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Welcome to the latest episode of the Physician Cents Podcast, where we explore complex financial topics tailored specifically for physicians. Whether you're a medical student, resident, fellow, or attending physician, you're going to find valuable insights that can help you increase your financial IQ, further your financial journey, and improve your overall well-being. Hosted by Chad Chubb and Tyler Olson, let’s dive in!
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You finish training, your attending paycheck finally hits, and suddenly the numbers in your bank account look completely different.
This is the moment where a lot of physicians accidentally choose between two very different futures:
This post is Part 2 of a three-part (Read Part 1 Here) series based on a wildly popular tweet thread from financial planner Tyler Olson, co-host of the Physician Cents podcast. The idea is simple: if you want freedom on your terms, your first few years out of training matter a lot more than you think.
Here, we are walking through Steps 5–8 of his 12-step framework so you can build a rock-solid foundation without feeling like you have to live like a resident forever.
Let’s start with why this whole thing blew up in the first place.
On July 27, Tyler posted a thread that started like this:
“Docs, you want to be financially independent 15 to 20 years into attendinghood. It starts the moment you finish training with these following 12 steps.”
The response was huge:
When the bookmarks beat the likes by that much, that tells you something. People are not just casually liking it, they are saving it because it hurts a little and feels very real.
So why did this particular thread hit so hard?
Over the past year, Tyler has talked about meeting more physicians in their 50s who are coming in with big incomes, big houses, big cars, and very small financial freedom. Some of them:
All because the early years after training were spent in “I earned it” mode instead of “I’m building my future” mode.
One of the most memorable lines from that thread was this:
“You can build generational wealth in these next three years or wake up at 40 with a boat, two BMWs, a million-dollar mortgage, and zero freedom.”
So, how do you pick the first option? You start with Step 1.
For many physicians, the hardest part of building wealth is not a lack of income. It’s the friction, student loans that feel endless, insurance choices that are easy to get wrong, retirement rules that change, and taxes that quietly eat the plan if nobody is paying attention.
This post covers steps 5 through 8 in a 12-step framework discussed on the Physician Cents podcast, focusing on the decisions that tend to move the needle the most in the early and middle years of a medical career: student loan strategy, the three insurances that matter most, retirement “buckets,” and tax planning that looks beyond this year’s refund.
Student loans are often the financial anchor for physicians. They can shape job choices, delay investing, and add stress long after training ends. The big point is simple: treat your loans like a strategy problem, not a gut-feel decision.
The “right” approach depends on details that sound small, but change outcomes fast:
Career track (nonprofit vs. private practice), loan type (federal vs. private), total balance, household income, marital status, tax filing status, spouse income, and even whether you live in a community property state.
And if there’s one rule that’s hard to undo, it’s this: once you refinance federal loans into private loans, there’s no going back.
If you’re eligible for Public Service Loan Forgiveness (PSLF), staying in the federal system matters. It’s also why many physicians who are not 100 percent certain about their first job keep loans federal for a while as an “insurance policy.” A first attending job does not always turn into a long-term job.
A few PSLF basics that come up again and again:
If you want a simple checklist of what to verify (loan type, employment certification, and program steps), the AAMC has a clear overview: AAMC steps to take to qualify for PSLF.
For married physicians, one of the biggest levers is often Married Filing Jointly vs. Married Filing Separately. That choice can change MAGI, which can change payments, which can change how much is ultimately forgiven.
It’s not a one-time decision. Many households need to run the comparison every year during the PSLF window because income, kids, deductions, and job changes can shift the math.
One more detail that can matter a lot: community property rules. In some states, income is treated differently between spouses, which can affect what shows up on paper and how repayment formulas behave.
If PSLF is not part of your plan, refinancing can still be a solid tool, especially if it gets you a lower interest rate and a payoff timeline you can live with.
The key is not guessing. Mixed situations happen all the time, for example, some federal loans you might keep, some you might refinance, or a changing job path where PSLF stops being realistic. Those situations call for modeling and comparisons, not vibes.
For physicians exploring refinancing options designed around medical training and early-career transitions, Laurel Road is one well-known lender in this space: Laurel Road medical school loan refinancing information.
Student loans can feel like the most complicated piece of the plan, even when you’re “doing everything right.” The better approach is:
Make the decision, document the plan, then set a reminder to check progress periodically (for example, every 3 months) instead of thinking about it every day.
That way you’re not ignoring the loans, but they also don’t get to live rent-free in your head.
Insurance is not exciting. Paying premiums never feels like a win. Still, for physicians, the downside of being underinsured can be brutal because your income is often your biggest asset.
The three policies emphasized here:
And one clear warning: skip whole life insurance if what you actually need is protection. You’re a doctor, not a bank.
Disability insurance is about protecting your ability to earn. For physicians, “own occupation” language is the difference between a policy that works and a policy that disappoints you when it matters most.
Own-occupation coverage is designed to pay if you can’t do your specific job, not just “any job.”
A common mistake is buying only enough coverage to pay the bills. The point made in the episode is stronger than that: saving now is future spending. If you become disabled, you still need the ability to save for later years because many disability policies pay only until about age 65.
The discussion also referenced the “Big 5” carriers commonly associated with strong own-occupation policies: Ameritas, Guardian, MassMutual, Principal, and The Standard. For a quick summary of that concept, this is a helpful explainer: “Big 5” own-occupation disability insurance carriers.
If you’re still in residency or fellowship (or you recently were), ask whether you have access to a Guaranteed Standard Issue (GSI) policy through your program. GSI can help physicians who might otherwise run into underwriting issues.
The key takeaway is less about a specific agent and more about behavior: work with someone who will check for GSI access and guide you to the best option, even if they don’t personally sell it.
A surprisingly common problem is a physician assuming that $1 million of life insurance “sounds like a lot,” so it must be enough.
A better rule of thumb used in the episode: 10 to 20 times income, if anyone relies on your income (spouse, kids, or even family you support).
Term life can also be built in layers (often called “term ladders”), where different amounts expire at different times, matching when financial obligations fade.
If you’re single and nobody depends on your income right now, life insurance may be less urgent. Many physicians revisit it after marriage, kids, or taking on long-term family support.
Umbrella insurance is about liability. Physicians are visible targets, and in a car accident or major incident, it’s not unusual for the other party to think, “They’re a doctor, they must have money.”
An umbrella policy in the $1 million to $3 million range was recommended as a common target. Some people try to match coverage to net worth, but the right number can depend on state-specific asset protection rules.
This is also where it pays to understand what your state protects (and what it doesn’t). Workplace retirement plans like 401(k)s and 403(b)s often have strong protections, while the treatment of IRAs, HSAs, and 529 plans can vary by state.
If you’re looking for the “hockey stick” part of net worth growth, retirement contributions are usually where it starts. Not because they’re flashy, but because they’re consistent, tax-advantaged, and hard to replace later.
The episode referenced 2025 contribution limits, including a $23,500 employee deferral limit for many 401(k) and 403(b) plans, and $7,000 for IRAs (with a higher limit for those age 50+).
Many employed physicians have access to a 403(b), sometimes paired with a 457(b). Private practice physicians often have a 401(k) and not much else.
Two strong preferences were mentioned:
One setup that got strong negative reviews: an employer offering only a SIMPLE IRA. If that’s your benefits package as an attending, it’s worth asking why the plan is stuck in the past.
High-income physicians often can’t contribute directly to a Roth IRA. That’s why the backdoor Roth IRA exists, it’s a method that can get money into a Roth through a non-deductible traditional IRA contribution followed by a conversion.
Two cautions were emphasized:
If you want a plain-English explanation of how the backdoor Roth works and why the pro-rata rule matters, this overview is a helpful reference: Backdoor Roth IRA overview (including the pro-rata rule).
Two additional tools came up for physicians with the right setup:
Mega backdoor Roth: This depends on your employer plan’s rules (plan documents matter). Not everyone has access, but when you do, it can allow much larger Roth contributions through after-tax 401(k) contributions and in-plan conversion features. One physician-focused explanation is here: Mega backdoor Roth strategy for physicians.
Solo 401(k) for 1099 income: If you have moonlighting or other 1099 income, a solo 401(k) can allow additional contributions (often described as up to about 20 percent of net self-employment income, depending on the situation) even if you’re already maxing your W-2 plan.
A practical bonus discussed: the solo 401(k) can sometimes be a place to consolidate certain older accounts, which may help clean up backdoor Roth pro-rata problems (depending on what types of accounts you’re dealing with).
Taxes are not just a filing problem. They’re a lifetime cost problem.
A deduction today might be a tax bill later (because pre-tax retirement contributions are deferrals, not permanent tax forgiveness). That’s why the goal discussed was minimizing taxes over your lifetime, not “getting a big refund this year.”
Moonlighting and side income can catch physicians off guard. If you don’t set aside money and pay quarterly estimates, you can get hit with an underpayment penalty, sometimes $1,000 to $3,000 or more, depending on the situation.
This can also happen on W-2 income if withholding is off, so it’s worth checking withholding whenever income changes.
Several deductions and strategies were mentioned, with an important caveat: many apply only in specific circumstances.
A few examples discussed:
A memorable example from the discussion: if switching to an HSA plan costs far more in extra premiums than the HSA tax benefit, the HSA should not drive the decision.
A few higher-impact planning ideas were highlighted:
Tax-loss harvesting: Even beginners can use tax-loss harvesting in a taxable investment account. It can reduce taxable gains and help keep more money invested.
Roth conversions: Roth conversions can be a major lifetime tax saver, especially in lower-income years (often early retirement years). They can also reduce future required minimum distributions (RMDs) that might otherwise push you into higher brackets later.
Municipal bonds and municipal money market funds: For high-income physicians investing in taxable accounts, municipal bond interest can be exempt from federal tax. The episode also noted that municipal money market funds can be appealing when comparing after-tax yields, while also being clear that these carry risk, and they’re not the same as FDIC-insured cash.
A key point from the episode is that modern financial planning should include people who love being “in the weeds” on the 1040 and who will coordinate with your CPA or EA.
Not every year will produce a dramatic, obvious tax win. The payoff is often cumulative. Over decades of earning and investing, small improvements in bracket management, withholding, and account choice can add up to real money.
For physicians, steps 5 through 8 are where financial planning gets real: student loan choices that can’t be undone, insurance that protects your income, retirement buckets that compound for decades, and tax strategy that looks beyond this year’s return.
If there’s a theme across all four steps, it’s this: your plan works better when it matches your real life, your job path, your household, and your state rules. Write down the strategy, review it on purpose a few times a year, and avoid reacting to every headline.
Thanks for reading. If you want more physician-focused money content, you can check out WealthKeel LLC for more from Chad or connect with Tyler through Olson Consulting LLC.
The best of the best list is a paid sponsorship, but these are professionals/companies that Tyler and Chad collaborate with within their own practices or have been vetted to earn a spot on this list. By supporting our sponsors, it allows Chad & Tyler to dedicate more time to you and the Physician Cents community. If you ever have a question (or not a great experience, which we don’t expect!) about a sponsor, please let us know. We call it the “best of the best” for a reason, and we will maintain that standard for our listeners & viewers.
This information is for general purposes only. This information is not intended to be a substitute for specific professional financial, tax, or legal advice, as individual circumstances vary. Please see a financial professional, CPA, and/or an attorney in regards to your own individual situation.
Wealthkeel’s Advisory Services and Financial Planning offered through Vicus Capital, Inc., a Federally Registered Investment Advisor. WealthKeel LLC, 615 Channelside Drive, Suite 207, Tampa, FL 33602 -- 267.590.9533.
Olson Consulting LLC, Offering Advisory Services and Financial Planning, is a State-Registered Investment Advisor.
A podcast designed specifically for physicians, offering a breakdown of complex financial topics to help you develop your financial IQ, further your financial journey, and improve your well-being. Whether you're a medical student, resident, fellow, or attending physician, you're sure to learn something new that will benefit your journey.
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Conversations helping graduating medical students to attending physicians build a strong financial foundation
