New Attending Physician Financial Checklist: Your First 90 Days

The financial whiplash of becoming an attending is real. You spent years earning $60,000–$75,000 as a resident while surrounded by patients who assumed you were rich. Now you're earning $250,000–$600,000+ and you have no idea what to do first — and half a dozen people are already trying to sell you something.

The decisions you make in the first 6–12 months as an attending have outsized consequences. Loan forgiveness paths close. Disability insurance rates lock in. Lifestyle inflation, once it starts, is hard to reverse. Retirement compounding lost in year one is compounding you'll never get back.

This is the sequence. Work through it in order.

1. Don't touch your student loans yet — but decide fast

Federal student loans have a 6-month grace period after you leave training. During that window, no payments are required and interest accrues at your loan rate. This is your window to make the most important financial decision of early attending life: PSLF or refinance?

The PSLF path has its own mechanics. See the PSLF for Physicians guide for the full playbook — including employer certification, common mistakes that disqualify payments, and what happens to the forgiven amount at the end. The short version: forgiven PSLF amounts are tax-free under current law, and 10 years of qualifying payments beats refinancing for most physicians with high loan balances at nonprofit employers.

2. Enroll in retirement accounts on day one

Most hospital systems open 401(k) or 403(b) enrollment in your onboarding packet. Many physicians ignore it until they "get settled." This is a mistake that cannot be fixed. Time in the market is the only input to compounding that you can't buy back.

Add the backdoor Roth IRA

As an attending, your income will almost certainly exceed the Roth IRA direct contribution limit: $153,000–$168,000 for single filers, $242,000–$252,000 for married filing jointly in 2026.¹ Above those thresholds, you can't contribute directly to a Roth IRA. The backdoor Roth solves this.

The mechanics: contribute $7,500 (2026 limit)¹ to a traditional IRA (non-deductible, since you're above the deduction phase-out for covered employees), then convert it to a Roth IRA immediately. The conversion triggers no tax because you contributed with after-tax dollars.

One critical trap: the pro-rata rule. If you have any pre-tax money sitting in traditional IRA accounts — SEP-IRA, SIMPLE IRA, or old rollover IRA from a prior employer — the IRS taxes backdoor Roth conversions proportionally across all your traditional IRA balances. A physician with $200,000 in a rollover IRA and $7,500 in a new non-deductible IRA will owe tax on 96% of the conversion, not 0%. The solution: roll the pre-tax IRA into your employer's 401(k)/403(b) before executing the backdoor Roth, if the plan accepts incoming rollovers (most do).

See the physician tax strategy guide for the full retirement account stacking sequence, including S-corp elections for 1099 income and the solo 401(k) opportunity for practice owners.

3. Get disability insurance before anything changes

This is the most time-sensitive financial product decision you'll make. Disability insurance premiums and eligibility are based on your health at the time of application. Any health event — a musculoskeletal injury from the heavy call schedule of your first year, a mental health episode, a chronic condition diagnosis — can trigger a rating (higher premium), an exclusion rider (the condition is carved out of coverage), or outright decline.

Residents have a narrow window to lock in favorable rates and maximum insurability. As a new attending, that window is still open — but every month that passes is a month where something could change.

The non-negotiable requirements for a physician disability policy:

• True own-occupation definition — pays if you can't perform the duties of your medical specialty, even if you could work in another capacity
• Residual disability rider — pays proportionally if you can work reduced hours or at reduced income
• Future increase option (FIO) — allows you to increase coverage as your income grows, without new underwriting
• COLA rider — inflates your benefit annually during a long-term disability claim

See the physician disability insurance guide for carrier comparisons, specialty-specific premium ranges, and how to evaluate the specific policy language. An independent broker who represents multiple carriers will get you better terms than a captive agent.

4. Fix your tax withholding before your first paycheck

Residents pay relatively little tax — $60,000 in salary produces a modest federal tax bill. An attending earning $350,000 in their first year can owe six figures in federal and state taxes, plus FICA, even with a salary job. If your withholding isn't adjusted, you may face a large underpayment penalty at tax time and a cash flow shock you weren't expecting.

5. Build a cash buffer before you start investing

Physicians coming out of training often have little or no liquid savings. The attending salary feels enormous, and the temptation is to invest immediately or pay down debt aggressively. But before either:

Build 3–6 months of attending-level expenses in a high-yield savings account. Not resident expenses — attending expenses. If your monthly spending is $8,000/month (mortgage/rent, loan payments, insurance), you need $24,000–$48,000 liquid before you start writing large checks to brokerage accounts or loan servicers.

Why: the first year of attending practice frequently involves unexpected expenses — licensing fees, board exam fees, malpractice tail coverage (if your employer doesn't cover it), relocation costs, practice setup. An emergency fund prevents these from derailing your financial plan.

6. Review your employment contract for financial landmines

If you signed your contract before you started this checklist, there's still time to understand what you agreed to. If you're negotiating now, do it before signing.

The financial terms that matter most and are most negotiable:

• Signing bonus clawback: Most signing bonuses are forgiven over 2–3 years. If you leave early, you may owe the full amount back — and the repayment is not tax-deductible in the same way the bonus was taxable. This asymmetry (pay taxes to receive it; repay gross amount to leave) is a real trap. See the contract guide for the IRC §1341 claim-of-right analysis.
• Non-compete scope: Some non-competes effectively prevent you from practicing within an entire metro area. The financial cost of a non-compete that limits your options — commute, lower-paying alternative employer, relocation — should be part of your compensation comparison.
• Malpractice tail: Claims-made policies require a "tail" payment when you leave. Tail can cost 1.5–2× the annual premium. Whether the employer or physician pays this at departure is a negotiable term that represents thousands or tens of thousands of dollars.
• Retirement plan terms: 403(b) match, vesting schedule, whether the plan accepts incoming rollovers (relevant for your backdoor Roth strategy).

7. Get life insurance if you have dependents

Life insurance decisions are simple for most early-career physicians: if you have a spouse, children, or anyone else depending on your income, buy a 20-year level term policy. The rule of thumb is 10–12× your gross income in coverage, which for a $350,000-earning physician means $3.5–$4.2 million in coverage. At current rates, a healthy 32-year-old physician pays roughly $90–$130/month for $3 million of 20-year term.

What you don't need: whole life insurance, variable life insurance, or indexed universal life. You will be pitched these products aggressively — often by someone calling themselves a "financial advisor for physicians." See the whole life insurance analysis for a full breakdown of why these products underperform term + invest-the-difference for most physicians. The short version: the return on the cash value component rarely justifies the premium over a term + tax-advantaged account combination.

8. Understand asset protection basics from the start

Physicians are among the most-sued professionals in America. Most new attendings assume malpractice insurance is enough. It isn't — it only covers claims up to its policy limit for clinical negligence. Everything outside that window is unprotected personal wealth.

The first two steps cost almost nothing and cover the most likely gaps:

1. Max ERISA-qualified retirement accounts. Your 401(k)/403(b) balance is fully protected from creditors under federal law with no dollar cap. This is the most powerful asset protection vehicle available — and it's also the best tax move. You get both benefits for free.
2. Get a $2–$3 million umbrella policy. Cost: $300–$700/year. Covers personal liability above your auto and homeowners policies — car accidents, guest injuries, and other non-malpractice exposures that your professional coverage doesn't touch.

See the asset protection guide for the full layered structure — including entity strategy, homestead planning, and when to involve a trust attorney.

9. Update all beneficiary designations

Beneficiary designations on retirement accounts and life insurance policies override your will. If you name your parents as beneficiaries as a resident and then get married, your spouse will not automatically inherit those accounts — your parents will, regardless of what your will says, unless you update the forms. This mistake is tragically common among early-career physicians who set designations during residency and never revisit them.

The update takes 10 minutes per account. Do it in the first week of onboarding before the forms get buried.

10. Avoid lifestyle inflation for the first two years

This is the step nobody wants to hear, and the one that has the highest financial consequence if you ignore it.

The average physician starts attending life around age 30–32 with a negative net worth (student debt minus minimal assets). Physicians who maintain something close to their resident lifestyle for 2–3 years while directing the income difference to debt, retirement accounts, and savings often reach financial independence a decade earlier than peers who immediately bought a large house, leased a luxury car, and spent to match their income.

This isn't about deprivation. It's about sequencing. The physician who defers the McMansion for 24 months and instead funds a backdoor Roth, maxes a 403(b), and builds a $100K emergency fund is not in a worse position. They are in a dramatically better position, because compounding works early and the marginal utility of the fifth bedroom bought at 32 versus 34 is minimal.

Use the take-home calculator to build a concrete budget — monthly take-home by income and state — before you commit to fixed expenses like a mortgage payment.