The Tale of Two Doctors: The First Paycheck

By Jimmy Turner, MD
The Physician Philosopher

Remember how strange it was seeing that large of a number in your bank account after your first “real” paycheck? After years of being paid as a resident, it seemed a bit surreal.  It is at this exact moment that you make some of the biggest financial choices of your life.  Come join Dr. Jones and Dr. EFI (Early Financial Independence) as they show you the importance of the decisions you make in your early years in practice. This is a tale of two doctors who just received their first attending paycheck.

Further Reading: If you like what you find in this post, you’ll like The Physician Philosopher’s Guide to Personal Finance even more!  Buy your copy today.

The Pivotal Moment

The reason that the moment you start making a “real” paycheck is such a pivotal point in time is because the decisions you make right then will determine your trajectory. It can be very hard to change your course after those first three to five years.  It’s possible, but it’s much harder.

Either you set yourself on a trajectory for great financial success and early financial independence OR you choose a lifestyle that will leave you in shackles and working ‘til you can’t work anymore.

The biggest problem here is that many of the choices you make are often binding. You cannot easily reverse a lot of decisions.  For example, if you buy a $1 million dollar home with nothing down and then find you want to sell it a year later… you better believe that financial pain will be real.

A Tale of Two Doctors: The Set Up

Here is how this post is set up.

We will follow Dr. Jones and Dr. EFI as they make very different choices when they finish training. For each doctor we will discuss their lifestyle inflation after training, decisions on student loans, retirement planning, and their eventual trajectory.

Let’s make some assumptions for both of them, though:

Doctor 1: Introducing Dr. Jones

Dr. Jones has waited long enough.  She spent four years in undergrad, four years in medical school, four years in anesthesiology residency, a year in fellowship, and now she is ready to reap the rewards of a lot of hard work.

Dr. Jones wants to live the doctor’s life she has always heard about.

She doesn’t want to keep up with the Dr. Joneses.  She is Dr. Jones.

Lifestyle Changes After Residency

Her monthly take home paycheck is now $14,500.  That’s $10,000 larger than her last residency pay check!

After signing on to her new contract, she found the exact house that she wants.  It’s only $800K with a 4% interest rate.  With a 30 year fixed mortgage that makes for a monthly payment of $4,100.

And the garage will fit the two new BMW’s she bought for her and her spouse perfectly.  She got a steal with 3.5% financing for a monthly payment of $1,800 to cover both cars.  Don’t forget the $200 monthly car insurance payment.

Student Loans & Retirement


She understands that she could pay down her debt quickly or max out her 401K, but she just doesn’t see the need.

Her employer has a mandatory contribution, and that sounds great! However, Dr. Jones didn’t see the benefit of chasing after an employer that matched or contributed above and beyond this in her 401K.  Retirement is so far away!

So, she puts in the required 2%, which is matched ($5,000 per year), but doesn’t see a lot of other reasons to save for a retirement that is 30 years away.

Student Loan Plan

Having said that, she also doesn’t want to keep her loans around forever.  So, she refinanced.

Her $250,000 in student loans are now being paid via a 10 year fixed plan with a 3.5% interest rate.  The monthly payment on this will be around $2,500.

The Breakdown of Dr. Jones’ Paycheck

Here is how her monthly paycheck would break down.

$14,500 Take Home
-$4,100 mortgage payment
-$2,000 car payment + insurance
-$2,500 student loan payment
-$600 Disability/Life Insurance
$5,300 remaining

This leaves Dr. Jones and her spouse with $5,300 for all of their other living expenses.  This might include a country club membership, cell phones, designer clothes/jewelry, cable TV, premium gas for the BMW’s, eating out, vacations, utilities, etc.

That doesn’t include furniture for the house she just bought.  But that can all be financed or go on a credit card, right?

All of her bonus pay will go towards the awesome vacations her and her spouse deserve. They’re working hard!

Take Home for Dr. Jones Over The Next Ten Years

Fire Your Financial Advisor

Another big decision to make is who is going to make your financial plan when you finish? WCI has your back.

The take home here is that Dr. Jones is living large.  She bought the house, the cars, and is not being aggressive with her student loans… she is really going to get behind the eight-ball.

How far behind?  Let’s see.

Given Dr. Jones’ lifestyle, she would probably want to have $200,000 each year in retirement.  If she retired at 65, she would likely need $200,000 x 25 = $5,000,000.

If this current plan continues, and we assume an 8% interest growth on the $10,000 she is saving each year ($5,000 contribution + $5,000 employer match).  After ten years (age 45), she will have an unimpressive $141,621 saved for retirement (TPP: corrected from previous math where I forgot the employer match).

At that point her debt would be gone. Maybe I am not giving her plan enough credit.  What if she started saving after her loans are paid off in 10 years?

Let’s say she changed jobs and found an employer with a good 401K after she realized how important that was.  So, she started maxing out her 401K and with her employer’s contribution and additional voluntary matching, she started investing $56,000 (max for 401K in 2019) for the next twenty years.

At age 65 how much would she have still assuming 8% growth?  The answer is a little more than $2.7 million.  Taking 4% of that each year for retirement, she would only have ~$108,000 per year.

Remember, because of her lifestyle, she needed $200,000 per year.  So, that’s half of what she wanted for retirement and she is now 65. Unless things change drastically for her, she will likely never get to that goal.

This is a story of big lifestyle inflation after you finish training.

Don’t do it.

Doctor 2: Introducing Dr. Early Financial Independence

Fortunately, there are better examples and Dr. Early Financial Independence (Dr. “EFI”) is going to show you that.

Dr. EFI knows better.  She has completed her four years of medical school, four years of anesthesiology residency, and also did a one year fellowship. However, she wants to start off on the right foot.

She has done her homework and knows enough about personal finance to do it herself.  And she knows where to get financial help, if she ever needs it.

With a more moderate approach to the lifestyle bump after residency, Dr EFI is not going to chase after a house three times her income right now, but she is going to buy a great house.  Eventually.

Before she can get the house she is going to make some good financial decisions. She will still enjoy a bump in lifestyle after finishing training, but Dr. EFI is going to limit lifestyle creep through The 10% Rule.

Let’s see how she does compared to Dr. Jones.

Lifestyle Change After Residency for Dr. EFI

Because she maxes our her 401K (pre-tax $19,000) her take home pay is $13,700 utilizing the same federal and state tax assumptions as Dr. Jones.

Dr. EFI followed The 10% Rule when she saw her paycheck increase dramatically. So, she took about 10% of that increase and decided to bump her lifestyle.  She has earned that.

She moves into a small rental home for $1,000 per month. It’s slightly bigger than the $750 apartment they were staying in during her fellowship year.

She drove a beater all during her years in medical school and residency to keep costs as low as she could.  But she really likes the new Toyota Prius (Touring edition for $30,000) because it gets almost 60 miles per gallon.

Making the same assumption as we did for Dr. Jones, she decides to surprise her spouse with one, too.

Despite the advice from other personal finance blogs, she finances a car. At 3.5% for 5 years, this will cost her approximately $1,000 per month for both cars, including insurance.

Dr. EFI wants to keep this plan in place for three years after she finishes.  Once her student loans are gone, she will be able to finally reap the real rewards.

How can she have so much discipline?  Well, she understands how important these beginning years are to her financial success.

Student Loans and Investing


Dr. EFI decided to take a job with a good 401K plan.  She maxes out her 401K to take advantage of her employer’s 2% required match, 4% voluntary match, and employer contribution. With everything included, she is maxed out to 401K limit of $56,000.

Camp Fire

Catching FIRE doesn’t happen without intentional decisions. Not usually.

Dr. EFI’s take home pay is $800 less each month ($9,600 for the year), but because of her employer match up to the 401K limit she is saving $46,000 more each year than Dr. Jones despite only contributing $14,000 more than Dr. Jones.

That’s a steal right there.

She and her spouse also max out the $12,000 each year for their first backdoor Roth.

All in all, she is investing $68,000 by contributing $31,000 of her own money.

Oh, and after her student loans are paid off… she will have even more going towards investments, likely in her employer’s excellent 457 account and a taxable account.  More on that below.

Student Loan Plan (Turned to investments)

Dr. EFI wants to be done with her student loans as quickly as possible.  So, she refinanced her loans to a 5 year variable because she knew this would offer her the best rate.

She averages 3.25% interest and she decides to pay $6,000 per month in student loans. This way, her loans will be gone in 3.5 years with no additional payments.

If she takes any extra bonus money she receives and, according to The 10% Rule, puts the other 90% of her bonus pay towards her loans; her loans would likely be gone in less than three years.

After her student loans are paid off, which have been costing her $6,000 per month, she plans on taking about a third of that money ($2,000), combining that with her current home rental payment ($1,000) and putting it towards her mortgage on a new “doctor” house ($3,000 mortgage payment on a $550,000 home).

She will take the other $3,000 remaining from her previous student loan payments that are now gone and put it into a taxable account.  That will total an additional $36,000 per year to take her annual investments to $104,000.

We have accounted for $5,000 of the previous $6,000 monthly student loan payment. What about the remaining $1,000 per month?

That, my friend, is for pure enjoyment on whatever she wants to spend it on. She could put it towards her mortgage and pay it off in 20 years instead of 30.  Or she could take two $6,000 vacations each year.

It’s up to her and her spouse, but they’ll find success because they know how to be intentional with their money decisions.

The Breakdown of Dr. EFI’s Paycheck

$13,700 Take Home Pay
-$1,000 rental/apartment payment
-$1000 car payment
-$6,000 student loan payment
~$900 Post-tax Backdoor Roth money
-$600 Disability/Life Insurance
$4,200 remaining

So, Dr. EFI has $4,200 (post-tax) left to spend each month compared to the $5,300 that Dr. Jones has.  Though, it is worth mentioning, that $4,200 is definitely more than she made on a resident or fellow salary.

So, despite buying two new cars for her and her husband and living in a slightly better place than in residency, she still has more money than she did as a resident to spend on eating out, going to the movies, or catching a ball game.

The Next Ten Years

What does Dr. EFI get for the $1,100 sacrifice she is making per month compared to Dr. Jones?

Well, ten years out from training she will be able to accomplish all of the following (compared to Dr. Jones who definitely won’t):

  • Dr. EFI’s student loans will be paid off in three years (compared to 10 + a lot of extra interest paid for Dr. Jones)
  • At ten years out of training, she will have accumulated $1,250,000 in her investment accounts (compared to the ~$141,000 of Dr. Jones)
  • She will have a very positive net worth (compared to Dr. Jones’ very negative net worth)
  • She will be well on her way to financial independence and retiring early (Dr. Jones will never be able to retire at her current lifestyle)

Take Home for DR. EFI

Dr. EFI is making some real progress!

She and her spouse get together and realize that once all of their debt is gone (no more car loans, mortgage, college for kids if they have any) they could live very comfortably on $120,000 per year in retirement.

Since they want to retire early they need it to last a little longer. So, they multiply their desired annual number by 30 (instead of 25 for traditional retirement).

They will need $100,000 x 30 = $3,000,000 to retire.  If they take out 3.3% ($100,000 per year), that should last as long as they need it.

Assuming she doesn’t change anything about her investments above, she will get to that number by age 52.  If she were to increase her investments in her taxable account by $1,000 per month (say, when those car loans are paid off after five years), she would reach that goal a year earlier at age 51.

Not too bad!  Retiring at age 51 would be swell.

This all assumes no increase in pay, no additional money from bonuses towards investments (which she would obviously make), and that her spouse never works or has retirement accounts of their own.  If any of those things happened, they would likely meet their goals in their mid to late 40s.

At that point, Dr. EFI could choose to be a doctor and work because she wants to, and not because she has to.

All the while, Dr. Jones would not be able to retire even at age 65 (fifteen years later).  And that remains true even if she really turned it around after 10 years of making mistakes.  Yikes.

Compound interest is wonderful, but it takes time!  That’s why your savings rate early on are so important.

The Big Picture

I should mention that there is a middle ground where you save 20% of your AGI each year and comfortably retire at 60 or 65.  That said, you can get there much sooner, if you want.  Who knows how much you will love your job in twenty years?

The big picture here is that you can have an increase in lifestyle immediately after you finish, but you have to keep it in check. You can have most anything (except the huge house), but you can’t have everything all at once.

Otherwise, you’ll be like Dr. Jones who looks wealthy on the outside, but will be working until she can’t work anymore.  Unfortunately, this is not as uncommon as you’d like to think.

The take home?

Residents, fellows, and newly minted attending doctors… take a small bump in lifestyle when you finish.  I suggest 10%. Then, put the rest towards building wealth for two to three years.  Your future self will thank you later.

What do you guys think?  What approach did you take (or will you take if not there yet)?  Did I leave anything out?  For those further along in the journey, what would you have recommended to yourself?  Leave a comment below.



  1. Millionaire Doc

    Good points TPP. The first several years of attendingship is so important because it sets the trajectory of your financial life. Set the spending thermostat low then dial it up slowly.

  2. Half Life Theory

    I’m not an MD so luckily i never had to deal with such large student loans, but getting that first paycheck as an engineer was so thrilling coming from being broke.

    I paid not attention to finances, and as such wasted 2 valuable years of wealth accumulation. Luckily, i did not take on too much debt before we got serious about money.

    You can read about our starting point here if you have some time;

    • ThePhysicianPhilosopher

      I’ll check it out, HLT! just got done with work and heading to little girl’s practice shortly.

      It can sneak up on you that’s for sure! Finances are important but unfortunately too infrequently taught. I am trying to change that in the medical school and residency programs that I am associated with.

  3. Dr. McFrugal

    Good comparison of how two different lifestyles can lead to two different outcomes!

    Btw, I think both Dr. EFI an Dr. Jones are paying quite a bit for life and disability insurance! I was thinking $300 would be enough for a reasonable insurance plan for both. That’s roughly how much I pay at least and I think it’s more than enough 🙂

    • ThePhysicianPhilosopher

      Haha that’s fair. I had to take a guess because I can’t get disability insurance 🙂 I might change the post to reflect the more realistic numbers you gave!

      • KT

        I actually think $600 / month for DI and LI combined for a female physician at age 35 in a procedural specialty is in the ballpark. I pay $500 / month for both (after taking advantage of one-time increase after attending salary bump) and these were purchased at age 32-33, and have been told by other female colleagues my rates are competitive. For women it’s so important to lock these favorable rates in before childbirth and medical issues arise!

  4. Xrayvsn

    Really outstanding post and drives home the point of lifestyle inflation after residency.

    I started out as Dr. Jones but because of my change in trajectory I have taken Dr. Efi’s course now (and actually on pace to retire in early 50’s as well). It’s funny but in your example, your withdrawal for Efi is quite similar to what I was planning (I went with $125k/yr). Being debt free that is a tremendous amount of money to have a fairly luxurious lifestyle I feel (given I live in a low cost of living area).

    • ThePhysicianPhilosopher

      Completely agree, Xrayvsn. That money goes a really long way when there is no car, house, college, or student loans to pay for!

      I’ll probably shoot for the same!

  5. Side Hustle Scrubs

    The road to FIRE begins with a single paycheck. Financial independence doesn’t necessarily mean leaving medicine – it may also mean choosing to stay in medicine for the right reasons. Dr EFI is giving herself the gift of freedom. She won’t regret it.

    • ThePhysicianPhilosopher

      Completely agree, SHS! Freedom provides the best kind of medicine, in my opinion.

      Thanks for stopping by!


  6. Cass, pre-med student

    Hello! Great post! I’m a pre-med considering OB/Gyn. I heard somewhere that malpractice insurance for this specialty is very high. Do you think this expense changes the monthly numbers very much for Dr. EFI? Thanks!

    • ThePhysicianPhilosopher

      Hey Cass, good question. Normally, if employed by a group, your malpractice insurance is paid for by your employer.

      If you were in solo practice, this would obviously be your own responsibility to cover. In that case, it could change the numbers.

  7. eirylis

    Great post!! Just what I needed to read! I’m about to start life after fellowship and was just thinking about the expensive cars, 3000 dollars rent. And I finish with a 500k debt. Thank you so much. There’s so much we beed to learn about right financial decisions!! Ant readings you recommend?

  8. AjitMD

    In addition to what EFI is doing, I would do the following:
    – $250k/year is way too low income for anesthesiologist. I would find a location where I could make $500k/year with extra call. Minimum. Not be afraid to work. Save $250k/year minimum.
    – Would continue driving cheap cars. Cheap insurance. No loans. Buy the Prius after student loans are paid in cash.
    – Buy middle class house in cash. In my area it costs $200-250k max.
    – After 10 years, work when and if I want. Regardless, I would quit at 50 tops. Got to enjoy life while I am healthy.

    • ThePhysicianPhilosopher

      That’s an interesting perspective, Ajit. Certainly none of what you said is wrong, and would prove helpful financially.

      I, for one, want to design the life I want to live much earlier than when I am 50. By that age, my youngest will be well out of the house. And I want to enjoy as much time with them as I can while they are young… which means before 50.

      So, I’ll give up some of the “hard work” now in order to have the time. It’s all about balance, and it will look different for each of us.


  9. Panda7

    I love this! I’m 38, and paid my student loans off 4 years after I graduated by taking extra shifts wherever I could. My business loan for my practice will be paid off in 6 months. I have a used paid of car and will tackle mortgage next. My husband and I have over $1million saved and live in one of the most expensive areas of the country. We live a modest, happy life and don’t feel that we are missing out on anything. It is a great feeling!

    • ThePhysicianPhilosopher

      Sounds like you are on the fast track to financial success, my friend! Keep up the strong work.

  10. PrudentPlasticSurgeon

    Great post! I feel very fortunate that I was able to learn enough to make the right decision RIGHT before I graduated and became an attending. Thanks to blogs like yours and stories like this. Otherwise my trajectory would be very different. So important to have a plan. I also agree with your point of not sacrificing everything to save as much as possible but to be intentional with what you splurge on and what you save on.

    Great post as always!

  11. Dr. Inc.

    Outstanding post with this case study of two doctors. For so many doctors all they can see is that their large paycheck “leaves some extra” in their bank account each month and thus they are content. Quite simply, Dr. Jones gets what she wants now, and still has money left over. Of course, this is primarily possible through the magic of breaking down every purchase into long-term financing (which lenders love to do for doctors due to their low likelihood of defaulting and high income). We become so conditioned to debt prior to becoming an attending, that it just seems normal to kick the debt can down the road a little further. But as you nicely point out, the “kicked can” eats away at one’s net worth and pushes retirement/freedom/autonomy even further away in the end. As you have stated in other posts, one has to start with the end in mind, in order to have the best outcome.

  12. Rad123

    So the minute you finish training you should be focused on retirement? Why not assume you’ll work til you can’t? Live it up. A lot of doctors enjoy their work and aren’t burned out.

    • Jimmy Turner, MD

      You are creating a false dichotomy. You should save for your future self WHILE you enjoy yourself. They are not mutually exclusive. However, most physicians choose to live it up at the expense of having enough to someday retire.

      Also, I’ve never met a single person who tripped, fell, and accidentally saved enough money to someday retire. It requires intentional planning (regardless of whether you are burned out or not).



  1. Side Hustle Spotlight 6.17.18 – Side Hustle Scrubs - […] You never forget your first……paycheck. What you do with it can set you on the path to financial independence.…
  2. Meta : Money Talk for Med Students – proxy t2 - […] #. https://thephysicianphilosopher.com/tale-of-two-doctors/ […]

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