New Attending Financial Checklist

Your first year as an attending is financially transformative—your income jumps 3-5x overnight. But with that income comes critical financial decisions that will impact your wealth for decades. Make the right moves now and you'll set yourself up for financial success. Miss them and you'll play catch-up for years.

This checklist covers the essential financial actions to take in your first year as an attending physician—prioritized by urgency and importance.

Month 1: Critical & Urgent

1. Review Your Employment Contract

Why it matters: You likely signed quickly to start—now review carefully for issues.

What to check:

• Compensation: Base salary, RVU targets, bonuses, incentives
• Call requirements and compensation
• Benefits: Health insurance, retirement match, CME allowance
• Restrictive covenants: Non-compete radius and duration
• Tail coverage: Who pays malpractice tail if you leave?
• Termination clauses: Notice period, cause for termination

Action: Have an attorney review if you haven't already. Contract reviews cost $500-$1,500 but can save you tens of thousands.

2. Get Disability Insurance IMMEDIATELY

Why it's urgent: Your ability to earn $5-10 million+ over your career depends on your health. Protect it NOW before any health issues arise.

What you need:

• Own-occupation policy: Pays if you can't practice YOUR specialty (not just any job)
• Coverage amount: 60-70% of income (usually $10K-$20K/month benefit)
• Key riders: Future increase option, cost of living adjustment, residual disability
• Non-cancelable & guaranteed renewable: Premium can't increase, can't be canceled

Cost: $3,000-$8,000/year depending on specialty, age, and coverage

Why NOW: Premiums are locked in based on your age and health when you apply. Wait until age 35 and you'll pay thousands more over your career.

3. Build Emergency Fund

Target: 3-6 months of expenses ($15,000-$40,000 for most attendings)

Where to keep it: High-yield savings account (currently 4-5%)

Why it matters: Prevents you from going into debt for unexpected expenses or job transitions

Month 2-3: High Priority

4. Finalize Student Loan Strategy

Decision point: PSLF vs. Refinancing

Pursue PSLF if:

• You work at a 501(c)(3) non-profit or government facility
• Your debt-to-income ratio is above 1.5:1
• You plan to stay in qualifying employment for 10 years

Refinance if:

• You're in private practice
• Your debt-to-income ratio is below 1.5:1
• You can get a rate 2%+ lower than federal loans

Action items:

• If pursuing PSLF: Submit Employment Certification Form, enroll in income-driven repayment
• If refinancing: Get quotes from multiple lenders, choose best rate and terms
• Don't do nothing—make an active decision

See our full guides: Complete PSLF Guide and PSLF vs. Refinancing

5. Max Out Retirement Contributions

Priority order:

1. 401(k)/403(b) to match: Free money—always do this
2. HSA max: $8,550 (family) or $4,300 (individual) in 2026
3. Max 401(k)/403(b): $23,500 ($31,000 if 50+)
4. Backdoor Roth IRA: $7,000 ($8,000 if 50+)
5. Mega Backdoor Roth: If your plan allows, up to $46,500 additional

Why it matters: Every year you don't max retirement accounts, you lose that tax-deferred space forever. Start maximizing from day one.

Tax savings: Contributing $32,000 (401k + HSA) saves ~$15,000 in taxes at a 47% marginal rate.

6. Set Up Proper Budgeting System

The 50/30/20 rule adapted for physicians:

• 50% for necessities: Housing, food, utilities, insurance, loan payments
• 30% for savings & investing: Retirement, taxable investments, down payment fund
• 20% for discretionary: Everything else (travel, hobbies, dining out)

Why this matters: Most physicians don't budget and wonder where their money went. Lifestyle inflation is real—control it early.

Action: Track spending for 2 months using Mint, YNAB, or a spreadsheet. Identify where money is going and set intentional spending targets.

Month 4-6: Important But Less Urgent

7. Review and Optimize Health Insurance

If your employer offers multiple plans:

• Compare premiums, deductibles, and out-of-pocket maximums
• If you're healthy: High-deductible health plan + HSA is usually optimal
• If you have chronic conditions or plan major procedures: PPO may be better

8. Get Life Insurance (If Needed)

Who needs it:

• If you have dependents (spouse, children)
• If someone relies on your income
• If you have significant debt your estate would inherit

How much: 10-15x your annual income for stay-at-home spouse protection, or 5-7x if both spouses work

What type: 20-30 year level term life insurance (NOT whole life, universal life, or variable life—those are expensive and unnecessary)

Cost: $50-150/month for $2-3 million in coverage

9. Create Basic Estate Plan

Essential documents:

• Will: Specifies asset distribution and guardianship for minor children
• Healthcare Power of Attorney: Names who makes medical decisions if you're incapacitated
• Financial Power of Attorney: Names who handles financial affairs if incapacitated
• Living Will/Advance Directive: Your end-of-life care preferences

Cost: $1,000-2,500 with an attorney, or $100-300 using online services for simple situations

10. Update Beneficiary Designations

Review and update beneficiaries on:

• 401(k)/403(b)
• Life insurance
• IRA accounts
• Brokerage accounts (TOD/POD)

Why it matters: Beneficiary designations override your will. If they're outdated or wrong, assets go to the wrong person regardless of what your will says.

Month 7-12: Build Long-Term Foundation

11. Start Investing in Taxable Accounts

After maxing retirement accounts:

• Open a taxable brokerage account (Vanguard, Fidelity, Schwab)
• Invest systematically ($1,000-5,000/month or more)
• Keep it simple: Total stock market index funds or target-date funds
• Tax-loss harvest annually to offset gains

Why it matters: Builds wealth beyond retirement accounts, provides liquidity for goals before age 59—½

12. Consider Home Purchase (If Appropriate)

Buy a home if:

• You plan to stay in the area 3-5+ years
• You have emergency fund fully funded
• You're maxing retirement accounts
• Monthly payment (including taxes, insurance, maintenance) is ≤ 28% of gross income

Physician mortgage option: 0-5% down, no PMI, flexible underwriting. See our guide: Physician Mortgage Loans Explained

Don't buy if: You're unsure about staying long-term, haven't built emergency fund, or housing would exceed 28% of income

13. Set Up Tax Planning System

Find a CPA who specializes in physicians:

• Cost: $500-2,000/year for tax preparation
• Worth it: Saves thousands through proper planning
• When to find one: NOW, before your first year-end as attending

Tax planning actions:

• Adjust W-4 withholding to avoid large refund or underpayment penalty
• Maximize pre-tax retirement contributions
• Track all deductible expenses (CME, licensing, medical equipment)
• Consider tax-loss harvesting in taxable accounts

14. Protect Against Lifestyle Inflation

The 50/50 rule: When your income increases, save/invest 50% of the increase and enjoy the other 50%.

Common lifestyle inflation traps:

• Buying too much house
• Luxury car purchases
• Expensive private school tuition
• Country club memberships you don't use
• Keeping up with other physicians' spending

Better approach: Live like a resident for 2-3 more years. The wealth you build now compounds for decades.

Common First-Year Mistakes to Avoid

Mistake #1: Delaying Disability Insurance

"I'll get it next year when I'm more settled." Then you develop a health condition and become uninsurable. Get it NOW.

Mistake #2: Not Making a Student Loan Decision

Sitting in forbearance or just "making minimum payments" without a strategy wastes years of potential PSLF credit or interest savings.

Mistake #3: Buying Too Much House Too Soon

You qualify for $1M+ with physician mortgage. That doesn't mean you should buy it. Stay at 20-25% of gross income.

Mistake #4: Lifestyle Inflation

Going from $60K resident to $300K attending and spending all the increase. This is the fastest way to stay broke at high income.

Mistake #5: Not Maxing Retirement Accounts

"I'll catch up later." No you won't. You lose that tax-advantaged space forever. Max it from year one.

Mistake #6: Ignoring Taxes

Your first year as attending you might owe $50,000-80,000 in taxes. Plan for this. Adjust withholding. Make estimated payments if needed.

Your First-Year Financial Scorecard

By the end of year one, you should have:

• Own-occupation disability insurance in place
• 3-6 month emergency fund fully funded
• Active student loan strategy (PSLF enrollment or refinancing completed)
• Maxing 401(k) and HSA contributions
• Backdoor Roth IRA completed for the year
• Budget and spending tracking system in place
• Basic estate planning documents completed
• CPA relationship established
• Beneficiary designations updated
• Clear financial goals for next 5 years

Final Thoughts

Your first year as an attending sets the trajectory for your entire financial life. Get these foundations right and you'll build sustainable wealth while enjoying your income. Skip them and you'll spend years playing financial catch-up.

The good news: these actions aren't complicated. They're just checklist items. Work through them systematically in your first year and you'll be in the top 10% of physicians financially.

Most important rule: Pay yourself first. Before the bigger house, nicer car, or fancy vacation—max retirement accounts, get proper insurance, and build your financial foundation. Everything else can wait.