The Smartest Moves I’ve Seen Doctors Make—And Why We’re Putting Them Inside Defined Benefit Plans
Over the past twenty years—since my time at UC San Diego and Dartmouth—I’ve had the opportunity to sit across the table from hundreds of physicians at various stages of their careers. Some were fresh out of residency, still paying off med school debt. Others were nearing retirement with a lifetime of savings and questions about what comes next. The consistent thread? Most were focused on the day-to-day of practicing medicine—and rightly so. But a few stood out. They made strategic, bold moves that didn’t just build financial comfort. They built wealth.
As the chair of the Investment Committee at Del Mar Medical Devices, a physician-run medical trade association, I’m often asked: “What are the smartest moves doctors are making with their money right now?” The truth is, in a world shaped by war, tariffs, and a depreciating dollar, capital preservation is as critical as upside growth. More than ever, our members are looking for a financial vehicle that offers both stability and the opportunity to build legacy wealth. For many, the most underutilized—but powerful—tool is the defined benefit (DB) pension plan.
It took me a mountain of reading to get sharp on all the particulars. I had to learn the mechanics of ERISA compliance, how PBGC insurance works, and how to structure investment policy statements that allow for private equity and real estate alongside traditional fixed income. But once I connected the dots, it became obvious: defined benefit plans aren’t just retirement tools—they’re wealth-building machines.
Each year, we file actuarial reports with the Department of Labor through Form 5500, and in doing so, we unlock the ability for participating physicians to contribute significant pre-tax dollars. More importantly, those dollars go to work inside a strategy that we design around real asset growth and downside protection.
Now, you don’t have to use a DB plan to execute the strategies I’m about to describe. But I’ve seen firsthand how much more powerful they become when wrapped in one—particularly with PBGC-backed payout guarantees. These aren’t speculative moonshots. Most doctors I know don’t have the appetite for unnecessary risk. These are repeatable, strategic plays built on professional credibility, predictable income, and long-term relationships.
Here are the five moves that have delivered consistent results for the physicians I’ve advised—and the reason we now help them house these strategies inside pension plans.
1. Bought Dirt, Brought Their Network, and Sold at a 5% CAP
Let’s start with one of the simplest yet most effective wealth-building strategies: buying real estate where you practice.
I’ve seen it time and time again. A physician purchases raw land or an underutilized building in a growing area, brings in a couple of colleagues from med or dental school, and co-locates multiple practices under one roof. Suddenly, that old strip mall becomes a bustling medical plaza.
The beauty here is in the tenant profile. Medical and dental practices are recession-resistant. The leases are long-term. The tenants are often the doctors themselves. That’s an incredibly stable income stream.
Over time, institutional buyers come knocking—looking for yield and safe assets. And guess what? They’ll happily buy that property at a 5% cap rate, even if it was acquired at a 10% cap years earlier. I've seen physicians walk away with 20x their initial investment, not counting the steady rental income along the way.
Inside a DB plan, this asset can contribute to long-term yield assumptions—and because you control the lease terms and tenancy, you’re not at the mercy of a volatile commercial market.
2. Integrated Angel Investing Into a Defined Benefit Plan
Defined benefit plans, by design, offer guaranteed retirement income and allow for high annual contributions—often hundreds of thousands of dollars per year, all tax-deductible. But most people think they have to park that capital in bland, conservative assets.
Not true.
Our investment policy at Del Mar allows for ERISA-compliant allocations into real estate, private equity, and even venture capital—so long as they meet the prudence standard and are part of a diversified strategy.
Some of the most impressive doctors I know wove angel investing into their DB plans. Instead of writing a personal check to a medtech startup, they used a pension plan vehicle to invest. The upside flowed through the plan; the downside was backed by PBGC insurance. In other words, you got the asymmetric return potential of a startup with the downside protection of a guaranteed pension payout.
We’ve even helped structure retirement distributions to mimic the waterfall of a venture fund: base income from traditional assets, with capital distributions timed to exit events from portfolio companies.
3. Bought a Practice Cheap, Then Gave Equity to the Protégé
Buying a practice at 1–2x revenue is already a savvy move. But here’s how the truly strategic doctors turned it into long-term wealth: they shared equity with the next generation.
One client of ours bought a sleepy practice in a high-foot-traffic area. He brought in a hungry, younger associate. Instead of just offering a salary, he gave her equity with vesting milestones tied to patient growth, operations, and community engagement.
That new energy doubled the patient base. Revenue went up. The practice’s valuation increased, and the original doctor’s equity stake appreciated while his clinical hours went down. Eventually, the younger doctor took over fully, and the original owner exited cleanly, selling his shares at a premium.
It’s succession planning with upside—and inside a DB plan, that value creation contributes to retirement funding while minimizing current income tax burden.
4. Joined a Venture or PE Fund as a Medical Venture Partner
Here’s a clever move I’m seeing more and more: doctors joining venture or private equity funds as medical advisors or venture partners.
You don’t need to launch your own fund. Instead, align with an existing one—preferably one investing in health, medtech, or digital therapeutics—and offer your clinical insight. You gain access to deal flow, upside in carried interest, and exposure across a diversified portfolio.
The fund gets credibility. You get economic participation—and you don’t have to risk your personal capital on one early-stage bet that might implode. Inside a pension plan, this type of exposure is especially powerful. You’re investing like an institution, not an individual.
The relationship becomes mutually reinforcing. Your credibility as a practicing physician lends the fund trust with investors. And your returns are decoupled from individual practice earnings.
5. Turned Their Office Into a Launchpad for Startups They Backed
This one’s my favorite—because it’s the most creative.
The smartest doctor-entrepreneurs treat their practices as live demos for companies they’ve backed. One ENT featured an otoscope from a startup he invested in—essentially turning every patient visit into a product demo. Another dentist showcased oral care products from a company she helped seed—turning her waiting room into a miniature brand showroom.
This isn’t about being flashy. It’s about authenticity. Patients trust doctors. When they see their provider using or recommending a product, it accelerates adoption—and it builds enterprise value for the startup.
For the doctor, this creates a flywheel effect: early capital → increased usage → more data → better fundraising → stronger valuation. And if the doctor is invested through their DB plan, all that upside accrues tax-deferred, inside a PBGC-insured retirement structure.
Final Thoughts: Wealth Building Without Chasing the Market
Here’s the truth: most physicians don’t have the time or interest to track markets daily, analyze startup pitches, or flip real estate deals. And they shouldn’t have to. What they do have is a steady income, a high level of trust, and a deep network. When you build a financial strategy that leverages those three assets, the results can be transformative.
A defined benefit plan gives you the structure. The five strategies above give you the playbook.
If you’re a physician, dentist, or medical professional who wants to turn a strong income into long-term financial independence—and do it with the kind of downside protection most investors can only dream about—join us.
At Del Mar Medical Devices, we host regular events, both virtual and in-person across Southern California, where we connect like-minded physicians, spotlight MD/MBAs doing incredible things in business, and introduce high-quality defined benefit plans that are both tax-savvy and legacy-minded.
You’ve worked too hard to settle for mediocre returns and unpredictable retirement.
We’ll help you do better—strategically, securely, and together.
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Subscribe to this Substack to join our network. The next chapter of your financial future starts with a plan—and we’re here to build it with you.