MoneyRx for CRNAs and NPs

A hospital-employed CRNA or nurse practitioner with a 403(b), an HSA, and a taxable brokerage account can fund all three on schedule for years and still lose ground to taxes because of what sits inside each one. In this episode, Brett Fellows, CFP®, walks through a setup he sees often with W-2 APRNs in their 40s and 50s. He shows how a coordinated swap across the three accounts can add up to six figures over 20 years without raising contributions or adding risk.

Brett Covers:

• The four leaks researchers keep finding in high-net-worth portfolios, and the one a W-2 APRN can fix this year
• Why hospital-employed APRNs have less room for error than 1099 and locums clinicians with a solo 401(k)
• How the 403(b), HSA, and taxable brokerage account are each taxed, and which investments belong in each
• What Morningstar's research shows about the tax cost of actively managed funds compared with low-turnover index funds
• A 20-year example built on a $55,000 HSA and a $150,000 brokerage account
• When a shorter timeline calls for keeping more bonds
• Three account checks to run in 2026, plus what to weigh before selling anything in a taxable account

Key Timestamps:

(0:00) Intro

(0:19) Four leaks that drain portfolio returns

(1:32) The four leaks researchers keep finding

(3:39) Why W-2 APRNs have less flexibility than 1099 clinicians

(4:31) The account setup Brett sees over and over

(6:13) How each account gets taxed

(9:07) The three-account fix

(9:43) A 20-year example across all three accounts

(13:33) When your timeline is shorter

(15:42) Your 2026 action steps

(19:12) How to get your accounts reviewed

For more information and resources related to this episode, please visit the show notes. 

CRNAs and nurse practitioners often spend decades with an employer sorting out their taxes automatically. Retirement hands that job to you, along with a set of rules a W-2 career never prepares you for.

In this episode of MoneyRx for CRNAs and NPs, Brett Fellows, CFP®, walks through the income types that show up once you stop working, how ordinary income and capital gains get taxed differently, and costs like the Medicare IRMAA surcharge that catch a lot of long-time W-2 employees off guard.

Brett Covers:

• What stops the moment your paycheck does, and what steps in to replace it
• How ordinary income and capital gains get taxed at different rates
• Why up to 85% of a Social Security benefit can end up taxable
• The net investment income tax and the Medicare IRMAA surcharge
• Why none of your retirement income is automatically taxed unless you ask for it

Key Timestamps:

(0:18) Why retirement taxes work differently than W-2 taxes

(4:13) What disappears the moment you stop working, and what replaces it

(6:05) Ordinary income versus capital gains, the basic distinction

(7:42) How Social Security benefits get taxed

(9:14) Traditional accounts, Roth accounts, and the RMD deadline

(12:22) Interest, dividends, capital gains, and rental income

(17:37) The net investment income tax and the Medicare IRMAA surcharge

(19:43) Why nothing withholds automatically once you retire

(21:04) A hypothetical nurse practitioner's withdrawal order decision

(26:27) One takeaway to build your account list

For more information and resources related to this episode, please visit the show notes. 

A CRNA sprinting from her early 30s into a target retirement at 55 doesn't get the standard five-year window to de-risk her portfolio. Retirement planning usually builds that window around a traditional 35 to 40 year career, so for a CRNA on a compressed timeline, the riskiest stretch can already be underway more than a decade before she stops working.

In this episode of MoneyRx for CRNAs and NPs, Brett Fellows, CFP®, walks through why a shorter working career changes the math behind the standard retirement red zone, then builds out a hypothetical 42-year-old CRNA's glide path and withdrawal rate to see what the numbers look like up close.

Brett Covers:

• Why a shorter working career pulls the retirement red zone earlier for a CRNA
• Sequence of returns risk, and why the timing of a downturn carries more weight than the average return
• The bond tent strategy, spread across a full 13-year runway instead of five
• The Guyton-Klinger guardrail system, and what a 7.5% withdrawal rate risks on a $2M portfolio
• Three levers for adjusting the plan, covering timeline, withdrawal rate, and savings rate

If you're planning around a shorter runway to retirement, this episode walks through the math before you lock in a number.

Key Timestamps:

(0:18) Why the standard five-year retirement red zone doesn't fit a CRNA's timeline

(3:01) Why the usual retirement safety net works differently for a CRNA

(4:14) Sequence of returns risk and why timing outweighs average returns

(6:31) The retirement red zone concept and the bond tent solution

(8:42) Building a 13-year glide path for a hypothetical CRNA

(14:49) Running the guardrail withdrawal math on a $2M portfolio

(17:25) Three levers for adjusting the retirement plan

(20:50) The practical step to run your own withdrawal rate

For more information and resources related to this episode, please visit the show notes. 

A stock and bond mix based on your age can only carry a retirement so far. In this episode, Brett explains why retirement runs on income rather than investment performance, and why that distinction carries extra weight for CRNAs and nurse practitioners juggling multiple account types, variable per diem income, and no pension to lean on. He covers the essential-versus-flexible spending framework, how Social Security fits as a deliberate income decision, the malpractice tail coverage bill that catches many retiring clinicians off guard, and a full hypothetical walking through how it all comes together for a 62-year-old CRNA closing out her practice.

This is illustrative only and not a substitute for an individualized financial plan.

Key Timestamps:

(0:18) Why a stock-and-bond mix isn't a retirement plan

(4:46) The cookie-cutter retirement plan, and why it doesn't hold up for CRNAs and NPs

(6:25) Building the income-first plan: essential versus flexible spending

(9:31) Social Security as an income decision, not a default setting

(10:30) Why multiple retirement accounts complicate withdrawal order for CRNAs and NPs

(12:46) The malpractice tail coverage bill most retirees never plan for

(15:16) A hypothetical: sequencing income for a 62-year-old CRNA

(17:15) Claim early, wait, or bridge the gap: running the numbers

(20:09) The one thing to take from this episode

(22:28) Closing: what your income needs to cover, and when

For more information and resources related to this episode, please visit the show notes. 

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 numbers

For 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 saved
• What a safe withdrawal rate supports on a $2,800,000 portfolio for someone who retired at 55
• Three specific purchases, a 529 gift, an international trip, and a home renovation, this plan could fund without putting it at risk
• Why pulling the same $50,000 from a 401(k), a Roth, or a taxable brokerage account produces three different outcomes at tax time
• The Medicare and ACA subsidy cliffs that can turn a single large withdrawal into a five-figure surprise
• Loss aversion, the one more year syndrome, and why the instinct to keep working can outlast the need to
• A simple 1% exercise for finding your own spending number and using it on purpose

Key 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 number

For 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 time
• How a portfolio drifts from its target allocation without a single decision causing it, shown with a real dollar example
• Calendar-based vs. threshold-based rebalancing, and the tax difference between rebalancing in a 401(k)/IRA vs. a taxable brokerage account
• What 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 drop
• Sequence of return risk, the "Red Zone," and how retirement age and funding level change how much cushion a plan needs
• How to size a speculative investment sleeve without putting the actual retirement plan at risk

Key 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 buckets

For 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 dollars
• Why that number translates to about $30 a month in retirement income once it's run through a conservative withdrawal rate
• Why an oversized cash cushion builds up so easily on PRN and locum income
• How redirecting unused cash into a 403(b) and backdoor Roth IRA over eighteen years can grow to roughly $180,000
• The 2026 contribution limits for a 403(b) and backdoor Roth IRA, and how much space typically goes unused
• A bank statement exercise for finding a real emergency fund number this week

Key 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 Brett

For 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 one
• The Social Security earnings test: how much you can earn before benefits get withheld, and why that money isn't gone forever
• The permanent 30% reduction tied to claiming at 62, and why it never resets once the PRN shifts stop
• How a higher earner's claiming age sets the survivor benefit floor for a spouse, walked through with real numbers
• The ACA subsidy cliff at 400% of the federal poverty level, and how a Social Security check can push a household over it
• A three-number framework to run before you file for benefits

Key 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 Brett

For 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 bill
• How much is enough, and why the number itself is rarely the hard part
• Social Security as a one-way door, and why the claiming decision changes the math on everything else
• The healthcare gap before Medicare, and the shadow tax created by a Roth conversion in the wrong year
• Withdrawal order once the paycheck stops, and why the sequence matters as much as the total
• The honest reason Brett keeps making this show, a hundred episodes in

New 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 #RothConversions

For more information and resources related to this episode, please visit the show notes.