New Attendings Should Consider an Investment Management Plan Before Their First Attending Paycheck Hits

Your first attending paycheck will land within days of starting your new role, and the order you handle it matters more than the size of it. Most new attendings get that order backward, not from a lack of discipline, but because no one taught them the sequence during training. That sequence question sits at the center of investment management for physicians in their first year: which account gets funded first, and why.

The Order That Can Help Protect Your First Attending Paycheck

Before any of that income goes toward an investment account, consider two things. Most residents and fellows carry group disability and life insurance through their GME program, coverage that was priced and structured around a resident’s salary, not an attending’s. The gap between what that group policy replaces and what an attending income actually requires can be significant, and it is worth confirming rather than assuming the old coverage still fits once the new contract starts.

Insurance and Cash Come First

A cash cushion works the same way. Three to six months of essential expenses in a liquid, high-yield account gives a new attending room to absorb a licensing delay, a slow first quarter, or a family emergency without touching a retirement account or taking on debt at exactly the moment income finally allows for saving. Building that cushion comes before the first investment dollar, even if it means a few months where the first attending paycheck is going almost entirely toward savings rather than an account with market exposure.

Then Capture the Match, Not the Extras

Once the foundation is in place, the first investing move for most new attendings is not a brokerage account. It is contributing enough to a 401(k) or 403(b) to capture the full employer match, if the new employer offers one. That match is a guaranteed return no market investment can promise, and skipping it to fund a taxable brokerage account first gives up money that was already earned. Extra contributions beyond the match, backdoor Roth conversions, and taxable investing all come after that first tier, not before it, no matter how much of the first attending paycheck feels available to invest right away.

Pre-Tax vs. Roth in Your First Attending Year

For most new attendings, deciding where the first attending paycheck goes after the match, pre-tax or Roth, looks different than it does for the general population, because attending income phases most physicians out of direct Roth IRA contributions almost immediately. In 2026, the Roth IRA income phase-out range is $153,000 to $168,000 for single filers and $242,000 to $252,000 for married couples filing jointly, ranges a first-year attending salary can exceed on its own. That makes the real first-year decision pre-tax retirement contributions versus a backdoor Roth IRA, not the usual Roth versus traditional comparison.

The two options work in opposite directions:

Pre-tax (401(k) or 403(b)): Contributions are capped at $24,500 in 2026 and reduce taxable income this year, but withdrawals are taxed as ordinary income in retirement. This fits best when a physician expects a lower tax bracket in retirement than they are in today.
Backdoor Roth IRA: Contributions are capped at $7,500 in 2026, funded with after-tax dollars with no deduction now, but qualified withdrawals are tax-free later. This fits best for the flexibility of having some tax-free income available, regardless of where tax brackets land decades from now.

Most new attendings benefit from using both, pre-tax contributions to capture the immediate deduction at a high marginal rate, and a backdoor Roth to build a source of tax-free income for later. The right split depends on the specific numbers, which is a goal planning conversation, not a generic percentage.

A PRS advisor can walk through the pre-tax and Roth split against your actual contract and student loan numbers.

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What Changes If You Switch Jobs in Year Two or Three

Many physicians change jobs within the first several years of finishing training, whether the reason is a better fit, a governance disagreement, or a location change, and that resident to attending transition rarely ends with the first employer. New attending investing decisions cannot assume a single employer for the next thirty years, because a job change resets several of the decisions made in year one:

Employer match vesting. 401(k) and 403(b) matches often vest over a multi-year schedule. Leaving before that schedule completes can mean forfeiting employer contributions that looked secure on the account statement.
Insurance coverage. Group disability and life insurance tied to an employer or GME program does not transfer to the next job, so the insurance review from the first paycheck needs to happen again, not just once.
Old accounts. Retirement accounts from a previous employer need a rollover decision, into the new employer’s plan or into an IRA, rather than sitting untouched across multiple former employers.

None of this makes changing jobs a mistake. It makes a plan built assuming zero job changes an incomplete one.

How PRS Meets New Attendings Before the First Paycheck

Physician’s Resource Services works inside GME programs before residents and fellows ever see an attending paycheck, through negotiated GSI disability coverage and lecture-based financial education during training. That relationship means the investment management conversation for a new attending is not a cold start. PRS already understands the training program, the group coverage already in place, and where the gaps in that coverage typically sit.

That coordination extends past investing. Investment management decisions at PRS happen alongside tax planning and insurance review, not as a standalone brokerage recommendation disconnected from the rest of a physician’s financial picture. Once the first-year sequence is in place, a long-term investment strategy built around the physician’s actual timeline is the next step.

Build the Plan Before the Paycheck, Not After

The financial planning for new physicians that matters most happens in the weeks before that first attending paycheck arrives, not in the months after it has already been spent on decisions made without a sequence. Getting the order right, insurance and cash first, then the match, then the pre-tax and Roth split, protects the income before it has a chance to disappear into good intentions without a plan.

Physician’s Resource Services works with residents and fellows through GME program relationships that start well before graduation. If your first attending paycheck is on the way, schedule a consultation with our team while there is still time to set the sequence before the money arrives.

This material is provided as a courtesy and for educational purposes only. Please consult your investment professional, legal, or tax advisor for specific information pertaining to your situation. Advisory Services Network, LLC does not provide tax advice. Advisory services offered through PRS Investment Advisors, a Member of Advisory Services Network, LLC. All information contained herein is derived from sources deemed to be reliable but cannot be guaranteed. All views/opinions expressed in this newsletter are solely those of the author and do not reflect the views/opinions held by Advisory Services Network, LLC.

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Advisory services offered through PRS Investment Advisors, a Member of Advisory Services Network, LLC. Tax services and insurance products offered through Physician’s Resource Services. Advisory Services Network, LLC and Physician’s Resource Services are not affiliated.