Year-End Financial Checklist for Orthopedic Surgeons (2026)

Hard deadlines, practice-specific moves, and the account-maximization sequence — from Q3 estimated taxes through the December 31 close.

Orthopedic surgeons face a uniquely compressed year-end window. You're in the OR through November, your Q4 ASC distributions land in December, and your wRVU bonus may not calculate until after your employer's fiscal year closes. Meanwhile, the tax code has hard December 31 deadlines for Roth conversions, tax-loss harvesting, new retirement plan establishment, S Corp payroll cutoffs, charitable giving, and annual gifting — each of which can move five to six figures in your 2026 tax liability if timed correctly.

This checklist covers every material year-end item for orthopedic surgeons. It's organized by category and practice setting. Check items off as you work through them with your advisor. Your progress saves automatically in this browser.

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Hard deadlines

These are calendar-driven. Miss them and the opportunity is gone for 2026.

Date	Item	Notes
Sept 15	Q3 estimated tax payment	Covers August–September income. Pay at least enough for safe harbor (100% of 2025 tax or 90% of 2026 estimated).
Dec 31	New retirement plan establishment	Solo 401(k), cash balance plan, or DB plan must be adopted (trust document signed) by Dec 31 to allow contributions for 2026. Self-employed surgeons: you can still fund after Dec 31 — up to the return due date — but the plan must exist first.
Dec 31	Roth conversion	Conversion must settle by Dec 31 — no extensions, no grace period. Model the IRMAA 2-year lookback and bracket interaction before executing. Conversion guide.
Dec 31	Tax-loss harvesting	Losses must realize in 2026. Coordinate with gains from ASC K-1 income and any practice sale proceeds. Wash-sale rule: 30 days before and after sale.
Dec 31	S Corp W-2 payroll cutoff	Reasonable compensation must be paid as actual W-2 wages processed through payroll — it cannot be reclassified retroactively after year-end.
Dec 31	QCD (age 70½+)	$111,000 limit in 2026. Transfer must go directly from IRA custodian to the qualifying charity by Dec 31. Reduces MAGI directly — key for IRMAA management.
Dec 31	Annual gift exclusion	$19,000 per recipient. Doesn't carry over year to year. MFJ gift-splitting doubles this per recipient — but both spouses must file a gift tax return.
Dec 31	Section 179 / bonus depreciation	Equipment must be placed in service (operational, not just ordered) by Dec 31 to claim the 2026 deduction. OBBBA restored 100% bonus depreciation permanently.
Jan 15	Q4 estimated tax payment	Covers October–December. Alternatively, file and pay by Feb 1 to skip the Q4 estimated payment.
Apr 15, 2027	IRA & HSA contributions (prior year)	You can make 2026 traditional IRA, Roth IRA (non-deductible), and HSA contributions up to April 15, 2027. Not extendable.
Oct 15, 2027	Employer 401(k) profit-sharing contribution	Employer contributions (match, profit-sharing) to a self-employed plan can be funded up to the extended return due date.

2026 contribution limits at a glance

Source: IRS Notice 2025-67. See sources below.

401(k) / 403(b) deferral

$24,500

+$8,000 catch-up (age 50–59, 64+)
+$11,250 super catch-up (age 60–63)

415(c) total (employee + employer)

$72,000

$80,000 with catch-up
$83,250 with super catch-up (60–63)

IRA (traditional / Roth non-deductible)

$7,500

$8,600 age 50+ ($1,100 catch-up)
Every ortho surgeon needs backdoor Roth

HSA

$8,750 family

$4,400 self-only
+$1,000 catch-up age 55+

Cash balance plan 415(b)

Up to $290,000

Age-dependent; actuary sets target
Ideal for private practice age 45+

Annual gift exclusion

$19,000 per recipient

MFJ gift-split: $38,000/recipient
529 superfunding: $95K–$190K/child

Retirement account maximization

401(k) / 403(b) deferral confirmed for final payroll cycle

Verify your year-to-date deferral total in your plan portal. If you're under $24,500 (or $32,500 if 50+), increase your election so the final December paycheck captures the shortfall. Hospital-employed surgeons: some plans restrict mid-year changes — call HR before November 1.

Catch-up contribution election activeAge 50+

Ages 50–59 and 64+: an extra $8,000 in 2026. Ages 60–63: $11,250 super catch-up instead. The super catch-up is per the SECURE 2.0 Act § 109 — not all plan administrators automatically apply it. Confirm your election explicitly. Retirement stacking guide.

Backdoor Roth IRA contribution made (or scheduled for Q1)

Every orthopedic surgeon exceeds the 2026 Roth IRA phaseout ($242,000–$252,000 MFJ). Contribute $7,500 to a traditional IRA (non-deductible) and convert immediately. Deadline: April 15, 2027 for the contribution, but completing it by December 31 eliminates pro-rata complications from any year-end IRA balances. Backdoor Roth guide.

HSA funded to the annual limit

$8,750 family / $4,400 self-only in 2026. HSA deadline is April 15, 2027 — but funding by December 31 gives you the full year of investment growth. Confirm you have an HSA-eligible HDHP; if you switched to a PPO mid-year, check last-month contribution rules. HSA strategy guide.

Cash balance plan annual target on trackPrivate practice

Your plan's actuary sets a target contribution for 2026 based on your age and design parameters. Underfunding can trigger plan disqualification; overfunding requires an excise-tax correction. Confirm the 2026 funding target with your plan's TPA before November 1 — late contributions create payroll and funding deadlines. Cash balance plan guide.

New plan established by December 31 (if none exists)Dec 31 hard deadline

Self-employed surgeons and new practice entities: a solo 401(k), cash balance plan, or defined benefit plan must be adopted — trust document signed — by December 31, 2026 to allow any contributions for the 2026 tax year. You can fund contributions for self-employed plans after December 31 (up to the return deadline), but the plan must be in place first. This is a use-it-or-lose-it deadline.

Mega backdoor Roth executed (if plan permits after-tax contributions)

Private practice 401(k) plans with after-tax contribution + in-plan Roth conversion provisions offer up to $47,500 in additional Roth space in 2026 ($72,000 total minus $24,500 employee deferral). Requires specific plan document language — not automatic. Confirm with your plan's TPA. Mega backdoor Roth guide.

Tax planning moves

Roth conversion amount finalized and executedDec 31 hard deadline

Calculate projected 2026 taxable income after retirement contributions and deductions. Fill to the top of your current bracket — but stop before crossing into the next bracket, an IRMAA tier, or the NIIT threshold ($250,000 MFJ). A 10-minute modeling exercise before conversion can save $20,000–$50,000 in avoidable taxes. Roth conversion strategy guide.

Tax-loss harvesting sweep completeDec 31 hard deadline

Review taxable brokerage positions for unrealized losses. At 23.8% combined federal LTCG + NIIT on long-term gains (the effective rate for most ortho surgeons), losses worth $500+ per position are worth realizing. Coordinate with your ASC K-1 capital gain and any practice-sale or real estate proceeds. Watch the 30-day wash-sale window on replacement buys.

S Corp reasonable compensation finalized and payroll processedDec 31 hard deadlinePrivate practice

Your W-2 wages from the S Corp must actually be paid through payroll — not accrued, not distributed, not reclassified after the fact. W-2 wages set your 25%-of-W-2 employer 401(k) contribution limit (capped at $360,000 of compensation). The IRS general benchmark for reasonable compensation: at least 40–50% of net S Corp income for most specialties. Payroll must process before December 31. S Corp FICA guide.

Q4 estimated tax safe harbor confirmed (due Jan 15)

Safe harbor: pay at least 110% of your 2025 total tax liability (AGI over $150,000). Check your YTD withholding plus estimated payments against your 2025 Form 1040 total tax. If your Q4 income jumped — large ASC distribution, wRVU bonus, or locum income — the January 15 payment may need to be larger than your previous quarterly amounts.

Section 179 / bonus depreciation purchases placed in serviceDec 31 hard deadlinePractice owners

Equipment, medical devices, computers, and other qualifying property must be placed in service — actually operational — by December 31. OBBBA restored 100% bonus depreciation permanently for property placed in service after January 19, 2025. If you ordered equipment in November, confirm delivery and verify it's in use before year-end. At a 37% marginal rate, a $100,000 equipment purchase is worth $37,000 in immediate deductions versus $3,700/year over 10 years of straight-line depreciation. Tax planning guide.

IRMAA lookback reviewed before executing large transactions

Your 2028 Medicare Part B premium is calculated from 2026 MAGI. At the top IRMAA tier, you pay $487/month per person as a surcharge — $11,688/year per couple on top of the standard premium. If you're retiring in 2026–2028, modeling the IRMAA impact of a large Roth conversion, practice sale, or ASC buyout this year matters more than the income tax calculation alone. File SSA Form SSA-44 for qualifying life change credits if income drops in retirement. IRMAA planning guide.

Private practice — ortho-specific items

ASC Q4 distribution: take in December or defer to January?

ASC partnership distributions are income in the year received for cash-basis taxpayers. If your 2026 income is already at the 37% bracket and you have flexibility on timing with your ASC's operating agreement, consider whether the Q4 distribution can be deferred to January 2027 to land in a lower-income year. Conversely, if 2026 is a transitionally lower income year, taking it in December is preferable. Coordinate with your accountant and confirm what distribution timing the ASC's operating agreement actually permits.

wRVU bonus payout date confirmed with your group

Hospital-affiliated and private group contracts often have Q4 wRVU production bonuses that pay out in either December or January depending on when the fiscal year closes and performance is calculated. A December payout is 2026 W-2 income; a January payout is 2027. At $900K total income, a $60,000 bonus shifting between December and January changes your Roth conversion window, quarterly estimate, and IRMAA exposure. Confirm the payout date now — not after it lands.

Practice entity structure annual review

Is your S Corp election still optimal? If your net practice income after reasonable compensation exceeds $500,000, confirm that FICA savings are still exceeding OBBBA's QBI deduction phaseout cost for physicians (SSTB phaseout: $394,600–$544,600 MFJ). As income grows, S Corp savings shrink relative to administrative cost — some late-career ortho surgeons are better served by a PLLC or PC. Annual review with your CPA. S Corp analysis.

Partnership buy-in installment and equity confirmation

If you're in a multi-year partnership buy-in, confirm the 2026 installment has been paid and properly recorded in the partnership's capital accounts. Verify your ownership percentage and associated ASC distribution rights are updated in partnership records. Buy-in interest (if you financed the buy-in) may be deductible as investment interest — confirm treatment with your CPA. Buy-in analysis tool.

Buy-sell agreement FMV updated

Practice and ASC buy-sell agreements typically require annual fair market value updates. A stale valuation creates estate tax risk and can lead to disputes on death, disability, or partner departure. Confirm your practice attorney or certified business appraiser has the current-year FMV on file. The funding mechanism (life insurance proceeds, installment note) should also be checked against the updated FMV. Estate planning guide.

Hospital-employed surgeon items

403(b) + 457(b) double-stack confirmed

Governmental employers (VA, public university hospital, county hospital) allow both a 403(b) and a separate governmental 457(b) — two independent $24,500 deferral limits for $49,000 in total pre-tax deferral, or up to $71,500 if you're 60–63 with both super catch-ups. Non-governmental systems (most private health systems) only allow a non-governmental 457(b), which has employer insolvency risk and cannot be rolled to an IRA. Confirm your employer type. 457(b) deep-dive.

PSLF payment count verified and employer certification filed

Log into StudentAid.gov and confirm your 2026 payments are recorded and your employer certification is current. The income-driven repayment plan landscape changed in 2026 — SAVE ended in March 2026 and the new RAP (Repayment Assistance Plan) begins July 1, 2026. Confirm your plan recertification went through correctly. Any gap in qualifying employment breaks your PSLF payment count continuity. Student loan strategy.

Side-income solo 401(k) employer contribution calculated

If you earned 1099 income in 2026 from locum tenens, expert witness work, device consulting, or other self-employment, you can make employer contributions to a separate solo 401(k) — up to 20% of net self-employment income, subject to the 415(c) total limit across all plans. This does not reduce your hospital plan employee deferral space. A solo 401(k) must be established by December 31 if you don't already have one. Locum tenens tax strategy.

Charitable giving

QCD from IRA executed by December 31Dec 31 hard deadlineAge 70½+

$111,000 QCD limit in 2026. The transfer must go directly from your IRA custodian to the qualifying charity — a check payable to you and then donated does not qualify. QCDs reduce adjusted gross income (not just taxable income), which directly cuts IRMAA exposure and Social Security benefit taxation. At retirement income levels, a $111,000 QCD can be worth significantly more than a standard charitable deduction.

DAF funded with appreciated securities or in practice-sale year

If 2026 is a high-income year — practice sale, large ASC distribution, PE buyout rollover — front-loading a donor-advised fund with appreciated stock or mutual funds generates a current-year deduction while granting to charities in later years. Important 2026 OBBBA change: a 0.5% AGI floor applies to itemized charitable deductions for top-bracket filers, and the effective deduction cap is 35% (not 60%) due to the 2/37 haircut. Model the actual deduction value before committing. Charitable giving guide.

Annual gift exclusions used before December 31Dec 31 hard deadline

$19,000 per recipient in 2026. Does not carry over to 2027. A surgeon with a spouse, two adult children, and four grandchildren can transfer $114,000 tax-free per year ($228,000 with MFJ gift-splitting) — reducing the taxable estate without touching the $15M lifetime exemption. For gift-splitting, both spouses must file a gift tax return (Form 709) even if no gift tax is due.

529 superfunding decision made

$95,000 per child ($190,000 MFJ gift-split) in 2026 via a 5-year election. The contribution is treated as five equal annual gifts; no additional gifts to that beneficiary during the 5-year election period without gift tax implications. Financial aid is effectively zero for ortho surgeon households, so the 529 account is a pure compounding vehicle. A $190,000 contribution at a child's birth compounds to roughly $730,000 at age 18 at 7%. 529 guide.

Insurance and asset protection

Disability insurance benefit level still adequate

Most ortho surgeons purchase disability insurance during fellowship or early in their careers at a benefit level matching income at that time. If your income has grown significantly and you haven't updated coverage, your $15,000/month policy may now replace only 20–25% of take-home. Own-occupation coverage is limited by most carriers to $40,000–$50,000/month total across all policies. Review the gap annually — adding a policy is significantly easier before a health change or claim occurs. Disability insurance guide.

Life insurance beneficiary designations verified

Beneficiary designations on life insurance, 401(k), IRA, and HSA accounts override your will — they're the most important documents in your estate plan in practice. Review after any marriage, divorce, new child, or death of a named beneficiary. For practice owners: confirm your buy-sell agreement funding policy's death benefit still matches the current FMV. Life insurance guide.

Umbrella policy limit reviewed against current net worth

Rule of thumb: umbrella coverage equal to or greater than your net worth. At $2M net worth, $2M umbrella minimum; at $5M, $5M umbrella. Orthopedic surgeons are frequently named in excess-judgment suits due to publicly known income levels. Umbrella limits tend to lag asset accumulation — review annually as net worth grows. $2M–$5M umbrellas typically cost $500–$1,500/year — among the best risk-adjusted insurance values available. Asset protection framework.

Malpractice tail coverage status confirmed (if changing jobs)

If you changed practice settings in 2026 or plan to in early 2027, confirm in writing who is funding your claims-made tail policy. A $50,000–$150,000 tail cost that isn't explicitly assigned in the separation or employment agreement is your personal liability. "The hospital said they'd cover it" is not an enforceable promise without written documentation. Malpractice tail guide.

Estate and legacy planning

Estate documents reviewed and current

Will, revocable trust, durable power of attorney, and healthcare directive should be reviewed after any major life change: new child, divorce, death of a named fiduciary, significant asset change, or move to a new state. If you haven't done this review: a surgeon with a surgical income and no updated estate documents is one accident away from a contested probate proceeding or intestate distribution that ignores your intentions. Estate planning guide.

Retirement account beneficiary designations confirmed with custodians

Check beneficiary designations directly with each custodian (Fidelity, Vanguard, etc.) — not just your paper file or financial advisor. The inherited IRA 10-year distribution rule (finalized under T.D. 10001, July 2024) means that named beneficiaries who are not eligible designated beneficiaries must distribute the full account within 10 years and, if the decedent had passed their required beginning date, must also take annual RMDs in years 1–9. Your beneficiaries need to understand what they're inheriting.

OBBBA $15M permanent exemption factored into estate plan

The One Big Beautiful Bill Act permanently raised the federal estate, gift, and GST exemption to $15M per person ($30M MFJ). If your estate plan was structured around the prior $5M–$12M sunset scenario — SLATs, GRATs, bypass trusts designed to capture the pre-sunset exemption — some of that structure may now have unnecessary complexity or ongoing cost. Your estate attorney should review whether any irrevocable structures established in 2020–2025 can be simplified. Estate planning guide.

The sequencing matters more than the individual moves.

The Roth conversion amount, the S Corp payroll level, the ASC distribution timing, and the charitable giving decision are not independent. The optimal sequence depends on your specific income sources, IRMAA bracket position, and practice structure. Most ortho surgeons working without a specialist are leaving $30,000–$80,000 per year in avoidable taxes — not from negligence, but from executing each item in a silo rather than as an integrated plan.

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Related guides

IRS Notice 2025-67 — 2026 Amounts Relating to Retirement Plans and IRAs. 401(k) employee deferral $24,500; 415(c) total $72,000; catch-up (50+) $8,000; super catch-up (60–63) $11,250; IRA limit $7,500 ($8,600 age 50+); HSA $4,400/$8,750; 415(b) defined benefit/CB limit $290,000; QCD limit $111,000.
IRS.gov Newsroom — 401(k) limit increases to $24,500 for 2026, IRA limit increases to $7,500. Official 2026 announcement confirming 415(c) $72,000 total and $83,250 for ages 60–63.
IRS Rev. Proc. 2025-19 — 2026 HSA contribution limits. Self-only $4,400; family $8,750. Confirmed by IRS.gov publication.
CMS 2026 Medicare Part B Premium Fact Sheet — 2026 base premium $202.90/month; IRMAA surcharges $81.20–$487.00/month (top tier based on 2024 MAGI above $394,000 MFJ). QCD limit of $111,000 reduces MAGI directly for IRMAA calculation per IRS Notice 2025-67.
One Big Beautiful Bill Act (OBBBA), Pub. L. No. 119-21 (July 2025) — permanent $15M estate/gift/GST exemption per person; 100% bonus depreciation restored permanently for qualifying property placed in service after January 19, 2025; new 0.5% AGI floor and 35% effective cap on itemized charitable deductions for 37% bracket taxpayers.
SECURE 2.0 Act (2022) § 109 — super catch-up contributions for ages 60–63 effective 2025+; § 126 — 529-to-Roth rollover. T.D. 10001 (July 2024) — finalized inherited IRA 10-year distribution rules with annual RMDs when decedent passed required beginning date.

All contribution limits verified as of June 2026 against IRS Notice 2025-67 and IRS.gov. Content is for informational purposes only and does not constitute financial, tax, or legal advice. Consult a qualified tax professional before acting on any checklist item.