Need help understanding my mom’s SIMPLE IRA

Hi there,

I am about to finish medical school and have started reading more about personal finance, planning for retirement, etc. Because of this, I’ve asked to see my mom’s retirement account and I’m a little puzzled at her SIMPLE IRA account provided by her employer. The account is through RBC Wealth Management and there is an advisor for the account that was provided by her employer. As I look at this account with my new, although still limited, knowledge, I am a bit worried.

My mom is a physician at a small private practice and is turning 61 this year. She has been contributing to this account for 13 years, but has been very hands-off with managing it. From my understanding, she has been maxing her contribution every year. Here are the details of the account:

* Account value: ~253k
* Available cash: ~135k
* Mixed assets: ~118k (comprised of two mutual funds, MDLOX and ETFAX, which both have very high expensive ratios of 1.09% for MDLOX and 1.69% for ETFAX)

My questions are:

1) Taking into consideration she’s been maximizing her contributions for 13 years, I feel like her account should have grown more than what it has now (if it was properly managed). Am I correct in thinking that?

2) My understanding is the available cash is basically cash that is not invested in anything. Is having 135k in available cash normal for a retirement account? It seems like a waste to leave it uninvested.

3) The two funds chosen have very high expense ratios. Wouldn’t it be better to instead invest in low expense ratio index funds/ETFs?

I appreciate all the help! This sub has been so valualble to me as I continue to learn more about personal finance.