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It’s that time of year: New CB residents are finding their rhythm. CA-1s are getting their feet under them in the OR. And you, new attendings, are finally earning the paycheck you’ve been waiting on for years. The question is…now what? By Jeffrey Steiner, DO, MBA

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Over the years, I’ve worked with a lot of early-career physicians. Most expected that once the money started rolling in, their financial stress would disappear. But here’s the truth: most docs don’t have financial problems. They have financial puzzles—and becoming an attending just makes the puzzle bigger.

These five money moves can help you get organized, reduce stress, and build a strong foundation right from the start.

Pause Before You Upgrade Everything

That first paycheck hits differently. It feels like the green light you have been waiting on. The new car, the upgraded vacation, the bigger place—finally, you can afford them.

But here’s the catch: you can't do it all at once.

Lifestyle inflation happens fast. One minute you’re celebrating, and the next, your entire paycheck is gone.

One way to keep things in check? The 50/25/25 Guideline:

• 50% for lifestyle (rent, groceries, fun stuff)
• 25% for upcoming expenses (vacations, board fees, a down payment)
• 25% to grow your net worth (paying off loans, investing)

This simple framework helps you enjoy your income without overspending it. Start there.

Prep for Financial Emergencies (Like You Do in the OR)

In the OR, you always have a backup plan:

• Doing an LMA? Tube’s ready.
• Peds case? Emergency meds are drawn up.
• Ortho with that attending who always asks about twitches? You’re covered.

Your finances need the same level of prep.

Start with an emergency fund.
Set aside 3–6 months of expenses in a high-yield savings account. Not invested. Just sitting there, ready to go.

It’s boring—until something breaks.
Water heater dies? $8,000.
Your dog goes into DKA and spends two nights in a dog ICU on an insulin/glucose drip? $6,200.
(Ask me how I know.)

When life happens, this fund keeps a stressful moment from turning into a crisis.

Next: Get disability insurance.
Your ability to work as an anesthesiologist is your biggest asset. If that goes away, your income does too. You need “own-occupation” disability insurance from one of the five big physician-focused companies: Ameritas, Guardian, MassMutual, Principal, or The Standard.

Get it early—before any health issues show up.

Have people depending on your income?
Then term life insurance matters. It pays out only if you die—and that’s the point.
Skip the permanent stuff (Whole Life, Universal Life, etc.) unless you really understand why you’d need it. Most people don’t need it.

Clean Up Your Retirement Accounts

Most people don’t think about retirement during training—and that’s fine. But now it’s time to get things in order.

Step 1: Find your old accounts.
If you worked during residency, fellowship, or undergrad, you probably have a few old 401(k)s or 403(b)s floating around.

Step 2: Know what kind of accounts they are.
Roth or traditional? This matters for taxes and what you do next.

Step 3: Check how they’re invested.
Sometimes, money gets parked in cash when you leave a job. If it’s just sitting there, it’s time to fix that.

Step 4: Decide what to do with them.
You’ve got four options:

1. Cash it out. Usually the worst move—hello, taxes and penalties.
2. Leave it where it is. If the investment options are good, that’s okay.
3. Roll it to an Individual Retirement Agreement (IRA). More control, but this can complicate backdoor Roths later if it is a traditional retirement account.
4. Roll it into your current work plan. This keeps things simple and keeps the door open for backdoor Roths.

Not sure which to choose? Talk to someone before you move money around.

Tackle Your Student Loans

The student loan system is a mess. Payments were paused during training, but now they’re back—and you can’t ignore them.

Start by getting organized.
Download your NSLDS file from StudentAid.gov. Don’t trust your loan servicer to have it right.

Going for Public Service Loan Forgiveness (PSLF)?

• You may want to switch from the SAVE plan to IBR to restart your clock.
• Submit your employer verification form.
• Make sure your payments are counting toward the 120 needed for forgiveness.

Not going for PSLF?
Then come up with a strategy that fits your goals. That might include refinancing—but be careful. Once you refinance federal loans, there’s no going back.

Student loans are tied to everything—your taxes, savings, career plans, and where you live. If it feels overwhelming, that’s normal. Consider working with someone who understand student loans (like a Certified Student Loan Professional (CSLP). You don’t have to figure it out alone.

Don’t Try to Do It All at Once

Even five steps can feel like too much. That’s okay.

Start with one thing:

• What’s easiest for you to check off?
• Or, what’s keeping you up at night?

If you’re not sure where to begin, start with disability insurance. It’s one of the most important foundations—and it takes time to get in place.

Final Thought

You’ve worked hard to get here. These steps aren’t about saying “no” to everything—they’re about building the stability to enjoy what you’ve earned.

You solve puzzles every day in the OR. Your financial life is just another puzzle. Now, you’ve got the tools to start putting the pieces together.

Jeff Steiner, DO, MBA, CSLP, is a former pediatric anesthesiologist turned financial planner. He helps physicians solve financial puzzles through his firm, Second Opinion Financial.

Dr. Steiner (Second Opinion Financial, LLC) is a registered investment adviser registered with the State of Texas. Registration does not imply a certain level of skill or training. The views and opinions expressed are as of the date of publication and are subject to change. The content of this publication is for informational or educational purposes only. This content is not intended as individualized investment advice or as tax, accounting, or legal advice. Readers are encouraged to consult with professional financial, accounting, tax, or legal advisers to address their specific needs and circumstances.

The ASA Committee on Young Physicians is pleased to present this monthly article series on personal finance. These articles are not written by hedge fund managers or real estate tycoons but by practicing physicians. Some have business degrees and some do not – but every contributor is an anesthesiologist who has some guidance to offer the rising generation of attending physicians. It is not the intention of the committee to offer definitive financial advice, but rather some pearls of wisdom to consider while developing a personal fiscal plan.

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