MoneyRx for CRNAs and NPs

Brett Fellows, CFP®, takes on a fear he hears from burned-out CRNAs, that leaving work at 55 will sink their Social Security. Using a hypothetical CRNA named Jen who has paid the maximum for more than 20 years, he shows how much seven more years of full-time work would add to her check, and why nurse practitioners may see a little more from their extra working years.

He also looks at what the latest Trustees Report says about the trust fund, what the 1983 reform suggests about future changes, and how to plan around a reduced benefit. The episode closes w...

Hitting the $24,500 403(b) limit early in the year can feel like the responsible move, yet for hospital-employed CRNAs and nurse practitioners whose match is calculated per paycheck, it can mean giving up thousands of dollars their hospital was willing to contribute. In this episode, Brett Fellows, CFP®, explains why the timing of your contributions can change what your employer puts in, following a hypothetical CRNA named Jess who sets her 403(b) contribution at 20% in January.

Brett also lays out the order he would think about for filling accounts after the match, including the trade-offs of a nonprofit h...

The 4% rule traces back to a 1994 study by financial planner Bill Bengen, and the number it produced came from the worst 30-year stretch he tested, a retirement that began in 1966. In this episode, Brett Fellows, CFP®, explains how that origin shapes retirement spending for CRNAs and nurse practitioners who follow the rule, and why stepping away from the OR or bedside in your early to mid-50s can make it even more restrictive.

Brett walks through three ways to tie retirement spending to how markets perform, including ratcheting, guardrails, and a base plus bonus approach he illustrates w...

A 2026 survey found that Americans now believe they need $1.46 million to retire comfortably. A CRNA or nurse practitioner who has built well past that number can still feel behind, and Brett Fellows, CFP®, traces that feeling to a number that was never built for a career like theirs.

On this episode of MoneyRx for CRNAs and NPs, Brett works out a retirement number from a household’s own spending and Social Security income, then looks at cash reserves, malpractice tail coverage, and the 15 to 18 years between the last paycheck and required minimum distributions. A hypothetical 54-year-old CRNA wit...

SECURE Act 2.0 gave employers the option to put their match into the Roth side of your 401(k), and the tax rules that come with it catch plenty of savers off guard. Brett Fellows, CFP®, explains why a Roth employer match can show up on a 1099-R and raise your tax bill in a year you never touched the money. He also walks through what to check in your plan before tax season.

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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.

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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.

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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 t...

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...

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...

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 w...

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 m...

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.

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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.

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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.

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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.

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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...

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. 

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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.

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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 s...

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.

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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.

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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.

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, a...

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 thi...

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...

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.

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...

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...

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...

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.

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Making the jump from employee to business owner can feel scary for NPs and CRNAs, but it can be done successfully. In this episode, Brett Fellows sits down with Dr. Michelle Cuevas, DNP, FNP-C, a family nurse practitioner, entrepreneur, and self-described explorer who made the leap from W2 employee to 1099 business owner and has not looked back.

Michelle built the NP Specialist Nursing Inc., her own clinical 1099 company, and then launched the NP Travel Specialist, a travel business that gives her flexible income and the freedom to explore the world with her family. Brett and Michelle share...

A CRNA or nurse practitioner can save consistently, build a $1.5 to $2 million portfolio, and be just a few years from retirement and STILL lose tens of thousands of dollars a year without knowing why. 

The answer? Because of these three specific decisions that got made quietly in the background right before retirement.

In this episode, Brett Fellows walks through the story of Sandra, a 58-year-old CRNA with $1.9 million saved. Two of those decisions had already been made wrong. The third she didn't know existed. 

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Where will your paycheck come from once you stop working, and which account do you pull from first? You saved well, maxed out your 403(b), and built a $2 million portfolio, but haven’t found clear answers to your retirement questions. 

In this episode, Brett Fellows talks through the three hidden issues that were quietly setting up a CRNA named Janie for $80,000 to $150,000 in taxes she did not have to pay, and the three-act retirement paycheck framework that changed her outcome.

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Most nurses arrive at retirement having done everything right for 30 years. The problem is not what they built. It is that nobody explained what happens when you have to start pulling money out.

In this episode, Brett Fellows walks through five retirement mistakes that look responsible from the outside and only reveal their cost much later. Most nurses are making at least two of them. Some are making all five. And the window to correct them is closing.

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Most nurse practitioners trying to answer the retirement question are using benchmarks that were never designed for them. The 4% rule. The 80% income replacement rule. Healthcare cost estimates built on worst-case assumptions. Used together, they can make a completely achievable retirement look years out of reach.

In this episode, Brett Fellows walks through an example, a 55-year-old NP named Diane with $1.2 million saved, to show exactly how three common planning beliefs were pointing her toward the wrong answer and how replacing them with the right framework changed everything.

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Most CRNAs and nurse practitioners treat their HSA like a checking account for medical bills. They put money in, pay bills, and move on. But the HSA is the ONLY account in the U.S. tax code that gives you 3 tax benefits at the same time, and when used correctly, it translates to hundreds of thousands of dollars in tax-free wealth.

In this episode, Brett Fellows walks through how to turn your HSA into a serious retirement savings tool, including the investment strategy most nurses skip, the shoebox receipt strategy for tax-free cash in retirement, and the...

Do you have a retirement tax bomb? Many CRNAs and nurse practitioners spend 30 years following traditional financial advice: max out your 403(b), live below your means, and defer taxes as long as possible. However, this strategy often leads to a "retirement tax bomb" where required minimum distributions (RMDs) and Social Security push you into a higher tax bracket than when you were working. AKA your tax bill might be jaw-dropping in your Golden Years. 

In this episode, Brett Fellows, CFP®, explains how to avoid this expensive mistake through strategic tax bracket filling. He shares real-world case studies of...

If you're a CRNA or nurse practitioner earning over the Roth IRA income limits, you're locked out of one of the best retirement accounts available. But there's a legal workaround. In this episode, Brett Fellows explains two powerful tax strategies that can save you hundreds of thousands of dollars over your career.

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"I've been earning $200,000 or more a year for most of my career. Social Security is going to be a drop in the bucket." If that's what you're thinking, you could be leaving hundreds of thousands of dollars on the table.

In this episode, Brett Fellows walks through nine critical Social Security strategies specifically for high-earning CRNAs and nurse practitioners. Using a real-world example of David and Sarah, both age 62 CRNAs with $1.8 million saved, he explains how to maximize lifetime benefits while minimizing taxes.

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