MoneyRx for CRNAs and NPs

Hosted by Brett Fellows, CFP®

Business Entrepreneurship Investing Education

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Episodes

101

Latest episode

Aug 2026

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EN-US

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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August 18, 2026Episode 10227 min

The CRNA Crystal Ball Test: What a "Perfect" 403(b) Fund Pick Is Really Worth

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 .

August 11, 2026Episode 10127 min

The Social Security Question Early-Retiring NPs get wrong

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 .

August 4, 2026Episode 10027 min

The 5 Retirement Topics That Matter (Lessons from 100 Episodes)

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 .

July 28, 2026Episode 9929 min

Your Retirement Has to Survive 35 Years of Inflation, Not 25

Retire at 53, and your plan needs to survive 35 years of retirement, not 25. Most retirement calculators were never built for that math, and the gap shows up first in your health insurance bill. In this episode of MoneyRx for CRNAs and NPs, Brett Fellows, CFP®, founder of Oak Capital Advisors, breaks down why the standard retirement math quietly falls apart for anyone leaving full-time work before Medicare age, and what to do instead. Brett covers: Why the 4% rule and most retirement software were built for a 30-year retirement, not 35 Medical inflation running nearly 40 points ahead of general inflation since 2000, and why that gap compounds every year Colleen's story: how a "safe" $72,000 withdrawal actually needs to support close to $109,000 a year by year ten The ACA subsidy cliff returning for 2026, and how $1,400 of extra income can erase an entire subsidy at once Why pulling the same dollar from a Traditional IRA versus a Roth or brokerage account can decide whether you keep that subsidy What changes, and what doesn't, once Medicare starts at 65 Key Timestamps: (0:18) Why retiring at 53 is the hardest stress test a retirement plan can face (1:05) The 4% rule and the 30-year model it was built around (1:34) Why that model was only ever stress tested to 30 years (2:02) Why a 35-year retirement is the realistic case, not the aggressive one (3:05) The flat inflation assumption almost every calculator makes (3:43) Medical inflation since 2000: 121% versus 86% for everything else (7:05) Meet Colleen: 53, a $1.8 million portfolio, and a calculator that says she's fine (8:51) Splitting $72,000 into two inflation buckets instead of one (10:16) The real gap: $37,000 a year, and the sequence of returns risk it creates (12:32) The ACA subsidy cliff returning for 2026 (16:27) Why which account you draw from is now a health insurance decision (18:49) What changes, and what doesn't, once Medicare starts at 65 (24:33) Running the plan to 90 instead of the standard 25 to 30 year horizon If your retirement starts before Medicare eligibility, or you want your own plan stress-tested against 35 years of real, two-track inflation, schedule a free Pre-Op Retirement Assessment at https://connectwithbrett.com/ and subscribe for more information. #CRNAs #RetirementPlanning #EarlyRetirement #HealthcareCosts #MoneyRx For more information and resources related to this episode, please visit the show notes .

July 21, 2026Episode 9826 min

The 2026 Roth Catch-Up Rule Just Changed The Math For Every Nurse Over 50

The IRS didn't reduce this tax break for high-earning nurses over 50. They took it away. Starting this year, catch-up contributions can no longer go in pre-tax if your wages cross $150,000, and most CRNAs and NPs haven't adjusted their plan for it. In this episode of MoneyRx for CRNAs, Brett Fellows, CFP, walks through the new Mandatory Roth Catch-Up Rule, what it costs the people who ignore it, and three accounts most CRNAs and NPs are not using together that can more than offset the change. He walks through a hypothetical CRNA named Dana to show what structuring it properly can mean over time. Brett Covers: Why catch-up contributions now have to go into Roth accounts for anyone whose wages cross $150,000 What it actually costs this April if your plan defaults you into Roth and you don't adjust anything Why most CRNAs and NPs are only using one of the three tax-advantaged accounts available to them How the 457(b) special three-year catch-up and a solo 401(k) can offset the new Roth mandate What structuring all three accounts properly could mean over a hypothetical 14-year period Key Timestamps: (0:18) The retirement rule that quietly changed for nurses over 50 (3:16) How the Mandatory Roth Catch-Up Rule works under Secure 2.0 (5:55) What doing nothing costs you this April (8:10) Why this is an awareness mistake, not a financial one (8:40) The three accounts most CRNAs and NPs aren't using together (13:50) Case study: Dana, a 51-year-old CRNA earning $230,000 (17:55) The dollar difference between reacting and structuring it right (20:41) The exact questions to ask your plan administrator (25:50) How to get help modeling your own numbers For more information and resources related to this episode, please visit the show notes .

July 14, 2026Episode 9721 min

The Three Retirement Phases Nobody Plans For — And Why They Hit CRNAs Differently

Most retirement plans do an excellent job modeling the money, but almost none of them model the time. For CRNAs specifically, that missing piece changes everything about when stepping back actually becomes possible and what it looks like when you get there. In this episode, Brett Fellows, CFP®, founder of Oak Capital Advisors, shows why standard financial plans built around a flat spending model can lead high-earning nurses to stay in the OR much longer than necessary. Brett Covers: The Time vs. Money Blindspot: Why the real question isn't just how much money you have, but what kind of time you will have and when. The Three Distinct Phases: Breaking down the Go-Go, Slow-Go, and No-Go years and how capacity and discretionary spending naturally shift across them. The Flat Model Flaw: How standard inflation-adjusted spending models cause CRNAs to overestimate late-life needs and underestimate early-retirement freedom. The Locum Bridge: How picking up just 10 to 15 days of locum anesthesia per year can fill early retirement gaps on your own terms. The 73 Collision: Why ignoring transitional gap years causes pre-tax RMDs and Social Security to collide into an unnecessarily high tax bracket. The Conversion Window: How to systematically move $50,000 to $70,000 a year from your pre-tax 403(b) into a Roth IRA while your bracket is temporarily low. Sequenced Withdrawal Strategy: The optimal account order (taxable first, pre-tax second, Roth last) to extend portfolio longevity. Key Timestamps: (0:18) Most retirement plans model the money, but fail to model the time. (1:26) Why standard financial conversations ignore the realities of health and energy timelines. (4:17) Defining the three distinct phases of retirement: Go-Go, Slow-Go, and No-Go years. (6:55) How flat spending assumptions trick CRNAs into overestimating late-life financial needs. (8:19) Navigating the personal identity shift when stepping back from clinical expertise. (9:26) Case study: The 10-year window for a 58-year-old CRNA named Maria. (11:27) The Locum Bridge: How 10 to 15 days of temporary work changes the retirement math. (13:20) Introducing the conversion window to shelter your nest egg from future IRS claims. (15:32) The 73 Collision: What happens when pre-tax RMDs and Social Security stack together. (17:26) Concrete actions to evaluate your personal timeline, local locum rates, and account mix. (20:27) How to access a complimentary 30-minute Pre-Op Retirement Assessment. Find out how to structure your retirement timeline and learn more about Oak Capital Advisors at https://oakcapitaladvisor.com/ . #CRNAs #RetirementPlanning #TaxPlanning #LocumTenens #MoneyRx For more information and resources related to this episode, please visit the show notes .

July 7, 2026Episode 9621 min

Can I Afford to Cut Back to Part-Time as an NP?

Most CRNAs and NPs who want to cut back to part-time have already decided it's impossible, because they're running the wrong number. In this episode of MoneyRx for CRNAs, Brett Fellows, CFP, walks through the framework for figuring out whether cutting back is actually financially viable, using the story of a hypothetical NP named Sarah who was $130,000 away from her real number, not $920,000 away from it. Brett Covers: Why the 2026 Nurse.org State of Nursing Survey points to a math problem, not a career problem Why modeling full retirement for a part-time decision always makes the numbers look impossible How to find your real healthcare cost after ACA subsidies instead of assuming the sticker price Why the 4% rule is the wrong tool for someone who's cutting back rather than stopping entirely How Roth conversion timing and account sequencing change the picture over time If you're 50 or older with at least $750,000 saved and you've been telling yourself you can't afford to slow down, this episode is worth your full attention. Key Timestamps: (0:18) Survey data on nursing burnout and financial necessity (1:25) Realities of dropping job satisfaction and growing career fear (2:58) Distinguishing full retirement from cutting back to part-time hours (4:34) Financial profile and baseline savings of case study subject Sarah (6:33) Accessing meaningful ACA marketplace subsidies with lower clinical income (8:38) Health insurance premium deductions within a 1099 independent contract model (9:58) Misapplying traditional investment drawdown metrics to partial retirement scenarios (11:13) Calculating the real net portfolio gap required to cover downshifted schedules (13:13) Optimal multi-bucket asset sequencing guidelines for tactical cash flow (14:28) Leveraging transitional low-tax windows for strategic Roth conversions (16:13) Chronological timeline walkthrough of Sarah's dynamic downshift plan (18:18) Navigating the professional identity shift when reducing clinical commitments For more information and resources related to this episode, please visit the show notes .

June 30, 2026Episode 9527 min

Retirement Mistakes Nurses Make After They Quit (These are harder to fix)

Almost every nurse walks into retirement with a short to-do list: file for Social Security, roll over the 403(b), and pull money for the things earned. On paper, it looks responsible. But in practice? Each item on that list can quietly close a door that no amount of future income can reopen. In this episode, Brett Fellows CFP®, founder of Oak Capital Advisors, walks through the story of Teresa, a CRNA who retired after 26 years and came to her first planning meeting with exactly three permanent decisions on her list. Brett explains why the fix-it-later mindset that served nurses well during their careers becomes a liability the day the paycheck stops, and introduces the Point of No Return Plan, a framework for identifying which decisions are irreversible and handling those on purpose, in sequence, before they lock. Brett covers: Why retirement mistakes feel different from working-years mistakes, and why that distinction matters Teresa's three-item list and what each decision would have cost her household Social Security timing: what it locks in, what the survivor effect means for a high-earning household, and when early claiming can make sense The gap years between retirement and RMDs: why doing nothing with a $2.1M 403(b) is itself a decision The two healthcare clocks and how a single $250,000 income year in 2026 creates a bill that shows up in 2028 The Point of No Return Plan: how to sort every retirement decision into fixable and unfixable, and protect the unfixable few before they close Key Timestamps: (0:18) Distinction between fixable working mistakes and irreversible retirement decisions (2:18) Household financial profile of Teresa and her retired husband Victor (4:11) Reviewing Teresa’s initial three-item retirement checklist (6:13) Hazards of applying a quick fix-it-later clinical mindset to retirement (8:08) Permanent lifestyle impacts of filing for early Social Security benefits on instinct (11:53) Risk of ignoring the low-tax gap year window for asset repositioning (13:33) How forced required distributions permanently exhaust cheap tax bracket space (15:58) Multi-clock tax triggers of pulling large lump sums from pre-tax accounts (17:08) Interaction between single-year income spikes and retroactive Medicare surcharges (21:41) Implementing the point of no return plan to safeguard irreversible choices (23:08) Maximizing gap year productivity with targeted annual Roth conversions (24:30) Pacing large capital lifestyle rewards from cash reserves over multiple years For more information and resources related to this episode, please visit the show notes .

June 23, 2026Episode 9431 min

The Right Age for a Nurse to Retire Isn't a Number. It's Five Windows.

Almost every nurse who sits down with Brett a few years before retirement asks the same question: "What is my number, and am I there yet?" The account balance keeps growing, the calculators keep confirming the money will last, and yet something still feels off. No calculator can see what a retirement date controls. In Episode 94, Brett introduces the five planning windows and explains why the date you stop working opens or closes all five of them at once. Brett Covers: Why the 4% rule and Monte Carlo success scores are silent on the most costly retirement decisions high-earning nurses face The five windows your retirement date controls: the ACA bridge, the Roth conversion runway, Social Security timing, the fragile decade, and RMDs at 73 How retiring at 60 versus 66 creates a $300,000 to $500,000 lifetime difference for the same nurse with the same balance Why "one more year" feels like buying safety and what it actually costs The Window Map: a method for working your retirement age backward from the five windows instead of toward a number Key Timestamps : (0:18) Portfolio readiness scores versus timeline window alignment (3:23) Case study profile of Cynthia and her retired husband, Raymond (5:18) Limitations of standard survival metrics and Monte Carlo success tools (6:53) Portfolio drawdown blind spots regarding early retirement tax structures (10:08) Window 1: Income thresholds and coverage cliffs within the ACA insurance bridge (11:33) Window 2: Utilizing early lower-income gap years for cheap Roth conversions (12:53) Window 3: Delaying Social Security benefits to protect a surviving spouse (14:23) Windows 4 and 5: Managing fragile decade market drops and forced required distributions (16:36) Interactivity between early retirement dates and Medicare look-back surcharges (18:56) Side-by-side lifetime analysis of exiting at age sixty versus age sixty-six (21:54) Reversing traditional retirement formulas by counting backward from open windows (27:24) Sequencing conversion and subsidy strategies so they do not collide over a single year For more information and resources related to this episode, please visit the show notes .

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 down The role of required minimum distributions in the problem How filing as a single filer compresses tax brackets and cuts the standard deduction in half The IRMAA surcharge that shows up two years after the funeral The 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 thousands If 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 Security For more information and resources related to this episode, please visit the show notes .