Author: Dr. Aaron Snyder
Date Published: 12/15/2025
Dr. Elena Martinez stood in her residency program director’s office, holding her first job offer. Emergency medicine, academic medical center, $320,000 base salary plus bonuses. She’d dreamed of this moment since her first day of medical school.
“Congratulations,” her program director said, reaching out to shake her hand. “You’ve earned this.”
Walking back to the resident lounge, Elena felt something unexpected: not excitement, but anxiety. She’d spent eight years preparing to be a great doctor. But nobody had taught her how to handle a six-figure salary jump. Nobody explained what to do with a signing bonus. Nobody prepared her for the financial whiplash of going from broke resident to wealthy attending in a single month.
If this sounds familiar, you’re not alone. The transition from training to practice is one of the biggest financial shifts most people will ever experience. Let’s talk about how to navigate it without losing your mind or your money.
The Six-Month Window: Why Your First Six Months as an Attending Matter Most
Here’s something they don’t tell you in residency: the financial decisions you make in your first six months as an attending can shape the next decade of your life.
These months are your golden opportunity because:
- You’re used to living on less – Your resident lifestyle is still fresh. You haven’t upgraded yet.
- You’re motivated – The finish line is finally here, and you’re ready to make changes.
- You have breathing room – For the first time in years, you have more money in 1 month than 6 months as a resident.
But there’s a flip side: this is also when most new attendings make their biggest mistakes. They see that first paycheck and think: “Finally! I can have nice things!”
And they’re not wrong. You can have nice things. You’ve earned them. But timing matters.
The Two Paths: A Tale of Two Colleagues
Let me tell you about two physicians who started attending jobs the same year at the same hospital.
Dr. A signed his contract in March, graduated residency in June, and started his attending job in July. In those three months, he:
- Bought a $65,000 BMW (he’d driven a 10-year-old Honda through residency)
- Signed a lease on a luxury apartment ($3,500/month vs. his previous $1,200)
- Bought new furniture, new clothes, took his partner on an expensive vacation
- Started eating out constantly because he “deserved it”
By the time his first paycheck arrived, he’d already spent $15,000 on a credit card (the car was financed) and committed to $2,300 more in monthly expenses. When that attending paycheck hit his account—let’s say $12,000 after taxes—he felt rich for about three days. Then he paid his credit card bill, his new rent, his car payment, and suddenly realized: he had about the same amount left over as he did as a resident.
Dr. B took a different approach. She:
- Kept her reliable 5-year-old Camry
- Upgraded from a studio to a nice 1-bedroom ($1,800/month instead of $1,000)
- Bought a few nice professional outfits but kept most of her resident wardrobe
- Started cooking at home but gave herself a reasonable “eating out” budget
- Took a long weekend trip to celebrate but skipped the Maldives vacation
Her monthly expenses increased from $3,500 as a resident to about $5,000 as a new attending. When that $12,000 paycheck arrived, she had $7,000 left over after paying bills and her planned spending.
She put $3,000 toward her credit card debt from residency, $2,000 toward building her emergency fund, and $2,000 toward maxing out her retirement accounts. Within 18 months, she was completely debt-free except for her student loans and had $40,000 in savings and investments.
Five years later? Dr. A still feels financially stressed despite making great money. Dr. B just bought a house with a 20% down payment—in cash.
Six Months Before Graduation: Your Preparation Checklist for New Attendings
The time to start preparing isn’t when you get your first paycheck. It’s now, while you’re still in training.
Month 6 Before (January for June graduation):
- Review your complete financial picture
- List all debts with interest rates
- Check your credit score (you’ll need this for loans and apartment applications)
- Research cost of living in your new (planned) city
- Start thinking about housing options
Month 5 Before:
- Create a mock budget for attending life
- Include realistic numbers: housing, utilities, food, transportation, insurance
- Research High-Yield Savings Account (HYSA) options and open an account
- Start small: even $100/month now builds the habit
Month 4 Before:
- Start or follow up on licensing: state, DEA, etc
- Research retirement account options (you’ll set these up soon)
- If you’re 1099, set up your LLC and apply for an EIN online
Month 3 Before:
- Read your job offer contract carefully (consider hiring a contract lawyer if you haven’t already signed)
- Understand your compensation structure: hourly, RVU, bonus, incentives
- Know your benefits: retirement matching, CME money, health insurance
- Calculate your actual take-home pay after taxes (federal, state, local)
- Start researching disability if you haven’t yet
- Start researching life insurance if you have dependents and haven’t yet
Month 2 Before:
- Set up your paycheck: decide how much goes to retirement accounts
- Plan your first-month budget in detail
- Open your Traditional and Roth IRA accounts (backdoor Roth process)
- Resist making big purchases “because you’ll have money soon”
Month 1 Before:
- Finalize housing
- Move if necessary (try to do this before you start working)
- Set up utilities, internet, etc.
- Take a deep breath. You’re almost there.
The First Six Months as an Attending: Your Success Blueprint
Month 1: Establish Your Foundation
- Set up automatic retirement contributions
- Continue contributing a small amount to High-Yield Savings Account
- Create your actual budget based on your first paycheck
- Pay all your bills on time to establish good habits
Month 2: Build Momentum
- Make your first backdoor Roth contribution
- Start emergency fund with $500-$1,000 from each paycheck
- Continue living mostly like a resident
- Treat yourself to one nice thing (you’ve earned it)
Month 3: Attack High-Interest Debt
- Any credit card over 15% APR needs to go
- Make the minimum on everything else
- Start thinking about student loan strategy (PSLF vs. payoff)
Month 4: Expand Your Financial Vision
- Reassess your budget: is it working? What needs adjustment?
- Continue building emergency fund toward $15,000
- Consider increasing retirement contributions
Month 5: Look Ahead
- Plan for tax time (you’ll owe more than you think)
- Consider whether you need an accountant (CPA) for 1099 work
- Evaluate your progress on emergency fund and debt payoff
- Start thinking about medium-term goals
Month 6: Reflect and Adjust
- Review all your financial progress
- Celebrate what you’ve accomplished!
- Make adjustments to budget if needed
- Now you can consider bigger lifestyle upgrades
The Three Most Dangerous Moments
There are three times when new attendings most commonly derail their finances:
Dangerous Moment #1: The Signing Bonus Many hospitals offer $20,000-$50,000 signing bonuses. This feels like free money, and your brain screams “NEW CAR!”
Resist. This is not spending money. This is debt-payoff and emergency-fund money. Put 50% toward high-interest debt, 50% toward your emergency fund. Done. Don’t even think about it. Consider that bonus as only partially yours. You’ll owe taxes on the lump sum. Consider the emergency fund contribution portion as withholding for your tax bill.
Dangerous Moment #2: The First Paycheck That first attending paycheck hits different. It’s more money than you’ve ever seen in your account at once. You feel rich. You feel like you’ve made it.
But remember: feelings aren’t facts. Stick to your plan. The money will still be there next month.
Dangerous Moment #3: The Comparison Trap Your co-resident just posted a picture from their new Tesla. Your friend from medical school just bought a house. Everyone seems to be living their best life immediately.
Remember: social media is a highlight reel, not a documentary. You don’t know their full financial picture. Maybe they have family money. Maybe they’re drowning in debt. Either way, it’s none of your business. Stay in your lane.
The Mental Game: It’s Not Just About Money
Dr. Jamal Thompson, now five years into his attending career, told me his biggest regret: “I wish someone had prepared me emotionally for the money transition. I knew how to do a lumbar puncture, but I had no idea how to approach my student loans or what a backdoor Roth was.”
The transition from broke resident to well-paid attending isn’t just financial—it’s psychological. You might feel:
Imposter Syndrome: “I don’t deserve this much money.”
- Reality check: Yes, you do. You earned it through years of education and brutal training.
Guilt: “My parents never made this much money.”
- Reality check: Times change. Your parents probably had a pension. You don’t. Different era, different rules.
Anxiety: “What if I mess this up?”
- Reality check: That’s why you’re reading this. You’re taking control. You’ve got this.
Pressure to Spend: “Everyone expects me to live like a rich doctor now.”
- Reality check: The people who matter don’t care what car you drive. The people who care what car you drive don’t matter.
The Lifestyle Inflation Equation
Here’s a simple formula for thinking about lifestyle upgrades:
Resident Annual Spending: ~$45,000
New Attending Take-Home: ~$180,000 (after taxes and retirement savings)
You could:
- Option A: Spend all $180,000 and save nothing extra
- Option B: Spend $90,000 (double your resident spending) and save/invest $90,000
- Option C: Spend $60,000 (just a modest increase) and save/invest $120,000
Option A leads to the “golden handcuffs”—you’ll never be able to retire or leave a bad job.
Option B is reasonable and sustainable long-term.
Option C is aggressive but will make you financially independent within 10-15 years.
Most successful physician wealth-builders choose Option B or C. Almost none choose Option A (even though it feels tempting at first).
Your Assignment: The Next 30 Days
Before you finish residency, before you get that first paycheck, make these commitments:
- Calculate your numbers: What will you earn? What will you spend? What will you save?
- Write down your plan: Not in your head. Actually write it down. Studies show written goals are 42% more likely to be achieved.
- Set up systems now: Open the accounts. Set up the automatic transfers. Make it as easy as possible.
- Find your accountability: Tell someone your plan. A spouse, a trusted friend, a financial advisor. Someone who will ask you in six months: “How’s it going?”
- Visualize success: What will your life look like in five years if you do this right? Hold onto that vision when the Tesla looks tempting.
The Bottom Line
The transition from training to practice is one of the most exciting times of your medical career. After years of delayed gratification, you finally get to reap some rewards.
You didn’t spend 4 years of medical school and 3-7 years of residency to end up broke with a nice car. You did it to build a life of meaning, impact, and yes—financial security.
The finish line of training is really just the starting line of your financial life.
Make it count.
The transition from training to practice is both exciting and overwhelming. Our Bridge Loan program provides financial support and guidance to help new attendings navigate this critical period and build long-term success.
