Chart · Money through a medical career
Medicine pays late. Plan for the years in between.
Loans start in medical school, real pay starts after training, and most saving starts later still. Find where you are on the timeline, read what tends to matter at that stage, and, when you want a person, request a referral to a licensed advisor who works with physicians and clinicians.
Readout: the late start
Illustration · $1,500/mo · 6% a year · to 65
- Start investing at 25
- $2,987,236
- Start at 35
- $1,506,773
- Start at 40
- $1,039,491
- Ten years of training, priced
- $1,480,464
Same monthly amount, different start. Not a forecast. Change the assumptions
Timeline · 6 stops
Six stops on a medical career
Open a stop for a short note, the articles written for it and a direct line to an advisor who works with physicians at that stage.
MS1–MS4
Medical school
Borrowing starts. Investing usually has not.Most of the debt is taken on here. Unsubsidized federal loans build interest while you are in school, so the balance on graduation day is usually more than what you borrowed.
Write down each loan, its type and its rate. Whether a loan is a federal Direct loan decides which repayment and forgiveness options you have later.
PGY-1 onward
Residency
A small salary, a large balance, and a choice about forgiveness.Income-driven repayment sets the payment from income, not balance, so a resident's payment can be lower than the interest. The balance can grow even when every payment is on time.
If you may work for a nonprofit or public employer, residency payments can count toward Public Service Loan Forgiveness. Refinancing into a private loan gives that up for good.
Moonlighting paid on a 1099 has no tax taken out. Set part of it aside for tax.
Subspecialty years
Fellowship
More training years, and a good time to look at disability cover.Fellowship years at a qualifying employer generally keep counting toward the same 120 PSLF payments. Track the count across residency and fellowship together.
Individual disability policies are underwritten on your health when you apply. Many physicians buy an own-occupation policy in training, with an option to raise cover as income rises.
Attending, year one
First attending contract
The biggest pay rise of a career, and a contract to read line by line.Base salary is the easy number. The wRVU threshold, the bonus rate, signing-bonus repayment terms, the non-compete and who pays for tail coverage often matter more.
The jump from resident to attending pay is large. Deciding the order of big purchases before the first paycheck matters more than any single purchase.
The long middle
Mid-career
Catching up on the years spent in training.A physician who starts saving at 35 has ten fewer years of compounding than a peer who started at 25. The plotter shows what that gap costs and what closes it.
Hospital employers often offer a 403(b), a 401(a) and sometimes a 457(b). With a backdoor Roth IRA, that is more tax-advantaged room than many physicians use.
Changing jobs, cutting back, retiring
Transition
Exits have costs of their own.Leaving a job covered by claims-made malpractice insurance can bring a tail coverage bill in the tens of thousands of dollars. Check who pays before you give notice.
Practice owners choose among SEP IRA, solo 401(k), 401(k) with profit sharing and cash-balance plans. Partner ages and practice size decide which fits.
Find an advisor
Complete a short intake for physicians and clinicians
How it works
Intake
Four short steps. Ranges are fine for the money questions.
Review
A person reads your answers and contacts you to confirm what you need.
Referral
To a licensed advisor who works with physicians and clinicians. Follow-up is your decision.
Tool · Illustration
The cost of a late start
Training delays saving and grows the loan at the same time. Set your own numbers: the plotter draws what the same monthly amount becomes by 65 from three starting ages, and what your loan does while you train.
- Start at 25, at 65
- $2,987,236$720,000 paid in
- Start at 35, at 65
- $1,506,773$540,000 paid in
- Wait until 40, at 65
- $1,039,491$450,000 paid in
- Cost of starting late
- $1,480,464the gap at 65 between starting at 25 and at 35
- Monthly amount from 35 to match
- $2,974what closes the gap by 65
- Owed after 4 years
- $252,000$52,000 of it is unpaid interest
- Interest charged
- $52,000$0 paid in total
Show these numbers as a table
| Age | Start at 25 | Start at 35 (you) | Wait until 40 |
|---|---|---|---|
| 25 | $0 | not started | not started |
| 30 | $104,655 | not started | not started |
| 35 | $245,819 | $0 | not started |
| 40 | $436,228 | $104,655 | $0 |
| 45 | $693,061 | $245,819 | $104,655 |
| 50 | $1,039,491 | $436,228 | $245,819 |
| 55 | $1,506,773 | $693,061 | $436,228 |
| 60 | $2,137,065 | $1,039,491 | $693,061 |
| 65 | $2,987,236 | $1,506,773 | $1,039,491 |
| Year | Principal | Unpaid interest | Amount owed |
|---|---|---|---|
| 0 | $200,000 | $0 | $200,000 |
| 1 | $200,000 | $13,000 | $213,000 |
| 2 | $200,000 | $26,000 | $226,000 |
| 3 | $200,000 | $39,000 | $239,000 |
| 4 | $200,000 | $52,000 | $252,000 |
Method
Illustration, not a forecast. Every number comes from the assumptions above, which you can change. Real returns vary from year to year and can be negative; fees, taxes and inflation are left out.
- Investing: the same amount at the end of every month from the starting age until 65, growing at the annual rate ÷ 12 each month. Balance after n months = amount × ((1 + i)n − 1) ÷ i, where i = rate ÷ 12.
- Matching amount: the monthly figure that gives the start-at-25 total by 65 from your starting age, using the same formula solved for the amount.
- Loan: simple interest. Each month adds balance × (rate ÷ 12) to unpaid interest, which is not added to the principal. A payment clears unpaid interest first, then principal. Federal Direct loans charge simple interest, but some events can add unpaid interest to the principal, which would make the balance grow faster than shown.
Started late, or about to? An advisor who works with physicians and clinicians can build a catch-up plan around your loans and your contract.
Reading list · 10 articles
Articles, each about four minutes
Written for people in medicine, with worked examples. General education, not advice.
Two more tools
- Student Loan Repayment Strategy During Residency: IDR, PSLF, and Refinancing Tradeoffs
Residents earn too little to pay loans aggressively and too much to ignore strategy. Here is how income-driven repayment, PSLF, and refinancing interact during training.
- Own-Occupation Disability Insurance for Physicians, Explained
A physician's earning power depends on a narrow set of physical and cognitive skills. Own-occupation disability coverage protects that in a way group policies usually do not.
- Attending Contract Negotiation: The Financial Basics Beyond Base Salary
Base salary is the number everyone compares, but RVU thresholds, signing bonuses, and restrictive covenants often matter more to your real financial outcome.
- Stacking 403(b), 401(a), and Backdoor Roth for Hospital-Employed Physicians
Hospital-employed physicians often have access to more tax-advantaged savings vehicles than they realize. Here is how the pieces fit together.
- Locum Tenens Tax and Retirement Planning
Locum work trades employment stability for 1099 flexibility — and a fundamentally different set of tax and retirement planning tools.
- Private Practice vs. Employed Physician Compensation: A Real Comparison
Ownership upside versus employment stability is not just a lifestyle choice — it is a financial structure choice with very different risk and reward profiles.
- Planning for the Cost of Malpractice Tail Coverage
Leaving a job with claims-made malpractice insurance can trigger a tail coverage bill running into the tens of thousands of dollars. Plan for it before you need to.
- Physician Mortgage Loan Programs Explained
Physician loans let new attendings buy a home with little or no down payment despite high student debt. The tradeoffs are real and worth understanding first.
- Timing Major Purchases Around the Residency-to-Attending Income Jump
The jump from resident to attending salary is one of the largest single-year income increases in any profession. Sequencing decisions matters more than the decisions themselves.
- Retirement Plan Options for Private-Practice and Partnership Physicians
Physician-owners have access to retirement plan structures that hospital employees do not — and the right choice depends heavily on practice size and partner age mix.
Wherever you are on the timeline, you can ask.
Four short steps. We review the intake, confirm what you need, then refer you to a licensed advisor who works with physicians and clinicians.