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A Focused Plan For Your First Attending Check
First paycheck season is upon us
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Imagine this: You spend the better part of a decade working eighty-hour weeks and mastering differential diagnoses while living on a resident’s salary. Suddenly, a new contract starts and a five-figure check hits your bank account.
What do you do?
Your first attending-size deposit will feel like a tidal wave compared with last month’s resident check. It is exciting, but it can also be risky if every dollar finds a new home right away.
This first year is make or break. Handle it well and you launch your wealth curve years ahead of schedule. Handle it poorly and lifestyle creep locks in habits that are painful to unwind.
So today we’re talking about a simple playbook designed for physicians who want the freedom that money can buy without letting money run the show.
The One-Year Cash-Flow Map
Think of the next twelve months as an intensive rotation with a clear treatment plan for each dollar. Here is a roadmap of your next 12 months:
Even if you’re not starting your attending job, these tips can be helpful!
Month | Priority | Target Amount | How to Automate |
|---|---|---|---|
1 | Build emergency buffer | One month of take-home pay | Weekly transfer to high-yield savings |
2–4 | Kill toxic debt | 100% of credit card and any loan >6 % | Extra payment set for payday |
5–6 | Max tax-advantaged accounts | 401(k) or 403(b) to annual limit | Raise payroll deferral to max |
7–9 | Fund Roth via backdoor + HSA | $7,000 Roth, $4,300 HSA (single) | Calendar reminders for transfers |
10–12 | Seed taxable brokerage | 10–20 % of gross income | Monthly auto-invest |
Note that the numbers above assume a base salary of $250k in a high-tax metro. Adjust the contributions but keep the order.
This plan is sequential and each step frees up cash flow for the next. Our approach is to address short-term needs and tackle the most immediate obstacles to long-term financial freedom while setting your money up to grow over time.
Resist Lifestyle Creep
A bigger paycheck feels like permission to upgrade everything at once. Human brains are wired to anchor on peer spending and “reward” after deprivation.
Attending Jump Rule
Live on a resident-level budget for the first 12–18 months. It’s tough, we know. Funnel the difference into the map above. After that period raise one category at a time—rent, car, vacations—not all three.
Mindset reminders:
A leased luxury SUV loses value faster than your index fund grows.
Colleagues rarely notice your apartment finishes; they do notice when you look stressed every call week.
Future options outweigh short-term dopamine hits.
Capture Employer Benefits on Day One
July onboarding packets can read like alphabet soup, yet missing deadlines is expensive. Focus on three levers with immediate payback.
Benefit | Quick Action | Immediate Gain |
|---|---|---|
Retirement match | Set payroll deferral high enough to grab the full match this year | Free money compounds forever |
HSA (if offered) | Choose the high-deductible plan only if you can pay the out-of-pocket max from your new runway | Triple tax advantage |
Own-occupation disability | Add supplemental coverage during the guarantee-issue window | Locks in rates before any claim history |
Block fifteen minutes with HR, jot down the deadlines, and automate contributions the same day.
Mini Case: July to September on a $280k Contract
Gross monthly: $23,300
Est. taxes and withholdings: $9,100
Net take-home: $14,200
Month | Savings Account | 401(k)/403(b) | Checking for Living |
|---|---|---|---|
July 15 | $2,800 (20%) | $1,400 (10%) | $10,000 |
July 30 | $5,600 total | $2,800 total | $20,000 total inflow |
Aug 15 | $8,400 total | $4,200 total | $30,000 total inflow |
By Labor Day the buffer is ready, the match is flowing, and lifestyle creep still sits outside the door.
Would you use this?
As this newsletter grows, we learn more and more about what early-career physicians need to feel confident about their financial health.
We’re considering building an app to help you save money, consolidate debt and become financially free.
Which one of these financials tools would you find most helpful? |
Action Items for This Week
✅ Draft your one-year cash-flow map
✅ Schedule automatic transfers for emergency fund, debt payoff, and retirement.
✅ Confirm retirement match percentage and adjust deferral to capture all of it.
✅ Elect or waive the HSA and disability options after a quick numbers check.
✅ Freeze lifestyle inflation until month 13, review progress, and reward yourself intentionally.
Your attending income can buy freedom faster than any other factor in your career.
Treat the first year like an ICU rotation—focused, protocol-driven, and decisive—and future-you will thank present-you.
Feedback Corner
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Meme of the Week
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Best,
M&H
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