Fellowship and Residency Graduates: Key Financial Considerations as You Transition to Attending Status in the next 60 days.....
Updated: 2 days ago
As a 2026, fellowship or residency graduate, stepping into the role of an attending physician is an exciting, yet complex, transition. With new responsibilities come new financial decisions, and it’s important to consider these factors as you move from training to practice.
Key Considerations When Transitioning:
Salary Adjustment and Tax Planning
Your salary will increase significantly as you transition into attending status. This means more income, but also higher taxes. Consider adjusting your tax planning strategies to mitigate the increased impact of taxes on your income.
Retirement Planning
Review your retirement plans (401(k), 403(b), pensions) and how your employer contributes. Your financial goals as an attending will shift, and you’ll need a strategy that accommodates your new salary and retirement benefits.
Things like vesting and minimum hours worked matter a lot in the attending world because a lot of employer benefits or all or none and if you fall beneath the require thresholds your benefits may be severaly curtailed or eliminated altogether even while you continue to collect your salary
Buying a Home
As an attending physician, you’ll likely want to buy a home soon. Buying a home is a very important financial decision and it can feel a little overwlehming. Getting some disinterested (i.e. someone who is impartial and not making money on the transactions) financial advice from a fiduciary financial advisor in this situation often helps bring a sense of perspective and helps you have reasonable expectations.
Realtors and financial advisors can both be very good referral sources for home loans and can you get perspective on the process. This is a lot like a surgery - it is kind a scary experience for someone going through it who may have never had a surgery before - but for people who do them all the time and see the results - they are able to provide a lot more perspective on the process which many young physicians find to emotionally comforting to have that perspective provider on their term and a neutral referral source.
Student Loan Repayment
Some people have student loans and some don't. If you do have student loans it can be helpful to talk to a fiduciary financial advisor to understand the pros and cons of different payoff options.
Investing and Building Financial Security for you and your freedom
You may now have more disposable income, so it’s important to establish a diversified investment strategy that will grow you and your family's financial security and financial freedom over time.
Why These Considerations Matter:
These factors influence both your short- and long-term financial health. Adjusting to your new role as an attending requires a shift in how you think about finances, and planning ahead can ensure you’re set up for success.
How Dr. Harris & Co. Can Help:
At Dr. Harris & Co., we specialize and have lots of experience
in guiding physicians through this critical transition. Whether it's adjusting your retirement plans, finding tax-efficient strategies, or managing your student loan debt, we offer personalized financial services tailored for attending physicians.
People use fiduciary financial advisors in different ways early in their career. Some plan to work together for just a year or two until they get their sea legs. Some plan to work together long term. Whatever approach feels right, it can be beneficial to be upfront about what you are looking for as fiduciary financial advisors like our firm routinely work with both groups.
Early in your career financial advice can feel kind of expensive and there are lots of balls in the air. But the benefit of being an early career physician is that the advisory fees are often lower because financial situations aren't as complicated yet.
You can usually get a good fiduciary financial advisor for a few thousand dollars a year early in your career. Our firm often has highly competitive rates for new attendings as well to help them on their journey.
The Price of Advice—and what is the value of trying to get it Right
Stepping into the world of professional advice can feel a lot like stepping into the world of medicine as a patient. I remember the first time I paid roughly $170 for a physician's visit as an adult. The doctor spent only a few minutes with me, the nurse practitioner or physician assistant another ten, and I walked away surprised by the cost. If you've ever paid $350 an hour for an attorney, $300–$500 for a tax return, or a few thousand dollars a year for financial advice, you may have felt the same way. That's understandable. Early in your career, you're working hard to build financial security, and you want to know that your money is being put to good use. Asking whether a professional's fee is worth it is not only reasonable; it's an important financial habit.
One concept that can help you evaluate these decisions is leverage. In physics, a lever allows a relatively small amount of force to produce a much greater effect. Professional expertise can work in a similar way. A well-drafted trust, a tax strategy that saves you thousands of dollars, or sound guidance on an important financial decision may provide value well beyond the fee you paid. You're combining your money with someone else's accumulated knowledge, experience, and judgment in the hope of achieving a better result. Of course, not every professional encounter delivers the outcome of value you'd hope for - just as not every medical intervention leads to the desired outcome. The goal is to understand what you're paying for, what you might reasonably receive in return, and whether the relationship makes sense for your circumstances.
This brings us to an important consideration when evaluating financial advice. You may encounter calculations showing how much a particular fee could reduce your wealth over a 30- or 40-year career. These calculations can be useful. Fees matter, and even small recurring costs can compound into substantial amounts over time. But there is another side to consider: what, if anything, might you gain from the service you're paying for? A complete evaluation considers both sides of the equation. Looking only at the cost can overlook potential benefits; looking only at the benefits can cause you to underestimate the expense. Neither gives you the full picture.
Consider an example from investing history. In 1992, you could buy a single share of a company's stock which cost approximately $21,287 in today's dollars (around $8k in 1992 dollars). Imagine having $21,000 to invest and facing that choice. Would you be willing to buy shares - in this stock - would it seem too expensive?
$21k (in 2026 dollars) may seem like a shocking amount to pay for a slice of a single company and people at the time could have rightfully said - no one in their right mind would pay $21k for a share of stock.
The individual stock, however, would have reached approximately $789,000 per share by October 15, 2026. Suddenly, that original $21,000 price looks rather different. If you had known in advance that a $21,000 investment would eventually be worth nearly $789,000, the price would not have seemed so extraordinary.
If you had known in advance that you could trade $21k for $789k (in constant inflation adjusted dollars) 34 years later - that would seem like a steal but if you just looked at the outputs but not the inputs or the inputs but not the outputs that would not give you a clear picture of what you are giving up and what you might be potentially getting.
The lesson isn't that you should have bought that stock, or that expensive investments are better. It's that the price you pay and the outcome you receive have to be considered together.
I think this is a useful way to approach financial decisions more broadly. Be cautious when someone presents a single approach as unquestionably right and dismisses all alternatives without fairly considering the evidence. Sometimes the argument is correct; sometimes it leaves out important information; and sometimes the reality is simply more nuanced than the presentation suggests. There are sound principles worth taking seriously, including being aware of fees and alternatives for identical things, managing taxes intelligently, matching investment risk to your goals, and maintaining a viable financial strategy to achieve your goals. But applying these principles requires judgment. In my experience, more than one approach can work well, and what makes sense for one person may not be the best fit for another. You don't need to reject conventional wisdom. You simply need to understand why it makes sense, where its limitations lie, and whether it applies to your situation.
One of the most valuable lessons I learned came from my estates and trusts professor at Berkeley Law when I was 25: accepted wisdom can change and boy was he right! Only a few years before the Federal Estate Tax Exemption was around $2 million, and up to 10% of deaths could result in a potential Federal Estate Tax issue. It was common at the time to use life insurance to pay estate taxes, put things in trusts to avoid high probate fees and to effectively double the estate tax exemption (in California) and to do all sorts of maneuvers to handle estate taxes that hit a decent number of families. Looking back since I took that class the estate tax exemption is substantially higher (more than 7 times higher), to my knowledge only about 1% of families have Federal estate tax issues, those life insurance policies proved to be kind of expensive in retrospect (their costliness was always known because it is expensive to insure older people but it wasn't known that they wouldn't be needed to pay estate taxes) and generally those policies were rarely used for their intended purposes of paying estate taxes.
Legal processes changed in unforseeable ways, including states like California creating and accepting transfer on death deeds which are basically like beneficiary designations for houses giving people a second way to potentially avoid some probate fees. Transfer on death deeds are inferior to trusts in some ways, but they are massively cheaper, and the landscape has changed tremendously in what people do to deal with estate taxes and liquidity after death. So many rules have changed ever since I sat in those classes and so before you take a death grip onto conventional wisdom and put all your eggs in that basket - I'd just pass along the awesomely helpful wisdom of my estate and trusts professor that things change quite a bit and conventional wisdom absolutely gets flipped on its head with time - so being able to think critically and keeping an open mind can be real assets in the long run.
Medicine, law and finance all have histories of ideas that were once widely embraced and later reconsidered (remember the use of leeches?). That doesn't mean we should distrust expertise; it means we should remain curious, humble, and willing to learn.
However, books that cover some basic tried and true habits (savings, spending, what to spend money, what kind of house to buy can genuinely be useful as a primer for those who are interested). Those habits based books more likely stand the test of time.
Thomas Stanley's The Millionaire Next Door is a worthwhile read on this subject. It is valuable because it is not really about techniques as it is about values and habits of those who ultimately achieve financial freedom and are comfortable and those who don't achieve it. The habits are enduring, even today in the world of AI, and it was a valuable read in 1996 when it was written, it was a valuable read in the mid 2000s when my boss gave it to me and explained this is what most of the wealthy clients at brokerage firms look and act like, and I'm confident that it will be a valuable read for you today.
One of its enduring lessons is the importance of education, ongoing self-education, and using professional advice to fill in blind spots in your own knowledge.
Now this can seem really strange because you'll hear and its not totally inaccurate that some of this stuff is simple or there are simple ways to do these things. This is true - some things are simple and there are simple ways to do things.
But simplicity is just the latest flavor of the month - its kind of like the Paleo diet or juicing in the mid 2010s. It was pretty huge and it seemed like everyone was doing it but it died down over time. Of couse those approaches still work great for specific issues but they have drawbacks too - a Paleo diet is maybe not the best thing for your heart and juicing is pretty expensive and some people find it to be cost prohbitive. When people match the outputs with the inputs - many people try for a while and then move on, because it wasn't the right approach for themselves over the long term.
The input of simplicity that makes it so attractive in 2026 - is that it is obvious - I don't have to think about this stuff. Wouldn't be awesome if I didn't have to think about things but still got good outcomes and never had to pay for professional help. That would be awesome!
But financial history has had so many of these through the years - easy decisions, one decisions, buy and hold forever and then a lot of these things in the past ran into a buzzsaw and people lost confidence in those approaches. People are okay and attracted to the input of simplicity as long as it comes with the presumed output of good results - who wouldn't like that. What is less likely is that people will tolerate bad results (a potential output) just because they were able to maintain the easy input of low effort/thinking throughout.
Now I won't tell you that this simple approaches won't work - because I have no idea whether they will work or not. That assumes that me or anyone can know the future with certainty - which we cannot. But we can know our history and know that there have been a lot of these promises of simple, easy, one decision approaches through the years and I'm not aware of any of them that didn't fall apart with time. And when I say fall apart I don't mean that they necessarily failed as theoretical strategies - but they failed in practice because people lost faith in them after a long period of them doing poorly while something else was doing well and they left the strategy over time. It is sort of like the Paleo Diet or juicing - I'm not alleging that they don't work - I'm saying the evidence, to my recollection, suggested that less people are doing Paleo or juicing than were doing them in 2015, to my knowledge - so a lot of people abandoned those strategies over time and that's normal.
This isn't to say that you should not consider a simple approach. A simple approach is the right approach for some people in our view. But just as in our experience a single approach for everyone usually hasn't worked out that well for the entire group historically and it is often better to customize your approach to your actual goals in our view.
As a physician, you don't need to become an expert in every field you interact with. If you like this stuff it is certainly okay to become one - but most people aren't that into taxes, law, health, that they want to spend all their time optimizing it. They often want to intellectually outsource some of the responsibility and they may continue to hold some responsibility themselves for those areas but it is a totally normal thing with time to "not want to think about something" and to recognize that you can just leverage other people's knowledge to save you effort and inform your self education and that is what a lot of the very succesful people in the Millionaire Next Door did.
So as you get started on your career, we'd encourage you to give yourself the same opportunity to learn how to care for your financial future—and to build a life in which your hard work gives you more choices, more security, and ultimately more freedom.
Don’t miss this opportunity to start your career with solid financial guidance.
About Daniel Harris
Daniel R. Harris is the founder and President of D.R. Harris & Co., a national, fee-only fiduciary financial advisory firm based in La Jolla, CA (near San Diego). With over two decades of experience helping physicians with their finances, Daniel is dedicated to helping physicians navigate the complexities of their financial lives. He earned his B.A. from Stanford University and his J.D. from UC Berkeley School of Law, where he focused on tax law—knowledge he uses to craft tax-efficient investment strategies for his clients.
Throughout his career, Daniel has observed over $1 billion in securities transactions, providing him with invaluable experience in wealth management, tax strategy, and financial planning. As a fiduciary, Daniel is committed to offering advice that puts client interests first.
At D.R. Harris & Co., Daniel works directly with physicians to create personalized investment strategies that address the unique challenges they face, from transitioning to becoming an attending to retirement planning. His goal is to help physicians manage their financial future with confidence, so they can focus on their careers and families and what matters to them.
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Disclaimer: This article is written for educational purposes only. Neither Daniel Harris nor D.R. Harris & Co. are your financial advisor unless you have a signed written advisory agreement with D.R. Harris & Co. This article largely represents the opinions and experiences of Daniel Harris working with physician clients over the last 16 years and should not necessarily be taken as statements of facts but rather just reflections based upon experiences he has had.
Jim Dahle's work in many was is an extension of many of the principles laid out in the Millionaire Next Door but it is a little more catered to the journey of physicians. I think Dr. Dahle, has done a good deal of positive work for the medical community by encouraging physicians to take their finances seriously, spend less than they earn, save consistently, and educate themselves. To a large degree Dr. Dahle echoes many of Thomas Stanley's ideas for 20 years earlier - just they are applied to a physicians journey and it works as well for physicians as it works for everyone else (if I recall correctly about 10% of the millionaires in the Millionaires were physicians or other highly paid professionals but 90% of them were not, but they used some similar values and strategies to achieve their goals).
Jim's advice on those fundamentals is excellent, and The White Coat Investor is a useful resource, particularly for physicians just starting out.
Where I disagree with Jim is in two areas: how financial incentives are evaluated and how narrowly the range of reasonable investment approaches is sometimes presented.
I think both subjects deserve a more nuanced discussion.
First, I don't think a compensation model should be judged solely by whether it creates a potential conflict of interest. Conflicts can matter but it is very situational.
The truth is that the compensation model generally reflects the nature of the cost of the product or service. If it is a very expensive product or service there is a good chance it will be paid for with a commission - if it is a more affordable product or service there is a good chance it will be paid for with a fee.
You don't want to be sitting on your high horse - and assume services are better than products or vice versa. They each have their role. For example, a cardiologist can analyze your heart or catheritize you - those are services and are valuable. A statin or a blood pressure medication or a blood thinner are products and they do things the cardiologist can't personally do and that is valuable too. Both have their roles - it is truly naive to distinguish a product from a service and anoint one as good and the other as bad. That is an asinine approach.
A product can be good or bad - but not because it is a product - but because of how it impacts people. A service may be useful and beneficial or harmful or not useful - and this is not because it is a service - it is because it isn't useful or beneficial to people - not because it is a service.
If it is also a fairly naive view to assume that fees are good and commissions are bad. The fields that have fees tend to be lower ticket per transaction - medicine, accounting, investment advice, some lower cost software products.
Fields that have commissions are things like insurance where you have to pay thousands of dollars to get started, or cars where you may pay tens of thousands of dollars, or heavy equipment which can be very expensive or real estate which is the most expensive of all.
Everyone is paying in some way shape or form and the question is really high much money is required to do the transaction.
Is a car good or bad - what about a workout in the emergency department? A good car is useful to many people's lives even if the salesman got a commission for showing cars to lots of people. A bad car is a bad car - but not because the salesman got a commission. A useful workup is a benefit to the patient - and a workup where significant mistakes are made is not helpful to the patient but the fact that one was fee for service and one was commission has almost nothing to do with the value of what you received - the value comes from whether the product or service, in your view, improved your life and this is a fairly subjective evaluation.
For example, a radiologist might charge you $300 to read your cat scan. He or she is not paid on a commission - but they are paid a fee. But they are providing a valuable service.
The CT Scan maker and salesman who helped facilitate the sale of the CT scanner to the hospital might have made $50k in commission on selling that CT scan to a facility. The CT scan maker might spend all year doing education and demonstrations and only sell 2 machines a year.
Who did the harm here or the benefit? Is the radiologist doing something wrong because he or she charged a fee for service and they won't read your study without you paying them $300. Or did the CT salesman do something wrong here by educating facilities and staff about their machine and having to do 6 months of free education to sell one machine.
At the end of the day you need both - the equipment and professional to judge and apply the results. They are paid to in the end perhaps help a emergency department doc quickly diagnose a stroke or a hemorrhage, both of which can help the patient.
A common mistakes amongst physicians and frankly all fields is to apply rules of their field to other fields - that operate under totally different conditions. To make this make sense I'll tell you the story of someone I know who works in the Silicon Valley and takes care of animals. Software engineers in the Silicon Valley like to move fast and break things which is a completely approach for software - but the way these people sometimes apply this is to mess with the medication dosaages and experiment. When you move fast and break a liver - you can't just order a new one on Amazon.
The point is that every field has their own way of doing things, and they are usually optimized for the problems they face. If it is not your field you may not really know the rules - even if you have a deep interest in it. And the biggest mistake of all is to assume that these other fields are out to get you - they absolutely are not. This is sort of like the anit-vax argument for professional advice - it is not based on measured reasoning - it is based on a few horror stories repeated. But guess what - vaccines sometimes cause harm - we all know that - and if patients used those stories of harm to never get a vaccine - as a population they'd likely be worse off.
My personal view is that if the financial product is really expensive - just like most other expensive products - less of them will be sold and the compensation will be in commission. You might have been able to get years of free one on one or group education out of these models before you buy - if you buy at all. The insurance agent, or realtor might educate 98% of the public with really good information for free to close the 2% that buy. That aren't really any different than the CT salesman. I've seen these models up close and a good realtor or good insurance agent can be very helpful to navigate a sometimes confusing process.
If the product itself is not as expensive -- read this study, do this tax return, examine this patient, run this test, the compensation is more likely to show up as a fee and more people will pay it and the total cost will be lower out the door than on most commission products.
Longtime readers of The White Coat Investor have seen the platform evolve from its earlier roots as a financial education blog toward a more commercial business, with a greater emphasis on selling their own products and financial services, and now they have fairly complicated and conflicted business relationships with what they write about.
That evolution is understandable as a business grows, but it does change the character of the platform and makes it worth distinguishing its educational content from its commercial activities. Despite that shift, I still think the blog offers useful financial education, and Dr. Dahle is a good writer who has made a meaningful contribution to the physician community. I'd encourage readers to take advantage of what the site does well while remaining thoughtful about how its business model may influence the journalism that can potentially be influenced by the highly entangled financial relationships between the recommended products and the topics Dr. Dahle writes about. Nonetheless, I do think there is some effort to remain neutral - but it is a massive enterprise now and many long term readers can sense the highly commercial nature of the site.
The same principle applies to the way we evaluate investment strategies. Index fund investing is a perfectly reasonable approach, with genuine strengths: low costs and simplicity. But it has limitations, too. Simplicity can become complacency, and investors can fall into the trap of projecting historical returns into the future without considering differences in starting valuations or economic conditions. I also think it's worth asking how much of indexing's success comes from indexing itself and how much comes from the characteristics that often accompany it, including low fees, quality holdings, and a sort of government push to mainly only use index funds in employer retirement accounts. Index funds package many of these features together very effectively, which is a real advantage. But that doesn't establish that indexing is the only way to achieve them or that it is the only reasonable path to building wealth. In my experience, I've seen people succeed using a variety of approaches. Comparing individual funds is one thing; evaluating complete portfolios has shown me that a suprising variety of approaches can work. If you like indexing there is nothing against that and almost all investors index a little bit - but there are a variety of ways for people to actually achieve their goals and have good outcomes in our experience, both with and without indexes.
But aside from these two small gripes - my view is the education and ideas in both Dr. Stanley and Dr. Dahle's are both excellent and can be a good start for a young physician who wants to learn more.
Thomas Stanley's The Millionaire Next Door offers a useful complementary perspective: his research suggests that financially successful people often combine self-education with professional advice rather than relying exclusively on either one. Not everyone needs an advisor, but neither should we assume that doing everything ourselves is inherently superior.
My view is straightforward: read Jim's book, learn the fundamentals, and take the good advice seriously. But don't confuse a valuable resource with the final word on personal finance, and don't mistake a popular investment philosophy for the only rational one. Educate yourself, understand how the people providing advice are compensated, question assumptions, and remain open to evidence that complicates what you already believe. As your financial life grows more complex, reassess whether you think professional expertise could help you make better decisions and become more aware of what is possible. The objective isn't to become tribal and defend one camp or dismiss another. It's to find the combination of education, investment strategy, and professional guidance that best serves your circumstances and, ultimately, gives you greater financial freedom.
Best of luck on your journey and congratulations on becoming an attending!