Brett K. Fellows CFP Financial Planning for CRNAs and NPs

Brett K. Fellows CFP Financial Planning for CRNAs and NPs Helping CRNAs and NPs make work optional, pay less in taxes, and invest smarter.

Oak Capital Advisors is an independent, fee-only registered investment advisor located in Charleston, SC. We specialize in exit and retirement planning for CRNAs located in and around Charleston, SC.

06/03/2026

A PA earning $130k a year looked me in the eye and said, “I’m not really a high-income earner.” Almost every time I hear this (which is all the time), it’s wrong. On my latest pod episode, burton, founder of Millionaires in Medicine, explains where this negative mindset comes from and what she did about it.

Two things that often make RNAs, NPs, and PAs feel like low-income earners:
- You spend your days around physicians earning 3–4x your income. By comparison, your salary feels average.
- Student loan payments drain cash flow every month. It doesn’t feel like you’re ahead because the debt makes it feel like you’re always catching up.

The national median household income is around $80k. A CRNA, PA, or NP earning $120–180k isn’t average at all, but the comparison to physicians makes it feel that way. If you’re in this boat, then this message is for you: The wealth-building math WORKS at your income. So what will you do next?

You can find the full conversation with Kristin on the MoneyRx podcast and our YouTube channel.

05/29/2026

I recently sat down with Amanda Kay, CRNA, coach, and founder of The Mindful CRNA, and she said something that I think a lot of CRNAs need to hear.

She had an accountant AND a system… and she still wasn’t sure what was inside her own tax return until we looked at it together.

That gap is more common than people admit. For CRNAs running their own entity, understanding your return means knowing:

- Whether your salary-to-distribution split is working in your favor
- What the QBI deduction is doing for you, or not doing
- Where your money is actually going versus where it should be going
- What your accountant filed versus what you could have structured differently

Filing on time is not the same as filing smart. If you have handed your return to someone and stepped back without really understanding it, that is worth fixing. Watch the full episode of MoneyRx to hear what Amanda took away when she finally looked at her own numbers.

05/28/2026

Amanda Kay is a CRNA, a coach, and the founder of The Mindful CRNA. She is in these communities every day, and she will tell you straight: most CRNAs are leaving money behind at tax time. 💰

The deduction question comes up every single year in every CRNA forum. And the answer is almost always the same: you probably missed some. Good bookkeeping is not about being a numbers person. It is about having a simple system you run consistently throughout the year so that when April arrives, the work is already done.

Watch the full episode of MoneyRx for a practical look at what CRNAs get wrong at tax time and how to fix it before next year.

05/27/2026

I had the pleasure of sitting back down with Amanda Kay, CRNA and founder of The Mindful CRNA, and one thing she said stuck with me: she made more money last year as a fully independent provider than in any year as a W2.

Most CRNAs who go 1099 do it for flexibility. The ones who stick with it find that the income eventually wins, too. The fear of leaving W2 is real, but so is the ceiling. Building your own schedule, choosing your contracts, and structuring your entity correctly changes the math in ways a steady paycheck never will.

Watch the full episode of MoneyRx for CRNAs and NPs to hear what one year of full independence taught Amanda about money, structure, and knowing when to hold the line.

05/22/2026

Let’s say we run two different plan scenarios for the same nursing household, with the goal of retiring debt-free.

➡️ The cost difference between scenarios is $181,000. ⬅️

Plan one: pull $228,000 from the 403(b) in January, pay off the house, and walk into retirement debt-free in a day.

The lifetime federal tax bill would have been roughly $190,000 higher than carrying the mortgage to term, with the ACA planning window cut in half.

Plan two: $25,000 a year of extra principal payments from current cash flow over five years. The mortgage balance dropped from $228,000 to $90,000 by retirement, paid off completely four years later from pension and Social Security.

The 403(b) went untouched the entire time. Lifetime cost of the plan: about $9,000.

The difference was where the money came from and when. For the full story, watch the latest MoneyRx episode streaming in all platforms!

05/20/2026

Some pre-retirees wonder whether to pay off their mortgage prior to retirement. What to do?

Here’s what to consider if withdrawing out of a 403(b) at age 60.

It’s more than just one cost.

It runs through four separate toll booths before a single dollar touches the mortgage, and because each bill lands on a different form in a different year, almost nobody adds them up.

Federal tax pushes through three brackets in one year, roughly $42,000. State tax adds another four to six percent on top, call it $11,000. An ACA subsidy evaporates because income spiked for the year, adding $14,000 in premiums (probably unplanned!).

Two years later, Medicare premiums are calculated off a tax return that now shows a very large income for the year.

When you add those four bills together, the tax cost alone is over $70,000. Layering in the $120,000 in compounding the money would have generated by staying in the account through age 73, the total real cost of writing that check comes out to roughly $190,000.

People see the $42,000 federal bill and think that is the damage. But it’s not even a quarter of it.

New episode of MoneyRx for CRNAs and NPs is live now.

05/15/2026

If you have ever asked whether you should prioritize ACA subsidies or Roth conversions in retirement, you are asking the question most nurses ask, and it is the wrong one.

The framing assumes the two strategies have to compete, but that is only true if you are making a fifteen-year decision on a single year's tax return. When you plan across the full retirement runway, placing each strategy on the right years, both levers run and neither one costs the other. The difference in lifetime taxes can be significant. For one CRNA household, it was $280,000.

Watch the latest MoneyRx episode to see how that played out, year by year.

05/13/2026

If you are planning your ACA subsidy strategy around the cliff line, you are missing the part that does the most damage.

Most nurse households know they need to keep income under a certain threshold to protect the subsidy. What they do not account for is the slope leading up to it, where every additional dollar of income is already quietly reducing the credit before you ever cross the line. In 2026, with the enhanced ACA credits gone, the math is less forgiving than it has been in years. Here is what that actually looks like in practice:

- A household converts $25,000, thinking they are in the 12% bracket
- Federal tax on the conversion: $5,500
- Subsidies lost: $13,800
- 77 cents of every converted dollar, gone

Watch the latest MoneyRx episode for the full breakdown of how the shadow tax works and what to do instead.

05/08/2026

96% of nurses never use this hospital plan feature. For Dana, that choice cost her close to $200,000 in contributions she could have (should have) made.

Dana works at a non-profit hospital. That means she has access to a 457(b), a separate deferred compensation account that can be funded on top of the 403(b) at the same contribution limits.

For 2026, that is $24,500 a year of additional tax-advantaged space.

She also has an after-tax sleeve inside her 403(b) that can roll into a Roth through an in-service rollover. And an HSA she could have been investing for two decades. She didn’t use any of these.

Plan documents are written by attorneys for compliance. The Summary Plan Description for her hospital is 43 pages long. HR did not walk her through the optional sleeves at orientation. The 457(b) is invisible unless you go looking for it.

For eight years, Dana had access to $24,500 a year she never used. That is close to $200,000 in contributions, not including the market growth.

Most nurses find out in a single HR call that they have at least one feature they are not using. The latest MoneyRx episode explains exactly what to look for.

05/06/2026

Dana is 58 and is married to Marcus. Together, they earn $310,000 a year and follow all the retirement guidelines they get from respected articles.

So WHY did she find out the structure of her $1.4 million savings was about to cost her household well into six figures?

What she learned: 96% concentrated in pre-tax. Unfortunately, that means one account equals one tax treatment.

This situation isn’t unusual. The latest MoneyRx episode walks through how this happens, and what to do about it.

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