When to Start Social Security: The Physician’s Dilemma
You've probably been told to delay Social Security as long as possible. Is that true?
You didn't earn anything until you were 30. Social Security noticed.
Four years of medical school at zero income. Three to seven more at a resident's salary. Your college roommate who went into consulting was eleven years into real earnings before you wrote your first attending-level W-2.
Social Security's benefit formula does not forgive that. It averages your highest 35 years of Averaged Indexed Monthly Earnings (AIME), and for a physician, that 35-year window typically includes the training years. Your roommate fills those same slots with real income. You fill them with numbers like $0 and $5,000.
There is a corollary that almost no other high earner gets to claim: working one more year in your sixties can still meaningfully raise your benefit, because each attending year displaces a training year in the average. A career maximum earner who has already banked 35 years at the cap gains close to nothing from another year of work. You are likely not that person.
One item worth special notice: physicians in S-corp practices who minimize W-2 salary to reduce payroll tax are also lowering their AIME. That trade is often made by a CPA optimizing the current year with no view of the 35-year record.
That is the first thing the standard claiming advice gets wrong about physicians. It is not the only one.
Here is the standard advice. Social Security is use-it-or-lose-it income. It starts when you claim, continues as long as you live, and - this part matters more than most articles admit - continues to your surviving spouse after that. You can claim as early as 62 or as late as 70. Each year you wait past full retirement age adds 8% to the monthly benefit, up to 24% at age 70. And it comes with a graph like this:
The takeaway is that if you live past about 80, you collect more in total by waiting. Pretty cut and dried, right?
Not quite. That graph was built for a career that looks nothing like yours. It assumes 35 years of steady covered earnings. It assumes you stop working on the day you claim. It assumes Social Security is the bulk of your retirement income rather than a rounding error sitting on top of a large tax problem. And it assumes you die on the general population's schedule.
Case study: Dr. Mike and Dr. Sarah
Take a hypothetical married couple. Dr. Sarah is four years younger than Dr. Mike. They earn roughly the same and are entitled to roughly the same benefit. Should both wait until 70?
In this case, yes. Both waiting until 70 comes out ahead.
But that heat map assumes both of them live very long lives. What if we use more realistic life expectancies, say 79 for Mike and 82 for Sarah?
The answer flips. Now it's best for Dr. Mike to claim at 62, and after he passes, Dr. Sarah steps in to receive survivor benefit in addition to her own benefits. Dr. Sarah delays until 68. The couple maximizes lifetime benefits by claiming at different ages, not the same one.
What if the trust fund runs short?
Projections show the Social Security trust fund becoming depleted in the 2030s, which would trigger benefit cuts of around 23% unless Congress acts. If we model that (assuming Dr. Mike was born in 1965):
Mike still claims at 62. The model puts Sarah's optimal age at 69, but the heat map shows little difference if she claims anywhere from 66 on. A cut to future benefits shrinks the reward for waiting.
The opportunity cost most planners skip
If you don't claim this year, you still have to fund your lifestyle somehow. If you've stopped working and aren't trading time for money, that means selling investments. Waiting isn't free, because you're drawing down your portfolio to buy a bigger future check.
The reverse also holds. If you cover your expenses another way and invest your benefits instead, claiming early gives that money more time to grow. Assume a modest 4% annual opportunity cost:
Now early claiming looks even better for Mike and Sarah.
And we're not done
Add planning to reduce taxes on your benefits. Then coordinate all of it with when to begin taxable withdrawals from IRAs and 401(k)s, or systematically Roth converting larger pre-tax retirement accounts, so you manage lifetime taxes rather than just this year's bill. It quickly turns into 4D chess.
The complexity continues:
Two physicians, one household
Spousal benefits max out at 50% of the higher earner's benefits at Full Retirement Age of 67 (FRA), which means in a dual-physician marriage where both are near the cap, spousal benefits are irrelevant and each spouse claims on their own record. In a single-earner physician household, the higher earner's delay is functionally a survivor annuity purchase. These are two completely different decisions to consider.
You are not going to stop working at 62
Do physicians stop working at 62? Will you? Keep in mind, if you keep working before FRA, for every $2 you make above $24,480/year, SSA deducts $1 from your benefits. If you keep working after FRA, SSA deducts $1 for every $3 you make above $65,160. For physicians, part time work, locums shifts, telehealth work, expert witness work, half-day clinic work easily pushes our income above these limits.
Social Security is small in your income statement and large in your tax and Medicare exposure
Three compounding items:
Taxation. For single filers with provisional income above $34,000, or $44,000 for joint filers, up to 85% of social security benefits are subject to federal income tax. For a physician household with required minimum distributions from retirement accounts (RMD’s) and a taxable portfolio, 85% is not a ceiling to worry about; it is the default.
The senior deduction does not apply to you. The OBBBA $6,000 senior deduction phases out entirely above $175,000 for single filers and $250,000 for joint filers, and expires after 2028. Any article your patients or your partners have read about "no tax on Social Security" describes a benefit this audience does not receive.
IRMAA, a not-well understood tax. The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is a surcharge on Medicare payments owed for higher income seniors starting at age 65. The 2026 Medicare surcharge begins at $109,000 for single filers and $218,000 for joint filers, with total monthly Part B premiums ranging from $284.10 to $689.90, on top of a standard 2026 Part B premium of $202.90. The two-year lookback means income realized this year sets the amount two years out. IRMAA surcharges are projected to increase over time. Because Part B is deducted from the Social Security deposit, a practice sale, a partnership buyout, or an aggressive Roth conversion at 63 can quietly shrink the net check at 65.
The claiming decision is really a Roth conversion decision
For a physician with seven digit pre-tax accounts, the years between retirement and the RMD start date are the only structurally low-bracket years of the entire financial life. Delaying Social Security might keep taxable income suppressed during that window, which might make conversions affordable. In some cases, it might make sense to Roth convert early, over only a few years, rather than take the other often-quoted suggestion to first spend taxable savings, then pre-tax savings, then Roth savings, to minimize taxes from higher later RMD distributions and minimize the number of years paying IRMAA surcharges.
Ultimately, right answer depends on your health, your spouse, your portfolio, your tax picture, and your assumptions about the future. That's exactly why it deserves a real analysis rather than a rule of thumb.
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