What should I do with my money in my first year as an attending?

Here is the whole year on one page. The sections below take each row in turn.

Put the dates on a calendar. Your last training paycheck, the move, your first attending paycheck and any expected reimbursement rarely line up. An annual salary doesn't answer a timing question, so plan for the gap in between, and don't count on a reimbursement or a bonus until it's confirmed in writing.

Ask when benefits start and when elections close. Ask too what happens if you miss the window, and whether there's a gap in health cover between your training program and the new job.

Sort what must be paid now from what can wait. Moving, housing deposits and licensing fees arrive before the new salary does. Most other decisions on this page can wait a few weeks without costing you anything.

Your ability to work as a doctor pays for everything else on this list, and disability insurance is what protects it. The question to ask of any policy is how it defines disability.

• Own-occupation (“own occ”): the policy pays if you can't do the duties of your own occupation, even if you could work in another one.
• Any-occupation (“any occ”): it pays only if you can't do any job that suits your training, education and experience.

A policy can start as own-occupation and switch to any-occupation later, for example after two years. Read that clause in the group plan at work before you rely on it.

Who pays the premium changes the tax. If your employer pays for the plan, benefits paid to you are generally taxable income. If you pay the whole premium yourself, the benefits generally aren't.

Individual policies are underwritten: the insurer decides whether to cover you, and at what price, based on your health and job when you apply. An advisor can read the definitions with you; the policy itself comes from a licensed insurance agent.

It depends mostly on who employs you. Public Service Loan Forgiveness (PSLF) forgives the rest of your federal Direct Loans after 120 qualifying monthly payments, made while you work full time for a qualifying employer.

• Qualifying employers include government employers and 501(c)(3) nonprofits, such as a nonprofit hospital. A for-profit group or private practice is not one.
• Full time means an average of at least 30 hours a week.
• The employer is generally whoever issues your W-2. If a physician group that contracts with a nonprofit hospital pays you, in most cases the group is the one that has to qualify.
• Qualifying payments are made under an income-driven plan, including the new Repayment Assistance Plan (RAP), or the 10-year standard plan.

Repayment plans have changed recently, so check which plans your own loans can use with your servicer and on studentaid.gov. An advisor can lay out both paths with your actual balances; the choice and the paperwork stay yours.

Find out what the match takes. If your employer matches contributions, ask how much you need to put in to get all of it, when it starts and how long until it vests.

A hospital 457(b) is separate room. It has its own $24,500 limit on top of a 403(b), but nonprofit and government 457(b) plans work differently when you leave. Should I use my hospital's 457(b)?

Once your income passes the top of the Roth IRA range, you can't contribute to a Roth IRA directly. The “backdoor” is two steps: put money into a traditional IRA without taking a deduction (you report it on Form 8606), then convert that IRA to a Roth IRA.

The catch is the pro-rata rule. If you already have pre-tax money in any traditional, SEP or SIMPLE IRA, the IRS treats all of them as one when it works out how much of a conversion is taxable, using their total value on December 31. So a conversion you expected to be tax-free can be largely taxable.

Money in a 401(k) or 403(b) isn't counted, because it isn't in an IRA. If you rolled an old plan into an IRA during training, talk it through with your tax professional before you convert.

A signing bonus is pay. It's taxed as wages, and an employer can withhold federal income tax on it at a flat 22% (37% on supplemental pay over $1 million in a year). That flat rate isn't set to your own tax bracket, so what's withheld may not match what you owe. Moving money paid to you is generally taxed as pay too.

Read the clawback. How long do you have to stay? Does what you repay shrink each month you stay? Is it the full bonus, or what you received after tax?

Check your withholding once the paychecks start. The IRS Tax Withholding Estimator shows whether to adjust your W-4. For the rest of the contract, see Joining a hospital or group: what should I ask before I sign?

Enough to get through the gap before your first full attending month, and then a cushion for your household's fixed costs. There's no single right number. A two-income household with steady jobs may need less than a single income on a new contract with a bonus that could be clawed back.

Build it before you invest more than the match. It's what stops a surprise bill from becoming credit card debt or an early withdrawal.

Life insurance matters if anyone depends on your income: a partner, children, or a parent you help. Term life is the usual starting point. Ask whether the group life through work stays with you if you change jobs.

Umbrella insurance is extra liability cover on top of your home and auto policies. It doesn't replace malpractice cover.

The money decisions above are the same in every field. What differs is the practice model, the path to partnership and how fast pay ramps up. We cover those for orthopedic surgeons, cardiologists, gastroenterologists, dermatologists and anesthesiologists.