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Last Year of Residency Finance Checklist

Written by: Corey Janoff

As a doctor in the last year of residency or fellowship, you can see the light at the end of the tunnel!  Now is time to get your financial house teed up for success as a you will soon morph into a new attending physician.  This week we put together a short finance checklist of things to address in the last year of residency or fellowship to help you on your journey.  Let’s get started!

1. Get an Attending Job

The first order of business in your last year of residency or fellowship is to graduate and get a job as an attending physician somewhere.

You have likely already determined if you plan to pursue a career in academic or clinical medicine.  If non-academic, do you want to be employed by a hospital, or join a private group?  That likely depends somewhat on your specialty and where you want to work.

Polish up your cover letter, start interviewing, and get a contract signed.  Before signing the contract, it’s wise to have someone who specializes in physician contract review to take a look at the contract for anything to be aware of or possibly negotiate on.

2. Develop a Student Loan Repayment Plan

The big question with student loans when you are finishing residency or fellowship is whether you are trying to pursue the PSLF program (Public Service Loan Forgiveness), or plan to pay of your student loans the old-fashioned way.

If PSLF is not a viable option for you, there are other ways to get medical school loan forgiveness.  Otherwise, once you become an attending, it could make sense to refinance your medical school loans to a lower interest rate so you can pay them off faster.

Regardless of which route you are pursuing, brace yourself for a higher loan repayment amount.  If you are on one of the income-driven repayment plans for federal loans (IBR, PAYE, REPAYE), it may take a year of full attending income before the loan payment amount goes up.  Be prepared for that increase though, as it could be several thousand dollars per month!


3. Get Own-Occupation Disability Insurance

If you do not already have it, get an own-occupation, specialty specific, physician disability insurance policy.

Your income is the linchpin to your entire financial world working properly.  Without income, there is no paying down debt, buying a house, saving for retirement, eating, taking vacations, or anything else you want in life.  As long as you depend on income, it’s prudent to protect it as best as possible.

Underwriting is more lenient while you are in residency/fellowship, and policy discounts are more prevalent.  This makes it easier to secure and less expensive than if you wait until you are in practice.


4. Get Term Life Insurance

While we are on the insurance topic, you may as well look at life insurance too.  If you have a spouse and children, life insurance is mandatory.  If you are currently single, but one day plan to have a spouse and children, use your age and health to your advantage and lock in an inexpensive term policy now.

Physician life insurance is no different than life insurance for the rest of the population.  The ability to get it is contingent on health and age affects cost, so get it as a future planning tool even if you don’t need it today.

If you are interested in looking into own-occupation disability insurance and/or life insurance, contact us to get quotes to see which company may be the best fit for your financial situation.

5. Put a Hold on House Hunting

As tempting as it can be to start looking at houses once you have a contract lined up, please wait.  Rather than looking at the new salary figure and asking yourself, “How much house can I afford?” hold on looking at the new house until you actually start working and are working in the new job for at least a few months.

I have seen scenarios where physicians think they have a job lined up and then a month before their start date, the employer pulls the rug out from under them.

Countless times I have had doctors start working at a new practice or hospital, quickly to learn it is not what they expected, and they start looking for new opportunities.

I ran into a situation once where a doctor failed their boards and therefore was unable to join their planned employer.

Ideally you plan to stay in that location for at least a handful of years before upgrading or moving on.

Selling a house shortly after purchasing it can be costly.  (Related: Cost of Short Term Home Ownership).


6. Learn the Backdoor Roth IRA Rules

Most likely, your attending income level will put you above the income eligibility for direct contributions to a Roth IRA.  Therefore, you will need to do the Backdoor Roth IRA in order to still get money into this account.

Since the academic calendar ends in June, there is a chance your attending income in the back half of the year will tip you over the limit.

Rather than blindly making a Roth IRA contribution in the year you graduate, calculate if your combined residency/attending income in that transition year will exceed the IRS threshold.  Google it to find out the limit, as it adjusts annually.

Also, you cannot have any pre-tax IRA account if you are doing the Backdoor Roth IRA. If that is the case, it could be worth rolling those into your 401(k)/403(b) account or converting those into a Roth IRA.

This can get complicated and can cause tax issues in future years if not done properly. If you have any hesitations in being able to complete this correctly, reach out to us and one of our financial advisors would be glad to help you through the Backdoor Roth IRA process.


7. Possibly Convert Old Retirement Plans into a Roth IRA

Your last year as a resident or fellow presents a decent opportunity to convert old retirement plans into a Roth IRA.  The reason for this is you’re in a relatively low-income tax bracket compared to where you will likely be during your attending years.

Converting old pre-tax retirement accounts requires you to claim the amount converted as income (and pay taxes on it, due the following April when taxes are due).

Depending on your circumstances, this could be a great opportunity to pay a little bit in tax now on some money that you will later be able to access tax-free in retirement.

If you’re starting your last year of residency/fellowship in 2023 and will complete it in 2024, converting these accounts before December 31st, 2023, would be ideal, as you’ll still be on your resident income for that tax year.  However, converting in 2024 when you only work half the year (or less) at an attending income level could still be advantageous.

Obviously, you need to have the ability to pay the income taxes due on the conversion.  Assuming that is the case, this is worth considering.

8. Map Out a Retirement Savings Plan

Now that you are about to begin your real career as a doctor, it’s time to start thinking about the end of that career!

Do you want to achieve rapid wealth accumulation so you can fatFIRE your way to financial independence and possibly get out of medicine early?

Are you content going the smooth and steady route and retiring in your 60’s?

Either way, you’ll need to start saving for retirement sooner rather than later.  If you can start saving at least 20% of your gross income for retirement, that should put you on a decent track to be able to retire at a reasonable age.

If you want to retire sooner, save more.  Simple as that.

Before mentally spending all your future attending paycheck, carve out at least 20% of it to earmark for retirement.


9. Establish a Relationship with a Financial Advisor

If all of this seems overwhelming to do on your own, or you simply need someone to hold you accountable, a financial advisor who specializes in financial planning for physicians can be of great service.

If you are not already meeting with us at Finity Group, I encourage doctors to consider an independent financial advisor (or independent financial advising firm).

By being independent, their company doesn’t manufacture any products, nor are they affiliated with companies who do.  This helps minimize conflicts of interest.

If you work with someone whose company has their own products, odds are, your advisor is recommending their own company’s stuff.  Not that their products are necessarily bad, but you potentially could be getting more objective advice elsewhere.

In Summary

You have a great opportunity to get the rest of your career and financial life on track during your final year of residency and fellowship.  Take advantage of it!

If you can establish good habits early and get things in order, your future self will thank you.

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This should not be construed as individual investment or tax advice.  Consult with your tax professional to learn the tax implications for your particular circumstances.  Qualified withdrawals from Roth IRA’s can be made tax-free if the account owner is over the age of 59.5 and has held the account for at least five years.