Case Study: Orthopedic Surgeon Builds Practice, Weighs Strategic Options


We first met this orthopedic surgeon when he was a newly minted graduate from his residency program, and we have been partnering with him on his life journey ever since (5 years). He comes from a large low-to-middle class family with a lot of siblings, which perhaps explains his attention to detail and propensity to save. Unlike most of our physician/surgeon clients who have seen the increasingly complex regulatory environment erode their income and take away their autonomy, this client has seen his compensation increase nearly every year that he has been with the practice. Not unlike one of our other clients (see case study), his group was approached to sell part of his practice that was not core to their specialty. Furthermore, after having a daughter and a son, they had decided their family was complete. A baby girl scuppered that plan and surprised them, four years after they thought they were done having children.

How Did We Help?

We started by educating this client on the benefits of diversifying the family’s wealth. We created a quarterly investment strategy which augmented his defined benefit and 401(k) plan.  While his quarterly bonuses are variable in nature, and other investment opportunities (real estate, storage facility, restaurant equity) present themselves regularly, this couple has been consistently setting money aside in their 401(k)s, his defined benefit plan, and also investing in non-deductible IRAs (later to be converted to Roth IRAs).

Our client's defined benefit plan remains a significant portion of their overall financial goal plan, but as their practice has weighed strategic options, they have also decided to re-configure the plan, thus freeing up the existing defined benefit plan to roll over to an IRA. We integrated this asset into their overall portfolio, and along with other opportunistic investments, continue to update their plan and maintain a current net worth statement. They appreciate the organization and accountability aspect, especially while in the throes of chasing three kids to basketball, swimming practice, dance classes and having call duty on weekends.

When they were approached by a corporate aggregator that was “rolling up” orthopedic practices, we helped him evaluate the pros and cons of selling. Once again, the merits of the deal came down to how tenured you were at the practice, and how long you had to meet or exceed the capital inflow that selling this part of the practice might bring. Importantly, this would change the work dynamic of the practice as the orthopedics no longer would work for the practice directly.


The group (and our client) sold the unit, and we worked with him to build the proceeds into his plan. The practice started a new cash balance defined benefit plan and we helped his Investment Committee think through allocation options. His family is thriving, but like all young families, they continue to struggle with managing their work-life balance. Family vacations are compulsory for staying in touch and we trade notes on how to coach our children to understand that they are not likely to be the next Lebron James, Missy Franklin, or Lance Berkman.