There were many tax code changes in the One Big Beautiful Bill Act (OBBBA) when it was signed into law in 2025. Many of these changes affected taxpayers at different income levels, and with so many changes, it can be a challenge to know which items can best benefit physicians and their families. One of the provisions in OBBBA was an update to the SALT deduction, a change that can …
SALT deduction for physicians: the $500,000 magic number
Nobody in my residency program would have predicted I’d end up in venture capital. Certainly not me.
I immigrated to the United States from India with a straightforward plan: become the best physician-scientist I could and build a career in academic medicine. For the first chapter of my professional life, that’s exactly what I did. I trained in internal medicine, published over 100 peer-reviewed papers including in the New England Journal …
Physicians in venture capital see what others miss
The extra 90 days is not a rounding error
A 90-day credentialing timeline and a 180-day credentialing timeline can sound like two versions of the same problem. They are not. The second version can mean another quarter of rent, software, malpractice coverage, staff time, loan payments, marketing spend, and owner compensation before the practice can bill a major payer.
For a typical primary care startup, 90 additional days of fixed costs can …
3 reasons credentialing delays push past 90 days
I used to think health care finance was mostly about numbers. Then I worked inside the financial operations of a health care organization and realized how much patient care depends on systems most people never see. One experience has stayed with me ever since.
A claim for care that had already been provided was sitting in a billing backlog, approaching the payer’s filing deadline. The treatment had been completed. The staff …
Missed claims filing deadlines threaten patient care
A cash symptom can have several causes
A practice owner notices the same warning signs: collections are lower than expected, the bank balance feels tighter, and the billing report shows money still sitting unpaid. The first conclusion is usually simple. Billing is the problem.
Sometimes that is true. More often, the word “billing” is covering several different problems that require different fixes. A slow front desk, a coding issue, payer delays, denial …
Accounts receivable days hide four billing problems
Credentialing mistakes are expensive before they are visible
Credentialing problems usually look administrative until the revenue gap appears. A new practice may be open, staffed, leased, insured, and ready for patients, but one missing payer panel can cut off a revenue stream for a quarter or more.
The timeline is not small. Payer enrollment commonly takes 90 to 180 days. For a practice carrying rent, software, payroll, malpractice coverage, phones, internet, marketing, …
5 questions to ask before you choose a credentialing service
Consider a pediatrician and his wife, a cardiologist. Together they earn over $700,000 per year. They have $200,000 sitting in a savings account earning 4 percent. They own a $750,000 house and lease a luxury sedan. They pay a financial advisor 1 percent annually to manage their retirement accounts, mostly because a colleague recommended him. Neither has ever heard of an expense ratio. When a friend suggests they open a …
Why your doctor invests like a vaccine skeptic
Every physician remembers the first time they ran a code. The adrenaline. The organized chaos. The moment you reach for the crash cart and trust, without thinking, that everything inside it is where it should be, that the medications aren’t expired, and that the equipment has been checked.
But here’s what most physicians don’t think about: Who’s making sure that crash cart is actually compliant? Who’s tracking whether every piece of …
The crash cart that taught me physician-led investing
Suppose you were offered the following two work opportunities. Which would you choose?
Career A: an acceptable opportunity that pays slightly more than your current job; you’re guaranteed never to make less than you do today.
Career B: a dream opportunity that sings to your soul but comes with no guarantees. While you may make much more than you do today, you could also potentially take a six-figure pay cut.
In other words, …
Physician career choices come down to risk tolerance
Clinical training does not teach operational survival
Clinical training prepares physicians for clinical decisions. It rarely prepares them for the operational decisions that determine whether an independent practice survives the first three years.
A new practice owner may understand diagnosis, treatment, documentation, and patient communication, yet still be unready for payer enrollment, days to get paid, denial management, lease math, compliance deadlines, electronic health record (EHR) tradeoffs, and vendor evaluation. These decisions …
Independent medical practice runs on operations
Most health care startups don’t fail because the technology is bad. They fail because of mistakes that happen long before the product ever reaches a clinical setting. After seven years of evaluating health care companies as a physician-scientist turned venture investor (and making over 20 investments across digital health, biotech, medical devices, and therapeutics), I’ve started to see the same patterns repeat.
These aren’t obscure business school failures. They’re patterns that …
5 patterns behind health care startups that fail
A few months ago, a well-connected investor sent me a deal for a surgical device with a proprietary safety feature. U.S. Food and Drug Administration (FDA)-cleared. Strong intellectual property. Thousands of units sold. Multiple institutional backers across several rounds. The investor who referred it had taken a company to a NASDAQ initial public offering and was putting in his own money.
On paper, this was exactly the kind of deal most …
Health care investing insights from a venture capital pro
Every month, thousands of physician practices receive a marketing report. It has charts. It has graphs. It shows impressive numbers moving in the right direction. And in most cases, it tells the practice almost nothing about whether their marketing is actually working. After managing paid digital campaigns for cosmetic and aesthetic medical practices, I have seen this pattern repeatedly: practices spending $3,000 to $8,000 per month on marketing, receiving polished …
The medical practice marketing metrics that actually matter
Your hospital recently adopted a new piece of technology. Maybe it was an electronic health record (EHR) module. A patient monitoring upgrade. A documentation tool. A new device in the operating room (OR). Think about what happened next. Some of your colleagues embraced it. Others resisted. The nurses figured out workarounds within a week. The information technology (IT) department sent three emails about training sessions that nobody attended. Six months …
Health care investing demands thorough clinical diligence
I am going to say something that will irritate some people. A lot of physician burnout is not coming from medicine. It is coming from financial dependence. We train for more than a decade to master the human body, but many physicians cannot explain how their own money actually works. Not really. They do not know where every account is, what the portfolio actually holds, or what the total fees …
How physician financial autonomy cures physician burnout
Last year, a startup pitched me a device designed to improve endoscopic procedures in gastroenterology. Slick deck. Strong team. Blue-chip venture capital (VC) backing. One problem: The device added three extra steps to a workflow that gastroenterologists have spent decades optimizing for speed. Any gastrointestinal (GI) physician would have flagged this in the first five minutes. But the investors who wrote the check? None of them had ever held a …
Health care startups desperately need clinical expertise
I have sat in a lot of rooms where smart, well-meaning people puzzle over why American medicine keeps producing the same outcomes: Too few doctors in too many places, primary care is underfunded, and rural hospitals are consistently closing. The answer, frustrating as it is, comes down to a single systems principle: Every system is perfectly designed to get the results it gets. By that standard, we should not be …
How medical education debt drives the physician shortage
It keeps us up at night. We pay thousands to hundreds of thousands of dollars a year to protect ourselves from it. Our hospitals or practices have entire departments dedicated to managing it.
It is “Risk.”
Avoiding risk is an inherent part of modern medicine. Every day, we practice CYA documentation, ensure our patients sign informed consent forms, and do everything we can to minimize the risk that someone will sue us …
Physician financial risk: Balancing capacity and tolerance
If you are frustrated by your high tax bill, you are not alone. I have spoken with many doctors who experience sticker shock when they see their total annual tax liability after completing residency. Stories in the media, such as The Atlantic’s recent study on billionaire taxes, about how rich people avoid taxes only fan the flames. It is no surprise, then, that one of the most common financial …
Physician tax strategies: Why your tax bill is so high and how to fix it
A few years ago, I met a talented internist who had been practicing for 15 years. She owned a small clinic, worked long hours, and ran a thriving patient base, but when we reviewed her financials, I realized she’d been paying far more in taxes and taking far more risk than she needed to.
Her response was one I hear often: “Clint, I’m not a businessperson; I’m a doctor.”
It’s a mindset …
Physician asset protection: a guide to entity strategy
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