Editors’ Note: From time to time, this column presents articles related to business and legal interests relevant to orthopaedic surgeons. Here, guest authors David Mandell and Jason O’Dell present financial, legal, and corporate strategies that will be of interest to many orthopaedic practices.

Financial Planning Gridlock:
Over the past few years, we have addressed potential strategies that a doctor can use to reduce income taxes, increase benefits, or build retirement savings. In that time, we have also had the opportunity to consult with hundreds of medical groups on how to implement such strategies for their practice. Unfortunately, the outcome of such consultations can sometimes turn out to be less than fruitful because of office politics related to the age-related perspectives of practice partners.

Typically, while the younger members of the orthopaedic groups are often very motivated to reduce their income taxes, the older doctors are often uninterested. Either the older partners are already so close to retirement that they don’t need extra retirement planning or they may be simply set in their ways and don’t want to change anything, i.e.,subscribing to the old “if it ain’t broke, don’t fix it” mindset. The result in such situations can be planning gridlock.

Unfortunately, for the younger physicians, the long-term costs of such gridlocks are significant – as they will have to work more years to reach the same retirement goals as their older partners. The so-called “golden days” of medicine are over, and these new times demand more creative planning. Nonetheless, each year we meet with hundreds of motivated doctors who cannot implement the planning we recommend because the powers-that-be in their group stand ready to thwart attempts at change.

We decided to write this article to suggest some alternatives to this dilemma. If you see yourself in this situation, please do not hesitate to contact us. Some solutions to the problem described above follow.

Use a Hybrid Benefit Plan
You should consider using a hybrid benefit plan, in addition to a traditional qualified plan (401(k), profit-sharing plan, defined benefit plan). The main attraction of a hybrid benefit plan is that each physician can choose the amount he/she wants to contribute in the plan formula. This can vary from $150 to $100,000 per year.

Simply because physicians can participate at their desired level, this plan is the only advanced technique (and it’s not really very advanced) that we have successfully implemented for a medical group larger than 4 doctors. The reality is that each surgeon has to deal with personal situations and individual overhead. Logically, each doctor needs more/less spending money than others. Physicians who feel like they are hamstrung by their group in their ability to reduce taxes and save for retirement may have a hybrid benefit plan as a practical alternative. Other benefits to this type of plan include:

• Utilization of the plan in addition to a qualified plan, such as pension, profit-sharing plan/401(k) or SEP IRA;
• Contributions can qualify for current tax deductions;
• The plan acts as an ideal “tax hedge” technique against future income, and capital gains tax increases
• Balances can grow in a top asset protected environment
• Employee participation requires a minimal funding outlay;
• There are no minimum age requirements for withdrawing income (no early withdrawal penalties);

Employ a more flexible corporate structure
Despite the availability of an elective benefit plan described above, we still see medical groups stuck in planning gridlock. Another way to address gridlock is to alter the practice’s legal structure so that it accommodates planning flexibility on the part of individual physicians.

In the typical medical group structure, there is one legal entity – whether it is a corporation, LLC, or professional association (PA). Physicians are either owners of the entity (informally referring to themselves as “partners”) or non-owner employees. In all such cases, the physicians have no ability to separate themselves from the central legal entity. If the central entity does not adopt a planning strategy, no individual doctor has any flexibility to adopt it on their own.

If this is the case in your practice,(as it is the case in many practices), you might consider an alternative structure when the central entity is not owned by, nor employs, the doctors directly, but rather is structured through their own professional corporations (PCs) or PAs. In this way, the group is paid by the insurers and the group, in turn, pays the physicians’ PCs – the payments are structured as 1099 independent contractor income.

From a tax standpoint, there is almost no downside to the central entity or to the doctors who are not motivated to engage in any additional planning. However, for the physicians who want to implement planning strategies, they may do so through their individual PCs. Their strategies will be implemented at the PC level, leaving the central entity unchanged, thereby avoiding conflict with partners. More to the point, such planning can give individual physicians the ability to put away $10,000-$50,000 more for retirement each year.

Bring in a consultant

In our business, we speak to over 1,000 physicians each year, many of whom experience the planning gridlock described in this article. Most practices that rely on internal resources to tackle financial gridlocks will end up identifying no solution to their dilemma. In such situations, outside help can be useful in helping surgeons realize their financial planning goals. Outside help can consist of advisors or consultants who convince the group to implement creative planning (including the solutions described here). These experts in the field of tax, benefits planning, or corporate law have the credibility and expertise to enlighten practice partners; much more so than fellow physicians. Additionally, outside financial consultants can explain the nuances of legal and accounting issues invoked by careful financial planning that can address the needs of individual partners. Thus, properly structured orthopaeadic practices should strongly consider using a firm or advisor who can bring in financial and legal expertise so that productive discussions can begin among partners.

Conclusion
If your practice is grappling with financial gridlock in a group practice or would like to explore advanced planning options, it may be that differential needs of various partners are at odds with each other. This article has presented some basic methods of dealing with such gridlock. Nothing can take the place of a professional trained and experienced in the fine points of financial planning for physicians. Authors welcome your questions,and can be contacted at (877) 656-4362 or at http://www.ojmgroup.com.


David Mandell is an attorney, lecturer, and author of five books for physicians. Jason O’Dell is a financial consultant, lecturer and author of two books for physicians. They are both principals of the financial consulting firm O’Dell Jarvis Mandell LLC (http://www.ojmgroup.com).