ER Doc Advisor - Financial Planning & Taxes for Emergency Physicians

EP 273: Capital Gains Planning for High-Earning ER Physicians

For high-earning ER physicians, capital gains aren’t just about investments—they’re about control. The way gains stack on top of earned income can change tax outcomes, portfolio risk, and even career decisions in ways that aren’t obvious at first glance.

Today, we’re unpacking how capital gains actually work in the context of ER income, and why small strategic choices can make a disproportionate difference over time.

Topics Discussed   

  • Why capital gains often matter more than your tax bracket suggests.
  • How gains quietly stack on ER income and raise true tax rates.
  • The hidden risk of holding appreciated assets too long.
  • The trade-off between diversification and permanent tax costs.
  • When “doing nothing” with legacy positions becomes the bigger risk.
  • How income choices affect the taxes you’ll pay on future gains.
  • Why small planning decisions can change outcomes by tens of thousands.

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ER docs, emergency medicine, capital gains tax, investment planning, portfolio risk, tax strategy, high income physicians, NIIT, taxable brokerage accounts, asset allocation, wealth management, tax optimization