Financial planning for physicians puts your loans, retirement plans, taxes and insurance on one page, and Assante Wealth Management starts by sorting the decisions you can reverse from the ones you can't. Refinancing federal loans with a private lender can't be undone, and a doctor who refinances in year two then joins a nonprofit hospital gives up Public Service Loan Forgiveness on the remaining balance.
A conversation with HR or the plan administrator often starts the search: you hear that both a 403(b) and a non-governmental 457(b) are available, receive an income recertification notice, and still don't know which election affects your loans, taxes or cash reserve. The usual cost of doing it alone or too late is not the planning fee; it is losing a federal option, accepting a lump-sum payout or paying taxes before you need to.
High pay can still leave you exposed
A new attending can earn $280,000, owe more than $300,000 in federal loans and have less than $100,000 saved. Salary alone doesn't protect you from a disability, a job change or a change in loan law. Those events can do lasting damage before savings catch up.
Assante Wealth Management puts the choices that can't be reversed at the front of the plan. You get fewer accounts, fewer funds and one page you can explain to your family; we don't hand over a binder of recommendations. Any investment can fall in price, and you could end up with less than you put in.
Which money decisions can I undo, and which can't?
Public Service Loan Forgiveness requires 120 qualifying monthly payments under a qualifying repayment plan while you work full time for a government or 501(c)(3) employer. The forgiven balance isn't federal taxable income. Refinancing into a private loan ends eligibility permanently because private loans can't be consolidated back into a federal Direct Consolidation Loan.
For 2026, the IRS limit for the 403(b) is $24,500 and the IRS limit for the non-governmental 457(b) is also $24,500. Someone offered both can defer $49,000. The 457(b) money remains the hospital's property and is subject to its general creditors until paid out; it also can't be rolled into an IRA.
Income-driven payments are reset at each yearly recertification, usually from AGI on your latest tax return. Recent federal law changed which plans are available, so check current terms on studentaid.gov before relying on a payment formula. Deferral elections can usually change for future paychecks; refinancing and 457(b) payout elections deserve review first.
Make the reversible move first. Omar can adjust deferrals now and wait through one full recertification cycle to see the new payment before he ever answers a refinance offer, because refinancing federal loans can't be undone.
- PSLF: 120 qualifying payments
- Federal loans: preserve eligibility
- 403(b): $24,500 in 2026
- Non-governmental 457(b): $24,500
- 457(b): hospital creditor risk
- Recertification: review current terms
What did one recertification letter change for a hypothetical hospitalist?
A loan-servicer notice can turn a retirement election into a loan decision. Assante Wealth Management would read the notice alongside the plan details, because the same $24,500 contribution can have a different value when PSLF, cash reserves or a hospital departure is near.
Hypothetical: Omar is 36, single and two years out of residency. He's a hospitalist at a nonprofit hospital, earns $280,000, owes $310,000 in federal student loans and has $90,000 saved. His employer offers a 403(b) and a non-governmental 457(b).
His income recertification notice sets an income-driven payment from his latest tax return. Here is how the $49,000 moves through his tax bill and his loan payment.
1. $24,500 to the 403(b) + $24,500 to the 457(b) = $49,000 deferred 2. $280,000 salary - $49,000 = $231,000 AGI for this illustration 3. $49,000 AGI reduction x 10 percent = $4,900 lower yearly payment after the next recertification 4. $4,900 / 12 = about $408 lower each month 5. $49,000 x 35 percent assumed marginal rate = $17,150 federal tax deferred 6. $49,000 - $17,150 - $4,900 = $26,950 net take-home cost across this year's tax bill and next year's payments
The $17,150 is deferred, not erased. Income draws from both plans are taxed as ordinary income later. Assante Wealth Management would first check whether Omar has about six months of spending in cash before funding the 457(b) half, since that account is an unsecured promise from the hospital and may be paid when he leaves.
Which assumption changes the result most? The table holds the salary, $49,000 deferral and loan formula constant while moving one assumption at a time. At a 24 percent rate, the net cost is $32,340, which is $5,390 higher than the $26,950 base. Refinancing removes the $4,900 payment drop altogether. Whether Omar stays on the income-driven track matters about as much as his tax rate.
| Assumption moved | Federal tax deferred | Yearly payment drop | Net take-home cost |
|---|---|---|---|
| Base: 35% rate | $17,150 | $4,900 | $26,950 |
| 32% marginal rate | $15,680 | $4,900 | $28,420 |
| 24% marginal rate | $11,760 | $4,900 | $32,340 |
| Refinanced, no IDR | $17,150 | $0 | $31,850 |
| 403(b) only, 35% rate | $8,575 | $2,450 | $13,475 |
Same question, different answers for two doctors
Two hospitalists ask whether they should put the full $24,500 into a non-governmental 457(b), but their facts point in different directions. Doctor A plans to stay at least ten years, has six months of spending in cash and works for a large, stable system. Funding the 457(b) after the 403(b) fits that situation.
Doctor B expects to join a private group within two years and has about $15,000 in cash. For B, Assante Wealth Management would keep the focus on the 403(b) for now. If the 457(b) balance is paid out when B leaves, the whole amount counts as income for that year, and the following recertification would raise the income-driven payment just as B starts a new contract.
How do I tell a careful planner from a sales pitch?
A careful answer identifies the choice that cannot be undone, asks for your servicer notice and 457(b) plan document, and shows the full cost of the advice in writing before you sign. A weak answer starts with a product or refinance offer. Assante Wealth Management writes down the decision sequence and keeps the recommendation to the accounts and funds that earn a place on your one-page plan.
Check these yourself, then call Assante Wealth Management
You can begin without a planner. Pull your loan list and the number of qualifying PSLF payments counted so far from studentaid.gov. Read the distribution and creditor sections of your 457(b) plan document, and set aside cash covering three to six months of your household spending. If you're still in residency or have less than about three months saved, a full plan comes too early; handle cash, disability coverage and your federal repayment choice first.
Call Assante Wealth Management before a refinance offer, a 457(b) payout-election deadline or a signed contract with a private group. Our meetings run over video calls or the phone. To become a client you need $500,000 in investable assets. A doctor below that minimum can complete the basic checks alone first; a doctor above it can bring the documents that control the irreversible choices.
The firm serves clients across the country remotely. Assante Wealth Management's office is at 317 South Juniper Street, Philadelphia, PA 19147, United States. The client sees the full cost in writing before signing anything.
- Download your loan list
- Check your qualifying payment count
- Read 457(b) distribution terms
- Build three to six months cash
- Call before irreversible steps
Your questions about financial planning for physicians, answered
My loan servicer sent an income recertification notice; does my 403(b) contribution change what I'll owe?
Usually, yes. A 403(b) contribution can reduce the AGI used for a later income-driven payment calculation, but the effect arrives through the next recertification cycle, not immediately. In Omar's illustration, a $49,000 combined deferral reduced AGI by $49,000 and lowered the annual payment by $4,900 under the stated formula. Check current terms at studentaid.gov.
Do I really need a planner if I already max out my hospital's retirement plans?
Possibly, but maxing both plans doesn't answer the loan, cash, creditor-risk or payout questions. A planner can compare the 403(b) with a non-governmental 457(b), review your PSLF position and test what happens if you leave the hospital. The value is lower when your accounts, loans and employment choices already fit on one page.
How many months of expenses should a new attending keep in cash before funding a non-governmental 457(b)?
Keep about three to six months of spending in cash before funding a non-governmental 457(b); Assante Wealth Management would check whether you have roughly six months before using that plan's half. The balance remains subject to the hospital's general creditors and may be paid when you leave, so a small reserve changes the decision.
Can I change my 457(b) payout election after I enroll?
Sometimes, but the plan's deadline and terms control. A non-governmental 457(b) payout election can become difficult or impossible to change after enrollment, and a default lump sum may arrive in one tax year. Read the distribution section before enrolling and ask the plan administrator which elections can still be changed.
Is a financial plan worth paying for while I'm still on track for PSLF?
It can be worth paying for when the plan protects an irreversible choice, such as preserving PSLF eligibility or avoiding a poorly timed 457(b) payout. If you're still in residency or have less than about three months of spending in cash, build the reserve, choose a federal plan and review disability coverage first.
Sources and further reading
This is general information, not advice tailored to your finances or circumstances. Investing involves risk, including the possible loss of principal. Before making any decision about money, taxes or your practice, talk with a professional who knows your full situation.