5 Money Moves for New Attendings
by Malik M. Amine
You survived residency. Your salary just 3-5x'd overnight. Now everyone — your parents, your old roommate who works in finance, your new colleagues — has an opinion on what you should do with the money. Here are the five moves that actually matter, in the order they should happen.
1. Build a 3-month emergency fund. First. Before anything else.
Three months of fixed expenses, in a high-yield savings account or treasury money market. Not a brokerage. Not crypto. Cash. This is the foundation everything else sits on. If you're a single-income household, push toward six months. If you have a working spouse, three is fine.
2. Figure out the student loan strategy before you start paying
You have two real options: PSLF or refinance. The wrong choice can cost six figures. PSLF is a fit if you're employed by a 501(c)(3) hospital, have federal loans, and are willing to stay public-sector for ten years (already including residency, in many cases). Refinancing is a fit if you're going private practice, have high private-loan balances, or have already disqualified yourself from PSLF. Don't pay aggressively until you've decided which track you're on. Aggressive payments on PSLF loans are pure waste.
3. Max your retirement accounts in this order
- 401(k)/403(b) up to the employer match (free money).
- HSA, if you're on a high-deductible plan ($4,300 single / $8,550 family in 2026, plus $1,000 catch-up at 55).
- Backdoor Roth IRA ($7,000 in 2026).
- Rest of the 401(k)/403(b) up to the contribution limit ($23,500 in 2026).
- Mega backdoor Roth, if your plan allows after-tax contributions and in-service rollovers.
For most attendings, this stack alone shelters $50K–$70K from current taxation in year one.
4. Get your own disability insurance — not the group policy
The group policy from your employer is taxable, capped low, and disappears when you change jobs. Buy an individual own-occupation policy with a non-cancelable, guaranteed-renewable rider while you're young and healthy. The premium difference between buying it at 32 vs 42 is enormous. This is the single most important insurance product a physician owns.
5. Invest the difference — boringly
Index funds. Three to five of them. A simple asset allocation that matches your risk tolerance. Tax-loss harvest in the taxable account if you have one. Rebalance once a year. That's it. If anyone is selling you "physician-only" investment opportunities, hedge funds, or whole life "infinite banking," walk away.
The pattern that destroys attending wealth is not lack of income — it's lifestyle inflation eating the raise before any of these five moves get done. Lock in this list in the first 12 months and the next decade does the heavy lifting.
If you want help running your specific numbers — PSLF vs refinance, retirement-stack sizing, or contract negotiation as you settle in — book a strategy call.