Physician Employer Guides (2026): Kaiser, VA, UC and IPERS Compared
Physician compensation guides obsess over salary. But for a large share of physicians, the employer's structure — pension or no pension, vesting rules, loan benefits, who pays malpractice — moves more lifetime wealth than the salary line does.
In This Guide
Methodology
Each guide in this series is built from plan documents, official materials and physician-reported data — with every figure sourced and dated.
Read full methodology →Key takeaways
- The same physician, same specialty, same salary can end up millions apart at retirement — based on employer alone.
- A $100K/year pension is the functional equivalent of ~$2.5M of extra portfolio. Four major employers still offer one.
- Every pension in this series has a vesting cliff (5 to 7 years). Short stints capture the below-market salary and forfeit the deferred value.
- Two of these employers eliminate your malpractice costs entirely. One makes you PSLF-eligible automatically.
Physician compensation guides obsess over salary. But for a large share of physicians, the employer's structure — pension or no pension, vesting rules, loan benefits, who pays malpractice — moves more lifetime wealth than the salary line does.
The problem: none of it is published clearly. Plan documents are semi-private, HR packets bury the caps, and the details live scattered across forums.
That's what this series fixes. Four deep dives on the biggest structured physician employers in America, each built from plan documents, official materials and physician-reported data — with every figure sourced and dated.
The comparison table
| Employer | Pension? | The headline number | The trap | Full guide |
|---|---|---|---|---|
| Kaiser (TPMG/SCPMG) | ✅ Up to 50% of pay at 30 years | ~$72K/year lands in DC accounts on top of the pension | 5-year vest — and "partner" means opposite things in NorCal vs. SoCal | Read → |
| The VA | ✅ FERS — and market pay counts toward it | $200K tax-free loan repayment (EDRP), no clawback | Total comp capped at $400K | Read → |
| University of California | ⚠️ Optional — a 90-day, irrevocable election | Savings Choice: 8% employer contribution on pay up to $360K | The pension counts only $159,773 of your salary (PEPRA cap) | Read → |
| Iowa public / IPERS | ✅ Up to 65% of pay at 35 years | Comp counted up to $360K — more than double UC's cap | 7-year vesting cliff; bonuses excluded from covered wages | Read → |
The four deep dives
🏅 Kaiser Permanente (TPMG and SCPMG)
Best for: physicians who want the strongest total retirement stack in private medicine — and plan to stay past year 5.
The most-searched physician employer in America, and the most misunderstood. In Southern California, "making partner" means becoming a true K-1 partner for about $2,500. In Northern California, there are no partners — you become a shareholder of a corporation, buying real stock ($40K mandatory, $140K–$150K typical with optional shares).
Underneath both: a genuine pension (2% of pay per year for 20 years, then 1%), an automatic employer contribution worth ~$26K/year, and a 401(k) with full Mega Backdoor Roth capability.
The catch: everything meaningful vests at 5 years. Kaiser as a 2-year stepping stone is a below-market deal by design.
Read the full Kaiser guide →🏅 The Department of Veterans Affairs
Best for: physicians with large federal loan balances, and cognitive specialties where the salary gap is small.
The VA's sticker salary understates the real package more than any employer in this series. The FERS pension counts Title 38 market pay toward your high-3 (the detail almost every projection gets wrong). EDRP pays up to $200K in loan repayment, tax-free, with no clawback if you leave early. VA employment is automatically PSLF-qualifying — and EDRP reimburses the same payments PSLF counts.
And the sleeper: you never buy malpractice insurance or a tail. Ever. The United States is your coverage.
The catch: total compensation caps at $400K, so the gap versus private practice widens as specialty income rises.
Read the full VA guide →🏅 University of California
Best for: understanding the one decision new UC physicians can never undo.
Every new UCSF, UCLA, UC Davis, UC San Diego and UC Irvine physician gets 90 days to choose: Pension Choice or Savings Choice. Do nothing, and you're defaulted into the pension — irrevocably.
Here's why the generic UC advice fails physicians: the pension formula counts only $159,773 of salary (the PEPRA cap), and under the Health Sciences Compensation Plan, much of a physician's clinical pay was never pension-eligible to begin with. For most mobile physicians, Savings Choice — with 1-year vesting and a later option to switch into the pension — is the asymmetric play.
Read the full UC guide →🏅 IPERS (Iowa public physicians)
Best for: UIHC and Carver faculty, county hospital physicians, and anyone facing Iowa's 60-day IPERS-vs-TIAA election.
Iowa's state pension counts compensation up to $360,000 — more than double UC's cap — and pays up to 65% of your high-5 average at 35 years. The Rule of 88 allows unreduced early retirement.
The catch: a 7-year vesting cliff (the longest in this series), bonuses excluded from covered wages entirely, and — like UC — an early-career irrevocable election most physicians make before understanding it.
Read the full IPERS guide →How to read any employer's package
The four guides above share one framework. Apply it to any offer:
Find the vesting cliff. Every deferred benefit has one — 5 years at Kaiser and the VA, 5 at UC, 7 at IPERS. If your realistic tenure is shorter, price the package without the deferred benefits, because you won't keep them.
Find the compensation cap. Pensions never count your full physician income. The question is which cap applies: the IRS limit ($360K — Kaiser, VA-adjacent, IPERS) or something far lower (UC's $159,773). The cap determines whether the pension replaces 50% of your income or 18%.
Ask what the salary gap buys. A below-market salary with a pension, retiree health and loan benefits can beat a higher salary with none — if you stay past vesting. Our contract negotiation guide covers how to run this comparison on paper before signing.
Check PSLF status. The VA qualifies automatically. Kaiser physicians qualify via the 2023 CA/TX rule change. UC is a public employer. For any physician carrying federal loans, the PSLF math can outweigh the entire pension-vs-DC question.
Stress-test the promise. Pensions and deferred comp are only as good as the entity behind them. Government backing (VA, IPERS, UC) differs structurally from corporate backing — and nonqualified deferred comp anywhere makes you an unsecured creditor. Our hospital bankruptcy guide covers the due diligence.
Frequently asked questions
Which physician employer has the best retirement benefits?
For total retirement value, Kaiser's TPMG stack (pension + ~$26K automatic employer contribution + Mega Backdoor Roth 401(k)) is the strongest in private medicine for physicians who stay past 5 years. The VA wins for indebted physicians (EDRP plus automatic PSLF) and for anyone valuing zero malpractice cost. The honest answer depends on your loan balance, specialty salary gap, and realistic tenure — which is why each deep dive includes a "who wins, who loses" verdict.
How much is a physician pension actually worth?
Roughly 25x its annual payment under the 4% framework: a $100,000-per-year pension equals about $2.5 million of portfolio. Full-career pensions in this series realistically reach $99,000–$150,000+ per year — meaning a pension-holding physician with $1.5 million in accounts can be better positioned for retirement than a pension-less peer with $3.5 million. See Net Worth at Retirement for the full math.
What happens to these benefits if I leave early?
Before the vesting cliff (5–7 years depending on employer): you keep your own contributions and forfeit the employer's — the pension, the match, sometimes six figures of deferred value. This is deliberate design, and it's why every guide in this series repeats the same warning: don't take a structured-benefits employer as a short stepping stone.
Are these plans' details public?
Partially. UC and IPERS publish plan documents fully. Kaiser's are semi-private — our guide reconstructs them from official materials, publicly filed plan documents, advisory-firm analyses and physician-reported figures, each labeled. The VA's are public but scattered across statute, OPM rules and Federal Register notices. Every figure in this series is sourced and dated, and corrections are invited at editorial@medmoneyguide.com.
Coming next in this series
UT System (TRS vs. ORP) — the 90-day irrevocable election at UT Southwestern and MD Anderson · Florida FRS — Pension vs. Investment Plan for UF/USF physicians · Mayo Clinic — the salaried model and its pension · Cleveland Clinic — the one-year contract structure.
New deep dives land in the weekly newsletter first.
Editorial Credibility
Joshua Dunigan, DO | Family Medicine Physician & Founder
I founded MedMoneyGuide to provide physicians with unbiased, specialty-specific financial guidance. My goal is to add transparency and credibility to your financial journey.