How Sanford Health Physicians Can Prioritize Their Financial Goals—and Invest Their Money

There is a point in many physicians' careers when making money becomes easier—and managing it becomes harder.

During residency, the problem was simple: there wasn't much money.

Then you become an attending physician.

Suddenly, there is substantially more.

And with that money comes a surprisingly long list of decisions.

Should you pay off your student loans?

How much should you put into your Sanford 401(k)?

Should you contribute to Roth or pre-tax accounts?

Are you saving enough for a house?

Should you start a college fund?

How much cash should you keep?

And perhaps the question that causes the most anxiety:

What should I actually invest in?

This is where we see many physicians become overwhelmed.

Not because they aren't intelligent.

Not because they aren't financially successful.

And certainly not because they aren't capable of understanding the basics.

It's because there are too many reasonable choices competing for the same dollar.

And unlike a medical problem, there usually isn't one obvious treatment protocol.

You need a way to prioritize the decisions.

Then you need an investment strategy that makes the money you've accumulated work as hard as possible.

That's the purpose of this guide.

First, Understand the Difference Between Saving and Investing

One of the biggest mistakes we see is treating saving and investing as though they're the same thing.

They're not.

Saving is about setting money aside.

Investing is about putting capital to work.

And for a Sanford Health physician who may have 20, 30 or 40 years ahead of them, that distinction can become enormously important.

Consider a physician who accumulates $1 million.

The question isn't simply whether that physician saved enough.

The much more interesting question is:

What is that $1 million invested in?

And what happens to it over the next 20 or 30 years?

Investment returns compound.

So do investment mistakes.

A physician who saves diligently but invests poorly can end up with a dramatically different outcome from a physician who saves a similar amount and has a thoughtful, diversified investment strategy.

That's why we don't view investing as something you get around to after you've handled your “real” financial planning.

For many physicians, investment strategy is one of the most important parts of the plan.

So Where Should Your Next Dollar Go?

Imagine telling us:

“I have $5,000 a month available after my normal expenses. What should I do with it?”

That's a much more interesting question than:

“Should I contribute to my 401(k)?”

Because the answer depends on the entire picture.

Think about financial planning like planning a trip.

If you're going to Chicago for a weekend, you need a certain amount of money.

If you're going to France for two weeks, you'll need considerably more.

The right budget depends on where you're going and how you want to get there.

Financial planning works the same way.

Your savings target depends on:

• When you want financial independence

• The lifestyle you want in retirement

• Whether you want to buy a home

• Whether you have children

• Your student loans

• Your expected future income

• Your current assets

• Your tolerance for investment risk

• And, importantly, how you want your money invested along the way

There isn't a magic savings percentage that works for every physician.

But there are some useful priorities.

1. Start by Capturing the Sanford Employer Match

This is one of the easiest decisions to get right.

If your employer is offering to contribute money to your retirement account when you contribute, you generally want to take advantage of it.

We believe that the Sanford employer match is:

• 100% of the first 4% you contribute

• 50% of the next 2%

  
  

That means contributing 6% of compensation can produce a 5% employer contribution, subject to the applicable plan terms.

In other words, you generally need to contribute 6% to receive the full 5% match.

YOU CONTRIBUTE 6%

↓

EMPLOYER ADDS 5%

↓

TOTAL = 11% of compensation into retirement savings (up to the IRS compensation limits)

That's a meaningful benefit.

And it's also an example of why financial planning shouldn't be done one goal at a time.

If you're putting every available dollar toward your student loans while missing an employer match, you may be making a mathematically inefficient trade.

Some opportunities are use it or lose it.

Once the year has passed, you can't go back and collect a missed employer contribution.

2. Decide How Much Cash You Actually Need

Next comes liquidity.

And this is where we don't believe in one-size-fits-all advice.

Some physicians are perfectly comfortable with a relatively small emergency reserve.

Others want six months or even a year's worth of expenses in cash.

It depends on your circumstances and your tolerance for risk.

But there is an important trade-off.

Cash provides security and flexibility.

Investments provide the opportunity for long-term growth.

If you keep too much money in cash for too long, you may be sacrificing years of potential compounding.

So the question isn't:

“How much cash does xyz person say I should have?”

The question is:

“How much liquidity do I actually need given my income, expenses, job security, family and investment portfolio?”

For some physicians, that could be one month of expenses.

For others, it could be substantially more.

The right answer is personal.

3. Don't Automatically Choose Between Student Loans and Investing

This is another area where physicians sometimes get trapped in an either/or mindset.

“Should I pay off my student loans?”

Or:

“Should I invest?”

Often, the answer is both.

The interest rate on your loans matters.

Your repayment strategy matters.

Your expected future income matters.

And your investment opportunities matter.

If you have a student loan charging a very high interest rate, paying it down may be an excellent use of capital.

But if you have relatively inexpensive debt and are simultaneously giving up valuable employer contributions or years of tax-advantaged investing, the answer may be different.

This is one reason we don't like financial advice that consists of universal rules.

Your financial plan should be built around your balance sheet, not someone else's.

4. Save Enough for the Life You Actually Want

Physicians sometimes ask:

“What percentage of my income should I save?”

It's a reasonable question.

But it isn't quite the right question.

A better question is:

“What am I trying to accomplish with this money?”

If your goal is to retire at 55 and maintain a very high standard of living, you're going to need a different savings and investment strategy than someone who plans to work until 70.

If you want to buy a $1 million home in three years, that's a different financial problem from someone who wants to rent indefinitely.

If you want to pay for your children's education, that's another goal.

Your financial plan should tell you how much you need to save for each destination.

And then it should tell you how those dollars should be invested.

5. Roth vs. Pre-Tax: Which Is Better for Physicians?

Traditional 401(k) Contributions "deferrals"	Roth 401(k) Contributions "income tax not deferred"
Tax deferral now - tax can compound over time (like a student loan in deferral the tax balance can grow over time to more than what you would have originally owed - even adjusted for inflation)	Taxes flushed out now - compounding of the taxes usually stops and withdrawals are typically tax free
Not a tax write off today - because the taxes have been merely deferred not written off (like a student loan in deferment) - but the deferral lessen income tax owed in the current year (just like a student loan deferral lowers interest payments in the current year and raises them in future years)	No tax deferral today - this income counts as income for the purposes of income taxes
Traditional 401(k) contributions can be better if a) income tax lowers in retirement (this is usually the case) and b) the investment gains haven't offset the income tax savings. So for example $100 deferred may save $50 in taxes today at at 50% tax rate. But if that $100 turns into $400 (after adjusting for inflation) and the tax rate drops to 25% the taxes would be $100 in retirement on a lump sum versus $50 if not deferred and Roth contributions were made (using a very simplied example for illustration). So even though the tax rate is cut in half in retirement the deferral doubled the taxes owed in real terms (this is a simplified example to explain the concept of how investment gains can actually making taxes higher when deferred not lower, not a real example)	Using the example on the left - Roth 401(k) contributions often result in lower taxes for higher earners who are good savers. Plus the better saver you are and the more growth oriented investor you may be the higher your income is in retirement and the higher your tax rate in retirement.

This is one of the most common questions we hear.

And for many attending physicians, Roth contributions deserve serious consideration.

With traditional pre-tax contributions, you generally receive a tax benefit today and pay taxes when the money is withdrawn.

With Roth contributions, you generally pay the tax today and qualified withdrawals can be tax-free later.

For a physician in their 30s or 40s with decades of potential growth ahead, Roth assets can be particularly valuable.

One way we think about this is in terms of expected future wealth.

If you expect to accumulate substantial wealth over your career, having a meaningful pool of tax-free retirement assets can become increasingly valuable.

If your expected retirement wealth is much lower, the relative advantage may be less significant.

There isn't one answer.

But for many attending physicians who can afford the contribution, Roth deserves a prominent place in the conversation.

6. What About the HSA, IRA and Other Accounts?

Once you've captured the employer match, you may have several other opportunities.

An HSA can be highly valuable when available and appropriate.

IRA contributions may be useful.

Education savings may be appropriate if you have children.

A taxable investment account can provide flexibility and additional investment capacity.

But here's where the process becomes complicated.

There is no prize for having the most accounts.

The goal is to determine which account should receive your next dollar based on your goals, taxes, time horizon and investment strategy.

That's a planning problem.

And it is precisely the sort of problem that can become overwhelming when you're trying to solve it yourself.

7. Don't Ignore the Investment Options Inside Your 401(k)

This deserves its own section because we think physicians often underestimate its importance.

Your retirement account is not the investment.

It's the container.

The investments you put inside the container matter.

And the difference between two investment strategies over several decades can be enormous.

Many physicians simply select a target-date fund or one of the options that looks familiar and move on.

Sometimes that's perfectly reasonable.

But sometimes there are other investment options worth understanding.

The Sanford plan also offers a self-directed brokerage option, according to plan materials available to us.

Many physicians don't realize this exists.

That doesn't mean every physician should use it.

It means you should know what's available before deciding what you don't need.

This is an area where we believe professional advice can add real value.

Not because physicians are incapable of choosing investments.

Quite the opposite.

It's because physicians have better things to do with their evenings than research fund menus, compare investment strategies, analyze portfolio construction and constantly wonder whether they made the right decision.

8. Investment Selection and Strategy Isn't an Afterthought - it is actually far more important than most people realize

There has been, in our view, a growing tendency in financial planning to talk about everything except investing.

Estate planning.

Tax planning.

Insurance.

Cash flow.

These things matter.

But we don't want to lose sight of the fact that your investments are the engine that grows your financial assets.

For an employed W-2 physician, this is particularly important.

Someone who owns a substantial share of a business may have significant opportunities to influence the character and timing of their income.

A W-2 physician has fewer of those opportunities.

Earned income is generally taxed less favorably than investment income, and business owners can have planning opportunities that aren't available to a typical employee.

That means your investment strategy can become an especially important source of long-term financial differentiation.

You may not be able to dramatically change how your W-2 compensation is taxed.

But you can make decisions about what you do with the money after you earn it.

That's why we believe investment planning deserves to be near the center of the conversation—not buried at the end of the checklist.

9. What Are the Biggest Mistakes We See Physicians Make?

The biggest mistakes aren't necessarily dramatic.

They're often quiet mistakes that compound over 10, 20 or 30 years.

Not using their retirement benefits efficiently

Physicians sometimes overlook employer contributions, tax-advantaged accounts or other plan features.

Those opportunities can be difficult—or impossible—to recover later.

Not understanding their investment options

A physician may have a six- or seven-figure retirement portfolio someday.

Yet they may spend very little time understanding what they're actually invested in.

That's backwards in our view.

The larger the portfolio becomes, the more consequential investment decisions can become.

Doing everything sequentially

Pay off the loans.

Then buy the house.

Then save for retirement.

Then save for college.

Then invest.

Life doesn't work that way.

Many of these things can happen simultaneously.

The question is how much should go toward each one.

Trying to solve everything alone

This may be the biggest one.

Physicians are trained to solve difficult problems.

That doesn't mean you should personally solve every problem in your financial life.

You wouldn't perform your own surgery simply because you are intelligent enough to understand anatomy.

And you don't need to become a portfolio manager simply because you understand statistics.

A good fiduciary financial advisor can help you determine:

What should I do first?

What can wait?

How much should I save?

How should I invest it?

And what should I stop worrying about?

10. There Is No Universal Physician Portfolio that is optimized for everyone's goals

Sometimes people ask:

“What's the best investment portfolio for a Sanford physician?”

That's a little like asking:

“What's the best medication for a Sanford physician?”

There isn't one.

The right investment strategy depends on the individual.

Two physicians with the same income can have completely different appropriate portfolios because they have different:

• Risk tolerances

• Time horizons

• Retirement goals

• Existing assets

• Family situations

• Debt

• Spending needs

• Career plans

That's why we're skeptical of universal portfolios.

The important question isn't:

“What's the best portfolio?”

It's:

“What's the right portfolio for me and for the financial journey I want to go on?”

Think of your Financial Advisor as Your Financial Doctor

Here's the analogy we find useful.

If a patient asks you:

“Which medications should I take?”

you don't hand them a generic list.

You evaluate the patient.

You consider their history.

Their symptoms.

Their medications.

Their lab results.

Their goals and preferences.

Then you develop a treatment plan.

We think good financial planning should work similarly.

Your advisor should understand your entire financial picture before recommending what to do.

Getting Financial Advice isn't all serious stuff either - it can actually be fun too...

And ideally, the experience should feel a little like shopping at Costco.

You walk in knowing you need a few things.

Then you discover things you didn't know existed.

Maybe it's an investment option you hadn't considered.

Maybe it's a more efficient way to coordinate your retirement accounts.

Maybe it's a strategy for investing money you've been leaving in cash.

Maybe it's a better way to balance student loans with long-term investing.

You don't have to buy everything.

But you should know what's available.

Who Is This Kind of Financial Advising For?

This isn't a service designed for someone who wants a quick answer to:

“What's a good mutual fund?”

And it isn't for someone looking for a free second opinion on a portfolio they've already built.

Those conversations can be useful.

But they aren't what we do best.

We work best with physicians who have reached the point where their financial life has become too complicated to comfortably manage on their own.

Maybe you're earning a strong attending income but don't know how to prioritize the competing demands on your savings.

Maybe you have accumulated meaningful assets but aren't confident they're invested appropriately.

Maybe you're maxing out accounts but have no idea whether you're doing it in the right order.

Maybe you keep thinking:

“I know I should be doing something with this money. I just don't know what.”

That's a serious problem.

And it's exactly the kind of problem we like to solve.

We Work With Physicians Nationwide—Virtually

You don't need to live in the same city as your financial advisor. In fact given that almost everything is done online and is largely paperless these days, there is really no advantage to a local advisor compared to one that works nationally. Think of it like this - if you wanted to buy something on Ebay but you limited your options of sellers to the county you lived in - would that increase or decrease your options and choices as a buyer? I just bought a phone from someone in Iowa on Ebay (we're in San Diego) - it makes no diffence to me where they are from - just what they can provide.

Our firm works virtually with physicians across the United States and has worked with physicians throughout the US for almost 16 years now.

That means you can have a financial advising relationship built around your circumstances rather than geography.

If you're looking for someone to give you a five-minute answer about your Sanford 401(k), we're probably not the right fit.

But if you're an attending physician who is earning substantial income, accumulating savings and increasingly uncomfortable with the question “Am I doing this right?”, that's a conversation worth having.

Our job is to help you answer:

What should I prioritize?

How much should I save?

Where should I put it?

How should I invest it?

And what can I stop worrying about?

You don't need to become a financial expert.

You need a financial strategy that makes sense—and someone you trust to help you understand how to execute it.

If that sounds like the problem you're trying to solve, schedule a conversation with our team.

For the past 16 years, we've work virtually with physicians nationwide and focus on helping successful physicians turn financial complexity into a clear approach that we believe can help them better achieve their goals.

Schedule a call with D.R. Harris & Co.

On this call we'll start by understanding what you're trying to accomplish and whether we're actually a good fit for the problem you're trying to solve.

Disclaimer: The information in this article is for educational and entertainment purposes only. You are not a client of Daniel Harris or D.R. Harris & Co. unless you have a signed written advisory agreement with our firm. We believe the information in this artcile is correct at the time of its writing on 8/19/26, but we make no warranties about the accuracy of the information in this article. We encourage you to do your own independent research and talk to your own professional advisors before acting on any information discussed in this article. If you do not have a fiduciary financial advisor currently and you'd like to explore what it might be like to work with D.R. Harris & Co. please fill out our contact form here.