trap that leads to regretFive specific instances when stopping contributions makes financial sense#CRNAs #RetirementPlanning #FinancialFreedom #Podcast #WealthManagementKey Timestamps:(0:35) Intro: The surprising truth about saving (2:35) Two principles: Compound Growth and Opportunity Cost (4:10) The Snowball Effect: When your money takes over (6:40) Opportunity Cost: What you are giving up today (12:20) Sign #1: You are already in a position to retire (13:15) Sign #2: You are on track to hit your number (14:35) Sign #3: You are sacrificing the most important things today (15:55) Sign #4: Legacy goals are not a priority (17:05) Sign #5: You no longer need the tax benefits (18:10) The Aligned Life: A new goal for your moneyFor more information and resources related to this episode, please visit the show notes. 

You may have heard the general rule of thumb for retirement withdrawals: Spend your taxable accounts first, then tax-deferred accounts, and save your Roth IRAs for last.While there IS truth to that logic because it preserves tax-favored money, it fails to address how to minimize your overall tax bracket throughout retirement.In this episode, Brett Fellows, CFP®, explains why the conventional withdrawal sequence can accidentally push you into higher tax brackets year after year.Brett explores:The three deeply ingrained beliefs that cause CRNAs to fall into a tax trapWhy account preservation is the wrong metric for successA real-world example of how a single withdrawal can double your tax rateThe three "buckets" of money you need to understand: taxable, tax-deferred, and tax-freeA 4-step strategic approach to managing your withdrawalsHow to manage long-term impacts like RMDs and Medicare surchargesKey Timestamps: (0:00) The problem with the "general rule of thumb" (1:02) Three beliefs that create a retirement tax trap (1:31) Example: How to accidentally double your tax bracket (2:45) Creating your own paycheck in retirement (4:20) The ideal approach: Managing tax brackets (4:40) The three buckets of money (Taxable, Deferred, Tax-Free) (5:35) Step 1: Identify your fixed income sources (6:02) Step 2: Calculate your shortfall (6:27) Step 3: Strategic withdrawal planning (7:35) Step 4: Consider long-term impacts (RMDs and Surcharges) (10:14) Tax gain harvesting and Roth conversionsFor more information and resources related to this episode, please visit the show notes. 

You've likely heard the advice: wait until age 70 to claim Social Security for the biggest check and safest retirement. But is that really the best choice for CRNAs?In this episode, Brett Fellows, CFP®, dives into the overlooked risks of delaying Social Security, proving the decision is far more personal than a break-even chart suggests. It's about maximizing dollars yes, but it’s also about your freedom, health, and peace of mind in retirement.In this episode, Brett explores the overlooked risks of delaying Social Security:Mortality Risk: What if you pass away before the break-even point?Sequence of Returns Risk: How delaying can magnify portfolio damage during a market downturn.Policy Risk: The chance of future benefit cuts or changes to taxation.Opportunity Risk: The potential returns your portfolio could have earned while waiting.Regret Risk: The emotional cost of waiting too long and giving up healthy retirement years.Health Span Risk: Why a dollar at 62 often buys richer memories than a dollar at 95.Spending Flexibility/Optionality Risk: Why preserving a flexible portfolio might be more valuable than a maximized Social Security check.Key Timestamps:(0:45) The 7 overlooked risks of delaying Social Security (2:01) Mortality Risk: What if you die before the break-even? (4:55) Sequence of Returns Risk: The danger of market downturns in early retirement (6:42) Policy Risk: Are future cuts a concern? (7:50) Opportunity Risk: The true cost of delaying (9:58) Regret Risk: Why emotions matter more than math (11:55) Health Span Risk: Living well, not just living long (13:59) Spending Flexibility Risk: The value of optionality (15:45) Underspending Risk: Why claiming early helps you enjoy your healthiest years (18:20) Real-world examples: Why claiming early made sense for Mark and JenFor more information and resources related to this episode, please visit the show notes. 

Cole Dill and Tanner Hulin, co-founders of Core Anesthesia, join the podcast to share the unexpected story of how their study conversations turned into a leading educational platform used by 75% of current CRNA students nationwide.Cole and Tanner discuss the raw, scrappy start of their business, from recording terrible quality audio in their car to cashing out almost everything they made to fuel product development. They also detail the strategic acquisition by Archer Review in 2025, which provided the financial and mental capital to take their business to the next level.Brett and the founders discuss:The organic origin of Core Anesthesia from simply trying to help themselves get through school.The early financial strategy of pricing their premium content at $4.99 a month and fueling growth by continually reinvesting cash flow.The challenge of running a business while being "broke college students" and the need to fuel the business before paying themselves.The experience of going through the Archer Review acquisition and why they chose to stay involved rather than make a complete exit.The importance of a business partnership being like a marriage, built on shared goals and mutual grace.Cole's most important financial advice: adopt the mindset of an investor, not a consumer, after graduation.Their exciting Q4 2025 partnership with Global Blade 3D, a nonprofit sending low-cost, 3D-printed video glidescopes to underserved communities.#CRNAs #Entrepreneur #FinancialAdvisor(0:45) Welcome & Meet Core Anesthesia Co-founders(2:15) The Organic Start: From Car Study Sessions to Spotify(4:50) Launching the Podcast & Naming the Business(7:32) Early Financial Strategy: Pricing at $4.99/month(9:49) Advice to Their Younger Selves: Take the Step, Even if It's Not Perfect(15:18) The Archer Review Acquisition (May 2025)(19:30) Why They Didn't Make a Complete Exit(22:23) 3-Year Vision: Reaching CRNAs and Program Directors(25:42) How to Handle a Business Partnership (Like a Marriage)(34:42) Financial Advice: Be an Investor, Not a ConsumerFor more information and resources related to this episode, please visit the show notes. 

Jenny Finnell, CRNA, founder and CEO of CRNA School Prep Academy (CSPA) and Teach RN, joins the Money RX for CRNAs podcast to discuss her journey from clinical CRNA to building a dual-business enterprise. Jenny shares the organic, passion-driven story behind CSPA, which has mentored almost 10,000 ICU nurses pursuing CRNA school in just five years, and explains how she launched the scalable peer-to-peer marketplace, Teach RN, to support the broader nursing profession. This special episode offers candid advice on the hard financial realities, business lessons, and unique challenges of juggling a family, clinical work, and two growing businesses by prioritizing being "fulfilled" over "busy".Brett and Jenny discuss:The accidental founding of CRNA School Prep Academy and its massive, organic growth.The shift to Teach RN, a scalable peer-to-peer marketplace, to meet nurse demand for support.The business model for both ventures and the future potential for institutional partnerships.Key business lessons, including the risk of scaling a team too quicklyThe current trends in CRNA education.Financial advice for new CRNAs on managing debt and living conservatively.The power of community and its role in achieving an 80% acceptance rate for Academy members.Jenny's biggest piece of advice to her past self and to all aspiring entrepreneurs: "Don't be so afraid".If you found this episode inspiring, please leave a review and share it with your colleagues.#CRNAs #Entrepreneur #FinancialAdvisorKey Timestamps: (0:46) Welcome & Meet Jenny Finnell, CRNA(1:45) The Journey to CRNA School Prep Academy & Her "Why" Story(3:48) CRNA School Prep Academy Business Model & Future Institution Partnerships(6:02) Business Milestones & The Importance of Support and Coaching(8:05) 3-Year Vision for CRNA School Prep Academy(9:15) Expanding into Broader Nursing Education with Teach RN(14:40) Biggest Financial Lessons Learned as an Entrepreneur(17:44) Advice to Intimidated CRNA Entrepreneurs: "Don't be so afraid"(28:34) Measuring Success: The 80% Acceptance Rate for Academy Members(37:09) The Massive Impact of Building CommunityFor more information and resources related to this episode, please visit the show notes. 

Download your Retirement Readiness Checklist here: https://moneyrxforcrnasnewslettersignup.kit.com/4764a9941dHow much money do you really need to retire as a CRNA? If you've got savings but still feel uncertain about when you can safely stop working, this episode is for you.Brett explores:The three retirement spending levels every CRNA needs to understand (survival, comfortable, and premium)Why retiring at 55 versus 65 can mean a $1.75 million difference in required savingsThe asset location strategy that could save you $300,000 in retirement costsThe healthcare gap problem and how to bridge the 10 years before MedicareThe Rule of 55 versus the 59½ penalty wallA systematic approach to calculate your true spending needs and portfolio requirementsThe tax trap of massive Required Minimum Distributions and how to avoid itTax-diversified withdrawal strategies including the 0% capital gains bracketRealistic retirement ranges for CRNAs at different spending levelsWhether you're sitting on $800,000 or $2.1 million, you'll see why the amount you've saved might not be the real issue and what you should focus on instead.#CRNAs #RetirementPlanning #FinancialFreedom #HealthcareProfessionalsKey Timestamps:(0:47) How much money do I really need to retire?(1:49) The reality of CRNA career demands and early retirement(2:53) The three retirement spending levels(4:22) Retirement numbers for $\$10,000$ per month after taxes(5:27) The asset location strategy most CRNAs miss(6:08) The healthcare gap problem before Medicare(6:33) The Rule of 55 vs. the 59-and-a-half penalty wall(7:48) Systematic approach: Calculate your true spending and portfolio needs(9:48) The tax issue and massive Required Minimum Distributions (RMDs)(10:50) Tax-diversified withdrawal strategy (0% capital gains bracket)(12:09) Realistic retirement ranges for CRNAs(13:48) The goal: Accumulate enough money to retire on your termsFor more information and resources related to this episode, please visit the show notes. 

Download your Retirement Readiness Checklist here: https://moneyrxforcrnasnewslettersignup.kit.com/4764a9941dIf you're a CRNA, chances are a big part of your retirement nest egg is tied up in your 401(k) or 403(b). But many healthcare professionals have no idea what to do with that money once they retire to make sure it works best for them.Here's the problem: There are three critical decision points that will either maximize your retirement wealth or quietly drain it away over the next 20 to 30 years. These decisions seem simple on the surface, but they're loaded with hidden traps that most people never see coming. Getting even one of these wrong could easily cost you six figures in unnecessary fees, taxes, or lost opportunities.In this episode, Brett walks through the strategic rollover framework that addresses all three critical decision points and helps you navigate the choices about your old retirement accounts without making costly mistakes.Brett explores:The hidden cost trap that's draining thousands from your retirement accounts each yearWhy control and flexibility matter just as much as low feesThe consolidation challenge facing CRNAs who have worked for multiple employersThe strategic rollover framework for optimizing your 401(k) or 403(b)Two critical considerations before making any moves with your moneyHow to evaluate your options carefully and make the choice that aligns with your goalsThese decisions can have a huge impact on your taxes, your flexibility, and your peace of mind in retirement. Don't rush the process.Have questions about your retirement accounts? Reach out through the link in the show notes, and download the free Retirement Readiness Checklist.#CRNAs #RetirementPlanning #401k #403b #WealthManagementKey Timestamps:(0:44) Welcome: The Six-Figure Risk of Making the Wrong Rollover Decision(1:43) The Three Critical Decision Points (Cost, Control, Consolidation)(2:22) Decision 1: The Cost Trap (The $15,000 Annual Fee Example)(3:36) Decision 2: The Control Dilemma (Ease of Access and Flexibility)(4:56) Decision 3: The Consolidation Challenge (Collectors of Accounts)(6:05) The Strategic Rollover Framework (Three Steps)(8:52) Critical Consideration: The Age 55 Rule (Penalty Free Access)(9:27) Conclusion: The Framework Addresses the Three ChallengesFor more information and resources related to this episode, please visit the show notes. 

You survived the grueling school years, mastered one of healthcare's most demanding roles, and saved diligently for decades. Now you're staring at your account statements showing seven figures and asking yourself the million-dollar question: Can I finally retire at 60?But when many CRNAs with substantial savings seek answers to retirement planning, they often fall into the million-dollar retirement trap. This is where high-earning professionals become paralyzed by the gap between having a lot of money and knowing whether their savings can sustain their lifestyle for potentially 40-plus years of retirement.In this episode, we walk through Jennifer's transformation. A CRNA who came to me convinced she needed to work until age 65 despite having $1.2 million saved at age 60. What she discovered about her retirement readiness completely shifted her perspective on when she could step away from clinical practice.Brett explores:The three fundamental misconceptions that keep CRNAs trapped in the million-dollar retirement trap.Why the 4% rule doesn't work for CRNAs retiring at 60.How to map your actual lifestyle instead of chasing arbitrary savings targets.The strategic withdrawal approach allowed Jennifer to retire at 61 instead of 65.The three key components of CRNA Retirement Reality Planning.How to confidently answer whether you can retire at 60 with $1 million.The answer for many CRNAs is yes, but it requires moving beyond generic advice to a personalized strategy that respects both your financial realities and your professional achievements.Click here to download the Retirement Readiness Checklist: https://moneyrxforcrnasnewslettersignup.kit.com/4764a9941dKey timestamps:(1:00) Welcome and the million-dollar question(2:10) The million-dollar retirement trap explained(3:40) Jennifer's story(4:20) Three fundamental misconceptions(4:40) Misconception #1: Magic number obsession(6:00) Misconception #2: Withdrawal rate paralysis(7:20) Misconception #3: Healthcare cost catastrophizing(9:45) CRNA Retirement Reality Planning(10:05) Jennifer's transformation(13:50) Free retirement readiness checklist(15:05) Final message and closingFor more information and resources related to this episode, please visit the show notes. 

Dr. Joe Rodriguez, co-founder of Guide Anesthesia (managing over 150 providers) and a respected voice in the CRNA community, joins the podcast for a candid discussion on CRNA entrepreneurship, advocacy, and the true meaning of career success. Joe shares the origin story of his company, built from a single negative experience, and offers important lessons learned from operating in the complex healthcare market.This special episode covers what most CRNAs miss about building and securing a long-term career.Brett and Joe discuss:The experience that led to the creation of his 150-provider anesthesia group.The financial realities of starting your own business: why you must be prepared to fail and why there is "no work-life balance."The unique advantages of the 1099 model for autonomous CRNAs and the importance of hiring financial professionals.Why current regulatory advocacy is asking the "wrong questions" and how control should be handled at the local level.The two most important financial and career decisions a CRNA should make today.How to find long-term personal and professional purpose.If this episode helps you rethink your career, please leave a review and share it with a colleague who is considering entrepreneurship or a leadership role.Key Timestamps:(0:45) Welcome & Meet Dr. Joe Rodriguez(1:35) Why I Started Guide Anesthesia(8:25) The Anesthesia Group Business Model(14:35) Building CRNA Ownership and Long-Termism(16:20) Future Goals: Operating in the Mid-Cap Lane(20:05) Financial Realities of Starting Your Own Group(24:17) Regulatory Advocacy: Asking the "Wrong Questions"(28:08) 1099 vs. W2: Key Financial Factors(31:03) Leadership: The Power of Communication(43:03) The Most Important Financial Decision You Can Make#CRNAs #CRNAEntrepreneur #1099CRNA #AnesthesiaBusiness #AdvocacyFor more information and resources related to this episode, please visit the show notes. 

You should be proud of yourself for saving $2 million for retirement, but instead, you're terrified. The problem? You don't know how much you can spend. A couple, Sarah and Mike, found that their initial plan with a 12% withdrawal rate would have left them broke by age 75. With a few strategic changes, their retirement plan not only worked, but it also allowed them to retire years earlier than they thought.In this episode, we use their example as a case study to show you how three key changes can mean the difference between struggling and living the lifestyle you've earned.Brett explores:Why a high withdrawal rate can decimate a portfolio in the first few years.How a realistic look at your expenses can extend your retirement savings.The importance of optimizing your portfolio allocation for a long retirement.The power of tax optimization and Roth conversions during your early retirement "gap years".A spending framework for CRNAs with $2M in savings.A bonus scenario showing how a sensible plan can make early retirement possible.Have questions about your own retirement plan? Let us know, and please share this episode with a friend or colleague who needs to hear it. Key Timestamps:(0:53) The $2 million question(3:02) Their flawed first retirement plan(4:40) The three strategic changes(6:02) Change #2: Optimizing portfolio allocation(8:35) The new successful plan(10:28) What this means for you: spending framework(12:24) Unique advantages and challenges for CRNAs(14:49) Final message and outro#CRNAs #RetirementPlanning #FinancialFreedom #RetirementSavings #WealthManagementFor more information and resources related to this episode, please visit the show notes.