Optimizing Your 401(k) as a Physician in Reno-Lake Tahoe: 5 Key Strategies for Top Employer Plans

If you’re a physician working in the Reno-Lake Tahoe area and approaching retirement, you’re likely in what I call the retirement red zone — that crucial decade where every financial move counts more than ever. Having a solid 401(k) plan through your employer is a great start, but optimizing that plan can make a meaningful difference in your retirement readiness.

Whether you’re with Carson Tahoe Energy Physicians, Tahoe Emergency Physicians, Tahoe Carson Radiology, Tahoe Carson Valley Medical Group, Reno Tahoe Anesthesia, or Carson Tahoe Health System, the following strategies can help you get the most out of your 401(k).

1. Maximize Catch-Up Contributions and Influence Employer Match Strategy

If you’re approaching retirement and hold equity or influence in your group, now’s the time to be strategic.

401(k) contributions — whether pre-tax or Roth — are still subject to Social Security and Medicare taxes up to the wage base ($176,100 in 2025), but how you contribute matters. At this stage, you likely have a clear picture of your retirement location and can begin to structure contributions in ways that reduce long-term tax exposure.

It’s also worth reviewing your employer match — especially if you’re in a group with older partners who might benefit from a richer employer contribution, even if it means slightly less take-home pay.

These structures can often be adjusted through group consensus, provided the employer isn’t left worse off and there’s support among physicians.

2. Adjust Your Investment Allocation — and Push for a Self-Directed Brokerage Option

In many ways, retiring successfully is like planning a trip. What you do with your savings is a lot like choosing how to get from Point A to Point B. You could fly, drive, take a train, ride a bike — even hike. Any of those options might work, but your choice depends on your goals, your timeline, and your comfort level.

Investments are no different. Most people don’t need to follow one set strategy. They should make decisions based on what gets them to their destination reliably — and in a way they can live with.

If you’re taking a cruise to Alaska, for example, it doesn’t matter how you get to the port — but the cruise departs at a set time. You need to arrive at the right moment to reach your goal.

Likewise, your lifestyle goals will determine how much you need in retirement. Your personality and experience will shape how much investment risk you’re comfortable with. These are your constraints — and from there, you choose the right tools.

At this stage, it may be helpful to speak with a fiduciary advisor — even just for a short time — to confirm you’re on track. Or, if you’re confident, you can manage the strategy yourself.

Either way, having access to a Self-Directed Brokerage Account (SDBA) inside your 401(k) — often called something different depending on the plan provider — can be a game-changer. With an SDBA, you can access a much wider range of investments, often with low or no commissions. This gives you two important advantages:

• You can lower your investment fees if needed

• You can select the tools that are best suited to your personal goals

  
  

At the end of the day, retirement is a personal experience — just like healthcare. And like medicine, you’re often better off using tools designed for your individual needs rather than relying on a generic, one-size-fits-all solution.

3. Leverage Unique Plan Features

Each 401(k) plan has its own quirks and perks. Some offer Roth 401(k) contributions, allowing you to pay taxes now and enjoy tax-free withdrawals later — a powerful tool when used correctly.

You’ll often hear, “Pre-tax is always better,” or, “Roth is always the way to go.” The truth is, it depends — on your situation, your goals, and your overall plan.

Think of your tax strategy the way internal medicine handles dosing. Doctors usually start patients on a low dose and increase gradually based on the individual’s response. One person might get the desired effect with half the usual dose. Another might need twice as much.

Just as medicine is personalized, retirement planning should be individualized too. If you can afford to be treated as an individual, whether by investing time or hiring help, you’ll likely get better results.

And to clarify: when I say “afford,” I don’t just mean financially. You can afford to do it yourself by investing time and attention, or you can afford to delegate it to someone you trust. Patients don’t need to know everything about the body — they just need to decide whether they want to learn it themselves or rely on an expert. The same logic applies here.

Ultimately, I believe people tend to do better when someone is spending time on their case — whether that’s a financial plan or a treatment plan.

4. Potential Ways to Improve Your Specific Plan

Because the Reno-Tahoe region is a somewhat smaller medical market, I’m grouping several employer 401(k) plans in this section to highlight key insights for each.

Carson Tahoe Health System 401(k)(This section is geared toward hospital executives or other highly compensated employees who participate in this plan.)

The Carson Tahoe Health System 401(k) is a solid, well-structured plan. As a true 401(k), it offers a broader range of investment options compared to 403(b) plans, which are often limited to mutual funds. Principal is a reputable 401(k) provider, and I’ve seen instances where I believe Principal plans were paired with Fidelity’s BrokerageLink — a powerful self-directed brokerage account. To our knowledge there isn't currently a BrokerageLink Account in the Carson Tahoe Health System 401(k) but such plans are usually easily added or widely avaialble for plans this size and they may be worth considering adding to benefit the executives or other highly paid employees of the Carson Tahoe Health System.

If you're an executive, it’s worth your time to ask about adding a self-directed brokerage option to your plan.  If your current financial advisor can’t or won’t provide a low cost self directed brokerage account – there are multiple firms that do provide it that you can look at.  Leading firms in this space include Charles Schwab and Fidelity.

Why does this matter? A self-directed brokerage account (SDBA) allows higher-paid employees to access the full market — including individual stocks, ETFs, and other investments — not just the limited mutual fund lineup typically offered by default. It gives you the flexibility to tailor your investments to your specific goals and risk tolerance.

In practice, only about 10% of employees at firms similar to Carson Tahoe Health System may tend to use the SDBA option — usually the more highly compensated or financially engaged employees, or those working with advisors who know how to leverage these features effectively. But for executives or high earners, this can be a significant enhancement.

Who to talk to if you want to improve your plan:Michelle Miller, Chief Human Resources Officer at Carson Tahoe Health.  Below is Michelle’s Linkedin Account: https://www.linkedin.com/in/michellemiller760

Tahoe Carson Valley Medical Group (TCVMG)

TCVMG is a strong, physician-led multispecialty employer. Based on what we’ve seen, they typically contribute $20,000 to $30,000 per year to an employee’s 401(k) — which is excellent for a group of this type.

What really matters here, beyond the generous employer contribution, is who the financial vendor is. With a group like TCVMG — where there’s a high ratio of specialists relative to primary care — it’s especially important to have a top-tier plan structure and vendor.

To know if your plan is truly competitive, it’s not enough to look at contributions. You’ll want to download your participant fee disclosure and have it reviewed by an independent expert (like our firm). We work with physicians across the country and can quickly determine whether your plan is excellent, average, or in need of improvement — sometimes with very simple changes that don’t even require switching vendors.

If you're within 10 years of retirement and employed at TCVMG, we invite you to fill out our contact form. We can help you review your participant fee disclosure, which every 401(k) participant is entitled to receive annually from the financial firm managing the plan.

Who to talk to if you want to improve your plan at TCVMG:Dr. Clare Rudolph who you can learn more about here: https://www.linkedin.com/in/clare-rudolph-31218890

Tahoe Emergency Physician Medical Corporation

Employer contributions at Tahoe Emergency Physician Medical Corporation generally fall in the $20,000 to $30,000 per year range — which is consistent with what I see nationwide in emergency medicine groups. That’s a strong contribution level and particularly tax-efficient for both employer and employee.

The key variable with plans like this, in my experience, is access to major low-cost brokerage vendors. In the self-directed brokerage space, the most established low-cost firms are Charles Schwab, Fidelity, Vanguard, and Robinhood, though there are a few others as well.

Ideally, your 401(k) plan includes a self-directed brokerage account (SDBA) with one of these vendors — and allows you to move at least 95% of your 401(k) balance into that account. From there, you should be able to buy individual stocks and ETFs with no commission (as long as you’re using online trading). That’s the most effective setup for a group of physician-owners like this, where everyone is an emergency physician and compensation is closely tied to long-term planning.

Where I tend to see plans fall short is when the vendor doesn't use one of the major low-cost firms or doesn’t offer an SDBA at all. That’s a missed opportunity, especially since SDBAs are generally neutral to the employer and highly beneficial to the employee.

Why neutral for the employer? Because employees typically bear the cost of the SDBA, and these accounts are inherently diversified — the employee can choose what they want to invest in. Why great for the employee? Because it opens up the ability to lower investment fees and build a more customized, optimized portfolio.

Not every employee will use the SDBA — and that’s okay. But having it available is a major value-add for those who are ready for more control.

Who to talk to if you want to improve your plan at TEPMC: Dr. Thomas Jantos

Carson Tahoe Emergency Physicians LLP (CTEP)

CTEP has built a strong 401(k) plan — with employer contributions typically around $30,000 per year, based on what we’ve seen. That’s slightly above the norm for emergency medicine groups, and it reflects a generous and tax-efficient approach to retirement benefits.

From what I’ve observed, employees at CTEP are also doing a great job saving on their own — showing strong personal financial habits and responsibility.

Looking ahead, as the plan continues to grow, it’s important to ensure the vendor quality keeps pace. Ideally, that means working with a top-tier brokerage firm and making sure a self-directed brokerage account is available — particularly from one of the major low-cost platforms like Schwab, Fidelity or Vanguard.  Vanguard seems to be retreating from the 401(k) business a little bit, so most self directed brokerage accounts I see today in physician 401(k) are at Schwab or Fidelity.  For what it is worth, I do not know but I suspect Robinhood may provide some 401(k) brokerage accounts with time since they’ve done a great job attracting clients in Generation X and millennials from what I’ve seen in my business and they’ve done it by offering consistently high quality products at low prices.

Often, I see smaller emergency groups start off with an insurance-based provider or a second-tier brokerage — and then stay there out of habit, even once the plan outgrows it. That can mean missed opportunities for cost savings and better investment flexibility as the plan grows.

In these situations, the key is employee advocacy. When employees — especially physicians nearing retirement — push for improvements, they usually get them. Most partners want a great plan too, but they’re busy. A few well-informed employees who speak up can make a big difference.

Let me be clear: almost all financial vendors can create an adequate 401(k), but some vendors are far better than others in the 401(k) space. Since everyone in the group is tied to the same vendor, it makes sense to advocate for the best one — especially if you plan to be with the group long-term.

Getting there involves two things:

• Having the right product knowledge (which a fiduciary advisor or independent expert can help with)

• And a lot of employee advocacy

  
  

Employee advocacy takes some time but it usually works in my experience and it has huge benefits to the employees when they succeed and it even puts the employer in a better position too most the time because people are actually happy with their retirement plan.

Who to talk to if you want to improve your plan at CTEP: Dr. Brett Eisenmesser.  Here is Dr. Eisnmesser’s Linkedin Account: https://www.linkedin.com/in/brett-eisenmesser-b4010189

Tahoe Carson Radiology

While employees at Tahoe Carson Radiology appear to be saving at a good rate, the employer contributions look a bit low to me — likely around $20,000 per year.

Radiologists are one of the more common physician groups we work with at D.R. Harris & Co., and we have extensive experience reviewing radiology compensation structures across the U.S.

Sometimes, lower 401(k) employer contributions in radiology groups can be explained by the presence of a defined benefit plan, which we believe may be the case here. If that’s true, it may mean some of the employer contributions are being funneled into the defined benefit plan instead — which can be a highly tax-efficient move for certain physicians.

Defined benefit plans are, in our view, a strong tax strategy for high-income earners who are further along in their careers. They generally allow for larger annual contributions than defined contribution plans like 401(k)s. While they may tend to benefit older physicians more than younger ones, if you’re an older partner or senior employee, a defined benefit plan is a very valuable tool to have.

Who to talk to if you want to improve your plan at Tahoe Carson Radiology: Dr. Stephen Loos

Reno Tahoe Anesthesia

Anesthesiologists often take a keen interest in investments, and Reno Tahoe Anesthesia seems to have a relatively balanced compensation structure. However, employer 401(k) contributions appear slightly below average — likely $15,000 to $20,000 per year. We've also seen employee contributions lower than expected, sometimes averaging just $9,000 annually.

This could reflect a younger team, capital needed to grow the group, high fixed expenses, or a preference for outside investments — all common in anesthesia groups. Still, many peers nationwide contribute $30,000 to $40,000 annually, so there's room for improvement.

A strong step forward would be ensuring access to a robust self-directed brokerage account (SDBA) through a firm like Fidelity or Schwab — not just mutual funds. Even as a newer, smaller group, excellent terms are possible if you know what to ask for. We’ve helped many physicians negotiate these upgrades as an independent fiduciary advisor.

If you're considering improvements, the right point of contact is Dr. Gavin Hartman — who, like us, trained at Stanford.

5. The Retirement Red Zone Action Plan

If you’re within 10 years of retirement, now is the time to be proactive:

• Review your investments to make sure they align with your goals and give you a good shot at success. As much as we’d all like a portfolio that never needs attention, that’s a bit like an anesthesiologist hoping for a patient who never requires adjustments — it’s rare. Some monitoring is usually necessary, whether you do it yourself or delegate it to someone you trust.

• Think about maximizing your retirement contributions with a long-term tax lens — not just to reduce this year’s taxes.

• Consider Roth contributions or Roth conversions where appropriate.

• Make sure you have a viable income strategy for retirement as you shift from the accumulation phase to the distribution phase of your life

  
  

Final Thoughts: You Don’t Have to Navigate This Alone

Getting on the right path for retirement and optimizing your 401(k) can feel overwhelming — but it doesn’t have to be.

As a financial advocate focused on physician retirement planning in Reno-Lake Tahoe and across the U.S., we’re here to help you make smart, tailored decisions that align with your goals.

If you’d like a personalized review of your 401(k) or want to discuss strategies for the retirement red zone, feel free to reach out anytime. Your financial peace of mind may be closer than you think.

Disclaimer: We believe the information in this article to be accurate as of the time it was written on 9/29/25 but you should always rely on your plan document, and own company's HR department or benefits people when determining the actual information about your plan. You should always contact your own tax advisor regarding any tax information you read about in this article. You are not a client of D.R. Harris & Co. unless you have a written advisory agreement from us. This blog post is educational in nature and is not designed to be specific financial advice for you. If you are a physician at any of these employers you can request a 15 minute get to know you call by filing out our contact form.

If you'd like to learn more about Daniel Harris or D.R. Harris & Co. you can do so here.