New attending financial checklist.
21 financial moves, organized by when to make them — from Day 1 of your first attending job through Year 1. Check items off as you complete them.
Your progress is saved in your browser. Not financial advice — for decisions of this complexity, a physician-specialized CPA and fee-only financial advisor are worth every dollar.
Submit PSLF Employment Certification Form
If your hospital is a nonprofit 501(c)(3) or government employer, submit the PSLF Form via the PSLF Help Tool on studentaid.gov on your first day of employment. Do not wait — every month you delay is a qualifying payment potentially lost.
Check employer eligibilityEnroll in an IDR plan (or switch plans)
If you haven't already, enroll in SAVE (or PAYE if SAVE is unavailable due to court challenges). Your IDR payment is recalculated from your new attending salary — this will jump significantly. Enroll at studentaid.gov before your first paycheck posts.
Model your new paymentRun your full loan repayment model
Your financial picture just changed dramatically. Run the MedDebt Calculator with your new attending salary to compare PSLF vs refinancing vs aggressive payoff — the math looks very different from residency.
Open the calculatorApply for own-occupation disability insurance
This is non-negotiable. Your most valuable asset is your ability to practice medicine. Own-occupation disability insurance pays if you can't perform your specific specialty — not just any job. Buy it before you're locked out by medical conditions. Most attendings need $10K-$15K/month in coverage. Carriers: Guardian, Principal, MassMutual, Ohio National. Apply ASAP — premiums are lower when you're younger and healthier.
Get 20-year term life insurance
If anyone depends on your income (partner, future children), you need life insurance before anything else. Aim for 10-12x your annual income. At 30, 20-year term for a physician runs $50-80/month. Get this in place before you take on a mortgage or have children.
Open and max an HSA (if on a HDHP)
If your employer offers a High Deductible Health Plan, the HSA is the only account that's triple-tax-advantaged. Max it every year. In 2026: $4,300 (individual) / $8,550 (family). Invest in index funds — don't let it sit as cash. A maxed HSA for 20 years compounds to a significant healthcare fund.
Make your final refinancing decision
Once you have a few pay stubs and know your employer is nonprofit (PSLF) or for-profit (no PSLF), make the refinancing call. If refinancing: compare Juno, ELFI, Earnest, Laurel Road, and SoFi for the best rate. Do NOT refinance if you have any path to PSLF — you permanently lose eligibility.
Compare refinancing lendersMaximize 403(b) or 401(k) contributions
2026 contribution limit: $23,500 ($31,000 if 50+). For PSLF, higher retirement contributions lower your AGI → lower IDR payments → more forgiven. For refinancing paths, maxing retirement is still the right move for tax efficiency. If your employer offers a 457(b) plan, that's another $23,500 you can contribute pre-tax.
Set up backdoor Roth IRA
Attending physician income typically exceeds the Roth IRA income limit ($161K single / $240K married in 2026). Use the backdoor Roth: contribute $7,000 to a Traditional IRA, then immediately convert to Roth. Do this annually — tax-free growth and withdrawals in retirement.
Set up high-yield savings for attending cash flow
Your paycheck is about to be 3-5x larger than residency. Before lifestyle inflation hits: automate savings at the beginning of the month. Open a high-yield savings account (target 4%+ APY) for your emergency fund — 3-6 months of expenses (for attendings, often $50K-$100K).
Review and update W-4 tax withholding
Most attendings are significantly under-withheld in their first year. Your attending income puts you in the 32-37% marginal bracket. Adjust W-4 withholding to avoid an April tax bomb, or set up quarterly estimated tax payments if you have side income.
Research physician mortgage programs (if buying a home)
Physician mortgage loans allow 0-5% down, no PMI, and don't count student debt in DTI at the same weight as normal loans. Available from several major banks (TD Bank, Flagstar, Huntington, etc.). If you're planning to buy in the next 12 months, talk to a physician mortgage specialist early — the market moves fast.
Hire a CPA who specializes in physicians
In your first year as an attending, tax complexity jumps dramatically: employee vs independent contractor status, retirement account options, potential self-employment income, state tax implications, MFS vs MFJ optimization if you're pursuing PSLF. A physician-specialized CPA pays for itself many times over.
Set recurring calendar reminder for IDR recertification
IDR recertification is annual. Missing it resets your payment to the 10-year standard — potentially $3,000-$4,000/month. Set a recurring calendar event 60 days before your recertification anniversary. Your servicer will email you, but don't rely on that.
Calculate your net worth baseline
Document your starting net worth on day 1 of attending life — likely deeply negative because of student loans. Track monthly. Watching net worth climb from negative to positive is one of the most motivating financial milestones of a physician's career. Use a simple spreadsheet or Empower (Personal Capital).
See net worth crossover projectionVerify your PSLF payment count with MOHELA
Log into studentaid.gov and check your PSLF payment tracker. Confirm your employer certification was processed and your qualifying payment count is correct. MOHELA errors are common — catch them early, not in year 9.
Track PSLF progressGet umbrella liability insurance
Physicians are frequent targets for personal injury lawsuits. An umbrella policy adds $1M+ in liability coverage above your auto and homeowners policies. Typically costs $200-$400/year for $1M of coverage. Essential once you have significant assets.
Have your physician contract reviewed by a healthcare attorney
If you haven't already, have a healthcare attorney review your employment contract — non-compete clauses, compensation structure, tail insurance responsibilities, call requirements, and partnership track. Non-competes in particular can severely limit your future options if you change jobs.
Create a basic estate plan (will, healthcare proxy, power of attorney)
Once you have income, debt, and potentially dependents, you need: a will, durable power of attorney, healthcare proxy/advance directive, and beneficiary designations on all accounts (retirement accounts, life insurance). If you have children, appoint a guardian. An estate attorney can set up a basic plan for $1,000-$3,000.
Find a fee-only financial advisor (optional but recommended)
A fee-only fiduciary advisor who specializes in physicians can provide significant value for the complexity of your financial situation. "Fee-only" means they charge a flat fee or hourly rate — not commissions. Find one at NAPFA.org or Garrett Planning Network. Many physicians find the cost worthwhile given the stakes.
Annual loan strategy review
Every year, reassess: Are you still on track for PSLF? Has your employer changed status? Has legislation affected your IDR plan? Is aggressive payoff now making more sense than you expected? Has your income changed enough to update your projections? The optimal strategy can shift — don't set it and forget it.
Re-run your numbersNot sure if PSLF or refinancing is right for your situation?
The most important item on this checklist is running your numbers. The MedDebt Calculator models your exact situation — specialty, debt load, employer type, income — and shows you the difference in total cost between every strategy.
Open the free calculator →