Your First Attending Year: Month‑by‑Month Investment Action Plan

The worst financial decisions doctors make happen in the first attending year.

Not because you are stupid. Because you are exhausted, overconfident, and finally have money. That is a dangerous mix.

This is the month‑by‑month plan I wish every new attending had taped above their desk. Follow it and you will be financially ten years ahead of most of your colleagues by the time you hit year three.

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Ground Rules Before Month 1

Before we start the timeline, you need three rules that do not change:

1. No major lifestyle upgrades for 6 months.
   No house. No new luxury car. No private school deposits. Survive. Observe. Plan.

2. Every new dollar gets a job.
   Salary hits? It splits automatically into taxes, fixed bills, investing, debt payoff, and truly guilt‑free spending. No “leftover” model. That always fails.

3. Automation beats motivation.
   If you have to “remember” to invest or pay debt, you will not. Set it and get out of your own way.

Now we go month by month.

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Month 1: The Reality Check and Setup

At this point you should not be picking mutual funds. You should be figuring out where your money is actually going and what legal/benefits environment you are in.

Week 1–2: Clean Data, Not Vibes

You:

• Pull your:
  • Contract
  • Paystub(s)
  • Benefits packet
  • Resident loan summary (NSLDS, servicer accounts)
  • Last 3 months of bank and credit card statements
• Build a simple monthly snapshot:
  • Net take‑home pay (per paycheck and monthly)
  • Required fixed expenses: rent, utilities, minimum loan payments, insurance, subscriptions
  • Discretionary: food, gas, random Amazon, DoorDash, travel

No budgeting app will rescue you if the raw data is nonsense. Start simple: spreadsheet or legal pad.

Week 3: Employer Plan and Legal Skeleton

You sit down (30–60 minutes) with HR / benefits rep. Do not let them rush you.

You want answers to:

• What retirement plans are available?
  • 401(k), 403(b), 457(b)?
  • Roth option?
  • Match formula and vesting schedule?
• Are you eligible for:
  • HSA (high‑deductible health plan)?
  • Employee stock purchase plan (ESPP)?
• Malpractice details:
  • Claims‑made vs occurrence
  • Who pays for tail?
• Contract questions:
  • Non‑compete radius and duration
  • Call pay rules
  • RVU thresholds (if productivity based)

Parallel track: you book a contract / asset‑protection review with a lawyer who actually works with physicians. Not your uncle who does real estate closings.

Week 4: First Automation Pass

By the end of Month 1 you should:

• Open:
  • A high‑yield savings account (online bank) – label it “Emergency / Taxes”
  • A separate checking for “bills + investing” if your primary account is chaos
• Set up:
  • Auto‑transfer from checking to savings every payday (even $500 to start)
  • Direct deposit splits if employer allows (some will send X% to savings)
• Decide temporary targets:
  • Minimum 5–10% of gross income earmarked for wealth building (investing + extra debt) starting Month 2
    You will ramp this up steadily.

No investments yet. You are building pipes first.

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Month 2: Cash Buffer and Debt Reality

Now that you see your numbers, you stop winging it.

Week 1: Emergency Fund Target

At this point you should:

• Set a clear emergency fund target:
  • Minimum: 3 months of bare‑bones expenses
  • Better: 4–6 months if you are in a volatile specialty or private practice
• Decide pace:
  • Aggressive: fully funded in 6–9 months
  • Moderate: 12 months

Then increase that auto‑transfer from Month 1 to hit the target on schedule.

Monthly Savings Needed for 3-Month Emergency Fund

Category	Value
Target $15k	1250
Target $25k	2083
Target $35k	2917

That is what it actually takes per month to get there in 12 months. You want it faster? Raise the number.

Week 2–3: Student Loan Strategy – One Decision, Not Ten

You gather:

• Federal loans: types, interest rates, current servicer, total
• Private loans: lender, rate, term, any refi offers

Then you make one core decision: Are you a forgiveness candidate or not?

• If you are at a 501(c)(3) hospital and may stay 10 years → likely PSLF track
• If private practice / for‑profit group and no plan to go academic → payoff track

Scenario	Likely Path
501(c)(3) hospital, hospitalist	PSLF
Academic surgery, teaching role	PSLF
Private anesthesia group	Payoff
Locums mix, no 501(c)(3)	Payoff
Rural hospital (nonprofit)	PSLF

PSLF track (federal loans):

• Consolidate wisely if needed (do not reset qualifying payments without understanding cost)
• File income‑driven repayment (SAVE / PAYE legacy etc.)
• Certify employment
• Do not refinance to private

Payoff track:

• Rank loans by rate
• Refinance highest‑rate private loans once you have:
  • Job stable for 3–6 months
  • At least 1–2 months emergency fund already in place
• Set a target payoff window:
  • Very aggressive: 3–5 years
  • Reasonable: 5–7 years

Week 4: Set Monthly “Wealth Rate”

By end of Month 2 you should know:

• How much per month you will:
  • Invest in retirement accounts
  • Put toward extra loan principal
  • Save in emergency fund

Total of those three = your wealth rate.

Target: 30–40% of gross income within 12–18 months.
You will not hit that today, but you must know the direction.

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Month 3: Retirement Accounts – Turn Them On

Now we finally invest. But only after your pipes, cash, and loan plan exist.

Week 1: Turn on Employer Retirement

At this point you should:

• Contribute at least enough to get the full match. That is mandatory. Free money.
• If you can push further, set contribution to:
  • 10–15% of gross income as a starting goal
  • Automatic increase by 1–2% per year if plan allows

If there is a Roth option:

• Early attending, not ultra‑high bracket yet → Roth is usually favorable
• If you are already deep in the top bracket → split between traditional and Roth is reasonable

Week 2–3: Core Investment Choices – Keep It Boring

You log into your 401(k)/403(b). You will see 25+ funds. You need 2–3:

• A broad US stock fund (e.g., “Vanguard Institutional Index,” “Total Stock Market”)
• An international stock fund (optional but preferred)
• A bond fund (for stability if you do not sleep well with 100% stocks)

For most young attendings:

• 80–100% stocks is appropriate
• You can use a Target Date fund (e.g., “2055 Retirement Fund”) if the fees are low (ER ≤ 0.15–0.20%)

Do not chase last year’s winner. Ignore the “hot” sector funds. Nobody at work remembers the guy who picked the biotech fund.

Week 4: HSA / ESPP (If Available)

If you have a high‑deductible health plan:

• Open and fund your HSA:
  • Aim to max it by year‑end if cash flow allows
  • Invest the HSA balance once above the cash minimum your provider requires
    Treat it as a stealth retirement account, not a checking account.

If you have an ESPP:

• Only join if:
  • There is a meaningful discount (e.g., 10–15%)
  • You understand the holding rules and tax treatment
• Cap exposure: do not let employer stock exceed 5–10% of your net worth

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Month 4: Legal and Protection Layers

Most doctors procrastinate here until someone gets sued or hurt. Do not copy them.

Week 1–2: Insurance Check – Cover the Catastrophes

By now:

• You confirm malpractice coverage type (claims‑made vs occurrence)
• If claims‑made and you might move → you plan for tail coverage cost mentally and financially

Then you secure:

• Own‑occupation disability insurance:
  • Individual policy, not just employer
  • True own‑occ language
  • Benefit targeting ~60–70% of your gross income
• Term life insurance (if anyone depends on your income):
  • 20–30 year level term
  • At least 7–10x your annual income, often more if high debt and kids

Do not buy whole life or permanent insurance masquerading as an “investment.” That pitch nails new attendings every year.

Week 3: Basic Asset Protection and Accounts

You set:

• Titling on personal accounts (individual vs joint)
• Primary and contingent beneficiaries on:
  • Retirement accounts
  • Life insurance
• Consider umbrella liability policy:
  • $1–3M coverage is standard
  • Cheap relative to risk transfer

Week 4: Simple Estate Documents

You are busy. I know. Do the minimum adult package:

• Will
• Healthcare proxy / medical power of attorney
• Durable power of attorney
• Guardianship provisions if you have kids

Many physicians put this off until something bad happens in their department. That is backwards.

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Month 5: Taming Lifestyle Creep – On Purpose

At this point the attending salary “feels normal.” This is when mistakes explode.

Week 1: Concrete Spending Limits

You set hard caps:

• Housing (rent or mortgage + taxes + insurance + HOA if any):
  ≤ 20–25% of gross income
• Car payments (if any):
  ≤ 10% of take‑home pay, total car value ≤ 0.5x annual income
• Recurring subscriptions and memberships: clean them up

Recommended Max Spending as % of Gross Income

Category	Value
Housing	25
Transportation	10
Other Fixed	15
Wealth Building	30
Discretionary	20

Those are targets. If you live in a HCOL area, housing may creep higher, but then you cut elsewhere.

Week 2–3: Permissioned Upgrades

You can upgrade some things. Just not everything.

Decide one meaningful lifestyle upgrade for this year:

• Slightly better apartment closer to hospital
• Reasonable car replacing the beater
• One big trip

Then lock out the rest. The rule:

Only increase lifestyle when you hit a new savings/investing milestone, not when you feel like it.

Examples:

• When net worth hits $0 (from negative) → you can raise discretionary spending by $200/month.
• When student loans drop below 1x salary → consider a modest housing upgrade.

Week 4: Review Wealth Rate

By the end of Month 5, you should:

• Recalculate your effective wealth rate:
  • (Retirement contributions + extra loan payments + emergency fund + HSA investments) / gross income
• See if you can bump by 2–5% starting Month 6 by:
  • Refinancing loans
  • Cutting wasteful recurring expenses
  • Taking optional extra shifts deliberately earmarked for debt or investing

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Month 6: Non‑Retirement Investing and IPS

Now you build the structure that will guide the next 20 years.

Week 1–2: Written Investment Policy Statement (IPS)

You write a one‑page IPS. Not a novel. It answers:

• Target stock/bond mix (e.g., 80/20)
• Main vehicles:
  • 401(k)/403(b)
  • Roth IRA / Backdoor Roth IRA
  • HSA
  • Taxable brokerage account
• Annual savings target (percentage and dollar amount)
• Rebalancing rule:
  • Once per year OR
  • When allocation drifts by >5%

That document keeps you from rewriting your strategy every time the market wobbles.

Week 3: Roth IRA / Backdoor Roth

If you are under direct Roth income limits, just open and fund a Roth IRA. If over:

• Do a Backdoor Roth IRA:
  • Contribute to a non‑deductible traditional IRA
  • Quickly convert to Roth IRA
  • Avoid pre‑tax IRA balances that complicate pro‑rata rules if possible

Invest the Roth the same way as your 401(k): broad index funds. No need for cute tilts.

Week 4: Taxable Brokerage – The Flexible Bucket

If:

• You are meeting:
  • Employer match
  • HSA (if available)
  • Roth IRA / Backdoor Roth
• And you still have extra to invest each month

Then open a taxable brokerage account:

• Use broad low‑cost funds or ETFs
• Keep it simple: Total US Stock + Total International

This account becomes your future down payment fund, “optional” retirement age fund, or early semi‑retirement fuel.

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Months 7–9: Ramping, Rebalancing, and Refining

Now we pull the camera back and plan quarter by quarter rather than week by week.

Month 7: Mid‑Year Financial Review

At this point you should schedule a 60–90 minute block with yourself (and partner if applicable):

• Update:
  • Net worth (assets – debts)
  • Loan balances
  • Emergency fund progress
• Adjust:
  • Retirement contributions (bump if below track)
  • Extra loan payments

First Year Attending Financial Timeline

Period	Event
Quarter 1 - Month 1	Setup accounts and map cash flow
Quarter 1 - Month 2	Choose loan path and set wealth rate
Quarter 1 - Month 3	Turn on employer retirement investing
Quarter 2 - Month 4	Add insurance and legal basics
Quarter 2 - Month 5	Control lifestyle creep
Quarter 2 - Month 6	Write IPS and add Roth / taxable
Quarter 3 - Month 7	Mid-year review and adjust
Quarter 3 - Month 8	Consider refinance / PSLF check
Quarter 3 - Month 9	Fine-tune insurance and estate docs
Quarter 4 - Month 10	Max contributions planning
Quarter 4 - Month 11	Tax prep and charitable strategy
Quarter 4 - Month 12	Year-end review and next-year goals

Month 8: Loans – Second Look

You reassess:

• If on PSLF track:
  • Confirm qualifying payments
  • Submit employer certification
  • Avoid overpaying; stick with IDR minimums
• If payoff track:
  • Shop refi rates again
  • Consider shorter terms if cash flow strong
  • Decide: extra principal vs investing more
    Early attendings overweight debt payoff emotionally. Balance is fine, but do not ignore compounding.

Month 9: Insurance / Estate Fine‑Tuning

By now:

• Adjust disability benefit if your income rose or coverage seems thin
• Confirm beneficiaries once more (people get engaged, married, divorced)
• Review umbrella policy limits vs your net worth and income risk

This is maintenance, not overhaul.

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Months 10–12: Year‑End Optimization

Now you stop thinking like “new attending” and more like “CEO of a small financial enterprise.”

Month 10: Contribution Maxing Strategy

You calculate:

• How much you have contributed YTD to:
  • 401(k)/403(b)
  • 457(b) (if available)
  • HSA
  • Roth IRA / backdoor Roth
• What it takes per paycheck to:
  • Hit the max for retirement plans by December 31 if realistic

Common 2024 Contribution Targets (Illustrative)

Category	Value
401k/403b Employee	23000
457b	23000
Roth IRA	6500
HSA	4150

(Use actual current year limits; numbers above are examples.)

If you cannot max everything:

• Priority list is usually:
  1. 401(k)/403(b) to match
  2. HSA (if available)
  3. Roth IRA / Backdoor Roth
  4. 401(k)/403(b) beyond match
  5. Taxable brokerage

Month 11: Tax Planning and Charitable Giving

By Month 11 you should:

• Estimate your tax situation:
  • Check if you are under‑withheld
  • Plan for any owed amounts in April
• Decide charitable strategy:
  • Simple: direct cash donations
  • More advanced: donor‑advised fund if you have a high‑income year and want to bunch deductions

This is where a CPA familiar with physicians can earn their fee. Especially if you have side gigs, 1099 income, or complex benefits.

Month 12: Year‑End Review and Next‑Year Targets

You close the loop:

• Recalculate:
  • Net worth
  • Wealth rate
  • Loan payoff date projection
• Compare to start of Year 1:
  • How much did your net worth change?
  • How much did your behavior change?

Then you set Year 2 goals:

• Wealth rate target (e.g., raise from 25% to 32%)
• Specific milestones:
  • Loans under X
  • Net worth to $0, then +$50k, +$100k
• Any planned lifestyle changes (house, kids, move) – and the savings strategy for them

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Common Detours to Avoid (All Year)

You will get pitched on:

• Whole life / universal life insurance as an “investment”
• “Exclusive doctor only” private real estate funds you do not understand
• Complex tax shelters you cannot clearly explain back in one paragraph

Your rule:

If you cannot explain the strategy to a co‑resident in plain language without notes, you do not buy it.

Stick to:

• Employer retirement plans
• Roth IRA / backdoor Roth
• HSA
• Low‑cost taxable investing
• Loan management
• Protection and legal basics

That is enough to make you very wealthy over time.

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Final Snapshot: What “On Track” Looks Like After Year 1

By the end of your first attending year, if you follow this timeline, you should roughly have:

• A clear loan path (PSLF vs payoff) and autopayments aligned with that
• At least 1–3 months of emergency funds on the way to your full target
• Active contributions to:
  • At least one employer retirement plan
  • Roth IRA or backdoor Roth
  • HSA (if eligible)
• Core legal and protection pieces:
  • Own‑occ disability, term life (if needed), umbrella
  • Basic estate docs
• Lifestyle that fits inside:
  • ≤ 25% gross on housing
  • A rising wealth rate heading toward 30–40%

You will not feel “done.” You are not supposed to. But you will be out of the danger zone that swallows too many first‑year attendings.

Remember these three points:

1. The first attending year sets your default. Make that default aggressive saving, simple investing, and slow lifestyle growth.
2. Automation wins. Decisions you make once and let run will outperform your best “trying really hard” month.
3. Boring beats brilliant. Straightforward index investing and steady debt payoff will outrun almost every clever scheme your colleagues brag about in the physician lounge.