What happens to my retirement accounts when I leave residency?

A governmental 457(b), from a state, county or public university hospital, can be rolled over to a 401(k), 403(b), another governmental 457(b) or an IRA. It also has a feature worth knowing before you move it: payouts from it aren't subject to the 10% additional tax on early withdrawals, except for amounts that were rolled into it from another kind of plan.

A tax-exempt 457(b), from a private nonprofit hospital, can't be rolled over. Leaving is one of the events that lets the plan pay you, and the money is taxed when it's paid or made available to you, whichever comes first. So the payout choices the plan offers, and any deadline to make them, matter more than anything you do later. Should I use my hospital's 457(b)?

A direct rollover sends the money from the old plan straight to the new plan or IRA. No tax is withheld.

A 60-day rollover pays the money to you first. The plan generally has to withhold 20% for income tax, even if you mean to roll it over. To keep the full amount tax-deferred, you deposit the whole balance within 60 days, making up the 20% from other money. Whatever isn't rolled over is taxable, and if you're under 59½ it may also face a 10% additional tax.

A backdoor Roth is a nondeductible contribution to a traditional IRA that you then convert to a Roth IRA. It comes up once your income is above the limits for putting money into a Roth IRA directly.

The tax on the conversion depends on all your IRAs, not just the one you convert. On Form 8606, “traditional IRA” includes traditional SEP and SIMPLE IRAs, and you enter the total value of all your traditional IRAs as of December 31, plus any outstanding rollovers. That total, set against your nondeductible contributions, is what decides how much of the conversion is taxed. This is often called the pro-rata rule.

A 403(b) or 401(k) isn't an IRA, so money left in the old plan or rolled to your new employer's plan isn't in that December 31 total. Money rolled to a traditional IRA is. That's the reason to decide where the old 403(b) goes with the backdoor Roth in mind, not separately.

From residency to fellowship, you usually have a new employer for a short stretch and a new plan. The questions are mostly about the old accounts: can the 403(b) stay where it is, what does a tax-exempt 457(b) pay out and when, and does the fellowship plan accept rollovers.

From fellowship to a first job, your income changes, and with it whether you can put money into a Roth IRA directly. That's when the December 31 total starts to matter. If you've had plans at two or three employers by then, the list below is the place to start.

• The name of each plan and the firm that runs it, with your login and a phone number.
• Whether each 457(b) is governmental or tax-exempt.
• Your latest statement for each account, with the pre-tax and Roth amounts shown separately.
• How much of any employer contribution is vested.
• Each plan's rules for payouts and rollovers (the summary plan description has them).
• For a tax-exempt 457(b), the payout options and any deadline to choose.
• Whether your next employer's plan accepts rollovers, and whether it has a Roth option.
• The value of any traditional, SEP or SIMPLE IRAs you already have.

This page lists the options and the rules. Which one fits depends on the plans you're leaving and joining, and on whether a backdoor Roth is in your plans.