New attending financial checklist.

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.

SAVE was vacated by the 8th Circuit in March 2026. Switch to IBR if you're pursuing PSLF. Your IDR payment is recalculated from your new attending salary and will jump significantly. Enroll at studentaid.gov before your first paycheck posts.

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.

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. Most attendings need $10K–$15K/month in coverage. Carriers: Guardian, Principal, MassMutual. Apply ASAP — premiums are lower when you're younger and healthier.

If anyone depends on your income, you need life insurance before anything else. Aim for 10–12x your annual income. At 30, a 20-year term for a physician runs $50–80/month. Get this in place before you take on a mortgage or have children.

If your employer offers a High Deductible Health Plan, the HSA is the only triple-tax-advantaged account. Max it every year. In 2026: $4,300 (individual) / $8,550 (family). Invest in index funds — don't let it sit as cash.

Once you have a few pay stubs and know your employer type (nonprofit = PSLF eligible, for-profit = no PSLF), make the refinancing call. Do NOT refinance if you have any path to PSLF — you permanently lose eligibility. If refinancing: compare Juno, ELFI, Earnest, Laurel Road, and SoFi.

2026 limit: $23,500 ($31,000 if 50+). For PSLF, higher retirement contributions lower your AGI → lower IDR payments → more forgiven. If your employer offers a 457(b), that's another $23,500 pre-tax.

Attending 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, immediately convert to Roth. Do this annually.

Your paycheck is about to be 3–5x larger than residency. Automate savings at the beginning of the month. Open a HYSA (target 4%+ APY) for 3–6 months of expenses — for attendings, often $50K–$100K.

Most attendings are significantly under-withheld in year one. Your attending income puts you in the 32–37% marginal bracket. Adjust W-4 to avoid an April tax bomb, or set up quarterly estimated payments if you have side income.

Physician mortgages allow 0–5% down, no PMI, and exclude student debt from DTI calculations. Compare programs from Fairway, BMO, Regions, and First Horizon.

In your first attending year, tax complexity jumps: employee vs. independent contractor, retirement account options, self-employment income, MFS vs. MFJ optimization for PSLF. A physician-specialized CPA pays for itself many times over.

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.

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 physician financial milestones.

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.

Physicians are frequent targets for personal injury lawsuits. An umbrella policy adds $1M+ in liability coverage above your auto and homeowners policies. Typically $200–$400/year for $1M of coverage.

Review non-compete clauses, compensation structure, tail insurance, call requirements, and partnership track. Non-competes can severely limit future options if you change jobs.

Once you have income, debt, and potentially dependents, you need: a will, durable power of attorney, healthcare proxy, and beneficiary designations on all accounts. An estate attorney can set this up for $1,000–$3,000.

A fee-only fiduciary advisor who specializes in physicians can provide significant value. "Fee-only" means flat fee or hourly — not commissions. Find one at NAPFA.org or Garrett Planning Network.

Every year, reassess: Still on track for PSLF? Has your employer changed? Has legislation affected your IDR plan? Is aggressive payoff now smarter? The optimal strategy can shift — don't set it and forget it.