OBBBA’s cuts and tax shifts are coming: How physicians can protect their practice and family with a modern estate plan

Under the One Big Beautiful Bill Act (OBBBA), the ground rules for how much physicians can protect and pass on are changing. It raises the federal estate tax exemption to roughly $15 million per person (or $30 million per couple) starting in 2026 and locks in key income tax cuts, which opens a wider window for tax-efficient wealth transfers than most families have ever seen. At the same time, federal health care cuts and changes to Medicaid, ACA Marketplace coverage, and Medicare payment increase unpaid care and squeeze practice margins, pushing more financial risk back onto physicians.

In that environment, a physician’s estate plan has to serve as a clear playbook for who controls the practice, who manages the digital systems, and how the family’s financial runway is protected if something happens, especially because traditional documents so often break down in terms of digital access and practice continuity.

Why OBBBA demands a new approach to estate planning

OBBBA’s expanded transfer-tax thresholds give physicians a time-limited window to move more wealth out of the taxable estate, shift practice equity, and pre-fund family goals with far less exposure to federal estate tax. Now, the real decision is whether you, the practitioner, treat this window as part of a deliberate strategy or let it close by default.

The same law also tightens federal health care spending. Cuts and restructuring in Medicaid and ACA funding are likely to mean more patients losing coverage or facing higher deductibles. For practices, that translates into a higher risk of unpaid care, more write-offs, slower collections, and ongoing pressure on margins.

In this setting, treating tax planning and estate planning as separate exercises no longer works. The same trusts, entities, and lifetime transfers that help you use OBBBA’s exemptions can also determine who owns the practice, how buy-sell obligations are funded, and what happens to compensation streams if you die or become disabled.

Designed through that lens, your estate plan becomes a bridge between tax opportunity and business continuity—yet most existing physician plans were never built to carry that exact load.

The cost of outdated planning: Digital gaps in physician estates

While most physicians have an estate plan, many of those documents still assume a world of paper charts, predictable careers, and simple ownership structures. They spell out who receives assets, but almost nothing about who can actually touch the systems that run the practice.

There is a major blind spot in many plans, and that’s digital access to clinical systems. EHR platforms, telehealth portals, and practice-management software sit behind multiple layers of authentication. When a physician dies or loses capacity, families and staff can end up locked out. To make things worse, HIPAA and state privacy laws do not automatically pass access rights to a spouse or office manager. That means, without explicit authority, the safest option for vendors is often to say no.

Static documents also struggle to keep pace with modern medical careers. Physicians change jobs, reduce clinical time, move into administrative roles, or exit practice earlier than prior generations. A plan drafted around one income model can ignore partnership obligations, equity earn-outs, or deferred compensation that surface only when your role changes.

Eventually, the downstream effects show up where it hurts most. Probate delays slow access to practice accounts. Unclear authority over EHR data raises compliance risk. Buyers discount or walk away from a practice if no one can demonstrate clear control over digital assets and record custody.

What a modern, digital-first estate plan for physicians should include

A modern plan starts with a clear inventory of personal and professional digital assets. That list should include core clinical and business systems, payer portals, licensing and credentialing accounts, prescribing credentials, telehealth tools, and key vendor relationships. It must link each asset to a person or entity with legal authority to act and to a practical way to obtain access when needed.

It then lays out succession mechanics. For practice owners, that means spelling out who will operate or wind down the practice and how receivables, staff, vendors, and record-keeping obligations will be handled. For employed physicians, it means addressing employer-based benefits, deferred compensation, side entities, and any personal guarantees tied to loans or leases.

Finally, a modern plan relies on tools that keep up with real life. Many digital estate platforms now allow physicians to store encrypted credentials, define access rules, and connect those rules to the legal language in their trusts and operating agreements. When passwords, vendors, or practice structures change, a simple update on the digital layer makes all processes more efficient instead of rewriting the entire legal stack. That gives trustees, spouses, and designated practice leaders a single, secure source of truth when OBBBA rules evolve or when an unexpected event forces action.

For most physicians, the next step is to review the plans with an estate-planning attorney and tax advisor who understand physician practices, map digital and practice assets, and choose a digital estate platform that can carry those details forward as OBBBA and the health care market continue to change.

Howard Enders is the Chief Operating Officer of The Estate Registry, where he leverages his extensive expertise in operations and management to drive growth and innovation. A graduate of the University of Delaware, Howard furthered his education at Widener University School of Law, equipping him with a strong foundation in legal and regulatory matters.