MoneyRx for CRNAs and NPs

Hosted by Brett Fellows, CFP®

Business Entrepreneurship Investing Education

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Jun 2026

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About the show

Go behind the scenes with host Brett Fellows, CFP®, as he explores the unique financial opportunities and challenges facing Certified Registered Nurse Anesthetists and Nurse Practitioners on the path to financial independence. Each episode delivers expert insights and actionable advice to help you lower taxes, invest smarter, and retire on your terms. Brett's firm, Oak Capital Advisors, specializes in high-earning CRNAs and nurse practitioners and is currently accepting new clients. From retirement income strategy and tax planning to Social Security timing, Medicare, and estate planning, they offer comprehensive financial planning that goes far beyond investment management. If you're ready to work with someone who truly gets your world, the link to schedule a discovery meeting is in the show notes.

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June 16, 2026Episode 9325 min

The Tax Bill Many Widowed Nurses Don't See Coming

Most retirement plans are built for two people. When one spouse dies, the survivor gets hit with a higher tax bill on lower income. At the same time.In this episode of MoneyRx for CRNAs and NPs, Brett Fellows, CFP, walks through the widow's tax penalty using a real CRNA household. He explains why this happens, what it costs over a lifetime, and the specific steps a married nurse can take to protect the surviving spouse before it's too late.Brett Covers:Why the survivor's tax bill goes up when household income goes downThe role of required minimum distributions in the problemHow filing as a single filer compresses tax brackets and cuts the standard deduction in halfThe IRMAA surcharge that shows up two years after the funeralThe Survivor's Window: a multi-year plan using Roth conversions, Social Security timing, and beneficiary cleanup to reduce the lifetime tax cost by tens of thousandsIf you have a large pre-tax 403(b) or IRA and a spouse, this episode is worth your full attention. The window to act is only open while both of you are still here.Key Timestamps:(0:18) Predictable financial surprises and tax penalties in retirement(1:18) The widow's penalty where survivor income drops but taxes rise(2:48) Case study introduction of Diane and Paul(5:48) Structural exposure of retirement plans built only for two people(7:29) Social Security and single-life pension changes after a spouse dies(8:43) Required minimum distribution rules for a single survivor schedule(10:03) Shrinking standard deductions and compression of single tax brackets(11:15) Impact of single filer Medicare IRMAA thresholds and surcharges(12:45) Total lifetime cost breakdown of the single filer tax penalty(15:44) Exploiting the low tax bracket window while both spouses are alive(18:41) Filling joint tax brackets with multi-year Roth conversions(19:54) Setting the survivor income floor by delaying Social SecurityFor more information and resources related to this episode, please visit the show notes.

June 9, 2026Episode 9219 min

Should I invest in a rental property in retirement?

If you are a CRNA or nurse practitioner thinking about rental property as part of your retirement plan, watch this episode before you write the check. When you run the numbers for a high-earning nurse buying the kind of property they want at today's rates, the result often surprises people.In this episode, Brett Fellows, CFP®, walks through the story of Yvonne, a 55-year-old CRNA in the Charleston area earning $220,000 a year who wants to buy a second rental property before retiring at 62. Brett explores the problems that arise when they explore her options.Why most rental property owners never calculate the one number that tells them if the investment workedThe Cash Flow Illusion: why a property that "covers the mortgage" can still run hundreds per month in the redThe passive loss rule that suspends depreciation deductions for most CRNAs and NPs earning over $150,000What the real exit looks like after commissions, depreciation recapture, capital gains, and state taxesWhy Yvonne's 403(b) outperformed her rental property over the same six-year periodThe Capital Priority Ladder: the order in which high-earning nurses should deploy capital before buying direct propertyHow Yvonne sheltered $71,000 from taxes in year one without buying a second rentalMost CRNAs who own rental property have never run the number that tells them whether it worked: the all-in, after-tax, after-expense, after-time annualized return. #CRNAs #NursePractitioners #RealEstate #RetirementPlanning #TaxPlanningFor more information and resources related to this episode, please visit the show notes.

June 2, 2026Episode 9139 min

Why High-Earning Nurses Never Feel Wealthy (with Kristin Burton, PA Millionaire)

Kristin Burton paid off over $160,000 in student loan debt in 16 months, became a self-made millionaire by 31, and built a platform called Millionaires in Medicine that now reaches PAs, NPs, pharmacists, and other non-physician healthcare professionals across the country. She also just published her first book, The PA Millionaire Path.In this episode, Brett Fellows, CFP®, sits down with Kristin to talk about what holds high-earning healthcare professionals back from building wealth. They cover the identity problem around income, why student loans should never be the whole money plan, the three tax buckets that create flexibility in retirement, and what it takes to make work optional. Kristin also shares the investing philosophy that built her net worth and the financial mistakes she would do differently.Key Timestamps:(0:18) Introduction of guest Kristin Burton and her personal wealth milestones(1:38) Origins and grassroots mission of Millionaires in Medicine(3:53) Failure of non-physician medical professionals to self-identify as high earners(5:13) Time management strategies for balancing clinical practice and entrepreneurship(6:18) Shift from short-form infographics to deep long-form conversations(10:23) Inspiration for publishing a tangible and enduring financial guidebook(12:05) Why behavioral choices and mindset outweigh pure financial intelligence(16:22) Reframing student loans as a career investment instead of an emotional burden(19:03) The three-pillar framework to track earnings, multiply investments, and build net worth(22:03) Long-term advantages of a boring and fully automated dollar-cost averaging approach(27:35) Spreading assets across three tax buckets to optimize retirement withdrawal strategies(30:04) Three-step process to establish and future-proof baseline lifestyle expenses For more information and resources related to this episode, please visit the show notes.

May 26, 2026Episode 9044 min

Amanda Kay on One Full Year of 1099: What She Got Wrong, What Changed Everything

A year ago, Amanda Kelly jumped into full 1099 independence with income goals, an S-corp, and many unknowns. Now she’s back.In this episode, Brett Fellows, CFP®, sits down with Amanda Kelly, CRNA, coach, and founder of The Mindful CRNA, to hear what happened once the theory met real life. They talk through the financial surprises that came with running an S-corp, why most CRNAs leave money on the table at tax time, how the independent market has shifted heading into 2026, and what Amanda learned from a 30-minute tax return walkthrough with Brett that changed how she thinks about her money entirely.They Cover:The honest financial case for going 1099 in your 40s or 50sWhy salary vs. distributions inside an S-corp matters more than most CRNAs realizeWhat CRNAs consistently get wrong with deductions and bookkeepingHow the 1099 market has shifted since 2024 and what to expect going forwardRunning a side coaching business, and when to spin up a second LLCThe tax return review that made her numbers finally make senseBaby Roths, HSAs, and what a "money machine" looks like in practiceThree financial moves she would tell every new CRNA to make first#CRNAs #1099CRNA #TaxPlanning #FinancialPlanning #MoneyRxKey Timestamps:(0:18) Return of guest Amanda Kay to review her first year of independent contracting (1:43) Simple bookkeeping and revenue tracking methods using basic apps (2:56) Psychological adjustments when transitioning away from W-2 employment (4:40) Spousal communication strategies for managing variable monthly income (6:50) Common first-year errors with S corp compliance and deductions (10:53) Tax efficiency benefits of prioritizing business distributions over salary (13:40) Proactive recordkeeping habits to easily track business expenses (15:56) Evaluating the financial case for switching to 1099 contracting (18:40) Choosing the right entity structures when managing multiple income streams (19:58) Projected overhead costs and platform fees for digital courses (27:13) Navigating anesthesia market shifts and establishing cancellation policies (30:04) Protecting income through continuous clinical skill diversificationFor more information and resources related to this episode, please visit the show notes.

May 19, 2026Episode 8923 min

Should I Pay Off My Mortgage Before Retiring?

If you are within five years of retirement and thinking about paying off your mortgage, you are asking the right question, but… you’re probably asking it the wrong way.In this episode, Brett walks through a sample client household, Imani, a 60-year-old nurse practitioner retiring in December with $1.7 million in her 403(b) and a $228,000 mortgage. Her plan was simple: pull the money from her retirement account and walk into retirement debt-free. Brett shows why that one decision would have cost her roughly $190,000 in taxes, lost growth, and destroyed planning runway, and the three moves that got her to the same outcome for about $9,000 instead.Brett covers:Why the mortgage rate versus investment return comparison is the wrong framework for most CRNAs and NPsThe four separate tax bills hiding inside a single 403(b) withdrawal, and why almost nobody adds them upWhy January of your first retirement year is the worst possible time to make this decisionThe three-move mortgage payoff runway that keeps retirement accounts untouched and the ACA planning window intactHow Imani went from a $190,000 mistake to a $9,000 solution without changing her goal at all#CRNAs #NursePractitioners #RetirementPlanning #TaxPlanning #MortgagePlanningKey Timestamps: (0:18) Financial risks of pulling from pre-tax accounts for mortgage payoffs (1:23) Case study introduction of a nurse practitioner aiming for debt-free retirement (2:33) Breakdown of how the wrong asset source creates a major planning mistake (4:33) Failure of standard rate versus return comparisons for pre-tax accounts (6:38) Four separate financial liabilities triggered by a single lump sum withdrawal (8:13) Delayed impact of retirement account liquidations on future Medicare surcharges (10:28) Heightened compounding dangers of large early retirement lump sum distributions (11:43) Preservation of the low tax window for strategic Roth conversions (13:03) Alternative approach using accelerated principal payments from current cash flow (14:53) Structural benefits of utilizing a five to seven-year payoff runway (16:00) Mathematical guidelines for evaluating mortgage payoff choices based on interest rates (18:03) Protecting retirement accounts from accelerated debt elimination plansFor more information and resources related to this episode, please visit the show notes.

May 12, 2026Episode 8817 min

Roth Conversion or ACA Subsidy? You Don't Have to Choose.

Most nurses retiring in their early sixties think they face one decision when it comes to ACA subsidies and Roth conversions: pick one or the other. But there’s another way. In this episode, Brett walks through the story of Renata, a 60-year-old CRNA retiring after 28 years with $1.78 million in her 403(b). She spent six months researching the ACA-versus-Roth question, talked to two CFPs, and was leaning toward skipping every conversion. What she discovered in a planning meeting changed everything. The cost of the question she had been asking, run across twelve years of her household's life, came to $280,000.In this episode, Brett walks through the three reasons this mistake keeps repeating, and introduces The Conversion Calendar: a 12 to 15-year framework that lets nurse households capture ACA subsidies and do Roth conversions at the same time, by placing each type of move on the right years of the retirement runway.Brett covers:- Why the ACA-versus-Roth binary is a false choice, and why 2026 makes it far more costly as enhanced credits expire- The shadow tax that adds 10 to 19 percent on top of your federal bracket without showing up on your tax return- How a household can go $3,000 over the cliff line and lose $14,000 in subsidies while saving only $300 in federal tax- The three-step Conversion Calendar built around Renata and Ben's 13-year runway- How this household saved $420,000 in lifetime federal taxes while capturing $45,000 in ACA subsidies#CRNAs #NursePractitioners #RothConversion #RetirementPlanning #ACASubsidyKey Timestamps:(0:18) Trade-off between ACA subsidies and Roth conversions(1:39) Case study of Renata and Ben’s early retirement transition(2:54) Risks of the false binary approach in tax planning(4:26) Reappearance of the hard 400% FPL cliff in 2026(6:07) Hidden shadow tax impact on real marginal rates(7:29) Actual cost of conversions compared to federal tax brackets(8:58) Shifting the planning focus to the multi-year retirement runway(10:33) Benefits of using a conversion calendar for long-term sequencing(11:33) Visual mapping of retirement into distinct tax environments(12:53) Strategy for pairing ACA years with measured conversions(14:53) Impact of sequencing on future required minimum distributions(16:08) Lifetime tax savings achieved through strategic decision orderingFor more information and resources related to this episode, please visit the show notes.

May 5, 2026Episode 8718 min

Why High-Earning Nurses Leave Money on the Table in Retirement

You've worked for decades, maxed your 403(b) every year, and built a solid balance. But what if the structure of those savings is quietly setting you up for a six-figure tax problem in retirement?This episode follows Dana, a CRNA with 22 years at the same hospital and $1.4 million saved. She did everything the articles told her to do. What she found out in the first planning meeting was that doing everything right in a single account is still a problem.Brett walks through the three reasons high-earning nurses arrive at retirement with a tax structure they can't control, and the three concrete moves any nurse can make in the next 90 days to get back on track.Brett explores:Why having 96% of savings in one pre-tax account creates a retirement tax rate the IRS sets for youThe hospital plan features most nurses never use, including a 457(b) that could have added $200,000 in contributionsThe eight-year window between retirement and Social Security that is the cheapest tax opportunity of a high-earner's lifeHow to audit your hospital plan, redirect future dollars, and draw a conversion calendarWhat the Tax Diversification Reset looked like for Dana and Marcus, and how it saved their household $190,000 in lifetime federal taxesIf you have a growing balance in your plan and no real strategy for how it gets taxed in retirement, this episode is for you.Key Timestamps:(0:18) Risks of long-term concentration in a single pre-tax account (1:23) Shift of financial control from the retiree to the IRS (2:32) Distinction between missed contributions and missed financial flexibility (3:38) Financial exposure of households with large pre-tax balances (4:54) Institutional incentives that promote the default retirement structure (6:03) Impact of Medicare IRMAA surcharges on retirement cash flow (7:38) Unlocking overlooked features in complex hospital plan documents (9:13) Identifying the low-tax planning window before required distributions hit (10:58) Gaining control through tax-aware ordering and account types (12:53) Three concrete steps to audit hospital plans for new options (14:53) Mapping the conversion runway to minimize future tax brackets (16:08) Lifetime tax savings achieved through strategic asset repositioning For more information and resources related to this episode, please visit the show notes.

April 28, 2026Episode 8612 min

Stop Budgeting for What Retirement Costs. Budget for This Instead.

Most retirement budgets are built around a method that almost guarantees an error. You sit down with a spreadsheet, write out every category you can think of, and estimate a number for each line. Research shows people who go through that exercise estimate what they think they can live on, not what they spend. Real retiree spending can run 20 to 30% higher than those estimates. On a $75,000 target, that's $15,000 to $22,000 per year, the plan never accounted for.In this episode, Brett walks through a different approach: the Subtract-and-Replace Budget. Two halves, eight lines, and a starting point that's already in your paycheck.Brett covers:Why the line-item budget fails: The psychology behind underestimating, and what a $500 error in your monthly estimate does to your plan's success probability.The Subtract side: Four expenses that disappear the day you stop working: payroll taxes, retirement contributions, debt service, and invisible work costs.The Replace side: Four categories that expand or appear at retirement: taxes in their retirement form, healthcare, go-go lifestyle spending, and healthcare inflation.David and Karen: Two CRNAs in their late 50s who thought their line-item budget was solid, until the Subtract-and-Replace method revealed the real number.If you're within five years of retirement, this framework is worth understanding before you build the plan.#CRNAs #NursePractitioners #RetirementPlanning #RetirementIncome #FinancialPlanningKey Timestamps:(0:18) Probability of success based on retirement spending accuracy(2:03) Ineffectiveness of the traditional line item approach for future budgeting(3:08) Discrepancy between imagined discipline and real retiree spending habits(4:53) Identification of major work expenses that disappear after retirement(6:06) Determining a real lifestyle baseline using current paycheck data(7:39) Average total healthcare expenditures for retired couples over a lifetime(9:03) Impact of healthcare inflation on long-term retirement planning(10:33) Financial value of strategic tax control and withdrawal timing(11:33) Moving from guessing to financial clarity with the paycheck method For more information and resources related to this episode, please visit the show notes.

April 21, 2026Episode 8515 min

How This Nursing Couple Retired with $2.5M and Still Underspent for 3 Years

If you retired with $2.5 million and were still afraid to spend it, you would not be alone. Many CRNAs and nurse practitioners have worked so hard for so long, but nobody ever taught them how to switch gears.In this episode, Brett walks through a sample client household, Chris and Heather, a CRNA and NP couple who retired with $2.5 million in pre-tax accounts and were only spending $6,800 a month when their plan could safely support $10,500. Brett names the three reasons that happened, and the three-part retirement spending blueprint he built to fix it, including a Roth conversion strategy on track to save them over $180,000 in lifetime taxes.Brett Covers:Why retirees spend 80% of their guaranteed income but only 50% of their portfolio assetsThe psychology behind treating savings as untouchableHow underspending creates a compounding future tax problemThe three-bucket retirement spending blueprintHow to build a monthly "retirement paycheck" from your portfolioLong-term care: the real data on who actually needs itHow to use the Roth conversion window before RMDs kick inWhy IRMAA surcharges cost some couples $18,740 a year in Medicare alone#CRNAs #NursePractitioners #RetirementPlanning #FinancialPlanning #MoneyRxKey Timestamps:(0:18) Challenges transitioning from saving to spending money(1:20) Comprehensive financial planning services for high-earning nurses(2:54) Potential tax liabilities of underspending in retirement(4:44) Psychological differences between monthly income and portfolio assets(6:36) Statistical data regarding long-term care cost risks(8:06) Benefits of using the Roth conversion window after retirement(9:08) Medicare surcharges and their relationship to required distributions(10:39) Three components of the retirement spending blueprint(12:33) Executing a Roth conversion strategy to minimize taxes(14:18) Summary takeaways and link to free retirement assessment For more information and resources related to this episode, please visit the show notes.

April 14, 2026Episode 8413 min

4 Signs You're Already Ready to Retire

Many CRNAs and nurse practitioners are already financially ready to retire… they just don’t know it. And yet, they keep working three, five, sometimes ten years longer than they need to. Not because they have to, but because no one has shown them clearly that they’re okay to stop.In this episode, Brett Fellows CFP® discusses four specific financial markers that show retirement readiness.Brett covers:Sign 1: Your portfolio can cover your income gap at a safe withdrawal rate, even if the market doesn’t cooperate.Sign 2: Your tax-deferred accounts are large enough that you’d benefit from starting Roth conversions now.Sign 3: You have, or can build, two years of living expenses in cash or short-term bonds outside of equities.Sign 4: Your plan still works under the widow’s penalty scenario, when one spouse is gone.If two or three of these apply to you, you may not be years away from retirement. You may already be there.#CRNAs #NursePractitioners #RetirementPlanning #FinancialIndependence #WealthManagementKey Timestamps:(0:18) Retirement readiness for CRNAs and nurse practitioners.(0:46) Overview of Oak Capital Advisors comprehensive planning.(1:47) Introduction to four specific financial signals.(2:14) Sign 1: Replacing your paycheck and the 4% rule.(4:39) Sign 2: Tax problems within pre-tax retirement accounts.(6:33) Power of Roth conversions during low-income years.(8:19) Sign 3: Protecting against the sequence of returns risk.(9:48) Sign 4: Stress testing for the widow's penalty.(11:28) Summary of the four markers for retirement.(12:36) Scheduling a complimentary discovery meeting.For more information and resources related to this episode, please visit the show notes.