Financial Health Assessment
Arnold and Aisha: Palliative Care Household Scores 57 Out of 100
By Ryan Inman
Published · Updated
Palliative careEstablished · Physician earner practicingCouple, two daughters
Financial Health Assessment score
57 out of 100
Corrections
- Needs a workup 0 to 39
- Corrections 40 to 69
- Stable 70 to 84
- Healthy 85 to 100
The score grades the household on 20 measures across seven frameworks. Arnold and Aisha lands at 57, in the Corrections band, score 40 to 69.
Aisha is a palliative care physician earning $238,000 a year, with a bonus of about $4,000 last year. Arnold is a stay at home dad who works part time as a realtor and investor, earning about $25,000 a year. The household earns about $267,000 and has two daughters, five and seven. The assessment scores the household 57 out of 100, in the Corrections band.
The saving flow is the engine. About $5,591 a month moves across her 403b, her 457b, the HSA, an IRA line and a taxable line, and her employer added about $28,000 to a 401a last year. Retirement balances total about $308,000, invested 90 percent in stocks and 10 percent in bonds. The stated savings rate is about 25 percent by calculation, and the Savings Floor grades it at full marks.
The open items are paper and one policy. The estate documents are not in place, with work under way through Thoughtful Wills and no guardian stated for two minor children. Aisha's disability policy pays $3,208 a month and is not stated as own occupation. A stronger policy was denied over her melanoma history. Malpractice type and tail are not stated. The traced path runs from 57 to a target of 63, and the prescription section shows the two steps that trace.
$439,000
Student debt · on a forgiveness path inside PSLF
About 25 percent
Savings rate · by calculation on stated flows
$25,000
Stated emergency fund · about three months
About $267,000
Household income · physician plus part time realty
About $5,591
Saved per month · across five stated flows
$911,000
Total stated debt · about 3.41 times income
The short version
- The score: 57 out of 100, in the Corrections band. The Transition framework earns the full 10 of 10 and the Protection Stack 14 of 22, while the 3 Bucket Framework earns 7 of 20.
- Total stated debt is $911,000, about 3.41 times the $267,000 income, over the established ceiling, so the Debt Anchor earns 0. The student loan inside it, $439,000 of federal debt, runs on PAYE inside PSLF, about six years from forgiveness.
- The savings rate is about 25 percent by calculation, from about $5,591 a month of stated flows plus about $28,000 a year of employer 401a money. The Savings Floor earns the full 12.
- Protection is bought on both earners: $2,500,000 of term life on Aisha and $1,000,000 on Arnold, a $1,000,000 umbrella, and disability policies on both, hers limited after a denial over her melanoma history.
- No estate documents are in place, and no guardian is stated for two minor children. The traced path to 63 runs through the documents (+4) and the disability gap on Aisha's line (+2).
Saving for freedom at 55, with a forgiveness clock doing most of the work.
What They Did Right
An established household saving at the full line while a forgiveness clock runs. This is the machinery already running.
- A savings rate at the full line About 25 percent by calculation across five stated flows plus the employer 401a money. The Savings Floor grades it at the full 12.
- A forgiveness plan, executed $439,000 of federal loans on PAYE inside PSLF, about six years of payments left, the deliberate path the Transition fork grades at full marks.
- Disability on both earners Two individual policies, one on each earner, and hers in force after a stronger policy was denied over her melanoma history.
- Life cover on both earners $2,500,000 of individual term on Aisha across three policies and $1,000,000 on Arnold across two.
- No consumer debt at all Cards paid in full monthly, the vehicles and the RV owned outright, and no lingering debt of any kind stated.
The Score: 57 out of 100
The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Arnold and Aisha scores 57, in the Corrections band. This household is scored on the attending rubric, on the established fork of the Transition framework.
20
Measures graded
7
Frameworks
57
Arnold and Aisha's score
The 3 Bucket Framework earns 7 of 20. Milestones earn 0, because the milestone net cannot be determined from what the intake states. The emergency fund earns 2: $25,000 against the stated budget is about three months. Named lanes earn 2, on two savings accounts and one operating account that sort the money, with no automated lane system stated. Goals funded earns 3, with dollars flowing to every goal area while the eight year goal of $1,500,000 in retirement investments sits far past the stated pace on the hosts' math, so goals are not fully funded.
The Physician Wealth Equation earns 4 of 14. The Debt Anchor earns 0: total stated debt of $911,000 against about $267,000 of income is about 3.41 times, above the 3.0 established ceiling. Stretch saving earns the full 4, on a savings rate of about 25 percent by calculation.
The Protection Stack earns 14 of 22. Health earns the full 4, on a high deductible plan with an HSA. Disability earns 2: individual policies stand on both earners, and Aisha's policy is not stated as own occupation, with a stronger policy denied over her melanoma history. Life earns the full 4, on individual term in force on both earners. Umbrella earns the full 4, at $1,000,000 against stated investable and cash assets of about $419,000. Malpractice earns 0, type and tail not stated. Estate documents earn 0: no documents are in place.
The Transition framework, on the established fork, earns the full 10 of 10. Education debt earns the full 6: the $439,000 federal loan runs on a deliberate forgiveness plan being executed, PAYE inside PSLF with about six years of payments remaining. No lingering consumer or vehicle debt earns the full 4: no debt of that kind is stated, and the vehicles and RV are owned outright.
The Tax Ladder earns 4 of 8, at 2 and 2: maxed pre tax accounts, funded Roth IRAs and a maxed HSA are used with no bracket reason stated, and one deliberate move stands in place, the fully funded HSA, with the bracket not stated. The Decision Filter earns the full 4 of 4 on five stated goals.
The Lifestyle Guardrails earn 14 of 22. The Savings Floor takes the full 12 on a rate of about 25 percent by calculation. The leak earns 0: the unaccounted share of spending is not stated. Wealth first automation earns 2: payroll deferrals and automatic drafts run the retirement flows, and the record grades the automation partial.
| Framework | What it covers | Points |
|---|---|---|
| 02 3 Bucket Framework | Milestones 0, emergency fund 2 at about three months, named lanes 2, goals funded 3 | 7 of 20 |
| 03 Physician Wealth Equation | Debt anchor 0 at about 3.41 times income, stretch saving 4 at about 25 percent | 4 of 14 |
| 04 Protection Stack | Health 4, disability 2, life 4, umbrella 4, malpractice 0, estate documents 0 | 14 of 22 |
| 05 Transition | Education debt 6, forgiveness plan executed inside PSLF. No lingering debt 4, none stated | 10 of 10 |
| 06 Tax Ladder | Roth against pre tax 2, bracket plus moves 2 | 4 of 8 |
| 07 Decision Filter | Goals written 4, five goals stated | 4 of 4 |
| 08 Lifestyle Guardrails | Savings floor 12, the leak 0, wealth first automation 2 | 14 of 22 |
| Total | Corrections band | 57 out of 100 |
Read the shape, not just the total. The flow side of this file is strong: a savings floor at full marks, a forgiveness plan executed and graded full, cover bought on both earners. Most of the drag sits in two places: an anchor that grades the stock of debt at 3.41 times income no matter how good the plan for it is, and an estate box at zero with two minor children and no guardian stated. The traced fixes are a signature and an application: sign the documents, and close the disability gap on the higher earner's line.
The Prescription
The traced fixes first, then the open items the record carries without a gain.
- Finish the estate documents and name a guardian. The household is already working with Thoughtful Wills. Documents in force, with a guardian stated for the two girls, move the estate box from 0 to the full pattern. (+4 points when in force.)
- Close the disability gap on Aisha's line. An individual own occupation policy on the higher earner, or the best upgrade her history allows, applied for through a vetted agent as the hosts advised. The box moves from partial to full. (+2 points when in force.)
- Keep the forgiveness paperwork current. The PAYE recertification and the PSLF employment certifications stay on schedule for the remaining six years. No points are claimed for this step. The Transition box already grades the executed plan at full marks.
- Put a price on the eight year goal. The $1,500,000 in eight years goal, on the hosts' math, needs about $200,000 a year with no growth. Either the flows rise to it or the goal restates. No points are claimed for this step. Goals funded already grades the stated flows at 3 of 6.
The traced path runs 57 to 63: plus 4 when the estate documents are in force, and plus 2 when the disability gap on Aisha's line closes. Nothing else in this file traces a gain in the record's basis: the malpractice line and the leak sit unstated, and the Debt Anchor grades a balance that only time and forgiveness will move. The target is 63, stated with its arithmetic.
What This Case Teaches
A forgiveness plan is a debt strategy, and the score grades the two halves separately. The plan earns full marks in the framework that grades execution, and the balance earns zero in the framework that grades the stock of debt. Readers who hold those apart can see why a household doing the loan exactly right still lands at 57: the anchor is a snapshot, and the plan is a movie.
Forgiveness is a plan. It is not a small balance.
The goal list teaches the second lesson. Five goals stand stated, and one of them, $1,500,000 in eight years, prices, on the hosts' math, at about $200,000 a year with no growth, against stated flows of about $5,591 a month plus employer money. A goal is a funding commitment or it is a wish, and the goals funded box grades the distance between the list and the flows.
Behind the score
The Household
Aisha is a palliative care physician at $238,000 a year, plus a bonus of about $4,000 last year. Arnold is a stay at home dad who works part time as a realtor and investor, at about $25,000 a year on a 1099. The household earns about $267,000, has two daughters of five and seven, and lives in a low cost of living area in middle America.
Retirement balances total about $308,000: her prior employer 401a at $78,000 and 457b at $18,000, her current 403b at $53,000, 457b at $65,000 and 401a at $50,000, and his solo 401k at $38,000 and IRA at $6,000, invested 90 percent in stocks and 10 percent in bonds. Cash stands in three stated places: a $25,000 emergency fund in an Ally high yield savings account, about three months of spending. A $20,000 solo 401k account, and a general Ally account of $66,000 with stated buckets, $12,000 earmarked for IRAs, $6,000 for taxes, and $20,000 kept for investment and flip opportunities.
The map says freedom at 55. The loan says forgiveness in six years.
The stated saving flow is about $5,591 a month: $1,625 to the 403b, $1,625 to the 457b, $508 to the HSA, $1,000 to IRAs and $833 to a taxable account, with her employer's 401a contribution of about $28,000 last year on top. The hosts corrected the household's own math in one place: mortgage principal and loan payments are fixed expenses, not savings, and on that reading the true saving is about 23 percent of take home pay. The stated itemized budget runs about $9,000 a month.
Debt sits in two stated lines. The student debt is $439,000 of federal loans on PAYE inside PSLF, with about six years of payments remaining and payments of about $1,600 a month before forbearance. The mortgage is $472,000 at 2.625 percent on a 30 year loan, $2,773 a month, about $900 of it to principal. There is no credit card debt, with cards paid in full monthly, and the vehicles and the RV are owned outright. Total stated debt is $911,000, about 3.41 times income.
Protection is bought and uneven at the same time. Disability stands on both earners: Aisha holds a Northwestern Mutual long term policy paying $3,208 a month at $90 a month, not stated as own occupation, and a stronger policy was denied over her melanoma history. Arnold holds an individual policy paying $2,000 a month with a 3 percent cost of living rider. Term life stands at $2,500,000 on Aisha across three policies and $1,000,000 on Arnold across two. An umbrella policy of $1,000,000 runs through Geico. Health cover is a high deductible plan with an HSA. Malpractice type and tail are not stated. The estate documents are not in place. The household is working with Thoughtful Wills and hopes to finish in the next few months, and no guardian is stated for the two minor children.
| Household fact | Where it stands |
|---|---|
| Careers | Palliative care physician. Stay at home dad working part time as a realtor and investor |
| Household income | About $267,000: $238,000 salary plus about $4,000 bonus, plus about $25,000 part time |
| Family | Couple, two daughters, five and seven |
| Student loans | $439,000 federal, on PAYE inside PSLF, about six years of payments left, about $1,600 a month before forbearance |
| Mortgage | $472,000 at 2.625 percent, 30 year, $2,773 a month, about $900 a month to principal |
| Other debt | None stated beyond the two loans. The vehicles and the RV owned outright. Cards paid in full monthly. Total stated debt $911,000 |
| Emergency fund | $25,000 in an Ally high yield savings account, about three months |
| Saving | About $5,591 a month across the 403b, 457b, HSA, IRA and taxable flows, plus about $28,000 a year of employer 401a money. About 25 percent by calculation |
| Balances | Retirement about $308,000: 401a accounts $78,000 and $50,000. 457b accounts $18,000 and $65,000. 403b $53,000. Solo 401k $38,000. IRA $6,000. Invested 90/10 |
| Disability | Aisha: Northwestern Mutual long term policy, $3,208 a month benefit at $90 a month, own occupation status not stated. Arnold: an individual policy paying $2,000 a month, 3 percent cost of living rider |
| Life insurance | Aisha $2,500,000 across three policies. Arnold $1,000,000 across two. Individual term in force on both |
| Umbrella | $1,000,000 policy through Geico |
| Estate documents | Not in place. Work under way with Thoughtful Wills. No guardian stated for two minor children |
| Goals | Five stated goals |
The Two Frameworks Behind the Score
The score grades 20 measures across seven frameworks. Two of them carry this case: the Protection Stack, which scores 14 of 22 on bought cover with the estate unsigned, and the Lifestyle Guardrails, which score 14 of 22 on a full savings floor with the leak unmeasured.
Framework one
The Protection Stack
The Protection Stack grades the coverage that keeps one bad month from ending the plan. Four of its six boxes earn full or partial marks on cover actually bought. The documents box earns nothing, because nothing is signed.
- Health, life and umbrella, in force Built
- A high deductible plan with an HSA, $2,500,000 and $1,000,000 of individual term, and a $1,000,000 umbrella against about $419,000 of stated investable and cash assets. Each box earns the full 4.
- Disability, on both earners, hers limited after a denial over her melanoma history Partial
- Aisha holds a $3,208 a month policy that is not stated as own occupation, after a stronger policy was denied over her melanoma history. Arnold holds $2,000 a month with a cost of living rider. The box earns 2 of 4.
- Estate documents, not in place Missing
- No documents are signed. Work is under way with Thoughtful Wills, and no guardian is stated for two minor children. The box earns 0.
Framework two
The Lifestyle Guardrails
The Guardrails grade whether today's lifestyle leaves room for the plan: the savings floor, the leak, and whether wealth is paid first.
- The savings floor Built
- A savings rate of about 25 percent by calculation, from about $5,591 a month of stated flows plus about $28,000 a year of employer 401a money. The box earns the full 12 of 12.
- Wealth first automation Partial
- Payroll deferrals and automatic drafts run the retirement flows first. The record grades the automation partial, and the box earns 2 of 4.
- The leak Missing
- The unaccounted share of spending is not stated anywhere in the intake, so the box earns 0 of 6.
The Forgiveness Clock Runs the Debt Story
The first look is the debt, because the debt is the biggest number in the file. Total stated debt is $911,000: a $472,000 mortgage at 2.625 percent and $439,000 of federal student loans. Against about $267,000 of income that is about 3.41 times, above the established ceiling of 3.0, and the Debt Anchor earns 0.
The anchor grades the stock of debt. It does not grade the plan for it, and the plan here is executed. The $439,000 sits on PAYE inside the Public Service Loan Forgiveness program, about six years of payments from forgiveness, at about $1,600 a month before forbearance. The Transition fork grades that executed path at the full 6, and the household's own goals assume it: forgiveness in six years is one of the five stated goals.
The loan is the plan: six years of payments, then forgiveness.
The hosts raised the two cautions that belong with a pre tax heavy, forgiveness led plan. The retirement saving runs mostly pre tax, through the 403b, the 457b and the 401a, which builds a tax bill into the retirement the household is aiming at, and the eight year goal of $1,500,000 in retirement investments needs, on the hosts' math, about $200,000 a year with no growth at all, a pace the stated flows do not reach.
None of that moves the anchor. A household can run the forgiveness plan exactly right for six years and the box stays at 0 until the balance falls. The score keeps those two facts in two different frameworks, which is why this file can hold a full Transition mark and a zero anchor at the same time.
Two Daughters and No Signed Documents
The second look is the estate box, graded at zero on an empty set. There are no documents in place. The household is working with Thoughtful Wills and hopes to finish in the next few months. Two daughters, five and seven, have no guardian stated.
The hosts told the household to stop putting the documents off. The record traces the fix at the full estate pattern: documents in force, and the box moves from 0 to 4.
Two daughters, five goals, and no signed documents.
The disability line sits beside it as the second traced fix. Aisha's policy pays $3,208 a month and is not stated as own occupation, and her melanoma history already closed one application for a stronger policy. The hosts advised keeping at it through a vetted agent. The record traces an individual own occupation policy on her line at +2, from partial to full.
Everything else in the protection stack is bought: health at full marks, life at full marks, umbrella at full marks. The two open items are a signature and an application, which is what makes this file's path to 63 short and specific.
Milestones: Scored on What Is Stated
Inside the 3 Bucket Framework, the milestone checklist tracks the markers a household has already hit. This checklist earns 0 for Arnold and Aisha, because the intake never states a milestone list the net can be computed from. The box pays only for stated milestones.
The rest of the bucket picture: the emergency fund earns 2 at about three stated months, named lanes earn 2 on accounts that sort the money without a stated lane system, and goals funded earns 3 of 6 on flows that reach every goal area below the stated target pace. The framework earns 7 of 20.
Questions this case answers
What score did Arnold and Aisha receive on the Financial Health Assessment?
Arnold and Aisha scored 57 out of 100, in the Corrections band. The Transition framework earns the full 10 of 10 and the Protection Stack 14 of 22, while the 3 Bucket Framework earns 7 of 20.
How does a household saving about 25 percent land at 57?
The savings floor earns the full 12, and the drag sits elsewhere: the Debt Anchor earns 0 because $911,000 of stated debt is about 3.41 times income, the estate documents are not in place, the leak is not stated, and milestones cannot be determined from the intake. Strong flow and an unfinished file land in the same band.
What happens to the $439,000 student loan?
It runs on PAYE inside the Public Service Loan Forgiveness program, with about six years of payments remaining at about $1,600 a month before forbearance. If her employment stays qualifying and the paperwork stays current, the remaining balance is forgiven at the end of the path. The Debt Anchor grades today's balance, which is why the box earns 0 while the plan grades at full marks.
What is missing for Arnold and Aisha?
The estate documents are not in place and no guardian is stated for two minor children. Malpractice type and tail are not stated, the unaccounted share of spending is not stated, and Aisha's disability policy is not stated as own occupation. A stronger policy was denied over her melanoma history.
Sources and Basis
This assessment is built from the household's own intake for the Financial Health Assessment and the episode assessment of it. Every figure on this page comes from that record, and the score is traced box by box under the locked attending rubric.
The attending rubric weights the seven frameworks at 20, 14, 22, 10, 8, 4, and 22, for a total of 100. The bands are Needs a workup from 0 to 39, Corrections from 40 to 69, Stable from 70 to 84, and Healthy from 85 to 100. Attendings are scored on the Transition fork by years since training: for established attendings, whether education debt is finished, and whether consumer or vehicle debt remains.
Written by Ryan Inman, MBA, MAFM. Last updated October 2026.