April 20, 2026
5 min read
Physicians spend a decade mastering the science of medicine yet receive almost no formal training in personal finance.
From medical school through residency and fellowship, the curriculum focuses on anatomy, physiology and clinical decision-making, but topics such as tax strategy, asset allocation and income diversification are rarely addressed. This gap is striking given that physicians graduate into one of the most complex financial environments of any profession, often carrying substantial educational debt while simultaneously entering the highest tax brackets.
At the same time, the economic structure of physician practice has undergone a profound transformation. In the past 2 decades, medicine has shifted steadily away from physician-owned private practices toward employment within hospitals and large health systems. According to a recent AMA survey, the proportion of physicians practicing in physician-owned practices declined from roughly 60% in 2012 to less than 50% by 2022.
Real estate: An investment strategy
Historically, private practice physicians benefited from multiple ancillary revenue streams associated with patient care. Orthopedic surgeons frequently held ownership stakes in ASCs, imaging facilities, physical therapy practices and DME services. In many cases, physician groups also owned the medical office buildings where they practiced, allowing them to benefit not only from clinical income but also from the real estate underlying their practice operations.
These ownership structures created multiple sources of income and allowed physicians to participate in the appreciation of valuable assets over time. As health care consolidation has accelerated, however, many physicians practicing in employed models no longer have access to these opportunities. For a growing number of physicians, income is now derived almost entirely from W2 clinical productivity.
As an academic orthopedic surgeon practicing within an employed model, I began thinking about how to recreate some of the financial advantages historically associated with private practice ownership. I enjoy clinical practice, research and teaching, and I have no intention of leaving academic medicine. However, I recognized that developing additional income streams could improve long-term financial resilience and professional flexibility.
Traditional financial planning advice for physicians often focuses heavily on public equities, bonds and retirement accounts. While these investments are important components of a diversified portfolio, many financial planners rarely discuss private real estate as a core investment strategy. Yet real estate has historically been one of the most important asset classes for wealth creation.
For centuries, income-producing real estate has played a central role in the portfolios of many of the world’s wealthiest families. Land and rental property represent tangible assets that generate income, provide inflation protection and often appreciate over time. Institutional investors, such as pension funds, university endowments and family offices, routinely allocate meaningful portions of their portfolios to real estate for these reasons.
Academic research supports this approach. Studies examining institutional portfolio construction have demonstrated that real estate investments can improve diversification and reduce portfolio volatility when combined with traditional financial assets such as stocks and bonds.
Investment trusts vs. syndications
Most individual investors gain exposure to real estate through publicly traded real estate investment trusts (REITs). REITs allow investors to purchase shares in companies that own diversified portfolios of real estate assets. While REITs provide liquidity and dividend income, the investor’s ownership interest is indirect, and the economic benefits are typically limited to dividends and share price appreciation.
Real estate syndications provide a different model. In a syndication structure, investors obtain a direct ownership interest in a specific property alongside an experienced sponsor team that identifies, acquires and manages the asset. Instead of owning shares in a public company that owns real estate, investors directly participate in the economic performance of the underlying property. Rather than receiving a limited dividend similar to a REIT, investors receive their share of rental cash flow, benefit from depreciation-related tax advantages and participate in appreciation when the property is ultimately sold.
A real estate ‘fellowship’
Approximately 6 years ago, I began investing in multifamily real estate syndications as a limited partner. This allowed me to gain exposure to institutional-quality real estate assets while experienced operators managed the day-to-day operations.
In time, I began to view these investments through a lens that was familiar to many physicians. In traditional private practice, surgeons often make a capital investment to buy into the practice or into an affiliated ASC. That investment provides an ownership interest that can generate ongoing ancillary income. I began approaching real estate syndication investments in a similar way. Instead of a buy-in to a surgery center or imaging facility, these investments represented a buy-in to income-producing real estate.
Recognizing that commercial real estate is a sophisticated asset class, I also invested heavily in education. I worked with real estate investment coaches, attended industry conferences and participated in investor mastermind groups to accelerate my understanding of commercial real estate markets.
In many ways, I began to think of this process as a parallel training pathway. Investing passively as a limited partner became my version of a real estate residency. It allowed me to observe how deals were structured, how assets were managed and how market cycles influenced investment outcomes. In time, that experience evolved into what I would describe as a real estate fellowship.
Recently, after several years of learning and investing as a limited partner, I participated in my first transaction as a general partner. While most physicians will likely remain passive investors, this progression illustrates how financial knowledge can develop gradually through education and experience.
Interestingly, many of the characteristics that make physicians successful surgeons also translate well into real estate investing. Surgeons are trained to evaluate risk carefully, analyze complex information and perform rigorous preparation before making high-stakes decisions. Similarly, experienced real estate investors often spend months performing due diligence before acquiring a property. This process includes reviewing financial statements, analyzing market trends, evaluating property condition, assessing financing structures and stress-testing assumptions under multiple economic scenarios.
Multifamily real estate syndications
Multifamily real estate syndications offer several characteristics that may be particularly attractive for physicians.
First, they can generate passive cash flow derived from rental income, creating income streams not directly tied to hours worked in the clinic or OR. This is commonly referred to as “mailbox money.”
Second, real estate offers tax advantages that may be meaningful for high-income professionals through mechanisms such as depreciation and cost segregation.
Third, syndications allow physicians to participate in property ownership without assuming operational responsibilities, as sponsor teams oversee acquisitions, financing, leasing and property management.
Finally, real estate can provide diversification relative to traditional public market investments, helping stabilize portfolios over long investment horizons.
Of course, real estate investing carries risk. Market cycles, interest rates, operational challenges and sponsor execution can all influence outcomes. For this reason, physicians should perform careful due diligence and maintain diversified portfolios.
Conclusion
The goal of investing in alternative assets is not to replace clinical income but to complement it. Medicine remains one of the most meaningful and intellectually rewarding professions. However, developing diversified income streams can provide physicians with something that traditional employment models often cannot: financial optionality.
For physicians practicing in employed models, real estate syndications may represent one way to recreate some of the ownership benefits historically associated with private practice. My hope is that more physicians begin applying the same discipline they bring to clinical training to financial education so that their capital works just as hard as they do.
Editor’s note: This article is for educational purposes only. Please consult a licensed financial advisor before making any investment decisions.
- For more information:
- Kirk A. Campbell, MD, is an associate professor of orthopedic surgery at NYU Langone Health and co-founder and CEO of Mila Penn Capital. He can be reached at: KirkCampbell@MilaPennCapital.com.
Sources/Disclosures
Source:
Expert Submission
- References:
- Hudson-Wilson S, et al. J Portf Manag. 2003;29(5):12-25.
- Recent changes in physician practice arrangements: Shifts away from private practice and towards larger practice size continue through 2022. https://www.ama-assn.org/system/files/2022-prp-practice-arrangement.pdf. Accessed March 11, 2026.
Disclosures:
Campbell is an academic orthopedic surgeon, entrepreneur and investor. He is the co-founder and CEO of Mila Penn Capital, which is a private real estate investment firm. He is an active investor in multifamily real estate and other types of commercial real estate.
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