The decisions with the longest tail
Training compresses the years in which small financial decisions have the most time to compound. Very few of them are taught, and the ones that matter most are reversible only at significant cost.
Three decisions dominate: how you handle federal loans, whether you insure your income, and what you do with the first attending paycheck.
Loans: one question first
Will you work for a nonprofit or government employer for ten years? That single question determines nearly everything downstream. If public service loan forgiveness is plausible, stay federal, use an income-driven plan, and certify employment annually — the certification is the part people forget and later cannot reconstruct.
If forgiveness is unlikely and your interest rate is high, model refinancing after training rather than during it. Refinancing federal loans into private ones is a one-way door: you cannot buy the forgiveness option back.
Disability insurance is cheaper now
Own-occupation disability coverage priced during training will never be cheaper, and underwriting is friendlier before the medical history most physicians accumulate in their forties.
Read for one clause: whether the policy pays when you cannot perform your own specialty, or only when you cannot work at all. That distinction is the entire product.
The first attending paycheck
Income often triples in a single month. Lifestyle expands to meet it within about ninety days, and it is very difficult to contract afterward. Deciding in advance where the increase goes — retirement, loans, savings — is far easier than deciding after it arrives.
A reasonable default: keep living approximately at your training budget for twelve months, direct the difference at the highest-interest debt and an emergency fund, then reassess with real numbers rather than anticipation.
Read your benefits, not just your salary
Employer retirement match, CME allowance, licensure and DEA reimbursement, and PTO accrual rules routinely differ by tens of thousands of dollars between otherwise similar offers.
Ask for the summary plan description rather than the recruiter's summary. The document is dull and specific, which is exactly why it is useful.
Key takeaways
- Answer the PSLF question before touching anything else about your loans.
- Buy own-occupation disability coverage during training and read the definition clause.
- Pre-commit where the attending pay increase goes, before it arrives.
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How to cite
Vejayan PD. What Residency Never Says About Money. On The Beat MD. Published July 29, 2026. Available at: https://www.onthebeatmd.com/insights/what-residency-never-says-about-money
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This material is educational and is not medical, legal, or financial advice. It does not create a physician-patient or attorney-client relationship.
© 2026 Priya D. Vejayan. All Rights Reserved. Except as permitted by applicable copyright law, reproduction, distribution, or commercial use of original content requires written permission.