Educational only. This is not legal, tax, or financial advice. Tax rules, contribution limits, state laws, and regulatory guidance change frequently. Consult your CPA, attorney, or financial advisor before acting on anything below. Last reviewed dates are shown at the bottom of each guide — numbers may be outdated.
A W-2 radiologist earning $500-800k has access to roughly $200-400k of annual tax-deferred space if the employer or practice structure makes it available — far more than most people realize. The limiting factor is usually plan design, not income.
The stack, from smallest to largest
1. 401(k) elective deferral — $23-23.5k (2024-2025)
The portion of your paycheck you defer pre-tax (or Roth). Same limit whether you are a resident or a senior partner. Catch-up adds if you are 50+.
2. 401(k) profit sharing — up to $70k combined (2025)
The employer side. Can be matched, cross-tested, or age-weighted. For partnership-track groups where older partners direct plan design, this often favors the partners — worth asking about during interviews.
3. Mega backdoor Roth — up to the $70k combined 401(k) cap
If your plan allows after-tax (non-Roth) contributions and in-plan conversion or in-service withdrawal, you can shovel tens of thousands into a Roth 401(k) on top of the standard $23.5k. Most hospital plans do not allow this; many private-practice plans do.
4. Cash balance pension — often $100-300k+
This is the one most radiologists have never heard of. A defined-benefit plan where contributions are actuarially calculated based on age — so a 50-year-old partner can legally shelter $200-300k/year on top of their 401(k). Paired with a 401(k)/profit-sharing plan, total deferrals can exceed $400k. Requires group buy-in (it is a practice-wide plan) and predictable cash flow to fund obligations.
5. Backdoor Roth IRA — $7k (2025)
Personal contribution. Because your income phases you out of direct Roth, you put the money into a non-deductible traditional IRA and convert to Roth immediately. Watch the pro-rata rule — if you have pre-tax IRA balances (e.g., rollovers from residency 403(b)), conversion becomes partly taxable.
6. HSA — $4.3-8.5k (family/self, 2025)
Triple-tax-advantaged (deductible in, grows tax-free, withdrawn tax-free for qualified medical). Works only with a HDHP. Underused by physicians as a stealth retirement account — you do not have to spend it on current medical care if you can pay out of pocket and keep receipts.
7. 457(b) — $23.5k (2025)
Separate from the 401(k) limit. Offered by many academic centers and some hospital systems. Governmental 457(b)s can be rolled over at retirement; non-governmental cannot and are subject to the employer's creditors — ask which kind you have.
8. Taxable brokerage
Whatever is left. At your marginal bracket this is the least efficient but the most flexible.
Cash balance plans in more detail
A cash balance plan is a defined-benefit plan styled to look like a defined-contribution plan. Each participant has a hypothetical account balance that grows by:
- A pay credit (actuarially set as a percentage of salary or a flat dollar amount, and sharply age-weighted)
- An interest crediting rate (often tied to 30-year Treasury)
The actuary designs the plan so partners' contributions can legally reach $200-300k/year at age 50+ while maintaining required non-discrimination testing. Younger employees get proportionally less, which is why it is a partnership tool, not an open hospital benefit.
Why radiologists love them: imaging groups often have a handful of well-paid partners and a small support staff, making the discrimination math work out. When the partnership wants to shelter large sums predictably, this is the tool.
The catch: cash balance plans require annual actuarial certifications (~$2-5k), a stable commitment to funding (you cannot skip years without amending the plan), and termination carries PBGC paperwork. Not a plan you adopt and forget.
Ordering suggestion for most radiologists
- Max the 401(k) elective deferral to capture any employer match
- Max the HSA if you have a HDHP
- Fill the 401(k) profit-sharing space your employer allows
- Do the backdoor Roth
- If you are a partner and the practice supports it, add a cash balance plan
- Consider 457(b) if governmental and you trust the employer's solvency
- Then taxable brokerage
Questions to ask your advisor
- Does my plan allow after-tax contributions and in-plan Roth conversion (mega backdoor)?
- Are we age-weighted or cross-tested on profit sharing?
- What would a cash balance plan look like for our group, and what is the actuarial cost?
- How does the pro-rata rule affect my backdoor Roth eligibility given old IRAs?
Common mistakes
- Leaving employer 401(k) match on the table — the most common and expensive mistake.
- Doing a backdoor Roth with a large pre-tax IRA balance still attached — triggers pro-rata tax.
- Assuming a 457(b) is "just like a 401(k)" without checking governmental vs non-governmental.
- Treating cash balance contributions as optional once the plan is set up — skipping years invites IRS scrutiny.
Last reviewed: 2026-04. Contribution limits and rules change annually; always verify current IRS figures before acting.