PracticalDermatology

In today’s medical economic environment, many physicians are attracted to the seeming “comfort” of a larger group practice, including dermatologists. However, larger groups often fail to react quickly and plan against challenges. In the vast majority of group practices with more than three or four physicians, they suffer from what we will call “lowest common denominator’ or “LCD” planning. LCD planning occurs when the practice will only implement the asset protection, tax-reduction, qualified or non-qualified planning techniques that everyone can agree on. This is not surprising—as doctors are notoriously independent, intelligent, and very busy. There are often too many opinions and distractions for a group of doctors to unanimously agree on anything other than the simplest (and least beneficial) strategies.

We have spoken to thousands of doctors who are frustrated with their practice’s LCD planning. The very physicians who want to implement more advanced and beneficial planning ideas are usually the same ones who are doing most of the work and generating most of the revenue for the practice. They are often “caught in the middle” in their practices. Their younger partners are usually busy paying off student loans or paying for a big new house. They can’t afford to fund retirement tools that may reduce taxes because they need every dollar they earn. Older doctors have the “if it ain’t broke, don’t fix it” mentality. The problem is that under the new medical economic environment, it is “broke.” The old ways cannot continue to be standard operating procedure.

If you are a dermatologist who would like your group to consider more proactive planning, this article is for you. It introduces a few concepts that can be implemented to help you avoid LCD planning and address these significant financial threats. We have seen these techniques work for solo practitioners up to very large groups. If any of these techniques are of interest to you and you would like to know more about how it may work for you, please do not hesitate to contact us for a free consultation.

1. Use a “Hybrid” Benefit Plan

If you are in a LCD situation, you should consider using a hybrid benefit plan in addition to a traditional qualified plan (401(k), profit-sharing plan, money purchase plan, or defined benefit plan). The main attraction of a hybrid benefit plan created under new pension rules is that each physician can choose the amount he or she wants to contribute in the plan formula. This can vary from $150 to $100,000 per year.

This simple plan can be implemented for a one-entity medical group with one, two, or even dozens of doctors. Other benefits of this type of plan include:

• Utilization of the plan in addition to a qualified plan like pension, profit-sharing plan/401(k), or SEP IRA;
• Contributions can qualify for partial net 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;
• There are no minimum age requirements for withdrawing income (no early withdrawal penalties).

2. Employ a More Flexible Corporate Structure

The plan above is the only significant plan a practice with a “one entity structure” (P.C., P.A., etc.) can utilize. This one entity structure promotes LCD planning gridlock. A common way to solve this problem is to alter the practice’s legal structure so that it allows individual physicians their own planning flexibility, without disrupting their day-to-day operations or requiring new insurance contracts or Medicare provider numbers.

In the typical medical group structure, there is one legal entity—like 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 flexibility to adopt beneficial corporate planning strategies for his or her benefit.

If this is the case in your practice, you might consider a superior structure. Doctors can own their share of the practice through their own professional corporations (PCs) or PAs. In this way, the group is paid by the insurers, pays its bills and overhead and then pays the physicians’ PCs—best through 1099 independent contractor income. For the physicians who want to implement planning strategies beyond LCD, they may do so through their own individual PCs without any impact to partners’ planning or operations. The strategies will be implemented at each doctor’s PC level, leaving the central entity and its operations unchanged. We have seen this strategy used successfully in some of the largest medical practices in the United States.

3. Bring in an Expert

In our interactions with more than 1,000 physicians each year, we find the most common hurdle to implementing advanced planning to be planning gridlock. Unfortunately, most find no solution to this dilemma as their practice planning gridlock is what stops them from creating a structure that allows them to avoid gridlock—a Catch-22. Because of practice politics, the doctors who are able to navigate past the gridlock generally have the help of outside experts (with whom none of the partners or other legal or tax advisors have any negative history). Experts in the fields of tax, benefits planning, and corporate law have the credibility and expertise that increase the probability that you will be able to convince your partners to “see the light” in a way that fellow physicians cannot. These advisors can often explain the suggested structure from attorney-to-attorney or CPA-to-CPA so that the local advisors are on board, agreeable, and involved in the planning. Often, we are asked to play such a role and are honored to be chosen to help physician practices. Whether you contact us or another advisor or firm that specializes in this type of planning, we strongly urge you to consider bringing in an expert to speak to your group to initiate productive discussions.

Conclusion: Push Your Partners Now

Financial success in the practice of medicine is harder than ever. Even if you are grappling with financial gridlock in group practice, you can explore advanced planning options to address these challenges. Share this article with your partners and order them a free copy of our book (see below) so they can become aware of the threats and potential solutions. n

To receive a free hardcopy of For Doctors Only: A Guide to Working Less & Building More, please call 877-656-4362. Visit www.ojmbookstore.com and enter promotional code PRDERM19 for a free ebook download of For Doctors Only or the shorter For Doctors Only Highlights for your Kindle or iPad.

Jason M. O’Dell, MS, CWM is a consultant, author of a number of books for doctors, including For Doctors Only: A Guide to Working Less & Building More, and principal of the financial consulting firm OJM Group www.ojmgroup.com, where Carole C. Foos, CPA, is a principal and tax consultant. They can be reached at 877-656-4362 or odell@ojmgroup.com.

Disclosure: OJM Group, LLC. (“OJM”) is an SEC registered investment adviser with its principal place of business in the State of Ohio.  OJM and its representatives are in compliance with the current notice filing and registration requirements imposed upon registered investment advisers by those states in which OJM maintains clients.  OJM may only transact business in those states in which it is registered, or qualifies for an exemption or exclusion from registration requirements.  For information pertaining to the registration status of OJM, please contact OJM or refer to the Investment Adviser Public Disclosure web site www.adviserinfo.sec.gov.

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This article contains general information that is not suitable for everyone.  The information contained herein should not be construed as personalized legal or tax advice.   There is no guarantee that the views and opinions expressed in this article will be appropriate for your particular circumstances.  Tax law changes frequently, accordingly information presented herein is subject to change without notice. You should seek professional tax and legal advice before implementing any strategy discussed herein.