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Financial Health AssessmentInternal MedicineEstablished

Bert and Alethea

Financial Health Assessment · Published October 22, 2026

Internal medicine primary care Established attending Married, first child due in weeks

Bert, 33, is an internal medicine primary care physician earning $250,000 plus $30,000 of core faculty work, and Alethea, 31, is a speech language pathologist earning about $30,000. Their first child is due in a couple of weeks. The assessment scores them 49 out of 100, in the Corrections band.

49

FHA score out of 100 · Corrections

About $310,000

Household gross income · two earners

$3,700/mo

Student loan payment · payoff projected mid 2022

Over $5,000/mo

Unaccounted for · hosts' calculation, top end figures

Start with the machinery that works. He maxes a 401k and an HSA, she maxes an HSA and runs a backdoor Roth, the student loans take $3,700 a month and end on a stated schedule, and the debt total sits under 1.41 times income, which puts the Debt Anchor at full marks. Term life is in force on both spouses and the emergency fund is stated at three months.

Then the two clocks. The hosts, adding up the household's own figures at the top end of every range, could not account for over $5,000 a month. And the baby arrives in weeks, into a file with no estate documents, no named guardian, and a disability policy on the main earner whose own household says the riders are wrong. The Guardrails earn 8 of 22, and the leak is the reason.

49

FHA score out of 100 · Corrections

About $310,000

Household gross income

Under $100,000

Student loan balance · exact figure not stated

57

Score with the three traced fixes · Corrections band

Key takeaways

  • The score: 49 out of 100, in the Corrections band. The Physician Wealth Equation earns 12 of 14 with the Debt Anchor at full marks, while the Lifestyle Guardrails earn 8 of 22.
  • Over $5,000 a month cannot be accounted for from the household's own stated figures, even at the top end of every expense range, on the hosts' calculation.
  • The student loans, under $100,000 of private debt, are being paid at $3,700 a month toward a projected payoff in mid 2022. The mortgage is a 5.125 percent physician loan the hosts wanted refinanced.
  • Bert's disability policy lacks the proper riders, by the caller's own statement. Fixing it with an independent agent is a traced fix.
  • The first child is due in weeks and there are no estate documents and no named guardian. Completing them is the largest single traced gain, 4 points of the 8 that take the score to 57.

The accounts are maxed. The month is not accounted for.

The Household

Bert is 33, an internal medicine primary care physician at $250,000 a year plus $30,000 of core faculty work. Alethea is 31, a speech language pathologist working 0.8 FTE on a school calendar at about $30,000. Household gross is about $310,000. They live in a small Midwestern town, about 90 miles outside a large city, in a home bought about a year and a half ago. Their first child is due in a couple of weeks, and they hope for a second.

The retirement machinery is switched on. Bert maxes his 401k and an individual HSA and puts $500 a month into an IRA. Alethea contributes 10 percent of pay to a 457b with a match, balance $35,000, maxes her own individual HSA, and puts $500 a month into a backdoor Roth. Another $800 a month goes to a taxable brokerage. The stated flows total about $51,000 a year, about 16.5 percent of gross. A family trust of about $60,000 arrives at age 40, earmarked for nothing yet.

Two maxed HSAs, a maxed 401k, and over $5,000 a month unaccounted for.

The cash layer is half built. The emergency fund holds three months of expenses at Ally, stated plainly. Checking carries a $10,000 to $15,000 cushion. The sinking fund accounts for travel, a car, and home projects exist and have not been funded in a couple of years. Per Alethea's statement, Bert is not on board with the sinking fund structure.

Debt is one student balance and the house. The private student loans sit under $100,000, the exact balance not stated, and are being paid at $3,700 a month to a projected payoff in mid 2022. The physician mortgage opened at $342,000 with nothing down and stands at $335,000, at 5.125 percent. The credit card is paid in full monthly, and no vehicle or other debt is stated.

Protection is bought, with two dated exceptions. Term life is in force on both: his 30 year $2,000,000 policy at $1,365 a year, her 30 year $500,000 at $335 a year. Her disability pays $1,400 a month with cost of living, partial, and catastrophic riders at $80 a month. His disability costs about $120 a month, and Alethea states that he does not have the proper riders in place. An umbrella is present, its amount not stated. Malpractice type and tail are not stated.

There are no estate planning documents. A conversation with an attorney was started, and no documents exist. No guardian is named, with the first child due in weeks. And over the whole file sits the hosts' arithmetic: stated income in, stated expenses and stated saving out, and over $5,000 a month left unexplained, even counting every expense at the top of its stated range.

Household factWhere it stands
CareersInternal medicine primary care physician and speech language pathologist
Ages33 and 31
Household incomeAbout $310,000 gross: $250,000 plus $30,000 of core faculty work, and about $30,000
Where they liveSmall Midwestern town, about 90 miles outside a large city; home bought about a year and a half ago
FamilyMarried, first child due in a couple of weeks
Student loansPrivate, balance under $100,000 (exact figure not stated), paying $3,700 a month, projected payoff mid 2022
Mortgage$335,000, opened at $342,000 with 0 percent down as a physician loan, at 5.125 percent
Other debtNone stated; credit card paid in full monthly
Emergency fundThree months of expenses at Ally, stated explicitly
SavingAbout $51,000 a year of stated flows, about 16.5 percent of gross: maxed 401k and HSAs, two $500 monthly IRA flows, $800 to a taxable brokerage
DisabilityHis policy lacks proper riders per the caller, own occupation not confirmed; hers pays $1,400 a month with riders, at $80 a month
Life insuranceTerm in force on both: $2,000,000 on him, $500,000 on her, both 30 year
UmbrellaPresent; amount not stated
Estate documentsNone; attorney conversation started, no guardian named, first child due in weeks
GoalsPay off student loans, financial independence by the mid-fifties, enjoy money without budgeting to the penny, sinking funds, a city condo within ten years

The Score: 49 out of 100

The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Bert and Alethea score 49, in the Corrections band. This household is scored on the attending rubric path.

20

Measures graded

7

Frameworks

49

Bert and Alethea's score

The 3-Bucket Framework earns 5 of 20. Milestones earn 0, because the milestone net cannot be determined from what the intake states. The emergency fund earns 2 at a stated three months. Named lanes earn 0, because the hosts' calculation leaves over $5,000 a month unaccounted. Goals funded earns 3, with dollars flowing to retirement and taxable goals while the sinking and college goals sit unfunded.

The Physician Wealth Equation earns 12 of 14, the strongest framework in this file. The Debt Anchor earns the full 10: stated debt under $435,000 against about $310,000 of income is under 1.41 times income. Stretch saving earns 2 on stated flows of about 16.5 percent.

The Protection Stack earns 12 of 22: health and life at the full 4 each, disability at 2 because Bert's policy lacks proper riders and its own occupation status is not confirmed, umbrella at 2 with its amount not stated, and estate documents at 0 with a child due in weeks. Malpractice type and tail are not stated.

The Transition framework earns 4 of 10: cards and other debt at the full 4, because no consumer or vehicle debt is stated and the card is paid in full, and the loan strategy at 0, because the student loans are not paid off and no forgiveness plan is stated. The Tax Ladder earns 4 of 8, 2 for the pre tax, HSA, and backdoor Roth mix, and 2 for the two deliberate moves inside it, HSA maxing and the backdoor Roth conversions.

The Decision Filter earns the full 4 of 4 on five stated goals. The Lifestyle Guardrails earn 8 of 22: the Savings Floor at 6 on the stated rate, the leak at 0 on the unaccounted $5,000 plus, and wealth first automation at 2, because the monthly retirement and taxable flows run while the sinking funds are neither automated nor agreed.

FrameworkWhat it coversPoints
02 3-Bucket FrameworkMilestones 0, emergency fund 2 at three stated months, named lanes 0, goals funded 35 of 20
03 Physician Wealth EquationDebt Anchor 10 at under 1.41 times income, stretch saving 2 at about 16.5 percent12 of 14
04 Protection StackHealth 4, disability 2, life 4, umbrella 2, malpractice 0, estate documents 012 of 22
05 TransitionLoan strategy 0, loans open with no forgiveness plan stated; cards and other debt 44 of 10
06 Tax LadderRoth against pre tax 2, bracket plus moves 24 of 8
07 Decision FilterGoals written 4, five goals stated including independence by the mid-fifties4 of 4
08 Lifestyle GuardrailsSavings floor 6 at about 16.5 percent, the leak 0, wealth first automation 28 of 22
TotalCorrections band49 out of 100

Read the shape, not just the total. The balance sheet boxes a young attending household is supposed to ace are aced: anchor, accounts, term cover, a stated emergency fund. The missing points sit in the monthly layer and the dated layer, a leak with no lane and documents with a due date measured in weeks.

The Two Frameworks Behind the Score

The score grades 20 measures across seven frameworks. Two of them carry this case: the Lifestyle Guardrails, which score 8 of 22 with the leak at zero, and the Protection Stack, which scores 12 of 22 with its two failures both running against the baby's due date.

Framework one

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 stated rate is respectable. The stated month does not add up.

The leak

Stated income against stated expenses and stated saving leaves over $5,000 a month unaccounted for, on the hosts' calculation at the top end of every range. The box earns 0 of 6.

Missing

The savings floor

Stated flows of about $51,000 a year, about 16.5 percent of gross, earn 6 of 12. Real money, routed to real accounts, every month.

Partial

Wealth first automation

The retirement and taxable flows run monthly. The sinking funds, the part of the system built for future spending, have not been funded in a couple of years and are not agreed. The box earns 2 of 4.

Partial

Framework two

The Protection Stack

The Protection Stack grades the coverage that keeps one bad month from ending the plan. Most of this stack is bought. The two open boxes are the two a newborn grades.

Disability

Alethea's policy carries its riders. Bert's, on the household's main income, lacks the proper riders by her own statement, and its own occupation status is not confirmed. The box earns 2 of 4.

Partial

Estate documents

No documents, no drafts, and no named guardian, with the first child due in a couple of weeks. The box earns 0 of 4.

Missing

Life and umbrella

Term life is in force on both spouses at $2,000,000 and $500,000, the full 4. An umbrella is present with its amount not stated, 2 of 4.

Built

What They Did Right

A Corrections score with a full mark Debt Anchor is a household whose debts are already handled. This is the head start.

A Debt Anchor at full marks

Stated debt under $435,000 against about $310,000 of income, under 1.41 times. The anchor earns the full 10 of 10, rare for a household this early.

Retirement accounts maxed on both sides

A maxed 401k, two maxed individual HSAs, a 457b with a match, and two $500 monthly IRA flows. About $51,000 a year moves before spending starts.

The student loans on a payoff schedule

$3,700 a month against a balance under $100,000, with a projected payoff in mid 2022 stated in the intake. The loan has an end date.

Term life in force on both spouses

$2,000,000 on the physician and $500,000 on the second earner, both 30 year term, bought before the baby. The life box earns the full 4.

An emergency fund stated in months

Three months of expenses at Ally, said in so many words.

The Missing $5,000 a Month

The first deep dive is the hosts' arithmetic. The hosts set the household's stated income against the stated expenses, the $3,700 student loan payment, and the retirement and taxable flows. Counted generously, at the top end of every range Alethea gave, over $5,000 a month remains with no stated destination.

The household's own goal frames why this matters. Goal three is to enjoy their money and save smartly without budgeting down to the penny. A household that does not track spending has to save automatically, off the top, so the untracked remainder cannot hurt it. That system is not in place. The flows run at about 16.5 percent, and the sinking funds that were built for exactly this purpose sit unfunded, with one spouse not on board.

You do not have to budget to the penny. You do have to know where $5,000 went.

The banking structure feeds it. The hosts' fix was structural: one bank, one checking account where both paychecks land, and the savings in named buckets at the same bank, so the month can be read in one place.

And they offered the shortcut for a household that will not budget at all: take 25 percent off the top the day income lands, route it to the IRAs, the debt, and the taxable account, and spend what remains without a ledger. It grades lower than real accounting, and the record scores the automation box on it as a partial step, not a finished system.

Two Fixes With a Due Date

The second deep dive is the pair of Protection boxes that run against a calendar. The first child is due in a couple of weeks. Two items in the file were built for exactly this event, and neither is finished.

The disability policy is the urgent one. Bert's cover costs about $120 a month, and the caller states plainly that he does not have the proper riders in place. His own occupation status is not confirmed. This is the household's main income, insured by a policy its own household says lacks the proper riders. The fix runs through an independent agent.

The guardian decision is easy this month. Next month it is a different conversation.

The estate documents are the second one. A conversation with an attorney was started. No documents exist, and no guardian is named for the child due in weeks. The guardian decision made by two calm parents is a decision. Left unmade, it becomes a court's decision.

An umbrella is present, malpractice type and tail are not stated, and both sit behind these two in the queue. The prescription orders the stack by due date, not by premium.

Milestones: Scored on What Is Stated

Inside the 3-Bucket Framework, the milestone checklist tracks the markers an established household has already hit. This checklist earns 0 for Bert and Alethea, 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 a stated three months, named lanes earn 0 because the month's largest flow has no lane, and goals funded earns 3 of 6. The framework earns 5 of 20, and the shape matches the case: the reserves exist, the routing does not.

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The Prescription

Three traced fixes, and the open items behind them.

1

Complete the estate documents, including a guardian for the child due in weeks.

This is the Protection Stack, and it gains 4 points, moving estate documents from 0 to 4. The largest single gain in the file, and the only one with a deadline set by somebody else's arrival.

2

Fix Bert's disability policy with an independent agent.

This is the Protection Stack, and it gains 2 points, moving disability from 2 to 4. The prescription in the record is true own occupation cover with proper riders, on the household's main income, reviewed while he is insurable on today's terms.

3

Automate pay yourself first transfers into the savings buckets.

This is the Lifestyle Guardrails, and it gains 2 points, moving wealth first automation from 2 to 4. The order discussed on air was 25 percent off the top into the routed accounts, with the sinking funds inside the same system so future spending stops raiding the month.

4

Refinance the 5.125 percent physician mortgage.

The hosts put this in the urgent set, refinancing into another physician loan. No point gain is traced for this item in the target basis.

Run all three traced fixes and the arithmetic is 49 plus 8, a score of 57. The gains are 4 for the estate documents, 2 for the disability fix, and 2 for automated pay yourself first transfers. A score of 57 out of 100 keeps the household in the Corrections band, with the dated items closed.

What This Case Teaches

Maxed accounts do not close a month. This household maxes a 401k, two HSAs, and runs two $500 monthly IRA flows and a taxable contribution, and still cannot say where over $5,000 a month goes. Funding accounts is a savings habit. Accounting for the month is a different habit, and the score grades them in different frameworks on purpose.

Protection work that can be done any month gets done in no month. A due date fixes that.

The second lesson is about due dates. Most protection work can be done any month, which is why it gets done in no month. A baby converts two of those items into dated work: the guardian and the main earner's disability riders. The file that treats them as urgent before the due date is the file that does not have to treat them as an emergency after it.

Questions this case answers

What score did Bert and Alethea receive on the Financial Health Assessment?

Bert and Alethea scored 49 out of 100, in the Corrections band. The Physician Wealth Equation earns 12 of 14 with the Debt Anchor at full marks, while the Lifestyle Guardrails earn 8 of 22.

Where does the unaccounted $5,000 a month go?

The record does not say. The hosts added the household's stated income, expenses, loan payments, and saving flows, using the top end of every stated range, and over $5,000 a month was left with no stated destination. Their answer was structure: one bank, named buckets, and 25 percent routed off the top.

Why does the mortgage need refinancing at 5.125 percent?

The physician loan was opened with nothing down at 5.125 percent. The hosts put refinancing it into another physician loan in the urgent set.

What do the fixes do to Bert and Alethea's score?

Run all three and the arithmetic is 49 plus 8, a score of 57. The gains are 4 for estate documents with a guardian named, 2 for fixing the disability policy, and 2 for automating pay yourself first transfers. A score of 57 out of 100 keeps the household in the Corrections band.

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: the student loan strategy, and the state of cards and other debt.

Written by Ryan Inman, MBA, MAFM. Last updated October 2026.

About

Ryan Inman is a retired financial planner who worked with about 500 physician families. He created the Financial Residency podcast (about 3 million downloads) and is no longer affiliated with it. Financial Fellowship is his sole focus. This guide is educational. Last updated October 2026.

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