A Physician’s Retirement Income: Expert Tools to Avoid Poverty

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Retirement income implies cash flow for life.  You never want to run out of money in your old age.  Know your Wealth Zone and reduce taxes on retirement income. Learn all you can about guaranteed retirement income options like Social Security. This post looks at more advanced ways of providing retirement income for life.

[This is a guest post by David Graham, MD.  He and I commiserated by email about starting our blog’s last year.  His site is FIPhysician.  As the name implies he reached FI and enjoys helping other physicians get there too.  He coaxed me into taking a CFP course online at BU. I’m embarrassed to say I neglected to include him on my list of physician bloggers. If you like this, read his other guest posts at White Coat Investor, DrBreatheEasyFinance, DebtFreeDr, and Physician on FIRE.-WD]

Picture retirement spending as a “smile”— you spend more in the early years of retirement on things you enjoy. Later, spending slows down only to increase again on medical and geriatric needs. Fixed income forms a floor through all of retirement, while the higher early and late expenses are mostly variable.

Some retirees desire to cover their fixed income needs with guaranteed income such as social security, pensions or annuities. As a result, this creates flexibility in the early retirement years and safety from those fears of cat food and refrigerator boxes in the later retirement years.


Retirement Income with Annuities

Let’s look at the role annuities play in retirement income planning.

Negative feelings circle annuities like proverbial vultures, though Wealthy Doc says you can safely increase your retirement income with a SPIA (Single Premium Immediate Annuity). In addition, the White Coat Investor calls SPIAs “The Good Annuity.”

You don’t invest in annuities, you buy them. They are insurance products that transfer risk. The purpose of a SPIA is to guarantee a life-long income in exchange for a lump sum of money.


Single Premium Immediate Annuity

A SPIA is an immediate income annuity meant to provide income and some longevity insurance (the risk of running out of income if you live a long life). The income you get every month doesn’t stop until you (or you and your spouse if you purchase a Joint and Survivor annuity) die.


Deferred Income Annuity

Another annuity specifically for longevity planning is a DIA (Deferred Income Annuity). With a DIA, you make initial lump sum payments but defer turning on the income for a number of years in exchange for a higher percentage of income when it eventually is annuitized.

You can buy SPIAs in both non-Qualified (AKA taxable or brokerage) accounts and in Qualified (IRAs and other pre-tax) accounts. The tax treatments for these differ. The former is partially taxable and the latter is fully taxable.

Until recently DIAs could only be purchased in your brokerage account. Enter QLACs.


Retirement Income with QLACs

There is a new kid on the block, though, gaining some interest: the QLAC (Qualified Longevity Annuity Contract), a DIA for your IRA.

Some investors are excited to use QLACs to decrease Required Minimum Distributions (RMDs). They actually just delay RMDs, though, and you will pay eventually. QLACs do allow you to defer until as late as 85 years of age. As a result, they can be an interesting option for longevity insurance and for spouse protection/planning if used as a Joint and Survivor annuity. More on QLACs below.


SmackDown Comparison

I thought it would be fun for high-income folks to see a smackdown comparison of The Good Annuity vs. The New Kid on the Block in a fictional couple planning for their retirement.  This is truly an “apples and grapes to oranges and raisins” comparison (an immediate income brokerage annuity vs. a deferred longevity IRA annuity). However, it should be interesting to see how the match goes.

I will also briefly compare a brokerage DIA and a Qualified SPIA as well.


Meet Our Couple

Our couple is 74 and 69 years old in 2019. They made a good living and spent freely in early retirement. Since longevity runs in both families they worry about outliving their money. A 30-year plan (until 95 and 100 years of age respectively) wouldn’t be excessive. 

Their remaining nest egg is $2,000,000. Now that their spending has slowed down a bit, they plan to spend about $7,500 a month—a 4.5% withdrawal rate.  This couple is conservative and believes the stock market won’t keep making the great returns of the last decade. As a result, they keep $250,000 in cash and have a 50/50 stock-to-bond ratio (which they assume will pay 6% and 3%).

They have $250,000 in a Roth IRA, $750,000 in a roll-over IRA, and a brokerage account worth $750,000. Inflation is 2.5% except for healthcare which is 5%. Finally, they receive $3,000 a month in social security.


Current Plan Without an Annuity

Monte Carlo simulation of this scenario demonstrates a 53% chance that their plan will succeed. In addition, stress testing shows a particular sensitivity to interest rate and longevity risks.

Retirement income forecast through asset simulation.
Figure 1


Figure 1 above shows the confidence levels that money will last to specified ages of the 74-year-old partner. The plan ends at 105 which is when the 69-year old partner expects to die at 100 years of age, a full 10 years after the older spouse passes.


Retirement income projection through withdrawal patterns.
Figure 2


Figure 2 shows the income sources with 28.6% of the income “stable,” as it comes from social security. Note that the expected need for income and the social security income drops when the older partner dies at age 95. Also note there is a spike in “income” to pay the taxes at age 102 when the brokerage account runs dry and taxes are paid on the IRA, which is used briefly to fund income needs until it too runs out.

From a cash flow standpoint, the brokerage account is accessed for needs above RMDs. Initial RMDs start at about $28,000 a year and increase to $50,000 a year at age 95. The brokerage account runs out of money at age 101 and the IRA is exhausted at age 103. Finally, taxes in this scenario start at about $12,000 a year and max out at about $18,000 a year at age 87.

This plan upsets the younger spouse who is determined to live to 100, and they wonder if a SPIA would help.


SPIA Plan for Retirement Income

They decide that $260,000 from the brokerage account would be an acceptable amount to buy a SPIA, and are offered a 7.2% yearly rate of return on a single life annuity on the younger spouse.

A few words about the assumptions above: the QLAC maxes out at $130,000 this year, so I decided to see what a $260,000 SPIA would look like. On the planning software, Monte Carlo projections improve the more money spent, but our couple didn’t want to exhaust their brokerage account. Also, they could have opted for a Joint and Survivor policy, but the younger partner felt sure of a longer life than the older spouse. Of course, a single life policy offers better returns than a joint policy. Finally, the percentage return will, of course, vary depending on specific circumstances and current interest rates.

With a $260,000 SPIA, the couple now has a 60% chance for success on Monte Carlo Simulation. The asset simulation (similar to figure 1 above) for the SPIA plan looks just slightly better, so it is not reproduced here.

Retirement income through SPIA as a tool.
Figure 3


Figure 3 above shows a drawdown comparison between the two plans. Initially, a $260,000 investment can be seen in dark blue, but the income from the SPIA slows the downward slope of the drawdown. The “crossover point” where the couple has more money with the SPIA is after 23 years–when the oldest partner is 97. It should be noted, however, that at no point is there a huge difference in the total amount in either plan. At the end of the plan, the SPIA saves about $103,000.

Retirement income projection with an annuity.
Figure 4


Stable Retirement Income?

In the SPIA plan, 39.6% of the income is stable from social security and the annuity. We can see the spike in income again at age 102, so let’s look at the cash flows to see if the brokerage account runs out of money about that time.

With expected cash flows, the brokerage account starts out $260,000 less than in the previous simulation. RMDs are the same, and the brokerage account runs out of money at age 100. The IRA runs dry at age 102. However, the Roth has $103,000 more at the end of the plan than without an SPIA.

In summary, we slightly increased this plan’s Monte Carlo odds and offered a bit more income stability, but the younger spouse asked to see a QLAC.



In 2019, you can invest 25% of your IRA up to a maximum of $130,000 into a QLAC. The couple decided to see what $130,000 from their IRA would buy and were offered a 14.4% rate of return for a 10-year deferral of income. Again, don’t get hung up on the interest rate.

Monte Carlo simulation for the QLAC is 60%, and an asset simulation is seen below in figure 5.

Retirement income asset simulation with QLAC
Figure 5


The drawdown comparison is pretty similar to figure 3 above, so not repeated here. The crossover point in this example is 99 years of age when the QLAC plan has more assets than the initial plan.


Guaranteed cash with an annuity and pension.
Figure 6


In the QLAC plan, 36.3% of the income is stable from social security and the annuity. In addition, we again see the familiar bump—now at age 103.

Looking at cash flows, the IRA starts $130,000 less than in the other two plans. RMDs start at about $23,000 (down from $28,000 before) and peak at $41,000 at age 94 (down from $50,000 at age 95). Finally, the brokerage account runs dry at age 102 and the IRA at age 103.

Like the SPIA, the QLAC provides a slight increase in Monte Carlo odds, and both plans lower the risk of inflation and longevity on stress testing.

So—who is the winner of the smack-down competition? That is for our couple to decide.

Meanwhile, let’s briefly consider the two other possible combinations for immediate vs deferred and non-Qualified vs Qualified.


Brokerage DIA

Running some simulations of a 10-year DIA in the taxable account, the Monte Carlo success rate increases the more spent. We can spend all of the brokerage accounts on a DIA and achieve a 94% success rate.

As a result, about 71% of the income is stable and the ending balance is over $1,000,000. However, again, the 99 is the crossover point, meaning that longevity insurance comes at a price.

The younger spouse has to live at least 25 years to see the large initial drop in their brokerage account return to the baseline amount without the DIA.


Qualified SPIA

Like the other plans above, for the SPIA in a Qualified account, Monte Carlo success rates increase with higher initial sums of money from the IRA. We can use the entire $750,000 to purchase a SPIA and get up to a 79% success rate. Again, the large difference in account balances until the age of 99 demonstrates the cost of longevity insurance (see figure 7).

Living expenses and its effect on declining portfolios.
Figure 7



In a nutshell, either of these annuity options (SPIA or DIA) in either account type (Qualified and non-Qualified) increases the odds of success, especially if the couple is willing to use a large sum to purchase the annuity.

Of course, you can mix and match. Each spouse could get their own (or Joint and Survivor) QLAC from their IRA, with or without a SPIA or DIA from the brokerage account. Planning for income and longevity with multiple annuities is common.


Simply a Tool

There is a saying in retirement circles that annuities are simply a tool. And, as in all investing, decisions are tradeoffs. Asset allocation, partial Roth conversions, and delaying social security are examples of tradeoffs between risk and reward. Annuities, when used appropriately, lower both potential risk and possible reward.

If you have significant fixed income needs, then a SPIA is a good tool.

If you have significant longevity risk and may run out of money, a DIA can come in handy.

For folks with health and expectations to live a longer than average life, a DIA can help you sleep at night. Annuities have no under-writing or medical exams. Insurance company and other folks in your insurance pool “want” you to die early.

You just have to live longer than the actuaries think you will get your money back. But the point is insurance—not getting your money back.

Do any of us complain when we don’t get our death benefits from term life insurance?


Retirement Income Opportunity Cost

Of course, there is opportunity cost—the lost opportunity to otherwise invest the money used to buy an annuity. No one, however, is going to guarantee that the stock market will give you stable, life-long income.

In addition, it is often said that annuities are sold rather than bought. While it is clear annuities do have strengths, each investor must weigh the guarantees against the money spent. Once you sign up for an annuity, that money is gone and cannot be used for emergencies or given to heirs.


Retirement Income Inflation Risk

Inflation is perhaps the biggest risk to retirees. For that reason, Variable Annuities and Fixed Indexed Annuities are often sold as a hedge against inflation, as you can participate in the gains of the stock market (with all the risks theretofore and extra fees to boot). Perhaps a better way to deal with inflation is to set aside some of your nest egg for a future SPIA as part of your overall plan. Cost of Living Adjustment riders in annuities have lower initial payments and are likely not the best option.


Final Thoughts on Retirement Income

If you are married and have a large IRA, you can hedge against the widow/widower tax penalty (where tax brackets decrease at the death of the first spouse) with a Joint and Survivor QLAC. This will lower RMDs while providing future fully taxable income for the surviving spouse.

Otherwise, a Joint and Survivor annuity can offer some piece of mind at the cost of significantly lower income payment.

Consider a single life annuity if one partner is significantly younger or healthier than the other. Income payments for males are higher (as we die earlier), so a couple can explore both dual single life and Joint and Survivor options.

Finally, annuities often come with riders. There can be a term certain (it will pay for a certain number of years even if you die) or other refund type options in case you die early. Riders like this can be expensive and are something to think about forgoing. When buying insurance in case you live a long life, do you really want a refund if you don’t?

[Thank you for persisting to the end of a challenging post.  Retirement income that comes as guaranteed cash flow for life is worth studying.  I convinced my mother to sell some of her mutual funds and buy a SPIA.  She has been enjoying that guaranteed monthly cash flow.  If you don’t like volatility or you haven’t saved enough over the years to provide adequate cash flow, consider these more advanced tools. -WD]

About the Author

David Graham, MD is a practicing Infectious Disease physician and blogs at FiPhysician.com. After discovering his passion for personal finance, he started a Registered Investment Advisory to promote his mission “Financial Literacy for Physicians.” For personal enjoyment, he recently sat for and passed the CFP exam.


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  1. Xrayvsn said:

    Another fantastic post by David. I have thoroughly enjoyed his guest posts that have been appearing on various platforms in the physician blogosphere.

    This was a topic I was quite naive on so thank you for educating me on it.

    Everything you do has pros and cons and it is up to your individual risk profile to see what something is worth to you. Longevity risk is a concern as people don’t want to run out of money but you have to have a realistic expectation of your own lifespan to see if the numbers work. If you are unhealthy, smoker, and have bad genes with people in your family dropping off in their 50s-70s this would not be the way to hedge your bet. Conversely if all your relatives lived into their 100s this is something that makes a compelling case.

    Great post WD. Thanks for sharing.

    June 12, 2019
    • Xrayvsn,
      I’m glad you liked it.
      David is taking physician finance, consulting, and blogging by storm. I can’t believe how many high-caliber guest posts he recently cranked out.
      We all can learn a lot from him.

      June 12, 2019
  2. Gasem said:

    I love this. OJ lives on a 3M annuity despite his legal issues. I’m not using an annuity but self insuring by separating out a Roth from a partial Roth conversion which I will not open for withdrawal except in case of disaster like a cancer diagnosis. If the market does so poorly as to wipe me out I doubt any insurance is going to be around to save me. To big to fail ,bailed out AIG with 85 billion and moving toxic debt to the Fed balance sheet allowed those debts to mature without bankruptcy, but the majority of that debt still exists on the FED balance sheet 10 years later. Except for that Hank Paulson’s Curley shuffle AIG would be worth pennies instead of $53.

    Not to say some annuity is not useful in the main for a typical retirement just the extent of it’s security may be as limited as the market itself.

    June 17, 2019
  3. Crispy Doc said:

    Mind blowing. Still wrapping my head around a good portion of the acronyms, but the SPIA value shone bright and clear for me.

    Appreciate the high level guest post,


    June 26, 2019
    • Crispy Doc,
      Thanks for stopping by and for the comment.

      David Graham is a smart guy. Very detail-oriented and knowledgeable. I was reluctant to run it at all since I barely understood this post. I actually have already “dumbed it down” for myself before I posted it. The original was more arcane. But I know a lot of my readers are smarter than I am and they will find it helpful.

      The bottom line for me is that some products (like SPIA) can reduce your risk of running out of money. If you must retire with a too-small nest egg, then consider some annuity products.

      June 26, 2019
  4. AThomson said:

    Excellent synopsis. Hope your financial advisor is as versed on the various topics. If not get another.

    July 1, 2019

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