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Financial Health Assessment (FHA): The Friday Show That Grades a Physician Household

Financial Fellowship · The Friday show

A Financial Health Assessment takes one real physician family’s complete finances and dissects them in their entirety: every account, every debt, every policy, scored out of 100 and walked through decision by decision. The households are submitted by physicians in this community, and the cases are organized by specialty and career stage, so the family on the table looks like the one at your kitchen table.

True case studies

Every household here is a real physician family who submitted their actual finances. The only thing changed is the name, to protect their identity. Everything else is exactly as submitted.

The point of all of it: helping physicians take control of their personal finances and feel more confident about them.

Real physician householdsScored out of 100A new case every FridayBands by score: 0 to 39 Needs a workup · 40 to 69 Corrections · 70 to 84 Stable · 85 to 100 Healthy

Who does this

Two experts read every household

Each case gets two points of view: the retired planner who built the rubric, and the practicing planner who does this work with physician families today.

Ryan Inman, MBA, MAFM

Host · Retired financial planner

Ryan spent his planning career working with about 500 physician families, then sold his practice. He created the Financial Residency podcast, heard by millions of listeners with about 3 million downloads, and Financial Fellowship is now his sole focus. He holds an MBA and an MAFM, a Master of Accounting and Financial Management. He built the Financial Vital Signs rubric these households are scored against.

Daniel Wrenne, CFP

Second read · Practicing financial planner

Daniel is the financial planner who bought Ryan’s practice, and he brings the second expert point of view to every case: the read of a planner who sits across from physician families for a living, checking the retired planner’s homework against the work as it is done today.

This is not advice, and it is not a sales pitch for a plan. It is what we would do if we were in their situation, said out loud, with the numbers on the table, so every physician listening can run the same thinking against their own household.

How it works

Your numbers in. A score and a prescription out.

Any physician household in the community can submit. The form asks for the real picture: income, debts, savings, insurance, and the goals in front of you.

1

Fill out the form

About 15 minutes. Use a fictional name, your general region, and rounded numbers, so nothing on the form can identify you. Round numbers only; the picture stays true.

FILL OUT THE FORM

Submit your Financial Health Assessment. Your assessment airs on the Friday show.

2

Record your answers

Come back and record your answers so they can be played on air, using the same email address on both steps so we can tie everything together.

RECORD
3

The household is scored

Your finances are graded measure by measure against the Financial Vital Signs rubric, published in full below. The total out of 100 lands in a band: Corrections (40 to 69), Stable (70 to 84), or Healthy (85 to 100).

4

The prescription airs

The case runs on the Friday show and lives here in full: what you did well, where the points went, and the prescription, the moves in order that earn them back.

One published rubric, every case

Every household is scored against the published Financial Vital Signs rubric below, nothing held back. Attendings share one set of point values; residents are scored on a resident version of the same seven frameworks, with debt-to-income left out and the buckets carrying more weight. Same 100 points, same four bands, whatever the specialty.

Inside an episode

How the show dissects a case

Every case is taken apart the same way, in the same order, so households can be compared honestly.

What they did really well

The show starts with the strengths, because they are real. The contract reviewed before signing. The cards paid in full. The match captured. Credit goes where the household earned it, in points.

Where they have not done well

Then the gaps, named plainly. The coverage still sized for a resident’s income. The loan plan nobody ever chose. The goals with no numbers on them. Each gap is a decision nobody made yet, and the episode prices it in points.

The prescription

Every case closes with a prescription: a short list of moves, in the order the household should make them, each one carrying the points it recovers. Five moves took one published household from a 42 to a 64. Every move was an afternoon of work.

Frameworks follow the gaps

Every case opens with the Financial Vital Signs, the six part reading (cash flow, debt, savings, lifestyle, liquidity, and the household’s own stress reading) that produces the score out of 100. After the reading, the show teaches the frameworks that fit where that household is weak. There is no fixed pair, because no two households are weak in the same places.

When the gap is insurance, the episode teaches the Protection Stack, the six layers between a household and a bad year. When cash flow is the weak point, it teaches the Three Bucket Framework, sorting money by time horizon so every dollar has a job and a date. A household with aimless goals gets the Decision Filter. A household whose spending rose with its income gets Lifestyle Guardrails.

See all the frameworks
The rubric

Grade your own household

This is the actual rubric, the Financial Vital Signs, published in full. Follow along during an episode and score the household on the table before the hosts reveal the number. Then run the same measures on your own plan.

How points are earned

Every measure below earns full points, partial points, or zero, and the measures add to 100. The values on this page are the attending rubric, the version most households are scored on: new and established attendings share it, and only the Transition Blueprint asks different questions by stage. Residents are scored on the same seven frameworks with a few values shifted, covered in the card right after the frameworks. Follow along at home and add yours up the same way we do. Most measures carry a middle tier; the Transition Blueprint measures are all or nothing, and their lines say so.

Defense carries the rubric: the Protection Stack (22 points) and Lifestyle Guardrails (22 points) are 44 of the 100. That is the show’s argument in numbers. Most physician money problems are defense problems, unprotected income and leaking cash flow, not offense problems.

20 points

The 3-Bucket Framework

Every dollar gets a job: Safety Net, Wealth Engine, Accelerator.

  • Filling the buckets (6). A 12 item checklist of bucket milestones, seven positives and five negatives; the positives minus the negatives set the score. FullA net of five or more. PartialA net of three or four. No creditA net of two or less. A checklist left blank scores zero.
  • Emergency fund (4). The Safety Net, counted in months of expenses. FullSix months of expenses or more. PartialThree to five months. A fund that exists but whose months are unknown also earns partial. No creditTwo months or less, or no fund at all.
  • Every dollar in a named lane (4). The lanes are the buckets. FullYou can sort every dollar you hold into one of the three buckets. PartialYou can sort most of it. No creditYour dollars do not sort into the buckets.
  • Goals funded (6). Whether dollars are flowing to the written goals. FullMoney is flowing to 100 percent of your written goals. PartialMoney is flowing to some of them, anything under 100 percent. No creditNo money is flowing to your goals.
14 points

The Physician Wealth Equation

The debt anchor and the accelerator: what the loans claim, and how hard the income is working.

  • The Debt Anchor (10). Total debt against income, with the bar set by stage. New attending FullDebt at 3.0 times income or less. PartialDebt up to 4.5 times income. No creditDebt above 4.5 times income. Established attending FullDebt at 2.0 times income or less. PartialDebt up to 3.0 times income. No creditDebt above 3.0 times income.
  • Stretch saving (4). The savings rate, judged against a bar that moves once $1M is compounding. FullSaving 25 percent or more, or 12 percent or more once you hold $1M or more compounding. PartialSaving 12 percent or more, or 6 percent or more with $1M or more compounding. No creditUnder those lines.
22 points

The Protection Stack

Six layers between the household and a bad year, one measure per layer.

  • Health insurance (4). FullEvery household member covered by a comprehensive plan. PartialSomeone is uninsured, or coverage had a short lapse. No creditNo coverage.
  • Disability (4). FullIndividual own-occupation coverage on every earner. PartialGroup or employer coverage only. No creditNo disability coverage.
  • Life insurance (4). FullIndividual term cover in force, any size, or a written sizing that concludes no cover is needed. PartialGroup-only or permanent-only cover. No creditNo cover in force, and no written sizing.
  • Umbrella (4). Sized against what the household owns. A policy by itself is not full marks. FullCoverage at least equal to your rough total assets. PartialA policy that falls short of your assets. No creditNo policy.
  • Malpractice tail (2). FullOccurrence coverage, or claims-made with the tail arranged. PartialClaims-made with the tail left open. No creditClinical work with no policy.
  • Estate documents (4). FullA will, a power of attorney, a health care directive, and a named guardian when there are minors. PartialTwo or three of them. No creditOne document, or none.
10 points

The Transition Blueprint

The fork in the rubric: each attending stage answers its own pair of questions, and every pair is worth 10. These four measures are all or nothing; none of them has a partial tier.

  • New attending: the loan call (6). FullA deliberate student loan decision made when training ended, and executed: refinanced to a real rate, chose a federal forgiveness plan, or coordinated an employer payoff. No creditNo decision was made, or the loans drifted into the default.
  • New attending: contract clarity (4). FullThe contract was reviewed by a professional, or the pay structure is fully understood. No creditSigned blind.
  • Established: education debt finished (6). FullThe loans are paid off, or a deliberate forgiveness plan is being executed. No creditThe loans are still lingering, with no plan being executed.
  • Established: no lingering consumer debt (4). FullNo credit card, personal, or vehicle debt outside the mortgage. No creditAny of that debt is still on the books.
8 points

The Tax Efficiency Ladder

The order the household funds its accounts as income climbs, and whether the choices are deliberate.

  • Roth against pre-tax, chosen on purpose (4). FullThe choice carries a reason tied to your tax bracket. PartialPicked one and stuck with it, without much thought. No creditNever thought about it.
  • Bracket plus deliberate moves (4). FullYou know your federal marginal bracket and run two or more deliberate moves: the HSA maxed, Roth conversions, tax-loss harvesting, bunching deductions. PartialThe bracket alone, or one deliberate move. No creditYou do not know your bracket, and run no deliberate moves.
4 points

The Decision Filter

The filter runs on stated goals. This area scores whether the raw material exists.

  • Goals written down (4). The goals themselves are never judged, only counted. FullFour or more written goals. PartialOne to three written goals. No creditNo written goals.
22 points

Lifestyle Guardrails

The Double Up Rule and the savings floor: whether wealth is paid before lifestyle gets its turn.

  • The Savings Floor (12). FullSaving 20 percent of gross income or more. PartialSaving 10 percent or more. Saving regularly with no numbers behind it, but a genuine sense that you are saving enough, also earns partial; the feeling alone never earns full marks. No creditSaving under 10 percent, or not sure whether you save at all.
  • The leak (6). FullZero dollars unaccounted for in a month. PartialMystery money under 3 percent of monthly income. No creditNot tracking at all.
  • Wealth paid first, automated (4). FullWealth building leaves the account first and runs on automation. PartialA planned split that is not automated. No creditLifestyle gets paid first.

Scoring as a resident

Still in training? You are scored on the same seven frameworks, out of the same 100 points and into the same four bands, with these changes. The 3-Bucket Framework counts 26 points instead of 20, because the buckets are a resident’s whole game. The Physician Wealth Equation counts 6 instead of 14, and the Decision Filter counts 6 instead of 4. The other four frameworks count exactly the same as they do for attendings.

One measure drops out entirely: debt-to-income is not scored for residents. The debt anchor arrives at attendinghood. What is scored instead is the strategy: a real student loan plan, and cards paid in full.

The whole rubric on one page

Print it, pin it up, and score your own household as you listen. Every framework, every measure, both sets of point values, and the four bands, on a single sheet.

Download the one-page rubric Print

What the total score means

Every measure on the rubric earns its points, partial points, or zero, and all of them add up to one total score out of 100. That total lands in one of four bands. The band names where the household stands, and it is where the prescription starts: the lowest-scoring area gets worked first.

Needs a workup Score 0 to 39 The foundations are not built yet. This is the band the prescription starts from.
Corrections Score 40 to 69 A working household with core systems still to build.
Stable Score 70 to 84 The machinery is built and running. What is left is aiming it.
Healthy Score 85 to 100 The full plan: funded, defended, and aimed at goals that are written down and tested.

Add your measures up and find your band. The band is a reading, not a verdict: it tells you which area of the plan to work on next, and the prescription is written in that order.

The case index

Every published case, by specialty and stage

The cases live here on the hub, under one roof. Specialty and stage pages link in to them. Filter to the households closest to yours, and read the one that matches your stage first.

Specialty

A specialty joins this list when its first case is published, so the list grows with the library instead of running ahead of it. Start typing to search it.

Career stage
Sort

Showing 16 of 16 cases

Case emblem for the Anesthesiology new attending assessment

First attending year, W2 vs PE

Anesthesiology · New attending

A first attending year household, weighing a hospital W2 job against a PE group.

Read the case
Case emblem for Priya and David, a first year hospitalist household

Priya and David

Score 42 Corrections

Internal Medicine · New attending

A first year hospitalist and a software engineer, earning about $400,000: strong contract habits and clean cards, with a protection stack still sized for residency, loans riding the standard plan, and no estate documents.

Read the case
Case emblem for Nadia and Kevin, an established internist household

Nadia and Kevin

Score 66 Corrections

Internal Medicine · Established

An internist thirteen years out and a logistics manager: the loans dead for eight years and the machinery automated, with goals that have no numbers, spending nobody tracks, and an umbrella sized for the first house.

Read the case

Harriet and Darren

Score 35 Needs a workup

Pediatrics · Resident and fellow

A pediatrics household in the resident and fellow stage.

Read the case

Sarah and Michael

Score 59 Corrections

Pediatrics · New attending

A pediatrics household in its first attending year.

Read the case

Claire and Matt

Score 62 Corrections

Pediatrics · Established

An established pediatrics household.

Read the case

Abby and Logan

Score 42 Corrections

Pediatrics · Established

A pediatrics household in the established stage.

Read the case
Case emblem for Pierce and Donna, an emergency medicine established attending household

Pierce and Donna

Score 31 Needs a workup

Emergency Medicine · Established

An emergency medicine attending fifteen years out and a part time teacher run seven people on about $680,000: the debt anchor is strong at 1.29 times income, and the 31 lives in an 8 percent savings rate, group only disability, and no estate documents for five kids.

Read the case

Tamara and Marcus

Score 51 Corrections

Family Medicine · Resident and fellow

A family medicine household in the resident and fellow stage.

Read the case
Case emblem for Alex and Jordan, a physiatry resident household

Alex and Jordan

Score 48 Corrections

Physiatry · Resident and fellow

A physiatry resident in the final year of training and a teacher run two incomes on about $125,000: the loan plan and the automation are already built, and the 48 lives in a protection layer the last year of training is supposed to finish.

Read the case
Case emblem for Gavin and Natalie, an ophthalmology new attending household

Gavin and Natalie

Score 79 Stable

Ophthalmology · New attending

A second year ophthalmology attending and an elementary school teacher earn about $385,000 with one toddler at home: the transition calls and the automated 20 percent savings floor are full marks, and the 79 lives in a default 401(k), one deliberate tax move, and protection still sized for residency.

Read the case
Case emblem for Serena, an anesthesiology new attending household

Serena

Score 59 Corrections

Anesthesiology · New attending

A first year military anesthesiologist in San Antonio earns about $250,000 on one income with no kids: the tax ladder is a perfect 8 of 8 and the debt anchor is full marks at 0.8 times income, and the 59 lives in an unmade refinance call, no umbrella policy, and no written goals.

Read the case
Case emblem for Victor and Leah, an orthopedics established household

Victor and Leah

Score 53 Corrections

Orthopedics · Established

Two orthopedic surgeons, 15 and 13 years out, earn about $900,000 with two kids at home: the debt is gone and protection earns 20 of 22, and the 53 lives in a 6 percent savings rate, no written goals, and no life insurance on Leah.

Read the case
Case emblem for Rachel and Mark, a neurology established household

Rachel and Mark

Score 62 Corrections

Neurology · Established

A neurologist twelve years out and an engineer earn about $550,000 with two kids at home: the loans are paid off and protection earns 20 of 22, and the 62 lives in a 12 percent savings rate, untracked spending, and four written goals with no money flowing to them.

Read the case
Case emblem for Rachel and Tom, a pain medicine established household

Rachel and Tom

Score 58 Corrections

Pain Medicine · Established

A pain medicine physician ten years in and a hospitalist earn about $750,000 with two kids at home: the loans are paid off and the Wealth Equation earns 14 of 14, and the 58 lives in leaky buckets, untracked spending, and group only disability on the second income.

Read the case
Case emblem for Heidi and Spencer, an OB/GYN new attending household

Heidi and Spencer

Score 54 Corrections

OB/GYN · New attending

A first year OB/GYN attending and a high school teacher earn about $400,000 with a toddler at home: the PSLF plan is executing and saving runs on its own at about 12 percent, while about $100,000 sits across six accounts with no jobs, disability coverage is the group policy only, and there is no umbrella policy.

Read the case
Case emblem for Lisa and Mark, an OB/GYN established household

Lisa and Mark

Score 57 Corrections

OB/GYN · Established

An OB/GYN eight years into attending life and an attorney earn about $550,000 with two kids at home: the student loans are gone and the protection stack is nearly complete, while saving runs at about 12 percent, the emergency fund holds about one month, and three written goals carry no numbers, dates, or dollars.

Read the case

Andrew and Aida

Score 53 Corrections

Physical Medicine and Rehabilitation · Resident and fellow

A transitional year intern headed into PM&R and a paralegal in the Midwest: a 25 percent savings rate and a deliberate loan plan, with the protection stack built on one side of the household only.

Read the case

Calvin and Carolyn

Score 53 Corrections

Gastroenterology · Resident and fellow

A second year GI fellow and a stay at home parent with two young daughters: no student debt at all and a protection stack built early, with the attending raise still to route.

Read the case

Alberta

Score 43 Corrections

Emergency Medicine · New attending

An emergency medicine household two years out of residency, earning about $350,000: the student loans nearly gone and a debt anchor at full marks, with coverage still riding on the group plan.

Read the case

Aaron and Ada

Score 38 Needs a workup

Pediatrics · Resident and fellow

A pediatrics resident and a social worker in New York with a baby on the way: no debt of any kind and a $225,000 taxable stock account with no job assigned to it.

Read the case

Adrienne

Score 56 Corrections

Veterinary Medicine · Resident and fellow

A board certified equine internist finishing a part-time fellowship: a bucket system runs every dollar, and the protection stack is missing its disability layer entirely.

Read the case

Aileen

Score 49 Corrections

Specialty not stated · Resident and fellow

A 39 year old PGY-2 resident with $325,000 of student loans and a rental home that cash flows: saving about 31 percent of stated income, with disability cover still in process.

Read the case

Archie and Aimee

Score 32 Needs a workup

Pediatric Critical Care · Established

A pediatric critical care household on $220,000 with two young children: protection bought and accounts funded, while over $4,000 a month of take home pay goes unaccounted.

Read the case

Beau

Score 54 Corrections

Emergency Medicine · Resident and fellow

A military emergency medicine resident with zero debt of any kind: saving above 25 percent and a net worth swing of about $100,000 in training, with disability cover at $3,000 a month.

Read the case

Bert and Alethea

Score 49 Corrections

Internal Medicine · Established

An internal medicine household earning about $310,000 with a baby due in weeks: retirement accounts maxed and a debt anchor at full marks, while over $5,000 a month goes unaccounted.

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Brad and Alina

Score 44 Corrections

Anesthesiology · Established

A new partner anesthesiologist on $400,000 with a house on ten acres: $389,100 of student loans stacked on $728,000 of mortgages, and no umbrella in the file.

Read the case

cases are published today. The library grows one case at a time, specialty by specialty, and every new case is scored on the same rubric as the above.

Your household has a score. Find out what it is.

Submit your numbers and get what these households got: a score out of 100, the band it lands in, two expert reads on your plan, and a prescription that starts with the move worth the most points.

Submit Financial Assessment

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Education for physicians. Run the numbers against your own contract, specialty, and state, and confirm moves with your licensed planner, CPA, or attorney.