Why Medical and Dental Practices Face Unique Retirement Plan Risks

May 7, 2026

Medical and dental practices often assume their retirement plan options are relatively straightforward and should be simple to administer. In reality, these businesses frequently present some of the most complex retirement plan challenges among small-to-mid-sized employers. 

Importantly, this complexity also creates favorable planning opportunities—allowing practices to structure retirement programs that maximize tax efficiency for high-earning professionals while strengthening long-term staff retention. 


The complexity we’re referring to stems from a combination of workforce structure and compensation design. Many practices include high-earning owner-physicians or dentists; associate partners, often with variable compensation packages; and various types of support staff—such as hygienists and assistants—paid on an hourly basis. In addition, bonuses may be tied to production, ownership may span multiple locations or entities, and partner buy-ins or exits occur regularly. 


These factors combine to create a dynamic environment, one where retirement plan administration requires a fair amount of precision and proactive oversight. 


Variable Compensation and Associated Nondiscrimination Testing Failures 


One of the most significant retirement plan risks for medical and dental practices is variable compensation, and its impact on nondiscrimination testing, required by the IRS. When there is a wide gap between owner compensation and staff wages, testing outcomes can become highly unpredictable. 


The situation becomes even more complex when compensation definitions are not applied consistently under the terms of any retirement plan(s) in place. For example, if bonuses are inconsistently included or excluded from plan compensation, it can distort testing results and lead to plan compliance issues. 


These issues may result in failed Actual Deferral Percentage (or”ADP”) / Actual Contribution Percentage (or “ACP”) tests; required corrective contribution payments; refunds to highly compensated owners; and other unanticipated employer costs. In many cases, the issues are only identified after year-end, when correction options are more limited - and more costly. 


Performing proactive testing projections and creating clearly-defined compensation policies are essential to reducing volatility and maintaining compliance. 


Ownership Changes and Controlled Group Compliance Risk 


Medical and dental practices also experience frequent ownership transitions, including the admission of new partners, partial ownership transfers, and the operation of multiple related entities. While these changes are often made for growth and succession planning purposes, they can significantly impact retirement plan compliance. 


If ownership percentages and entity relationships are not regularly evaluated, it can trigger something called “controlled group rules”. When this occurs, employees across all related entities must be considered together for retirement plan coverage and nondiscrimination testing purposes. 


Failure to properly identify and apply controlled group status can lead to plan testing failures, missed employee eligibility, and incorrect contribution allocations. These risks are particularly common in practices that expand to multiple locations or operate through separate legal entities without a coordinated retirement plan strategy. 


SECURE 2.0 and Evolving Retirement Plan Requirements 


Recent legislative changes have introduced additional layers of complexity for medical and dental practices. Provisions under the SECURE 2.0 Act require employers to interpret and implement new rules that can disproportionately affect practices with variable compensation structures and diverse workforces. 


Key considerations include Roth catch-up contribution requirements for higher earners, long-term part-time employee eligibility tracking, and increased penalties for late or inaccurate filings. Each of these changes requires careful coordination between payroll, plan administration, and compliance processes. 


For practices already managing complex compensation and ownership dynamics, these regulatory updates further increase the importance of proactive retirement plan oversight. 


The Bottom Line: Aligning Retirement Plan Strategy with Practice Structure 


Medical and dental practices benefit most from a retirement plan strategy that is intentionally aligned with their compensation models and ownership structures. This includes clearly defining plan compensation, anticipating the impact of ownership transitions, conducting nondiscrimination testing projections throughout the year, and adapting plan design to meet evolving regulatory requirements. 


Without proactive oversight, even small inconsistencies in compensation or ownership tracking can lead to recurring compliance failures. Over time, these issues can result in increased costs, administrative burden, and regulatory exposure. 


By taking a strategic and coordinated approach to retirement plan design and administration, medical and dental practices can reduce compliance risk, improve testing outcomes, and better support both owner and employee retirement goals. 

September 15, 2026
The Challenge Sometimes the most expensive retirement plan mistakes aren't dramatic. They're quiet. A former client of ours changed retirement plan providers following an acquisition several years prior. On the surface, everything appeared to be operating normally after moving to the new provider: employees continued making contributions to the plan, the plan’s investments remained in place, and the business continued its normal operations. Then another merger opportunity came along. As part of their due diligence process, the buyers reviewed the retirement plan. What they found immediately raised concerns. The annual Form 5500 filings required by ERISA law had not been submitted for several years. That also meant that none of the required compliance testing had been completed, and routine administrative responsibilities had also gone undone. What had started as a routine review quickly became a significant obstacle to completing the business sale. The Hidden Risk Many employers assume that once a retirement plan provider is hired, responsibility for the plan’s ongoing administration has effectively been transferred to that provider. But a plan sponsor is never completely relieved of its responsibility to oversee the plan. Even when outside providers are hired to handle filings, testing, recordkeeping, or other administrative functions, the employer still needs to make sure those responsibilities are being fulfilled. At the same time, there is an important difference between a provider that simply waits for the employer to supply information and one that actively works with the employer to make sure the plan stays on track. In this case, some of the missing work may have resulted from information requested by the provider that was never supplied by the employer. Technically, the employer still had a responsibility to provide that information and ensure the work was completed. But years of required administration should not quietly disappear into a communication gap. A proactive administrator follows up. If the usual contact isn’t responding, they escalate the issue. They make sure the appropriate people understand what is outstanding, why it matters, and what could happen if it isn’t addressed. Retirement plans require ongoing attention every year, including government filings, compliance testing, participant administration, documentation, and, when necessary, operational corrections. When those responsibilities are neglected, the consequences may not become obvious immediately. Instead, problems can accumulate quietly in the background until an IRS inquiry, Department of Labor investigation, audit, or—as in this case—a business transaction suddenly exposes years of unresolved issues. The prospective buyer made it clear that the retirement plan issues needed to be addressed before the transaction could move forward. The Rescue Knowing we had previously administered their plan, the current company leadership contacted us. Our first step was to determine the full scope of the problem. The timing made the situation particularly challenging. This wasn’t simply a retirement plan cleanup project. A business transaction was underway, and the company needed answers quickly. We assembled a team to determine the full scope of the problem and begin developing a path forward. Because we have deep experience with taking over neglected plans, we were able to separate perceived problems from actual compliance issues and reconstruct the plan's history. In reviewing the prior documentation, we identified exactly which administrative functions had been completed and which had been missed. We gathered historical payroll and participant data and developed a comprehensive correction strategy. Having access to historical plan records was especially important. Retirement plan problems may not surface until years after the underlying event, making good record retention critical. If you’re curious about how long to hold onto plan documentation, please see our blog post here . The final correction effort proved to be far more manageable than originally feared. Instead of allowing uncertainty around the retirement plan to continue hanging over the transaction, the employer now understood what had actually gone wrong, what needed to be corrected, and what steps were required to move forward. The Outcome With the correction efforts clarified and a clear roadmap in place, the employer was able to begin correcting the plan and continue moving toward its business transaction. More importantly, the company avoided entering the acquisition process with unresolved retirement plan liabilities hanging over or ruining the deal. The experience also reinforced an important lesson: Changing retirement plan providers doesn't eliminate administrative responsibilities. But it also demonstrated why the quality of the administrator matters. A good retirement plan administrator doesn’t simply process the information that arrives. They help make sure the information arrives in the first place. The Lesson: Oversight Is a Shared Process Employers ultimately have a responsibility to oversee their retirement plans, even when they hire professionals to handle much of the day-to-day work. That doesn’t mean the employer should have to become a retirement plan expert or personally track every filing deadline and compliance requirement. That’s one of the reasons experienced administration matters. A proactive provider should help keep the employer informed, identify missing information, follow up when something is outstanding, and escalate issues before a missed request becomes a missed filing—or several years of missed filings. The cost of failing to do so can extend well beyond an annual administration fee: Missed filings and potential penalties Incomplete compliance testing Corrective work Additional professional fees Delayed business transactions Uncertainty during mergers and acquisitions  By the time those costs appear, they can far exceed whatever might have been saved by choosing a lower-cost service model. That’s why retirement plan administration shouldn’t simply be viewed as paperwork. It should be viewed as an ongoing partnership in managing risk.
August 18, 2026
The Challenge A business owner came to us after receiving confusing news from their retirement plan actuary. Their Defined Benefit (Cash Balance) Plan had performed exceptionally well over several years; strong investment returns seemed to have created what’s called an overfunded Plan. While it seems like a positive name, an overfunded plan can create excessive and unexpected tax liabilities. So, their actuary recommended terminating the Plan by transferring the excess assets into the company's other Plan, a 401(k)/Profit Sharing Plan, before eventually closing both Plans, a lengthy and complicated process.
July 15, 2026
As we wrap up the second quarter of 2026, one trend continues to stand out: retirement plans are becoming increasingly specialized. Whether driven by changing regulations, unique workforce structures, or evolving business goals, employers are finding that a one-size-fits-all approach simply doesn't work. This quarter, we explored the unique retirement plan challenges facing several industries—including medical and dental practices, construction companies, architecture and design firms, wineries, and California employers navigating CalSavers requirements. We also continued our series on the hidden risks of low-quality retirement plan services, highlighting how operational complexity, fragmented accountability, and misaligned incentives can create costs that extend far beyond administrative fees. For employers still evaluating their retirement plan options, we also discussed opportunities that many business owners overlook, including the ability to establish retirement plans after filing a tax extension and potentially generate meaningful tax savings. Below is a recap of the articles we published this quarter. We hope they provide practical insights to help you reduce risk, improve plan performance, and make more informed retirement plan decisions.
More Posts