Academic medicine gives you prestige and stability, but there are challenges for sure.

You need a clear plan to make the numbers work long-term.

I wrote down 14 important points of consideration: Your compensation formula matters more than your title.

Know your base salary, RVU expectations, bonus structure, and how often anything actually gets updated.

You can insure your car, your phone, even your Peloton.

But many doctors don’t properly insure the $5–10M asset that actually matters:

👉 Your income

Disability Insurance (DI) is non-negotiable.

Here’s the no-BS breakdown 👇 Physicians aren’t alone in waking up to this risk.

The individual DI market surged 7.8% in new premium in 2023 - the fastest growth since 2002.

Carriers wrote $444M in new IDI premium.

Why?

Because more high-income professionals are realizing their paycheck is their greatest asset.

💰 Signing Bonus vs Forgivable Loan for Physicians:

What’s the Tax Difference?

Let's talk it out... You’re about to finish residency.

A job offer is on the table.

They’re dangling a big “bonus”... but the fine print says it could be:

✅ A signing bonus
✅ A forgivable loan

The tax difference can be thousands.

Let’s break it down.

You don’t need a financial advisor to start building wealth.

Here are 10 simple strategies that work if you’re disciplined.

No fees required. ✅ Spend Less Than You Earn

Aim for a 20–30% savings rate once your income allows.

When you get a raise, increase savings first, not spending.

I hate to write this, but seems relevant to share…

Should a person go into medicine for the money?

Short answer: No.

Long answer: Hell no.

And here’s why: Let’s kill the fantasy.

If you’re picking medicine for the $$$, you’re signing up for one of the worst ROI deals in professional history.

Most physicians aren’t broke because of low pay or student loans.

They’re broke because of silent, uncomfortable money habits that are uncomfortable to talk about.

So let's talk about them.

Here are 9 behaviors quietly wrecking even the highest incomes: 1. Lifestyle creep

Your first attending paycheck hits.

You upgrade your car, house, vacations.

Income grows...but spending grows faster.

Savings rate? Stuck.

Wealth isn’t what you earn. It’s what you keep.

Build out your savings rate first. THEN spend the rest.

Docs -

You want to be financial independent 15-20 years into attendinghood?

It starts the moment you finish training, with the following 12 steps: Here’s the thing:

You can build generational wealth in these next 3 years… or wake up at 40 with a boat, 2 BMWs, a $1M mortgage, and zero freedom.

Let’s get this right.👇

Doctors face higher-than-average risk for lawsuits.

Protecting your hard-earned wealth isn’t just smart - it’s essential.

Here’s a breakdown of practical strategies every physician should consider: Start with the Basics: Insurance

•Malpractice insurance with high limits (and tail coverage if you leave a job).

•Umbrella liability insurance: $1M–$5M of extra coverage is inexpensive and critical.

•Own-occupation disability insurance and life insurance to safeguard income and family.

🚨 New attending physicians: don’t leave $$$ on the table.

Here’s your quick tax-planning checklist for your first big attending paychecks.

Low-hanging fruit that could save you thousands 👇 ✅ Max Your Retirement Accounts

401(k), 403(b), possibly 457(b)

2025 limit: $23,500 (+$7,500 if 50+)

Consider Roth vs pre-tax.

I tend to recommend pre-tax first for high earning attendings.

I literally just had a meeting with a client about this yesterday.

Let’s talk 3 real-life options. 👇

https://twitter.com/averagemoneymd/status/1938590240920248530

Scenario 1: The Math Nerd

✅ Keeps investing instead of paying off the mortgage.

Mortgage = 3.75%

Market returns = historically ~7-9%

More cash invested = bigger nest egg later

But… you’re stuck with that monthly mortgage bill.

And possibly more shifts than you’d like.

Academic docs who actually want to do research are getting squeezed HARD.

The system says it values discovery.

The paychecks say: “More RVUs, less thinking.”

Let’s talk about the quiet collapse of the research track in medicine. In theory:

Academic medicine = ⅓ research, ⅓ teaching, ⅓ clinical care.

In practice?

Try 100% patient care, 0% protected time, and a “bonus” if your patient’s parking experience was pleasant.

Most physicians go from broke to a significant salary overnight.

It feels like a win.

But for many, it’s overwhelming.

Let’s talk about why doctors struggle with money.

Even the smart ones. Step 1:

Spend your 20s buried in books and maybe burnout.

Step 2:

Spend your late 20s and early 30s making $60K working 80 hours a week.

Step 3:

Suddenly make $300K+ and think you deserve to “live a little”

This is the trap.

You’re a doctor making $250K a year.

You’ve got a 2-year-old.

Your mortgage is $5,500/month because, of course, you live where everything costs a kidney.

You want to save for retirement and your kid’s college.

Let’s get real for a sec. First, taxes. Let’s call it 27%.

And then after your pre-tax retirement plan contributions (more on that later) leaves you with around $146K/year to work with.

You’re not broke, but you’re not balling either - especially not with that mortgage.

Congrats, you’re a brand-new attending.

You just finished residency, and now someone hands you a contract that says:

“$39 per RVU”

Cool, cool…

What the heck is an RVU? And how much money is that?

👇 Caveats:

A lot of physician comp structures are not pure RVU-based.

But they are the foundation of production that all employers (of physicians doing clinical work) care about.

Also, mind you, the per RVU rates and average RVU production per specialty below are estimates.

Private practice is under siege.

Hospital consolidation, CMS cuts, and insurance lobbyists are squeezing independent physicians harder than ever.

But if you run your practice like a business, not a legacy, you can survive and potentially thrive!

Here’s how👇 The threat is real.

CMS cuts reimbursement every year.

2025 could bring another 2 to 3 percent reduction in Medicare rates.

Commercial insurers often try to follow CMS.

The higher your revenue is insurance-based the more impactful these hits are.

Medical school tuition has skyrocketed.

It’s outpacing inflation and leaving many physicians wondering:

“Is it financially worth it?”

The short answer: Yes—but only if you use your degree like an investment.

Here’s how to turn that massive cost into massive freedom: Let’s get real:

Physicians often graduate with $200K–$500K+ of student debt.

That’s intimidating and ridiculous.

But the value of your medical education doesn’t depend on what you paid, but rather it depends on how you use it.

It’s pretty common to hear, physicians say that since they only have W-2 income, filing their taxes themselves is pretty easy and that most people in their situation can DIY.

I’m going to explain why this thinking can be potentially wrong, particularly if you are married and have student loans to manage. First, let’s review the latest student loan news and potential action items relevant to physicians:

A physician who earns $250,000 is going to face a steep hill if they want to buy a home that costs $800,000.

The mortgage ➕ taxes/insurance is about 44% of their take-home pay!

Why am I even bringing this up?

Because of the good people of NYC/LA/SF.

This thread is for you.✊🏻 2 important points -

1) there’s no wrong answer, even if “the math doesn’t lie.”

We are not products being evaluated by calculations. We are humans. We value/need different things to make life our version of success.

Nevertheless the math is helpful for us to sift our options.

Calculating what dollar amount one needs to save for retirement is pretty simple.

Say you’re 35 years old, got out of training in 2023. Not counting your retirement (and potentially college) savings contributions, you spend $10,000 per month.

How much you need to save for retirement depends on two calculations:

1️⃣ Inflation projection

2️⃣ Sustainable retirement income withdrawal rate

HALF of all disability insurance applicants either are only allowed limited coverage or flat out denied. 😱

Nothing short of millions in a trust fund can assist a physician in overcoming an income-halting disability.

I have two pieces of advice for you. Physicians really need to pay attention to this.

It is THE earliest critical financial decision of your career.

Your attending income must be protected at all costs.

So take the following 2 steps:

📚 New Attending
Financial Checklist📚

The inclination to hire a financial planner to take care of all of this once you complete your training isn’t a bad idea.

But even then, you need to protect yourself by knowing the important financial steps to take.

Let’s learn!👇🏻 1️⃣ Debt Management

This step can have quite the variation.

Credit card debt needs to be eliminated as soon as possible from your new higher paychecks. Private student loans and other personal loans also deserve such elimination.

Now federal loans…

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