The Attending Financial Checklist - Year One Priorities

Your first year as an attending is the most financially consequential year of your career. Here is a prioritized checklist of what to get done and in what order.

Before Your First Paycheck Arrives

The window between signing your contract and receiving your first paycheck is the best time to make financial decisions because you are not yet in the spending patterns that come with a new income. Use this time to elect your benefits carefully, set up your retirement contribution deferrals at the maximum amount, and open any accounts you will need - a high-yield savings account for your emergency fund rebuild, a brokerage account if you plan to invest in a taxable account, and a Roth IRA or traditional IRA for the backdoor Roth process.

If you do not already have individual disability insurance, apply now. Your attending income creates a coverage need that your resident policy - if you have one - may not fully address. Most insurers allow you to increase coverage within 90 days of a qualifying income event like starting an attending position. If you have a future purchase option rider on your resident policy, exercise it. If you do not have a policy at all, this is the most important financial protection purchase of your first year.

Months One Through Three

Confirm your first paycheck reflects the correct 403b deferral amount. Errors in benefits setup are common during onboarding and may not appear until the second or third paycheck. Verify that your contribution rate is correct, that the investment elections are what you intended, and that any employer match is being applied. If your employer offers a 457b plan, enroll and begin contributions simultaneously - do not wait until you have settled in.

Execute your first backdoor Roth IRA contribution early in the year. Contribute $7,000 to a traditional IRA as a nondeductible contribution and convert it to a Roth IRA within a few days. Do the same for your spouse if applicable. File Form 8606 with your tax return to document the nondeductible basis. Set a calendar reminder to do this again in January of the following year.

Do not buy a house in your first year unless you are certain about your location. Closing costs, transaction fees, and the illiquidity of real estate make a home purchase expensive if you move within two to three years. Rent for at least one year in a new city before committing to a purchase - your preferences about neighborhood, commute, and school district will clarify once you are actually living there.

Months Three Through Six

By month three, you should have a clear picture of your actual monthly take-home pay after all deductions. Build a written budget around that number - not your gross salary. Assign specific amounts to housing, transportation, food, savings, and discretionary spending. The most common financial mistake new attendings make is assuming income will accommodate any spending level and never building the discipline of a budget. High income does not prevent overspending - it just means overspending takes longer to create a crisis.

Review your student loan situation. If you are on PSLF track at a qualifying nonprofit employer, confirm your payment plan is still correctly set up and submit your Employment Certification Form for your new employer. If you are not pursuing PSLF, calculate your payoff timeline under an aggressive repayment scenario and decide how much of your monthly surplus to direct toward extra principal payments versus investment accounts.

End of Year One

Before December 31, review your tax situation with a CPA. Your first full attending year is often a significant tax event - higher income, new deductions, potential estimated tax obligations if you have any self-employment income, and the need to confirm retirement account contributions are correctly documented. Proactive tax planning before year-end allows adjustments that are not possible after January 1.

Assess your insurance coverage comprehensively. Confirm disability coverage is adequate for your current income. If you have dependents, evaluate whether you have sufficient term life insurance - a common benchmark is 10 to 12 times your annual income in coverage. Review your liability exposure and consider whether an umbrella policy is appropriate. These reviews take a few hours and protect everything you spent a decade building.