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Financial Planning for
Physicians & Attendings

The jump from $60K to $300K is disorienting. Most of the expensive mistakes happen in the first five years as an attending, before anyone warns you about them.

Quick Answer

Should I pay off medical school loans aggressively or invest first?

The math depends on your interest rate. At rates below roughly 5–6%, investing in a diversified equity portfolio has historically outperformed aggressive loan paydown over long periods. At rates above 7%, guaranteed paydown often wins. The real answer also includes your PSLF eligibility (which can make minimum payments the right move regardless of rate), income trajectory, and risk tolerance. This is general educational information, not personalized advice.

The Attending Transition

Five Mistakes Most
Physicians Make Early

You're over the income limit for a Roth IRA, but there's a legal workaround most attendings don't know about. And if you rolled your residency 401(k) into a traditional IRA at any point, you may have accidentally broken it without realizing.

The backdoor Roth is the most commonly discussed strategy. The pro-rata rule is the thing that silently kills it. We walk you through both, and check whether your current IRA setup creates a tax problem on conversion.

For loans: PSLF may be worth more than aggressive payoff if you're at a nonprofit institution. The math often points to investing the difference rather than paying down low-rate federal debt.

Physician Planning Areas

  • Backdoor Roth: setup, pro-rata rule check, mega backdoor strategy
  • Student loan strategy: PSLF vs. aggressive payoff vs. refinancing
  • 403(b) and 401(k) audit: expense ratios, fund selection, contribution order
  • Attending income planning: investing sequence for the first 5 years
  • 1099 income tax planning for moonlighting or private practice

Free Resource

Physician Financial Guide

The 5 attending mistakes, the backdoor Roth setup, the pro-rata trap, and how loan strategy actually works at your income level.

What We Cover:

  • The backdoor Roth: how it works and what breaks it
  • The pro-rata rule, and how to fix it before you convert
  • Mega backdoor Roth: up to $46K extra per year tax-free
  • When PSLF beats aggressive loan payoff

FAQs

Common Questions from Physicians

The math depends on your interest rate and PSLF eligibility. At rates below 5–6%, investing has historically outperformed aggressive paydown. At rates above 7%, paydown often wins. PSLF eligibility changes the calculus entirely. Qualifying physicians may be better served making minimum loan payments and maximizing retirement contributions. We model both paths before recommending either.
Own-occupation disability insurance is the cornerstone: it pays benefits if you can’t perform your specialty, not just any job. Many physicians underinsure here. A policy covering 60% of current income should cover core obligations. We review existing coverage and identify gaps before they become crises.
The financial considerations are significant: buying into a practice typically requires capital, and partnership track timelines affect when you share in practice value. We model the economics of employment vs. ownership based on your specialty, geography, and personal goals before you commit to either path.

Go Deeper

Physician Planning Resources

Article

Generational Pension Planning: What Physicians Miss

 Article

OBBBA Planning Window: What High Earners Should Do Now

 Article

PSLF for Nurses 2026: The Forgiveness Roadmap

 Video

The Backdoor Roth Strategy Most Physicians Miss

 Research

Inside the Portfolio: Our Equity Research, Free to Subscribe

 Newsletter

The Retirement Brief: Retirement Decisions, Explained Plainly

 LinkedIn Newsletter

The Behavioral Investor: Why Behavior Beats Brains in Investing

Free Tool

Where Do You Land
on the Risk Spectrum?

Seven questions, about two minutes, no login. See which of our five model portfolios lines up with how you actually think about risk, then look at the models themselves.

Take the 2-Minute Risk Profile

Or browse the five portfolio models →

A physician loan-vs-invest calculator is also in the works, so you can see payoff against investing on your actual numbers.

Get the calculator the day it launches.

Ready to Begin?

15 Minutes. No Pressure.
Just Honest Answers.

Book a free 15-minute call. We'll look at your loan situation, check your IRA setup for pro-rata issues, and answer whatever's on your mind.

Book a Free 15-Min Call